Question
QUESTION: I recently had a functional capacity test done and wanted to see if you can give me an idea on what they mean exactly if possible.

Cervical Spine ROM:

Extension....Occiput 32, T1 12, my result 20, NORMAL IS 60

Lumbar Spine ROM:

Extension...T12 6, Sacrum 5, my result 1, NORMAL IS 25
Left Flexion....T12 26, Sacrum 11, my result 15, NORMAL 25

Right shoulder:

Flexion...164, NORMAL 180
Extension....70, NORMAL 50
Abduction...144, NORMAL 160
Internal Rotation....15, NORMAL 90

Hip ROM:

Extension...15, NORMAL 30
Abduction...37, NORMAL 45

Knees ROM:

Right: Flexion 137, NORMAL 150
Left: Flexion 133, NORMAL 150

I had a work related injury and felt a pop in the area between my shoulder blade and spine 2 1/2 years ago.  I have been to chiropractor, acupuncture, PT, electric stimulation and nothing has helped.  

I have also taken MRI's and CT-scan and everything is fine and my doctors don't know where my pain is coming from.  I have been diagnosed with chronic back pain.  Do you have any idea?

Need help!

Thanks

Mark

ANSWER: Hi Mark,

Sorry to hear your having such difficulty.

It is not easy to determine what is going on. The FCE falls short of providing information related directly to the area in question. I don't know if the limitations in the cervical and lumbar spine are due to upper back pain or pain directly from the tested areas. There are obvious limitations. Not sure if you just listed abnormal findings or if certain ranges of motion were not performed during the test.

Nevertheless, it is always problematic when there is a lack of objective findings regarding the MRI/CT scans and a lack of response to treatments noted. However, this does not get you better, the most frustrating situation of all.

I wish I could be more specific regarding this, however, it seems like a complicated situation. What I would suggest, and what I would be interested in seeing results from, is a manual examination of the muscles involved. Being a specific and specialized evaluation, and noting lack of response to traditional therapies, I would suggest finding a certified Active Release practitioner who can evaluate the area for both function regarding quantity, and quality of the specific tissues.

You can find a certified practitioner in your area. This would be my next step in obtaining an evaluation that is often missing in standard testing. If problems are found, they can be addressed in an efficient manner.

All the best and I hope you find an answer soon.

Dr. Steve

---------- FOLLOW-UP ----------

QUESTION: Dr. Steve,

I did actually just list the abnormal findings on the ROM that was done on me.  I have dome all the therapies and nothing has worked foe me at all.  I think my greatest concern is whether my limited range of motion is temporary or permanent due to the fact that it has been so long.  

My other problem is I'm also an Iraq war veteran and my doctor does not know what is causing my problems and is telling me to get hwlp at the VA.  So, im getting really frustrated.

Mark

Answer
Hi Mark,

I understand the frustration. Chronic pain associated with functional deterioration is very frustrating and has far reaching consequences. I am very familiar with trying to find a pain generator when all the doctors say there is none. My first experience was some years ago when I was studying Kung-Fu. I got to the point where my back pain was so bad, I could not kick with my right leg. I had undergone many attempts to find and fix the problem. Many therapies, tests and treatments failed to find anything or help at all. I finally came across a colleague who did Active Release and was able to locate the problem and fix it in a few visits. I was so amazed that I took the course and began using it in practice and the results were tremendous. I would have patients come from long distances to get treated. That is why I suggested you might look into this. It may not be the answer, however, I would certainly try.

Fast forward some years; eventually, I had to give up studying martial arts after about 10 years. My back was a mess and even Active Release did not help. Again, no answers from doctors and tests. It has been many years. I cannot lift more than 25 pounds. I had to stop practicing because I could not bend over tables without falling on patients! I'm not even mentioning my neck, which is perhaps worse.

When no pain generator can be found, doctors will tell you, or they may not say it directly, however, their prescribing makes it clear they think it is all in your head. It is true that chronic pain has an effect on your brain, especially when it involves functional limitations and this can cause depression. There is something called hyper-centralization, where even if there was a pain generator and it is gone, the brain still perceives pain. Like a "phantom limb", where the limb is gone, but sensation is still perceived as it is still there.

So, I will not deny there is hyper-centralization, however, my research for a pain generator continued, because I would not accept it was "all in my head". Finally, last year I had an MRI done of my lower back. It showed Modic Type 1 changes. Traditionally, these were seen as a normal finding by radiologists. Through research, I found a doctor in London who did studies on patients with these findings and treated them with antibiotics. The results were impressive. I took a certification course and found out all I could about it. Finally, a pain generator! Well, there are only 4 clinics in the world; 3 in London and 1 in Denmark. Bottom line, I cannot afford to travel. My doctor does not want to prescribe antibiotics and there is a backlash against this form of treatment. Being a Chiropractor, I cannot prescribe antibiotics. The doctor who did the study said it would take about 10 years before it is accepted here. Imagine a surgeon giving up thousands of dollars for an operation to prescribe 200 dollars worth of antibiotics and you can see what I am up against. So, more frustration and no help.

This is an unusual forum to be relating this information to you and I don't mean to talk about myself so much. I want to let you know that, just because they have not found a pain generator, does not mean one does not exist. I would look into Active Release. Go to the website and read a little about it. It may be able to help. If it does not, I might visit the VA to see what they have to say. Don't give up and always have hope. I hope you have a supportive family and this Country owes you a debt of gratitude for your service. I hope you can find a solution and wish you all the best.

Regards,

Dr. Steve