Believe it or not, this is not a common question. Often, I find myself letting patients know the serious symptoms that may arise with a back injury so they are aware of what to look for. I wonder sometimes if this scares people, but I know that in discussing this with patients they will be better prepared to recognize these symptoms and may not ignore the symptoms if and when they arise.
One of the first signs or symptoms to look for is the presence of “saddle parathesia”. This is numbness or tingling in the medial thighs, groin and/or around the anus. Cauda equine syndrome, which causes saddle parathesia, occurs when there is damage to the nerves at the bottom of the spinal cord. One example of injury to the cauda equine can come from a bad disc herniation and a piece of the disc breaks off. This broken piece can float around the spinal canal making contact with several nerves which innervate the skin in this area. The potential for this to become an even more serious problem is very high, particularly if the piece of the disc floats higher in the spinal canal. For example, if this piece travels as high up as the brainstem there could be interference in several of the vital functions in the body including respiration and cardiovascular function.
Another symptom that is considered an emergency would be change in bowel or bladder control, either loss of control or incontinence. This is a sign that there is damage that is affecting the neurological system. Whether this is from swelling from a fractured vertebrae or a bad disc herniation, pressure on the nerves in the spinal canal can cause lack of control for either bowel or bladder movements.
When disc injuries are progressing, one sign we continuously monitor is motor control or strength. Are you dragging your feet when you walk? Are you dropping objects with your hands? Each nerve that exits the spine has a specific muscle designated to it so we can determine the level in the spine that is involved. Some motor control issues that you can do on your own would be walking on your heels; making sure that your leg can hold your foot up the whole time not letting the foot drop. You can also test toe walking by rising up onto your toes and taking a couple of steps. The most common level for a disc herniation is L4/5 which would affect the L5 nerve root. In this case, heel walking may show a deficit on one side or the other or both. The most important thing to watch for with motor control is if it is progressively worsening.
In the office, healthcare providers will be watching for the symptoms as mentioned above, but also they will check reflexes. The reflexes that you are familiar with, hitting the reflex hammer over the patellar tendon for example, may change suddenly as injuries become worse. The presence of some pathological reflexes (reflexes that are found that shouldn’t be present) may indicate upper motor neuron lesions which occur with damage to either the spinal cord or brain. When these are present, it may not necessarily mean an emergency room visit, but likely a visit to your family doctor and/or a specialist like a neurologist for further assessment.
Is there presence of shock like pain that shoots down your arms, legs or both with spinal movement? When there is an injury to the spinal cord, all the nerves below the level of the injury will be affected, ie. if there is a fracture at the C4 vertebrae (in your neck) that causes swelling around the spinal cord, then everything below that level will be affected. On examination, there will be numbness and tingling down both arms and legs that may get worse with cervical spine flexion. With meningitis, an infection of the nervous system, movement of the neck will cause shock like pain that shoots down the spine and into the arms and legs. Shooting pain needs to be assessed by a qualified healthcare provider.
The last thing that needs to be considered is the patient’s medical history or recent changes in overall “well being”. Is there a history of cancer? Has there been any recent weight loss? Is there on going treatment for another condition? If there has been significant history of a pathology and now there is severe back pain, we need to confirm that the pathology is not the reason for the spine pain. If there are any other symptoms happening as mentioned above, present to the nearest emergency department. If not, your best option would be to try to see your family doctor or specialist that has been treating you for this other condition.
Motor strength and reflexes should, at least, be assessed by your chiropractor or other health care provider during assessment and monitored throughout care. If testing results change for the worse, the injury is progressing and treatment may need to be changed or altered.
If you are ever concerned and are not sure if you should go to the hospital, family doctor or chiropractor, please call us, 905-529-2911, to review your symptoms over the phone and we can guide you in determining your best route of care.