I am convinced, through experience teaching
The O'Connor Technique
(tm), that, it is not difficult for a patient
of normal intelligence with back pain
or neck pain and no formal medical
training to identify, without expensive modalities,
the exact site of the painful disc material displacement;
and, thereby, make their own diagnosis. This is done
by performing specific movements of the spine and focusing
on what happens to the pain. These movements can be
categorized and technically defined as a DIAGNOSTIC
CIRCUMDUCTION because the movements employed constitute
what is known in anatomical or orthopedic parlance as
"CIRCUMDUCTION."
Based upon a knowledgeable and logical
deductive reasoning process, anyone properly educated
can arrive at their own diagnosis by engaging in DIAGNOSTIC
CIRCUMDUCTION
and, thereafter, identify the exact location of their
displaced disc material so as to, later, be able to
manipulate it back into the pain-free configuration.
In developing this technique, I discovered that, whenever
a person with back pain attempts to
circumductionally pivot (as in Figure 1) the spine at
a particular vertebral level where disc material is
herniated and significantly displaced,
they almost invariably experience pain that has an arresting
component to it. That is, their freely
mobile CIRCUMDUCTION is physically interfered with,
or even stopped, due to the mechanical obstruction created
by the displaced disc material. In its
most severe expression, it can be said that one has
ARRESTED CIRCUMDUCTION. However, often, the pain doesn't
completely stop CIRCUMDUCTION, and many times, it amounts
to a dramatic increase in the pain that is relieved
by straightening up slightly to get over a "hump"
-like, unseen, obstruction to the smoothe CIRCUMDUCTION.
As they CIRCUMDUCT through that particular arc where
decentralized disc material is located (almost always
in the extended configuration to the posterior
or sides), they begin to trap, pinch or put pressure
on the disc material that is off-center; and a very
specific pain is produced that is easily distinguishable
from other types of pain. This pain, as described in
the previous chapter is due to the FULCRUM
EFFECT. It is a pain that inhibits, normal, full,
range of motion or stops the pivitol movements of CIRCUMDUCTION
as though an actual object was physically obstructing
the movement. The effect is not highly unlike a pencil
being put in a door hinge and the door attempted to
be shut. One can't continue to force the door shut without
breaking something. Similarly, when one tries to gyrate
through a point between two vertebrae where a piece
of disc material is de-centralized, one cannot complete
the normal CIRCUMDUCTIONAL movement while maintaining
the same degree of lateral bending or extension. When
this action is attempted, the person with decentralized
disc material feels something like a wedge or swollen
object is obstructing the normal path that the vertebral
column would otherwise be able to take. This sensation
is frequently described as a "catch," as if
something was"stuck" in the back or something
in the back went "out." The sensation, almost
uniformly, feel as though, if they could just move in
the proper way, the pain would resolve or the back "go
back in."
The pain, more often than not, feels like an object,
such as a wedge, is stuck in the spine between the vertebral
bones at a fixed point. It doesn"t have to feel
like that, it can be a pain that is felt in the extremities,
between the shoulder blades (if the disc is in the low
neck) or in the upper buttocks if in the low lumbar
region.
Every time the person rotates the region of
the spine that is painful through CIRCUMDUCTION and
reaches the same area where the wedge is stuck, the
back pain they have becomes obviously increased if they
persist in the same degree of bending. Sometimes it
is subtle and only interferes with the smooth progress
of gyrating the spine; however, it is often so great
that the CIRCUMDUCTION is actually stopped by it.
Either way they CIRCUMDUCT, (clockwise from left to
right or counterclockwise from right to left) upon reaching
approximately the same point where the disc material
is herniated, they are arrested in their range of motion
by pain. The person senses that if they persist in the
CIRCUMDUCTION without reducing the degree of lateral
bending or extension, the pain will become unbearable.
So, in order to continue CIRCUMDUCTING, they have to
relax the degree of extension (or leaning) over the
site of the herniation by dropping the hip, bending
the knee on the same side of the pain, or straightening
up the spine slightly to reduce the degree of lateral
bending or extension. Once this is accomplished, the
CIRCUMDUCTION can usually be continued unimpeded because,
by so doing, they are shifting the center of gravity
at the problem disc to a configuration wherein the vertebral
bones are no longer putting fulcrum-like, FULCRUM
EFFECT, forces on the displaced disc material.
After they adjust their center of gravity so that the
increased pain is no longer present, the usual background
pain may still be present; and, no matter how many times
they try, the range of motion through that same part
of the arc at the particular spinal level is repeatedly
and reproducibly impaired as if a pie-shaped area of
their normal circumductional range of motion was being
denied to them. What is happening has been anatomically
described in the PHYSICAL REALITY Chapter as the FULCRUM
EFFECT PAIN.
However, sometimes it is difficult to determine if
the interference of range of motion is just a product
of their unique, natural, anatomy that prevents them
from that range of motion versus aberrant anatomy caused
by a displaced piece of disc material. This dilemma
can be solved by simply comparing the ability to circumduct
on one side with the other. The ease with which one
circumducts should be the same on both sides. If it
is impaired or restricted at any point, the most probable
explanation is a piece of de-centralized disc material.
Often, when a person is CIRCUMDUCTING and they come
to the point of restricted range of motion, they often
will automatically bend the knee on the painful side
so as to drop the hip or straighten up automatically
and thereby reduce the degree of lateral bending. When
I am examining a patient, I sometimes have them move
their upper body in such a way that maintains a maximized
degree of lateral bending and extension which doesn't
allow them to try to return to the more straight up
and down, neutral, position in order to get through
the area of restricted CIRCUMDUCTION. This forces them
to bend their knee or drop their hip to avoid the pain
if it is in the low back. If the pain is in the low
neck or shoulder region, they try to drop their shoulder
or bring their neck to a more vertical alignment to
get over the "hump" created by the displaced
disc material.
This is a sure sign that I have identified the site
of the disc displacement, but some people are able to
sustain the pain and push their necks or backs through
it, nevertheless. In those instances, the repeatedly
reproducible pain in the pie shaped distribution is
an equivalently convincing finding.
Too, there are some people who have very flexible adjacent
discs that they are able to recruit to perform what
appears to be a full CIRCUMDUCTION. In essence, they
are unintentionally splinting the damaged disc, often
because they have unconsciously been protecting that
segment for a prolonged period or it is in spasm and
is difficult to activate. In spite of that, they still
have a back pain problem. These people usually have
to carefully focus on the problem disc to insure that
they are actually stressing the damaged disc. Usually
when they do so, they can convince themselves that they,
indeed, have an ARRESTED CIRCUMDUCTION.
The pain is generated by the same type of forces that
strain the hinge when an object prevents a door from
closing. A long moment arm is acting on a very small
fulcrum-to-object lever arm length. In the disc's case,
the hard, displaced, disc material is acting as the
fulcrum, the vertebral body and the adjacent disc component
above and anterior to the displaced disc material is
the long moment arm, and the ligaments that hold the
vertebral bodies together are equivalent to the "objects"
moved by a fulcrum when it operates. Just as a long
pry-bar can lift a heavy stone, similar force applied
to tighten such short ligaments results in pain. (See
Figure 2)
IF, AT THIS JUNCTURE, YOU HAVE PERFORMED THE
ABOVE "O'CONNOR TEST" AND YOUR CIRCUMDUCTION
IS IMPEDED, RESTRICTED, PAINFUL, OR STOPPED BY A PAINFUL
OBSTRUCTION TO MOVEMENT WHILE BENT TO THE SIDE
OR BACKWARDS, YOU CAN GO TO THE MANEUVERS
SECTION AND IDENTIFY THE IDEAL SET OF MOVEMENTS THAT
CAN RE-PLACE THE DISPLACED DISC MATERIAL. IF YOU NEED
MORE EXPLICIT DIRECTIONS ON HOW TO PERFORM THIS TEST
OR CONVINCE YOURSELF THAT YOU ARE EXPERIENCING THIS
SYMPTOM --READ ON.
The presence of this ARRESTED CIRCUMDUCTION might properly
be termed a "POSITIVE O'CONNOR TEST" in medical
parlance since, to my knowledge, this distinction has
never been made before in the medical literature.
Although the above Figure 1 shows a circumduction centered
around a Lumbar vertebrae, this test can be used for
any level of the spine so long as the pivioting is focused
at the spinal level where the pain is greatest.
Now, the reader may scour the existing medical literature
on back pain in search of the clinical term--DIAGNOSTIC
CIRCUMDUCTION. To my knowledge, it does not exist outside
of this book, and I have been specifically exploring
back pain literature for well over 15 years. Moreover,
no mention of DIAGNOSTIC CIRCUMDUCTION is made in the
newly published government guide to back pain management
which, by virtue of its "definitive" auspices,
should contain it or a similar test if it exists. Therefore,
when DIAGNOSTIC CIRCUMDUCTION is used by professional
clinicians to diagnose a disc herniation, in the absence
of alternative nomenclature, it can best be referred
to as "THE O'CONNOR TEST." If it can
be shown that some other author described it prior to
1990, I would gladly re-title it; however, until such
time, I will continue to represent it as my contribution
to clinical medicine.This method of DIAGNOSTIC CIRCUMDUCTION
to diagnose a disc condition is so successful for me
in my practice that, many times, I get an NMRI (Nuclear
Mass Resonance Image) or CT Scan simply to confirm my
clinical diagnosis. I seldom find a major discrepancy
between the image study and my clinical exam, except
in the presence of spondylolisthesis.
In order to discover where the displaced disc material
is actually located along your spine, you need to learn
how to perform a DIAGNOSTIC CIRCUMDUCTION in which you
attempt to CIRCUMDUCT in a leaning FLEXION that progresses
clockwise or counterclockwise to an EXTENSION such that
the body is pivoting at the disc unit level where the
spine is most painful. This is done by first leaning
forward slightly (flexing) such that the body is bending
exactly at the site of spinal pain. Ideally, the area
below the pain should stay immobilized as best as you
can and only the vertebrae above it should be allowed
to engage in CIRCUMDUCTIONAL motion.
To understand how to perform a meaningful DIAGNOSTIC
CIRCUMDUCTION on yourself as well as how the designation
of clockwise and counterclockwise is used in this book,
you need to view (in your mind's eye) a clock face from
a perspective such that you are looking down upon the
clock as though it were superimposed upon the vertebral
bodies in such a manner that the plane of the clock
face is parallel to a cross-sectional view of the disc.
The clock is superimposed upon the spine such that the
vertical (up and down) axis of the spine transects the
center of the clock. The plane of the clock face should
be horizontal and perpendicular to the axis of the spine.
For practical purposes 12:00 should be directly in front
of you. The 6:00 position would, understandably, be
directly behind you, and 9:00 would be on your left.
Depending upon what particular disc unit of the spine
you are addressing, the plane of the clock can be elevated
or lowered in your imagination; but it should always
be kept perpendicular to the plane of the spine. The
intricacy of this designation is not important.
What is important is that you develop some way of orienting
yourself to some conventional diagram for the purposes
of this discussion and future reference because, if
properly aligned, the horizontal plane of the clock
face is superimposed upon and parallel to the horizontal
plane of the discs (See Figure 3). It is as if the problem
disc now has clock face numbering system superimposed
upon it so its reference points can be discussed and
the reader can be directed without confusion.
Now, to perform a DIAGNOSTIC CIRCUMDUCTION, start by
facing towards the 12:00 position on the clock, putting
your hands on your hips for balance and support, and
mildly lifting your upper body off of your lower body
by pushing inferiorly with your arms (this takes some
hydraulic pressure off of the disc and makes it easier
to know which pain is acting); then flex anteriorly
(flex approximately 15 to 20 degrees but no greater
than 30 degrees forward off of an upright posture).
If you flex forward too much, that will increase the
prolapsing pressure and unnecessarily increase the pain.
One way of knowing if you are flexing the right amount,
flex forward (anteriorly) until a stretching pain comes
to your back, then back off (reduce the amount of flexion)
until that pain stops.
Leaving your feet firmly planted at about shoulder
width, begin smoothly leaning/CIRCUMDUCTING (not twisting
which is technically termed axial rotation) only that
portion of your body above the painful site in one direction
or the other. If the pain seems to give you more symptoms
to one side or the other then start CIRCUMDUCTING towards
that direction.
For this example, I choose to CIRCUMDUCT clockwise
(to the right) first, pivoting at the level of a lower
Lumbar disc. So, begin to tilt towards the 1:00 position
(clockwise) while keeping the angle of the upper body
at the same degree of flexion. The leaning is continued
by a tilting of the body above the pivot site to this
same side while eventually you will be moving from flexion
to extension. You should be only allowing the spine
superior to the site you are pivoting around to flex
or extend, the segments below the site should be kept
in neutral position. When you start CIRCUMDUCTING to
the right, you lean more and more to the right; and,
in a smooth continuous motion, you progressively CIRCUMDUCT
in an arc, a little more each time by leaning more to
the right and posteriorly until at the end of the movement,
it is as though you were leaning backwards in full extension
(as in Figure 4).
Since this may be difficult to understand, I will elaborate
in other words. At the level of the spine where the
pain is located, try to make your spine bend or lean
enough to reproduce the same-sided pain you are usually
experiencing with movement. About 15 to 30 degrees off
the axis of a normal erect posture should be sufficient.
While keeping this same degree of tilt, slowly and carefully
make a gyrating-like rotational movement (like a gyro-scope
or a top when it begins to run out of energy and begins
to carve out an inverted cone in space) so that, by
the time you progressively CIRCUMDUCT to the 3:00 position,
you are in effect leaning sideways to the right as much
as you can without losing your balance. This DIAGNOSTIC
CIRCUMDUCTION is not to be confused with twisting. You
are not twisting the spine during this test. Continue
this same movement towards the 4:00 position. You may
at this point have to thrust your hips forward (like
you were sticking out your belly-button) at this point
to keep the center of gravity of the upper body over
your legs. If your back pain usually gives you pain
more on the right side of your body this means that
the disc is herniated more to the right than directly
in the posterior midline; so, somewhere between about
3:00 and 6:00 the pain should begin to increase so much
as to prevent you from CIRCUMDUCTING further without
straightening up slightly or dropping the right hip
or bending the knee to allow the movement to proceed.
If your motion is arrested, what is arresting your motion
is the off-center displaced disc material that has begun
to act as a fulcrum; and, as the peripheral portion
of the vertebral bodies progressively compress from
the 3:00 to 6:00 positions on the periphery of the disc,
they begin to compress and pinch the displaced disc
material, forcing it to act on the intervertebral ligaments
with a fulcrum effect (review Figure 2 here and Figure
32 in Chapter 2) and creating increased pain to the
point where you have to stop. The obstruction caused
by the displaced disc material makes Continued CIRCUMDUCTION
IN EXTENSION, in this manner, realistically impossible.
If the disc is "out" (by that I mean that
it is displaced enough to impede CIRCUMDUCTION IN EXTENSION,
you should not be able to accomplish full extension
over that point of herniation without experiencing pain.
I have termed this phenomenon ARRESTED CIRCUMDUCTION
IN EXTENSION, in this case, ARRESTED CIRCUMDUCTION IN
EXTENSION TO THE RIGHT.
The pain that ARRESTS CIRCUMDUCTION IN EXTENSION should
have a mechanically obstructive character that makes
it feel as though something were physically blocking
the ability to CIRCUMDUCT further. That is, you sense
that if you continue the motion without decreasing the
angle at which you are leaning or extending, the pain
will be markedly increased, possibly even unbearable.
When this happens, don't force it further, you are just
establishing the diagnosis of a de-centralized piece
of disc material, herniation, prolapse, or protrusion
and testing the right-sided margin of the disc bulge
at this point.
As a side note, this is the type of sensation that
patients routinely describe as a "catch,"
or their back is "out" or "stuck."
They also agree that it feels like if they could just
move the right way the pain would be relieved. If this
is the sensation you feel, you are doing the test properly.
When your clockwise CIRCUMDUCTION is halted by this
obstructing pain, you have just identified the position
of the right margin of the displaced disc material.
In most cases, you will be stopped in your movement
to the right (or clockwise) before reaching the region
of the posterior midline. Then, you continue THE O'CONNOR
TEST by repeating the movement to the left (or counterclockwise)
by starting from the front again and, only this time,
successively perform the flexion, abduction, extension,
and adduction in sequence to the left which similarly
brings you around leaning progressively more posteriorly
until finally you are leaning backwards. To do this,
go back to the 12:00 position and repeat a similar leaning/gyration-like
movement in the opposite direction as before. This time,
move to the left (counterclockwise) by continuously
leaning/CIRCUMDUCTING to the 11:00 position then on
to 10:00 position, and so on. As you did before, continue
to smoothly CIRCUMDUCT and thrust your hips gently forward
when you get to the 9:00 position if necessary. As you
go from 9:00 on towards 6:00 and the back begins to
assume an extended posture, the pain should be elicited
at some point in the CIRCUMDUCTION before reaching the
posterior midline if the disc material is herniated
predominately to the left. Similarly when you moved
in a clock-wise direction, your movement should be arrested
by pain when you reach the point where the pressure
created by the two vertebral body's edges begin to apply
force to the herniated disc material. The point that
now stops you defines the left margin of the displaced
disc material.
If your pain is predominately one sided, (and for the
purpose of this example I will assume that it is more
to the right) one should notice that the movement counterclockwise
is not arrested until CIRCUMDUCTING somewhere well beyond
the 9:00 position. It will usually become arrested again
at least when one approaches the 6:00 position (the
posterior midline) from a counterclockwise direction
because the vertebral body's peripheral margins will
be compressing the other side of the herniated material
as the DIAGNOSTIC CIRCUMDUCTION proceeds to this point.
Of course, the actual site of the arrest is largely
dependent upon the actual position of the displaced
disc material. The more lateral the obstructing disc
fragment, the more lateral the range of ARRESTED CIRCUMDUCTION.
Unless you have two discs out simultaneously, one on
one side and another on the other (this would be unlikely
if this is the first episode of severe back pain, but
not unusual if you have had several traumatic flexion
injuries) your motion should be arrested predominately
to one side. If only one piece of disc material is to
blame it usually is apparent which side the herniation
is on because the pain will be mostly on that same side.
As you repeat these DIAGNOSTIC CIRCUMDUCTIONS alternately
clockwise then counterclockwise, the places where your
motion is arrested identifies for you the borders of
the displaced disc material.
As a procedural consideration, if your pain is predominately
right-sided, then start with a clockwise CIRCUMDUCTION
because that should get you to identify the most anterior
aspect of the prolapsed disc first. Then, to locate
the other side of the disc bulge you next CIRCUMDUCT
in the counterclockwise direction. Keep doing this until
you have fixed in your mind the position of the aberrant
disc material.
This is much like being given the task of finding the
position of a brick placed between two barrels with
your eyes closed. You do it simply by progressively
rocking the top barrel in a circular/gyrating fashion
until you can figure out where the most force is necessary
to roll the barrel over the hump that the brick creates.
As you "CIRCUMDUCT" the top barrel, the closer
the rim gets to the brick, the more energy it takes
to force it over the hump. The barrel would be analogous
to the barrel-like component of the vertebral bones
adjacent to the herniated disc and the herniated disc
material would be the brick. I doubt that anyone would
have trouble describing the position of a brick between
two barrels with their eyes closed, so one needn't make
finding a disc herniation any harder than that. You
just have to picture the vertebral bone gyrating above
a piece of hard material resting on another similar
barrel surface, unmoving below it.
Now, if the disc is herniated directly to the posterior
(in the posterior midline) and it is a wide bulge, arrest
can occur as early as the 9:00 position CIRCUMDUCTING
counterclockwise and again at the 3:00 position while
CIRCUMDUCTING clockwise. This is not unheard of, so
when this happens one can assume that the disc bulge
is directly in the mid-line, extremely wide based, and
herniated directly to the posterior. When this is the
case, usually the back pain doesn't seem to be directed
or radiating to one side or the other but stays centrally
in the posterior midline or gives pain to both sides
more or less equally. In my experience, the centralized
disc bulges usually only occur in the lower Lumbar region.
I believe this is owing to the extra anatomical strength
afforded by the posterior longitudinal ligament as it
ascends to the superior reaches of the vertebral column
making midline posterior prolapses less likely as one
ascends the spinal column. When it enters the lower
Lumbar region, the wideness of the vertebral bodies
causes the posterior longitudinal ligament to be spread
thinner, thus predisposing to posterior midline disc
bulging. Also, this area usually sustains the greatest
forces when flexion injuries occur, and most people
flex directly forward when they lift.
It is so unusual for discs to herniate anteriorly except
under extreme traumatic stress such as in an automobile
accident or major fall in which the spine is violently
hyperextended that I do not feel a discussion of that
condition is appropriate here; but if the pain is indicative
of an arrest in motion when CIRCUMDUCTING through the
9:00 to 12:00 to 3:00 positions, then suspect an anteriorly
prolapsed disc.
In the approximately ten years of treating disc herniations,
I have seen only a single anterior herniation. Of course,
in the event of a major traumatic injury such as mentioned
above, an examination by a qualified medical doctor
is in order, and an appropriate imaging study might
just as easily and safely demonstrate the lesion. Nevertheless,
repeated DIAGNOSTIC CIRCUMDUCTIONS around from one side
to the other should allow you to fix in your mind the
approximate direction and position of the disc bulge.
The level (i.e.: L5-S1, C5-C6, etc.) of the spine where
the pain is elicited and at which you should be pivoting
tells you the level of the disc segment that is herniated,
bulging or prolapsed. For instance, if you lean your
torso and center your pivot at the area right where
the spine meets the hips and an arrest in motion occurs,
your protrusion is probably at the L5-S1 disc space
level. If you only need to lean your head to one side
and rotate it (as if looking over your shoulder) and
the motion is arrested, it is at the C2-C4 level. Depending
upon how much you have to lean that portion of your
body superior to the area of pain away from the mid-line
tells you how far down the putative segment is located.
This is understandable because the more away from the
midline you have to lean your upper body to get to the
painful segment, the lower the portion of the spine
that will be required to bend in order to allow for
the movement. As that segment bends in the direction
of the herniation, bulge or prolapse, the wedge-like,
painful sensation is elicited as the bulge is squeezed
and the peripheral intervertebral ligaments containing
the bulge are stretched.
So, once you have fixed in your mind the borders of
the disc bulge as described above, you can carefully
aim a leaning extension directly over the center of
where the herniation should be. The onset of the pinching,
wedge-like, pain (immediately upon the degree of the
leaning extension being sufficient to put pressure on
it) should confirm the exact center of the disc herniation,
bulge, or prolapse. Strictly speaking, when you are
compressing the disc directly over its herniation, the
pain you feel is mostly due to the hydraulic, direct
mechanical, or pincer-like pressure exerted by the displaced
disc material pushing against and deforming the posterior
component of the capsule (depending upon the displaced
disc material's position relative to the disc's center).
The instant you move off of that point directly over
the displaced disc material, the fulcrum pain comes
in as adjacent capsular ligaments are stretched.
If there is no arrested motion or pain during this
test, either your pain is not due to a disc or you are
not leaning far enough off the vertical axis to ideally
effect the spinal segment with the herniation. It may
sound obvious, but if you are attempting to CIRCUMDUCT
by pivoting at the lower Thoracic region, you are probably
not going to illicit sufficient discomfort to diagnose
a herniation at a low Lumbar lesion and visa versa.
To insure such is not the case, you can do some experimental
testing by increasing the degree of off-center leaning
to find the location of the problematic disc unit.
DIAGNOSTIC CIRCUMDUCTION can be used at any level of
the spine to determine whether a particular disc is
herniated. In the Cervical region, CIRCUMDUCTING the
head at the neck such that you pivot around the lowest
vertebral segment that is painful will give the best
determination of the level of the herniated disc material.
The Thoracic spine is somewhat more difficult due to
its inherent lack of mobility; however cocking the shoulders
to effect a leaning gyrating CIRCUMDUCTION and focusing
your pivotal point slightly below the area of discomfort
usually will reveal what segment of the spine is involved.
For the Lumbar region, pivoting at the hips usually
is enough to confirm where the pain precisely stops
your motion. Regardless of the spinal region, the more
you increase the angle of the spine superior to the
area of concern, the more you activate the disc segment
in question. If you keep the spine superior and inferior
to the site of pain and the disc unit you are testing
relatively straight. That way you can be certain that
you are testing only a single disc unit.
You may note, leaning or flexing anteriorly too much
towards the opposite side relative to the disc herniation
during this test can sometimes elicit a stretching type
of pain near the site of the disc herniation because
the degree of leaning is so great as to stretch the
peripheral intervertebral ligaments affected by the
disc herniation or due to the hydraulic-type pressure
exerted by a bulging disc material (depending upon the
actual type of herniation and degree of off-centered
position of the herniation). This means that you are
over-doing the degree of anterior flexion or leaning;
however, this pain can usually be distinguished from
the range of motion, obstructing-type, pain or disc-bulge,
pinching, sensation. The pain of too much flexion is
more of a stretching type pain and different from the
pain induced by trapping and squeezing a herniated piece
of disc material that comes while CIRCUMDUCTING IN EXTENSION.
Also, the stretching type of pain, although brought
on by the movements, doesn't arrest CIRCUMDUCTION anteriorly
so much as it is so painful that you don't want to continue
to flex forward. Too, straightening up from this pain
sometimes produces pain actually greater than the pain
you induced by flexion. You should also feel the discomfort
on the posterior side opposite to the side towards which
you are anteriorly flexing. This is the pain caused
by weight-bearing flexion on a herniated disc (to be
covered in greater depth later). This is a consequence
of the de-centralized disc material being pushed further
posteriorly, but I don't want to confuse the reader
anymore by focusing on it, except to say if it occurs,
straighten up until it is relieved before it causes
the disc to prolapse more and potentially compress a
nerve root.
As I indicated above, there are other ligaments, inflamed
tendons, and torn or spasmed muscles all possibly present
concurrently, any one of which is capable of generating
back pain; and, therefore, capable of confusing the
picture, especially just after an injury. Since standing
and CIRCUMDUCTING while weight-bearing involves the
activation of these structures, it can be difficult
to distinguish between these sources of pain when trying
to determine if de-centralized disc material is the
source or if a major contributing component is due to
the activation of damaged muscles or tendons. In reality,
one can expect these other types of pain, especially
spasm, to participate in the total back pain experience
especially when in close proximity (both anatomically
and near in time) to an injury. In that event, wait
a few days or, if necessary, as much as a week or two
to let these other structures calm down. They will heal,
the disc's structural tears will not. One can be reasonably
certain that if the disc is involved, it will stay broken
and eventually it will become apparent that such is
the case.
If the DIAGNOSTIC CIRCUMDUCTION test described above
is not obviously and convincingly successful in distinguishing
whether pain is from a piece of decentralized disc material
or some other source while weight-bearing, you can try
lying down and reproducing the same test in a reclining
position. Simply put pillows in such a manner that you
can roll or change your position successively to reproduce
the same configurations as achieved when leaning and
extending from an upright posture. For instance, for
the neck area, the obstructive component of the pain
can be identified without interference of any other
active muscular motions by simply relaxing and propping
the head up on a pillow then log-rolling the entire
body. In effect, the angle formed by the neck with reference
to the axis of the body doesn't change as the neck is
fixed in its orientation and the body moves through
space. This moves the selected disc unit through its
range of CIRCUMDUCTION motion equivalently to the manner
which is accomplished while standing only, in this case,
it is on a horizontal axis and the body below the disc
is doing the moving.
In the reclining scenario, the previously described
"O'CONNOR DIAGNOSTIC CIRCUMDUCTION TEST" would
be referred to as "PASSIVE" and can be differentiated
from the standing test which would be conversely designated
as "ACTIVE." In the upright posture, the body
is actively moving and contracting muscles, activating
other potentially inflamed soft tissues, and stretching
those structures necessary to balance the body; but,
in the reclining case, the body is more passively determining
the site of the lesion because the disc unit is only
moving as a consequence of the body rolling and the
non-disc structures are exempted from fighting gravity.
For Thoracic spinal pain, similarly propping the upper
torso on pillows or any suitably comfortable structure
will suffice. For the Lumbar region, especially while
in acute pain, lying on a soft mattress is an excellent
vehicle. You will probably be doing that anyway, so
you might as well "make hay while the sun shines."
As the body sinks into the mattress while a pillow or
the elbows raise the prone torso up, the Lumbar spine
passively assumes an extended posture. Rolling through
the same pattern as above can reveal the same information.
Instead of leaning and gyrating, you only need to roll
from side to side to localize the site of the de-centralized
disc material. The principle is the same, only the passive
positioning eliminates the likelihood that spasm and
inflamed tendons or muscles are being activated to cause
the pain.
After becoming very familiar with these methods, through
repeated experience, the reader can expect to instantly
identify when the disc material has become de-centralized
and instigating the pain from any position. Once familiar
with the feeling (especially if your disc material repeatedly
is prone to de-centralization), every time it goes "out"
you can immediately tell if it is "out" by
gently CIRCUMDUCTING from even a seated position. It
isn't necessary to make a big project out of CIRCUMDUCTING
after you conceptualize the mechanics and become adept
at the movement. After awhile, simply rolling the neck
or shoulders around from almost any position will reveal
the presence and position of Cervical or Thoracic decentralized
material, and gyrating the hips without so much as changing
your seated position can be expected, eventually, to
be all that is required for the "expert" you
can become at your own back pain diagnosis.
I've become so adept at doing it, when I suspect (due
to the onset of discomfort) the disc material has migrated,
I only need to lean towards the place where it usually
displaces and feel the characteristic "wedge-like"
pain to confirm whether it is truly "out"
or not. I don't necessarily have to go through the entire
DIAGNOSTIC CIRCUMDUCTION process I described above.
Don't think that just because I described it in such
exacting detail that you need to obsessively adhere
to the entire rigmarole forever. Even while driving,
I can shift my hips in a leaning posture and feel the
"wedge" or "lump." I then can do
the appropriate MANEUVER (to be described later) and
relieve the pain. There is no reason why anyone else
who comprehends the mechanical principle of this test
cannot do likewise. Reading on, the MANEUVER will be
taught so that once the displaced disc material is identified,
it can be re-centralized with equal ease.
In the absence of DIAGNOSTIC CIRCUMDUCTIONAL ARREST
throughout the full range of posterior extension, it
is harder to evoke a decentralized disc as the origin
of the pain. If nothing stops or limits you when making
these gyratory movements, the pain is possibly not from
herniated, protruding, or de-centralized disc material's
effect upon the capsular intervertebral ligaments and
the re-centralizing MANEUVERS described later will have
a lower probability of helping your type of back pain.
However, I have known patients who involuntarily splint
the affected segment and despite attempts to CIRCUMDUCT
at the affected segment; instead, unconsciously they
CIRCUMDUCT only at the segments above or below it. Therefore,
simply because you do not get a pain that arrests your
movement does not mean that the MANEUVERS outlined in
this book will not help you. I have had several patients
who are helped by my method yet never had an arrested
motion that I could identify. In one case, I was able
to conclude that the person was so flexible and had
accommodated to the pain for so long that other segments
of the spine performed all the circumductatory movements
without necessitating the activation of the involved
segment or she was so accustomed to the pain that she
unconsciously avoided the use of that segment. The MANEUVERS
worked very well in this patient, ending her years of
neck pain.
Consequently, I would suggest that the readers attempt
the MANEUVERS described later in the book, regardless
of whether or not they have a rotational CIRCUMDUCTION
ARREST or if they understand how to diagnose their own
disc. Anyone with back pain has nothing to lose and
everything to gain by trying The O'Connor Technique
(tm) MANEUVERS. Sometimes, when I see that patients
are not arresting in their own CIRCUMDUCTION attempts
even though I have instructed them in what to do, I
can usually properly guide their movements so as to
insure that the affected segment is being loaded or
stressed. This usually proves to me that, indeed, they
have an arresting component due to a disc problem; and
I can locate it even though they cannot without physical,
individualized, and personal guidance. However, it is
impossible for me to examine everyone of this book's
readers who have herniations but are unable to properly
perform a DIAGNOSTIC CIRCUMDUCTION. This series of movements
is designed so that you can do it yourself; and, thereby,
identify the site, direction, and position of the displaced
disc material. If that cannot be accomplished, no big
deal, continue reading; and, after the method becomes
known to you, you can come back and try it again to
see if you can succeed. In other words, don't get frustrated,
disappointed, or give up just yet because the foregoing
appears to be too complex or difficult.
Of note here, even though I'm getting ahead of myself,
when the MANEUVERS described later in the book are successfully
accomplished, one can expect this "wedge"-like
pain that arrests your movement and the obstructive
component of the pain to be instantly resolved. As the
disc material is re-centralized, it no longer impedes
the normal circumductatory and gyrational actions of
the spine. When the displaced disc material goes back
into its central location, it does so usually with dramatic
relief because it no longer obstructs the normal circumductatory
capacity of the spine. If the MANEUVERS are accomplished
and no dramatic relief is achieved, then probably either
a disc is not the problem or the corrective MANEUVERS
are not being accomplished properly and, therefore,
not yet successful in replacing the misplaced disc material.
Repeating this "test" but treating it as
a component of a MANEUVER while unweighting the superior
part of the body above the lesion at the end of one
of the MANEUVERS that are described later in this book
also can re-seat a displaced disc that is not very much
off-center. I often see people with mild back symptoms
performing this type of movement (especially after getting
out and stretching after long drives) because it gives
those with minimally displaced disc material relief
from the "stiffness" they experience due to
the prolonged WEIGHT-BEARING FLEXION of driving.
Often, the MANEUVERS I describe later in the book are
able to move the disc material almost completely, but
a little extra nudge is necessary to get them to seat
completely. Simply doing a mild weight-bearing THERAPEUTIC
CIRCUMDUCTION nearly identical to the "O'Connor
Test" frequently accomplishes the "coup-de-Grace"
and provides the final effort necessary to completely
re-seat the disc, but more about this aspect later.
Another reasonable rule of thumb to be guided by is
that, if there is no arrested motion on weight-bearing
DIAGNOSTIC CIRCUMDUCTION, the disc material (or fragments
of same) are probably not decentralized. An interesting
problem sometimes prevents the immediately successful
resolution of all components of the back pain. The disc
material can have been returned to the proper centralized
position, yet a residual pain may still be present.
When it seems that even though you are doing everything
as you are supposed to do and recreating the same sequences
of MANEUVERS (as will be described later) that were
successful in the past, yet still nothing seems to totally
stop the residual pain, it often is the case that the
disc fragment has been putting pressure on the capsule's
ligaments so long that an inflammatory focus has been
created. In this case, there may be pain associated
with flexion or extension; yet no actual arrested motion.
In that event, using anti-inflammatory medications
and rest to prevent repetitive irritation of the inflammatory
focus is the best policy to relieve residual pain. More
on that subject follows later in the section on medicines
and strategy for pain relief; but inflammatory pain
is of a dull aching or warm (like heat generating) character,
continuous, and present regardless of the position.
Then, it probably originates from an arthritis-like
inflammation of the joints, ligaments, or tendons acting
on some nearby spinal segments. Especially, the accessory
articulations of the vertebral bones (the facet joints)
can also become inflamed. Facet pain is usually distinguishable
from the pain of a herniated disc because facet joint
arthritis pain has no physically arresting component,
hurts when standing, and relieved by sitting (the opposite
of disc pain.) In this case, drugs like acetaminophen,
aspirin, Ibuprofen (Advil, Motrin, Nuprin, etc.) or
other non-steroidal anti-inflammatory drugs are indicated.
These drugs are often helpful for pain of disc origin,
also; but, usually, they don't offer much relief if
the disc material is still "out." After the
disc has been re-centralized, the anti-inflammatory
medicines are especially helpful in reducing the pain
caused by the disc material rubbing against the ligaments
or the inflammatory arthritic pain caused by the vertebral
bodies rubbing together when discs degenerate to the
point that the disc space has collapsed.
The key to this consideration, of course, is the understanding
that if the disc is decentralized, the "wedge"-like
pain that stops your movement will be present while
leaning and CIRCUMDUCTING IN EXTENSION. If you have
completed a successful MANEUVER that frees up the circumductatory
capacity of the involved spinal segment such that there
is no longer the arrest in DIAGNOSTIC CIRCUMDUCTION
that there was before completing the MANEUVER yet there
still is pain coming from that area, this is probably
a residual soreness or inflammatory-type pain. Understandably,
if a disc has been protruding and tearing the adjacent
ligamentous structures, they will have been damaged
or at least irritated. Be aware that once an inflammatory
focus is set up after prolonged pressure due to protruding
disc material, it is reasonable to assume it will take
some time and anti-inflammatory medication to achieve
total relief.
Many times, I have "fixed" a person's back
to the extent that they no longer have arrested motion;
but they continue to describe pain for a short time
afterwards. Usually, the pain is of such reduced severity
and so closely related to the MANEUVER done to them
that they acknowledge the relief came from my method.
Most patients recognize that the majority of the pain
is gone the following day, attributing my application
of The O'Connor Technique (tm) as the point
when their recovery began.
Further Reading:
Damage / Pain Scenerio
Traditional
Diagnostic Methods
Self Diagnosing
your Disc
Documenting your
disc
