Is it a Dance or Treatment for Neck and Back Pain-Part 1

Crack, Twist, Heat, Then Stretch, Electrify and Knead

This is not a hot new dance routine, nor are we baking soft pretzels. This is the typical treatment for those who suffer from neck and/or lower back pain.

I often have the opportunity (and sometimes the misfortune) to be the last practitioner to see patients who suffer with back and/or neck pain.

Usually prior to seeing me, the patient has seen a medical doctor and received muscle relaxants and/or pain medicine. The patient has seen an orthopedic doctor and received epidural injections (an injection of the steroid cortisone into the spine). The patient has also seen a chiropractor for the crack and twist and a physical therapist for heat, stretch and electrify--using EMS (which stands for electrical muscle stimulation)--and knead (massage), followed by stretching.

When the patient arrives at my office he or she is still in pain. Were the treatments incorrect? Were the doctors wrong? Should the back or neck be ''cracked''? Is ice better than heat? Are all exercises created equal?

The answers to all of the above questions are ''yes, no, maybe and it depends''.

Let's start from the beginning. When someone experiences persistent neck or back pain that comes on gradually or seemingly ''out of nowhere'' and not always a result of an injury he or she usually sees a primary care physician (PCP) first. That doctor's job is to listen, assess and perform an exam regarding the complaint and then make a recommendation or referral to a specialist and/or prescribe a medicine so the patient is not in pain.

The patient returns, still in pain, and the PCP refers to an orthopedic doctor. The orthopedic doctor has the following choices: determine whether surgery is indicated, offer an injection (epidural or anesthetic) and/or prescribe medicine to decrease the pain, or refer to a physical therapist.

Sometimes the injection and medicine do not work and the patient presents to a physical therapist. The physical therapy facility provides heat, ice, electrical muscle stimulation, ultrasound, massage, manual therapy and/or exercise. This appears to be a sound treatment program and the patient reports temporary relief but is still in pain, and sometimes worse after treatment. Depending upon the insurance carrier, the patient might have only one or two months of treatment, and all services may not be covered.

The patient is still in pain and now tries chiropractic care. Most chiropractic offices offer essentially the same treatments modalities as physical therapists: electrical muscle stimulation, ultrasound, massage, exercise, etc. The difference is that chiropractors perform spinal manipulation or adjustments. The result can be favorable, but in the case of this particular patient it is not; just as when he or she received physical therapy, there was temporary relief but the pain returned.

This is a common presentation in my facility. All these procedures are sound and supported by evidence. I also refer patients to these practitioners (medical doctors, orthopedic doctors, physical medicine and rehabilitation, neurologists, physical therapists, chiropractors, etc). It is the timing of these procedures that is not in sync.

The patient's best bet for treatment of a neuro-musculoskeletal (nerve, muscle and bone) complaint is a multidisciplinary facility where the doctors communicate with each other and treat patients from a team perspective.

First and foremost, the team has to determine the true cause of the pain. Sometimes special tests are required, such as MRI (magnetic resonance imaging), CT/CAT scan (computer tomography or computer-assisted tomography), myelogram (injection of a special dye and then X-ray) or EMG/NCV (electromyography/nerve conduction velocity, an assessment of the nerves).

The job of any physician is to rule out the ''bad guys'' first. The bad guys are tumors and infections. Once these types of dysfunctions are ruled out, the doctor's goal is to determine if a neuro-musculoskeletal condition is caused by nerve impingement (pinched nerve), ligament irritation, disc herniation or bulge, or myofascial syndrome (irritation of the muscle and tissue, commonly referred to as muscle knots or trigger points, which could cause local and/or referred pain). Sometimes it's a little bit of everything.

Unfortunately, testing does not tell us the whole story. Studies have demonstrated MRI results showing disc herniation and disc bulges in people who have no pain whatsoever. For example, a patient who reports to the facility with lower back pain may have had an MRI that revealed a disc herniation or bulge at a certain level, but the pain does not correspond with the level that has the disc herniation. Interesting, but not related. Then there are the patients who have CT scans and MRI's that reveal degenerative disc disease (loss over time of the disc material that acts as a shock absorber between the spinal vertebrae) and think that is the reason for their pain. Yet when patients are questioned about the start of the pain and the answer is ''six weeks ago,'' it is unlikely that degenerative disc disease is the cause of the pain. Again, interesting, but not related. Then we have the opposite that occurs with testing. How about the patient who reports with arm pain and weakness but the EMG/NCV and the MRI are negative (do not reveal any pinched nerve)?

Dr. Michael J. Kaye has been a practicing Chiropractor over the last 18 years. He holds a post-graduate degree in Rehabilitation. His practice focuses on treatment for the chronic and post-surgical patient. He has published articles on post-surgical knee rehabilitation; and chronic myofascial pain syndrome. He has developed a web site www.frompaintopersonalgain.com devoted to health, wealth and happiness. His coaching site is www.coachinggps.com Contact the author, Michael Kaye , at mijokye@comcast.net.