These are the lectures at medical conferences, articles and video tutorials Dr Stoxen has done to help you learn about his approach to examining, treating and preventing foot and ankle conditions.
The Functions Of Your Bodies Spring Mechanism
- Your spring engineering is what allows you to safely land your body when walking, so the impact doesn’t put stress on your joints, which can lead to early degenerative arthritis and chronic pain.
- The spring mechanism provides the engineering to recycle energy during walking and running to allow you to be most efficient, so locking of these mechanisms can lead to chronic fatigue.
- Most important, the discs of your spine are engineered not as a shock absorber but with spring mechanics to maintain the safe passage of nerves. That is why doctors have such a difficult time understanding, evaluating, and treating herniated discs.
We know the Spine is a Spring but what does the doctor do?
Doctors examine and treat you as a lever mechanism when, in fact, you are a combined lever and spring mechanism. Subsequently, the rehabilitation process focuses on restoring the lever component, while your spring mechanisms remain compressed or locked.
This is when exercise actually accelerates the aging of the body rather than reverses it.
Are you starting to get the picture?
Elastic deformation is good.
The definition of elastic spring deformation is when an object deforms its shape, stores energy when it deforms, then reforms to its exact original shape, releasing the energy it stored. The word exact is important. Elastic deformation is good, because your spring does not become damaged.
Plastic deformation is bad.
Plastic deformation occurs when you compress or stretch a spring. It changes its shape but does not snap back to its exact, original shape. It is deformed permanently.
This can happen instantaneously, with an abrupt change of the shape of the spring, like when you experience a herniated disc.
A herniated, bulged, or slipped disc is a plastic deformity of the compression spring in your spine— which is a torsion spring. The disc deforms its shape during loading but can’t reform to its original shape. Continued pressure on the disc maintains it in a deformed shape.
Release the compression on the spring, and the bulging disc pressure is reduced, relieving the radiating symptoms and pain. This happens fairly routinely every day in my practice when treating patients with herniated discs.
When the human spring has to fight the forces of gravity for a sustained period of time, muscles can weaken, fatigue, and even go into a pathological contraction state, causing a pathologic compressive state leading to compressive disorders, such as thoracic outlet syndrome and accelerated aging of the joints, called degenerative joint disease.
This was the primary point of my keynote presentation, “The Sports Medicine Approach to Anti-Aging Medicine,” delivered at the Seventh Annual Thailand Congress on Anti-Aging and Aesthetic Medicine in Bangkok, Thailand, presented in September 2015.
In this presentation, I said that pathologic spring tension, caused by predictable patterns of abnormal muscle tension, is the primary cause of compressive disorders, such as herniated discs, thoracic outlet syndrome, degenerative joint disease, and accelerated aging. No doctor in the audience disagreed.
Compression of Your Spring Can Reduce Human Performance and Cause Early Fatigue
In 2014, I was approved to give a presentation at the World Congress in Sports and Exercise Medicine titled, “Athletes, Coaches, Trainers and Physicians Can Improve Human Performance by the Earliest Detection, Intervention and Prevention of Spring Stiffness over Modulation.”
In this lecture, I presented scientific studies that demonstrated how the body can exert an over control of the tension on the bodies spring mechanism. It happens with these super contractions controlled by your nervous system. I discussed how that can reduce human performance in sport and activities of daily living. I taught the doctors how can detect the abnormal spring stiffness and how to reverse it.
For many of you it’s worse than just a reduction in human performance it is thoracic outlet syndrome and widespread chronic pain caused by compression of the entire human spring.
These constant, protective, superspasms can cause a variety of problems for you.
- A slight tension can cause friction and drag on the spring, leading to early fatigue. A full compression of the spring won’t allow it to recycle energy through this natural spring mechanism, leading to chronic fatigue and even chronic fatigue syndrome.
- More tension can cause stiffness in the neck, upper back, shoulders, arms, and hands, leading to compressive conditions, such as thoracic outlet syndrome, headaches, neck pain, cubital tunnel syndrome, median nerve compression of the forearm, carpal tunnel syndrome, and compression of Guyon’s canal.
- Added contractions can compress joints, such as the knees, hips, and spine, and cause accelerated wear and tear and chronic arthritis during years or decades. This might end up necessitating joint replacements or other radical surgery that was never necessary.
These muscular compressions can preload your spring, putting you at risk for herniated discs in the spine. What do mainstream physicians think of trigger points? More than 1,600 American Pain Society members were surveyed in 1997 about their opinion of myofascial pain syndrome. Approximately 89 percent of respondents reported that myofascial pain syndrome was a legitimate diagnosis, with 81 percent describing myofascial pain syndrome distinct from fibromyalgia (17).
So, why don’t doctors short-circuit these self-perpetuating reflexes that are leaving you in a chronic state of compressive suffering?
- Some doctors don’t know these superspasms exist, because they don’t touch you in the examination.
- Other doctors don’t have the skills in their hands nor the experience to know what is a normal muscle or what is an abnormally contracted muscle.
- Most doctors don’t want to take the time to go so deep into the examination and treatment.
- All doctors earn a better living giving injections and performing operations.
A friend tells you it’s better to get an MRI scan, so you demand the doctor order an MRI. He agrees. Now, you think this doctor is getting down to business!
Your MRI scan comes back and sure enough the radiologist’s report reads you have a herniated disc at level L4 , L5 and C5 and level C6 to a lesser degree.
The doctor walks into the room and says, “I found your problem. You have two herniated discs in your back and neck.
You can get physical therapy and traction and if that does not work we can try injections. If that doesn’t work we will have to do surgery.”
How could this happen?
You saw those herniated discs on the MRI yourself.
If you are getting an MRI scan and want to know the facts rather than just let your doctor determine your fate you must know the facts just in case your doctor doesn’t.
For instance, Japanese researchers at the Department of Orthopaedic Surgery, Keio University, Tokyo, Japan, did MRI scans on 94 volunteers who had never had neck or back pain. The average age of the people tested was 48 years old. Here are the surprising findings on the MRI scans of the patients who had absolutely no pain.
- 46% of the patients had degenerative changes between the discs at one or more levels
- 2% had degenerative changes between the discs
- 30% had disc protrusion (slipped disc, bulged disc, herniated disc)
- 29% of them the discs were pressing on the covering of the spinal cord
- 4% had visable disc narrowing
Surprisingly, more than 30 percent of these volunteers had herniated discs in their necks they didn’t know they had. (1)
So what if you are one of those patients who had a herniated, bulged or slipped disc for years that never caused you pain? The doctor does an MRI scan, sees it, blames the numbness and pain on it and recommends neck surgery to remove your disc when it never was and isn’t the cause of your pain.
Another study done at the Keio University School of Medicine, Tokyo, Japan studied degenerative changes in the cervical (neck) intervertebral discs, posterior and anterior disc protrusion, narrowing of the disc space and foraminal stenosis in 497 asymptomatic subjects by MRI scan. (2)
None of these volunteers had neck pain and none of them had a previous history of neck pain, disease or trauma to the neck or brain, which had needed medical care. Degenerated discs were found in the younger patients in their twenties.
- 17% of men in their 20s who had no history of pain had degenerated discs
- 12% of women in their 20s who had no history of pain had degenerated discs
- 86% of men in their 60’s who had no history of pain had degenerated discs
- 89% of women in their 60’s who had no history of pain had degenerated discs
So degeneration of the discs is a common concequence of aging but you cannot say it is normal because there were many in their 60’s who did not have degeneration of their discs.
Disc protrusions, bulged, slipped or herniated discs were found on these pain free subjects.
- 27% of the patients had posterior disc protrusions
- 17% had anterior disc protrusions
The finding that was shocking was that 7.6% or 38 of the 497 pain free subjects had a Grade-2 posterior disc protrusion, with spinal cord compression.
Posterior disc protrusion with spinal cord compression means that the spinal disc has bulged so much that it has dented or compressed the spinal cord.
If a doctor found a grade 2 herniated discs with visible spinal cord compression on your MRI you would be hospitalized immediately and prepped for emergency spinal surgery in many cases. So many of you are walking around with a severely herniated disc or two and you have no pain.
What if the real cause of your symptoms was a compression of the thoracic outlet but the doctor did an MRI scan and found a severely herniated disc compressing the spinal cord? Do you think the doctor would be recommending surgery? Of course! This is when diagnostic tests can lead a doctor to do medical procedures that are not medically necessary.
Also, don’t forget, after you have your back or neck surgery for the herniated disc that was not the cause of your symptoms you still have the real cause of the compression nerve and the original symptoms plus maybe a few more from the surgery you didn’t need.
Doctors Think Diagnostic Tests Are All They Need to Make the Diagnosis
Doctors are learning less and less anatomy and certainly almost no biomechanics. They don’t think they need to know so much, because they can always order an MRI. Do you need these diagnostic tests or is it just that your doctor needs them because his exam skills are not adequate and neither is his understanding of the thoracic outlet anatomy? This might be the real reason your doctor ordered the MRI.
You don’t know much about these tests, and you definitely cannot determine if a herniated disc found on the MRI is the cause of your symptoms or just an old herniated disc from 25 years ago you did not even know you had.
So, a doctor could easily look you in the eye and say, “It is medically necessary to do this test to determine what’s wrong with you,” and you would have to believe him. The doctor will show you right on the MRI the obvious herniated disc on the study, read the radiologist’s report to you, and you would have to say, “The cause of my pain is the herniated disc, and if the physical therapy and injections don’t work, I’m headed for surgery.”
Some doctors have good intentions. Some think they are doing what is right. Others have no idea what they are doing.
You really need to know if a test is medically necessary and if the findings are going to help your doctor decide the best course of care for you or throw the doctor off the right course.
MRI Abuse Can Be Dangerous and Expensive for Patients
Chris Rangel, MD, asked the question, “What is MRI abuse?” in his article, “MRI Abuse Can Be Dangerous and Expensive for Patients.”
These are the erroneous assumptions that he says providers make about MRI scans.
- MRI will usually yield a correct diagnosis.
- MRI will usually rule out a serious condition.
- MRI is the BEST of all imaging studies.
- MRI will usually help direct further evaluation efforts and lead to the correct treatment.
- MRI is without risks.
- The costs for an MRI do not matter.
It’s been my clinical experience that oftentimes MRIs can pick up many abnormal findings that can often confuse the clinical picture and lead the doctor to a radical procedure you never needed.
If you walk into a doctor’s office and demand an MRI, you are just begging for surgery. A positive MRI is not a ticket to the operating room.
Doctors are just beginning to understand that a visible finding on an MRI scan is not a ticket to the operating room.
Dr. James Andrews, a well-known orthopedic surgeon in Birmingham, Alabama, wanted to see if positive results from MRI scans could be misleading doctors to recommend shoulder surgeries that weren’t necessary. He scanned the shoulders of 31 perfectly healthy, professional baseball pitchers with no injuries or pain.
In 90 percent, the MRIs showed abnormal shoulder cartilage. In 87 percent, the MRIs showed abnormal rotator cuff tendons. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. Andrews said in a New York Times article (4).
Now, more and more people have scans for everything, from headaches to foot aches. Doctors do use MRIs as fishing expeditions to find something to operate on. These scans are easily misinterpreted and can result in misdiagnoses, leading to unnecessary or even harmful treatments, including unnecessary surgeries and the complications that come with them.
What about a herniated disc of the neck?
What about a herniated disc of the neck pinching the spinal cord?
Doctors see something on a scan and quickly assume that is the cause of the symptoms. But there are many people walking around with abnormal findings, such as herniated discs in the lower back, torn rotator cuff tendons, and even herniated discs in the neck compressing the spinal cord, and they have no symptoms.
In one study, doctors reviewed MRI scans for 35 patients who previously had MRI scans to determine the cause of symptoms of the larynx. These patients had no symptoms of neck pain or spinal cord symptoms. They found disc herniations or bulges in these 35 cases, so they expanded the study to a total of 100 patients.
What they eventually found was disc protrusions or disc bulges in 44 of 100 cases and disc narrowing in 70 percent of the patients. Twenty-four patients had bone spurs and four patients had very large bone spurs impinging on the spinal cord. In fact, they found 20 of the patients had impingement of the spinal cord (3).
So, if your doctor does an MRI scan the first day and immediately tells you your pain is coming from a herniated disc found on your MRI, you need to get a second opinion immediately
Cervical Disc Injury (Cervical Disc Herniation)
Herniated discs are caused by trauma, such as a car accident (whiplash), a bump on the top of the head, a fall on the head, sports trauma, or a lifting injury, causing compression of the neck.
These discs are fairly tough, so you would have had to have a substantial hit to herniate a disc. If you do not have substantial trauma, but your MRI scan reveals a herniated disc, it is highly unlikely that the herniated disc is the cause of your pain.
Many patients who come to me have had MRI scans, which show herniated discs. After they are treated for two to three weeks and free from pain, they ask me “Where did the disc go?” If I did another MRI, the disc herniation would still be there.
The difference is there is no pressure on it, so it cannot press on the nerve to cause numbness or radiating pain. So herniated, slipped, bulging discs aren’t the problem. The compression on the spine from the muscle contractions squeezing the disc is the problem.
You could hypothesize that if you release the spasms around the disc, there wouldn’t be sufficient pressure to cause radiating pain, and you would be right. Discs usually herniate on only one side.
If you have numbness on both sides, then the numbness is usually not from the disc herniation. If a disc herniates up the middle (central), then it could radiate down both arms, however, it is highly improbable. I have not seen this in 30 years.
For your doctor to suspect that herniated disc is the cause of your pain, you MUST have a trauma associated with the disc herniation and severe pain leading right into the date of your examination. Discs don’t herniate while you sleep, while at the computer, when using the cell phone too much, or too much overhead work.
Your symptoms should match the exact date of the trauma. If you can see deposits or spurs on an X-ray, then they are at least six or seven years old. The date of the onset of the symptoms should match the age of the disc herniation. If not, then it’s probably not the diagnosis or the cause of your symptoms.
A disc injury will affect the nerve in the one area where the disc is herniated. It maps out a pattern on the arm and hand that is fairly predictable. The pattern of numbness and tingling of thoracic outlet syndrome is more random on the entire arm.
How to Understand the Findings of an MRI Scan of the Neck
If you have the findings that suggest a herniated disc from an MRI scan, it does not automatically mean it is the cause of your pain.
- If there is no mention in the radiologist’s report of the disc encroaching or impinging on the nerve, then the disc is not pinching the nerve. If a medical radiologist sees a disc pinching a nerve, he or she will say so, because it is a significant finding for the treating doctor to know.
- If the report states that the disc is encroaching or pushing in on the thecal sac, it only means that it’s pinching the covering around the nerve and not the nerve.
- If the report states that the disc is encroaching on the nerve, it still doesn’t mean this is the cause of symptoms, such as pain, radiating pain, numbness in the extremity, or weakness. Many asymptomatic people have herniated discs that show direct pressure on the nerve but have no symptoms.
At this time in my life, I would like to mostly work with cases that are extremely difficult to reverse or those patients who have been to many doctors and tried everything, yet have made no progress on their TOS or herniated discs.
If you have a herniated disc I can help you. Call our office and let’s talk about this.