Author Topic: Plastic Surgery Forum - Back Hurts Get X-Ray to Check Scoliosis? Wrong 1st Step  (Read 3411 times)

Offline DrBermant

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@DrBermant I'm curious if you agree. Is this why my back hurts so often? What do you think dude?

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

I dedicated a life to learning about comfort and minimizing surgical pain. It was part of the art of Plastic Surgery Anesthesia and trying to optimize a traumatic experience of surgical sculpture. Back pain was part many factors assessed from the trauma victims of motor vehicle accidents, to internal organs referral sensation patterns, to muscle disruptions from trauma, to the imbalanced forces of limb reattachment, to compensation activities from patients recovering other regions of surgery. I did a great deal of foot surgery from trauma cases, nerve entrapment, tumor, frost bite, burns, and so forth. But body awareness, pain in other parts from compensation was factored into my patient education pain education approach of prevention vs. letting it get started and spiral out of control. There is nothing more frustrating than to design a great operation that is comfortable and then have the patient complain that they have pain elsewhere from a compensation protection mechanism I could prevent. So I taught my patients to understand about such issues, call me and let me know about pain so I could listen, ask questions what they were doing, and then see them or offer advice if I had an idea what was going on. This was one of the components I had to deal with with my Comfort and My Tumescent Tummy Tuck. "Pain, my stomach is fine, I am taking the medication for my back pain!" Was better managed altering what was causing the back pain than medication covering up the maladaptive protection activity done. It was great getting such calls and seeing the operation convert to a Tylenol for comfort surgical sculpture.

I think a page trivializing a real topic with an advertisement that seems to say Back Pain needs an X-ray as the first step. I would consider any doctor suggesting such a course of first step advice committing malpractice in my opinion, if that is what you were saying. At least that is what I got out of reading the link you put there.

Back Pain Why Does My Back Hurt So Often
The first step to understanding back pain is getting a patient history of what is going on, then a clinical exam, and then possible testing. New workers who take on new tasks as well as recovering patients now doing something differently to protect an injury can get frequent new back pain if they are using muscles unaccustomed to that load or effort. For my patients with back pain complaints, the scoliosis X-ray was not anywhere near the top of our list of testing unless the pain described had been going on well before the event and now we were seeing a compound situation.

Gait analysis, seeing someone walking or performing that action such as getting out of the chair or lifting can with the experienced physician be a powerful tool. X-rays are not anatomic, forces change laying on a table vs upright, but we were able to accommodate that with special tilting tables to permit the patients to stand when being tested. How the bones move also is a factor that can cause pain, but animation options in a MRI or CAT are beyond any technology I have yet seen.

Sometimes I would watch some amazing team members just take a temporary riser external shoe temporary velcro attachment and ask the patient to try walking again. Short distances first, then longer. Other times it was try doing that activity this way or that way.

My eye was very good in picking up curvature alignment and balance of the human body and just about everyone has a scoliosis. Xrays proving a normal anatomic variation is meaningless other than a money making source unless the test is going to impact making someone's pain less or life better.

If you want to have a discussion about back pain analysis and reduction, glad to do so here on the forum. If you want to market x-rays anyone who has back pain, I do not want to get involved.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
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Michael Bermant, MD
Retired Plastic Surgeon
Surgical Sculptor, Artist, Creative Thinker, Problem Solver
Plastic Surgery
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