Unlocking Pathways of Pain: Stories of Innovative Treatments and How They Work

By Karlene Huntley

Unlocking Pathways of Pain: Stories of Innovative Treatments and How They Work tells of the unrelenting agony caused by long-term unresolved pain. As a physical therapist, author Karlene B. Huntley met many people for whom traditional treatment had failed, patients who were frustrated, in constant pain, and ready to give up. Huntley became determined to find treatment that would give them back a pain-free life.

• Language: English
• Publisher: BookBaby
• Release date: Jul 30, 2013
• ISBN: 9781483505091

Book preview

Indiana

INTRODUCTION

The note said, My life was a s*#t sandwich without any bread before I came here, and now I am well. Thank you. Rick. It expressed the gratitude of a patient who felt as if he had found a miraculous treatment that resolved his pain. Some 16 million Americans suffer from unresolved pain that is caused by inflamed nerves, just as Rick had. Furthermore, it is estimated that between 12 and 20 percent of all women have pain in their pelvic area that makes their most intimate moments almost unbearable. Medication, surgery, and repeated sessions of physical therapy have not changed these dismaying statistics.

After graduating from physical therapy school, I started one of the first free-standing outpatient physical therapy clinics in my state. At that time the common belief was that the only place people could get competent, successful physical therapy (PT) was at a hospital. However, it wasn’t long before doctors started sending me patients who had not recovered from disabling pain despite repeated PT sessions. In fact, people began to refer to me as Last Chance Lucy.

In my work I was passionate about learning more than just the treatments taught in textbooks. Soon my explorations were helping me find new approaches for treating pain that had previously seemed unresolvable. This book describes my journey to untangle the mysteries of debilitating, unresolved pain that is seemingly impossible to heal. In these pages you will find true stories about people who came to me in terrible pain—and what I did when I faced the question of what to do when what I knew did not fit the need.

Eventually, I was to develop a technique that made recovery possible for many of my patients. Oftentimes their pain resulted from inflamed nerves, but in other patients it came from injury or abnormal soft-tissue or joint function. The stories are often heart-wrenching, but they tell of people with the hope, courage, and determination to find help that would put their pain behind them. That’s how they found me. When there seemed to be nowhere else to turn, when all possible treatment approaches had been exhausted, Last Chance Lucy went to work, finding pathways to solutions for unresolved pain.

Many times in my career I was reminded of a story my children loved when they were small. It was about a boy who lived with an old woodcutter. One day the woodcutter went away, knowing he would never return. And so he left the boy a cat and a magic fiddle. To the boy’s surprise, the cat could talk and play the fiddle. The boy took the cat and the fiddle with him out into the world, having no idea what he would encounter. Anytime the boy came upon something he didn’t understand, the cat played the fiddle and explained the situation to him. The boy would respond, I didn’t know that. And the cat would reply, You don’t know much, but now you know that much and soon you will know more.[1]

In the early years I had no idea how significant the words, and soon you will know more, would be for me as my life’s work unfolded. I was working closely with an area physician whose practice included work-related injuries. He sent patients to me, hoping that I could get them back to work quickly with less chance of re-injury. The majority of these early workers’ compensation cases were uncomplicated ones of sprain, strain, and tendonitis. I could treat them with the skills and knowledge I already had, and I thought I knew everything I needed to know. But I was soon to discover, as the cat in that old children’s tale said, I didn’t know much.

Note: I have changed most of the patients’ names to protect their privacy. Although the treatment approach I describe here works for many who suffer, it is not the only answer for those who seek help for their problems. The contents of this book are not intended as personal medical advice, nor should they be used in that manner. Always consult with your doctor before considering any treatment options.

PART ONE

THE DISCOVERY

CHAPTER 1

JIM: A PAINFUL HAND

The beginning of the greatest discovery of my career started as any other day. The doctor had sent a young man with a serious hand injury to me for treatment. When I went to the reception area to greet this young man, Jim, there before me was a big burley guy, clutching his treatment order tightly in his good hand, while holding his injured hand close to his chest.

He glanced suspiciously around the exercise area of the clinic, stopping to observe a patient who was sitting on a large piece of exercise equipment. As the patient grimaced while gripping the bar to pull it down, Jim gave me a look that said, I’m not coming in there. His eyes darted from one area of the clinic to another, and when we finally made eye contact, it was clear that Jim was not a happy man.

I calmly invited him to come into the treatment area, and led him to a chair near a window that looked out onto the parking lot. I thought this might give him a sense of freedom and a connection to the way out. After Jim sat down, I placed a pillow on his lap to cushion his injured hand, pulled up a chair to face him, and asked for the doctor’s order.

As he handed me the paper, he told me in no uncertain terms that he was not going to let me treat him if it was going to hurt. I looked at his injured hand, which was red and swollen, then down at the treatment order, then back at him. The order called for active and passive range-of-motion exercises to restore function to his hand. Intuition told me I had to approach this patient with caution if I was going to get him to participate fully in his rehabilitation. Therefore, I started by having Jim tell me, in detail, what had happened to him. I wanted him to vent his frustration and feel that he was in control. And I wanted to give myself time to think.

Jim was pleased to talk about the accident, and I could see that he was starting to relax. He explained that he had been working on an assembly line when his fingers got caught in the equipment as the line went by. Not only were his fingers caught and smashed under the hot equipment, but his hand and arm were being pulled down the line toward yet another machine. To avoid further injury, he had to reach back with his other hand to turn off the line, stretching and twisting the fingers that were already being mashed by the machine. As he talked about the incident, Jim’s entire body moved because it was impossible for him to use his actual hands to demonstrate his story.

As Jim showed me the burns on the pads of his fingers, I reassured him that I would not touch his hand until he was ready. The ultimate goal of a physical therapist is to help a patient achieve the highest level of functioning with the least amount of pain. However, traditional methods were indeed painful for the patient, and the saying, No pain, no gain, was accepted as just part of the rehab process. In order to restore motion to stiff fingers, active and passive range-of-motion exercises require the therapist to push the stiff fingers down and hold them, trying to stretch the tissue while asking the patient to actively try to make a fist. The patient usually grimaces with pain while working hard to get the fingers to bend. I knew this wouldn’t do for Jim, and I had to find a new way that would reduce the pain he would experience with treatment. At the moment I had no idea how I was going to do that. I imagined I felt the cat gently rub against my leg, reminding me that I did not know much.

But at the same time I thought about something I did know: a soft-tissue massage technique that Dr. James Cyriax described in his book, The Textbook of Orthopaedic Medicine: Treatment by Manipulation, Massage, and Injection. After applying ice to the injured area for a few minutes, therapists are to rub back and forth with the pads of their fingers, perpendicular to the injured tissue they want to release, and repeat this several times. This is to loosen scar tissue around and on tendons and ligaments.

The result of the massage is that stiff limbs move freely with less pain because the tissue can glide easily. An area of the body where this massage works particularly well is the sides of the knee joint after the ligaments have been strained or torn by twisting injuries. A healthy ligament gives stability to the sides of the joint but does not prevent the knee from bending. However, injury triggers bleeding in the tissue and causes the ligament to stick to the bone. With this massage technique, instead of pushing against the lower leg to get the knee to bend, therapists massage over the injured ligament to free it up from the bone, allowing the knee to bend with less pain.[2]

Knowing that finger joints also have ligaments on their sides and that Jim’s fingers were twisted as well as mashed, I decided to use cross-friction massage on them. I thought this would be far better than trying to make the fingers bend the traditional way. I explained to Jim that I was going to try something different to get his fingers to move, and that I would be very careful not to hurt him. Jim sighed in relief and said, Boy, when I first got here I thought you were gonna put me on one of those machines. I was ready to walk out—and I would have if you hadn’t given me a chance to look things over. Maybe this won’t be so bad after all. He and I became friends at that moment.

Jim willingly placed his injured hand in mine, and I began the treatment. As I very lightly performed cross-friction massage with my finger to the sides of the joints on his fingers, I felt a tiny sensation, something like that of a packing bubble bursting. It also made a popping sound, which seemed to come from my finger. I stopped for a moment and looked at my finger, moved it around, and wondered what was happening.

As I continued what I thought to be cross-friction massage, the sensation of a packing bubble bursting and the popping sound also continued. Jim’s fingers started to loosen and bend without pain. It was hard for both of us to believe what was happening. He no longer held his other hand in a tight fist, and I sighed with relief, knowing we could both see progress.

I would continue to release his fingers one by one over the next five weeks, but I did not realize what a new and wonderful thing was happening. I kept looking at my fingers in awe because it was hard to believe the sound was coming from his tissues . . . and not from my fingers! My fingers were not getting sore. His tissue was loosening up. At the beginning of treatment, his fingertips were about 4 inches from his palm. After a week he could get his fingers to within 1 inch from his palm, and by the fourth week he could make a fist. Jim lightened up a lot during that time, making jokes and talking about getting back to work. He was the kind of person who liked to accomplish things, who was eager for life to return to normal. It was summer and there were many projects he wanted to work on. But there was more treatment needed, and as it continued, more unexpected things began to happen.

The open wounds from the burns were still present, so I used the side of my finger that created the popping sound to work gently around the outside of them. I could hardly believe it when the wounds closed up quickly. In a couple of weeks, the swelling in his hand had completely disappeared. Whatever made the popping sound had worked. Jim returned to work, fully recovered. He was grateful not to have been put through a lot of pain, and I was humbly grateful to have offered him something besides painful stretching.

The cat sat and licked his paws, knowing it was time to get his fiddle tuned.

CHAPTER 2

PAINFUL KNEES:

THE SNAPPING TECHNIQUE EVOLVES

Ibegan to try this new technique on other patients. It appeared that I could cause this popping sound and feel the bubble-bursting sensation on any area of the body. I named my new method the Snapping Technique. I was like a kid with a new toy. Something new and helpful was coming into being. Future patients were in for a surprise!

Orthopedists were now starting to use arthroscopic surgery more widely to repair knee cartilage, but many patients failed to achieve successful rehabilitation. Sometimes surgeons had to perform the surgery more than once to resolve the problem. However, repeated arthroscopic surgeries occasionally built up a considerable amount of scar tissue in the knee, and the patients who had this did not respond to traditional therapy. As Last Chance Lucy, I began to see more patients whose painful knees would still not bend after they had exhausted all other treatment options.

I started using the Snapping Technique to release the scar tissue created by the scope holes that doctors make for inserting surgical instruments when performing arthroscopic surgery. It was fascinating to be able to actually see the tissue release, in addition to hearing and feeling it. As I treated patients who had several scope holes from repeated surgeries, I began to use one hand to move the tissue around and my other hand to snap. Often, patients’ scope holes were scarred-down, meaning that the tissue was adhered, stuck, or entwined. Their kneecaps were immovable, with crisscross layers of scar tissue caused by the lack of movement and the inflammation created by the injury and surgery. Pulling straight against the soft tissue would cause the tissue to get tighter, but the circular motion I was using in snapping seemed to release this cross-fiber scarring.

As this group of patients began to recover, they could bend their knees without pain and walk without limping; therefore, they were then able to finally use traditional strengthening to complete their rehabilitation. All of them were grateful, but most still thought it was my fingers making the popping sound. Their doctors were also glad that their patients had come across a successful rehabilitation program, but they were puzzled