In our fumbling effort to deal with rhuematic pain, one fact stands out so clearly that it is hard to believe we have been blind for so long.
We all knew that pains were much worse in some positions than others, but none fo us pursied the idea more than to learn to avoid the most painful positions. I treated people for nineteen years without any interest in positions of greater or lesser pain until it was so forcibly impressed upon me I could ignore it no longer.
Yet the pain and tension of every one of these problems is markedly influenced by stretches of the areas involved varying from agony in the worst position to complete comfort in the ideal position. Perhaps we lost interest because we knew that as soon as we returned the patient from his postition of comfort, pain would immediately return. As some sage said, "It isn't what you don't know that defeats you. It's what you know that isn't so." A period of only ninety seconds in a position of comfort will have a lasting beneficial effect every time, if we only return from it slowly, It is the most therapeutic thing we can do and almost the easiest.
- Relief of rheumatic pain by placing a joint in its position of greatest comfort.
- Relief of false messages of continuing strain arising in dysfunctioning proprioceptor reflexes, by applying a strain in the direction opposite that of the false messages of strain. This is accomplished by shortening the muscle containing the false strain message so much that it stops reporting strain. The body in nromal positions can suffer this pain for years yet have it stopped in niney seconds of the opposite strain.
I have received credit for having the insight to develop this improved way to relieve pain. The truth is that all I supplied was much frustration. I wasn't even trying to treat my patient at the time, but just to help him learn to find a comfortable position that would let him sleep better. The spectacular recovery he had surprised me much more that it ded him. It was so unexpected as to be astinishing. I didn't dream that a thing like that could work so well.
My patient was a healthy thirty-year-old man with a severe back pain that he had suffered from four four months, a third of it while under my care. I had exhausted all my tricks and didn't knowhich way to turn before admitting to failure.
He volunteered, "Maybe, I could respond to your treatment if I could just sleep at night. I wake up about every fifteen minutes all night long and try to find a more comfortable position."
By this time I was grasping at straws, ready to try anything no matter how improbable.
I had learned how easy it is to get such a patient addicted to sleeping pills in addition to his other troubles, so I tried to help him find a position of comfort.
I stretched him in some direction and asked him whether he felt less or more pain. I had been trying for twenty minutes before I had much success. By then he was in a wild, grotesque position that looked like he must be in a strain, but he was finally almost completely comfortable, This was the only good thing that had happened to him in four months of treatment and I didn't have the heart to move him back into his position of pain. With a few pillows and a chair, I propped him up to enjoy his comfort while I treated another patient.
When I returned he was still happy and we discussed how he was going to try to find this good position when he went to bed.
When he reose from my talble the pain did not return! We were both delighted, but I was dumbfounded. This impossible problem was greatly relieved just from one postition of comfort! Something had happeded in his position of comfort that was far more therapeutic for his pain than four month's efforts supplied by three physicians! So far it was lasting. I was suddenly able to reduce my rate of failure from about thirty percent to about five percent. This was so much more effective than any other treatment I knew, I had to try to learn to use it on other problems. along the way I made many mistakes, but when I did it right it worked on everything. I have been happily devoting the rest of my life to learning to use it and to teaching it to other physicians and physical therapists. It was a lucky accident and nohting more.
As I worked, trying to learn how to use comfortable postitions to relieve backpain, I was able to observe many surprising things about how this part of the body behaved. As mentioned before I knew I must return the patient from his position of comfort slowly or his pain would return. My second accidental discovery was the location of the missing tenderpoints. Many of my previous failures, I believed, was because the only reliable diagnosis for me had been the tenderpoints found in the posterior paravertebral area close to the pain site. These, when present, addured a knowledge of where the affected joint was in distress and whether I had succeeded with my treatment. If I had succeeded, the tenderpoint and the pain were both much improved. Unfortunately only about half of the backaches were accompanied by these tenderpoints and other methods of diagnosis were often sketchy in my hands.
My second lucky day occurred perhaps three years after I had begun treating with positions of comfort. A patient I had treated once for a back that couldn't come out of a forward bend was improved enough he was able to hoe in his garden three days later. He called much disturbed that he struck himself in the groin with the end of his hoe handle and duffered agonizing pain. He told me he thought he had caused a "rupture".
When I examined him I found none of the classic symptoms of an inguinal hernia in spite of his sore spot. I reassured him about the hernia. Since he was due back for a second treatment for his back the following day, I suggested we do it while he was in the office to have him another trip.
By this time I had been able to reduce the length of time in the postiion of comfort to ninety seconds, but while I had him in his position of comfort again, I idly probed his tender groin again. The tenderness was mostly gone! He was pleased, but he set me off on another tangent. Could the missing tenderpoints not found in the posterior paravertebral area be over the front of the body? For the next three years I searched every square inch of the front of the body whenever I needed a tenderpoint and did find them. Half of them are on the front of the body where there is seldom any pain! Now I had a fast and nearly complete ability to make a reliable diagnosis. Partly because of improved ability to diagnose, my rate of success improved remarkably. Again I learned by a lucky accident. These points are not limited to the spinal disorders, but may be found near any joint of the body.