Samples of Pain Mismanagement

◎Emerson M. F. Jou, M.D.

One day on a flight from Honolulu to Los Angeles, I responded to an in-flight call for a doctor offering my help as always. A young doctor was there ahead of me tending to a female passenger. He had already placed her lying down on the aisle and a flight attendant was checking her blood pressure every 5 minutes per doctor’s instruction. I knelt down to chat with the patient what was wrong. She was healthy-looking at her early twenties with no past or present illness taking no medication. She accidentally banged her head against the light bathroom door and noticed slight dizziness. I asked her to point to me the impact site on the head and I palpated slight tenderness at the site. I told her that it was the exact source of dizziness which could be resolved by light touch for 5 minutes. The doctor yelled at me not to touch the patient. I explained to him that there was a tender site of fascia strain underneath the scalp causing dizziness and I could resolve it by light touch for 5 minutes. He did not care about what I said but insisted on me not touching the patient. Without knowing the cause of dizziness, he only thought of a possibility of neck fracture that touching the head might render her paralyzed from the neck down. I was puzzled as to how lightly hitting on a thin bathroom door can break the neck and neck fracture only causes slight dizziness. Apparently, he wanted to be in charge and there was nothing I could do, I returned to my seat. Later he relocated passengers making four empty seats to lay her down for the rest of the flight and told the flight attendant to continue checking blood pressure, even though it remained normal. He even arranged for an ambulance to take her to a hospital emergency room upon arrival at LA airport. I was deeply disturbed shaking my head at what this doctor did. He did not even check the impact site which was the only thing happened to her nor examine her neck to see if there was really a fracture or not. He just irrationally overreacted without proper medical judgement turning a minor incident of slight dizziness into a major medical emergency as possible neck fracture! The poor patient must be fearful and worried. I really felt bad for her going through such an ordeal for no good reason.

A neurologist referred a patient to me for consultation who was limping on one leg and might require therapy. The patient was a healthy middle-aged man with nothing wrong except limping for a few days. I observed his walking and noticed something wrong with the foot. I asked him if his foot was painful and he said yes, pain at the sole. I examined his foot and found a painful corn. I cut and pasted a soft donut pad around the corn to avoid it from touching the ground, he then walked without pain or limping. I asked him if his neurologist ever questioned him or knew about pain at his foot, he said no and no examination of his foot. Instead, his neurologist ordered some blood tests and brain CT scan, focusing only on neurological pathology of the brain. I phoned the neurologist about my finding and he cancelled all tests.

One patient had a small nodule in the front of the neck on the right side. It was tender upon palpation indicating strained and tightened muscle/fascia. After I applied light touch for 10 minutes, it disappeared. Yet her family doctor had treated it with medications for years as a thyroid tumor while thyroid function remained normal. I was bewildered about a small tender nodule 2-3 cm away from and unconnected to the thyroid gland being considered as a thyroid tumor. A tumor does not hurt or disappear by palpation. Her doctor had not carefully palpated it but assumed it was a thyroid tumor. A tumor near the thyroid can only be a thyroid tumor and nothing else? Another patient suffered back pain for a few days and her doctor initially suspected it as kidney stone until all tests failed to confirm it. A kidney stone causes acute attack of severe pain at the onset and requires emergency management. This is rare and so different from the most common back pain due to muscle strain, why is it the first consideration of back pain?

One patient suffered acute severe pain in the upper abdomen and went to an emergency room in the middle of the night. She was diagnosed as acute abdomen due to stomach cramps. Few hours later, various tests showed no definite finding. She was then prepared for laparoscopy but she declined. The next morning, she had an appointment with me. I immediately realized that it was abdominal cramps due to muscle strain, not stomach cramps. I was able to resolve it by light touch to the abdominal muscles for 30 minutes. It was an easy and immediate relief for her. Afterwards, her husband was so upset towards the emergency room that he called to scold at the staff there.

Another patient went to an emergency room because of dizziness. After many tests and hospitalization for 2 days of observation, there was nothing pointing to any possible cause. She came to see me the next day and her dizziness was resolved after 15 minutes of light touch to the scalp. Dizziness usually comes from nothing but fascia strain beneath the scalp. It disappears as soon as the tightened fascia tissue is released.

There are so many cases of pain mismanagement in medical practice. Based on my personal observation and experience in treating pain for more than 40 years, this perplexing phenomenon is discussed in the following.

First, we need to understand the essence of pain. Pain must have its source. Pain indicates an injury and/or acute inflammation. Pain is often not associated with inflammation because of its brief duration. Pain is where the injury is, not radiating from or to other sites. All pain comes from soft tissue (muscle, fascia) injury. Once injured, the injury accumulates and remains with or without pain for a lifetime until treated. Pain can only come from an injured tissue that has pain sensation. There is no pain sensation in the spine, joint or blood vessel, thus back pain is unrelated to the spine, knee pain unrelated to the knee joint and migraine unrelated to the blood vessel. We rely on nerve to perceive pain. The fact of feeling pain means nothing wrong with the nerve, otherwise no pain in a damaged nerve. Pain can hardly be a problem of the nerve. Pain is derived from mechanically strained muscle and fascia, like hair tangled. In diagnosis, the exact injured sites can be manually probed and accurately located; X-ray, CT scan or MRI is of no use. Any treatment that does not untangle the strained tissue is deemed to be ineffective, including all external means such as medication, injection, hot/cold application, electrotherapy, massage, manipulation, brace, surgery, acupuncture, etc. Strained tissue can only be effectively untangled internally by the body itself and light touch is the way to initiate such self-healing. Anything that irritates the injured site worsens the injury and should be avoided such as strengthening, stretching, traction, forceful massage, manipulation, exercise, etc. Pain from soft tissue injury and/or acute inflammation can be readily and quickly cured by applying Touch-and-Hold & Stretch-and-Hold of The Precision Method precisely on the injured site. Touch or Stretch initiates physiological response of self-healing to release the injured tissue and Hold sustains the release until reversing to normal.

In all textbooks regarding pain, soft tissue injury is largely neglected. Therefore, healthcare providers are very limited in learning and understanding about muscle and fascia injury, knowing what it is but not how or why it is. This makes them not pay much attention to soft tissue injury with no examination of muscles or fasciae in the diagnosis and treatment of pain. Hence, those books are inadequate and unreliable simply because muscle and/or fascia strain in fact accounts for nearly all pain. Therefore, those readers are misinformed and misguided. As in a Chinese saying: “It is rather without a book than believing all in the book.”

I wonder whether those scholars/professors who wrote medical textbooks are based on the clinical experiences in personally examining and treating patients. How many of them did? Do they know where the pain comes from? Or do they just follow the long-established tradition while the exact nature and source of pain remain unknown, unnoticed or unattended? Therefore, the previous errors are unknowingly passed on and on leading to misdiagnosis (wrong diagnosis) and thus misled approach to treatment (wrong treatment).

Interesting enough, you may find it odd and incomprehensible to note how physicians evaluate pain often without actually touching the painful sites. When your child falls down and suffers pain, you would naturally want to find out where and what the injuries are by palpating the painful sites with your fingers. Yet when you go for a medical check-up because of pain (e.g., back pain, knee pain, headache), your physicians are guided by the textbooks relying on tests (X-ray, MRI) but hardly ever manually touch the painful sites to know where the pain comes from, how many and what they are. It is so very essential to palpate tenderness in order to locate the injured sites in the diagnosis of pain, regardless of what other tests and workups are done. In doing so, one will find soft tissue injury as the source of pain and not the spine, joint or blood vessel, thereby avoiding wrong diagnosis and wrong treatment. Otherwise, the patient is likely to end up with mistreatment because of misdiagnosis.

The common concept that back pain is caused by bone spur or disc herniation pinching the nerve as sciatica is based on the textbook. However, the structure of spine has no pain sensation and the inflammatory pain from acute pinching of nerve is short-lived. Back pain is definitely derived from soft tissue injury unrelated to bone, disc or nerve. The source of pain can be located by palpating the tender soft tissue at the painful sites. Physicians genuinely follow the textbook but without examining soft tissue, thus erroneously treat it as “sciatica”.

The universally accepted notion of other conditions such as hand pain due to compression of median nerve (carpal tunnel syndrome), tennis elbow due to inflammation (lateral epicondylitis), shoulder pain due to rotator cuff tear, frozen shoulder due to adhesive capsulitis, knee pain due to meniscus tear or bone-grinding-on-bone, migraine due to arterial spasm, pre-menstrual syndrome due to hormonal disturbance, etc., is all wrong. They are factually due to soft tissue injury.

Restless hand is said to be a neurological disorder, but basically soft tissue injury instead. Many of such patients are misdiagnosed and mistreated as Parkinson’s disease. The former presents gross shaking/tremor (essential tremor) upon movement (no shaking at rest) in many parts of the body (not only fingers), while Parkinson’s disease manifests with fine (pill-rolling) tremor limited to the fingers and only at rest (tremor ceases upon movement) as well as slow mobility (bradykinesia), (lead-pipe or cogwheel) rigidity, and posture/gait disturbances (stooped posture, impaired balance, rapid shuffling or festinating gait), facial apathy, etc. There are obvious differences between these two conditions, not to be mixed up. The same situation is seen in focal dystonia, which is also due to soft tissue injury but not nerve disease. Its treatment should be focused on soft tissue rather than nerve.

Numbness of feet is believed to be due to diabetic peripheral neuropathy, along with shingles pain and trigeminal neuralgia, all pointing to pathology of the nerve. Our body relies on nerve to feel pain. The fact that there is pain indicates the nerve to be intact. When a nerve is damaged or diseased, its sensory perception is impaired or lost, being unable to perceive pain, numbness or tingling. Pain and neuropathy are mutually exclusive. Therefore, pain is rarely associated with neuropathy and there is no “neuropathic pain”. Upon examination, the foot and toes are very tender, indicating soft tissue injury as the source of foot numbness. The same is true in shingles pain and trigeminal neuralgia.

No pain ever comes from a joint regardless of bone grinding on bone, cartilage tear, degeneration or arthritis simply because there is no pain sensation in its inner structure. Therefore, knee pain is unrelated to knee joint and hip pain unrelated to hip joint. Pain only comes from soft tissue outside and around the joint which has pain sensation. Such soft tissue injury can be easily identified by palpation and resolved by light touch for 1-2 hours. Yet, physicians routinely do not examine soft tissue to find the source of pain but blame it all on the joint, then make a big deal to change the joint (total hip/knee replacement).

As far as arthritis, it means inflammation of the joint by definition. There may be inflammatory pain, yet no pain without inflammation because the joint structure has no pain sensation. Pain comes from inflammation but not the joint; i.e., there is no “arthritic joint pain” other than occasional short-duration “arthritic inflammatory pain”. Once inflammation subsides, there is no more pain, even with joint deformity. It can be said that pain is not related to arthritis (when not actively inflamed) and arthritis is not to be considered in dealing with pain. The popular view by medical professionals and general public that attributes arthritis as a common cause of pain is without merit. However, during flare-up of arthritis, the fascia tissue around the joint is also inflamed and strained, then further strained by the inflammatory swelling and stretching resulting in pain, tenderness, tightness, stiffness and bulging. Such fascia strain is the true source of so-called “arthritis” pain.

There are always two kinds of injuries at the time of fracture: fracture of bone and strain of soft tissue. In reality, a person does not break a bone without injuring the soft tissue around it. It is imperative that both of them must be addressed, yet soft tissue injury is unfortunately neglected and untreated. After healing of fracture, the residual pain and dysfunction come from soft tissue injury rather than fracture itself. If untreated, soft tissue injury remains unresolved for years without spontaneous recovery. In treatment, it is not appropriate to apply strengthening exercise or forceful stretching to the already injured muscles/fasciae because the injury may further worsen. One patient suffered wrist fracture and was treated with surgical fixation followed by casting for one month. After the cast was removed, there was some degree of wrist contraction. She underwent 55 hours of occupational therapy for stretching and strengthening, but ended up with severe contracture of all finger joints, wrist, elbow and shoulder, rendering the entire upper extremity totally disabled. She also suffered severe pain requiring heavy narcotics. Six months later, she came to me for therapy and it took me more than 200 hours to release all joint contractures and restore function. There was another patient with an identical fracture, being unable to use her hand in daily activities such as eating, driving. Right after surgery and before therapy, it took me only 2 hours of light touch to restore her hand function with no more pain or contracture so that she resumed normal daily activities, requiring no other treatment. The difference is so great between the two patients, indicating that therapy for stretching and strengthening is counterproductive and harmful.

Dyspnea (difficulty in breathing) upon climbing hill or stairs is mainly derived from soft tissue strain in the rib cage, diaphragm and abdomen causing limited chest/abdominal breathing. This is much more common than lung or heart disorders. Rib cage pain in the left upper chest is easily mistaken as heart attack. It takes less than a minute by manually checking tightness and tenderness in the rib cage to know if soft tissue injury is the source of pain. This should be done first before looking into mild lung or heart condition. Commonly nasal and throat symptoms with excessive secretion (stuffy nose, runny nose, post-nasal drip, scratchy throat, dry cough, snoring) are the most standout presentation of acid reflux which is the result of abdominal muscle strain, but it is usually presumed as “allergy” or “chronic infection/inflammation”. Dry cough is due to irritation of soft tissue in the throat consequent to acid reflux, not to be treated as bronchitis. Leg cramps are related not to lack of water or potassium but soft tissue injury. Foot pain comes from soft tissue (fascia more than muscle) strain of the foot but not inflammation of fascia in the forefoot (plantar fasciitis).

In drooping eyelid, the eyelid is weak and lax because of muscle/fascia strain in the eyebrow and upper orbit. Cutting a piece of the eyelid to shorten it may reduce drooping, but there is a drawback. It makes eyes asymmetrical in opening half way that the operated side goes up higher than the other side. Since it can be easily fixed by light touch in 20 minutes, why surgery? Dry eye is the consequence of strained/tightened fascia blocking tear flow, it can be relieved by light touch for 15 minutes, why using artificial tear for a lifetime? Strabismus (cross-eyed) is the result of strained eye muscles limiting eye movement and can be restored not by surgery but by light touch for a few hours. Nearsightedness and farsightedness can be corrected by releasing the strain and tightness of the ciliary muscle via light touch to resolve its defect in focusing function, not just relying on eyeglasses or laser to compensate for the defect. After treatment, vision returns to normal and eyeglasses are no longer needed.

Urinary dysfunction (urgency, frequency, hesitancy, retention, stress incontinence, post-void dribbling) and bowel dysfunction (urgency, frequency, stress incontinence, bowel retention, constipation) are also due to soft tissue injury and can all be restored to normal function after 2-4 hours of treatment with light touch, but not by medications. The same is applicable to impotence in male and sexual pain in female.

Without further elaboration of many other conditions, here is a conclusion:

There is a misconception among healthcare providers and the general public about the causes of pain. For example, back pain is actually derived from soft tissue injury rather than those written in the textbook such as bone spur, disc herniation, pinched nerve, sciatica, arthritis or other conditions of the spine. Soft tissue injury can be easily diagnosed through manual examination of the involved muscle and fascia via palpation of tenderness/tightness, testing for muscle strength and active/passive range of motion, observation of posture/gait, etc. Other diagnostic tests are not needed. Based on an accurate diagnosis that identifies the precise injured sites, back pain can be effectively and cost-effectively treated, not with medication/injection/ surgery but soft tissue release; i.e., Touch-and-Hold & Stretch-and-Hold of The Precision Method. By using this method, injured soft tissue can quickly recover with no more pain. Without proper and adequate treatment, it may remain unresolved and disabling for years. The same principles of diagnosis and treatment can be successfully applied to pain anywhere in the body, even extending to other pain-related conditions. It cannot be over-emphasized: Soft tissue injury is the culprit of all pain. A diagnosis with no regard to soft tissue injury is deemed to be a misdiagnosis; a treatment with no regard to soft tissue injury is deemed to be ineffective.

September 28, 2022

For further details, please visit my website: NoMorePainClinic.com or my book “NO MORE PAIN All Pain Considered ─ A Breakthrough”.


作者周明峰為復健專科醫師 (Emerson M. F. Jou, M.D., M.P.H.)