Where Are All the Muscle Doctors?

Muscles In Human Back

With so many conflicting opinions on the healthcare bill, it’s hard to separate reality from fiction. One thing does rise from the fracas; however, and that is that getting people well is NOT the issue that is being argued. And this is very sad.

There is a lot of amazing work and research happening in medicine today, but there is also a lot of outdated thinking that can at times be an obstacle to patient wellbeing. As doctors, we need to broaden our horizons, be open to new ideas, and be smart and humble enough to work with our colleagues, and pool our resources to work integratively. As patients, we need to be informed, do our research on our health issues, and on the doctors and treatments we might be seeking out, so that we don’t fall victim to both our health issues and the baffling labyrinth of the healthcare system.

This leads me to the question, “Where are the muscle doctors?” There is no established group of medical specialists who specifically diagnose and treat muscle. Maybe because muscle is too subjective? In my practice, and the practices of my colleagues, experience and results show us that muscle can most definitely be the primary cause of pain and dysfunction, or can be a very symptomatic corollary. In fact, ignoring the muscular component can actually prevent a complete recovery from a structural issue or a surgery! But there is no clinical scale yet to measure muscular pain or tightness. Even when muscular damage shows up on an MRI, it is often dismissed as clinically irrelevant, especially if there is other, more quantifiable structural damage present. Does the current healthcare system adequately allow for the diagnosis and treatment of muscle?

If you Google the relationship between doctors and muscle, you find a circular maze. There are a lot of roads that lead to pharmaceuticals. There are lots of roads that lead to diseases and other diagnosable conditions that explain away the muscle pain. I found Australian Sea Lion Poisoning as a reason for muscle pain. If you eat the liver, it can result in muscle pain and even death. As anyone knows who watches “House,” it’s easier to treat a condition than it is a set of symptoms that might not have a cause that you can easily look up and treat with a prescription or a referral. It is certainly not wrong to look beyond muscle pain for something more serious that could be underlying-thank goodness we have the ability to do this! If there is a problem in the body that drugs or a specialist can fix, Great! But what if the cause is not something underlying, and you just have muscle pain, soreness, and dysfunction that nothing seems to really pinpoint. It is not an uncommon occurrence for a patient to bounce around in the system from treatment to treatment without ever getting closer to addressing the problem.

As a chiropractor whose practice focuses on muscular involvement, I see everyday how muscle is overlooked in today’s healthcare. I make it a point to work closely with orthopedics, neurologists, acupuncturists, physical therapists, and other practitioners who deal in recovery, pain management, and other problems that don’t have an immediate answer like penicillin or stitches.

If a client walks into my office with knee pain, I want to know the whole story of why he is having knee pain. Not what is probably causing it, what might relieve some of the symptoms, or what might be the quickest, most obvious solution. This requires that one see the big picture: we are all a part of a team of care-there is not always one easy answer.

To illustrate this concept, below are a few cases where muscle was at the heart of the issue with varying involvement of other structures:

Runner’s knee: A runner comes in with a dull unspecific ache in his knee area. The pain is under and around the kneecap, and becomes very painful when he runs. He runs through it for a while but it gets worse, hurting sooner in the run, and eventually during other activities. He lays off running a bit, but when he goes back, the pain is right there again. No doctors or therapist have been able to return him to his sport. He asks if he should just stop running.

This is a relatively simple case. Runner’s knee is often patello-femoral syndrome. Two of the quadriceps muscles, which attach to the kneecap become unbalanced. The quad on the outside (vastus lateralis) pulls harder than the quad on the inside (vastus medialis), which forces the knee cap to grind into the groove of the thighbone, where the kneecap normally glides. This can cause pain in the knee joint, by tearing up the cartilage and irritating the knee, and can also cause muscular pain, as the weak muscle gets strained, and the tight muscle gets contracted and over-worked. In the case of this runner, we used manual therapy to release the contracture in the lateral quad, which restored the muscular potential to work correctly, then sent the runner to the physical therapist to strengthen the weak medical muscle. Finally, we recommended a program of flexibility and functional strength work to assure that he keep his muscles balanced, and his body awareness intact. When harmony was restored, the runner went back to running pain free. No surgery, no medication, no giving up running, no problem.

The case of a torn meniscus is a little more complicated…

The thing you can do to best utilize the healthcare system–no matter what state it is in–is to help yourself. By this we mean, educate yourself; be aware of yourself. Make an appointment with a doctor, but be prepared for that visit: research the doctor, research your issue, research the treatment options. Be involved in your care. If you have pain that could be muscular in origin, ask a medical professional who addresses muscle specifically, and respects the affects it can have on the body. Make sure that the muscle is treated, and ask for help in developing some guidelines for some self-treatment. Even if that is not your doc’s specialty, they should be able to refer you to someone. If you’re kidney has an issue, there may not much you can do yourself, but if you have back pain from sitting at a computer all day, there is a wealth of helpful information and self-treatments options to address that pain under a doctor’s supervision. The key is to find the answer that addresses the cause and not just the symptoms. Now if only we could all agree on the cause of the healthcare problem.

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  • Dennis M. Nelson, LMBT

    “Where are all the doctors?” indeed? I am a licensed massage therapist that dreams of pursuing a doctorate in Myology. If  only there were such a program in our country. No wonder there is such a failed healthcare system. I have assisted chiropractors in the very same sports injuries you mention above. The problem is, few chiropractors utilize us to assist them in their adjustments, and we can not self refer. Some neurologists are picking us up as neuromuscular therapists, but not enough to sustain our ability to pursue and achieve higher education. This needs to change in our country. We as medical massage practitioners are ready to help fill the gap of treating muscle imbalance manually, but we need the help of doctors and patients to demand it.

  • Patrick

    The missing link is Muscle Activation Techniques, which assesses and corrects these muscle imbalances not just locally but globally related to the issue at hand. Weakness is the cause of tension which is a protective mechanism related to instability, and this can be corrected immediately in one fell swoop.

  • George C. Nash

    As someone with post-polio syndrome that includes fibromyalgia, as well as ligament/cartilage issues, this situation has become very important to me. All the doctors I’ve seen, including the last chiro, have not attended to the muscular issues at all, preferring to look at the bone, the nerves, even the psychology. Too many drugs that are too ineffectual. Too many physical therapies that seem unuseful. And don’t get me started with osteopaths. So I’ve wondered – where are the muscle doctors?

  • Maria Canzano

    Tha whole thing started after I recived chemotherapy (to take care of that pesky breast cancer) it took some time for my body to regain strenght and mental willing. Being a couch potato was not in my plans, and I wanted to speed up the recovery and may be get rid of the neuropathy in my feet, legs and hands so I joined a terrific exercise group, it has been about 3 months but it appears that I might have made things worse for these parts of my body. I need a great doctor to guide me in the right direction and start enjoying my young 62 years and many more to come…. Any suggestions ? I would prefer some specialist from the Syracuse, NY area…Thanks

  • Priscilla Freeman

    Amen. I have suffered the late effects of whiplash syndrome for 9 years. I didn’t really I had whiplash at first because it took 3-4 months before pain and discomfort settled in. I was afraid of medication and didn’t take the flexeril as prescribed. I tried physical therapy but the time and exercises was difficult to fit into my management profession. Three years later my next was bent

  • Kath

    I have a problem with my kneecap grinding and my knee joint deteriorating since I had an operation to repair a ripped cartilage 2.5 years.

    Before the operation my joint and kneecap were in very good condition but within 12 months of the operation my joint and kneecap is in such a bad state I need a knee replacement.

    It is visually obvious my kneecap is displaced and the muscles above my knee are twisted but no consultant or physiotherapist has discussed realigning it. Every day I can hear the grinding and locking of my joint.

    Do you know of anybody who soecialises in muscle realignment in the north west UK?

  • Gail Nash

    So it’s been 2 years since i found this article and it’s still at the top of the google search. And there’s still nothing else written about this? The problem with ALL doctors treating post-polio is that they want to “fix” things that cannot be fixed, and strengthen things that cannot be strengthened. Adressing the problems with joint bones or the neuropathy of the situation really does not address the constant problems with the muscles. Drugs. That’s the only solution given. Maybe a nice swim in a warm pool or a massage. When the spasms & pain start up, I want better answers. Why AREN’T there any myologists?

  • JosephMcMurray

    In 2008 I suffered a herniated disc in my lower back; had surgery and went back to work. Six months later”pop” herniation of the same disc, requiring me to have spinal fusion. A year later with occasional bad days I was finally able to return to work. I was doing some heavy lifting, standing awkwardly and I felt a popping sensation in my lower back, since then my symptoms are thus….severe low back pain. All of the back muscles feel like an overstretched rubber band getting ready to snap. Periodic muscle spasms which increase the pain. At the base of my spine I have tow small incisissions parallel on the left side of my spine and also the right side. The greater he activity, those two area begin feeling as if a red hot screwdriver is stabbing me in the areas. I recieved one set of spinal injections by one Michael Winer, M.D. In my lowerback…that experience was a blessing, I could finally stand u completely itch out any pain? A couple of hours later, all the pain came back. pain radiates down both legs and into feet and toes. Burning sensations in toes. Cramping in calves, pins and needle in calves and pins and needles in feet and toes.I have numbness in calves and shins. Radiating pain town from his through both legs and into feet and toes. My ortho surgeon gave me a series of injections in my lower back and it was a miracle! Immediately I was able to stand with little discomfort, even if only briefly. The next step was hardware removal, here I am a year later and I can’t honestly say that the surgery helped? I’m in so much pain. I want to find the cause and fix it, not drugs, who should I go see? What type of tests should I ask for?

  • Joyce

    Age 70, I decided to “analyze my pain” and discovered (recently) most of my problems are OBVIOUS muscle issues. Prior to self-analysis, evaluations were done by a Neuro Dr., Ortho Dr/Surgeon., Gastro Dr., Gyn, Chiro–MANY MRI’s were done. ALL were informed of prev. auto/ped accident–as young child I ran in front of a car–released from hospital but did not return for treatment–then adopted. My neck has fused vertebrae and many symptoms from prev. injury. Fortunately the Ortho Dr, who said I needed surgery, said it was a bad idea (after viewing radiology reports) because I would not be able to turn my neck. After 2 yrs of Gerd/Barretts/Colon issues and a MASS of tests–noting that ALL these drs. omitted important details–like MUSCLE SPASMS. During Balloon Test, The Tech/Tester RAN from the Test Room and accidently leaked WHY–SPASMS–she said “1K per minute”), I then refused INVASIVE colon surgery and did not return to Colon Surgeon. I phoned the lady who did the Balloon Test and asked why report did not MENTION SPASMS. She said, “Please do not say I told you–I will be fired”. OK–for the Good News. I read (from Mayo Clinic, I think) that Baclofen is a good Skeletal Muscle Relaxant–got prescription from my Primary Dr. & 90% colon issues have disappeared–morning Pain (severe/bent over pain) 99% gone. Upper Gastro Issues–I still NEED GERD meds, since needed stomach enzymes are gone–another accidental slip from medical person. GOAL is to stop PPI meds and if needed (after one year), get non-invasive lower colon issue corrected. My Message–Don’t give up, keep reading from TRUSTED SOURCE, use common sense and don’t accept BANDAID FIXES. ALSO get COPIES OF EVERYTHING!

  • rao

    i cannot watch TV or computer more than one or two hour because a lot of pain occurs in my eyes and head and i want to know what is the reason because my eye sight is 0.25

  • Kathleen

    I have had a problem trying to get up stairs and chairs. Been to physical therapy and still can’t get up without assistance. Been to neurologist and still no help. Who do you suggest. Help