As previously discussed, Sub-Threshold Micro-Trauma (STMT, Dean 2016) describes subclinical soft-tissue (voltage-gated tissues: muscle, fat, fascia, lymph, arteries-veins, and nerves) and hard-tissue (collagen-based tissues: bone, ligaments, tendons, cartilage) injuries, implying that the patient is asymptomatic and not seeking care, and is likely due to an abnormal movement pattern (faulty movement pattern; FMP) and associated with a symptomatic area of tissue, but not always at the symptomatic area.
In which Phase of Healing do most people seek medical intervention? They seek intervention when either: (1) the pain is unbearable, (2) the pain interferes with daily activities, work or sports performance, (3) movement is made impossible due to pain, (4) there is fear that their problem may get uncontrollably worse, be untreatable, not get diagnosed, or (5) their preferred treatment plan is not covered by insurance, and when out-of-pocket costs will be high. All of these circumstances describe the threshold at which the patient/athlete can’t suffer any more. It is the responsibility of the clinician to explain STMT, and how it will be treated.
The Green Zone represents tolerable limits of ADLs and sports performance, even in the presence of unresolved tissue damage. The Red Zone represents intolerable limits of symptoms and functional deficits. The yellow dot represents the threshold of tolerance; each patient/athlete has a different level of tolerance. The blue line graphically represents how the occurrence of tissue damage increases. The red arrows represent the extent of tissue damage, and the white arrows represent the extent of tissue repair. Over time, the occurrence of insults increases and hovers just below the threshold of tolerance.
This diagram illustrates the progression of STMT towards necessity for intervention.
Once the threshold of tolerance is reached (yellow dot), the patient seeks out care, and is likely prescribed palliative care and drugs to reduce the pain and symptoms. Surgical consult is recommended. The tissue damage, FMP, and POH are not addressed. This results in endless palliative care that delays healing, adds cost and frustration for the patient, and for the clinician. The patient is stuck in the red zone since the FMP is never understood or addressed. The patient’s experience in the red zone can be eliminated altogether… by Zooming-Out, then Zooming-In.
When the FMP is addressed on the first visit, the patient can begin healing on the same day.
These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and restore ADLs and patient confidence on the first visit at low cost.
And here is the proof… ‘pain is not the only problem.’ The problem is the limitation of clinical vision to understand and treat patients, not pain. Physicians are the problem. Doctors are the problem. Clinicians are the problem. Their methods are the problem. These articles represent 1200 hours of my personal time to research and document a solution for LBP, while… attempting to raise the accountability of all medicine to meet patient expectations and values at low cost on the same day.
LBP Blog General information
These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and (5) restore ADLs and patient confidence on the first visit at low cost. This article has a companion podcast.
Dr. Dean Bio
Forester Dean is a chiropractic and physiotherapy sports medicine doctor practicing in Los Angeles, California. Dr. Dean is a lifetime athlete, and currently teaches tennis, track, boxing, yoga. The Core X System™ Campus flagship location was opened by Dr. Dean in 2020. www.preformancecxs.org
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