• Surgery works well if there is an identifiable structural problem. This situation was present here in the form of tibial malalignment creating tracking problems with the patella. Re-aligning the joint is helpful. The reason I wrote my book, Do You Really Need Spine Surgery? Take Control with a Surgeon’s Advice was not to dismiss surgery, but only to have it done when the problem is clearly identifiable.
• The diagnosis of spondylolisthesis is mentioned. It is a surgical problem only if there are pinched nerves causing leg pain. Then you almost have to undergo surgery. Back pain is vague and is not a structural problem. Fusing a stable spondylolisthesis for back pain is not indicated. Indeed, the pain was resolved with a regular yoga practice and surgery may never be required.
• This reader took control. That is the one most important step.
• Finally, the mindset of being connected to only what is present is a major part of healing. Very nicely said.

The letter

I have a story to tell, and this surgical screw sums it up very nicely. It represents a turning point in my life. Some of my bones are a bit defective in shape, enough to cause problems after decades of wear and tear. Bear with me, I’ll get to the part that yoga has played in a bit…

This screw held my shin together for several months after a surgery to realign my kneecap by surgically fracturing my tibia and putting it back together at a different angle. That was only one of my multiple orthopedic surgeries on both feet, both knees, and both shoulders.

I went from pre-surgery not being able to carry a laundry basket down a flight of stairs, to post-surgery backpacking the 93-mile Wonderland Trail around Mt. Rainier. Now I average several hundred miles a year of hiking, backpacking, and snow-shoeing, something I could only dream about before.

Spondylolisthesis

Several years ago I also found out I have a spine defect (spondylolisthesis and pars fractures) that will eventually need a lumbar fusion as it progresses. I sometimes can’t feel my right foot and my low back feels less-than wonderful. I had started practicing yoga inconsistently before that diagnosis, but when I realized how incredible yoga has been for managing my low back pain (I don’t even take Advil or Tylenol), I dove into yoga head-first and never looked back.

That led to me to a regular yoga practice, then 200-hour Yoga Teacher Training (YTT) and recently 300-hour YTT. I went from dabbling in yoga because it was kinda “fun” to becoming a yoga teacher with several classes a week. It has changed my life.

I can’t imagine where I would be right now without having gone through what I have gone through. Just like that screw and what it represents. Rehab was not very pleasant, but I came out so much stronger and happier on the other side of it.

Moving forward

Sometimes life throws curve balls at you, some good, some bad. It’s easy to let your mind go into the “Why me?” or “It’s not fair!” mindset. I spent years in that dark place. Decades. It’s not a good place to be, either for yourself or for those who love you.

Mindset – Yoga has taught me to always try to find the positive in things, no matter how bad they might look on the outside. To see the blessings even when things look daunting. To know that it’s OK to take time to take care of myself, because that makes me better able to take care of others. To be completely content with where I am RIGHT NOW regardless of hurdles I’ve been through or what might be coming in the future. I guess what I’m trying to say here is that sometimes you have to go thru a bit of hell to come out oh-so-much-better on the other side. Smile. Get on your yoga mat and smile.

Final thoughts

This story is a wonderful illustration of moving forward, regardless of the obstacles. The rehab is a critical factor but life outlook is equally important. Your brain will develop wherever you place your attention and is physically altered through neuroplasticity. People often thrive at a level they did not know was possible.

The post “Un-screwed”–Yoga Healing Back Pain first appeared on Back in Control.

The post “Un-screwed”–Yoga Healing Back Pain appeared first on Back in Control.

I believed that pain was always structural–I was wrong!!

During my first five years of practice, it was my assumption that if a patient had experienced low back pain for six months, then it was my role to simply find the anatomic source of pain and surgically solve it. I was diligent in this regard. The test I relied on most heavily was the discogram. The discogram is a test where dye is injected into several discs in the lower back; if the patient’s usual pain was produced at a low injection pressure, it was considered a positive response. The only patients I did not fuse were those who did not have a positive response or had more than two levels that were positive. I performed dozens of low back fusions and felt frustrated when I could not find a way to surgically solve my patients’ low back pain.

I have a physiatrist friend, Jim Robinson, who is a strong supporter and contributor to the DOC Project. From 1986 to 1992, we both served on the Washington State Worker’s Compensation clinical advisory board and helped set standards for various orthopedic and neurosurgical procedures. Our discussions were based on this assumption that there always is an identifiable “pain generator.” That means there was always some anatomical problem generating a pain impulse and we need to discover it to save the problem. It was just a matter of figuring out what test is the best one to discern it. We did not think in terms of structural versus non-structural sources of pain. We knew about the role of stress, but did not fully appreciate how large a role it played in altering the body’s chemistry and perception of pain.

BTW, our original concept of a “pain generator” was wrong. The only place in the body where pain is felt is in the brain. Sensory input has to be first interpreted by the nervous system and if a certain threshold is exceeded, your brain sends out a pain signal that indicates danger and your body will respond with an appropriate action to keep you safe. A bone spur has no inherent capacity to generate pain.

Structural problem

I define a structural lesion as one that is distinctly identifiable on an imaging test, which correlates with the patient’s symptoms. An example would be a ruptured disc pinching a nerve that causes pain down the leg. A ruptured disc between the fourth and fifth lumbar vertebrae will cause pain down the side of the leg. This is the pathway of the fifth lumbar nerve root. A ruptured disc between the fifth lumbar and first sacral vertebra will cause pain down the back of the leg, which is the pattern for the first sacral nerve. If in either of these two examples the pain was going down the front of the leg, it would not be considered the cause of the pain because that is the path of the fourth lumbar nerve root and it does not match.

Other examples are:

• Bone spurs on one or both sides of the spinal canal with matching leg pain and/or nerve damage
• Central spinal canal constricted by bone or ligaments with one or both legs feeling weak, tired, or painful
• Isthmic spondylolithesis (slippage) with corresponding leg pain.
  • More that 3 mm of back and forth motion on X-ray if only back pain; This would be considered unstable.
• Degenerative spondylolithesis (slippage) AND canal constriction with corresponding leg pain or fatigue
  • >3mm of instability if just back pain; considered unstable.
• Acute compression fracture with fluid on the MRI (indicates bleeding).
• Acute unstable fracture/dislocation
• Tumor
• Infection
• Flatback—whole body tilted forward because the normal curvature of the lower back has been straightened – many causes.
• Scoliosis that progresses over time-just the presence a curve does not count.

Pain problem

Many of you experience pain whose source is not identifiable on any test modern medicine has to offer. When there is no identifiable structural source of your pain, we cannot surgically treat it. But we can still help you and the good news is that you don’t have to undergo the risks of spine surgery.

The only scenario that surgery should be even considered is in presence of an identifiable problem with matching symptoms. Other factors such as the severity of the pain compared to the involved risks must be taken into account. If you can’t see it you can’t fix it.

The post A – Structural Sources of Pain first appeared on Back in Control.

The post A – Structural Sources of Pain appeared first on Back in Control.

Aching Back? Why Surgery Is Not Indicated for Lower Back Pain, Case In Point, July 201.  (Reproduced with permission from Case In Point.)

BF

The post Video 8/19: Fusions For LBP Don’t Work first appeared on Back in Control.

The post Video 8/19: Fusions For LBP Don’t Work appeared first on Back in Control.