Where Are All the Muscle Doctors?
Rob DestefanoJanuary 06

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There is a lot of amazing work and research happening in medicine today, but there is also a lot of outdated thinking that can at times be an obstacle to patient wellbeing.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.