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Chad: This guy came to me and he said, “I hurt my back a couple years ago.” He’s on a special forces team. He had deployed to Iraq and Afghanistan at least 5 times. Had done everything that we’ve asked him to do. He is a Green Beret; he’s gone through the course. He’s done really everything. He’s at the pinnacle of his career as far as the special operations goes.
Bryan: Just so our listeners know, you’re his doctor. You are a military doctor, right?
Chad: That’s correct.
Bryan: Yeah.
Chad: That’s correct.
Bryan: He’s coming to you for, specifically- [crosstalk 00:06:19]
Chad: He comes and he says, “My back hurts. If you can’t fix my back, then I want you to send me home.” I did my evaluation. In the evaluation, everything was normal. He could actually do anything. He could do his physical fitness tests. He could go do his rut marches that he … He could do everything, but he would pay for it for a week or two weeks, and it was so debilitating to him, he was like, “Man, if you can’t fix this, then send me home. I can’t continue-”
Bryan: Miserable.
Chad: … “in this path.”
Bryan: Yeah. I think a lot of people have experienced those kind of pains.
Chad: Absolutely, absolutely. We got an MRI, which would be the next normal step. This was back in early 2008. Got an MRI, and the MRI came back normal. There’s no herniated discs, there’s no evidence of anything torn, dislocated, pushing out, poking out. No nerves involved, no nothing. I remember having a conversations with my other physicians in 5th group, and we said, “Well he must-” We wondered, “Is he making it up?” Because there’s quote, “nothing wrong with him.” Just like, we talked about the labs and all those things, and you feel bad there’s nothing wrong. Same thing here. Just because you have a normal MRI, does not mean that-
Bryan: You’re normal.
Chad: … that your normal. It doesn’t mean that you don’t have pain. We just didn’t ask the right question. I didn’t know prolotherapy at the time and I didn’t understand ligament/tendon pathology like I understand it today. We ended up medically boarding this guy out of the military. We did a medical discharge and sent him home.
Bryan: Let me just ask you here. The ligament piece that you were just talking about, what? Explain that.
Chad: Okay, so ligaments are structures, and you can think about them as steel cables. Each strand of the steel cable is composed of a protein called “collagen,” very high tensile strength, really strong stuff. Those steel cables, the ligaments, just hold bones to bones. They’re kind of holding a joint or they’re holding something together.
Bryan: Kind of like a rubber band that holds it together.
Chad: Only rubber bands stretch and ligaments don’t.
Bryan: Okay.
Chad: Rubber band, but steel cable is how I kind of think of it, because they shouldn’t really stretch.
Bryan: Okay.
Chad: Tendons are the exact same structure, but they hold bones to muscles, so the tendons help us with movement. The ligaments help us with stability. The ligaments and tendons are very densely innervated with nerve fibers. The nerves have an important role, and it’s to give our brain a sensory-
Bryan: Something’s wrong.
Chad: … an idea of what’s going on.
Bryan: Yeah, something’s wrong.
Chad: They can tell you something’s wrong, but they also tell us where our body is in space. It helps with what we call “proprioception.” You can know, I can close my eyes and raise my arm, and I know my arm’s in the air. That’s because of the nerves that are within all these structures that give signal to the brain.
Well, those nerves are very sensitive to pressure and stretching. When ligaments or tendons get damaged, they irritate those nerve fibers and if you think about this steel cable holding up 2000 pounds. If you go in and cut one of the little strands in that steel cable, it can’t hold the weight in the same way. It may begin to stretch even microscopically under that load, but it irritates those nerve fibers.
It sends a signal to the brain. The brain sometimes doesn’t know how to interpret this, because it’s supposed to give one kind of signal, but it gives a different kind of signal. Sometimes this sensation is interpreted as pain. Sometimes it’s a tingling. Sometimes it’s just this anesthesia type feeling. Sometimes it feels unstable. There’s a whole plethora of ways that these things will manifest.
Bryan: Well let me ask you, when it comes to back pain, knee pain, joint pain, how much of, typically of that type of pain do you see, and then this young soldier, is related to either the nerves, the tendons or the ligaments, primarily?
Chad: Nerves, tendons and ligaments, so let’s define the nerve. Because most people will think about, “Oh I’ve got a nerve problem in my back.” What they’re generally referring to is they’ve been told, or they think, or whatever, that there is compression of the actual nerve coming out of the spinal cord, what we call “nerve root compression,” whether it’s by a herniated disc, whether it’s by the bones pushing on it, any number of different things, especially this common scenario of, “I’ve got pain going down the back of my leg.” It’s so common that people will say, “I’ve got an impinged nerve,” or, “I’ve got a pinched nerve in my back.”
I’ll tell you in the last, since 2008, when I started doing prolotherapy in late 2008, since that time I’ve had one patient come into my clinic, and I can’t speak to the overall statistics, but in my clinic, with the patients that I’ve seen, and I do a lot of muscular-skeletal medicine, I’ve had one patient, one, that was true nerve root impingement by like a herniated disc.
