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Thread: Why a 26* curve plus trunk shift can be so painful

  1. #1
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    Why a 26* curve plus trunk shift can be so painful

    http://drlloydhey.blogspot.com/2012/...or-second.html

    Excerpt...

    Her X-Rays confirm that her curve was 26 degrees, which isn't huge, but because of the location of the curve, she did have nearly a 5 cm trunk shift to the left. I explained how this type of trunk shift can be associated with back pain. Note the green lines drawn along outer edge of pelvis, and relationship to her rib cage! On one side, it is shifted over 4.5 cm.

    We got her started on a conservative program, including seeing a special scoliosis physical therapist for home training program, a special lightweight back brace, NSAID medications, and follow-up to recheck her trunk shift and scoliosis progression.

    We also talked at length about the importance of tracking this curve as she gets older, since these thoracolumbar curves with large trunk shifts can lead to progressive painful curves in adulthood with severe progression of lumbar disc degeneration. If the curve does continue to progress, or if pain worsens despite conservative treatment, scoliosis surgery can help get her "hour glass" centered again, and thereby center the loads better so the back muscles don't have to work so hard. It can also decrease the loading on the lower lumbar discs, which might save her from needing a bigger scoliosis surgery as an adult, which might even have to include the pelvis/ilium.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  2. #2
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    Many scoliosis specialists do not believe that scoliosis is painful (nearly all that I have seen). They always assume that it is something else that is causing the pain. I have found more understanding physicians OUTSIDE the scoliosis specialty realm that can see the very obvious reasons why scoliosis is painful. I don't understand why the specialists fail to recognize this. I realize that it doesn't hurt everyone, but I think THAT fact should be the "huh?" factor, NOT the ones that hurt. I would tend to wonder more why someone doesn't hurt than wonder why someone does hurt.

  3. #3
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    Rohrer...

    I understand your frustration about the medical community saying that scoliosis does not cause pain, but I think that statement is factually correct. In kids with scoliosis, a relatively small percentage have pain. To say that scoliosis = pain would be like saying scoliosis = single curve. If it doesn't happen to at least the majority, it's essentially an incorrect statement. That doesn't mean, however, that some kids have pain caused by their scoliosis. The medical community should probably say "most kids with scoliosis have no pain".

    --Linda
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    Thank you for at least understanding where I'm coming from. I know a LOT of people with scoliosis and the majority of the people I know have pain associated with it. I have had pain since I was eight years old, granted the pain went away with some stretches I would do before getting out of bed. Pain was the driving factor that led to my diagnosis. I had pain first, then diagnosis. Not diagnosis, then pain (which would imply to me that the pain would be psychosomatic). So it infuriated me when they told me, "Scoliosis doesn't hurt." If you look in any book on PT for back pain, they will point out bad posture and bad body mechanics with diagrams of the bend(s) that these cause in the spine. That bend is unquestionably associated with pain and PT's are instructed on how to help the person strengthen certain muscles, gain better posture, and use better body mechanics so as to eliminate the bend which, in turn, would eliminate the pain. So, if a bend in a "normal" spine is known to cause pain because of uneven pressure on the spine, then how does anyone say that the bend(s) in a scoliotic spine can not hurt?

    I just think that the scoliosis specialists need to rethink their stand on pain and scoliosis. It seems that the rest of the medical community has no problem understanding the dynamics of the spine and what causes pain. That is why I said that I would be more curious as to why some or "most" do not have pain.

    One of the very first scoli specialists that I saw actually told me that scoliosis doesn't hurt because he had it and it didn't hurt him. Then he said my pain must be arthritic in nature. He failed to show me ANY arthritic changes in my spine. As a young person, I went home devastated, thinking that I had not only scoliosis but arthritis, too! Even now, at 43, I have very little arthritis in my spine, just the amount that they would expect to see in anyone else my age.

    My daughter has "mild" scoliosis, yet she has terrible back pain.

    Here's a perfect example of what I'm talking about. In order to get my referral to a scoliosis surgeon, I had to be seen by the head of neurosurgery at the local hospital (this is a very good hospital ranked in the top 5% in the nation). When he looked at my x-rays, he described areas of pain that he thought I would be having without me saying a word, and he was right! When I showed my films to my OB/GYN she told me areas that would most likely be problematic if I became pregnant. So why are the rest of the so-called experts so far behind?

    Sorry to vent, but I'm very passionate about this subject.

    Rohrer01
    Last edited by rohrer01; 02-04-2012 at 04:28 PM.

  5. #5
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    If the majority of kids with scoliosis have no pain then it seems reasonable to suggest that the few that do have something in addition to scoliosis going on that is the actual source of the pain. In the subject case, it is a trunk shift. In other cases, it is something else probably. I wonder what it was in your case.

    Now when the other thing (not the curvature) that is causing the pain in the few kids is a direct result of the curvature, then I think it annoys folks to hear that scoliosis isn't causing the pain. In those cases, it is causing the pain although indirectly. It might be like saying macular degeneration causes broken hips on the basis of folks who lose their eyesight fall down more and break more hips. It's related but not primary.

    Now in adults, it seems like most have pain. But because some folks have big curves without pain then even all that pain in adults is probably technically secondary to the curve. All the damage that gets done from simply having a curve over the years would not have happened absent the curve. But apparently, it is not inevitable in some folks so the curvature doesn't seem like the primary cause of pain. Unless the discs are compromised, it might be impossible to impinge a nerve no matter what the Cobb angle. If that were true then all scoliosis pain is by definition secondary due to the accompanying disc damage.

    Now I don't blame scoliosis patients for thinking all this hair splitting is, well, hair splitting. I am just saying that what surgeons presently say is probably technically correct which is their job. But how they say it should be explained more.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  6. #6
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    Quote Originally Posted by Pooka1 View Post
    Now when the other thing (not the curvature) that is causing the pain in the few kids is a direct result of the curvature, then I think it annoys folks to hear that scoliosis isn't causing the pain. In those cases, it is causing the pain although indirectly. It might be like saying macular degeneration causes broken hips on the basis of folks who lose their eyesight fall down more and break more hips. It's related but not primary.
    I disagree. If the "other thing" wouldn't have happened absent scoliosis, then the scoliosis is the primary cause, being that it (scoliosis) happened first and the "other thing" followed as a result.

    I would agree with your broken hip illustration only IF a good percentage of children (at least the same percentage as those with scoliosis), absent scoliosis, also suffered from the same kind of back pain. This just isn't the case. Kids with healthy backs don't hurt unless they have injury that can be easily diagnosed. Kids with AIS pain are not easily diagnosed with another logical reason for their pain without scoliosis playing a huge role in the cause. People break hips more frequently as their age advances. So while macular degeneration may cause more falls due to blindness, you still see a large and maybe even a "larger" population, absent macular degeneration, falling and breaking hips.

    So I'm thinking TYPE of curve (no two people are identical) must play a huge role in whether or not scoliosis is painful. What caused my upper backaches when I was eight? Probably the presence of a mild curve pulling abnormally on back muscles. At 12, I had neck strain from trying to hold my head up. So ordinary tasks for most people, such as reading, were difficult for me. As I grew, I continued to have the same neck problem. But as the curve progressed, it created a different musculature, which made using proper body mechanics (proper for someone without scoliosis) all but impossible, as there was no way to balance out the spine and neck with body mechanics. This resulted in muscle strains, sprains, and pinched nerves. Now that I am much older, the problem compounds even more as the curve progresses even though I have "normal" wear and tear on my spine for my age. The fatigue is recognized by the scoliosis community of doctors. They have pretty much all said that since it takes so much energy to stay upright, then that in turn causes fatigue and created a need for more sleep than the nonscoliotic person.

    It's fairly easy to diagnose someone my age that has sciatic pain, numbness, neck pain, arm pain, etc. because a simple MRI will show DDD, pinched nerves, arthritis and what-not. But when I go in, it's not that simple. I have HARD muscles masses that feel like a heavy mesh and even solid bone. This is due to the fact that I've had to work harder just to remain upright and hold my head up as a result of scoliosis. The scoliosis caused this difference in my muscles and nerves trying to make their way through the muscle masses. Therefore since scoliosis was the first in the chain of events, then that is the real cause. I challenge anyone to take a history of back pain in the non-scoliotic population vs. the scoliotic population and see who has more back pain. If the numbers are statistically insignificant (meaning they are about the same), then I will recant.

    My guess is that scoliotics without pain have curve types that are either very balanced or are in areas of the back that aren't used as strenuously as with people with the "painful curve types". Does that make sense?

    Rohrer01

  7. #7
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    just a note about stupidity of doctors, rohr...
    i was told by a doctor at a supposedly "knowledgeable" hospital for Lyme Disease,
    that i didn't need pain meds because "Lyme doesn't hurt that much"
    i swear, that is exactly what she said!!

    my back started hurting around age 30/31...i went for X rays, and they found scoli...
    nothing else at that point...no other conditions besides scoli

    jess
    Last edited by jrnyc; 02-05-2012 at 09:30 PM.

  8. #8
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    Quote Originally Posted by rohrer01 View Post
    In order to get my referral to a scoliosis surgeon, I had to be seen by the head of neurosurgery at the local hospital (this is a very good hospital ranked in the top 5% in the nation). When he looked at my x-rays, he described areas of pain that he thought I would be having without me saying a word, and he was right!

    Did he know before seeing the x-rays that you have pain? He was sure that a curve with that shape should to provoke pain in those areas or he was sure that if it was pain, it should to be located there?
    Might be that pain would not be provoked (only or mainly) by the kind of curve and some cause provoke the curve increasing and pain? Might be that some kind of curve would be the effect of the pain and not (only) the cause?
    I have read about many different causes provoking back pain. Also there is a scoliosis vicious cycle pain<--> bad posture.

  9. #9
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    I had never seen this man before. It was before I was seen for "pain". So to answer, no, he had never heard me complain of pain. He nailed my headaches right on the spot! That quite impressed me, as one supposedly very good scoli surgeon from TCSC completely ignored my headache pain, even though I was in obvious agony right in front of him. He told me to take some tylenol...

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    Did he explained you how he knew that?.. He seems to know about the pain in curves with your shape.. but maybe that all people he saw before with that kind of curve was also in pain and he supposes that always should to be the same in those cases.. and may be .. or not.

  11. #11
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    Roher, as I said you once, a way (and probably the only one) to be sure that your pain is because your curve, is reducing it for a while. Are you sure that it's not significatly reduced when you are lying down?

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    Quote Originally Posted by flerc View Post
    Did he explained you how he knew that?.. He seems to know about the pain in curves with your shape.. but maybe that all people he saw before with that kind of curve was also in pain and he supposes that always should to be the same in those cases.. and may be .. or not.
    No, he didn't explain. I didn't feel the necessity to ask him, as he was right. He's a neurosurgeon, so I figured he knows what he's talking about when he sees a twisted upper back and neck and how the muscles pull on those areas.

    My shape is rare. I have yet to meet ONE doctor that has told me that they have seen a curve like mine. My current surgeon hasn't said either way, but the rest have ALL said that they had never seen a curve like mine.

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    I know some cases of (very) adults without pain (at least no more than general popuņation) that when surgeons see the x-ray said something as 'my god, how may be possible for you to walk? it should to be tremendous your pain' and they were surgeons.. althought I have heard many times before about a big difference among a surgeon and a neurosurgeon..
    Last edited by flerc; 02-06-2012 at 12:12 AM.

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    I could understand a surgeon saying that if he wants to do surgery on that person. This doctor stated clearly why he was not qualified to operate on me, so there was no motive.

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    Quote Originally Posted by flerc View Post
    I know some cases of (very) adults without pain (at least no more than general popuņation) that when surgeons see the x-ray said something as 'my god, how may be possible for you to walk? it should to be tremendous your pain' and they were surgeons.. althought I have heard many times before about a big difference among a surgeon and a neurosurgeon..
    Also, in these cases that you speak of, why were they at the doctor getting x-rays if they had no pain?

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