One alternative pain management technique I think is such a safe method and can be of some help is hypnosis. I don’t believe enough people believe and take advantage of the minds ability to alter our own perception of our pain. I am currently reading a book by an MD who recommends hypnosis as well as journaling out our stressors and pain on a daily basis. I think of alternative pain management techniques as a great but ultimate temporary aid, until the patient finds his or her pathway to recovery.
One type of alternative treatment for chronic pain that both M.D.s and D.O.s generally are open to are injections of tenderpoints or triggerpoints. The injected material can be something as basic and innocuous as sugar water called prolotherapy or the newest and latest substances are the patient’s own body substances, such as their own plasma, called PRP.
The sugar water is supposed to incite a mild repairing kind of inflammation. Some of my patients do report some relief. I am opposed to it because the cause is never really addressed. At any price per injection, it can really add up, no matter your level of commitment to getting some relief. I do believe it is unrealistic because the patient response is quite variable. For some people it last months and some people not at all. It is all a gamble as to whether it will help you or not. Patient response cannot be predicted. Finding the cause is more difficult, takes more time and effort to try and figure out that there is a whole body process that led to the existence of the tenderpoints or triggerpoints. Chasing and injecting each and every one distracts from getting to the bottom of causation. Traditional osteopathy gets to the answers while getting patients relief so that eventually they start to feel better and start to need less.
The jury is still out on the results of injecting a patient’s serum into other parts of their body that is injured. As a physician, there are continuing medical education courses in these injection methods, put I find it antithetical to my philosophy of holism. If we concentrate of part of your blood, the clear serum part, and inject it into an area where there isn’t a whole lot of it, to me, that is not ‘holistic.’ If is not made there, I do not see any sense in putting more of it in there.
Outside of the risk of strokes, there are other issues of chiropractic neck adjustments. Patients who find their way to me, if they have had many chiropractic adjustments, even if it was years ago and they had stopped these effects are essentially permanent. These chronic changes stay in the body and I then have to undo the chronic adjustments in order to get to their original injury.
There is so much more to be said but this is enough for now. The overall emerging picture is one of a patient who chooses to allow too many others to do too many things that, although appearing innocuous, in the long term add permanent lasting physical changes that I would term ‘damage.’ I choose this word because these body alterations are permanent and stay in there until someone (like me) gets it out. It takes me 3 to 5 times as long to recover a patient compared to someone who just came to me after an injury, fall or car accident.
I do not agree with many of the physical therapy modalities used for pain management. To me, philosophically, some of them are antithetical to healing. Several examples below have led me to the understanding that these modalities may be temporarily helpful, but in the long run, more harmful to the patient. Here are some of my pet peeves and why:
1. Deep tissue massage: I hate with a passion. There are people whose tensions knots are so wound up tight that they need someone to “dig” in there to get relief. Please do not believe that this method will ever, in the long run, lead to a recovery. Digging in there actually beats up and bruises muscle, I call it “tenderizing meat.” Muscle is broken down and rebuilt linearly. When tension knots are rubbed out, the underlying foundation is now confused. What guidance is left for the formation of new muscles, how can they ever be ‘normal’ if the infrastructure is so distorted?
2. No pain, no gain active and passive range of motion – a patient should only do what they can do to a point of tension. I believe that if patients are pushed beyond that, they can tear muscle, fascial, tendinous or ligamentous tissue. Then the repair is ugly and thickened and scarred.
3. Electric stimulation – increasingly, I am seeing more patients having electricity applied to their bodies and especially to specific areas of pain and spasm. This is very wrong headed. The reason the muscle is in spasm is that there is a messaging loop from the spinal cord to the muscle. Electricity disrupts that message and may give the patient some temporary pain relief. Essentially, electric stimulation serves to short circuit and ‘blow the fuse.’ The message and memory remain in place, so later patients continue to hurt again. In fact, for complex patients who have failed everything, the very first thing I do is…I undo the electricity first and foremost.
Physical therapy is the most common conventional approach used by physicians to get patients back to regular function for activities of daily life. The physical therapy profession uses multiple modalities to try to restore the patient to a reasonable expectation of function for the degree of disability. It all depends on the patient’s disease or injury.
Most patients do well with physical therapy. Often there will be patients who complain of physical therapy being painful , which leads them to stop, and maybe contributing to failure. Patients who seek osteopathic treatment quite often have failed many forms of other treatments.
Psoriatic arthritis is a discombobulated immune system attacking the body’s own joint cartilage. Most conventional doctors think of this disease as a genetically caused medical issue. The joint is so hot, swollen and painful that there can be no other way of looking at treating it.
Traditional Osteopathic Physicians View
The treatment is to suppress and slam that immune system down with medications. The way we traditional osteopathic physicians look at this issue, we don’t automatically attribute this to a primary genetic cause. Yes, there is a familial tendency to these types of problems.
We can look at psoriatic arthritis in another way if we compare it to another very common medical problem. Allergies are an immune system’s tendency to overreact to benign substances such as food or inhalants. We inherit that tendency from our parents. It is always there in the background. For those of us who have seasonal attacks of hay fever or worse, the asthma, there always a trigger that pulls that background history out to the forefront. This sensitivity has been pushed out into clinical manifestation. It just doesn’t one day decide that it is going to act out. Chronic irritation in the immune system has been building up over time and something’s gotta give. The same can be said with psoriatic arthritis. My patients don’t come to me primarily with psoriasis problems. They have other problems and pains. When we address those other issues, the psoriasis calms down.
Some new fangled options for joint pain management at the big research centers include injections of either a substance that causes the body to react to promote “healing” such as Prolotherapy and PRP or substances that mask the cause such as steroids or anesthetic.
To a traditional osteopathic physician, this is all invasive and all unnatural. Yes, even the platelet rich plasma (PRP). Most conventional doctors do not see the PRP as unnatural or unwholesome because it is part of the patient’s body. I object to it because the process of harvesting the PRP from your body and then injecting it into a part for which it does not exist in the volume it does is fundamentally wrong. After these conventional pain management injections fail, then they want to start cutting. These are your options once you decide to go their way. How would a traditional osteopathic physician treat this differently?
I would look to all past physical traumas, not just at the joint, but throughout the body. Direct impacts to a joint are devastating and they do stay forever. In any field of medicine in general, old traumas to other parts of the body are rarely considered contributory. In any field of medicine, most doctors only look at high velocity impacts but repeated low force repetition imparts its own type of injury. So, if we look at a football player who is now retired and limping from knee arthritis, I would ask about traumatic injuries to the hips, car accidents, dental work (such as teeth pulls or braces) and surgeries to other parts of the body. And then, I would work to wake up the memory of the traumas in the muscles and then work to disengage them.
Most patients, when they have pain in an area that persists, first try pills. After a short period of time, they start to notice that either it just doesn’t go away or, if it goes away, it always comes back. Then they go to their regular doctor. The first step is usually getting an x-ray. When a person is diagnosed with “arthritis,” it is really an evaluation of the ratty appearance of the joint area combined with the complaints of the patient that it is made.
What is the meaning of arthritis? The word itself means inflammation of the cartilage of a joint. That would imply that the pain is coming from the cartilage. So why wouldn’t it hurt 24/7? And while at rest and as well as while using muscular effort to move.
Pain, with movement of a joint, means that something is restricting its motion. What helps move a joint? Well, that would be the agonist/acting muscles that span the joint, stabilized by surrounding tissues and muscles and an antagonist counterbalancing muscle.
Trauma as a Cause
If there has been trauma ever in the past, those tissues have been shocked and locked into a memory they can’t let go. How do you think you are going to walk, if the tensions across that joint are wrapped up in themselves, can’t let go and be free enough to pick up and extend just for a fraction of a step? Really, after a trauma, the muscles don’t know what their tension is supposed to be, so they are “on” all the time. This is an acute spasm. If the muscles involved in that trauma are not disengaged from the memory, guess what happens over time? The brain and spinal adapt that shocked group of muscles as normal and now it becomes the resting lengths. After a period of rest, people think they are ok. What really happens is that the cartilage continues to grind down on top of each other and over time they thin out and become ratty.
The x-rays show a smaller joint space. What it does not show is what the muscles are doing. If you found an oreo cookie with the double stuff oozing out, what is your first thought? Some kid just squeezed the daylights out of it. And yet, when a conventional doctor looks at a ratty arthritic joint x-ray that has an itty bitty bit of space between one bone and the other, what do they think? Can this joint be destroyed and replaced? This is done for the hips and knees quite frequently. What happens when they find “arthritis” in your fingers or your back or ankles or your neck?
Rarely, do I hear about a too tight a pelvic floor. Women generally (nor men for that matter) do not come in for a consultation with the complaint of, “My pelvic floor is too tight.” You patients generally have other symptoms for which you Google or seek medical help right off the bat.
The tone of the pelvic floor has to be just right for women, tight enough to hold structures up but able to relax to allow passage of waste (urine or fecal) or a penis. Chronic tension or spasm in the floor does not manifest itself as tension that needs to be massaged out (like, for example, the neck). Instead tightness in the front of the floor results in bladder symptoms of frequency, needing to go frequently but tests of infection are negative. Tightness in the middle of the floor results in painful sex or decreased libido. Tightness in the back results in chronic constipation and even small stools.
All the various presentations of a tight pelvic floor usually arise from…past trauma. Often changes in the muscular tensions down there are initiated after a fall to the tailbone. Car accidents can cause these problems too. Psychological and physical trauma of a sexual assault can alter the tensions and lock both together in a vicious cycle.
Osteopathic mechanical principles of treating the anatomy to reduce traumatic vectors of injury can return those tensions to more normal. Unlocking the physical is a key to freeing up the spiritual and emotional in cases of assault.
So, you are having problems controlling your bladder and your bowels. You are constantly looking to find the nearest bathroom when you are out. If we think of the pelvic floor as a hammock tied to two trees, in the human body those two trees would be bony attachments, one in the front called the pubic symphysis and the one in the back called the coccyx and sacrum.
The best way for a woman to tighten her loose pelvic floor is to “string up” the front of the hammock. How do we do that? Think of the anterior abdominal wall as the topmost attachment of the front of the hammock. In fact the attachment at the pubic symphysis actually blends into the fascial coverings of the rectus abdominus muscle. When we tighten our abs, we indirectly lift up the front end of the pelvic floor.
As an osteopathic physician, I treat directly the pelvic floor muscles. I teach my patients several ways to do a safe, non-straining abdominal crunch. One of my secrets for helping my patients maintain the tightening work and exercises is to consume more salt to tighten up the fascia after we do the work and achieve some change. I call this salt loading. Yes, you can try it on your own…but a few words of caution…monitor blood pressure, if you have tension, tightness or stiffness in your neck or back, additional salt will help tighten the already tight parts. If you are one of these people who are salt sensitive, that is, when you eat salt your hands and feet swell, you have several other major structural injuries that are not allowing your body to regulate salt properly. Salt loading is a quick test and easy remedy for women who have had children, tend to eat low salt and are chronically feel fatigued.
And of course, exercise is the number one safe way to maintain pelvic floor health (for us osteopathic physicians, maintaining pelvic floor tension). If you want more information, or want my secrets for pelvic floor exercises please checkout my exercise video at www.pelvicfloorhoangs.com
What is a pelvic floor dysfunction? Dysfunction means that it is not working right. Well, let us ask, “What is the job of a pelvic floor?” The pelvic floor is a group of muscles, our undercarriage, that blend together to form a hammock like structure that attaches to the front of our pubes and slings across to the back of our tailbone. This hammock, in men has one opening, and in women the hammock has 3, yes 3 openings as exits for the bladder, the uterus and the rectum. The pelvic floor keeps our insides in. Now visualize all the indoor plumbing that the pelvic floor has to support. In men, it is primarily the guts in terms of size and weight, and the bladder comes next. Men do have a prostate, but it is a rather smaller structure. To be sure, men do have pelvic floor problems, not readily recognized by the men, but also not considered by most doctors. In women, that hammock has to contain the bladder up front, the rectum in the back and a potential baby oven in the middle. As we age, those muscle start to sag and stretch from all the years of back and forth (during sex and pregnancy and delivery).
There are two types of pelvic floor dysfunction. Most of the time, and by the time we hit nursing home age (around our 70’s), about 77% of us women will have a floor that is too loose and floppy. As this is the more common problem, I will address it first. In later posts, and in case you were wondering, the other type of pelvic floor dysfunction is that it is too tight. In either case, if the muscular and fascial tensions in the muscles of the pelvic floor are not right, the patient will have a medical problem.
In cases of a loose pelvic floor dysfunction… very simply, things start to feel like they are falling out. At first, it presents as loss of control. With the bladder loss of control is called urinary stress incontinence. With the rectum, when you have very little control of your bowels, it is called fecal incontinence. Since the vagina is a space, a passageway, that does not hold any waste, problems here affect sexual function and yes, even libido.
When the pelvic floor is absolutely floppy, flaccid and most of the time does not do its job, then your doctor will diagnose you with “prolapse.” Prolapse is when your stuff wants to fall out past the lower most portion of your undercarriage/floor. The always recommend watching you until its get really bad and then they offer you surgery. Sometimes they refer to physical therapy. Sometimes it helps, sometimes it doesn’t. I’ve seen enough patients that I get the sense that your results are completely random and you may have just rolled dice to find anyone to help you.