Is it a Dance or Treatment for Neck and Back Pain-Part 2

Here comes the important part--the patient interview and the physical examination. We have to question the patient regarding the initiation of the pain. When did the pain really begin? Did it come on gradually or occur immediately after performing a certain activity (golf, baseball, gardening, etc.) or a certain movement (bending, lifting, turning, etc.)? Have you ever had this pain before? How were you before this injury or current complaint? Is the pain an ache or a throb, dull or sharp, and what can you compare it to? Does the pain radiate down your arms or legs? Do you have tingling or numbness or weakness in your legs and feet or arms and hands? Do you have pain upon bowel movement, sneezing or coughing (ruling out a disc herniation)?

The multidisciplinary facility should also have the patient complete an ADL (activities of daily living) scale. This scale will allow the doctor to understand how the person's ADL's (standing, sitting, driving, recreational activities, washing and dressing, working, lifting, sleeping and social life) are affected in terms of their life.

The physical examination usually consists of orthopedic testing (maneuvers to determine a condition (is it nerve, muscle, disc?), neurologic exam (reflexes, motion and strength), ROM (range of motion to determine how well a joint or body part can flex forward, back and side to side and rotate), palpation (manual exam to determine the extent and location of muscle spasm and trigger points) and functional movement exam (to determine whether the patient can squat, get up from a chair, perform a wall squat, perform a sit-up, twist against resistance, raise the arms above the head, perform a push-up, etc.).

In a multidisciplinary facility, a team of doctors interprets the results of the testing and examination. This team could consist of medical doctors, chiropractors, physical therapists, psychologists, acupuncturists, naturopaths, or anyone from one or more of the healing art disciplines. Regardless of the types of doctors or therapists, the most important aspect is the communication factor. These professionals must put egos aside and work for the betterment of the patient.

As stated previously, the treatment for this patient was out of sync. Of course we look to medicine initially because we are in pain. But the current medications cannot decrease a disc bulge and half the time cannot decrease muscle spasm (many patients report that they just get very fatigued with muscle relaxants or, if they are on anti-inflammatory medicine, that their stomachs hurt). The reason physical therapy did not work is that the patient was in too much pain to perform the exercises and, in turn, the pain got worse. The chiropractor performed spinal manipulation, which might have aggravated the condition because the patient was not ready to undergo this type of procedure.

The initial goal is to reduce the patient's pain before progressing to an exercise regime. Initial treatment could consist of manual therapy if it is a muscle-tissue dysfunction (a technique to decrease trigger points, improve range of motion and reduce pain). This technique is usually applied by a chiropractor and/or physical therapist. In conjunction with manual therapy, the patient can receive injections to the muscles if it is a muscle problem. If it is a disc problem and epidurals have failed, the patient can receive a different type of treatment specifically for the disc problem. If it is a nerve problem, the patient can receive a nerve block or a specific type of hands-on therapy. The advantage of a multidisciplinary facility is that it's all in-house.

Once the cause of the pain is determined, it is much easier to treat and reduce the pain. Only when the pain is reduced and the patient's range of motion has improved should he or she progress to a rehabilitation program. This program should be based upon the patient's specific needs as determined by the ADL scale. It's not a matter of just lifting some weights or performing push-ups. The patient should first begin with stretching the injured tissues and then incorporate whole-body stretching, and then progress as follows: stretching to posture movements; posture movements to balance and core (deep spinal muscles); balance and core to functional movements (progressive resistance training for activities of daily living). It is important to note that the patient will most likely experience flare-ups of pain while initiating these movement patterns. These flare-ups should be addressed immediately to avoid downtime from the rehabilitation program. At the end of the treatment program the patient will have a thirty-minute exercise regime incorporating the learned movement patterns, from stretching to functional movements, and will also have learned the movement patterns to use during flare-ups.

To conclude, if you choose a multidisciplinary facility, ask to learn more about the types of care and patient management before you agree to treatment. You want to find out if the doctors communicate with each other. Doctors who work together in the same facility don't necessarily speak with each other. Remember that you want a true team approach. You also want to find out if the facility has treated problems like yours and what the specific outcomes have been. Often, by the time the patient reaches this type of facility, insurance benefits have been exhausted. It is important to learn all the costs that will be associated with your care at the facility of your choice. If you would like to learn more about your choices log onto www.frompaintopersonalgain.com

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.