When I met Carol, she came to me because she had low back pain and pelvic pain. When I say pain, I’m not talking like “ouch” my back and pelvis hurts. I’m talking like “every time that I walk, move, or do anything it feels like my pelvic bones are going to rip through my skin and like my insides are going to tear” kind of pain. The pain would pierce from her low back, through her pelvis, and continue into her right thigh.
Pain is a very common complaint these days and it is becoming increasingly clearer with prescription pain medication related deaths that the current approach may not be the most appropriate. Perhaps we need to look at pain differently. I will try to explain how osteopathic physicians approach pain through a story.
Carol is a mother of 3 children. Parents know how physically and emotionally exhausting parenting is. She also works as a nurse, which is also very physically and emotionally demanding. Imagine how this affects her daily life. It affects her ability to pick up her kids or lift her patients at work. This created tension in her family because then it put more pressure on her husband. It was more stress for her coworkers having to pick up the slack for her. This was the state she was in when stepped into my office. This is her story.
After the birth of her second to last child, Carol’s pain started. Luckily it was not so severe initially. It was worse in the mornings, but would ease up as the day went on. With chiropractic treatments and physical therapy, she was able to control the pain enough that it really didn’t affect her day to day life. Things were going well and life was good, until she got pregnant again. It was not until she gave birth again that the pain really came back, but this time it was worse. Now the “my insides are going to tear” pain was here to stay and nothing was changing it. It was now bad all the time and nothing would improve it.
Before coming to my office. She tried going to her chiropractor. She loved her chiropractor, but this time there was no change. She tried physical therapy but had no success. Her doctors worked her up, did x-rays, and recommended medications, but none of that offered any solutions or clues as to why she was having her pain or more importantly, how to resolve it.
So how do I approach pain differently? I evaluated her whole body and formed a treatment plan based on my findings. Pain in most cases is simply a signal from the body something is not right. It doesn’t matter if the pain is actively felt or only fully noticed when it is stimulated by touch. It’s like the engine light coming on in a car. Just like with the engine light, where one experiences pain is not necessarily where the problem is. In the body sometimes it is, sometimes it isn’t.
Imagine someone wearing a tie with a heavy weight on it that pulls your neck forward. The pain will show up in the back because that’s where the most stress is put on the body, but the real problem is in the front. It’s not the light on the dashboard or the wiring that is necessarily the problem, but the faulty part that is causing the light to turn on. Perhaps that’s how we differ from the current model. We’re all trying to do what’s best, but sometimes without finding an underlying cause, we just look to place a piece of masking tape over the light. We have to learn how to read the pain.
When Carol came to me, I had to look at things differently than everyone else who had seen her. After I listened to Carol’s story and focused on what she was telling me, wheels were turning in my head. There was already a thought process going on. A mindset. I was trying to figure out what may have happened anatomically to cause the symptoms she was describing. This is how I think, I think in terms of anatomy. If truly there was a dysfunction in the anatomy, I needed to find the right structures and help correct those. This is one of the osteopathic principles we work with, the interrelationship of structure and function.
Correcting the wrong things, will not produce any result. It does not matter if one does the wrong thing for 20 years, doing the right thing, sometimes once, can change everything. It’s like having an engine that isn’t working in the car, fixing everything else around it, and expecting that somehow the engine will start working. That’s not reasonable. Doing the right thing though, can change everything.
I assessed Carol’s whole body from her feet up to her head. Taking in clues about what muscles felt “knotted” and were painful to touch, what joints they were associated with, bones that felt too dense and without a pliability that healthy bones have, and any organs that felt rigid, congested and tight. These are all hallmarks of unhealthy tissues. They’re universal. They may vary slightly from tissue to tissue, but a knot in a muscle really is a muscle feeling more dense, just like an unhealthy bone, organ, or tissue will. A joint will feel more rigid as well. It will lose the pliability in it. This is how I have learned to interpret these tissues.
This is how I often know where people hurt sometimes before they realize how painful a place on their body is. Identifying where people hurt is easy. I have to take it a step further. I have to know the anatomy in detail so I can know how to make a change. I have to understand what structure it is under my hands. Especially if I want to have a real chance at changing it.
So with Carol, as I evaluated her right leg, I noticed that her muscles on her inner thigh, her adductors, were knotted. The area was sensitive to touch. This was not so surprising because I suspected there was an issue with the pubic bones and the joint between them. With the adductors attaching to the pubic bones, I suspected that they were incredibly tense and contracted because of the problem there. Therefore, working directly on the adductor muscles would have been useless.
Even though the adductors were responding the the pubic bone dysfunction, this did not mean that the pubic bones were the primary problem. I know from experience that the pubic bones can affect the way the whole pelvis functions and affect the low back. The pubic bones, especially the one on the right, had lost their resiliency, were extremely tender the touch and they did not align well. These bones separate and come together at the pubic symphysis during labor as the baby passes through the birth canal. Perhaps they did not come together properly?
This is not it, however, the problem is not just solved. Because there is the pubovesical ligament that attaches near the pubic symphysis joint. This means the bladder can either be affected by a problem or be causing a problem at this joint. Similarly, the round ligament of the uterus attaches into the pubic bones. The broad ligaments suspend the ovaries and attach onto the inside of the pelvic bones, and lastly the uterosacral ligaments anchor from the uterus onto the sacrum. Her right lower abdomen was tense, the tissues contracted. Her pelvic bones lacked motion, and her sacrum was also twisted and stuck and not moving at the sacroiliac joints.
A stuck sacrum will make the muscles in the back contract all the way up and can have effects up to the head via the dura mater, a specialized membrane. The sacral twist can also be a problem because there are nerve fibers that come out from the sacrum. The nervous system plays a huge role in pain. Furthermore the abdominal muscles also attach to the pubic bones so it would not be unreasonable her lower rib cage and sternum were sore and dysfunctional also. That’s the other end where those muscles are attaching into. When it comes to anatomy, I am constantly going through exercises like this. Sometimes to explain things I have noticed that have no clear anatomical relationship.
What osteopathic physicians care about is how well things work and move. That’s why none of these things show up on x-rays. They’re subtle dysfunctions. Imaging studies have their uses but do not tell you about motion. It’s like looking at a picture of a rusty nut and a bolt and trying to gauge how much torque it will need to loosen it.
I began to suspect there was a significant twist in her uterus that was influencing all these areas. That’s another principle we work with – the body functioning as a unit of mind, body, and spirit. Affecting one part, the whole is affected. You see, using my hands, I not only have to be able to assess the whole body and read the patterns of what I am finding, but I also have to be able to help bring resolution to these areas.
As an osteopathic physician, I have to know where to begin by knowing my anatomy, form a theory, and test it out. I didn’t just try to force all these structures to where they were better aligned. Why? Because it doesn’t work. She’s not a car. We’re dealing with a living dynamic person. One with self-healing mechanisms. Her body is actively maintaining that problem and we have to figure out why. Her body is trying to heal, what I am trying to achieve is to create the environment within her body where her body can heal the problem. What I have to ask myself is, “Why is her body maintaining this shape?”
So palpating over her lower abdomen through her bladder to her uterus, I was able to gently isolate and untwist her uterus until I felt it start to relax. Then I just maintained it there and let her body release the issue with her uterus. If my theory was correct, then there would be improvement in the structures associated with the uterus. Immediately, the tension in her lower abdominal muscles and organs felt more relaxed, the pelvic bones and sacrum were moving more freely at their joints and felt more pliable, and her adductors had begun to relax.
The cause was addressed, the effects were now able to change. This does not mean everything was perfect and there was nothing left to do. Although there were big improvements, the related structures were not working perfectly so I worked to facilitate release as much as I could in a similar fashion. I do not try to impose how I believe the body should work, but be open to the idea that the body knows better than I what it needs to heal and I have to step out of the way and pay attention. That’s really all we are is facilitators or catalysts giving the body the boost it needs to heal.
When we were done, Carol got up and moved around. She no longer felt like her insides were going to tear apart and like her pelvic bones were going to rip out of her skin. Immediately, she was able to move more comfortably, pick up her kids, lift patients at work. She was happier, her family was happier, and her coworkers were happier. Osteopathic physicians were now her new favorite! Things still took multiple visits, but the pain was never that intense as when she first came in. Each time we were able to improve more. Sometimes new things came up like her mid back hurting from carrying her baby all the time. Eventually, Carol got to the point where she could live her life being a mother, nurse, and an awesome person without having to worry about the severe pain.
If you’re in the Denver area and want to make an appointment for yourself or someone else, visit us at www.oimcare.com or call 303-350-7990. If not do a search for an osteopathic physician that specializes in Osteopathic Manipulative Medicine / Neuromusculoskeletal Medicine (www.omtdirectory.com). See for yourself why according to Vitals, based on 6 million reviews, neuromusculoskeletal specialists are the most liked specialty in medicine1.
“Dr. Lopez has been able to help me keep up with my three little ones, work as a night shift nurse, and exercise pain free after 2 years of constant pelvic pain. He listened to my symptoms and description of the pain and was able to give me some relief on the very first visit. Subsequent visits have decreased the pain even more. He is obviously very knowledgeable and really concentrates on getting to the root of the problem, and not just temporarily fixing symptoms. The office staff is very friendly and promptly gets me in for my appointments.”
1 “Vitals Analyzes 6 Million Reviews: Reveals What Patients Say About Doctors” http://vitalschoice.vitals.wpengine.com/posts/press-center/press-releases/vitals-analyzes-6-million-reviews-reveals-patients-say-doctors#.