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scar tissue, chronic pain, and autoimmunity: a couple of case histories


Chronic Pain Case History

Sometimes I take CASE HISTORIES that people send me and discuss them via a blog post where everyone can see.

Oh dear God, PLEASE help me with my right hip pain. It stated aged 19 and I’m 39. I don’t take pain killers for it and never have. It’s enough to drive anyone crazy. I don’t complain about it but anyone else I know would at least have gone to their GP and would be whining about it non-stop. I just get on with it. I’ve been to so many physios (and one GP). I even went to a sports medicine physician (who sent me to a physio).

It starred when I got glandular fever.  At the time I had anterior thigh pain and a very very very very tight IT band with it.  I then developed foot drop and urinary incontinence. I was sent to a neurologist and waited over a year for a T-L MRI.  I’ve never had a hip x-ray, and as I dislike the amount of radiation, no one has scanned me.

I have muscle wasting down my whole medial right leg. At the time and for years I had fasiculation right up to my right eye.  My right toe still catches on the ground.  The pain back then and for ages also went to my knee and the sole of my right foot and right great toe.  My hip is tender always. I have not the same strength in my right-sided glutes as left.

I also had pain from the middle of my back across my right scapula, under my arm in to my elbow and right wrist then.  I also had intense pain where you would describe the gallbladder to be.  I’ve tried everything (so far have declined steroids or surgery).  I can’t externally rotate or abduct.  I can’t do yoga. Sitting, standing, walking, running, and high heels hurt.  I can’t even sit in the yoga position.  I finally have to admit that I have chronic pain.

Up until that time I played sport for my country, and enjoyed immense immense immense fitness, and intense success in sport. It was easy for me. At club level, the coach used to run me extra / separately and had me training with him. And he was at his peak fitness.  I was ridiculously fast and had ridiculous stamina and flexibility. It feels like my life changed overnight. I remember no injury.

Now I’m lethargic and overweight with a sugar addiction. A shadow of the athlete that I was.  Truth is I am now finally admitting…. this has made me depressed.  Thank you for any help you can give!  Jane.

Hello Jane. 

Let’s start at the beginning.  Glandular Fever is the Aussie’s name for mononucleosis (Mono), which is most often caused by either the Epstein Barr Virus (Herpes Virus 4) or Cytomegalovirus (Herpes Virus 5).  If you spend any amount of time looking at message boards or talking to people in FUNCTIONAL MEDICINE, you’ll find that while these two infections are usually self-limiting, they have the potential to do some crazy things and cause some ugly problems — problems that are not well understood inside the mainstream medical community.

Part of the reason for this is that all herpes virus have the ability to lay dormant for decades, raising their ugly heads when given an opportunity (some sort of IMMUNE SYSTEM DYSFUNCTION).  You can see this with things like cold sores, HPV, SHINGLES, etc.  The other thing about these two virus is that they are both associated with Guillain Barre Syndrome.  According to Wikipedia….

Guillain–Barré syndrome (GBS) is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. The initial symptoms are typically changes in sensation or pain along with muscle weakness, beginning in the feet and hands. This often spreads to the arms and upper body with both sides being involved. The symptoms develop over hours to a few weeks. 

Some are affected by changes in the function of the autonomic nervous system, which can lead to dangerous abnormalities in heart rate and blood pressure. The cause is unknown. The underlying mechanism involves an autoimmune disorder in which the body’s immune system mistakenly attacks the peripheral nerves and damages their myelin insulation. Sometimes this immune dysfunction is triggered by an infection or, less commonly, surgery or vaccination.

Simply do a Google search of “Epstein Barr, Cytomegalovirus, Guillain Barre Syndrome” and look at the freaky amount of freaky information that comes up — some of it brand new and some of it fifty years old — much of it from the peer-reviewed literature.  In other words, this connection is not a reach and it’s not anything new.  Honestly, GBS is a simple diagnosis to make, so I doubt that you actually had GBS.

However, you most assuredly had something along those same lines — something in the same family (there are many many neurological reactions and autoimmune issues that are unnamed — can anyone say MUPS?).  This tells us that you are not dealing with just a simple hip issue.

This stuff may have affected your left brain / right cerebellum on some level, and undoubtedly attacked your lumbar plexus.  You have radicular symptoms on the right side (foot / toe drop, muscles not firing, sciatic-pain, etc).  Also, your bladder is neurologically controlled (at least partly) by nerves that come from about the L3 level down through the sacrum — the same area that makes up the SCIATIC NERVE

If you look at myotomes and muscle innervation charts, you’ll see that these are the same levels that innervate the muscles around your hip, quad, and certain other areas of the lower extremity, thus, the reason they wanted an MRI of your (TL area) THORACOLUMBAR SPINE (BTW, you are correct about CT being dangerous).  It’s important to be aware that it’s very difficult to correlate what’s found on the imaging with real-world symptoms (HERE).

So; getting down to fixing (or at least addressing) this beast.  I think your approach has to be three-pronged.  You’ll have to address the AUTOIMMUNE ISSUE, you’ll have to address the occult (hidden) viral infection (HERE’S a common example of this phenomenon in a different arena), and you’ll have to address the neurological issue (undoubtedly you are in SYMPATHETIC DOMINANCE).  This is not just a matter of strengthening and stretching; the reason that your PT was unhelpful. 

The very first thing you are going to do is to do an ELIMINATION DIET to figure out if there are foods you are reacting to (Gluten is assumed with autoimmunity — HERE).  The next thing you’ll have to do is get off the sugar (BREAK THE ADDICTION) simply because it, along with PROCESSED AND EVEN WHOLE GRAINS, are the single most inflammatory things we collectively tend to put in our mouths all day long (HERE). 

You’ll also need to get started on a PALEO DIET because nothing squelches INFLAMMATION better.  And depending on your lifetime history of ANTIBIOTICS and OTHER SIMILAR MEDICATIONS, you may even need to contemplate an FMT.  All of this info can be found HERE.

As far as addressing the virus, there are all sorts of cool things out there that help a lot of people assess and address the occult virus hiding in their body.  For instance, I have a patient (HERE) who has been able to win world championships in off-road triathlon, despite having Lyme Disease (bacterial).  She underwent ozone therapy from an MD in Florida (Ozone Sauna among other things) with great success.   And as far as the neurological aspect; hands down, I would make a trip to see DR. RANDY BECK — an instructor and author for the CARRICK INSTITUTE.  Don’t know him personally, but if he is teaching for Ted Carrick’s group, he’s sharp.

God Bless and hope this helps.  I want an update in six months Jane.  I also commend you for recognizing that “THE BIG FIVE” is not going to help you with this problem.
Russ Schierling

****  From her response to this post, I learned that “Jane” is a physician — ‘Dr. Jane’.  Her (edited) response to me can be found near the top of my TESTIMONIAL PAGE.

This next Case-History comes from an OUT OF STATE PATIENT I treated for CHRONIC NECK PAIN, upper back pain, RIB TISSUE PAIN, and pain around her shoulders.  She also has TMJ issues.  “Sally” wrote to me saying….

I worked as a cashier for 3.5 years beginning in Feb. 2014. During this time, I began having shooting pain in my ribs on the right side. Then I could start feeling it in my chest. I was seen by a few Chiros briefly with very little improvement. The areas between the ribs are tender. I was told by an ER Dr it’s costochondritis.

Next, My shoulder blades feel like they do not lay correctly, and my left shoulder is so tight. It does not relax when I sleep. I eventually thought this was being caused by repeated motions at work. Eventually I had joint shoulder pain and nerve pain across the collar bone region and down my arms, along with numbed arms and fingers. I looked into Thoracic Outlet Syndrome. A surgeon said I didn’t have that. A work comp doctor said I have a fascia problem with some scapular winging, but didn’t provide any assistance. I had 12 PT sessions while still working that did not help at all.

Since quitting the cashier job that made me repeat my motions and over-extend my shoulder blades, the nerve pain and numbness have mostly gone away. But the overall pain across my shoulder blades, joints, and ribs remain. And I have bad “flare ups” when I use my arms too much, or experience bouncing motions of exercise like running or jumping jacks. Putting up the Christmas tree at work caused a week of extra pain and discomfort.  My primary MD mentioned fibromyalgia to me, and I ran the other direction.

Along with all this, I’ve experienced neck/throat spasms on my left side. Currently, I have a knot on the underside of my jaw/neck area that’s been there for a couple months. It’s causing my jaw and mouth muscles to tighten. My dentist is creating a special mouth guard to help with TMJ, but she said I need PT help to improve posture. I wondered if it was a swollen gland, but the dentist swears it’s a knot in the SCM muscle. I fear opening my mouth too wide while yawning, singing, etc.

I’m at a loss. I cannot/have not laid on my sides in over 2.5 years. Instead I lay on my back using a wedge pillow that helps keep low back pain away. Tonight I had shooting chest pain that also shot across my ribs to the left of my breast under my armpit region. I’m scared and need help. Please let me know if this is anything you could help with?

Because in my mind, this was all being driven by some sort of SYSTEMIC INFLAMMATORY ISSUE, I told her that I doubted I could help, not realizing she had been addressing these systemic issues for quite some time as you’ll notice momentarily.  For the record, the costochondritis diagnosis she had received was a commonly-seen cop out from someone who surely knew better, as was the FIBRO.   Sally responded with this email.

Dear Dr. Russ,
That is the opposite of what I thought you would say. I read your website, and I see myself in your patients as well as your extensive information. Chronic pain patient. Slowly losing mobility. Fascia is inflamed and needs work. I thought that is what you treated? This pain has taken over my life.

I replied thusly.  “I might (emphasis on might) be able to help you, very difficult to say.  I’m sure what I do would help you for at least awhile.  The thing is, your problem sounds systemic.  What are you currently doing to deal with systemic inflammation?”  I included THIS LINK with my email   Sally replied… 

I’ve seen a functional medicine Dr for  the past 6 years.  He has tested me for hypothyroidism, insulin resistance / hypoglycemia, estrogen dominance, and other hormone imbalances including sex hormones and cortisol levels. My insulin resistance and hypoglycemia symptoms are gone. My insulin and glucose levels are in healthy ranges. My thyroid is in range. I dropped 40 lbs through dietary changes. My diet is predominantly organic and grass-fed meats, vegetables, healthy fats, little fruit, some nuts and seeds.

I developed food sensitivities overtime, which included grains, dairy, soy, and yeast; all of which I cut out of my diet. I still experience some PMS and PMDD symptoms. I haven’t had my cortisol tested in a while, but my energy levels are better than ever and I sleep well. My yeast sensitivity caused 1.5+ years of constipation, which has recently improved. I no longer drink kombucha. I believe it was a big part of the constipation problem. I’m trying to figure out what else to do. I am considering acupuncture. 

Sally ended up coming and getting treated.  She was loaded with SCAR TISSUE all over the place. This factor alone (along with the history of HASHIMOTO’S THYROIDITIS — itself an autoimmune disease) makes me think that she might also be dealing with one of the myriad of unnamed autoimmune diseases that work against connective tissues FASCIA, LIGAMENTS, TENDONS, etc) and maybe MUSCLES (so many remain unnamed because no one has figured out what the auto-antigen is — the possibilities are limitless). 

The thing you must remember about autoimmunity is that it is never primarily a problem with the thyroid, fascia, or whatever other organ or tissue is being attacked — it is an immune system problem.  Fail to address overactive immune system (HERE) and before you know it, you’ll be fighting half a dozen autoimmune diseases — like THIS PERSON was before I got involved.

I have a hunch that Sally has PCOS, although she was never tested (her functional doctor had been doing things that would have addressed this anyway).  After talking with her, I suggested that she do an Elimination Diet with NIGHTSHADES since she had not done that yet.  As far as what might have caused some of her FIBROSIS other than hidden inflammation (Inflammation always leads to fibrosis — HERE), she was in two relatively harsh MVA’S a number of years ago, as well as falling off the top of the monkey bars flat onto her back when she was about ten.

I treated Sally (broke the FASCIAL ADHESIONS and then gave a MANUAL ADJUSTMENT which she had not experienced before).  I then got her started on THE DAKOTA TRACTION DEVICE.  Below is her one-week response to treatment that I received yesterday.

Russ, I would say maybe 50% better? Maybe a little less. I can tell there’s a difference involving the fascia/scar tissue, so that’s great!  But the pain and tightness I am feeling is strong. My collar bone area is angry. 

That collar bone area is where muscles like the SCM and PLATYSMA attach (BTW, TRIGGER POINTS in the SCM can be tricky), creating a strong propensity for FHP (Forward Head Posture).  Interesting how the kombucha was causing her CONSTIPATION — undoubtedly the same sort of mechanism that leads to VITAMINS or even PROBIOTICS causing various sorts of DYSBIOSIS.  It’s why anymore, my mind almost automatically turns to FMT when known or suspected autoimmunity is involved (Sally couldn’t remember whether her ANA test was positive or not). 

I want you to know that I am rooting for you “Sally” and that I thoroughly enjoyed our time together.  Keep me in the loop.  Wishing you the best, Russ  BTW, once Sally got started on a regimen of Pilates, her pain virtually ended.


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