CHAPTER 1

FOUR EXAMPLES OF PAIN FROM MUSCLE

SPASM CHAIN REACTION:
Case 1, Patricia
When it struck, the pain was sudden, sharp, and
severe. She described it as if a spear had been thrown at
her from a distance and, without warning, impaled her
through the back, exiting out through her chest. She
couldnt breathe. She clutched her chest. She gasped a
quiet scream, enough for her family to hear.
Immediately everybody blamed the heart. Could she be
having a heart attack? The children cried. Her husband
called 911. The ambulance arrived promptly and she spent
five hours in the emergency room. An electrocardiogram
showed a normal heart rate and rhythm, and more
importantly, no evidence of heart muscle tissue damage.
Blood tests measured her cardiac enzymes which spill into
the circulation and skyrocket when heart muscle cells die;
but there were no enzyme elevations. Tests for a painful
air pocket within the chest (pneumothorax), for general
inflammation, and for infection were all normal. Clearly,
it was not a heart attack.
Fortunately for Patricia, the emergency room doctor
gave her a strong narcotic pain medicine injection. The
cause of the pain attack was never determined, but the
medicine worked. When the injection wore off the pain
pills, although not nearly as strong as the shot, cut the
pain to a tolerable level.
From the start Patricia suspected it wasnt her heart.
She was too young, forty one. Neither she nor her family
members had heart problems in the past. The pain spread
into her throat, neck, and arms, and was worse on her left
side. The pain had almost paralyzed her left shoulder and
arm. When she sat down to rest, it didnt help. Instead,
it seemed almost to make the pain worse!
She hadnt been doing much physical work when the pain
struck. She had just finished loading the dishwasher and
had washed some larger cooking pots. For the activities of
a mother of two little girls, this was nothing. She felt
the problem just couldnt have been her heart. She was

relieved but perplexed when the emergency room physician

agreed, and said only that it was muscle spasm and that
she should rest.
Because of family connections to Patricia, I evaluated
her shortly after the pain attack, while the problem was
still acute. For that same reason, I could closely monitor
her treatment and clinical progress, more so than with my
usual patients who come to see me perhaps every two to four
weeks.
Although I heard of the painful events by phone, and
of the emergency room evaluation, she gave me a big clue to
the problem when she arrived at my office with her husband.
When it came to the obligatory, friendly hug of greetings,
she couldnt lift her left arm. You could tell by her face
that it hurt to try.
My examination included a detailed inventory of all
the muscles, ligaments, and joints of the spine, shoulders
and rib structures. I wanted to know precisely, to the
cubic millimeter, what was tender, and in what way the body
as a machine was malfunctioning to cause such pain. Both
the long term causes as well as the acute inciting event,
which brought the problem to a head, were obvious on
examination. Patricia proved to be a good example of what
this book is about.
Patricia was a good patient and did exactly what I
recommended for treatment. She did the exercises I taught
her. By the next day the pain was cut in half and she
discontinued her pain pills. The rest of the problem went
away over the next two weeks. Pain has not reoccurred, and
if it does, she knows what to do for it. She has control
over the pain.
*

Case 2, Jeffrey
For more than twenty years Jeffrey was tortured by
chronic, recurrent, migraine headaches. Severe, body
numbing, blinding, throbbing headaches would come and go
without warning or cause, and left only when he was
fortunate enough to lapse into an unconscious sleep.
He told me he had three types of headache. Most of
the time there was a milder background headache that he
felt all over his head. He had no inkling why some days he
was pain free, and others not. In spite of the background
headache pain he could function: go to work, go to church,
play with his children. Background headaches didnt

automatically evolve into migraines, but at times would

miraculously go away. Other times, he was not so
fortunate.
He could tell when a throbbing migraine was imminent.
A transition headache occurred that gave him time to get
home and to bed with the lights out. A full blown migraine
would then captivate his life for several hours until he
slept. The morning after, he was stiff, had a sore neck,
and his background headache would be back until late in
that day.
Over the years, decades actually, Jeffrey had many
medical evaluations by neurologists, neurosurgeons, pain
specialists, chiropractors, even a psychologist. He had
tests and more tests, but no answers. Lots of pills had
been tried, many with side effects. At best, the narcotic
pain pills would help a little and the tranquilizers would
help him sleep; but he wasnt a pill oriented person and he
knew they would eventually conflict with family
responsibilities. Long term, no medication seemed
worthwhile.
In spite of the migraines, Jeffrey was a successful
thirty-six-year-old insurance agent, husband, and father of
two. He was handsome and athletic. His only past injury
was to his right shoulder in high school football years
ago. He continued to be athletically active with weight
lifting and playing softball.
When I asked him if he could pin point anything he
believed brought on the headaches or made them worse, he
stated stress was one culprit, but not always. To his
knowledge, he had no more stress than the average person,
indeed less. The children were healthy. He got along well
with his wife. He wasnt in significant debt. He seemed
to have only the everyday, usual stresses.
At one point during the physical examination, with
Jeffrey lying on his back on the table, I placed my
fingertips on the upper left side of his neck, below and
behind his ear. Suddenly his eyes opened wide. He tensed
and exclaimed, Doc, thats my headache! You are going to
start my migraine!
I palpated the sternomastoid muscle. This is one of
the neck muscles famous for radiating pain to the head,
mimicking a migraine even with the bodys numbness and
photophobia. I will talk a lot more about this muscle
later in this book. Indeed, Jeffrey had muscle spasm in
the sternomastoid muscle.
Moments later I placed Jeffrey on his side to give me
clear access to a special shoulder muscle, the serratus

anterior muscle, which is often found to be in spasm along

with the sternomastoid muscle. Again his eyes grew wide
and he exclaimed, What are you doing Doc? I didnt know I
hurt so much there! The migraine is going away!
Nothing else was wrong with Jeffreys physical
examination. His head bones werent jammed. There were no
spine motion restrictions or lesions. All the muscles,
even those in spasm, were actually healthy. I taught
Jeffrey how to self stretch the muscle spasm, and how to
anticipate when stress would cause spasms, so he could
prevent his migraine headaches.
Clearly Ill boast with this case, my best clinical
case ever. Months later Jeffrey dropped by to let me know
he hadnt had a headache since then. Literally decades of
pain were cured by one clinic visit. If only they were all
that easy!
*

Case 3, Lori
This next case example was much more difficult. In
all, I spent two years and two months working with Lori
helping her get over a bad whiplash injury. For me this
was more of an average pain case than the last patient.
Whiplash can cause a mean chronic pain condition. Here is
her story.
I met Lori fifteen months after her car accident. She
had been side struck and merely bruised her left hip and
shoulder. Even though nothing broke - there were no
fractures - the accident caused neck pain, headache, and
lower back pain, all worse on her right side. The
emergency room physician referred her to an orthopedic
surgeon whose evaluation led to a diagnosis of whiplash and
lumbar strain. He concluded there was no need for surgery.
For treatment she was sent to physical therapy. After
three months she returned to work, but, in spite of
treatment, her pain never got better.
In character, I believe, Lori was tougher than most
people. When I met her she was thirty three, married, and
a mother of a teenager and two well behaved pre-teen boys.
Her husband was supportive. She worked in a sewing factory
as an inspector, a job that demanded rapid, repetitive,
continuous work with the arms, stooping, twisting, lifting,
pushing, and pulling. She worked in spite of her pain.
Her pain was with her everyday.

Lori had a mature, easy going, tolerant, and

optimistic point of view. She was stoic, didnt whine,
cry, complain, or show much emotion. She preferred
learning what she could do to help herself rather than
relying on somebody treating her. She didnt even have a
lawyer!
Other doctors had also evaluated Lori, including two
neurologists and a second orthopedic surgeon. She had MRI
scans of her neck, low back, and head. Except for the
pain, nothing was found to be medically wrong. Lori had
chiropractic treatment for six months which lessened but
didnt cure the pain. Out of sheer exasperation, by the
time I met her, she was receiving from her family physician
repeated injections into her painful muscles and taking
three types of medicines.
She told me that a hot pack or an electrical heating
pad seemed to help temporarily. After work she would take
a hot bath that some days would last two hours. For the
benefit of the heat, she often took several baths a day.
In addition to pain, Lori had episodes of
lightheadedness and dizzy spells. If she was driving and a
dizzy spell struck, she would have to pull over and wait
until the spell would pass. One of her prescribed
medicines was for sea sickness, but this was just as
ineffective as the rest of the pills she tried.
In the eyes of Lori and her family physician I was the
last chance for her to obtain some relief from chronic
pain. She had neck pain and low back pain on both sides
but worse on the right. She had headache. All of this
pain afflicted her everyday for the preceding fifteen
months.
As I have mentioned previously, my clinical
examination looks at the human body as a machine, searching
for what mechanical faults may yet exist in spite of past
treatments. While this sounds simple, it turns out there
is much more detailed testing and examining, and indeed a
somewhat non-medical philosophy that must be taken into
consideration. There will be more on this topic later.
Fortunately for Lori, several mechanical problems were
identified after the physical examination which could be
remedied. The particular collection of abnormalities, in
my experience, typically occurs in whiplash injuries that
dont get better from the usual physical therapy and
chiropractic care.
Shoulder muscles that connect the shoulder blade to
the body were injured, and as a result were in spasm,
tight, and weak. This led to a chain reaction of muscle

spasm that went down the trunk into the low back and hips,
causing widespread pain, tightness, and weakness. The
chain reaction also went up into the neck muscles causing
headache. Even though she had chiropractic manipulation
treatment, still there was tightness of spine facet joints
at the base of the neck.
In the long run, it turned out that emotional factors
were important. On the surface she appeared stoic and easy
going. In actuality, there was an undercurrent of a very
understandable level of: anger that this had happened to
her and her family, fear that nothing was ever going to
help her, grief over the lifestyle she lost, and stress
because the chronic pain didnt let her keep her accustomed
clean and organized home. These emotional issues fed into
the muscle spasm chain reaction and accounted for a slower
response to treatment compared to my two previous case
examples. But when all of this was dealt with, the
physical problems as well as the emotional issues, there
was a good outcome.
Using osteopathic manipulation techniques, I adjusted
the tight spine joints at the base of the neck. Repeatedly
I did deep, trigger point massage and I manually stretched
the worst offending muscles. I taught her husband and
children how to massage these muscles to lessen spasm.
Most of the treatment was home exercise. I identified
the location of muscle spasm, and taught her how to self
stretch and to later strengthen these muscles. I taught
her how to anticipate muscle spasm and to take preventive,
therapeutic steps. Progress was slow.
I started medication because massage and exercise, on
top of chronic muscle spasm, will often cause temporary,
but severe pain flare up. At her request these were
limited to a mild pain reliever and muscle relaxant. I
took her off work for three months.
Lori improved nicely, but worsened after she returned
to full time work. To compensate, she increased her hot
baths and began to use a small electrical stimulator (TENS)
for pain relief. She continued to improve but eventually
seemed to plateau in her progress. At that point, I
involved a pain psychologist for several sessions to deal
with the emotional factors.
To this day, Lori is not one hundred percent pain
free. She has pain free days. She is off medication and
not receiving any treatment, even from family members. She
works her regular job at a normal level of productivity.
On days when she does too much with her arms, at work or
with home chores, she uses the electrical stimulator and

10

takes a hot, soothing bath. She exercises daily, at least

doing the muscle stretches I taught her. She feels she is
continuing to slowly improve. But more importantly, she
feels she is now in control of the pain and of her life.
*

Case 4, Mark
Mark is a thirty-one-year-old, young man whose
situation almost got me into trouble. Being in the pain
business like I am, often invites the specter of politics
and the involvement of money conscious bureaucrats. This
was a workers compensation case, making it very difficult.
About ten weeks prior to my meeting him, Mark had an
accident at work. He slipped off a three foot podium onto
his back. There was a sudden onset of low back pain as
well as numbness of the back and both legs. A physician
examined him and he was referred for treatment to physical
therapy. When his pain didnt go away, he was evaluated
and treated by a chiropractor. This too didnt help. He
was examined by two new physicians and sent for a second
bout of physical therapy treatment, which helped only a
little.
Then a controversy developed. One physician thought
he needed to strengthen up. Mark thought he needed time to
heal. He continued to work, but his physician placed him
on a lifting restriction that his employer thought was
excessive. His employer didnt trust him.
When I first examined Mark, I too thought he needed to
strengthen his muscles. After all, he couldnt do even one
sit-up and his job involved considerable lifting and
repetitive twisting.
Mark was cooperative. He did his exercises and he
strengthened, but it didnt help. He became anxious that a
serious problem was being missed and asked that more tests
be run. He worried that he could lose his job.
Repeat physical examination was confusing. I couldnt
assure him he didnt have a pinched nerve in his low spine.
His reflexes were mildly abnormal. The sciatic nerve
stretch test and the straight leg raise test were
definitely abnormal. A MRI scan of his spine was ordered,
but the results were normal. He clearly didnt have a
pinched nerve and wouldnt be needing spine surgery.
More troubles developed with the employer over work
restrictions. In conflict were my recommendations, versus
those of another physician that he continued to see, versus

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those of his chiropractor, versus what he thought were

realistic. The insurer refused further therapy. Mark
refused pain pills.
He was so anxious and scared that at one point in
clinic he cried. He was convinced his job was lost and his
upcoming wedding was ruined.
The low back pain had not
responded to treatment and anytime he pushed himself it
flared up causing even the leg numbness to return.
Again I examined Mark. The muscle spasm I had found
in his flank continued to be present in spite of treatment
and exercise. Intuition told him this wasnt the primary
source of his pain problem. I examined his shoulders. We
both were startled at the severe spasm in the left shoulder
muscles that attach the shoulder blade to the rib cage, the
serratus anterior muscle. Not only did he wince and scream
out in shock (after all he had no shoulder pain this whole
time), but he told me that by pushing on this muscle his
back pain flared up!
Experience has taught me muscle spasm occurs in
patterns, the most important of which is muscle spasm chain
reaction. I will describe the details about it later in
this book. However I continue to be amazed when I see one
area of muscle spasm cause pain symptoms so far away. In
this case shoulder muscle spasm appeared to be causing
Marks low back pain!
Mark, I said, this is going to hurt, but with all
the trouble you have had, and all the treatment failure, I
want to treat this myself, here and now, just to see if
this shoulder muscle spasm is the cause of your back pain.
He responded in a trembling voice, Go to it, Doc. I
didnt hold back.
I had to push hard. Mark was a big man, stout and
thick. The shoulder muscle is easy to get to, but not the
flank muscle, which I also treated. I located the most
tender points (trigger points within areas of muscle
spasm), and pushed and held. Every tender knot was
treated. He limped out of the office, but intuitively he
felt hopeful. At least something new was being tried. He
called me the next day to report he was much better.
At the clinic follow up I did a repeat treatment to
the muscle spasm, taught his family how to massage these
muscles, and taught him how to self stretch and to
strengthen the shoulder muscles. In about two weeks he was
able to resume his usual unrestricted work activities and
the pain problem never returned.
In hindsight it appears to have been a simple problem,
just another case of muscle spasm, but soft tissue pain

12

problems such as this can be complex and troublesome. I

had to talk to insurance bureaucrats everytime I saw Mark
in the clinic. At first it seemed he wouldnt get better.
With this being a workers compensation case a lot of money
was at stake. In spite of the tension and mistrust, Mark
was motivated and cooperative. Perhaps as a sign of his
innocence, after he was cured, he invited me to his
wedding!
*

They each had the same pain problem!

Incredible as it may seem, these four cases describe
the same condition. The pain problem came from the same
source, a condition of muscle spasm that starts in a
particular shoulder muscle that can link up with muscle
spasm in other body areas: the neck and the low back. In
other patients I have worked with, the muscle spasm may
link up with muscles in the forearm, the hip, and the calf.
The condition is a chain reaction of muscle spasm. In each
of these four cases it was essential that the muscles of
the chain reaction, and in particular the culprit shoulder
muscle, be effectively treated for their pain to go away.
Notice the differences among these people. One had
sudden onset, mid back and chest pain that developed
without injury. The next had more than a decade of severe,
recurrent, migraine headaches, also without injury to cause
the condition. Lori had a whiplash injury from a car
accident. Her condition was neck pain, headache,
dizziness, and low back pain. Mark had low back pain and
numbness in the leg caused by a work injury.
Notice the similarities: each person had severe,
disabling pain. Each had failed traditional medical and
chiropractic assessment and treatment. Medical specialists
such as neurologists, neurosurgeons, and orthopedic
surgeons couldnt help. Diagnostic tests were normal. MRI
scans were normal. Physical therapy, chiropractic
adjustments, and drugs didnt help.
Each person improved after the shoulder muscle spasm
condition was identified, the chain reaction of muscle
spasm was accounted for, and the body as a machine was
brought back to normal mechanical functioning by
eliminating the muscle spasm. Simple treatment was
effective: massage, self stretch exercise, strength
exercise, and education about how to recognize the source

13

of the problem and how to prevent the spasm from getting

out of control.
Some additional treatments were tried and they
provided limited benefit: temporary pain pills, hot packs,
and an electrical stimulator to block pain. Lori received
very helpful benefit from psychological counseling. Indeed
traditional treatments did help a little, but temporarily.
The common thread among these four cases was the
identification of and treatment of particular areas of
muscle spasm. Actually these cases were deceptively
simple.
Notice how much was wasted. Unfortunately the latter
three cases had months of ineffective treatment that
ultimately we all paid for. There was much lost work time.
They had expensive tests that turned out to be worthless.
There were multiple physician examinations and charges to
pay. However, successful treatment turned out to be quite
inexpensive.
All of this may mean a lot to you. Experiences should
be learned from. If you have, or know of somebody who has
a difficult pain problem, be it neck pain, headache, arm
pain, back pain, chest pain, abdominal pain, or even leg
pain; there may be a simple reason why the pain has defied
medical investigation and treatment. The real cure may be
surprisingly quick and easy, and best of all, may be
carried out by you alone without the need of expensive help
from anybody. To know if you are subject to the muscle
spasm chain reaction condition there are simple tests you
can do on yourself and with the help of a friend or family
member.

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