What Should I Do?

Managing Pain without Meds

Monday, March 7, 2011, 7:46 PM

The Peak Affordability Lifestyle

If I were to summarize everything I have learned from Dr. Martenson and this community over the last few years into one statement, it would be “our future is unaffordable.” The mechanism by which our unaffordable future is realized - be it inflation, deflation, Peak Oil, resource scarcity, currency crisis, or overt corporate corruption - is largely irrelevant. The bottom line for each one of us and our families is that we can no longer expect the macro economy to provide for our needs. Our best chance at surviving the myriad of future predicaments facing us is to develop the capacity to provide for our own needs and to progressively achieve functional independence from the economy-at-large. I like to refer to this daunting process as “adapting the Peak Affordability lifestyle,” as it is really much more than just an agenda of preparations; it’s a way of life.

One particular personal need that is destined to become increasingly unaffordable, or even unavailable, is healthcare. The field of healthcare encompasses an infinite number of subjects and topics, but today I want to focus on one particular aspect of healthcare that people frequently feel helpless to address on their own: managing physical pain. Although physical pain complaints, such as low back pain, headaches, etc, are typically not life-threatening conditions, they nevertheless are perfectly capable of destroying a person’s life. This is an extremely unfortunate situation, because the majority of these pain complaints result from a simple misunderstanding about the nature of physical pain. 

My intention with this post is to provide the reader with an understanding of common pain complaints that will empower them to effectively deal with these disorders on their own, without the need of professional healthcare services. My wife and I run a small pain clinic in Houston, and the insights shared in this post are garnered from several decades of study and clinical experience. 

Don’t Kill The Messenger

The natural reaction for a person in the throes of a physical pain complaint is to identify their pain as the problem itself, and overlook the fact that the sensation of physical pain is merely a form of communication. As such, most people mistakingly turn to painkillers as a solution to these particular disorders. This approach never works, because by “killing the pain,” one is also blocking the very information that is needed to find an effective solution to it. 

The most effective use of painkillers is to promote sleep, as regular sleep is critical to the body’s healing process. When you are awake, however, you are best served by avoiding the use of painkillers. Pain is information, and the first step to finding a solution to your pain complaint is being open to the flow of this information.

Your Pain Has A Purpose

The purpose of pain is to protect an injured body tissue. While this statement seems dreadfully obvious, it is remarkably easy to overlook this fact when pain has seized control of your daily life. The mechanism by which pain acts to protect an injured tissue is a twofold process.

  1. The sensation of physical pain itself is an attempt to make you consciously aware of the injury; it is seeking your attention. At first, it may attempt to get your attention with a “whisper,” but this quickly escalates to a “roar” if you choose to ignore it. 
  2. It uses your conscious awareness of the injury to modify your behavior and physical activity in a way that prevents you from damaging the injured tissue further.

A simple example of this process occurs when you sustain a cut on your foot. The pain associated with the cut both makes you aware of the injury and prevents you from walking on the foot so that the cut can heal. But in many cases, the injury is not as obvious as a simple cut. This is particularly true in pain complaints involving the neuromuscular system, such as low back pain, shoulder pain, hip pain, etc. The key to identifying the injury (or injuries) in these disorders lies in understanding how the presence of a particular pain modifies your normal bodily movement or physical activity.

Get To Know Your Pain

Early on in my study of the various manual therapies, I came across the remarkable story of Moshe Feldenkrais (D.Sc.). Dr. Feldenkrais worked as a physicist during World War II, and was the first European to earn a black belt in Judo after the war. Throughout his adult life, he was plagued by pain in a knee that he had injured playing soccer when he was younger. Several doctors he consulted advised that surgery was his only option, and that even with surgery, his chances of ever walking normally again were only 50/50. Frustrated with his lack of viable options, Moshe became determined to fix his knee himself. One day he surprised his colleagues by jumping up in the air and slapping his injured knee several times. All were astonished that he was apparently pain-free after so many years of suffering. Several months later, over libations, Moshe revealed to them how he had healed his knee; he personified his knee pain and made a real effort to ‘get to know it.’ Instead of trying to avoid his pain, like he had done for most of his adult life, he gave it his complete attention. “I soon as I had complete awareness in my knee joint” Moshe said, “I had no pain in it.”

Dr. Feldenkrais went on to write numerous books on his method of pain-relief, and his work became collectively known as The Feldenkrais Method of Somatic Education. While I would highly recommend becoming familiar with his work, the essential application of his method boils down to taking some time to understand your pain in greater detail. This process involves answering these two basic questions:

  • What activities, body movements, and body positions make the pain worse?
  • What activities, body movements, and body positions make the pain better?

Take some time to explore your pain. You will be amazed at how the simple act of giving physical pain your complete conscious attention, if only for a short period of time, can transform even the most unbearable pain into a kinesthetic sensation that is both tolerable and manageable.

Trigger Points And Referred Pain

While many in this community may be familiar with the term “trigger point” from an economic perspective, this term is also used to describe a very common, but relatively unknown, type of injury that occurs in muscle tissue. A myofascial trigger point is most simply described as a micro-spasm within a muscle. Trigger points occur when we place a demand on a muscle that it is unaccustomed to, or not “conditioned” to perform. As the muscular system takes most of the brunt, or “wear and tear,” of our daily life, trigger points are much more common than injuries to the joints, tendons, and bones.

One of the more fascinating aspects of trigger points is that they produce a type of physical pain known as referred pain. Referred pain simply means that the pain is experienced in a region of the body that does not contain the injury, or source of the pain. As you might expect, this phenomenon can create a great deal of confusion, as the actual injury is often not found where it appears to hurt. 

An example of trigger point referred pain is the common headache. A person experiencing pounding pain in their temples, is naturally going to conclude that the problem is systemic in nature. Maybe they think it’s caused by high blood pressure, a migraine attack, or if the pain persists long enough, they may even entertain the idea of a brain tumor. But, the most frequent cause of a pounding headache is referred pain from trigger points in the Trapezius muscle, that lies in the upper back and neck region of the body.

This begs the question, “Why would the pain from an injury in an upper back muscle be experienced in the head?” To answer this question we only need to examine how this referred pain causes you to modify your activity and movement. Most people, when faced with a pounding headache, are inclined to lay down for a while and immobilize their head. As the Trapezius muscle functions to move the head, immobilizing the head serves to allow this muscle group to rest, and prevents further aggravation of the trigger point(s) contained within it. 

Another fascinating aspect of the referred pain phenomenon involves phantom limb pain. It is quite common for people who have had an arm or leg removed because of traumatic injury or disease, to continue to experience pain in that limb. Quite often, this phantom limb pain is referred pain from trigger point activity in trunk or neck muscles, and responds very well to the appropriate Trigger Point Therapy protocol. 

What Should I Do?

So let’s say you find yourself in a situation where you or a loved one is incapacitated by physical pain, and no doctor or professional treatment is available to you. What do you do? My advice would be the following;

  • Before you get into that situation, educate yourself on Trigger Point Therapy. One excellent book that I would recommend is The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Edition by Clair Davies. You can also view parts of this book in Google Books
  • My wife, Dr. Laura Perry, and I also host a website where you can get information about trigger points and Trigger Point Therapy. You can visit our site at www.PainWhisperer.com. Additionally, for those interested in learning more about the practice of Trigger Point Therapy, you might want to take our free online introductory course in Clinical Trigger Point Therapy. While this course is geared towards the professional therapist, many nonprofessionals have found its content valuable.
  • And most importantly, don’t try to avoid your physical pain. Give it your complete attention and learn from it. Now if only we could get the politicians to adapt this approach to the “3 E” pain facing us all, the world could be a better place.

Thank you for reading this and I hope you find this information useful.

Best, JAG

P.S. Don’t tell my wife that I’m CaptainSheeple, LOL!


This What Should I Do? blog series is intended to surface knowledge and perspective useful to preparing for a future defined by Peak Oil.  The content is written by PeakProsperity.com readers and is based in their own experiences in putting into practice many of the ideas exchanged on this site.  If there are topics you'd like to see featured here, or if you have interest in contributing a post in a relevant area of your expertise, please indicate so in our What Should I Do? series feedback forum.

If you have not yet seen the other articles in this series, you can find them here:

This series is a companion to this site's free What Should I Do? Guide, which provides guidance from Chris and the PeakProsperity.com staff on specific strategies, products, and services that individuals should consider in their preparations.  

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40 Comments

Tycer's picture
Tycer
Status: Platinum Member (Offline)
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Outstanding!

Thanks JAG

mobius's picture
mobius
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Posts: 152
The Quality Contributions keep coming, Thanks!

Truly appropriate.  Thanks for this quality piece.

Regards, Joanne.

Travlin's picture
Travlin
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JAG Nice article.  I've

JAG

Nice article.  I've read about people with fibromyalgia having pain centered around trigger points.  Have you had success in relieving this?

Travlin 

ao's picture
ao
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Feldenkrais,

Jeff,

I appreciate your effort to teach people to manage their own pain.  I'd like to offer some clarifications of what you wrote, however.  I happen to be a Feldenkrais practitioner trained under Mia Segal (and a number of others).  The Feldenkrais Method has very little to do with pain and everything to do with somatic awareness.  Also, the story about how Feldenkrais "cured" his pain is not quite accurate.  He essentially psychocybernetically took himself through all the various movements, positions, activities, etc. that caused him pain and developed motor strategies that were the most efficient and therefore, the least painful. 

Also, Janet Travell's work on trigger points (and subsequent evolutions of her work) is very effective for myofascial pain but not effective for pain arising from other somatic structures such as discs, joints, etc.

In addition, true phantom pain is not referred pain.  It is a very different phenomenon.

The PRRT (Pain Reflex Release Technology) work of John Iams is some of the most effective work on treating pain of nociceptive reflexogenic origin that I've seen after 32 years in the business and teaching in 40 different states and several universities.

The Total Motion Release work of Tom Dalonzo-Baker is another effective strategy for self treatment of musculoskeletal pain.

The McKenzie Approach is the most effective self treatment  single (not aggregtate) method I've seen for spinal pain of discogenic origin. 

But most importantly, where musculoskeletal pain is involved, treating function is the most effective way of treating pain.  Treating pain without treating function leads to a high rate of recidivism.

Also, a key thing to remember is that virtually all pain (except that of psychogenic origin) is secondary to one of only two factors, chemical irritation or mechanical deformation.  Pain of chemical origin is best treated chemically and pain of mechanical origin is best treated mechanically. 

A good (but overly expensive for what you get book) for explaining pain to the layperson is Explain Pain by David Butler.  Another neat little book (that unfortunately is out of print) is The Brilliant Function of Pain by Milton Ward.

Pain, unfortunately, is such a complex and misunderstood subject that even most health professionals seem or are poorly equipped to effectively resolve it.  Kudos for tackling such a tough subject.

Dragline's picture
Dragline
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Article

Thanks, JAG.  This is a nice addition to this series.  Finding ways to be in good health is a neglected area -- but if you can stay off unnecessary meds and avoid unnecessarily invasive medical treatments you'll conserve a lot of resources.  And if you are not in decent health, preparing for your (own) future in other ways may be a waste of time.

A good generic resource for health is the book Eat, Move and Be Healthy by Paul Chek.  It discusses some of these methods and gives some simple exercises with diagrams.  My favorite part of his advice is that if the person giving you health advice is not in excellent shape, the advice is probably not worth very much.

I've also been favorably impressed with the Egoscue method for back pain.  Very simple and effective.  See www.egoscue.com and try the Get Help Now under the Method tab.  This was recently featured in Tim Ferris' "4-Hour Body", which is an interesting read because he turns himself into a human guinea pig and tries all sorts of medical and non-medical treatments and exercise and eating regimens.  (A lot of things in the "Don't try this at home" category, though.)

JAG's picture
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Fibromyalgia and Trigger Point Therapy

Travlin wrote:

JAG

Nice article.  I've read about people with fibromyalgia having pain centered around trigger points.  Have you had success in relieving this?

Travlin 

Hi Travlin,

On the average, we see about 20 fibromyalgia patients/year in our practice. The majority of these patients have a component of their symptom presentation that is effectively treated with trigger point therapy protocols, but this component is usually a concurrent complaint that is clinically distinct from fibromyalgia. There is some overlap in the location of the tender points that clinically define fibromyalgia, and the location of common trigger points that contribute to various pain disorders, and some researchers consider the presence of trigger points to be an important factor in the severity of fibromyalgia symptoms. In our experience, we typically can help in the management of the fibromyalgia disorder, but a solution to this disorder is beyond the scope of trigger point therapy.

Best....Jeff

JAG's picture
JAG
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Scope

Thanks for your contribution to this thread ao.

From reading your posts over the years, I have no doubt of your expertise in the healthcare field. And if you didn't live on the other side of the nation, I think we could engage in some excellent professional discourse over libations.  I had the idea of contacting you to do a joint post on this subject, but given the limited scope of this post, I thought your time would be better served elsewhere.

I recognize that their are many effective approaches to dealing with physical pain complaints, but I thought Trigger Point Therapy and the Feldenkrais Method the most applicable to the self-treatment scope of this post. 

Thanks for the book recommendations, I think I could probably get joyously lost for days in your personal library.

Best...Jeff

peter31's picture
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Post peak medicine

Nice article.  I don't have any special expertise in pain - I just whack it with pharmaceuticals, same as most other docs - but I am trying to create a framework which may help and encourage physicians to continue to offer healthcare in a post peak world:

www.postpeakmedicine.com

I created the website because I remember feeling very confused when I first learned about the economy and peak oil and wondering "what do I do now?" and this is my attempt to reach out to physicians in a similar position.

ao's picture
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review

Dragline wrote:

A good generic resource for health is the book Eat, Move and Be Healthy by Paul Chek.  It discusses some of these methods and gives some simple exercises with diagrams.  My favorite part of his advice is that if the person giving you health advice is not in excellent shape, the advice is probably not worth very much.

I've also been favorably impressed with the Egoscue method for back pain.  Very simple and effective.  See www.egoscue.com and try the Get Help Now under the Method tab.  This was recently featured in Tim Ferris' "4-Hour Body", which is an interesting read because he turns himself into a human guinea pig and tries all sorts of medical and non-medical treatments and exercise and eating regimens.  (A lot of things in the "Don't try this at home" category, though.)

I concur with Paul Chek's book being a very good resource for overall health.  Some of the exercises may be a little bit daunting for some patients with pain and pathology, however.  He is very knowledgeable, especially considering that he is largely self taught, and I respect him for not only talking the talk but also for walking the walk. 

Egoscue is also self taught and makes some good points.  His method can be beneficial but he tends to hype it beyond its capabilities.  In my opinion, his method lacks biomechanical, neurophysiological, and pathological specificity and often fails to produce rapid short term results where some other methods would.  IIRC, he was on San Diego area TV and "treated" some patients.  None of them had their pain relieved in the short term.  John Iams was also on TV and obtained immediate results with pain relief.  Pete Egoscue certainly knows how to market his method though.  As an ex-Marine officer, he knows how to motivate people.  For better or worse (depending upon how you look at it), the public tends to believe most or all of what it hears with regards to marketing and doesn't have the knowledge and experiential base to critically evaluate what they see, hear, and feel.  If you have a lot of time and a lot of money, it's OK and relatively safe.  Otherwise, you may want to look elsewhere.  

frankgrill's picture
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Acupuncture

Thanks for posting this thread.  Another great low-cost option for treating pain is acupuncture.  Community acupuncture is a new model in the acupuncture world that utilizes a low-cost, no-insurance business model.  It is also a decentralized network of practitioners that share information and help each other.  Treatments are based on a sliding scale of $15-35 and often times lower for those who can't afford it.  Check it out!

http://www.communityacupuncturenetwork.org/

green_achers's picture
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Our drugged population

Thanks for the good information JAG.  This could be very important to individuals going forward, but it might be an even bigger issue for our society in general.

The number of people I come across regularly who are on pain meds is amazing.  I know whenever I mention one of my many aches and pains to an MD, they are quick to offer me something pharmaceutical for it.  We're getting to be a society of addicts.

My back went out on me doing hard physical labor in my early 30s and the medical establishment was ready to put me on disability and prescribe pain killers for the rest of my life.  A couple of bouts of not being able to get out of bed because of the pain, and I can understand the appeal.  Instead, I parlayed some worker's comp into a start on getting a BS degree, and spent about 15 years working very actively in the natural resources field for the US Forest Service.  About 5 years ago I left that and am now operating a one-man vegetable farm.  When I think of how easy it would have been to go the other way, I can only thank dumb luck and a higher power.

I have a tenant who has a bad back, and am pretty sure he would be utterly helpless without his meds.  As it is, he manages to work a part time job to supplement his SS payments, but it seems to me that he just sleeps or watches TV the rest of the day.  His son had an injury on the job, and got strung out on the pain killers, too.  I'm pretty sure there's no way the country can go on that way.

During the Katrina recovery I was in a relief center eating lunch one day and there was a husband/wife team of medical volunteers at the same table.  I had barely gotten started in an interesting conversation with them when word got around the table that he was an MD.  The number of people at that one table who started trying to find a way to get him to get them the meds that they were used to was  frightening.  A lot of the "instantly homeless" from Katrina who were in the camps were probably people who were pretty close to the edge to begin with, but a lot were regular, middle-class people.  I also suppose some might well have been trying to game the system to get something for recreational use or to sell, but for me, this was a leading indicator of how far down this culture has gone.

So from where I sit, I can't be too optimistic about how a large segment of the population is going to be able to withstand any disruption to our system.  Add to that the people on psych meds (I have a doozy of a Katrina story about that, too), and the situation could be more than scary.

Now, I'm not saying pain killers whould be withheld in general.  I know they can do a lot of good for people in severe pain.  I also don't want to contribute to the sadistic, puritanical regulations we have controlling drugs.  I watched my brother die of lung cancer, and we we had a very hard time getting him good pallative care.  The irony is not lost on me.  I guess it's just another example of a dysfunctional legal, political and social system.

Grover's picture
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Natural Pain Relief

JAG,

Nice article! I broke a lumbar in my lower back when I was 17. The pain came and went, but 4 years later, it was much worse and I went to a MD to see what I could do about it. Rather than prescribe pain medications, the MD told me to strengthen my stomach muscles and keep them taut while walking. I exercised by doing abdominal crunches and consciously kept the stomach flexed whenever standing or walking. After a few months, the pain disappeared and since then it only returns when I forget this simple rule.

I've also had "bad" knees all my life. In 1995, I dislocated my knee pretty severely at the end of a backpacking trip. I went to the doctor, got an MRI, and the doctor said that I had deteriorating cartilage. His prognosis was that there wasn't anything to be done except deal with it until the pain became unbearable. When I couldn't tolerate the pain any longer, I should get a knee(s) replacement and it will seem to be an improvement. By 1997, the pain and inflamation were getting severe enough that I was ready to make the appointment for the replacement of both knees. Then, a friend told me about a Knox Gelatin product called "Nutrajoint" which is ground up deodorized beef cartilage with 7 added minerals. I was desperate, so I bought a can. The product still has a beefy odor, but orange juice covers it fairly well. After a few weeks of drinking it daily, my knees started feeling better. Over the course of about 3 months, the pain disappeared completely. Now, nearly 14 years later, I still have my organic knees - and they still feel great.

From doing a little reading on the subject, I found that I'd probably get the same results by eating the cartilage on the ends of chicken or cattle bones. It is one of those natural things that our ancestors used to do before the act of gnawing on the ends of bones became uncouth. I think a lot of our medical problems stem from differences in evolutionary versus current practices.

Grover

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Back pain

JAG, thanks so much for your article, and for starting such an important thread!  Ao, Grover and others, thanks also for sharing your knowledge, recommended resources and suggestions.  This is such an important topic. 

I hurt my lower back early last summer (carrying water and bags of manure to my garden?:), and am now learning what chronic lower back pain is like.  Having always been one who loves walking, exercising regularly, and doing (moderate)  physical work, I have been distressed by the degree to which something so simple sounding as "lower back pain" can be almost crippling, in terms of limiting motion and activities.  I have seen a doctor (no help there), and have since been pursuing alternative means of helping my back.  So I look forward to trying out some of the info and references provided here.

My husband also suffered from back pain and painful sciatica some years ago.  Through trial and error, he found a book on back pain that made all the difference for him.  As soon as I get a chance, I'll ask him what the title and author are so I can post them.  But one of the techniques he learned from it was a relaxation and visualization technique.  It goes something like this: He squats, with his back and head gently curled forward, (kind of like a squatting fetal position).  While doing the squat, he holds lightly onto a post or something else in front of him, to help maintain an easy balance.  He says it is important to take care not to be in a position that puts any pressure (to maintain balance) on your back when you do this .  Then he closes his eyes, and visualizes the pathway his blood takes to his spine as if it iwas a big tube, with blood cells filled with oxygen traveling down to his spine.  He visualizes this pathway expanding as he relaxes more and more, while taking deep breaths, allowing more blood flow and oxygen to reach his spine.  He only does this for a couple of minutes at a time, until his back has relaxed. But he tells me the trick is to do this a number of times a day, whenever you feel the back pain kicking in. 

My husband says he did not think this technique would work, out tried it out of desperation.  To his surprise, it worked even though he didn't think it would. I think he said it tool maybe 2 or 3 weeks. I've tried the relaxation technique now and again, and it does feel good, although I have to admit to not being disciplined enough at sticking with it to give it a fair shake. Ok, so I'm also afraid to get caught in the ladies room at work squatting down, holding onto a stall...

Thanks again for the great post, Jag!!

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Dragline
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Egoscue

ao wrote:

I concur with Paul Chek's book being a very good resource for overall health.  Some of the exercises may be a little bit daunting for some patients with pain and pathology, however.  He is very knowledgeable, especially considering that he is largely self taught, and I respect him for not only talking the talk but also for walking the walk. 

Egoscue is also self taught and makes some good points.  His method can be beneficial but he tends to hype it beyond its capabilities.  In my opinion, his method lacks biomechanical, neurophysiological, and pathological specificity and often fails to produce rapid short term results where some other methods would.  IIRC, he was on San Diego area TV and "treated" some patients.  None of them had their pain relieved in the short term.  John Iams was also on TV and obtained immediate results with pain relief.  Pete Egoscue certainly knows how to market his method though.  As an ex-Marine officer, he knows how to motivate people.  For better or worse (depending upon how you look at it), the public tends to believe most or all of what it hears with regards to marketing and doesn't have the knowledge and experiential base to critically evaluate what they see, hear, and feel.  If you have a lot of time and a lot of money, it's OK and relatively safe.  Otherwise, you may want to look elsewhere.  

Oh, I completely agree that some of these methods can get over-hyped and you can pay too much for them.  But I'm cheap, so I take what I can from them that is free or low cost.   That's why I mentioned the 4-hour body book.  The author went through all the Egoscue stuff and came back with "here's the five most useful exercises and how to do them".

What did Bruce Lee used to say -- I think it was  "Use only that which works, and take it from any place you can find it.."

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specificity

Dragline wrote:

Oh, I completely agree that some of these methods can get over-hyped and you can pay too much for them.  But I'm cheap, so I take what I can from them that is free or low cost.   That's why I mentioned the 4-hour body book.  The author went through all the Egoscue stuff and came back with "here's the five most useful exercises and how to do them".

Dragline,

The problem with the statement in bold is that it is so general that it lacks any usefulness.  If I could offer an analogy, it's like someone saying here are the five best investments.  For who, at what age and stage in their life, with what risk tolerance, with what investment experience, with what financial status, etc., etc.  For example, the best exercise for low back pain originating from a central posterior disc derangement in a 30 year old may be the worst exercise for a 70 year old with spondylolisthesis, even though both individuals are suffering from low back pain.  There're some things that Tim Ferris may be expert at but therapeutic and remedial exercise is not one of them.

Even Bruce Lee, who I have the greatest respect for and who was very knowledgeable about training for his time didn't understand the risks involved in performed a good morning lift, especially when one has a considerable leg length difference as he did.  It's the reason he blew out his back. 

ao's picture
ao
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professional expertise

pinecarr wrote:

I hurt my lower back early last summer (carrying water and bags of manure to my garden?:), and am now learning what chronic lower back pain is like.  Having always been one who loves walking, exercising regularly, and doing (moderate)  physical work, I have been distressed by the degree to which something so simple sounding as "lower back pain" can be almost crippling, in terms of limiting motion and activities.  I have seen a doctor (no help there), and have since been pursuing alternative means of helping my back.  So I look forward to trying out some of the info and references provided here.

pinecarr,

I can't emphasize this strongly enough to anyone who has low back pain (or other forms of musculoskeletal pain for that matter).  There can be MANY different causes for the same type of pain.  Buffet style or trial-and-error selection of treatments is usually destined for failure or less than optimal results.  Find a well trained, experienced, board certified orthopaedic physical therapist with manual therapy training and skill and an excellent reputation who (1) fully understands spinal problems, (2) will perform a thorough, detailed evaluation to determine the exact cause of your problem, (3) will develop an accurate, detailed, specific, scientifically based treatment plan, (4) will effectively render that treatment, and (5) will teach you how to take care of yourself once you are pain-free.

All treatments and all practitioners are not equal ... far from it.  While self reliance is great, sometimes consulting the right professional can make all the difference in the world and save you a lot of pain, suffering, and money in the long term. 

Hint: if someone has to advertise heavily, take a pass.  I've never had to advertise (knock on wood) and neither have most of the other top practitioners that I know.  Just today, I treated someone who had "physical therapy" in an orthopaedic surgeon's office (which is a BAD choice for a number of reasons) for 10 sessions and was not much better.  He had heard about me by reputation.  After one visit, he felt better than he had in months.  He asked me why the physical therapists at the doctor's office hadn't done what I did.  I gave him my stock answer, "You got me ... go ask them."  How do you explain to them the difference without sounding like you're bragging?;-) 

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Thanks for the advice, ao! 

Thanks for the advice, ao!  My experience was much more like the one you referenced in your last paragraph. 

A friend at work recommended a different doctor who helped her tremendously with back pain and sciatica after the birth of her second child.  I am planning to pursue that lead.  I think she called him an "osteopath".  The term is new to me.  Does that imply anything good/bad/quacky to you?

Thanks again for the response.

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JAG
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Posts: 2490
Chemical vs Mechanical Pain

ao wrote:

Also, a key thing to remember is that virtually all pain (except that of psychogenic origin) is secondary to one of only two factors, chemical irritation or mechanical deformation.  Pain of chemical origin is best treated chemically and pain of mechanical origin is best treated mechanically. 

ao,

I'm afraid you lost me on this statement. The mechanism by which trigger points create referred pain is distinctly a chemical process, yet their treatment is best achieved by mechanical means. In fact, there is no drug or nutraceutical that has shown any effectiveness in the resolution of trigger points (at least not in a double-blind, placebo controlled study). Even the injection of trigger points with a local anesthesia must be classified as a mechanical treatment method, because trigger point injection with a saline solution works equally as well.

Perhaps by "mechanical pain" you were implying nerve compression, in which case removing the mechanical compression would be warranted, and probably best done by mechanical means. But I know of one case of nerve compression that was effectively addressed by chemical means. My father came to me with a complaint of sciatica-type pain. I knew from X-rays that I had taken of my father when I was in Chiropractic College in the late 80's, that he had a spondylolisthesis, so I suspected that his symptoms were secondary to nerve trunk compression in his lumbar spine. I told him surgery would probably be needed at some point. My father, who was at the time being treated for lymphoma at M.D. Anderson Cancer Institute, mentioned his sciatica symptoms to one of his doctors there, who then referred him to another doctor in the M.D. Anderson ecosystem. This doctor suggested that my father try a treatment protocol involving the drug Neurontin, before committing to a surgical option. To my amazement, the neurotin actually worked for my father. It took about 6 weeks for all his symptoms to subside, but he has been off the drug for several years now and is still pain-free. 

I realize that discussing alternative healthcare topics is a bit like discussing politics or economics, as many professionals in the field hold deep-seated beliefs about the efficacy of their particular approach, myself included. I think it's important to remain open to other approaches, but to always have a foundation of good medical research to base your work on. To this end, no alternative treatment to pain has more medical research supporting it than Trigger Point Therapy, which is why I felt comfortable recommending it here.

Thanks to everyone for their comments on this thread....Jeff

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Damnthematrix
Status: Diamond Member (Offline)
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Posts: 3998
lower back pain

I've suffered from this for decades.  Of late, I have found stretching exercises of immense value.  Before pain strikes (ie when you know you're about to do something that might cause the onset of pain) or afterwards as a means of getting rid of pain.

It won't fix a major problem, but I'm convinced it actually shortens recovery time...

Mike

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green_achers
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Posts: 203
Location thoughts

For me, this article also raises another issue besides the "bigger picture" one I commented on earlier.  I think of all of the people looking for remote hidey-holes to weather out the coming storm.  By a chain of circumstances, I have ended up in N Miss.  One thing I really miss about N Cal. is the large number of good professional alternative treatment modalities I could find there.  I don't know how I would have ended up if it hadn't been for the excellent chiropracter I had in the 80s in the Bay Area or the other excellent one I found later in the Central Valley.  Most medical resources in this part of the country are far from ideal, and alternatives are almost nonexistant.  Something to think about in making preps.

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DurangoKid
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Posts: 173
I'm siding with the exercise

I'm siding with the exercise and stretching strategy to manage lower back pain.  I've been working on stretching the piriformis muscle that joins the head of the femur to the sacrum.  Many people who bicycle intensively have a problem with this muscle and the nerve routed around it.  Usually the nerve goes underneath it, sometimes over it, and sometimes even through it.  When the pirifomis spasms, ouch!  Two doctors diagnosed me with a crushed disc in between my sacrum and lowest lumbar vertebra.  Neither performed any tests or exam.  It has been shown that a bulging disc alone is often not sufficient to cause back pain.  Whether it's a bulging disc or piriformis spasm, I don't know.  What I know for sure is that my exercise program helps me manage my lower back without drugs or surgery.  The more I use it, the better I feel.

I refuse to give up cycling and still train fairly regularly.  What I do is after every ride I stretch the piraformis by first lying on my back with knees raised.  Then cross one leg over the other and gently but firmly tug on the knee or on the top portion of the tibia.  Make sure the pelvis sits flat.  Hold for twenty seconds per side.  There are several variations on this.  Google “piriformis stretch”. I also stretch by touching toes with my knees locked and unlocked.  Simple sit-ups with the knees bent helps to maintain alignment of the pelvis and strengthen the abdomen.  Improves posture.  Start a program of sit-ups beginning with an easy number of reps at first and then increasing the number by a few weekly.  I'm up to 30 this week.  Another help is rotations.  There are two versions of this.  While on the bike if I'm having discomfort, I straddle the top tube and face 90 degrees from the direction of motion.  With both feet on the ground and grasping the saddle, I rotate clockwise when facing right until my back pops and then reverse.  This takes some practice in relaxing the abdomen and diaphragm.  Repeat facing left.  It's about 90% effective in relieving lower back pain during a ride.  As part of my after ride stretching, I sit upright on the mat, bend one knee and cross it over the other leg.  Grasp the ankle with the hand from the same side and place the opposite hand on the floor behind me.  Then rotate gently including looking behind me and hold for twenty seconds.  Sometimes I can get my spine to pop on this one.  Of course, reverse it and hold for twenty.  Another big help is moving my car seat up until my left foot is against the firewall.  No need to cramp or apply pressure.  The foot against the firewall is a queue to keep my pelvis firmly against the seat back and prevent slouching.  Before I figured that one out, driving could be torture.  Brisk walking on level ground is another good treatment.  Keep your chin up, swing your arms, and walk far and fast enough to get your body temperature up.

One thing to keep in mind is obesity is no friend to your back.  By significantly reducing the sugars in my diet, I’ve dropped about 8 pounds over the last month.  My goal is a BMI of 22 or so.  Not there yet and I expect it will take the better part of a year.  Some people claim that BMI is too strict.  Mule fritters.  What’s normal in America is not healthy.  We exercise too little and eat way to much crap.  We snack on confections instead of restricting our intake to wholesome foods taken only at meal times.  How many of us in our 50’s remember when we were children being told not to snack between meals?  Now snacking is taken as a norm.  What are snack foods made of?  They’re mainly concocted from some combination of the three big, heavily subsidized commodity crops: wheat, corn, and soy.  High in calories, low in nutrients, and very profitable.  Read Michael Pollan.  The quantity and quality of food that goes into your mouth affects your back.

And now the Peak Oil angle.  Rising oil prices will drive up the cost of medical care, or, more properly called, disease intervention.  All of my treatments have a low carbon footprint.  They cost nothing.  I can do them anytime and anywhere.  Eating food with less processing uses less oil. 

They say a person who has himself as a patient has a fool for a doctor.  This fool had been getting good results.  Is it foolish to believe a consistent routine of good maintenance practices can keep you from needing expensive repairs?

ao's picture
ao
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Posts: 2220
mechanical/chemical clarification

JAG wrote:

ao wrote:

Also, a key thing to remember is that virtually all pain (except that of psychogenic origin) is secondary to one of only two factors, chemical irritation or mechanical deformation.  Pain of chemical origin is best treated chemically and pain of mechanical origin is best treated mechanically. 

ao,

I'm afraid you lost me on this statement. The mechanism by which trigger points create referred pain is distinctly a chemical process, yet their treatment is best achieved by mechanical means. In fact, there is no drug or nutraceutical that has shown any effectiveness in the resolution of trigger points (at least not in a double-blind, placebo controlled study). Even the injection of trigger points with a local anesthesia must be classified as a mechanical treatment method, because trigger point injection with a saline solution works equally as well.

Perhaps by "mechanical pain" you were implying nerve compression, in which case removing the mechanical compression would be warranted, and probably best done by mechanical means. But I know of one case of nerve compression that was effectively addressed by chemical means. My father came to me with a complaint of sciatica-type pain. I knew from X-rays that I had taken of my father when I was in Chiropractic College in the late 80's, that he had a spondylolisthesis, so I suspected that his symptoms were secondary to nerve trunk compression in his lumbar spine. I told him surgery would probably be needed at some point. My father, who was at the time being treated for lymphoma at M.D. Anderson Cancer Institute, mentioned his sciatica symptoms to one of his doctors there, who then referred him to another doctor in the M.D. Anderson ecosystem. This doctor suggested that my father try a treatment protocol involving the drug Neurontin, before committing to a surgical option. To my amazement, the neurotin actually worked for my father. It took about 6 weeks for all his symptoms to subside, but he has been off the drug for several years now and is still pain-free. 

I realize that discussing alternative healthcare topics is a bit like discussing politics or economics, as many professionals in the field hold deep-seated beliefs about the efficacy of their particular approach, myself included. I think it's important to remain open to other approaches, but to always have a foundation of good medical research to base your work on. To this end, no alternative treatment to pain has more medical research supporting it than Trigger Point Therapy, which is why I felt comfortable recommending it here.

Thanks to everyone for their comments on this thread....Jeff

Jeff,

Good points.  That statement about chemical and mechanical pain comes from Barry Wyke, the eminent British neurologist.  Sorry for my omission and not clarifying that certain problems can have pain of mixed origin (i.e. both chemical and mechanical) while with other problems, one form or the other dominates.  Also, I excluded pain of psychogenic origin since I didn't want to go there.

Let's look at trigger points as defined by Travell.  In general, some type of mechanical deformation will generate them (even though sometimes the mechanism could be neurological).  Mechanical deformation is inclusive of but goes far beyond just nerve compression (if by nerve compression, you mean nerve root compression).  It can involve any type of compressive, tensile, shear, or other force to virtually any tissue in the body. 

Getting back to the chemical pain, if you recall from Travell's Vol. 1 Chapter 4 on Perpetuating Factors, there are a whole range of nutritional deficiencies (i.e. a chemical problem), for example, which can act to perpetuate trigger points.  You can spray and stretch or inject until the cows come home and the problems will tend to come back because the underlying nutritional deficiency has not been addressed.  Mechanical deformation will obviously create some level of chemical irritation (the extent depending upon the extent and rate of mechanical deformation, among other factors) since pain is ultimately dependent upon nerve signalling which is an electrochemical process.

Neurontin can definitely be effective since it deals with a chemical component of pain.  If there is nerve root compression, there is a mechanical problem to begin with but as the nerve root becomes inflamed and swollen and the patient becomes increasingly symptomatic, the symptoms will become increasingly of chemical origin.  It'd be better to correct the spondylolisthesis (which can often be performed with ventral technique) or train in postural and movement strategies to minimize or alleviate spondylo sourced deformation AND also treat the chemical component of pain,  but if the nerve root swelling subsides, the pain will generally subside and allow the patient to recover.

The point I was making was that if a patient has a mechanical problem like a derangement syndrome (let's say a bulging disc or a meniscal displacement), the best approach is a mechanical approach to reduce the derangement rather than a chemical approach of prescribing NSAIDs, analgesics, or muscle relaxants to decrease inflammation, pain, or muscle spasm, respectively.

On the other hand, if a patient has a chemical problem such as an acute rheumatioid arthritic flare-up, the best approach is chemical such as medication and/or an appropriate diet to quiet down the inflammation.

A problem such as an adhesive capsulitis (i.e. frozen shoulder) will have mixed origins.  The capsular restriction is definitely mechanical and requires mobilization (i.e. mechanical treatment).  But the inflammation of the anterior inferior capsule is chemical and will benefit from anti-flammatory medication and normalizing estradiol levels (i.e. chemical treatment).  That's a gross oversimplification but you get the point.

Hope that makes it clearer.

FWIW, I consider trigger point therapy more of a mainstream than an alternative approach.  I don't know if you ever met Janet Travell but she was a very smart lady and knew the science behind what she did very well.  Being an MD, her work progressively gained credibility with the mainstream (possibly faster than if one were a non-MD) and is pretty well accepted in most medical circles.  Feldenkrais, on the other hand, is definitely an alternative therapy but again, Feldenkrais was an absolute genius who understood the physics, neurophysiology, etc. behind human movement better than most licensed healthcare professionals.

Also, with regards to the perusal of the library comment, if there are any old or out of print books you're interested in and can't find, drop me a line.  I just did an inventory of my library and in checking the prices of some of the reference books I have that I haven't used in a while, I found that many of them are rare and worth $200, $300, $400, or more online.  I'm probably going to be selling off those I rarely use in anticipation of getting a better price for them now than I will post Crash when I retire.  I'm sure if we met in person, we could have some great discussions.  I've always valued and learned from your input here.     

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grandefille
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sciatica & piriformis spasticity

DurangoKid-

Like you, I struggled with a tight piriformis and associated sciatica for many years.  Mine was caused by a mild case of cerebral palsy.  About a year ago, I attended a seminar series entitled "Pain Free Living" by Henry Ford Hospital in the Detroit area.  There was a physical side and a mental side to their philosophy.  The physical side started with the assumption that much pain is caused by overly tight muscles:  When a muscle is always contracted, the brain learns that contracting it more doesn't result in much motion, so the brain recruits other muscles to perform the desired movement and "forgets" how to relax and contract that muscle.  The seminars taught us somatic muscle education to re-engage the brain to control contracted muscles.  The link below shows a version of exercises for the low back.  You can also google "somatic education" to learn more exercises.  I can honestly say that, at age 49, these simple exercises changed my life!!  For me, they were much more effective than stretching, and the results have been consistent for nearly a year.  If you are interested, try these once in the morning, and again just before bedtime.  I also do them after activity which contracts my piriformis.

Another thing that I learned from those seminars is that using a strap (preferably with slight stretch) to hold your thighs together while seated greatly reduces low back stress. Driving is much easier when I use the strap.  In a pinch, I have wrappec a jacket around my legs and tied the sleeves together. 

Julie

http://www.somatics.com/sciaticasymptoms-piriformissyndrome.htm

ao's picture
ao
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Posts: 2220
one or both?

DurangoKid wrote:

I'm siding with the exercise and stretching strategy to manage lower back pain.  I've been working on stretching the piriformis muscle that joins the head of the femur to the sacrum.  Many people who bicycle intensively have a problem with this muscle and the nerve routed around it.  Usually the nerve goes underneath it, sometimes over it, and sometimes even through it.  When the pirifomis spasms, ouch!  Two doctors diagnosed me with a crushed disc in between my sacrum and lowest lumbar vertebra.  Neither performed any tests or exam.  It has been shown that a bulging disc alone is often not sufficient to cause back pain.  Whether it's a bulging disc or piriformis spasm, I don't know.  What I know for sure is that my exercise program helps me manage my lower back without drugs or surgery.  The more I use it, the better I feel.

I refuse to give up cycling and still train fairly regularly.  What I do is after every ride I stretch the piraformis by first lying on my back with knees raised.  Then cross one leg over the other and gently but firmly tug on the knee or on the top portion of the tibia.  Make sure the pelvis sits flat.  Hold for twenty seconds per side.  There are several variations on this.  Google “piriformis stretch”. I also stretch by touching toes with my knees locked and unlocked.  Simple sit-ups with the knees bent helps to maintain alignment of the pelvis and strengthen the abdomen.  Improves posture.  Start a program of sit-ups beginning with an easy number of reps at first and then increasing the number by a few weekly.  I'm up to 30 this week.  Another help is rotations.  There are two versions of this.  While on the bike if I'm having discomfort, I straddle the top tube and face 90 degrees from the direction of motion.  With both feet on the ground and grasping the saddle, I rotate clockwise when facing right until my back pops and then reverse.  This takes some practice in relaxing the abdomen and diaphragm.  Repeat facing left.  It's about 90% effective in relieving lower back pain during a ride.  As part of my after ride stretching, I sit upright on the mat, bend one knee and cross it over the other leg.  Grasp the ankle with the hand from the same side and place the opposite hand on the floor behind me.  Then rotate gently including looking behind me and hold for twenty seconds.  Sometimes I can get my spine to pop on this one.  Of course, reverse it and hold for twenty.  Another big help is moving my car seat up until my left foot is against the firewall.  No need to cramp or apply pressure.  The foot against the firewall is a queue to keep my pelvis firmly against the seat back and prevent slouching.  Before I figured that one out, driving could be torture.  Brisk walking on level ground is another good treatment.  Keep your chin up, swing your arms, and walk far and fast enough to get your body temperature up.

One thing to keep in mind is obesity is no friend to your back.  By significantly reducing the sugars in my diet, I’ve dropped about 8 pounds over the last month.  My goal is a BMI of 22 or so.  Not there yet and I expect it will take the better part of a year.  Some people claim that BMI is too strict.  Mule fritters.  What’s normal in America is not healthy.  We exercise too little and eat way to much crap.  We snack on confections instead of restricting our intake to wholesome foods taken only at meal times.  How many of us in our 50’s remember when we were children being told not to snack between meals?  Now snacking is taken as a norm.  What are snack foods made of?  They’re mainly concocted from some combination of the three big, heavily subsidized commodity crops: wheat, corn, and soy.  High in calories, low in nutrients, and very profitable.  Read Michael Pollan.  The quantity and quality of food that goes into your mouth affects your back.

And now the Peak Oil angle.  Rising oil prices will drive up the cost of medical care, or, more properly called, disease intervention.  All of my treatments have a low carbon footprint.  They cost nothing.  I can do them anytime and anywhere.  Eating food with less processing uses less oil. 

They say a person who has himself as a patient has a fool for a doctor.  This fool had been getting good results.  Is it foolish to believe a consistent routine of good maintenance practices can keep you from needing expensive repairs?

DurangoKid,

Is one or both piriformis muscle(s) affected?

ao's picture
ao
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Posts: 2220
the right tool for the job

grandefille wrote:

DurangoKid-

Like you, I struggled with a tight piriformis and associated sciatica for many years.  Mine was caused by a mild case of cerebral palsy.  About a year ago, I attended a seminar series entitled "Pain Free Living" by Henry Ford Hospital in the Detroit area.  There was a physical side and a mental side to their philosophy.  The physical side started with the assumption that much pain is caused by overly tight muscles:  When a muscle is always contracted, the brain learns that contracting it more doesn't result in much motion, so the brain recruits other muscles to perform the desired movement and "forgets" how to relax and contract that muscle.  The seminars taught us somatic muscle education to re-engage the brain to control contracted muscles.  The link below shows a version of exercises for the low back.  You can also google "somatic education" to learn more exercises.  I can honestly say that, at age 49, these simple exercises changed my life!!  For me, they were much more effective than stretching, and the results have been consistent for nearly a year.  If you are interested, try these once in the morning, and again just before bedtime.  I also do them after activity which contracts my piriformis.

Another thing that I learned from those seminars is that using a strap (preferably with slight stretch) to hold your thighs together while seated greatly reduces low back stress. Driving is much easier when I use the strap.  In a pinch, I have wrappec a jacket around my legs and tied the sleeves together. 

Julie

http://www.somatics.com/sciaticasymptoms-piriformissyndrome.htm

Julie,

Thanks for that reference.  Thomas Hanna studied under Moshe Feldenkrais (who Jeff referred to) and added in some PNF (proprioceptive neuromuscular facilitation) work from Knott and Voss.  The work is a bit of an oversimplification of complex problems but there is no doubt that many of the interventions can be very effective.

The key is picking the right "tool" for the job and knowing how and why to pick the right "tool".  The problem with so many practitioners is that when all you have is a hammer, everything looks like a nail.

Some people need stretching, some need strengthening, some need motor control, some need stabilization, some need mobilization, some need postural training, some need body mechanics training, some need improved somatic awareness, some need changes in their mental conceptualizations, etc., etc.  A hammer is a great tool for pounding a nail but lousy for cutting wood.  A saw is great for cutting wood but lousy for pounding a nail.  For some folks, the strap to hold the thighs together works great, for others is will raise holy havoc.  The key is understanding WHY. 

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JAG
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Posts: 2490
Stretching and Trigger Points

DurangoKid wrote:

I'm siding with the exercise and stretching strategy to manage lower back pain.  I've been working on stretching the piriformis muscle that joins the head of the femur to the sacrum.  Many people who bicycle intensively have a problem with this muscle and the nerve routed around it.  Usually the nerve goes underneath it, sometimes over it, and sometimes even through it.  When the pirifomis spasms, ouch!  Two doctors diagnosed me with a crushed disc in between my sacrum and lowest lumbar vertebra.  Neither performed any tests or exam.  It has been shown that a bulging disc alone is often not sufficient to cause back pain.  Whether it's a bulging disc or piriformis spasm, I don't know.  What I know for sure is that my exercise program helps me manage my lower back without drugs or surgery.  The more I use it, the better I feel.

Nice post DK,

I couldn't have said it any better. We get a few patients every month in our practice that have symptoms related to Piriformis Syndrome. I would clarify one point however, stretching is a good method for maintaining a pain-free state, but generalized muscle stretching techniques applied to a muscle harboring trigger points, will do nothing but intensify any trigger point activity that is present. So the key here, as you described, is to be vigilant with your stretching routine and try to prevent the activation of trigger points in the particular muscle group.

Another point that you made, which I want to emphasize, is that is very common for people have spinal disc herniations and have no pain complaint associated with it. Likewise, many physicians attribute heel pain complaints to a heel spur found on X-ray, but if they were to X-ray the other foot they are more than likely to see a similar heel spur on it that is not producing a heel pain complaint. 

Statistically speaking, the majority of musculoskeletal pain complaints are myofascial (muscular) in origin, so it serves one well to rule out trigger points as a cause of physical pain, before looking towards the traditionally recognized joint damage/dysfunction paradigm of modern medicine. As Dr. David Simons, the co-founder of modern Trigger Point Therapy wrote:

"Muscle is an orphan organ. No medical specialty claims it. As a consequence, no medical specialty is concerned with promoting funded research into the muscular causes of pain, and medical students and physical therapists rarely receive adequate primary training in how to recognize and treat myofascial trigger points..."

Thanks again for the excellent post...Jeff

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JAG
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Posts: 2490
Re:mechanical/chemical clarification

ao,

Thanks for the clarification, and I completely agree with the points expressed. Regarding nutrient deficiencies and myofascial pain syndromes, you are correct that certain trace element, mineral, and vitamin deficiencies can perpetuate trigger points. Not long ago I read some research confirming this. Here is the abstract on PubMed. Take your zinc if you want to minimize pain and depression.Laughing

Best...Jeff

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Southerner
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Joined: Sep 7 2009
Posts: 36
ao and JAG, All PT's (like

ao and JAG,

All PT's (like any other profession) are not created equal.

Many thanks for input on this thread.  About 10 yrs ago I learned to appreciate the value of an excellent manual physical therapist on spinal and associated issues from C1 to L5 and the iliosacral joints.  That intensive experience has helped me for a decade, along with:

  1. 1. adequate lumbar support at all times when seated or reclined
  2. 2. Sleeping with correct height of pillows for C spine and pillow between legs to support L spine
  3. 3. maintaining good posture
  4. 4. Staying active
  5. 5. Proven supplements
  6. My biggest weakness is not enough stretching.  I do some for my spine but i'm sure more and different would help.

Southerner

ao's picture
ao
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Joined: Feb 4 2009
Posts: 2220
piriformis demystified

ao wrote:

DurangoKid wrote:

I'm siding with the exercise and stretching strategy to manage lower back pain.  I've been working on stretching the piriformis muscle that joins the head of the femur to the sacrum.  Many people who bicycle intensively have a problem with this muscle and the nerve routed around it.  Usually the nerve goes underneath it, sometimes over it, and sometimes even through it.  When the pirifomis spasms, ouch!  Two doctors diagnosed me with a crushed disc in between my sacrum and lowest lumbar vertebra.  Neither performed any tests or exam.  It has been shown that a bulging disc alone is often not sufficient to cause back pain.  Whether it's a bulging disc or piriformis spasm, I don't know.  What I know for sure is that my exercise program helps me manage my lower back without drugs or surgery.  The more I use it, the better I feel.

I refuse to give up cycling and still train fairly regularly.  What I do is after every ride I stretch the piraformis by first lying on my back with knees raised.  Then cross one leg over the other and gently but firmly tug on the knee or on the top portion of the tibia.  Make sure the pelvis sits flat.  Hold for twenty seconds per side.  There are several variations on this.  Google “piriformis stretch”. I also stretch by touching toes with my knees locked and unlocked.  Simple sit-ups with the knees bent helps to maintain alignment of the pelvis and strengthen the abdomen.  Improves posture.  Start a program of sit-ups beginning with an easy number of reps at first and then increasing the number by a few weekly.  I'm up to 30 this week.  Another help is rotations.  There are two versions of this.  While on the bike if I'm having discomfort, I straddle the top tube and face 90 degrees from the direction of motion.  With both feet on the ground and grasping the saddle, I rotate clockwise when facing right until my back pops and then reverse.  This takes some practice in relaxing the abdomen and diaphragm.  Repeat facing left.  It's about 90% effective in relieving lower back pain during a ride.  As part of my after ride stretching, I sit upright on the mat, bend one knee and cross it over the other leg.  Grasp the ankle with the hand from the same side and place the opposite hand on the floor behind me.  Then rotate gently including looking behind me and hold for twenty seconds.  Sometimes I can get my spine to pop on this one.  Of course, reverse it and hold for twenty.  Another big help is moving my car seat up until my left foot is against the firewall.  No need to cramp or apply pressure.  The foot against the firewall is a queue to keep my pelvis firmly against the seat back and prevent slouching.  Before I figured that one out, driving could be torture.  Brisk walking on level ground is another good treatment.  Keep your chin up, swing your arms, and walk far and fast enough to get your body temperature up.

One thing to keep in mind is obesity is no friend to your back.  By significantly reducing the sugars in my diet, I’ve dropped about 8 pounds over the last month.  My goal is a BMI of 22 or so.  Not there yet and I expect it will take the better part of a year.  Some people claim that BMI is too strict.  Mule fritters.  What’s normal in America is not healthy.  We exercise too little and eat way to much crap.  We snack on confections instead of restricting our intake to wholesome foods taken only at meal times.  How many of us in our 50’s remember when we were children being told not to snack between meals?  Now snacking is taken as a norm.  What are snack foods made of?  They’re mainly concocted from some combination of the three big, heavily subsidized commodity crops: wheat, corn, and soy.  High in calories, low in nutrients, and very profitable.  Read Michael Pollan.  The quantity and quality of food that goes into your mouth affects your back.

And now the Peak Oil angle.  Rising oil prices will drive up the cost of medical care, or, more properly called, disease intervention.  All of my treatments have a low carbon footprint.  They cost nothing.  I can do them anytime and anywhere.  Eating food with less processing uses less oil. 

They say a person who has himself as a patient has a fool for a doctor.  This fool had been getting good results.  Is it foolish to believe a consistent routine of good maintenance practices can keep you from needing expensive repairs?

DurangoKid,

Is one or both piriformis muscle(s) affected?

DurangoKid,

I didn't get an answer on this so I'll explain why I asked.  If only one piriformis is affected, then the problem obviously isn't just the pressure of a bike seat causing piriformis syndrome.  Piriformis syndrome is very commonly misdiagnosed.  It was unrecognized for years other than mention in some osteopathic journals.  Then an article appeared in the Archives of Physical Medicine and Rehabilitation (which was not a very good article by the way) and every Tom, Dick, and Harry with pain in their buttock was being diagnosed as having piriformis syndrome.  In my experience, piriformis related pain most commonly arises in one of three ways: (1) direct macro or micro trauma, (2) sacral dysfunction causing length/tension changes in the piriformis, and (3) disc derangement causing pain referred into the piriformis or piriformis up-regulations.

In your case, I would guess the most likely probability would be a flexed spine position when cycling contributes to a disc derangement which neurally sensitizes the piriformis.  While stretching it is fine, it's a bit of a bass ackwards approach.  Some of what you recommended is good and some is not so good.  Sit-ups are not the best approach.  They strengthen the rectus abdominus but can neglect the transversus abdominis.  The transversus abdominus is the key for postural support, not the rectus abdominus.  Similarly, the toe touching may feel good initially but could be contributing to increased disc derangement that ultimately keeps contributing to your need to stretch.  The rotational stretches with self manipulation are fine but could contribute to eventual development of hypermobility. 

You didn't mention any trunk extensor strengthening (or more specifically, multifidi strengthening) which should always complement trunk flexor strengthening (i.e. your abdominal exercises).  You also didn't mention any trunk extension mobility exercises which could help reduce any potential disc derangement and possibility eliminate your need to habitually stretch the piriformis.  If you always have to stretch a structure, something is wrong, something is out of balance.

Your positive response to proper sitting posture in your vehicle and brisk walking also suggest disc derangement rather than a primary piriformis syndrome.  If you have a sacral rotation, it could stress the disc and sensitize your piriformis.  The sacral rotation could be corrected with appropriate manual therapy and if hypermobility has developed (which it may have from some of your activities), you could be trained in self correction of that dysfunction.

Also, HOW you use your body is at least as important as exercise.  Most athletes don't realize how subtle variations in body use and "body being" can create big differences in performance and comfort during that performance.  In 32 years of working with an exercising population and patients including world class Olympic and professional athletes, I've never found one yet that didn't have at least minor postural, movement, and awareness faults. 

A good (and I emphasize good) evaluation by an appropriate professional could ascertain all this and allow your to target your problem with more specificity and enable you to more effectively prevent recurrences.  You mentioned two doctors above (and I'm assuming you meant MDs) but unfortunately, very, very few know how to do a truly thorough structural and functional work-up of a patient with mechanical spinally based pain (including piriformis pain).

I would venture to guess (but I have no evidence) that if the study below focused on mechanical spinal pain rather than musculoskeletal problems in general, the orthopaedic manual therapy PT in private practice would come out on top.  As I and also Southerner said, practitioners are not equal.   

top.http://www.putmebacktogether.com/Home/PhysicalTherapyArticles/PhysicalTherapyArticle/tabid/134/itemId/98/Default.aspx

Bytesmiths's picture
Bytesmiths
Status: Silver Member (Offline)
Joined: Apr 29 2008
Posts: 103
Herbal and traditional medicine

While I appreciate the physical/energy approach to managing pain, this article seems to have neglected natural low-tech herbal pain remedies. In the case of trauma, remedies (as opposed to therapies) can be very useful. If you hit your thumb with a hammer, you probably don't want to lead off with stretching exercises. :-)

In particular, the cambium (inner bark) of willow trees is a potent pain reliever. In fact, this tree's latin name (Salix), is the same root as the name of compounds in many artificial pain killers, such as aspirin (acetylsalicylic acid).

Willows are ubiquitous; you are probably no more than walking distance to one when you are in pain!

Another useful pain reliever is common ginger, which by weight, has been found to have the same pain relief as aspirin or ibuprofen.

SagerXX's picture
SagerXX
Status: Diamond Member (Offline)
Joined: Feb 11 2009
Posts: 2115
Glad to see...

...this subject addressed here.  The more we can do to maintain/improve our health outside of the expensive and complex Western sick-care system, the more resilient we (and our communities) will be.  Bravo, Capn' Sheeple!

timelyconcepts's picture
timelyconcepts
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Posts: 2
earmarks of the Presence Process

Jag,

Some of the ways of responding and terms you used in this article were reflected in a book I've been involved with for the last 6 months - The Presence Process by Michael Brown.  Just curious if you had read the book as well.

Dan

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JAG
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Posts: 2490
The Presence Process

Dan,

I've never heard of the book you mentioned, but the title appeals to me. Thanks for the recommendation, I'll check it out.

Here is it's listing at Amazon: The Presence Process: A Journey into Present Moment Awareness by Michael Brown

Jeff

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playon
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Joined: Mar 23 2011
Posts: 9
Feldenkrais

I am also a graduate of a Feldenkrais training and sometime practitioner, and even though this author did not get it quite right, I am impressed that he has some awareness of this fantastic work, which remains not nearly as well-known as it should be.  

Less technically, the Feldenkrais Method is about the ease and efficiency of movement, and the organization of the nervous system and self-image, which of course has a relationship to pain. It can be very effective in relieving chronic pain, if the pain is related to poor organization of movement, and as you mentioned, mechanical in nature. 

oxnard111's picture
oxnard111
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Joined: Jul 14 2011
Posts: 1
What I do

I have been living with sciatica pain for years. Stretching has been a life saver for me. I have seen so many doctors that only want to perscribe me an opiate or want to do back surgery. For them it is only about their bottom line. I hate that. So unconventional sciatica remedies including stretching and eating foods that full of natural anti-inflamatory qualities are the things that have helped me the best.

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Nervous Nelly
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Posts: 209
NutraJoint

I was a little curious and amazed about your experience with Nutra Joint. It turns out that the  main ingredient is Gelatine.

Gelatine is extracted by boiling bones. I'd say most of the population doesn't cook from scratch and won't benefit from it unless they eat jello regularly. There's no gelatine in any of the store bought broths. It's been extracted to sell as a separate item as Knox Gelatine or to add to Jello. 

So throw all the scrap left over chicken, beef etc bones in a kettle and add your favorite veggies and voila your natural medicine in a soup.

Sonya

Grover's picture
Grover
Status: Platinum Member (Offline)
Joined: Feb 16 2011
Posts: 507
"Bone" Appetit

Sonya,

Knox has listened to their marketers and have a myriad of products with all sorts of additives and strengths. The original version - gelatine and 7 minerals/vitamins is still my favorite. About a year after I started taking it, I bought a couple of cans of the more expensive Nutra Joint with glucosamine and chondroitin. After 6 weeks, my knees started hurting again. Now, I stick with the cheap stuff. If I use it every day, my knees start "floating" and it feels like they may dislocate. Then, I stop taking it for a month or so until my knees feel raspy.

The local drugstores only carry the expensive versions with all the bells and whistles. I would prefer to buy local, but the stores won't even order me a case (6 cans which lasts about a year for me) so I buy it here: http://www.drugstore.com/osteo-bi-flex-knox-nutrajoint-with-gelatin-drink-mix-unflavored/qxp273297?catid=183281. About every 2-3 months they have various sales and you can get it as cheap as 2 for 1 ... plus shipping.

Your solution of making soup is an excellent and tasty alternative. Do you crack the beef bones to get the goodness of the marrow out? If you don't have the time, inclination, or wherewithal to make a pot of soup regularly, this might work for you.

Grover

Nervous Nelly's picture
Nervous Nelly
Status: Silver Member (Offline)
Joined: Nov 23 2011
Posts: 209
Gelatine

Groover,

          Thanks for the extra info, but I'm just trying to understand what's happening here. I'm a little amazed  with your results. I've been using glucosamine and chondroitin ( calcuim etc ) on a regular basis and it has helped significantly with one joint in particular (hand). I do make soups almost every week not always with bones . I find chicken, turkey and ham bones have a LOT of gelatine. The broth just makes this gel (jello) as it cools. Maybe the expensive version of Nutra Joint has way less gelatine? I have to look into this a little deeper. I'll experiement. It would make aging people more mobile .

Thx

Sonya

Grover's picture
Grover
Status: Platinum Member (Offline)
Joined: Feb 16 2011
Posts: 507
It works for me

Sonya,

I've told several people about this product and it helped all but one guy who was disappointed that he still had pain the next day. One gal had really bad carpel tunnel problems. She worked for a Title Company and had lace up leather corsets on each arm. We first met her when we bought a house and then used her services when we sold our other house about 3 months later. At the first meeting, I asked her if she had whips and chains with her leathers. ;-) She said she had terrible pain in her wrists and was considering surgery to correct it. I told her about nutrajoint and suggested she tries it before getting the surgery.

Three months later, we see her again. She isn't wearing the wrist bands so I ask her how her carpel tunnel is doing. She didn't remember that I was the one who told her to try it, and she was telling me how wonderful nutrajoint was. She said she started to feel better after a couple of weeks and in 6 weeks, she no longer needed the wrist bands.

I've been using it for 15 years. I remember crying (more like sobbing) after my last backpack trip of the season in 1996. I thought I would have to give up backpacking because of the pain in my knees. August, 2012, I carried a pack that weighed over 75 lbs to a lake 16 miles from the trailhead in one day. The first (and worst) pass was nearly 1900 feet of vertical. The next biggest was about 600'. It wasn't an easy hike. My whole body was sore that first night, but I woke up fresh and ready to go the next day. From then on, no knee pain until near the end of the hike out (coming down that 1900' pass.)

Try the formulation without glucosamine or chondroitin. It is cheaper and worked much better for me. Follow that link on my last post. I don't own any stock and I'm in no way associated with them. It just works for me. I hope it works as well for you. Please let me know.

Grover

Nervous Nelly's picture
Nervous Nelly
Status: Silver Member (Offline)
Joined: Nov 23 2011
Posts: 209
I will most definitely try it.

Hope they have this in Canada.

Thx

So

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