Think Your Pain Symptoms are Caused by a Structural Problem? Think Again.

Have you or a loved one ever been in that uncomfortable position of asking a health provider:

“What is the cause of my back pain?

“…shoulder pain?”

“…neck pain?”

or some other painful condition? And your well-meaning nurse, doctor, or physical therapist was kind enough to do a “diagnosis” with an MRI or X-Ray, solemnly telling you afterward that the cause was:

a torn rotator cuff

degenerative disc disease

disc protrusion

or some other scary and official sounding “cause”? And those explanations sound convincing, do they not? If a person has intense and recurring back pain and someone shows them an x-ray with a “herniated disk” that disk must be the cause, right? After all, SOMETHING must be causing the pain. It is difficult to not associate pain that with some type of structural abnormality…especially when someone who is supposed to be an authority on pain tells you so.

But do structural anomalies cause pain?

Is it true that disk protrusions, torn rotator cuffs, herniated disks and the like actually cause pain? It’s not a trivial question. If a surgeon believes a spinal problem is causing a pain symptom, he or she may want to conduct an expensive and invasive surgery to “fix” the structural “problem.” The “cure” could cost tens of thousands of dollars and require months of recuperation. It might be nice to know if structural abnormalities are a necessary and sufficient cause of pain.

I’m not going to directly answer the question of whether so-called structural problems cause pain symptoms. You will have to be the judge. I will give you some information from several studies that demonstrate how many people with structural issues are, in fact, pain-free. In other words, the research shows that some people have pain “causes” and yet do not report pain symptoms. Let’s begin.

Pain and the Lower (Lumbar) Spine

The first research I will cite was conducted in 1991 and reported in the Journal of Neuroimaging (cited in PubMed). The researchers used magnetic resonance imaging (MRI) to examine the lumbar spine (the lower part of the spine) of 66 asymptomatic people. Asymptomatic means they had no back pain.

Given that they had no back pain, they had structurally perfect lower backs, right?

Not so fast.

Twelve of the people in the study (18%) had either a disc protrusion or a herniated disk of some kind. Twenty-six of the people in the study (39%) had a bulge that could associated with degenerative disc disease. In addition, there were many other structural issues found, including spinal stenosis, and narrowed nerve root canals. The researcher’s conclusion? “Degenerative disc disease is a common finding in asymptomatic [pain-free] adults…”

Pain and the Cervical Spine (Neck Region)

Next up, a more recent study, reported in 2005 in the European Journal of Radiology (PubMed). This study examined the cervical spine of 30 pain-free individuals. The cervical spine is the seven vertabrae at the top of your spine, beginning at the base of the skull and ending near the top of your shoulders. Again, 30 people who have no reports or history of pain near the cervical spine likely have no structural problems in that area, right?

Au contraire.

An astounding 73% of the sample (22 of 30) had a “bulging disk”! Fifty percent of the sample had a “disk protrusion”. The thought occurs to me that if the majority of the sample had a bulging disk perhaps having a bulging disk is normal? In that particular sample it certainly was not out of the ordinary. Let’s do one more.

Shoulder Pain and the Rotator Cuff

This one is from the Annals of The Royal College of Surgeons of England and was published in 2006 (Full-text online: Dead Men, and Radiologists Don’t Lie). This study is a review study, meaning they did a review of many different studies that had already been conducted. They reviewed the prevalence of rotator cuff tears in people who had reported pain and people who had not. Interestingly, they reported on studies of living people as well as cadaver studies of people who had died. In the cadaver studies, on average, people who had pain symptoms in the shoulder area had rotator cuff tears at a rate of 42%. Meaning that only 42% of those who were in pain had a rotator cuff injury. And for those without any pain? About the same: 39% of them had injuries.

The study of living people was a bit different. According the the studies 26% of pain-free people had rotator cuff injuries and 49% of those in pain had injuries. The researchers concluded that “rotator cuff tears demonstrated radiologically during investigation of the shoulder may well not be responsible for the presenting symptoms.” In plain english, rotator cuff injuries might not be the cause of pain symptoms.

You’ve got the take home message by now? According to the research, pain and structural problems are not necessarily related. Be wary when someone tells you that they are, even if they have an X-Ray or MRI scan to “prove” it. Get a second opinion. Look for other factors.

I am not a medical doctor, nor am I giving medical device. I am merely reporting on the literature that has been produced. Do not make any medical decisions based on my opinions.

Tags: Medicine, Physical therapy, Research, Rotator cuff

Upcoming Podcasts, Plus Feldenkrais Mp3 Discount Code

Chava and Ruthy Podcasts

I am slowly working my way towards podcasts with Chava Chelhav of Child’Space fame and (I hope) Ruthy Alon, creator of Bones for Life. More than just students of Moshe Feldenkras, Chava Chelhav and Ruthy Alon are thinkers and innovators in their own right and I am looking forward to speaking with each.

The hold up, as usual, is my own schedule and the multitude of projects that I am working on. Check back for more details.
   

Feldenkrais Mp3’s: 50% Discount

For the first time ever, I am discounting the mp3 downloads from my Feldenkrais store (a full 50% until 11/30). I am doing this for several reasons.

First, sales have been down the last few months, and I want to get them back up again. Second, there are still many Feldenkrais practitioners, students, and aficionados who have not learned how simple and easy it is to purchase and use downloads. Third – and most importantly – as technology continues to change and as people continue to want greater access to materials, the demand for instantly accessible mp3’s and transcripts and other products is only going to increase. Learn about them, so you can continue to evolve YOUR method and practice.

The discount code is “PEACE” and it takes 50% of at checkout. You can pay with any major credit card via GoogleCheckout or Paypal. The process is as “safe as kittens.” Both services use SSL which is military-grade data enrcyption, meaning all of your sensitive data is encoded. And I never have access to the info, I only get your name and email address. (Expired)

Try it out: Feldenkrais mp3 Downloads.

Tags: Feldenkrais mp3

Feldenkrais Methods and Viral Marketing, Part 1

Every so often a member of one of the Feldenkrais communities will approach me about viral marketing – a way of using internet technologies to help an idea or product spread very rapidly online.

To date, I have not agreed to do any viral marketing campaigns for anyone in the Feldenkrais community.

Why?

There are four reasons. They have to do with remarkability, accessibility, ease of delivery and trust.

Remarkability and Accessibility

Ideas that spread on the internet are ideas that are remarkable. That is, a person has to really like your idea in order to send it to another person. It has to be outstanding, unique, curious, fascinating or have some other quality that really makes someone WANT to share it with friends. And part of that remarkability is being able to understand your idea. If it’s too complicated not enough people will know what to do with it.

Ease of Delivery and Trust

Likewise there needs to be a delivery method that is quick and easy and that has trust built in. People need to trust you and you idea for it to spread.

So far, no one has approached me with an idea that fits the four criteria above and has not been able to convince me that they will make the changes necessary for viral marketing success.

Let me give you a specific example of a successful viral marketing campaign.

Viral Marketing Example

An old (in internet terms) but hugely successful viral marketing campaign was Hotmail email. It was a company that offered free email accounts. It was so successful that it was adopted by 12 MILLION users in less than two years.

How did it do so? At the time, many people already had email addresses, but they were through a paid service such as AOL, or through their employer. Having a free email not tied to work or home? That was remarkable and needed. And what about those that wanted email but couldn’t pay for internet access? They too could get their own free email. It was remarkable for them as well. But just as important, it was easy to understand. “Free” and “email” are concepts that most people understand already. So there was a low cognitive load in understanding the offer.

But something can be remarkable and accessible but hard to spread. This is where hotmail did something simple, but brilliant. They created a built in delivery method for their virus. At the end of very email sent from it’s account was the tagline:

“Get Your Private, Free Email from Hotmail at www.hotmail.com”

Every time that someone sent an email they were advertising the service! And not only that, but if you got an email from a friend, or several friends, who were already using hotmail, then you had a built in reason to trust the system. If your friends, were using it, it was likely OK, right?

Are you following me here? Remarkable, accessible, easy to deliver and trustworthy. Those are a few characteristics needed for a viral marketing campaign. There are others. We will cover them in a later blog post, part two of this series.

Are you ready to go viral?

What could you do to make your practice more remarkable? What could you do to make your ideas more accessible…and easier to share and…trustworthy? Of course, this isn’t just about viral marketing, but about marketing in general.

Here are a few website suggestions:

1) Remarkability. Is there a clear statement of what you do on your website? Is it remarkable? Is it emotional? Does it specifically connect with the need or desire of a particular person or group?

2) Accessibility and Ease. How easy is to contact you? Is your contact info on every page? Do you make it clear that you want people to reach you? Do they know that they can talk to you free of charge to see how you can benefit them?

3) Trust. Do you have a picture of yourself on your website so that people can see who you are? Are you smiling in the picture? Do you have testimonials on your site so that people can see that others trust you?

Good. Now, you are ready to start thinking about viral marketing.

Your Feldenkrais Viral Advantage

In future posts, I am going to write more about the specifics of viral marketing. I am going to show you how this website gets a substantial amount of traffic through Facebook, other blogs, and the search engines such as google. This will be information that you can use immediately for your own products and services.

For now, whether you are a practitioner of the Feldenkrais Method, Bones For Life, Child’Space, Sounder Sleep, Core Integration, or some other Feldenkrais-based or inspired method, I would like you consider your viral advantage.

You have a huge advantage (HUGE) compared to a physical therapist, massage therapist, doctor and other health practitioner.

Do you know what it is?

It’s part of the elusive obvious of the modern networked world that we live in. More in the next post.

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Tags: feldenkrais method, Marketing, viral marketing