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Aug 15th, 2017
My 25 year old daughter has chronic pain syndrome following a whiplash injury.
In the last few weeks she also has had acute lumbar pain and spasm.
Imaging demonstrated Scheuermanns disease in the lower thoracic spine and a unilateral pars defect at L5.
What do you advise?
The Guru Responded:
It’s pretty important that all of your daughters symptoms are looked at as a whole rather than just a set of individual “feelings”.
Her back pain may or may not be related to the MRI findings which could be incidental – certainly SD is very rarely painful and the pars defect probably has been around for a long time – both sitting there totally pain free and undiagnosed until she feels some pain. 2 + 2 = ….
But she feels pain and there needs to be a logical, well thought out explanation.
One of the issues with chronic pain syndromes is there is often little good diagnostic criteria as to why it continues. Most whiplash (and I could be taking a punt) has little change on MRI or X-ray or at least significant enough change to relate to an significant or appropriate amount of pain she feels.
It’s a little like getting a paper cut – the intense pain you feel has very little relation to the tiny nick on your finger.
My advise is rehab. Rehab and a good logical explanation. She needs a progressive, personalised program – and prescribed by someone who understands things like pacing, central sensitisation and hurt doesn’t mean harm.
There is not a quick fix but she needs to have some sensible goals established and set and some good expectations established over a 12 week period.
The one thing I don’t think she needs is someone pushing, poking or prodding any of her tissues or joints. She needs a good active based program with very little, if any passive interventions.
Your daughters entire nervous system is sitting in a highly sensitised state due to the chronic pain. The volume knob on her pain sensation is maxed up to 11 – so what she feels may not be related to any tangible pathology, despite MRI. Little things feel massive. The way to help restore normal nerve activity and turn down the volume knob is to move, move well and get strong – in that order!
I’m also very aware that it’s really easy for me to type this without seeing your daughter, but she doesn’t sound unusual and I know with the right input (not just input) she can be put back to where she’d like to be.
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