FEATURE PATIENT CARE LSS BOOTCAMP New approaches for patients with complex back and leg pain T BY DIRK KEENAN hroughout many years as a practising chiropractor, I have found myself frus-trated with patients who have experienced long term back and leg pain, with no relief from my approach. I utilize various chiro-practic techniques and include many mechanical and PEMF physical therapies that seemed to be beneficial in most spinal conditions, but not with the treatment of lumbar spinal stenosis. It was my experience that older patients presenting with severe lumbar arthritic degeneration, the principal symptom being leg pain, would often experience disap-pointing clinical outcomes. My first introduction to new research surrounding lumbar spinal stenosis (LSS) was through Dr. Carlo Ammendolia at the Canadian Memorial Chiropractic College. Shortly after our detailed discussion, I recog-nized that this approach was going to be an essential development for the chiropractic profession. Dr. Am-mendolia is a world authority on the non-surgical man-agement of LSS and has led a number of us through the very latest research available on the diagnosis and man-agement of this condition, and its long-lasting effects such as neurogenic claudication. Based on my experience with LSS patients, I con-cluded that by simply having the patients tilt forward, they experienced immediate and significant relief. As Dr. Ammendolia explained, the type of pain they are DIRK KEENAN is a second-generation chiropractor practising in Ottawa’s oldest clinic for the past 34 years. Dr. Keenan pursues an active interest in multi-disciplinary clinics, Interprofessional education, and chiropractic practices abroad. He is currently in the midst of establishing an international locum service. Interested parties in international locums, multi-disciplinary practices, or interprofessional education can contact him at [email protected]. [I told patients] that reducing inflammation was key to reducing pain, but I discovered that strategy was ineffective in treating LSS. CONTINUED ON PAGE 24 www.canadianchiropractor.ca 20 Canadian Chiropractor June 2019 Photo: Adobe Stock experiencing is not inflammatory, and therefore medica-tions, herbals, anti-inflammatory diets, and corticoster-oids are ineffective. The simple movement of the body bending forward allowed more room for the spinal cord and spinal nerves within the central and lateral canals. The instantaneous relief was due to the sudden improve-ment in the microvascular circulation to the spinal nerves. Once the patient regained their upright posture, the pain would soon return. This etiological sequence provided evidence as to how the condition should be treated. His research eventually led him to develop the “Lumbar Spi-nal Stenosis Bootcamp.” I had always instructed my patients that reducing in-flammation was key to reduce their pain, but I later dis-covered that strategy was ineffective in treating LSS. The pain originating from diminished circulation explained why typical chiropractic, physiotherapy, massage, and medications including anti-inflammatories, opioids and corticosteroids, did not provide significant relief (if any).
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