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Low Back Pain is a Diagnosis Problem

Back pain is one of the great failures of modern medicine. There are no great solutions, and many afflicted. Low back pain is the most common cause of disability worldwide and yet there is no defined answer. One consensus paper came out in 2013 and stated that in a great majority of cases there is no possible diagnosis.

This has led to many, many different practitioners of many different techniques claiming that they have the cure. Years ago, when disc bulges were found to be a cause of nerve irritation, and when steroid injections into the epidural space were found to help this irritation, anesthesiologists were the perfect solution to this problem. They were already doing epidurals for anesthesia and the transition to doing this procedure was easy. The problem was that not all back pain came from the discs and other procedures were soon developed. Deciding what procedure needed to be done involved a physical exam and an advanced diagnostic skill in low back pain causes. This is not what anesthesia physicians were trained to complete, so instead an algorithm was developed. If someone hurts here, do this. If that works, do this, if it doesn’t work then do this. An either/or type scenario that makes decision making easy. This then became standard of care and is the only accepted path to be taken according to insurance companies that pay for such procedures. The problem is that, in a significant number of cases, the algorithm doesn’t work.

So we have developed spinal cord stimulators to cover up all the pain, but they don’t work forever. Diagnosis disasters, like failed back syndrome and myofascial syndrome, which mean nothing except ‘we don’t know what is wrong’ became common. An opioid epidemic has developed that is blamed on patients rather than the failed system, and now we have patients denied a diagnosis, an adequate treatment plan and given medications that are harmful. All because of a lack of a diagnosis.

If you wonder if this is you, ask yourself if you got a detailed exam when you saw someone for your back pain. Did they look at you or just your MRI/X-rays? Did you leave with a diagnosis or just an explanation of the algorithm?

At Body Guitar Clinic, we promise you will get a diagnosis. Back pain is incredibly complicated and sometimes we need to unravel several problems, but there is a large and significant difference between a differential diagnosis and an algorithm. Come to Body Guitar Clinic and see why we are different.

Facet Joint Pain

Outside of muscle spasm, facet joints are the most common cause of low back pain. Facet joints are joints in your spine where movement occurs. Facet joints get hurt when the joint is impacted against itself in a trauma, or when the muscles around the joint are not holding it stable.

Normally, the facet joints allow the weight of the upper body to be distributed, and they limit motion. When the facet joints get irritated, the muscles around the facet joint try to pull the surfaces of the joints apart.

Patients with facet joint pain will have pain when getting up in the morning or after sitting for a while. They will lean over counters and shopping carts and avoid backbending activities. Treatment of facet pain begins with an attempt to control the inflammation. This is done with anti-inflammatories, a steroid injection or radiofrequency ablation (which is burning of the nerves to the facet joint). The decrease in pain must be significant enough to allow us to then treat the muscle weakness, instability, tightness and compensation that occurs rapidly when one develops facet pain.

Treatment of these joints without treating the resulting issues that come with the pain will ultimately lead to continued facet pain that needs to be treated over and over. Our approach to treating facet pain has led to a great majority of our patients having long-lasting pain relief without return of pain.

Sacroilitis

The SI (sacroiliac) joint is the joint between the sacrum, the triangular bone at the base of your spine, and the ilium. The ilium are the bones on either side of the sacrum that make up your pelvis and create the hip where the leg bones (femur) attach. These pelvic bones make up a very stable joint that is essentially unmovable. However, if your back is not stable from facet pain and you are swaying from side to side when you walk, you are putting pressure on the ligaments of this SI joint with every step. Eventually, the ligaments will stretch out. Then the SI joint moves with each step. When this joint moves, it can become inflamed. Most of the time SI joint pain begins from prolonged facet pain, but it can also start from an injury to the joint itself.

Most people can remember the day that their sacroiliac joint began to hurt. It is a significant day in the respect that the pain goes from, “I did this today and that is why my back hurts,” to, “My back hurts every day no matter what I do”. It also is the day where getting better becomes more difficult. To cure your SI joint, you have to walk better. To walk better you have to have the strength in your stabilizer muscles to support the back when you move. And to get these muscles stronger, you have to stop the pain in your facets and get your posture corrected!

People with inflammation of their sacroiliac joint have pain if they sit too long – they feel like standing. They have pain if they stand too long –  they feel like sitting. They hurt if they walk too long; they even hurt if they lay down too long. They hurt more if they hold something heavy in one arm. They find themselves standing on one leg and then the other. Some people find that crossing their legs to tie their shoes is very painful. The treatment for Sacroilitis is much the same as the treatment for facet pain, but the strengthening afterwards is even more important and takes longer to improve the way you walk.

Bulging Discs

There is a difference between disc bulges, disc herniations, disc protrusions, disc extrusions, etc. But, not enough to change the conversation about where they came from, what they mean and what to do about them. Everyone thinks that an MRI is the diagnostic end-all/be-all in the care of back pain. How did we get to this point? Doctors in many cases think that it is the end-all/be-all.

“You have back pain? Well, let’s see what the MRI shows.”

The problem is that less than half of the people with MRI findings of disc bulge have the symptoms of disc bulge. Couple this with the knowledge that several studies have shown that a large percentage of people without any pain have disc bulges, and you start to realize that MRI’s are a poor diagnostic tool. Studies have shown 35% of 20 year olds with no history of pain have disc bulges on MRI, and so do 60% of 60 year olds.

Do you have any idea how much time I have to spend on some first visits with a new patient convincing them that the MRI doesn’t fit their pain? This is especially true when they have had back pain for a long time. They have explained to everyone who has ever asked them to help them move, “I can’t. I have a disc bulge at L5/S1 and it is impinging on my L5 nerve root.” Then, there I am saying, “you still can’t help them move, but you have no weakness associated with an L5 nerve, no reflex changes and nothing down your leg that looks like L5.” It rarely goes over well, at least initially. Do many disc bulges correspond to the pain that people are having? Of course they do, but probably a lot less than you have been led to believe.

If this is you, you need to come in and be evaluated. One of the problems with using an algorithm to diagnose low back pain is that if you have back pain and a disc bulge you are automatically on the road to back surgery. If you are one of those people who have a disc bulge that has nothing to do with your pain, then surgery is a disaster. Make sure that isn’t you.

Sciatic Nerve Pain

There are many things that cause pain down the legs. For patients, anything that causes this pain is called sciatica. For physicians, the only thing that is called sciatica is something that irritates the sciatic nerve. So what irritates their sciatic nerve? A problem with the disc that irritates or pinches the nerve going past it that becomes the sciatic nerve, or a spasm of the piriformis muscle that irritates the sciatic nerve. That’s it. Now, there are two things that can cause the piriformis to spasm: hip pain and sacroilitis. Everything else is non-sciatic leg pain. This includes facet pain, sacroilitis that doesn’t irritate the piriformis muscle, hip pain that also doesn’t irritate the piriformis. Hamstring pain, muscles pain, along with other medical problems. While not every pain down the leg is sciatica, if you do have leg pain along with bowel or bladder changes, call your doctor or the hospital immediately as nerve damage that persists can become permanent. But if you have leg pain without the bowel or bladder changes, come and see us and get an accurate diagnosis.

Degenerative Disc Disease}

This is a common diagnosis that patients are given frequently. In almost 2 decades of caring for back pain, I have yet to care for a single patient that this was the cause of their pain. Does it tell me that their back is not stable? Yes. Is it the cause of their pain? No. Come in and get an accurate diagnosis.

Failed Back Syndrome

Failed back syndrome is an often-used name in medical circles that often means that the medical system has failed someone with back pain. The most common cause is when someone with back pain makes it through the algorithm used for treating back pain and then ends up having back surgery that they didn’t need. When back surgery inevitably fails, they are labeled as ‘failed back syndrome’ and regulated to pain pumps, spinal cord stimulaters and pain medication.

Sometimes it is because of damage during surgery or previous procedures. There are times when people have so many diagnoses involved that cure seems impossible. We have helped with so many people with ‘failed back syndrome’. In most cases we can help with both diagnosis and provide a chance for improvement.

Spinal Stenosis

Spinal stenosis is a narrowing in the spinal canal. This narrowing can be caused by arthritis, disc bulging and/or ligament swelling. Most people have all of these things. Spinal stenosis usually causes leg numbness after walking or moving for a while. Then the person sits and rests and the numbness goes away. This is not how it always goes, but very often. Sometimes this patient needs surgery and sometimes we can get the ligament swelling to decrease, followed by physical therapy to keep the ligament swelling from coming back. If this sounds like you, then we might be able to help you.

Your body is a finely tuned instrument. Like all finely tuned instruments, it must be properly cared for in order to play the beautiful music it was intended to play. Care for your body and use it correctly, and it will play music that is unique to you – your life song.

– Sean M. Wheeler, M.D.

Pain Treatment Options

Lower Back Pain
Neck Pain
Sciatica & Leg Pain
Neuropathy
Spinal Stenosis
Herniated or Bulging Disc
Degenerative Disc
Headaches & Migraines
Hip Pain
Knee Pain
Failed Back Syndrome
Facet Syndrome
Arthritis

Contact/Location

11040 Oakmont,
Overland Park, KS 66210

+1 (913) 291-2819
PATIENT PORTAL

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