The patient: Ann, a 35-year old information technology expert and exercise enthusiast.
Why she came to see me: After consulting with her primary care physician, who had been prescribing muscle relaxant drugs, she was referred to an orthopedic surgeon who examined her thoroughly, and ordered a CT Scan of her lower back and pelvis. She was told that the scan showed no distortion of her vertebra and no compression of the disks between the bones. The doctor further explained that there was also no evidence of any compression of the nerves exiting her spine that would cause the pain and her chronic recurrent pain in the small of her back. He thought that the symptoms were probably related to the stress of sitting long hours in front of a computer monitor. Ann was instructed to receive physical therapy three times a week for six weeks and then return for evaluation. The therapy provided hot packs, stretching maneuvers, and external electrical stimulation. At her follow-up visit to the orthopedist, she complained that not only was she not better, but that she seemed to be worse, now waking up in the morning with low back pain. She was now finding it difficult to remain seated at her computer and was considering cancelling her exercise classes because she couldn’t engage in the Zumba and kick boxing routines that she loved. In a conversation with a neighbor, they compared medical problems and Ann heard about my success in treating a similar problem that the neighbor had experienced.
How I evaluated her: During our initial appointment, we spent an hour reviewing the origin and progression of her pain, her course of treatment with other physicians, and the fact that the medication and physical therapy had not helped, but had in fact made things worse. The missing part of her previous examinations was a functional analysis of the movement of the bones in her hips. I explained to her that an interference with the normal motions between the two hip bones and the bone at the base of the spine (the sacrum) could cause strain on the low back. Often this strain is complicated by long hours of remaining seated and can result in a flattening of the normal concave curve, causing the nerves exiting the spine in this area to become compressed. My functional analysis of these joints confirmed that this was in fact the case, and the normal movement of these bones was skewed. She had noticed that her inability to stand with equal balance on one leg when the other was bent at the knee and drawn towards her chest had started with the beginning of the back pain.
How we addressed her problem: Along with the supplement MSM (methylsulfonylmethane) to provide support for tissue flexibility, I employed several physiotherapy and manipulative techniques during our first visit. First, I placed special gel hot packs on her lower back and hips to relax the muscles, tendons, and ligaments. Then I used a special ultrasound gel containing pain-relieving and relaxing botanical extracts and performed a therapeutic treatment called phonophoresis. This uses a form of focal ultrasound that cause the extracts in the gel to move through the skin into the underlying tissues, allowing the effects of the therapy to last many days and improve outcomes. Lastly, I employed a pain-relieving acupuncture treatment using pulsing, low-voltage electrical current directly connected to the inserted needles. This produces contraction and relaxation cycles in the tissues that were holding the hip bones and the sacrum out of alignment and producing joint stiffness. After the therapeutic part of our visit was over, she could stand, bend, and squat normally.
Even though Ann felt “cured” after one visit, her relief wouldn’t last without more attention. I showed her specific stretching exercises focused on maintaining normal movement in her hips. I also advised her to get away from the computer for 10 minutes every hour and, during that time, to slowly go up and down a flight of stairs in her home office; two steps at a time, sinking down and bending her legs with each step,
The patient’s progress: While Ann’s back stiffness partially returned a week after the initial treatment, it became better day by day. I repeated the same combined physiotherapies at her next visit and performed additional deep tissue trigger-point treatment. We scheduled a follow up visit for one month with the understanding that she could call for a visit in the interim if she felt it was necessary. I see Ann about once every two months or so, and she reports that she is back to her old self and that her kick-boxing workouts are better than ever.