The Definition of Crazy
What is the definition of crazy? You may have heard it’s doing the same thing over and over and expecting a different result. This is not a direct reference to mental health. It is a reference however, to how our healthcare system addresses and treats pain. Why is pain treated at all? There is a whole industry geared towards "Pain Management". At what point in time did pain become a diagnosis? Answer, never! Pain is nothing more than a perception of a noxious stimuli. Pain can signify actual damage (minimal, major, or extreme), or it can signify a chemical irritation (inflammation=pain) without viewable damage. It is subjective in how we describe it and even how intense we feel it. It is different for everyone and its different for chronic pain sufferers. It is the focus of most treatment plans.
For 25 years I have been helping people figure out why they are in pain. If you are a patient, you know I don’t treat pain. I look to identify the causes of pain. Now, locating the structures inflamed or damaged will give you the source of the pain (MRI confirmation), but what it will not give you is the causes and/or contributing factors as to why the area is inflamed or why the structure became damaged. Is it biomechanical? Is it repetitive stress? Is it something your doing without knowing your doing it?
The Opioid crisis was our healthcare systems answer to treating and managing pain. Opioids alter our perception of pain. Old saying, no brain no pain. Alter the brains perception of pain and there you go, problem solved! To a lesser extent other medications can also have an effect on blocking or altering pain. But in the end, there is no medication that actually helps with treating or restoring the damaged structure. After some time, and medication, and some rest, a lot of damaged structures will feel pain free and maybe even heal to some degree. Problem solved! Well, depending on the area we are talking about, problem not solved, new problem created!
Let’s take the low back (lumbar spine) and the chronic nature of the disease. Most people at the first sign of low back pain will go to their City MD or primary care. Rest, ice, Advil and you’re going to feel better the majority of time. If that was the answer, then why are low back issues an epidemic? Ok, so maybe we can add in some natural pain killers like manipulation (yes there is proof that spine manipulation can offer short term pain relief) acupuncture, massage, PT, and passive therapies (Ultrasound, e-stim). All are designed to rid you of pain. Then, add in some core exercises to build your core and pain goes away over time, that is until it doesn’t! Again, if this was the answer long term then why is low back pain on the rise every single year (Sitting is not the only reason)?
Problem is, the way low back pain is treated is literally the exact definition of crazy. In 25 years, I have seen patients who came to me with low back issues that spanned 5, 10, 20 years plus. What I saw was a person that was treated the same way for all that time by countless providers; our healthcare’s best (MD, DC, PT, DO, etc.). For those of you who have been through low back rehabilitation with me, you know that a big part of your long-term success is understanding why. Why did your disk herniate? Not that an MRI showed the cause of your pain as a herniated disk, but rather where in your history did the long term process of your disk breaking down start? What have you been doing long before the pain started that started the cascade of breakdown that led you to the eventual pain? Remember the no brain no pain saying, well you can’t feel the gradual degradation of the low back structures, but you can feel pain when the proverbial straw breaks it. The problem here is that we base good health as the absence of pain, when in reality pain will come and go but the underlying dysfunction continues to spiral out of control.
What this all means is that the way low back pain is treated needs to be radically overhauled and made more consistent across all professions and its individual providers.
People ask me all the time, who should I see for my low back? MD, DC, DO, PT? I say it really does not matter what those initials mean unless we are talking pathology and possible surgery, then it’s the MD.
But, the bigger question is this: Who is going to help you uncover the causative factors? Who is going to educate you to find the destructive forces in your day? Who is going to remove those restrictions in your movement that contributes to poor and destructive movement? Who is going to hold you accountable for your own care? And who is going to teach you how to functionally move so that you can resume all your favorite activities and feel safe in the process? And who is NOT going to focus on pain but rather function?
Well, all those things take TIME in your care. So, if you’re thinking about who is going to help you, interview the person first and if they offer passive therapies only for pain (Ultrasound, E -stim, manipulation, acupuncture, massage), pain management focused care (conservative or invasively), and no education (why did it happen and what are we going to do to address this so the stress is removed and the healing can start) then maybe the care you are about to receive is going to waste your time and eventually lead to more frustration and pain down the road.
Also, of note is that Natural or conservative care (Yoga, Pilates, Chiropractic manipulation, Core exercises, etc.) alone is no better than an invasive approach if they only focus on pain management and do nothing to improve functional awareness and ability. And moving like a mantis, warrior, or child posing may not be more than a short-term bandage that only adds to your long term issues (No I’m not trashing Yoga, I love some aspects and fear others).
I have been fortunate enough to have been in the position that I could spend my time, one on one with all my patients and take them through a functional rehabilitation program geared towards identifying the causes first and then working long term to promote functional awareness and movement.
I may use various soft tissue techniques (ART, MET, NMR, etc.) but I never claim that a technique is going to cure anything. I use education, movement analysis, Manual Medicine Techniques (MMT), and the promotion of functional movement, as a means to educating and empowering patients to be able to continue helping themselves long after their rehabilitation is over.
I ask all of you to think of those people in your life (friends, family, co-workers, fitness partners, or acquaintances) who have been a victim of the craziness that is our healthcare approach to treating low back pain.
If you trusted me with your health, I thank you and hopefully I rewarded you with an experience that beat your expectations and continue to affect your life positively long afterwards.
I will never change my approach to helping people. I will never yield to the insurance companies repeated attempts to force me to be in network so I would need to see 6 patients an hour. I will never sacrifice quality for quantity as I know that the TIME I invest in patients care will be rewarded in the end.
Many patients have told me that they don’t know how to describe what I do to those people they want to refer. He’s a Physical Therapist, no he’s a Chiropractor, no he’s a great hands on doctor who also knows functional movement, no he’s a listener who is empathetic, etc..
All those things are true but make it hard to simply describe what and how I do it. Well, I finally tried to narrow that down and put it in print on my long overdue website. My site is not a technical marvel and it isn’t an interactive experience. It is the honest truth about what I do, how I do it, and a touching compliment of patient’s personal testimonials.
Share this article with people you know. Share my website link (https://www.nyspinehealth.com) with people who you believe have been a victim of the craziness that is our healthcare system.
Until next time, Be healthy. Be safe. And be mindful of the world around you.
Best in health,