Where Does Pain Come From?
So, the patient we just say would be a common patient who had a traumatic event. The patient had a traumatic event and had back pain. And so, a big part of our practice is explaining people’s diagnosis, where their pain comes from. We see routinely, commonly in the community where it is very simple that a patient is told that they just have pain from their disc. Meaning their disc in their lumbar area or neck area. We find that it is usually a little more complex or complicated than that.
Once we start seeing patients in our clinic, patients typically have pain from multiple sources. They have pain from the disc. The fibers at the back of the disc can produce pain and be disruptive. As you’ll see, I’ll show you in a minute on the model, the joints, the lumbar facet joints, the cervical facet joints, are in close proximity to the actual discs.
And so, if you imagine in an energy, some type of trauma, energy is going to go through all the muscle tissue, thorough the ligaments, through the joints, through the capsule of the joints, and then also to the disc. That energy doesn’t just seek right into the disc. And so, when patients leave we have a discussion, we use the model to show this fact that they have pain from the discs, they have pain from their joints, they have pain from the ligament complex around the joints. Your body they senses that you have injury to these structures, which causes spasms to, and pain the tissues around these structures.
Imaging you were running, and you pulled your hamstring, your body pulls that muscle tight, it spasms and contracts, your body is telling you I can run any further due to the pain. Something similar happens when your body is injured, your disc is injured, your ligaments are injured, your joints are injured, and the muscle tissue in that area is protecting you which is one of the main reasons you fell pain.
So, the patient we had just seen had gone through physical therapy, chiropractic treatment, stretching, home heat and ice, and using medication such as a muscle relaxer or anti-inflammatory. Over the course of three months, the patient now today is feeling quite a bit better having less pain when working, she works as a waitress. And we didn’t need to do anything more aggressive with this particular patient as she was able to heal.
Now unfortunately we get many patients who continue to have pain and that we may need to do further treatment. Pain management procedures, spinal injection procedure into the epidural space, or to the lumbar joints. So, just to get an idea of what we are talking about, a lumbar disc is this blue and the bones around this area, these are called vertebral bodies. And if I flip to the back, to get you oriented, this is you standing looking at the side. You have a bone, a disc, and a bone. You have these yellow nerves that are cut for this model. They are coming out of the holes and into your leg. This would be like looking at you from behind, you can see that there is a joint on the right side and a joint on the left side.
So, when I use the concept of a motion segment, that involves the bone, the disc, and the bone with the corresponding right joint and the corresponding left joint. Those joints are called facet joints. When someone is moving, and I hear popping, snapping, and cracking, you are hearing movement, feeling movement through the joint. The joint has a strong capsule that covers it, there is a cartilage surface, almost think of like a finger joint, on each side. The disc is better at compression, it doesn’t have a lot of movement to it, it’s not what you are hearing, it’s not what’s snapping.
So, a patient in the age range, I’m talking this patient was a 39 year old, her pain was almost completely derived from a traumatic event. Injury to her joints, injury to the capsule of the joint, and then injury to the muscle tissue that inserts on these processes. She didn’t have a disc injury, but you can imagine if someone did have a disc injury, that disc sits with less than an inch away from that joint. So commonly we’ll see injury and pain from the disc, injury and pain from this joint, and then spasming and pain from the tissue.
Therapy is important, stretching is important to help decrease the chances of having scar tissue, increasing mobility and strength, breaking the cycle of that tissue causing pain while you are healing form the ligament injury, the facet injury, and the disc injury. So, in a step by step progression you would expect to have therapy, you would expect to be working on range of motion, soft tissue massage, gentle traction to the tissue mobilizing the tissue. Then if the anatomic structures, the joints, the joint capsules, the ligaments, and the discs are injured it may require further treatments with a corticosteroid, to further help the healing process, make you more mobile, and help you through the physical therapy process.
In the rare case when we get more time away from the injury, a patient may then need what I have to offer, which is surgery. Surgery would be to open up space for nerves, and or lock motion segments down with screws and bone graft
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