Pain which emanates from the musculoskeletal system may be due to damaged structures.  Examples include broken bones, torn ligaments, injured/degenerated discs, compressed nerves, inflamed tendons or joints, and so forth.  When those damaged structures can be clearly identified as the source of pain, they are often successfully treated with medications, injections, surgery, and/or physical methods.

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However, all too frequently individuals experience severe, persistent pain and, after undergoing standard clinical exams — sometimes from multiple specialists — along with imaging studies, lab tests, and other — sometimes invasive — evaluations, no explanatory structural damage can be found.

 

In turn, these individuals often seek relief from a wide variety of other modalities such as "trigger point" injections, "cortisone" injections, "nerve blocks", manipulation to "align" the spine or body, "cranial-sacral therapy", massage, "manual therapy", stretching, yoga, Pilates, Feldenkrais, "work hardening", and acupuncture. Some of these methods provide temporary relief either by "deadening" the nervous system or by flooding it with stimuli, which, in either case, blocks the perception of pain.

 

In contrast, some techniques actually improve, at least temporarily, the function of the symptomatic region and, thus, relieve pain. If, at least, partial pain relief is achieved by these function improving methods, then there is a reasonable probability that the pain is caused, not by overtly damaged structures, but by structures that are relatively overused. Overused structures become irritated and eventually malfunction (which compounds the irritation). When, unfortunately, the malfunction and pain recur, it is often because the sources of the irritation and malfunction have not been addressed.

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Malfunctioning structures manifest as disturbances of functional biomechanics, in other words, of posture and movement.  However, until now, there has not been a standardized, reproducible, semi-quantifiable, and consistently interpretable method for determining these disturbances.  As a result, when no structural damage can be found, there is often doubt and controversy regarding the genuineness and severity of the pain.  Consequently, social and economic supports may be severely strained, and — as frustration mounts — more pain, discouragement, and disability may develop. Additionally, overtime, considerable expense may be incurred, as continuing care is required to maintain some semblance of comfort.  This is called “maintenance care.”

 

In contrast to maintenance care, “restorative care” is characterized by finding and eliminating the source(s) of the persistent malfunction.  The likelihood that the cause(s) of symptomatic malfunction can be discovered is significantly increased by employing a new method of physical examination, which my colleagues and I have developed during the last four decades.

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One distinguishing feature of the exam is that the entire musculoskeletal system is examined regardless of where the pain is located.  We do, after all, function with our whole body — when we walk, rollover in bed, get in and out of cars, as well as a vast variety of other routine daily activities, and certainly when we engage in more complex activities such as physical labor, dance, and athletics.  Consequently, we also potentially malfunction with our entire bodies. Very frequently the cause of symptomatic malfunction is malfunction of non-symptomatic regions. Therefore, unless the entire body is examined, those "key" (primary) malfunctions may be overlooked. Thus, the whole body must be examined in order to understand the dysfunctional context of any symptomatic area. 

 

A second distinguishing feature is that the exam takes into account the fact that optimal movement patterns vary widely between individuals.  Some movements that are interpreted as “normal and symmetric” by traditional examination criteria (for structural damage and for malfunction, respectively), may be revealed by this exam to actually be substantial malfunctions.

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A third distinguishing feature of the exam is that the data obtained are reproducible, semi-quantified, and consistently interpretable based upon the concept of proportionality, of which the concept of symmetry as traditionally employed by the osteopathic profession is but a subset.

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As a result, an examiner using this method is much more likely to find the source(s) of the symptomatic malfunction - as these are usually the proportionately most severe limitations of available motion along with the most distorted patterns of control of posture and movement.  When these primary malfunctions are discovered and restored to proper function, many secondary and compensatory disturbances, either spontaneously or with comparatively less treatment, improve and are much more likely to stay improved.  Consequently, chronically irritated and painful structures — which are typically functioning in a compensatory manner for malfunctions elsewhere — are given a chance to “heal” and chronic pain improves or even resolves.

 

This approach to pain problems may also complement the care of damaged structures in two ways. First, when capacity of the entire system is improved, damaged areas are put relatively at rest and, at least, continuing irritation subsides.  Second, when healing is not probable, such as in advanced osteoarthritis of the hip or spine, areas of improved function can more effectively compensate for the defective structures and an improved quality of life results.

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Because the exam is standardized, reproducible, semi-quantifiable, and consistently interpretable, it also has great utility in several other respects:

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1.  It provides guidance as to the appropriateness of further care, which is warranted as long as objective improvement in function is being achieved along with appropriate symptomatic response.

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2.  It may demonstrate that comprehensively restoring function is not sufficient and, thus, that further investigation for structural damage/insufficiency or for perpetuating illness/deficiency is needed.

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3.  It provides objective evidence for recommendations to and opinions for third parties such as insurers, attorneys, employers, and family.

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The therapeutic methods I use to restore function include most forms of osteopathic manipulative medicine (including osteopathic cranial manipulative medicine) and complementary exercise prescription.

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Disclaimer: the information contained on this website is not to be understood as

medical recommendations or professional advice.