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Breaking the Pain Cycle (Lesly J.)

Anyone who experiences chronic pain can easily get caught in a cycle of pain, stress, and depression that often leads to the use prescription drugs for relief. This is a problem because medication often treats only the symptoms, but not the cause, of pain. In order to break a pain cycle, it is important to apply clinical reasoning to determine the root cause of pain and then implement an individualized treatment plan that includes strategies to relieve pain, restore movement, and prevent further problems.

The issue:

Lesly had suffered from chronic back pain for more than ten years when we met her in the summer of 2010. Her symptoms had begun while on vacation and rapidly progressed to the point where every position hurt and sleeping had become almost impossible. Thus began her journey to try and find relief.

In the attempt to determine the cause of her pain and the most effective treatment, Lesly embarked on a seemingly endless cycle of being referred from specialist to specialist. Despite countless tests and diagnostic imaging, including x-rays and MRIs, the root cause of her pain was not identified.

She was told repeatedly that she was just “too active” and was asked to consider a change in her lifestyle to help control her symptoms. But a lifestyle change was unacceptable for the former competitive bodybuilder who was a regular at the gym and enjoyed hiking, biking, rock climbing, inline skating, and racquetball (among many other activities). However, with 24/7 back pain, her participation in these activities came to a screeching halt.

Concerned that she was going to spiral into total depression, Lesly began investigating alternative health care treatments (which unfortunately were not covered by her health insurance policy). She tried physical therapists, acupuncturists, and herbal treatments, all with no luck. For a few years she was treated at a pain center and received up to three epidural steroid injections twice a year. She saw an osteopath who provided her with stretching exercises. Although these treatments helped, they provided only temporary relief. So for three years, Lesly did little beyond walking before she succumbed to using prescription medication to help her manage her pain.

Despite her experiencing pain of 8 or higher (on a scale of 0 to 10) on any given day, Lesly decided to try to get back to pursuing her sporting interests. It was then that Lesly had the pleasure of meeting Sarah Thorpe, President of Sports + Spinal Physical Therapy, at a local swim clinic and thus began her journey at SSPT. Sarah had every confidence that the SSPT team could put Lesly back together again, perhaps even better than before, and she was correct.

The first step:

Lesly’s physical therapist (PT) at SSPT conducted a thorough assessment of her functional movement patterns, posture and joint alignment, strength, neural tension, muscle tone and activation, and accessory joint motion. This information, along with a comprehensive patient-reported history and the PT’s experience and clinical reasoning, led her PT to believe that the root cause of Lesly’s back pain was lumbar facet arthropathy that was aggravated on a daily basis by poor posture, particularly in sitting, which put excess pressure on several lumbar levels. Lesly’s poor posture also made it difficult for her very important stabilizing muscles (namely, the transversus abdominus and pelvic floor) to activate in a coordinated manner to support her back when she moved.

As a result, Lesly’s PT initially focused her treatment on addressing her postural deficits. In the first few visits, Lesley received manual therapy that included soft tissue and joint mobilizations to normalize joint mechanics and muscle activation. As an adjunct to this treatment, her sessions also incorporated specific core stabilization exercises and postural modifications, with this treatment significantly diminishing Lesly’s symptoms.

Achieving her goals:

The PT then incorporated additional manual therapy in her plan of care, including deep tissue work targeting her quadratus lumborum, hip flexors, tensor fascia lata, gluteus medius and lumbar paraspinals, and joint mobilizations throughout her lumbar spine. These techniques were applied to reduce the fascial and muscle tension in her musculature and normalize the accessory joint movement in movements such as going from a sitting to standing position. (A tight muscle may prevent proper joint mechanics and lead to trigger point formation, which can refer pain to remote areas of the body and add to discomfort with activity or at rest.) Normalizing Lesly’s muscle tension and joint mechanics reduced her symptoms further.

Each of Lesly’s visits involved slightly different interventions. The interventions included rehabilitative ultrasound imaging, to determine if her transverse abdominus (main core muscle) was activating properly, and specific Pilates exercises (on a reformer and trapeze table), to ensure that the muscles that were being released with the manual therapy were being taught how to function properly again.

The PT combined these precise clinical interventions with specific home-based treatments that included stretching, strengthening, and postural modifications, especially in sitting (because Lesly’s work involved prolonged periods at a desk), to ensure the benefits of each PT session carried over into her daily life. While being treated, Lesly was encouraged by her PT to pursue the activities she enjoyed and instructed how to correctly execute the movements involved.

Lesly made great strides with these interventions. In roughly two months, her pain had reduced from 8 to 2, and even the rare 0. However, she continued to experience nagging pain in her glutes and piriformis. This led her PT to recommend that she try another treatment technique: intramuscular manual therapy (IMT), or trigger point dry needling.

Although Lesly is NOT fond of needles, she trusted her PT enough to try IMT. She began a course of treatment focused on her lower lumbar paraspinals, glutes, piriformis, tensor fascia lata, and proximal hamstrings. IMT was able to release these muscles enough to allow for normal muscle activation and significantly decrease nerve tension, which led to more and more pain-free days.

Lesly is now back to her old active lifestyle and doesn’t even think about pain. She’s biking, hiking, skiing, skating, golfing, swimming, running, and participating in three to four Crossfit workouts each week. In Lesly’s words, “My mind is clear, my body is strong, and I know if I feel the slightest twinge I have my go-to team. Thank you Sarah, Jennifer, and Amy...In fact, thanks to the entire staff at SSPT, from the receptionist to the office manager. My experience has been exceptional.”

If any part of this story strikes a familiar chord with you, please don’t hesitate to call us for an appointment so we can help get you back to doing what you love—with less pain.

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