I recently saw a woman who had a history of sharp stabbing back pain for about 40 years. I performed my evaluation and gave her the exercises to correct the issues I found. She felt relief but still had occasional stabbing pain. I asked her when this happened and she told me it was after sitting in a chair or getting up from bed. So I evaluated her sitting and lying habits and made a few changes. Today she told me her pain was 98% gone–in one week.
To me this highlights the importance of addressing how you do things as much as what you do. She happened to have a hypermobile spine which made it difficult for her to stabilize well. She was out of touch with her body and couldn’t connect with her abdominals to stabilize the pelvis or spine. So focusing on habits such as how she stood up, sat down, slept, and worked at her desk was where we were really going to make a difference quickly. She was amazed.
This was deeply satisfying to me because she came to me a couple years ago with back pain and I wasn’t able to make a big difference in her pain. Now I know why. I didn’t focus on the things she did 99% of the day and instead focused on anatomical problems I found. This was a good lesson for both of us!
I’ve had two patients referred to me recently with difficult neck and shoulder pain issues. Their complaints were of the typical pain distribution–from the base of the skull down the neck to the shoulder blade and across the top of the shoulder as well as pain in the front of their shoulders. MRIs and X-Rays were negative for disc or other pathologies. They had been through several specialists and felt no relief other than with steroids and Vicodin.
After examining both women, I found they had very similar problems in that the shoulder blades were sitting too low on the trunk (Figure 1.).
Figure 1. Depressed Right Shoulder Blade (Copyright Boone Publishing. 2009)
Also the humeral head was sitting too far forward in the shoulder socket (Figure 2) causing pain in the front of the shoulder. I taped both the humeral head and the shoulder blades in a corrected position and their pain was eliminated–until the tape was taken off a few days later. This told me my diagnosis was correct. But how could I get them to hold these corrected positions on their own? Our attempts at specific corrective strengthening only met with irritation of their pain.
Because the shoulder blades’ position on the trunk is partially determined by ribcage orientation, I revisited this aspect of their pain and found that by elevating their rib cages, pain was eliminated. This did two things: 1. it reduced the anterior tilting of the shoulder blade and, 2. activated key scapular positioning muscles that were deficient. The other maneuver I discovered to be of great help was asking them to place their painful side’s hand on the opposite shoulder. This elevated the painful shoulder blade and posteriorly glided (pushed back) the humeral head into a corrected position in the shoulder socket. Both felt about 80-99% relief from their symptoms during the following week.
Both are now able to begin their strengthening program without pain. If irritation does occur, they know exactly how to eliminate it, finally giving them a means to control their own pain.
Both of these women had one more issue in common. They were self-conscious of their breast size and therefore slouched their shoulders. Over time, I believe this established the environment for these mechanical issues to become painful. Both commented that upon fixing their posture, they felt they were sticking their chests out too much, drawing attention to themselves. They clearly saw the mechanical connection, however, as their pain returned after resuming their slouched postures (Figure 3). Ultimately they needed to come to terms about their personal issues of drawing attention to themselves in order to be better.
This reinforces to me that, although my point of view focuses more on the mechanical causes of chronic pain, there are also significant emotional or psychological causes. I believe often there exists a combination of dietary, musculoskeletal, and psychological issues that contribute to chronic pain. There are probably others as well. Each person’s pain is a function of a different combination of these issues. My training is in understanding the musculoskeletal aspects of pain but occasionally I bump into someone with more psychological issues instead.
I’ve had several emails from people who have purchased my book on back pain. They’ve written me to say they have identified the cause of their pain and are just beginning to fix themselves. This alone has been a huge weight lifted from their shoulders after hearing multitudes of diagnoses and theories from specialists. This makes me very excited because once you understand the cause of your pain, you can take the necessary steps to fix it. I’ve outlined how to understand the causes of back pain and these steps in my book. I’ve made it as simple as possible.
I feel like a parent witnessing my kids take their first unsure steps! Yes, there will be some wobbling and mistakes but if they stick with it and think about the underlying causes of their pain, they’ll be not only walking but running before you know it! It’s very exciting and satisfying to know I am making a difference in these people’s lives whom I’ve never met.
I wish I could be there to guide them personally and make sure they do all the right things. In a way, I can. I just had my first Skype session with someone who purchased my book. It went quite well. Better than I expected. Ideally though, I hope readers feel they can go it themselves. I think it’s important to understand that everyone has all the tools within them to fix their back pain.
