Issue link: https://www.massageandbodyworkdigital.com/i/72195
ESSENTIAL SKILLS I first learned this lesson years ago when I was living in Oregon. I was working with several physicians who were treating 30 or 40 patients with intractable low-back pain that had lasted anywhere from three to 20 years. Most of these individuals had already pursued various medical and alternative routes: everything from surgery to acupuncture and Rolfing to massage. Several of these patients had been to live-in pain clinics, and many had been referred to psychiatrists for psychogenic (imagined) pain. I had been called in to consult with several of these doctors about some of their patients and was as confused as they were. At my suggestion, we invited a physician we had heard about through one of Dr. James Cyriax's books to come and see if he understood what was happening in these intractable cases. He taught us more than we expected and changed my perspective about back pain forever. In case after case, he showed us that the sacrum had rotated, leaving one side of the sacrum more posterior than the other. In some instances the hip bones were out of balance, with one side raised or twisted. This seemed interesting, but not that impressive at first. However, he then explained that when the sacrum was rotated or out of alignment, it created a shearing stress in the ligaments on one or both sides of the sacrum (pain on one side as opposed to both was dependent on the angle of rotation and the degree of the torque). He then proceeded to explain why these patients did not generally respond to treatment. He said that these sacroiliac ligaments had become lax and the bones were therefore unstable; while manipulation would often correct the rotation and temporarily relieve the symptoms, the patients' ligaments were too loose for the bones to stay put. After seeing these dramatic improvements, I became convinced that the ligaments of the sacrum were at fault in most cases of severe, intractable low- back pain. He then taught the physicians how to inject all of the major ligaments in the low back and sacrum with xylocaine (the numbing medicine your dentist uses) to illustrate his diagnosis. He surmised that if he was correct and the ligaments were causing the pain, the xylocaine injections should make the pain disappear for 15 or 20 minutes. If he was wrong and the cause of the pain was a disc or arthritis or strained muscles, then the xylocaine would have no effect. We agreed to see his hypothesis through, but we were still quite skeptical. I'll never forget what happened next: under his guidance, one of the doctors used injections to numb the ligaments of each patient's sacrum. In case after case, the patients could bend and twist and lift things without pain while the xylocaine was in effect. All sorts of strange pains disappeared for a half hour or so. After very clearly making his point, he went on to teach the physicians how to treat these ligament problems so the pain would disappear permanently. About 40 people, with some of the most difficult back pain problems I had ever seen, were treated over the next several months with these methods. Most of them healed completely, some noticeably improved, and only a few were not helped substantially. When we followed up on these patients a year or so later, 85 percent were still well or had even improved further. After seeing these dramatic improvements, I became convinced that the ligaments of the sacrum were at fault in most cases of severe, intractable low-back pain. As the years went on, I began to suspect that these structures were often at fault in less severe cases as well. In the next article, we will look at the assessment and various treatments for these injured ligaments. education and sports medicine. He is founder of the Muscular Therapy Institute. Benjamin has been in private practice for more than 40 years and has taught communication skills as a trainer and coach for more than 25 years. He teaches extensively across the country on topics including SAVI communications, ethics, and orthopedic massage, and is the author of Listen to Your Pain, Are Your Tense? and Exercise Without Injury and coauthor of The Ethics of Touch. He can be contacted at bbby@mtti.com. Note: Massage & Bodywork is dedicated to educating readers within the scope of practice for massage therapy. Essential Skills is based on author Ben Benjamin's years of experience and education. The column is meant to add to readers' knowledge, not to dictate their treatment protocols. Ben E. Benjamin, PhD, holds a doctorate in massagetherapy.com—for you and your clients 109