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 There is still-unpublished data documenting the staggering savings by utilizing this form of care.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 disabling neck pain and the other disabling back pain, both persisting for more than two years despite actively seeking care.

I was present when Peter was first examined for his chronic neck and arm pain.  It was a demonstration to attendees at an international spine conference of how the MDT evaluation identifies rapidly reversible conditions and then guides rapid recoveries.  References to “Figures” below pertain to illustrations in the book.

PETER’S HISTORY
Peter is a 38 year-old adventure guide and instructor who was on his honeymoon when the car he was driving was hit from behind while stopped. He passed out at the scene and was taken by ambulance to the hospital where no severe injuries were identified. He was discharged, given Tylenol, and told to see his doctor when he returned home.

Severe headaches soon started that kept him from sleeping at night as well as pain and numbness progressing down his left arm to his hand. His physician at home sent him to physical therapy that he continued for 18 months.

His pain forced him to stop working because he couldn’t rotate his head when kayaking nor look upward when leading rock-climbing groups.

A neck MRI showed bulging/prolapsed discs at his C5-6 and C6-7 levels that were pressing against his nerve causing the pain and tingling in his left arm.

He was referred to a neurosurgeon who offered him surgery to relieve the pressure on the nerve.  He was told there was a 50% chance of improvement, 40% chance of being the same, and a 10% chance of worsening as a result of the surgery. Because he didn’t like those odds, he decided against surgery.

PETER’S MDT EXAMINATION
He was finally given the opportunity to be examined by a physical therapist with extensive training in Mechanical Diagnosis & Therapy (MDT). At that time, he reported he had improved only 10% over his 18 months of physical therapy. He had pain, numbness and tingling into his left palm and fingers as well as tension and tightness in his neck and aching in his left arm. He did report some improvement in those symptoms four months earlier when he changed his job and stopped climbing and kayaking.

Attempts to bend his neck in any direction seemed to increase his neck and arm pain, including bending his head and neck backward. But a special variation of neck extension (bending the neck backward) noticeably decreased the arm and hand tingling that then didn’t return, which he stated was a “huge difference” from his last 18 months. With more neck extension movements, his hand and arm symptoms improved substantially and remained better, which greatly impressed Peter.

PETER’S MDT EDUCATION AND SELF-CARE INSTRUCTIONS
The therapist told Peter that something was pressing on the nerve and they were perhaps learning that that “something” might be able to be withdrawn from the nerve so his pain and tingling would go away.

He was instructed to perform 10-12 repetitions of the cervical extension exercises 5-6 times/day.  He was shown how to perform them standing, sitting and lying down. He was shown how his forward head position when sitting aggravated his condition and was given a lumbar roll to use behind his lower back, especially in the car, to enable him to sit more erectly with his head positioned much better to keep from aggravating his condition while sitting (Fig. 22.6).

FOLLOW-UP
Using this self-care strategy, the tingling in his arm and hand disappeared almost immediately despite having been present for 18 months.  His headache, neck and arm pain progressively decreased over the next four weeks to where he no longer had any pain. He reported three months later that he was pain-free as long as he did his exercises. He admitted to only doing them 1-2 times per day and if he stopped those exercises for more than two days, his headaches would return very slightly which reminded him to return to his exercises.

He was able to return to all of his work and had even taken up snowboarding as a new sport that he could now include in his work.

SUMMARY
In hindsight, Peter had an undiscovered rapidly reversible problem all this time. Like so many with motor vehicle whiplash injuries, his neck and arm pain didn’t begin until many days after his accident. He then underwent 18 months of useless physical therapy and almost accepted an unnecessary surgical procedure because neither he nor his physicians knew his underlying problem was actually rapidly reversible all this time. Fortunately, Peter finally found someone trained to evaluate and treat him using MDT principles of care.

Peter Is Not An Unusual Patient! There are published data indicating that half of chronic back and neck pain patients respond similarly. While not unusual, sudden and rapid recoveries like this 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.

Peter’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 Peter is Robin McKenzie himself, who developed the MDT method of care.

Dr. Ron

Ronald Donelson, MD, MS
President

SelfCare First, LLC
Blog: blog.selfcarefirst.com

 

A very common complaint patients with back or neck pain have is that their doctor doesn’t provide them with a clear diagnosis or explanation of their pain.23,79

That complaint is quite understandable because the conventional examination used by most doctors, along with the best imaging procedures available, are unable to identify the precise cause of most back and neck pain. That does not mean there isn’t a cause; it just can’t be found in most cases using those methods of evaluation.

Nevertheless, back and neck pain often go away on their own in a few days or weeks, regardless of what treatment you pursue.21,59,81,82 Therefore, the underlying problem, whatever it is, is somehow often able to recover, even without formal treatment.

Unfortunately, even though it goes away, it often returns a few weeks or months later.21,59,81,82 Each time it returns, it is referred to as a new “episode”. Each episode ends when the pain goes away again for a few more weeks, months, or maybe even years. Unfortunately, it is all too common for back pain to return several times each year and continue to do so for many years.

Many report that, when their pain returns, it’s even worse than before.30,83,84 Perhaps you have had a few episodes.  Is your pain now more intense, more disabling, lasting longer than in your early episodes? Has it now spread into your arm or leg and require more care than in the past? Often, after many episodes, your pain finally just doesn’t recover again. When it persists for three months or more, it is usually referred to as “chronic”. Once symptoms become chronic, the underlying problem is often much more difficult to solve.

Sometimes back or neck pain become so severe that it prevents you from doing things you want and need to do: you can’t work, take care of your home and family, or participate in the fun things in life. If you are just not improving, your doctor may offer a referral to another doctor for spinal injections or to a spine surgeon to consider an operation.

Besides being no fun, these procedures are risky. They are not always successful, may make your pain worse, cause new symptoms, and also limit future treatment choices. In most circumstances, these risks are unlikely, but they are certainly possible. Unfortunately, it is not unusual to end up with long-term, even permanent, disabling pain.

But these procedures can also be helpful for many. But who are they? There is no way to figure that out ahead of time. And unfortunately, even those who improve are often still unable to return to their former level of activity or work.

So are there any better solutions? Yes, thankfully, for most there are.

The above is a chapter excerpted from my book entitled “Solving The Mystery: The Key to Rapid Recoveries for Most Low Back and Neck Pain.”  This book, my first book (“Rapidly Reversible Low Back Pain“), the SelfCare First website, and many posts on this blog are all devoted to spreading the message:  yes, thankfully, there are better solutions.  In fact, most back and neck pain is rapidly reversible using simple-but-specific exercises and posture modifications. Keep reading these resources. (Numbered references in this excerpt cite specific scientific articles listed in this book.)

Dr. Ron

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.

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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