AMPLIFY: News + Discussion

Learn more about achieving back pain emancipation - how to amplify your Body Guitar - with news and discussion you can share updated here.

Most back doctors are lousy diagnosticians.

The vast majority of my patients who have seen multiple back specialists tell me that I am the only doctor who has ever actually examined their back.

The problem arises from an over-reliance on the MRI as a diagnostic tool.

Few pain doctors are skilled at giving physical exams, and fewer still read their own MRI films, instead relying on the radiologist's report.

Consequently, any finding on the MRI is assumed to be the cause of the pain.

You must empower yourself with knowledge of the many potential causes of your pain and become your own best advocate during the diagnostic process.

Especially when it comes to the back (where the causes of pain are often multiple and interconnected), you need to reverse the doctor/patient dynamic and ask a lot of questions.

One ailment where the cause of the pain is commonly misdiagnosed is sciatica. 

This is an irritation of the sciatic nerve, a large nerve made up of parts of four nerves which emerge from the spinal cord and bind together, running from the L4 vertebra down to S3.

The usual symptom pattern of sciatica is pain or numbness which runs down the back of the leg to the calf and sometimes into the foot.

Illustration 6 Lumbar Nerves Back Pain

To the uninformed patient, however, "sciatica" can mean any pain down the leg.

My purpose in this blog is not to train you in diagnosis, but to give you a quick overview of this pain's many possible causes and empower you to question a rubber-stamp diagnosis made by a doctor who has failed to properly examine you.

We'll discuss the two most common causes, and in an accompanying video I will summarize several of the more obscure ones.

The most common cause of sciatica is a disc irritating a nerve. 

As your spinal cord descends through the spinal canal, nerves are given off at each level. A disc can irritate or compress these nerves, causing pain along the path.

The location of the pain or numbness helps us ascertain where the disc problem may be.

Illustration 13 Piriformis Sciatic Back Pain

 

A second common cause of sciatica is piriformis syndrome.

The piriformis muscle runs from the pelvis to the hip and is one of the muscles which stabilizes the hip. When the sacroiliac joint in the hip or the hip joint has dysfunction, this muscle will spasm to protect the joint in question. The problem occurs with the sciatic nerve as it passes under this muscle.

The pattern of pain and numbness this causes is very difficult to differentiate from that caused by a disc.

Here is a classic case of where the MRI can lead to a misdiagnosis. Some studies have suggested that 30% of twenty-year-olds with no pain symptoms have disc bulges and over 90% of sixty-year-olds with no symptoms have significant findings (disc bulges or stenosis) on a spinal MRI.

In other words, many people have disc issues which don't bother them.

 

But the diagnostic instinct here is to blame the disc bulge for the symptoms and be done with it.

This brings us to a horror story we see too often, one in which the patient is assumed to have "sciatica" and, coincidentally, is found to have a disc bulge on the MRI. Three epidurals provide some relief but not enough, and surgery is performed.

If the cause of the pain down the leg is something other than nerve irritation, the patient does not get better and falls into a rabbit hole of a diagnosis: "Failed Back Syndrome."

By empowering yourself with knowledge and carefully considering all the other causes of pain down the leg, you can be your own best advocate and help to arrive at your best treatment option in the process.

In a groundbreaking departure from conventional medical wisdom and past practice, the American College of Physicians released new guidelines for the treatment of chronic back pain, including a recommendation of proper exercise before turning to medication, as reported by the online news site Vox.

As part of these new guidelines the American College of Physicians also strongly discourages opioids - such as morphine, oxycodone, and fentanyl - in treating chonic back pain, as these drugs are only modestly effective for back pain and carry serious risks, including overdose and addiction.  

Finally, the medical profession is removing their decades-old blinders and catching up.

Catching up to the diagnostic and treatment realities of chronic back pain.  And focusing ever more precisely on understanding cause, before relying on the "magic pill" solution in which too many doctors, and patients, place their misguided faith in hopes of achieving relief.

As back pain expert Dr. Sean Wheeler has been advocating for years.

For example, Dr. Wheeler advocates that opioid use is no more effective than using aspirin in the treatment of low back pain.

More importantly, notwithstanding that many in the medical profession and healthcare media claim that doctors don’t know what causes back pain, the answer to the causation question has indeed been found. Says sports medicine and pain expert Sean Wheeler, M.D.: 

The answer to the causation question has been found, with the needed shift in thinking about cause of chronic back pain maddeningly small and intuitive. Recognition of this change is what spins the entire discussion of low back pain on its ear. We should all be challenging the status quo of accepted back pain treatment practice.

The answer?

The answer resides within the Bracing Muscles of the body, as discussed on the pages of this site and in Dr. Wheeler's book, UPRISE, where he systematically identifies and challenges the manner and methodology of how the medical profession has misunderstood and treated back pain over the past 40 years. 

And how to prevent the onset of chronic low back pain.

As Dr. Sean Wheeler advocates:

The solution to the broken system of treating back pain is not better, more expensive treatments.  Lack of treatments isn't our problem.  The solution is to engage in a revolution in how we think about chronic back pain and pain management.  We need a revolution in the way both patients and healthcare providers, as well as medical researchers, approach chronic back pain.  Patients and doctors need to come together to make chronic back pain diagnosis, cause-identification, and effective treatment a reality.

And the answers are literally staring us in the face.  We need simply to act." 

 

Sean Wheeler, M.D. is board certified in both Pain Management and Sports Medicine. He is a leading expert on chronic back pain and its cause. His recently released book, UPRISE, is changing the way the world thinks of back pain causation and its treatment. With a new vocabulary in aid of understanding the cause of back pain, and new medical approach focused on increasing the endurance of your bracing muscles, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. 

The BRACING Series: No. 3

By Sean M Wheeler, M.D.

The simple exercises that target the small gluteus bracing muscles from the STABILITY Series No. 1 and No. 2, may at first appear as exercises meant for the very old or very weak, or as exercises done only until one is ready to go back to the gym for a "real" workout.

I'm here today to disavow you of this mistaken assumption.

Let me start with a story.

I have a middle-aged patient who is a record-setting weightlifter for his age and weight-group. He's in another universe of strong, like guys on ESPN2 named Magnus who fling beer kegs for prize money.

He came to see me with pain in the back and knee.

We found that his small bracing muscles of the gluteus were weakened and his compensation for this weakness was causing his pain.

I had to deliver this diagnosis to a professional power-lifter, and he wasn't easily persuaded.

I described bracing muscles and explained that rather than actively lifting the weight, these muscles instead stabilize the legs for walking hills and stairs, for jumping down, or for squatting, as he does to pick up the barbell.

Bracing muscle weakness destabilizes the leg, which can lead to pain in the knee, hip and back.

Finally, he experienced a breakthrough when he realized that while squatting down to pick up the bar he had to deeply concentrate to keep his left knee from buckling in.

He was compensating by actively pushing his left knee out as he bent down and stood back up with the weight, and he'd been doing it throughout his career.

After this realization, he spent the next several months working on some of the exercises I present in The STABILITY Series.

If small bracing muscles were strengthened by lifting weights, anyone with all of my client's years of experience and training would have developed strong and capable bracing muscles and wouldn't need to compensate by pushing the knee out.

Now, he starts every workout by doing his stabilization exercises, before working to strengthen his action muscles.

The goal is to view stability exercise as an entirely different type of exercise, and prioritize the stabilization workout as necessary and the weightlifting as secondary.

Proper bracing muscle stability allows action muscle strengthening without injury.

Weightlifting by itself doesn't provide stability, only strength.

As you watch and engage with these exercises, remember that they are designed to strengthen these bracing muscles that provide stability, and you should do them for as long as you are active, whether you choose to do a strength workout separately or not.

Stability Exercise #3: Deep Bracing Muscles of the Spine

This exercise is for the bracing muscles of the spine.

Be aware: this exercise is much harder to master than the gluteus exercises described earlier in this Series.

The first step is to locate and isolate the bracing muscle without compensating with the surrounding action muscles.  This may require spending days doing only the muscle-finding part before progressing to the actual exercise.

In the effort to find these muscles, make sure that you are not tightening your hamstrings or rotating your pelvis.

If this exercise proves too difficult to execute, you may need to consult with a physical therapist or other professional.

Good luck.

The BRACING Series: No. 2

By Sean M Wheeler, M.D.

Spine stability is an inherent component in the design of our bodies.  

We gain spinal stability throughout childhood and early adulthood.

As infants, we can only stand once we achieve the stability to do so.  As toddlers, we crawl until we gain the strength in our bracing muscles to walk and then to run

With spinal stability comes a smooth daily coordination and balance for each of us, that demonstrates the power and inspiration of the human body, similar to the awe many experience in watching a professional athlete.  Our ascent to stability continues until derailed by injury or by a shift from an active life to one that is more sedentary.

Back pain often accompanies a sedentary lifestyle. In a futile attempt to sidestep the pain,  we stand and walk differently.  We avoid using the very muscles designed to stabilize the spine - the bracing muscles

And now our back hurts. 

Once the bracing muscles are no longer doing their job, they rapidly atrophy.  These muscles weaken, the spine destabilizes, and the spiral of chronic back pain deepens.  

In research studies observing the effect of weightlessness in outer space on different muscle groups, astronauts were tested for muscle strength before and after a two-week trip into space.  Researchers found that, during those two weeks in space, action-muscle strength (the muscles that move us) decreased by 5 percent in the arms and 7 percent in the legs, while bracing muscle stabilization of the spine (the crucial endurance muscles) decreased by up to 70 percent.  

While in space, astronauts continued to exercise their action muscles daily, but they couldn't consistently utilize their bracing muscles because of the absence of gravity. 

Bracing muscle strength is easy to lose but challenging to recover.  As adults, we can't reproduce the conditions and movement patterns of childhood development.

To repair our bracing muscles in the aftermath of injury or atrophy we need to target them with site-specific strengthening exercises, which is the purpose of the STABILITY Series.

Stability Exercise #2: The Hip Hiker

The bracing muscle exercise viewed above is called hip hiker.

In this exercise, keep both legs straight with your knees locked.  It's important to understand the hip being strengthened is the one that stabilizes as the other hip moves. 

Do 25-50 reps on each side. As the STABILITY Series continues, remember that you do not have to do all the exercises at once.  Do a couple of different exercises for your bracing muscles each day and become expert at each exercise.

I will introduce another exercise next week.  

The BRACING Series, No. 1

By Dr. Sean M. Wheeler, M.D.

I have seen some strong patients in my twenty years of practicing medicine: bodybuilders, professional athletes, Pilates instructors, laborers and others who depend on strength for their work.  

"Weak" is not a term we would associate with them, but the longstanding back pain they suffer is the result of a weakness in a particular set of obscure muscles.  The weak muscles in these very strong patients are the bracing muscles, which are unique muscles that require a particular approach to strengthen. 

I introduce the concept of bracing muscles in my book, UPRISE--Back Pain Liberation by Tuning Your Body Guitar, which will have a major impact on the future care of back pain.  In my book I promise to develop a set of exercises targeting these muscles that can improve the stability of everyone, not just people with chronic back pain. 

Over the coming months, that promise will be fulfilled here as we release a series of videos to demonstrate these exercises. 

In a few weeks local gyms will fill with new members on a New Year's resolution bender, trying to get in shape for that spring vacation they've already purchased.  Many will focus on "core" training, which has become an industry in itself.  And yet an extraordinary number of people who are working on their core still experience back pain. 

This is because you have to get the spine stabilized before you can "get in shape."  

Six-pack abs boost your ego but not your stability.  Stability is the role of bracing muscles. 

Trying to exercise heavily when your spine is not yet stable is like trying to build a second story on a home with a cracked foundation.  It is an invitation to injury.

So which muscles are the bracing muscles? 

Truthfully, they can be hard to find.  They aren't muscles you can flex and impress yourself with in the mirror.  Exercising them doesn't build their size, it builds their endurance and circulation. 

There are six bracing muscles that pull your hip into a stable position in the socket, which collectively I call the gluteus stabilizers.  They work in conjunction with the psoas muscle and the pelvic floor muscles to suspend the hip in "mid-air" inside the hip joint, providing stability while allowing movement. 

When these bracing muscles weaken, the psoas spasms, the hip is pulled up into an impinged position and the pelvic floor weakens, leading to pain and dysfunction.  That's the theory, anyway.

Stability Exercise #1:  The Clamshell

The first exercise appearing in the video above is called a clamshell. 

The important points of technique are to keep the body rotation closed, stay leaning forward, and to keep the knee low.  As with any exercise, rushing through it is not helpful. 

Try to do 30-50 reps on each side every day for the next week until I introduce the next exercise. 

Good luck.

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