Date: Wed, 19 Jan 1994 23:26:54 -0800 From: Peter Bower Subject: Re: Muscle pains To: Multiple recipients of list C+HEALTH I've been reading this listserve for a few weeks now with great interest. I'm a physician who specializes in nonsurgical orthopedics and on a daily basis I treat 10 to 12 people with various degrees of computer generated maladies such as those listed here. Chest pain, as in the recent discussions, is not uncommon at all. My main interest is in the group of maladies that defy standard classification. The typical story is "They think its tendinitis but no one is really sure. The anti-inflammatory drugs and physical therapy doesn't really work. My MRI and EMG studies are all normal. I've been on anti depressants and anti seizure medications and they don't help. Three consultants seem to think its stress related. The workers' compensation insurance company is saying that there is nothing wrong with me. The only thing that keeps me from thinking that I'm crazy is the fact that my (insert...hands, fingers, wrist, elbow, shoulder, neck etc....) hurt bad every day. Why can't anyone tell me what is wrong with me?" This is extremely common. The discussions I've seen here have identified the standard causes of these problems, i.e., tendinitis, bursitis, arthritis. It has been my experience that these conditions do quite well with conventional therapy (and unconventional therapy too). This is due to the incredible ability of our body's immune system to regenerate and heal injured tissue. Yet there are many people who do not get better despite all the correct interventions I have not searched the archives of this forum but anticipate that there may be some reference to what is called "Adverse Mechanical Tension" (AMT) somewhere in the past. For those folks unfamiliar with this term, it derives from the work of an Australian physical therapist named Elvey. What many people suffer from that remains so elusive a diagnosis is this condition. It is almost completely unknown in the United States though in countries that were in the United Kingdom it is gaining acceptance rapidly. Essentially, the development of pain, swelling, vascular instability, and numbness is due to a restricted mobility of the nervous system within the body. Carpal Tunnel Syndrome is an example of a very focal "AMT" of a single nerve.. Much more commonly found is the diffuse adherence of the nerves in the neck and shoulder region leading to pain and numbness in the arms. Without exception, one finds this condition coexisting in everyone with carpal tunnel syndrome. In fact, it most likely predates the development of the carpal tunnel impingement. The physical examination of the injured person is critical to the correct diagnosis. Using the "Upper Limb Neural Tension Test" or Elvey Test, the nervous structures of the arm are selectively stretched and stressed. Upon performing this test (it is extremely simple to learn) I commonly hear people say "That's my pain. That's the first time any examination has made the WHOLE THING HURT just like it does when I'm flared up." It is a great relief to people to have someone recreate their complaint and give validation to their story with clear, simple, repeatable, and objective physical findings. Not only is this seen in the RSI or RMI type injuries, but is also the underlying pathology in chronic neck pain from whiplash injury and commonly chronic low back pain as well. At any rate, I am very interested in contacting others who are familiar with this testing, and the treatments that follow. As I said, in the U.S. I can count the physicians familiar with this on one hand. There must be more people out there. Folks that would like more information are encouraged to drop me an email line. Peter J. Bower, M.D. (cyberdoc@crl.com)