Millions worldwide are struggling with low back and neck pain and many of these are frustrated by having tried numerous treatments without success.  Of great importance is how few know that most low back and neck pain is rapidly reversible. That means that the underlying painful condition can be corrected and the pain turned off fairly quickly, often as fast or faster than it turned on. Many can learn how to turn their pain off, and keep it off, in just 1 or 2 sessions.  That includes those with acute and chronic pain, those with neck or back pain only as well as those whose pain radiates away from the spine and down the arm or leg.  But how to reverse the problem differs from person to person.

What is truly amazing is just how common rapidly reversible back or neck pain is.  Numerous studies document that nearly 90% of those with recent onset (acute) and 50% of longstanding (chronic) low back pain can be rapidly reversed.  Unfortunately, most people don’t know these things and, even worse, neither do most doctors.

How do you know if your back or neck pain is rapidly reversible?
To answer that question requires a special form of examination of your back or neck. For that,
you need to be examined by someone with special training in how to perform this evaluation. There are several studies that show that lesser trained clinicians cannot reliably implement this type of examination. If that examination demonstrates that your pain is reversible, it also reveals what is needed to reverse it so you can quickly recover.

That so many people are not being examined in this way means that many are suffering unnecessarily.  Most are prescribed medications that aren’t needed, given unnecessary MRIs, and many undergo spinal injections and even surgery that is simply not needed.  All players in the spine care community, including patients, need to learn more about this as well as the many scientific studies that validate the use of this type of care.

This form of care will have tremendous impact on the costs of managing individuals who seek care for their back or neck pain. In the U.S., nearly $90 billion is spent each year on the problem of low back pain alone! There is still-unpublished data documenting the staggering savings by utilizing this form of care.

In other blog entries, I discuss these savings available to employers and health plans frustrated with paying for so much unnecessary and very expensive care.

You can read more about that examination process and rapidly reversible back and neck pain at www.selfcarefirst.com and especially in my new book entitled: “Solving the Mystery: The Key to Rapidly Reversing Most Back and Neck Pain”.

Ron Donelson, MD, MS

Ronald Donelson, MD, MS
President

SelfCare First, LLC
Blog: blog.selfcarefirst.com

In my book “Solving the Mystery: The Key to Rapid Recoveries from Most Back and Neck Pain”, I included the stories of two individuals, one with neck pain and the other back pain, both disabled for more than two years despite actively seeking care.

I was present when Clare was first examined as a demonstration to attendees at an international spine conference of how the Mechanical Diagnosis & Therapy (MDT) evaluation identifies rapidly reversible conditions and then guides rapid recoveries. References to “Figures” below pertain to illustrations in the book.

CLARE’S MDT HISTORY
Clare was 52 years old when she developed a sore back after moving some furniture. When her pain worsened, she saw her family doctor who sent her to physical therapy, but that was not all that helpful. During treatment, her pain even began to spread down her left leg. Her doctor and therapist nevertheless felt she should continue physical therapy and was also given anti-inflammatory medications.

With more and more flare-ups, she was referred to an orthopedic specialist. An MRI was ordered but she was told it didn’t show very much. She was told to continue physical therapy even though it didn’t seem to be helping her.

She saw a second orthopedic specialist who also felt it would simply take more time and she needed to become more fit. Physical therapy was continued but now her left leg pain had become constant and so painful she was unable to continue working.

A second MRI higher up in her back showed some herniated discs in her thoracic (chest portion) spine but those were not considered responsible for her pain.

One of her orthopedic surgeons discussed the option of surgery and referred her to a neurosurgeon who found nothing to operate on and labeled her as having “chronic pain”.

She was sent to a pain specialist who told her she would have to learn how to live with her pain and manage it with drugs. She was evaluated by a “specialty team” consisting of an occupational medicine physician, physical therapist, and psychologist who developed a plan that would include an intense rehabilitation program.

She had now been in pain for two years. It had become constant with shooting pain down her left leg and she was too painful to work.

Through another contact, she was finally given the opportunity to see a physical therapist well-trained in Mechanical Diagnosis & Therapy (MDT).

She stated that prolonged sitting would consistently bring on or worsen her leg pain.

CLARE’S MDT EXAMINATION
The therapist observed that she sat very slouched. By having her sit very erectly, Clare reported that the intensity of her leg pain promptly decreased. When she repeatedly extended her lower back (bent backward), her leg pain decreased more and more until it disappeared. Slouched sitting would bring the pain back again but she found she could decrease and eliminate her leg pain with backward bending while standing or sitting but was especially effective when lying facedown performing a series of press-ups (Fig. 22.2).

CLARE’S INITIAL EDUCATION
The therapist explained that her pain had clearly “centralized” (come out of her leg) with low back extension test movements and this was a very good sign. She likely had a bulging disc that was irritating a nerve causing the pain, numbness, and tingling in her leg. The longer she sits slouched, the more it bulges and the pain increases. But extension (backbending) likely decreases that bulge by putting the displaced disc material back in its place that then takes the pressure off the nerve.

It was important to find out whether she would be able to stop her pain and keep it from returning using these extension exercises and very erect sitting posture. Could she now prevent the leg pain from returning and eliminate whatever low back pain was still present?

CLARE’S INSTRUCTIONS & TREATMENT
She was given a lumbar roll to place behind her lower back whenever sitting (Fig. 22.6) to help her avoid the slouch and she was to perform 10-12 press-ups (Fig. 22.2) 5-6 times per day for the next several days. She needed to be seen for another 2-3 visits to be sure that this was working.

With considerable hope that something useful had been found, Clare began to work diligently on her sitting posture and performed her exercises as instructed. By doing so, when she returned two days later, she reported she was able to stop her leg pain herself and even keep it from returning.

She was encouraged to keep up the same self-care efforts. She soon found herself pain-free and off all medications. She was also able to become much more active and soon was able to return to work with no pain.

SUMMARY
In hindsight, despite two years of worsening pain, seeing numerous physicians, therapists, and a psychologist, despite having had two MRIs, lots of medications, and nearly two years of physical therapy, it is clear that Clare had a rapidly reversible problem all that time that simply had never been evaluated adequately or discovered. Unfortunately, none of her physicians or physical therapists ever provided the MDT evaluation nor sent her to someone who could.

Clare had been unnecessarily doomed by all her care-givers to a life of “chronic pain” while her true problem, when finally fully evaluated using MDT principles, was actually a rapidly reversible derangement that she was able to easily correct herself and then able to maintain that correction and get back to work and her life.

Clair Is Not An Unusual Patient!
There are published data indicating that half of chronic back and neck pain patients may respond similarly.  While not unusual, sudden and rapid recoveries like these, after so long, are not widely known, which is why I have written my books and created this blog.  Unfortunately, and most importantly, such dramatic recoveries are also unfamiliar to most health care providers, payers and policy makers who do not provide their back and neck patients with this Mechanical Diagnosis & Therapy (MDT) form of evaluation.

From a cost perspective, every one of these patients who have an undiagnosed rapidly reversible condition costs tens, if not hundreds, of thousands of dollars in direct medical costs and lost productivity,……..all unnecessarily! It only requires a thorough MDT evaluation at the outset of their care to identify them early and guide their rapid recovery to avoid nearly all of that unnecessary expense.

Clare’s actual initial MDT evaluation at this conference can be viewed on DVD available at http://www.optp.com/A-Day-with-McKenzie-DVD_914DVD.aspx. The therapist on the DVD who assessed Clare is Robin McKenzie himself, who developed the MDT method of care.

This past weekend, I made a presentation to a group of 20 or more spine surgeons on the topic of “Improving Your Surgical Outcomes With Better Patient Selection”.  This was at the New England Spine Study Group meeting in Springfield, MA.  That’s also the home of the Basketball Hall of Fame where our meeting was actually held, in their lovely auditorium.  After the meeting adjourned, I had the afternoon to tour the H. of F., which was great fun for this long-time basketball fan.

My 30-min. presentation focused on the rationale and benefit of utilizing a special form of clinical evaluation of low back and neck pain patients developed by Robin McKenzie and often referred to as “Mechanical Diagnosis and Therapy” (MDT).  My intent was to make the case for incorporating that assessment somewhere along the care pathway leading up to the surgeon’s decision.  Happily, rather than focusing on the potential loss of surgical cases, surgeons instead expressed their appropriate concerns about not wanting to perform unnecessary surgery.

You can learn more about those MDT methods in some of my other postings and in my books, found at www.selfcarefirst.com.

I told them about four published studies (see references below) that all document that this form of assessment can identify patients who would otherwise have undergone unnecessary surgery if not provided the opportunity to identify that their condition could still recover using non-surgical care.  Whether this form of evaluation is offered at the fairly late point of surgical decision-making, or much earlier in a patient’s care, it is extremely important for both recovery and cost outcomes.

You see, in each of those pre-surgical studies, as many as 52% of patients were able to rapidly diminish and eliminate their own pain, and thereby avoid surgery. One study reported that just over half of the individuals with full sciatica and neurologic deficits were able to eliminate all their pain themselves within 2-5 days after their MDT evaluation was finally performed just prior to being scheduled for surgery.  They eliminated their pain using only some simple “disc-correcting” exercises.

In an earlier blog posting, you can also read about a friend of mine who was scheduled for surgery when finally provided the opportunity to be evaluated with MDT principles.  His response during the initial evaluation was very encouraging and he consequently cancelled his scheduled surgery and was able to completely recover using some simple exercises and other self-care strategies.  He only wished his family physician, or anyone else for that matter, had referred him for that evaluation many months before when he would have recovered even more quickly but, most importantly, he would have avoided all those months of pain and disability, along with all that unnecessary cost to his health plan.

Such rapidly reversible cases are especially common in those whose back or neck pain is of recent onset, generally referred to as “acute”.  Studies report that 70-89% of acute back and neck pain patients have this rapidly reversible kind of condition that can only be identified by using this form of MDT evaluation.  Unfortunately, whenever this assessment is delayed, many of these individuals’ pain becomes chronic and that percentage whose pain is rapidly reversible drops to 45-55%.  Even though that’s still a sizable percentage of chronic pain that remains rapidly reversible, it also means that many back conditions lose their ability to rapidly reverse that they had when they were acute.  This sizable subgroup of patients has lost its window of opportunity to rapidly reverse the underlying painful condition before it deteriorated and became irreversible.  The solution to their problem, if there still is one, is often much more complex, sometimes even requiring surgery that could have been prevented.  For so many, an early assessment using MDT methods avoids so much pain, disability and cost.

One of the spine surgeons who heard my presentation caught the importance of educating family physicians about the value and importance of providing this assessment early for their back and neck pain patients.  He expressed interest in developing an educational effort for the family physicians in his community.

I believe there will be a point in the next few years when the standard of care for acute and subacute back and neck pain will become the provision of this special form of assessment.  The prevalence data speaks clearly that, if this assessment is not implemented in time, patients with either acute back or neck pain can lose that window of opportunity, finding themselves instead on a slippery slope, in danger of sliding into long-term (chronic) pain at considerable expense to themselves, to society, and to employers who are paying the tab.

Unfortunately, most family physicians remain unfamiliar with MDT and all its benefits to them and their patients.  All the scientific studies that validate MDT have been published in spine care-related journals that are unread my family physicians.  We need to establish educational opportunities to influence their education on this topic.  One way I’ve attempted to help is by writing two books entitled “Rapidly Reversible Low Back Pain” and “Solving the Mystery”.  Family physicians who have read them have found them extremely enlightening.

Some hospital and physician networks have expressed interest in educating their primary care docs in order to improve both the quality and the cost of spine care in their communities.  That is an excellent step and we need expand that to a much broader scale across the family medicine practicing and academic profession, as well as within the curriculum of their training programs.

Please leave comments and your input regarding ways to deliver this education so we can substantially halt the flow of acute to chronic back or neck pain.  You may visit www.selfcarefirst.com for more information.

1. Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain: A predictor of symptomatic discs and anular competence. Spine. 1997;22(10):1115-22.

2. Kopp J, Alexander A, Turocy R, Levrini M, Lichtman D. The use of lumbar extension in the evaluation and treatment of patients with acute herniated nucleus pulposus, a preliminary report. Clinical Orthopedics. 1986;202:211-8.

3. Laslett M, Öberg B, Aprill C, McDonald B. Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power. The Spine Journal. 2005;5:370-80.

4. Rasmussen C, Nielsen G, Hansen V, Jensen O, Schioettz-Christensen B. Rates of lumbar disc surgery before and after implementation of multidisciplinary nonsurgical spine clinics. Spine. 2005;30:2469-73.

Dr. Ron

Ronald Donelson, MD, MS

President
SelfCare First, LLC
Blog: blog.selfcarefirst.com

We’ve all read about individuals who have had near-death experiences.  But what about a “near-surgery experience” (and rescue) for someone in excruciating back and leg pain?

Last week, I had dinner with a good friend and reminisced about his “near-disc surgery” experience three years ago and how grateful he was to have avoided his scheduled operation.  He had developed severe back and leg pain and numbness in his foot that all started as just back pain after carrying some heavy equipment, falling on the ice three weeks later, and then cutting firewood for two hours.

Because he also developed some thigh pain, he was initially misdiagnosed by his family doc as having a hamstring tear.  But his pain became severe, interfering with his recreational, work activities, and simply walking.  Over the next 4-5 months, he saw a massage therapist, a chiropractor, a Reiki therapist, had cranio-sacral therapy, and treatment by a physical therapist while also trying Advil, Prednisone, Hydrocodone, Vicodan, Percocet, Neurontin, muscle relaxants, and had two epidural injections. But his pain and ability to function just kept worsening.

An MRI eventually showed a bulging disc compressing a nerve in his lower back.  Because of his excruciating pain and lack of improvement with all these treatments, he felt he had no choice and reluctantly consented to be scheduled for disc surgery.  Only then was he finally examined by a physical therapist trained in Mechanical Diagnosis & Therapy (MDT).

That unique examination revealed that certain movements and positions began to take away his lower leg and foot symptoms, indicating that his disc pain was possibly reversible and correctable, without surgery. As directed, he continued these specific pain-relieving movements/exercises and some posture changes at home. When his leg pain continued to improve, he decided to at least postpone his surgery.  His continued improvement also enabled him to progressively discontinue his numerous medications.  His foot numbness soon disappeared and his ability to walk and bend his lower back in all directions also progressively improved.

I also had given him a copy of my newly published book “Rapidly Reversible Low Back Pain” that he still says was “powerful” in helping him recover and understand what he was going through and why no one had introduced him to this kind of care long ago.

Six weeks after starting his MDT care, he was able to return to work and was soon pain-free.  He continued his simple exercises to keep his pain from returning.  He was elated to have complete recovery from this extremely painful disc problem while also avoiding the pain, apprehension, risk, and uncertainty of undergoing surgery.

At dinner, now three years later, he told me he remains pain-free, doing everything, including being a very active recreational athlete.  He had one brief, mild episode of back pain two years ago that he quickly eliminated using the same methods that helped him recover from his bad episode.

He is very grateful that he was finally taught how to eliminate his own pain that enabled him to dodge that surgical bullet that was about to strike him. He knows that if he hadn’t run into MDT care, and read that book, that he would certainly have undergone surgery.  He also realizes that his surgery, even if it had have been successful, would have been unnecessary.

One more thing.  He knows how many different clinicians prescribed and provided ineffective and even misdirected care.  If he had just been referred for evaluation and treatment with someone well-trained in MDT principles at the outset of his care-seeking, he would have recovered much earlier, much faster, avoided all those useless and expensive treatments and drugs, and not had to miss work and all his family and recreational activities for all those months.

My friend’s experience is not unusual, both from the standpoint of being treated with useless remedies but finding that even the most severe back problem can often be reversed easily with some simple-but-precise exercises.  There are at least four published studies all showing that 50% of those who are considered by their doctors to be candidates for disc surgery can still recover, usually much more quickly than my friend, when MDT methods of evaluation and treatment were properly implemented.

In fact, just like my friend, many other studies show that most back and neck pain sufferers can rapidly recover using self-care exercises and posture changes, providing they are evaluated properly using MDT methods.  Maybe your back or neck pain will respond rapidly like this too.

To find out more about how you, your patients, or your employees might be able to recover early and quickly from both simple and severe back and neck pain, come to www.selfcarefirst.com

Dr. Ron

Ronald Donelson, MD, MS

President
SelfCare First, LLC
Blog: selfcarefirstblog.wordpress.com

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