Dr. Sean Speaks

Apr 07 2017

Byron Nelson

The legendary Mr. Byron Nelson with Dr. Sean Wheeler, 2005The legendary Mr. Byron Nelson with Dr. Sean Wheeler, 2005

By Sean M. Wheeler, M.D.

As the Masters golf tournament approaches each year my thoughts turn to Byron Nelson.

As a ‘marginally’ famous back pain and sports medicine doctor, I often get to care for patients who are actually famous.

I have pictures and mementos from these patients, but I only have one that hangs in one of my patient rooms.

I met Lord Byron, as he was known to the golfing world, through a friend and saw him a few times as a patient.

He was the consummate gentleman.

I would ask him about his life and he would answer as if it was unimportant and then stop and ask me about my life as if it was much more interesting than his.

I brought my kids with me on one of our visits and it was very important to him that they got a picture with him. Each visit would end with him asking to see my golf swing followed by a few suggestions.

When I told him that I was moving back to Kansas City he went into his house and retrieved a framed picture off of his wall of him and Tom Watson (a Kansas City native) practicing at the Masters. Dr Wheeler GolfDr. Sean Wheeler’s shot heads into Rae’s Creek

I always felt that Mr. Watson should have this picture but I have never had the opportunity to give it to him.

A couple months later I received a call from his wife asking if I would be able to come to the Masters with them and take care of him for the week. Stunned I asked for details and then asked if this would include going to the Champion’s Dinner.

This is the dinner hosted by the previous year’s champion for all the previous champions. It is extremely exclusive. They assured me that this was possible.

I had been a volunteer at the Master’s tournament the few years before that and had played the course a couple times, but this was an entirely different deal.

Byron Nelson had played in the second Master’s tournament in 1935. He had won the 1937 and 1942 tournaments. In 1945 he had his legendary season where he won 18 tournaments including 11 straight at one point.

He then had raised enough money to buy a ranch that he and his wife wanted and he retired in 1946.

Two weeks before we were set to leave for the tournament I called his wife to set some final arrangements and she informed me that he had fallen sick and was in the hospital.

The trip was off and I was disappointed, but hoped that, even at age 94 maybe we could go back the next year.

I sent him some Kansas City BBQ during the summer and got a nice letter back, but the handwriting was much shakier.

Then in September of 2006 I learned from the news that he had died.

The world lost a golfing icon that day.

Many may have thought that they lost a great golfer from 60 years previous. What they really lost was a great soul who happened to play golf.

I remember the day that his wife called and asked for assistance at the tournament most of all.

It was as if the history of golf reached out to me personally. Invited me in.

When I watch the master’s on television I often feel the same way.

I think we all do.

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.

5069adae5efe077c6c692453622e451bTiger Woods
By Sean M. Wheeler, M.D.

Professional golfer and chronic back pain sufferer Tiger Woods appears to be doing worse, much worse.

Golf journalist Robert Lusetich, formerly of Fox Sports, reported this week that Tiger Woods' condition has worsened since a pair of back surgeries in Fall 2015. Lusetich, author of “Unplayable: An Inside Account of Tiger’s Most Tumultuous Season,” indicates Woods can’t move well and has pain while sitting.

Although Woods' agent was quick to deny the Lusetich report and a video of Woods swinging a golf club was posted @TigerWoods, Woods has become the face of modern medicine's failure in treating chronic back pain.

He is athletic, strong, active, determined, rich, employs the best trainers, golf coaches, physical therapists and travels to see the best doctors he can find. With access to any professional help he wishes, if anyone should be able to overcome chronic back pain it is Tiger Woods. Yet, after three surgeries his back pain keeps him absent from the professional tour.

As predicted here one year ago, Tiger Woods is another victim of the healthcare industry's decades-long lack of progress in the treatment of chronic back pain.

With Woods the latest victim, what does this say to the many worldwide sufferers of chronic back pain?

Today's medicine relies upon a mistaken treatment theory of "get the patient out of pain and back to normal activity, and all will be well." If this theory were true, it would work successfully with an uber-athletic, driven-to-return-to-his-previous-activity patient with access to every available resource such as Tiger Woods. The theory does not work, because modern medicine ignores the human body's power to brace.

When the power to brace functions in unison with the power to move, the human body performs without chronic pain.

A baby begins to walk as she gradually masters the innate use of her bracing muscles, so that her young body is able to brace itself permitting self-directed movement, including the taking of her first steps.       

Understanding how our bodies must develop this power to brace within months of birth, and combine it with the power to move, offers deep insight into how we learn to walk, and how our bodies retain mobility through a lifetime — or lose it — whether professional athlete or couch potato.

The power to brace is provided by specialized Bracing Muscles® found in six high-performance locations within the body — ankles, feet, low back, neck, shoulders, hips. 

At peak capability and as the label implies, bracing muscles brace, providing all-day stability by not moving, while our action muscles provide dynamic movement.

As the condition becomes chronic, back pain indicates a diminished or even full loss of the body's power to brace the low back. In losing the stability that comes through fit bracing muscles, no amount of moving [for example, no amount of strength training] will bring back this needed bracing stability. The lack of stability leads to compensating use of action muscles, which leads to more pain and increasing back pain severity. 

How did modern healthcare reach this point? Let me count the ways:

  • Modern medicine does not understand the cause of chronic back pain; 
  • Reliance upon a failed algorithm for back pain diagnosis;
  • Failure to distingush bracing muscles as unique within the body, leading to a misguided belief bracing muscles may be strengthened while the patient remains in pain; and
  • A mindset that bracing muscle fitness may be restored as quickly as can action muscle fitness, within a few short weeks.

For Woods and all back pain sufferers, modern healthcare must focus first on restoring the body's bracing power, before any focus on movement.

Given medicine's lack of effectiveness in treating this disease, a new prediction for Tiger Woods.

Assuming the Lusetich report is true, Woods may look for products touted as back pain remedies outside of established medicine, as do many who suffer, such as a spinal cord stimulatorinversion table, perhaps even acupuncture. He will attempt a return to golf and fail to return to his competitive standard, having not found a medical specialist who understands the role of bracing muscle fitness in back pain causation. For both Woods and his fans, only memories of past golfing greatness will remain.

Chronic back pain sufferer Tiger Woods; all that is wrong with modern medicine's understanding of the world's leading cause of disability.

Dr Sean Wheeler The Human BackThe Human Back © Sean M. Wheeler, M.D.By Sean M. Wheeler, M.D.

Reading a Guitar Bench interview with luthier Kevin Hall recently allowed me to appreciate challenges encountered during my own professional journey.

One of discovery, in the search for back pain liberation. For my patients, and for all who suffer beyond the reach of my clinic.  

Hall, who began repairing guitars in the late 1960s, shares a wealth of experience, from guitar styles and tonewoods, to the wisdom behind his build philosophies:

“Builders who start off as repairmen tend to look at instrument design and construction a little differently than those who come to the trade directly as apprentice builders.  Working as a repairman gives you a...jaundiced view of the world, since most of what crosses your bench has some form of problem...”

“If you have to repair distorted tops on a number of examples of one make or model, or see a disproportionate number of neck resets needed in another, you...start looking for the causes of such [problems]. That serves you well when you start to build your own [guitar].”

As a young doctor in general practice, I acquired my own jaundiced view of chronic back pain patients. Neither I nor anyone else could help them, and any recovery seemed random. The longer they hurt, the less likely they heal. Repetitive visits to my clinic began with hope and too often ended in disappointment.

It was an outcome I dreaded.

In spite of this dread, I accepted a fellowship in pain management for the unique skill set it gave me paired with my sports medicine specialty.  My frustration in treating those in chronic pain remained however.

To channel this frustration, I threw myself into searching for the cause of chronic back pain.

Says Mr. Hall, offering an instructive comparison:

"[Performing many stringed instrument repairs]...invariably makes you think about instruments in a different way and teaches you something which may...improve your own product.”

I found myself thinking about our medically accepted patient treatment system in a different way, and seeking answers challenging over four decades of medicine's "wandering in the wilderness."  My treatment protocol evolved and improved, leading to my “a-ha” moment to help patients heal from back pain, by creating the Body Guitar framework as the new way of thinking about the cause of, and effective treatment relief for, chronic back pain.

My epiphany included a recognition of the incredible design of our musculoskeletal system: Our backs are designed perfectly.

Flawless.

We can learn to redesign our lives to remain physically active.

Throughout a lifetime.

And as medical professionals, we too can learn to modernize our healthcare system to accept and treat the cause of chronic back pain.

Achieving pain liberation.  

As nature intended.

 

[Image © Sean M. Wheeler, M.D.]

Dr. Sean Wheeler's new book, UPRISE: Back Pain Liberation, By Tuning Your Body Guitar, presents the cause of chronic low back pain and provides a roadmap for leaving this condition behind – for good. UPRISE conversations are welcome @DrSeanWheeler, Facebook, Google+ and at LinkedIn

Bubonic plague, or Black Death, is one of the great scourges of human history. In the 14th century it was responsible for the deaths of 25% — 60% of the European population alone. Today, while Bubonic plague has not been eliminated entirely, its effect on humans has been vastly downgraded from a death sentence to a treatable infection. This progress is the direct result of modern medicine and its discovery that the plague is one of three types of bacterial infection caused by Yersinia Pestis, usually resulting from the bite of an infected flea present on rats. When the rat dies, the fleas search for a new host.

Why is this important?

Because, before the cause of Bubonic plague was found, it affected — and took — the lives of millions. It was not until the cause was found that the medical community was able to discover the antibiotics to effectively work against the bacteria and create the public health measures necessary for prevention. In other words, identifying the cause directly resulted in an effective treatment. 

The similarities between Bubonic plague and chronic low back pain are extraordinary.

Yes, people don’t die directly from back pain. Yet, in the US alone, 65 million people are living with chronic low back pain, which has a significant negative effect on their lives and the lives of their loved ones. Low back pain is the leading cause of disability worldwide. Yet, somehow, we continue to be told (or sold) that the cause of low back pain doesn’t matter as long as we can treat the pain — temporary as that may be. The generally accepted and pervasive mindset among the healthcare and medical communities has been one focused on treatment — procedural, rather than diagnostic — with little regard to addressing the cause of back pain in the context of progression. Back pain specialists want to treat back pain like a surgeon treats abdominal pain: find one cause and treat it. The problem with this approach is that it ignores the progressive nature of back pain. Identifying and treating the true cause of chronic back pain — Bracing Muscle weakness — is the key to chronic back pain prevention, amplified by public health measures to decrease the number of people affected, and a forum to improve our care of low back pain. 

There are a lot of people in this world who claim to have a miracle cure for back pain. Without a known cause, they all resemble the snake oil salesmen working out of the back of a wagon in the middle ages. How is one able to tell what works? I spent six years writing UPRISE: Back Pain Liberation, By Tuning Your Body Guitar — in which I clearly present the cause of chronic low back pain and provide a roadmap for getting out of pain — for good. My hope is that, in the future, this book, this method, Bracing Muscle weakness, will be viewed as significant an advance as the identification of the flea in the cause of the plague. 

It changes everything.


Learn more about Dr. Sean Wheeler, Bracing Muscles, Healthy Posture, and how we can finally treat the cause of chronic back pain in UPRISE: Back Pain Liberation, by Tuning Your Body Guitar.

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