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In this article, you’re going to discover how treating 8 back muscles with specific exercises cured a lady’s back pain. The most interesting thing? Her pain was believed to be incurable. These exercises were administered by Dr Marcus of the Norman Marcus Pain Institute.
In this exerpt, Dr Marcus describes how he met his mentor – Dr Hans Kraus, and discovered the world of treating muscles, tendons and ligaments for pain.
If you’re interested in seeing these 8 muscles and finding the trigger points in them (a common cause of pain) – check out this free tool here: The Trigger Point Finder >>
Transcript:
I was introduced to Hans, and he asked me what I did, and I told him I helped patients manage their pain, pain management. That is – how to live with your pain, how to still have a productive life in spite of your pain.
He said, “Well, why don’t you just get rid of the pain?”
I said, “Now, come on, it’s chronic, how can you get rid of it?”
He said, “Well, how do you know it’s not coming from muscles?” I said, “Well, I’ve examined them.”
I said, “Well, I’ve examined them.”
He said, “Well, how did you examine them?”
The bottom line was, I didn’t really know how to examine a patient for muscle pain, because I was never taught. It wasn’t taught in medical school, and it’s not taught in any residency, and it’s not taught in any fellowship, because we really ignore soft tissue. 50% of the body, by weight, muscle, tendon, ligament, is pretty much ignored in the paradigm for the evaluation and treatment of back pain.
Hans asked me, “Did I have any patients who failed my program?”
We had this large inpatient program, and a patient stayed for 19 days in the hospital.
I said, “Yeah.”
He said, “Well, can we take a look at one of these patients?”
I said, “Sure.”
Before that, he had asked me what exercises I used.
I said, “Well, we used low-impact aerobics,” which was the exercise du jour at the time. It then became close chain exercise, and now it’s core strengthening. They were all exercise du jour.
Hans said to me, “How could you do any kind of aerobic with somebody with bad back pain?”
I said, “Well, you’re right, that 20% of them couldn’t do any of the exercises.”
That’s when he told me about the exercises that he had created. I was very impressed, and of course, was open to his invitation to see a failed patient.
I chose a patient that I thought he could not help. He was the new guy on the block, he was 85, but I still felt, well he’s the new guy on the block. That’s what you do to the new guy on the block. You give him something that’s impossible. I was sort of a wise guy, saying, “Let’s see what you do with this patient.”
This patient was a 50 year old woman who had had 2 failed back surgeries, and had had 2 myelograms prior to the surgeries. At the time, we were using an oil-based medium, and it sometimes caused arachnoiditis, which is inflammation of the tissue surrounding the spinal cord.
Arachnoiditis can cause really untreatable with horrific pain. I had had patients who had already committed suicide with arachnoiditis, because there’s not much that one could do. It’s scarring around the nerve roots at the end of the spinal cord. We examined this patient, and Hans found 8 muscles, 4 on either side, gluteus maximus, piriformis, tensor fasciae latae, and vastus lateralis, which we considered as one muscle essentially. Then the quadratus lumborum.
He said, “I believe that if we treat these muscles…”
His treatment was an injection protocol that focused on the attachment sides of the muscle, the enthesis, the musculotendinous junction and the bone tendinous attachment. Then following that, there was 3 days of a very structured physical therapy protocol where you did neuromuscular stimulation to the muscle that was injected, causing the passive contraction.
Then using his basic exercises after that for 3 days, with restrictions on the patient’s ability to walk more than 5 minutes without a stop, not sit for more than 30 to 40 minutes without getting up and moving, at least changing position, no prolonged positioning. We did that with this patient, because we could only do 2 muscles a week with the protocol. We did the 8 muscles in 4 weeks, that was 1 month. She had been on 60 milligrams of oral Morphine every 4 hours around the clock, then she couldn’t work. After treating those muscles, she stopped taking the Morphine, she reported n0 pain, and went back to work.
It was an epiphany. I said, “This is impossible. This can’t happen because she has arachnoiditis, and arachnoiditis is untreatable.”
What I had to get through my mind, was that even though she carried the diagnosis of arachnoiditis, that wasn’t the cause of her pain at that moment in time – it was muscles. I had no paradigm to address that in terms of an evaluation technique, or treatment technique.
I had to think to myself, “How many patients am I seeing now who I assume can never get rid of their pain, because they have some underlying diagnosis like failed back surgery syndrome, or herniated disc, or spondylolisthesis, or diabetic neuropathy, or impingement syndrome, or rotator cuff tear, or cervical radiculopathy – and because they have that diagnosis, do I really know if their pain might not be coming from muscles, and therefore be treated, and perhaps even eliminated?”
I started to assess with Hans’ help, all the patients that I was seeing from a soft tissue perspective.
What it did was essentially destroy my business model, because we stopped hospitalizing half the cases that we were hospitalizing, because we got them better, because we found that indeed muscles were the cause of their pain, and if we treated them with a variety of approaches, that we could eliminate or significantly reduce their pain.
There’s also the energy crisis theory of trigger points. What it essentially says is that there’s an area in the muscle that somehow has become traumatized in some fashion, maybe repetitive use, or some blunt trauma, or an athletic injury, and that area tightened up with the trauma.
That tightness in that part of the muscle squeezed its own blood supply and created an area of low oxygen, hypoxia. This hypoxia is associated with lowered pH, a certain amount of acidity there. That is enough to stimulate the pain fibers, we don’t call them pain fibers, we call them nociceptive fibers, because they’re fibers that transmit the experience of damage in the tissue.
Pain is only felt in the brain, so these are the fibers that bring to the brain the information telling you that some sort of damage has occurred. When those fibers are stimulated, they release chemicals such as substance P, calcitonin gene-related peptide, somatostatin. From the small vessels, the arterials, is released prostaglandins, bradykinin, and we have from platelets serotonin being released, and from mast cells, which are these little cells that are hanging out, that are also part of the inflammatory process, we have histamine being released.
All of these chemicals together create this neuro vasoactive soup that re-inflames the nerve, and that can go on indefinitely. What happens is that, that soup makes the vessels permeable and may leak some fluid, and gives you a little bit of swelling, so when you press there, you have these little knots sometimes in the muscle. That area has all of those chemicals, lowered oxygen, lowered pH. f we traumatize that tissue, we bring in inflammation from the damage, so new blood comes in, can bring in oxygen to the area, can wash out the chemicals, and can repair the calcium pump.
If we traumatize that tissue, we bring in inflammation from the damage, so new blood comes in, we can bring in oxygen to the area, can wash out the chemicals, and can repair the calcium pump.
The calcium pump is the metabolic process in the cell that allows the cell to take out the calcium ion from the muscle fibers, actin and myosin are the fibers in the muscle, they come together when the muscle is contracted. In order to relax the muscle, you need to take the calcium, which binds the actin and the myosin together out of the actin myosin complex.
The mechanism that does that is the calcium pump, and the calcium pump runs on ATP, adenosine triphosphate, which is the energy molecule in the cell. If we don’t have enough oxygen, we don’t produce enough ATP, so the calcium pump doesn’t work well.
If we can bring in more oxygen, we can produce more ATP, we can repair the calcium pump, we can relax the area, and now we can normalize blood flow, and hopefully normalize the tissue if we can restore normal length and flexibility to that tissue. Which is what the myofascial injection physical therapy protocol attempts to do.