What Is Causing My Pain? Wichita Pain Center, Wichita Kansas

If You Suffer From Musculo-Skeletal Pain, It Is Highly Probable That It Is Caused By A Joint Derangement[25] [26] 

Musculo-skeletal disorders are a very common cause of chronic pain and long-term physical disability in human populations[27] and joint derangements are the most common cause of musculo-skeletal pain[25, 26]Joint derangements can cause neck pain, upper and middle back pain, lower back pain, pain that radiates from the neck into the shoulder blade or into the arm and fingers, pain that radiates from the lower back to the buttock or into the leg and foot, shoulder pain, elbow pain, wrist pain, hip pain, knee pain, ankle pain and headaches. 

  Medical Diagnoses That Could Actually Be Caused by  Derangement's:  

  • Acute Pain
  • Arthritis
  • Bone Spurs
  • Bulged Disc
  • Carpal Tunnel Syndrome
  • Chronic Pain
  • Degenerative Discs
  • Facet Syndrome
  • Failed Back Surgery
  • Fibromyalgia
  • Hard to Diagnose Pain
  • Headaches
  • Herniated Disc
  • Bulged Disc
  • Myofascial Syndrome
  • Migraines
  • Neuropathy
  • Osteoarthritis
  • Pinched Nerve
  • Prolapsed Disc
  • Radiculopathy
  • Sciatica
  • Spinal Stenosis
  • Sprains
  • Tarsal Tunnel Syndrome
  • Tendonitis
  • Tendonosis
  • Whiplash

  Common Findings With Derangement Syndrome

  • Pain can be localized in the back or radiate from the back to the buttock or down the leg.
  • Pain can be localized in the neck or radiate form the neck to the shoulder blade or shoulder and down the arm to the hands and fingers.
  • Symptoms are usually variable: Pain may be local at times and referred at other times, and it can change sides.
  • Pain can be either constant or intermittent or a mix of the two.
  • Pain varies with different postures or activities.
  • Changing positions is bothersome, for example, pain may be worse when standing up after sitting for a period of time.
  • Pain can be Acute (of short duration) or Chronic (of long duration)
  • Onset or flare-ups can be associated with considerable pain and functional disability (can't stand up straight, can't move neck at all).
  • Loss of motion, sometimes severe, is commonly associated with the pain.

 Four Classifications of Pain

According to Robin McKenzie, founder of McKenzie Diagnosis and Therapy®, there are four unique pain classifications. Each one has distinguishing patterns of symptoms, called syndromes, which can be used to guide treatment. These syndromes are entirely separate entities with unique symptoms. Details gained during the history and exam will determine which syndrome your condition is classified in. 

Causes of Back Pain and Extremity Pain- Wichita Pain Center

Which Classification Of Pain Do You Have? 

Causes of Pain - Derangement Syndrome - Wichita Pain Center


 Joint Derangement Syndrome 

A Derangement Classification means that there has been tissue damage within the jointJoint derangement or displacement of the internal joint tissues, such as discs, menisci and cartilage can tear, rip or bunch up. Pain with derangement always varies, either improving or worsening depending on particular movements, positions or daily activities such as standing, sitting or rising from sitting, etc.  The derangement syndrome is the most common cause of musculo-skeletal, back and extremity pain by far, according to Robin McKenzie, CNZM, OBE, FCSP (Hon), Dip. MT and Stephen May, PhD, MA, MCSP, Dip. MDT, Msc.[25, 26]
learn more about derangement syndrome at wichita pain center

Causes of Pain - Dysfunction Syndrome - Wichita Pain Center


 Muscle & Tendon Dysfunction Syndrome 

Muscle and Soft Tissue DamageInvolves either scarred or contracted, already structurally impaired tissues that are present due to imperfect repair due to previous trauma, inflammatory disease or degenerative means. Pain is only felt when the abnormal tissue is contracted (loaded) during normal movements, usually towards the end of a restricted range of motion. The dysfunction syndrome is the second most common cause of musculo-skeletal back and extremity pain.
learn more about dysfunction syndrome at wichita pain center

 

Causes of Pain - Postural Syndrome - Wichita Pain Center


 Bad Postural Syndrome 

Pain that comes on after assuming prolonged end-range posture, typically sitting, in which the tissues are stressed or loaded to the point of causing discomfort that goes away almost as soon as the position is changed. Otherwise individuals are without pain until they resume that same improper posture. Pain is always temporary and controllable by the individual simply by moving out of an end-range posture. Pain never occurs during movement or activity. Rarely seen for care due to its trivial nature and its incident rate is unknown because patients don't usually seek care.   

 

Causes of Pain - Other Classification - Wichita Pain Center


 Other Classification

Occurs in less than 2% of the population.[viii] Any pain that does not fit in the first three syndromes is placed into the other classification. These include some serious disorders that are commonly found during the history portion of the assessment.  It is vital to rule out any of the serious spinal conditions as they may need prompt medical attention.  Conditions in the Other classification may include: 

 

 Conditions of the "Other" Classification

  • Spinal Stenosis
  • Spondylolithesis
  • Hip or S-I Joint problems
  • Mechanically inconclusive- an unknown vertebral joint pathology that has inconsistent responses to test movements and assessment strategies.
  • Serious Spinal Pathology
    • Cauda Equina Syndrome- compression of sacral nerves by disc herniation or tumor that involves the bladder or bowel, especially urinary retention, saddle anesthesia and Sciatica.
    • Cancer- growth of malignant tumor in or near vertebrae. Seen in age >55 with history of cancer, unexplained weight loss, constant & progressive pain which is not relieved by rest.
    • Fracture- bony damage to vertebrae caused by trauma or weakness due to metabolic bone disease. Caused by significant trauma or trivial trauma with osteopenia.
    • Spinal Infection- infection affecting vertebrae or disc. Usually see a fever, constant severe back pain unrelated to movement.
    • Ankylosing Spondylitis- a systemic inflammatory arthropathy affecting spinal and other structures. Has common exacerbations and remissions of pain marked by morning stiffness with persisting limitation of all movements. Better with exercise but not relieved by rest. Positive blood tests ESR and + HLA B27.

 More About Derangement

Causes of Pain - Joint Derangement - © 2019 Wichita Pain Center

Simply stated, Derangement Syndrome is a disruption in joint articulation. Damage has occurred to the internal tissues of a joint such as a disc between two vertebrae or meniscus cartilage in the knee that causes pain symptoms during movement or at rest, and usually involve a loss of motion.  All joints have the capability of having derangement damage occurring even without a known traumatic event. Postural strains and minor trauma over time can change the integrity of the internal workings of a joint. 

 

 What Causes A Derangement?

The most common cause of a derangement is "for no apparent reason". In other words there is not an incident of trauma that can remembered that caused the pain. Most derangements are an accumulation of wear and tear and small traumas and postural stresses that deform tissue over a long period of time, called Tissue Deformation.  The four most common causes are:

  • No apparent reason
  • Trauma (accident, fall)
  • Forceful overload
  • Repetitive trauma.

Joint Derangement Model
Rips, Tears and Scarring Inside a Joint Cause Pain and Disability

The internal tissues of joints, such as discs, can rip and tear and become bunched up causing pain, loss of motion, and when the damage encroaches on spinal nerves or the spinal cord, it can cause neurological symptoms such as numbness, paresthesia and radiating pain into the arms or legs. Although this model uses the spinal disc as the model, the concept can be used for any joint in the body.  

Joint Derangement Model, Wichita Pain Center, Wichita Kansas

 

Examples of How Different Positions & Movements Can Either Cause Pain or Relieve Pain

When the disc tissue is damaged (deranged), normal everyday movements can cause pain, loss of motion and avoidance of moving in that direction.

The hallmark sign of having a derangement is that it always behaves variably. Pain levels are variable according to your positions, activities and movements during the day. Normal daily forces of bending, twisting, sitting, standing, walking and lying on deranged tissue can cause pain on some days, but on other days pain may be less intense or not be present at all. The activity or position that causes pain provides beneficial clues as to the type of movement that will be required to remodel the derangement.

posterior-derangement-in-flexion1.jpgExample 1: Pain comes on when sitting for a period of time.

Sitting causes the spine to bend forward, pushing the disc tissue backwards further deranging the already damaged disc.  It is likely that the derangement in your disc is toward the back aspect and as you force more disc tissue towards the back the worse the pain can become. Getting out of the position of sitting removes the force on the derangement, the pain gets better or goes away after a period of time. Getting up from sitting to a standing position can be difficult. However, once you are up and moving, the pain usually improves or goes away.

 

Disc pain with standing and walking - © 2019 Wichita Pain Center

Example 2:
Pain comes on when standing or walking

Standing & walking cause the spine to bend backward, pushing the disc tissue forwards further deranging the already damaged disc. It is likely that the derangement in your disc is toward the front aspect and as you force more disc tissue towards the front the pain worsens. Relief may come while sitting or bending forward.

Is A Derangement Causing Your Pain?

The Only Way To Know, Is To Be Tested...

Book appointment for acute and severe back and neck pain with Wichita Pain Center in Wichita Kansas

 

 

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Derangement
Dysfunction

 More About Dysfunction

Although not as common as rapidly responsive conditions, certain conditions that involve shortened or scarred tissue require time and consistency to remodel the contracted tissue. When tissue is torn or ripped and does not heal properly due to improper or no treatment, it will heal shortened and the fibers of the tissue will heal in all different directions producing a scar. Pain from this type of tissue is called Tissue Dysfunction and usually occurs during a specific point in the arc of motion, and hurts the same every time. Pain does not remain worse and does not hurt at rest.  To remodel this type of injured tissue, the tissue needs to be used under tension through the painful motion many times daily for weeks, months or over a lifetime. The body can remodel the fibers according to the direction and load placed on it to be better aligned to improve function and reduce or eliminate pain. Treatment requires that the pain that is experienced when moving through the painful arc, be reproduced over and over again until the fibers have remodeled, commonly within 6-8 weeks. 

 

normal-tissue.jpg

The Dysfunction Syndrome

Damaged, shortened and scarred tissue results in pain during or at the end of a joint motion and needs to be remodeled by specific exercise.


normal-tissue.jpg

Normal Tissue

Muscle fibers are aligned in one direction and function normally without pain or loss of function.


torn-tissue.jpg

Torn Tissue

Torn muscle fibers need protection yet gentle pain free movements are a must to lay down a good directional scar

torn-tissue-2.jpg

Improperly Healed

Scar tissue is aligned in different directions causing painful restricted motion. To restore function and reduce pain the tissue must be remodeled with exercise

 


 

References:

[1] Spine (Phila Pa 1976). 1997 May 15;22(10):1115-22. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence. "The McKenzie assessment process reliably differentiated discogenic from nondiscogenic pain (P < 0.001) as well as competent from an incompetent anulus (P < 0.042) in symptomatic discs and was superior to magnetic resonance imaging in distinguishing painful from nonpainful discs."

[2] Deyo (1993) RICHARD A. DEYO, M.D., M.P.H., AND JAMES N. WEINSTEIN, D.O.  For patients with nonspecific low back pain, a precise pathoanatomical diagnosis is often impossible, which leads to various imprecise diagnoses.

[3] Roland and van Tulder 1998 Should radiologists change the way they report plain radiography of the spine? Lancet 352.229.230.  "There are limitations to diagnostic imaging, their excellent ability to identify abnormal morphology, is matched by an inability to link pathology to symptoms (van Tulder et al. 1997). When any of these abnormalities are found on radiography 40-50% will be a false positive finding that is found in those with no back pain (Roland and van Tulder 1998)".

"Equally disc herniations and spinal stenosis can be found in at least half of asymptomatic individuals on MRI (Boden et al. 1990, Boos et al. 1995, Jensen et al. 1994, Weinreb et al. 1989,)".

[4] Wiesel SW, Tsourmas N, Feffer HL, Citrin CM, Patronas N (1984). A study of CAT scans: The incident of positive CAT scans in an asymptomatic group of patients.

"Spine 9.549-551. In order to study the type and number of CAT scan abnormalities of the lumbar spine that occur in asymptomatic people, 52 studies from a control population with no history of back trouble were mixed randomly with six scans from patients with surgically proven spinal disease, and all were interpreted by three neuroradiologists in a blinded fashion. Irrespective of age, 35.4% (26.6%, 51.0%, and 31.3%) were found to be abnormal. Spinal disease was identified in an average of 19.5% (23.8%, 22.7%, and 12.5%) of the under 40-year-olds, and it was a herniated nucleus pulposus in every instance. In the over 40-year-old age group, there was an average of 50% (29.2%, 81.5%, and 48.1%) abnormal findings, with diagnoses of herniated disc, facet degeneration, and stenosis occurring most frequently."

[6] Robin McKenzie CNZM, OBE, FCSP (HON), FNZSP (HON), DIP MT; The Lumbar Spine, Mechanical Diagnosis & Therapy Vol 1. pg 124 "Mechanical evaluation can identify and affect the mechanism of symptom generation".

[7] Robin McKenzie CNZM, OBE, FCSP (HON), FNZSP (HON), DIP MT; The Lumbar Spine, Mechanical Diagnosis & Therapy Vol 1. pg 125 "Classification of Back Pain"

[8] Stephen May 2009, Development of aspects of Mechanical Diagnosis and Therapy

[9] Ronald Donelson, MD, MS  Rapidly Reversible Low Back Pain - An evidence based pathway to widespread recoveries and savings

[9] Nachemson A, The lumbar spine. An orthopedic challenge. Spine, 1976. 1(1):p. 59-79 "... in the great majority of patients with low back pain, no clear diagnosis or explanation for their pain could be found".

[10] Eddy D, Clinical decision making: from theory to practice: a collection of essays from The Journal of the American Medical Association. 1996, Sudburry, MA: Jones and Barttlett Publishers.

[11] Ronald Donelson, MD, MS  Rapidly Reversible Low Back Pain - An evidence based pathway to widespread recoveries and savings. p. 13

[12] Spitzer W, LeBlanc F, and Dupuis M, Scientific approach to the assessment and management of activity-related spinal disorders (The Quebec Task Force). Spine, 1987. 12(7S): p. S16-21

[13] Overview of Supportive Studies:  McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) Richard Rosedale PT, Dip. MDT, Robert Medcalf PT, Dip. MDT, Predicting Outcomes.  "The McKenzie Method also has an important asset in its ability to predict patient outcome through classification and the determination of Centralization. If a patient with lumbar or cervical pain is classified as a Derangement and can centralize their symptoms in a short time after initiating MDT, the prognosis for a rapid and lasting improvement is very good. Overview of Supportive Studies: McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT)... The McKenzie Method of MDT continues to be one of the most researched conservative approaches to musculoskeletal problems available"

[15] Robin McKenzie CNZM, OBE, FCSP (HON), FNZSP (HON), DIP MT; The Lumbar Spine, Mechanical Diagnosis & Therapy Vol 1. pg 44

[16]

a) Damkot DK, Pope MH, Lord J. Frymoyer JW (1984). "The relationship between work history, work environment and low back pain in men". Spine 9.395-399

b) Videman T, Nurminen T, Tola et al. (1984). "Low-back pain in nurses and some loading factors of work". Spine 9.400-404

c) Frymoyer JW, Clements JH, (1983). "Risk factors in low-back pain". JBJS 65A.213-218

d) Mundt DJ, Kelsey JL, Golden AL et al. (1993) "An epidemiological study of non-occupational lifting as a risk factor for herniated lumbar intervertebral disc." Spine 18.595-602

[17] Punnett L, Fine LJ, Keyserling WM, Herrin GD, Chaffin DB (1991). "Back Disorders and non-neutral trunk postures of automobile assembly workers". Scand J Work Environ Health 17.5-21

[18] Magora A (1973). "Investigation of the relation between low back pain and occupation. Physical requirements: bending, rotation, reaching and sudden maximal effort". Scandinavian J Rehab Med 5.186-190

[19]

a) Kelsey JL (1975). "An epidemiology study of acute herniated lumbar intervertebral discs." Rheumatology & Rehabilitation 14.144-159

b) Kelsey JL, Githens PB, O'Connor T (1984b). "Acute prolapsed lumbar intervertebral disc. An epidemiological study with special reference to driving automobiles and cigarette smoking". Spine 9.608-613

c) Damkot DK, Pope MH, Lord J. Frymoyer JW (1984). "The relationship between work history, work environment and low back pain in men". Spine 9.395-399

d) Krauss N, Ragland DR, Greiner BA, Fisher JM, Holman BL, Selvin S (1997). "Physical workload and ergonomic factors associated with prevelence of back and neck pain in urban transit operators. Spine 22.211-2127

[20] Kelsey JL (1975). "An epidemiology study of acute herniated lumbar intervertebral discs." Rheumatology & Rehabilitation 14.144-159

[21] Magora A (1972) "Investigation of the relation between low back pain and occupation". Industrial Medicine 41.5-9

[22]

a) Frank JW, Kerr MS, Brooker As et al. (1996). "Disability resulting from occupational low back pain. Part 1: What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine 21.2908-2917

b) Bombardier C, Kerr MS, Shannon HS, Frank JW (1994). "A guide to interpreting epidemiologic studies on the etiology of back pain". Spine 19.2047s-2056s

c) Burdorf A, Sorock G (1997). "Positive and negative evidence of risk factors for back disorders". Scan J Work Environ Health 23.243-256

d) Ferguson SA, Marras WS (1997). "A literature review of low back disorder surveillance measures and risk factors". Clin Biomech 12.211-226.

[23]  Robin McKenzie CNZM, OBE, FCSP (HON), FNZSP (HON), DIP MT; The Lumbar Spine, Mechanical Diagnosis & Therapy Vol 1. pg 35

[24] Ronald Donelson, MD, MS  Rapidly Reversible Low Back Pain - An evidence based pathway to widespread recoveries and savings. The Concept of Rapid Reversibility. p. 121 "No other diagnostic tool has ever provided such specific and valuable information about the pain-generating pathology. The MDT repeated movement exam, properly and thoroughly performed, is capable of providing a whole new dimension of information about the pain source: the 'reversibility' of the underlying painful lesion."

[25] Hefford C, McKenzie classification of mechanical spinal pain: profile of syndromes and directions of preference. Manual Therapy, 13.75-81,2007. " Over 90% were classified with a mechanical syndrome and more than 80% with derangement."

[26] Otero J, Bonnet F, Low back pain: prevalence of McKenzie's syndromes and directional preference. Kinesither Rev, 14:36-44,2014.  "...Certified McKenzie therapists each collected data on 10  consecutive patients, providing data on 349 patients with back pain. At baseline 92% were classified with Derangement..."

[27] Fejer R. and Ruhe A., What is the Prevelance of Musculoskeletal Problems in the Elderly Population in Developed Countries? A Systematic Critical Literature ReviewChiropractic and Manual Therapies, 2012.20(1): p. 31 10.1186/2045-709X-20-31

[28] Ronald Donelson, MD, MS. Rapidly Reversible Low Back Pain- An evidence based pathway to widespread recoveries and savings. P.75 "A derangement's characteristic signs are that of rapid changes in both a joint's mechanical behavior and its symptoms, just as happens when a knee meniscus tears, often referred to as an internal derangement of the knee."

[29] Ronald Donelson, MD, MS. Rapidly Reversible Low Back Pain- An evidence based pathway to widespread recoveries and savings. P.83 

[30] Ronald Donelson, MD, MS. Rapidly Reversible Low Back Pain- An evidence based pathway to widespread recoveries and savings. P.72-73

[31] Ronald Donelson, MD, MS. Rapidly Reversible Low Back Pain- An evidence based pathway to widespread recoveries and savings. P.65 “The value of this assessment is that it routinely reveals valuable characteristics of each patient’s underlying pain-generator… there is no need to understand the anatomic source of pain in most patients in order for them to recover. Yet being able to rapidly affect symptoms provides an excellent model (to help clinicians and scientists come to understand the physiological and psychological factors that actually cause, perpetuate, resolve and prevent low back symptoms.  It is the validity of this assessment in identifying relevant reflections of the underlying pain source that makes it so unique and so valuable in the field of non-operative care of LBP” 

[33] Ronald Donelson, MD, MS. Rapidly Reversible Low Back Pain- An evidence based pathway to widespread recoveries and savings. P.70-71

[34] Overview of Supportive Studies: McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) Richard Rosedale PT, Dip. MDT, Robert Medcalf PT, Dip. MDT, Predicting Outcomes The McKenzie Method also has an important asset in its ability to predict patient outcome through classification and the determination of Centralization. If a patient with lumbar or cervical pain is classified as a Derangement and can centralize their symptoms in a short time after initiating MDT, the prognosis for a rapid and lasting improvement is very good.

[35]  The Lumbar Spine, Mechanical Diagnosis & Therapy. Vol 2. Robin McKenzie, Stephen May. Centralization -"The phenomenon by which distal limb pain emanating from although not necessarily felt in the spine is immediately or eventually abolished in response to the deliberate application of loading strategies. Such loading causes an abolition of peripheral pain that appears to progressively retreat in a proximal direction. As this occurs there may be a simultaneous development or increase in proximal pain. The phenomenon only occurs in the derangement syndrome."Disclaimer: We do not claim that our evaluation and treatment procedures can remedy any pain in a rapid time frame or that they have a clear benefit above any other conservative treatment options available. Each case is unique and responds to care differently. You should not expect to have rapidly reversible pain, or that your pain will be rapidly reversed, simply from this advertisement, you must be examined by a qualified professional.

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Dysfunction

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