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Screensize: 640 x 480 800 x 600 1024 x 768 1280 x 1024 UserName: Password: Format Mode: Basic  Help  Prompt  Format: Font Andale Mono Arial Arial Black Book Antiqua Century Gothic Comic Sans MS Courier New Georgia Impact Lucida Console Script MT Bold Stencil Tahoma Times New Roman Trebuchet MS Verdana   Size 1 2 3 4 5 6   Color Black Red Yellow Pink Green Orange Purple Blue Beige Brown Teal Navy Maroon LimeGreen Message: * HTML is OFF * Forum Code is ON Smilies [quote][i]Originally posted by shawnsmith[/i] [br]TO BE OR NOT TO BE … PAIN-FREE THE MINDBODY SYNDROME by MARC D. SOPHER, M.D. **************** Chapter 18 HIPS, KNEES AND LEGS I’d like to start by stating that total hip joint replacement can be a miraculous surgery. However, just as CT scans and MRI studies of the spine show degenerative changes in most of us as we age (usually incidental and not the cause of symptoms), so, too, will hip x-rays often reveal degenerative changes that are not the cause of symptoms. This case proves this point. Jack was a former athlete, now in his 40’s, with left hip pain. His orthopedist told him that he would benefit from a new hip joint as his x-ray showed “significant” degenerative changes. After this visit his left hip pain increased and he mentioned it to me at the time of his annual physical exam. When he told me that his right hip felt fine, I asked him to humor me by having both of his hips x-rayed. On x-ray, both hips had the same “degenerative” changes, yet his right hip did not hurt! I advised him to put off surgery, resume activity (he had significantly decreased his exercise after being told of his arthritic condition) and not pay too much attention to his hips. Following these instructions, his discomfort subsided and he successfully resumed exercise and athletics. I’ve had quite a few patients like Jack. Enough to recommend xrays of both hips in all of my patients with complaints of chronic hip pain. Invariably both appear similar on x-ray, though only one will hurt. This is often sufficient to convince someone that they have TMS – that their very real physical pain has a psychological cause. What is particularly interesting are the explanations offered by various practitioners when x-rays are normal. People are given elaborate explanations about biomechanics and told they have problems with various muscles (like the psoas), tendons (ITB, or iliotibial band) or bursae (bursitis). Sometimes they are told they have a knee problem that is resulting in hip pain. While this is possible, I believe it is far less common than generally claimed. Leg length discrepancy is another condition that has been blamed for hip, knee or foot pain (and even back pain). I find this extremely amusing. Assuming that the patient’s legs are the same as the set he was born with, that he has used these very same legs for all types of activities before without any problem, then why should this asymmetry be responsible for symptoms NOW? How does this make sense? That person’s musculoskeletal system has never known differently – it is perfectly adapted to its structure. TMS affecting the knees is also fairly easy to recognize. A significant physical process responsible for knee pain is invariably indicated by the history and examination. A sudden blow to the knee, a forceful twisting or acute hyperextension can cause damage to bone, cartilage or ligament. However, most of the chronic and episodic knee pain lacks this type of history and exam fails to reveal important intra-articular pathology. Eager to give a physical rationale for these chronic, intermittent symptoms, physicians will offer chondromalacia patella, patellofemoral syndrome, iliotibial band syndrome (ITB again), arthritis, bursitis, tendonitis or possibly a small cartilage injury not evident on exam. What all of these have in common is the presence of a chronic, non-healing process. Although we are incredible creations with a remarkable ability to heal, for some reason, we are told that there is an ongoing physical problem. So, a litany of physical remedies are prescribed: anti-inflammatory medication, steroid injections, braces and supports, glucosamine chondroitin (no better than placebo in my experience), physical therapy, special exercises to strengthen the quadriceps and possibly arthroscopy (surgery). In my experience these physical remedies either fail or provide only temporary relief, supporting the notion of a placebo response. Not infrequently if pain subsides, pain will surface in a new area – the brain does not give up its strategy! Lately I’ve noted an increasing frequency of lower leg pain, either in the calf or shin. Calf pain is described as sharp or stabbing and may be precipitated by certain weight-bearing activities, but not by others. The common diagnosis is muscle strain, pull or tear, though I’ve seen it explained as compartment syndrome (this is an unusual condition where exercise induces such an increase in blood flow and muscle swelling that the pressure within the muscle compartment becomes too great, resulting in pain). Usually the person has done adequate stretching and warm-up before the activity and the activity itself is not unusually strenuous or unreasonable for the given level of fitness. I know this one from personal experience because this is what my brain hit me with after I eliminated my back pain and sciatica. Want to hear ridiculous? I could walk without much difficulty – if I tried to jog, I’d get intense pain after 50 yards! I could bicycle 50 miles or do one hour on the Nordic Track, but I couldn’t run 100 yards! After many vociferous discussions with my brain, I was able to get rid of this pain and have run five marathons in the past three years. Pain in the anterior lower leg, or shin, can be described as dull, aching or sometimes sharp. Diagnoses may include muscle strain, shin splints or stress fracture. X-rays or bone scans may be used to support these diagnoses. Despite this, I have found that TMS is the most common culprit. Again, I will acknowledge that we can get injured, particularly if we do a new activity to excess or improperly. However, the typical individual with shin pain will have appropriate footwear and gear, they will be doing appropriate stretching and warm-up, and they will be doing an activity that they have been doing regularly, with facility and expertise. So, why do they get pain now? Once I point this out, most will accept TMS and be able to get rid of their pain and resume exercise. This is an exemplary case: Steven is a teenager and a budding running phenom. In the course of his training he began to experience left shin pain. He had not suddenly increased his mileage or suffered any trauma. Methodical in all things, his footwear, nutrition and hydration are all appropriate. Podiatrist and orthopedist recommend rest as treatment for presumed stress fracture. When he returns to running the pain returns. A bone scan is ordered and interpreted as showing a stress fracture and more rest is advised. At this point he came to see me. He admitted to being a perfectionist and putting much pressure on himself. Not surprisingly he’s a straight A student and participates in a host of extracurricular activities in addition to running. After I explained why I think his leg pain is psychological and running should not cause him pain, he went home and read The Mindbody Prescription. The next afternoon he phoned, obviously very excited. He had just returned from a long run and felt fine! He went on to have an outstanding season, continually lowering his times and improving his performance. His only frustration was an inability to convince his teammates to think psychological and better deal with their “injuries.” Barbara came in for evaluation of chronic hip pain. She also noted intermittent heel, knee and low back pain. Symptoms appeared to have begun around the time of her mother’s illness and death several years prior. She worked full time in addition to her responsibilities at home to her husband and teenagers. She admitted to self-esteem issues and was candid about growing up in an environment with multiple alcoholic family members. Her pain vanished and has not returned since she learned that it was psychologically caused. [/quote]   Check here to include your profile signature.