In the last part of Chapter 1 from End Back Pain Forever, we turn to the story of “Stephanie”. Please review this blog for the complete chapters 1 and 2 from my book.
“Doctor, My Back is Killing Me!”, Part 3
Take the case of a patient whom I shall call Stephanie. She is a married attorney who in 2004 began to experience stiffness whenever she she got up out of a chair. She also had problems straightening up if she bent over. This was bothersome, but it was nothing compared to her first attack of spasms in her low back, on the right side. The spasms were incapacitating. She couldn’t walk and had to lie in bed for four days, taking painkillers and muscle relaxants. When the spasms broke, she still felt an inkling of discomfort that would frequently and unexpectedly morph into repeat episodes of painful spasms.
It was during one of these crippling occasions that Stephanie went to a major teaching hospital, where an orthopedic surgeon ordered an MRI. The results showed that a disc in her lower spine was flattened, and the surgeon felt that the best treatment for this condition, called degenerative disc disease (DDD), would be a lumbar disc replacement. Stephanie wanted a less aggressive treatment and saw another surgeon, who referred her to a physiatrist (a doctor who treats physical impairments and disabilities). The physiatrist felt that her problem arose from one of the small joints in her spine, known as facet joints, rather than from the DDD. He treated her with injections of a local anesthetic to block the nerve that innervates the facet joint, which relieved some of her pain. Since the nerve block had proved partly successful, Stephanie’s doctor suggested that the nerve be “turned off” temporarily with a procedure known as radiofrequency ablation. In this procedure, the physician makes a small incision in the skin and then uses a hand-held probe to deliver radio waves to the offending nerve, heating it until it can no longer transmit pain signals. Fearful of tampering with her nerves, she rejected this option. With no other conventional pain treatment options, and although there was no good indication for it, she agreed to an epidural steroid injection into her lower spine, but this was ineffective. Five courses of physical therapy were also unsuccessful, and some of the sessions made her feel worse.
Stephanie first saw me in 2006 during one of her periods of muscle spasms. Her pain was so severe that she had been unable to work for two weeks. The pain had spread on this occasion from her right low back to both sides of her back and buttocks, with pain going to her hips and groin and also to her lower legs, feet and toes. It consisted of a dull ache in her legs and a sense of pressure in the region of her spine. Her family, alarmed by the severity of the attack, urged her to finally have back surgery and “get it over with once and for all.” Since she needed to “fix” the “damaged” disc sometime, why not now?
I examined her with an electrical instrument I devised that can identify specific muscles causing pain. The device works by stimulating a specific muscle to contract. If that contraction produces pain, it suggests that that muscle is a source of your pain. Using electrical stimulation, I determined that five muscles in her low back and buttocks were tender. But continued stimulation reduced the pain and actually eliminated it in most muscles. This told me that it was her muscles causing that pain, and that it was due to spasms, tension, and stiffness. I treated her with my spasm protocol: electrical stimulation to fatigue the muscle, followed by a different form of electrical stimulation to make the muscle move gently, followed, in turn, by gentle limbering exercises.
After Stephanie’s first visit, her pain was reduced by 60 percent. She returned for two additional sessions to relieve the spasm and was taught all twenty-one exercises (found in Chapter 7 of the book). This brought her total relief. She now does the exercises every day, and four years later, remains completely pain free.
Stephanie had “abnormal” findings on her MRI. Nerve blocks to the facet joints of her spine had managed to relieve some of her pain. But with my treatment, she never needed or had a disc replacement or long-term blocking of the nerves that serve her facet joints. She had received a host of well-meaning, costly interventions and suggestions for even more. But all of her pain could have been treated from the start simply, inexpensively, and safely by addressing tense, stiff muscles.
Given Stephanie’s previous experience with doctors, she well understands the quotation that hangs on my office wall. it is from Eugene Bauer, an internist at the University of Vienna Medical School, who said in 1931, “A word in the mouth of a physician is as dangerous as a scalpel in the hands of a surgeon.”
By showing her the results of X-rays and MRIs, her doctors led her to believe that she was permanently damaged goods. What they saw on the MRI was definitely there. But in her case, as in so many others, the true source of her pain was elsewhere: in her muscles. The truth is that without a muscle examination, we do not have an accurate explanation for your pain or anyone’s pain.
My professor of anatomy at SUNY Upstate Medical University, Philip Armstrong, MD, used to say, “Reiteration without irritation is the essence of good education,” and so to repeat the mantra for you: the primary source of 75 percent or more of all back pain is from the muscles, not the spine.
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Tagged with: back pain
Filed under: back pain posts • pain management
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