First Chapters

The pages through the first three chapters are sequenced: 1 | 2 | 3 | 4 | 5 | 6 

The Fundamental Flaw is the absence of manipulative reasoning from the first therapeutic encounter. Nothing compensates for this lack, and a flaw in the foundation adversely affects all that follows.

Manipulation is neither magic nor panacea. Considering the complexity of life processes, it is common sense that no single approach alone could universally make all things right (though it certainly may happen in appropriately selected cases). And even when manipulation is appropriate, it may fail. But its attended (biomechanical) reasoning is virtually universally applicable, and when it is thoughtfully applied, the possibilities for success, in my experience, are remarkably enhanced. All this is reasonable and achievable by clinicians who habitually think about such basics. The Pain Pandemic exists because doctors, in general, do not .

My purpose in these pages is to leave no room for doubt, no place to hide. I will describe to you how common examinations in traditional medicine are so self-defeating that many painful conditions become a morass of misunderstanding. None of this will be remote theory. You will learn this through the lives of real people. I will describe manipulative procedures in detail so there will be no misunderstanding about them or for their efficacy to be questioned again.

Manipulation is not merely the "cracking of joints." Thinking in those terms is crude and inadequate. I will show you how it is much more. I will discuss other fundamental issues as well: the appropriate role of science, the inappropriate substitution of adjuncts such as x-rays and the benefits of a number of associated therapies. I will not be concerned with "laying on of hands," or of miracles, or suggestibility, or placebo effects. They are all valid subjects for discussion, but not here.

Acknowledgments

Full many a gem of purest ray serene, the dark unfathomed caves of oceans bear.

Thomas Gray ⁶

The first people responsible for this story antedate recorded history. Time passed and in different places manipulative treatments took forms and survived because often enough they worked and were literally handed down in families through generations and millennia.

The spirits of all of them are in this book. I can only write this to you by ‘standing on the shoulders of giants' ⁷ only some of whom are now known, but assuredly they were well known in their times and honored by their patients.

I most gratefully acknowledge every forbearer of the healing arts who carried these skills through virtually every culture and civilization until now where incredulously, they have been contested in an age of assumed conquest through science; all practitioners who first studied their patient's problems through developed senses, who understood the immutable essential that careful observation and trained touch are irreplaceable elementary skills to good care; every physician of my tradition who lays aside today's dictates to dispassionately examine this issue as an individual responsibility.

Dr. Viola Frymann's name is on any authoritative list of the world's great osteopathic physicians. She is now engaged in developing The Osteopathic Center for Children, in La Jolla , California , a labor that deserves massive support. From her vast experience, when she expressed awe at the power of the accumulated cases I present herein (and several more have been added), she validated the uniqueness of this labor and the purpose of the seeming meandering path that has been my career. Her consent to join Dr. Flax is powerful evidence of how vitally important this is.

Dr. Frank Schoenholtz and I met in a very special way. I was teaching for the first time at LACC and was projecting a special slide when he opened the door for just a moment to take a fast look at the M.D. who was in the building. Very few instantly understand its significance, but he did. It bonded us, and he trusted me with his friendship, candor, honesty and integrity. By opening an inner chamber of chiropractic to me, I became wiser in these issues sooner, and this book reflects his trust.

I cannot sufficiently repay the osteopaths who primarily taught me about manipulation. More than any others, I owe any skills I have with them, especially to Loren (Bear) Rex, D.O.

After my teachers, I acknowledge with profound gratitude all who over the years trusted me to provide their care. They were my true textbooks because so often I was stumbling on uncharted territory and only through their forbearance could I finally come to answers that helped them and educated me. When there were no answers some persisted with me and together we made new discoveries from which to relieve them.

I gratefully acknowledge the use of a small book I bought for $3.00 the year before I started medical school, from which most of the longer quotes came: T he Quiet Art --- A Doctor's Anthology compiled by Dr. Robert Cope, published E & S Livingstone, Ltd., England , 1952.

I express my gratitude to Eiler H. Schiotz, M.D. who particularly contributed to my references regarding the history of manipulation: Manipulation Past and Present, William Heinemann Medical Books Ltd., London . Where other quotes were used, I referenced them in context.

I abjectly apologize for any oversight in not quoting a source I might have discovered. A person's work must always be acknowledged.

I thank Jeffrey Wade Phillips, D.C. who, hopefully, is representative of a new breed of chiropractors who are anxious to work in accord with like minded medical colleagues. Unselfishly and without request he provided literature that enhanced this purpose.

I began writing this book in 1992. The amount of editing and rewriting throughout can only be appreciated by another author. Many have tried to influence it, and at times I acquiesced, but early on Release From Pain (by other titles) demanded a life of its own and eventually rejected influences that sought to disarm it.

Along the course, gifted editors assisted, and they have my ongoing gratitude. Doyle Henderson edited the first manuscript. His incisive comments about my assumptions continuously commanded my respect. Denise Grissom and Katriela Lent enthusiastically edited as the manuscript developed. Then, Pamela, my daughter, provided more valuable pages of commentary.

Jerry Gross, the "Book Doctor," then edited it. When I poured out why I wrote this, he told me his job was not to get emotionally involved so he could do his job properly, but it was he who later told me that he had to wear asbestos gloves when he read it.

If you who are in unappreciated and undiagnosed pain had only one name, it could be Jane Presta. Jane was given a copy of the manuscript that I sent to my dear friend, Peter Edgelow , P.T., who has witnessed much of this story as my friend. My acknowledgment to Jane is to all for whom this book is ultimately written. Unsolicited, Jane sent me letters of encouragement to get this published. I am so sorry it has taken this long, but the stories of others, like Alberta Bryant and Diane Gates would not have been in here then, and they are essential. Jane told me she found herself, her pains and her answers "all over the book." She sent me pages describing how the many physicians she had seen who were unable to help her for lack of knowledge I relate herein.

A few (long) years ago, I was introduced to Joseph C. Keating, Jr., Ph.D., when he was Professor of Chiropractic History at Los Angeles College of Chiropractic. Joe befriended me and again went over this manuscript with his unique insight. He is the unquestioned authority on chiropractic history.

In the mid-nineties, Laurie Harper (Sebastian Literary Agency) tried to get this published, but it wasn't time. In retrospect, my Visalia experience with some chiropractors, Diane Gate's story and others had not yet happened. I will always be grateful to her, especially because she introduced me to Nancy Ellis-Bell (LitWest Group) when she couldn't be available to continue with me. Nancy 's immediate recognition of this book's importance was joyful, and I happily gave it into her hands. But is still was not its time.

John and Wendy Williams have been my friends for well over ten years. When they owned the Redlands Print Shop, in Redlands , California , their assistance was invaluable in readying the early manuscripts. John and Wendy have also been my patients. They have experienced what I teach here. When Nancy needed a new Proposal, Wendy became my dedicated editor. Then she became your representative throughout this book. She challenged every phrase as I reread and reedited it, sometimes appalled at what I had thought was good writing five years before. I am forever grateful.

I will always owe a special debt to Lisa, my youngest daughter. Every little girl needs her Daddy, especially when she is just coming into becoming a young woman. To finish my specialty training, I was compelled to leave the Los Angeles area. All of it has been part of the trial my life required, and in the end it was good, but along the way there was pain, and no one felt it more intensely and at such a critical stage of her development than Lisa. I was in Sacramento most of the time she needed me most. For the first six months, every mail delivered a letter from her. To cover her pain, she imagined that when I returned after the year we would saddle our horses and ride off, but that couldn't happen, and I will always carry that burden. Everyone whom I have been able to help since 1974 has Lisa to thank, as well.

And finally to a very special and beloved woman: My mother, whose ongoing prayers brought this book to fruition, who the Holy One, Blessed be His name, took home this year before she could see it published.

⁶Elegy Written in a Country Churchyard

⁷ My search for the origins of such an essential phrase went back to the 12 th century, to John of Salisbury, then to Peter of Blois, who tried to emulate him. Ronald Reagen made similar reference in his First Inaugural Address in 1989. In truth, virtually every contribution to society is from the shoulders of the past.

CHAPTER ONE

FIRST ISSUES: VALUE OF THE MANIPULATIVE APPROACHES

AND PENALTIES OF IGNORANCE

In the country of the blind, the one-eyed man is king.

Michael Apostolius               

“First decide the principle. Then decide what to do about it.”

Anon                

• Lessons about chest pain
• Distinguishing cardiac from skeletal pain
• The manipulative process
• The first physician/patient encounter
• The time for advantageous technology
• The obligations of examination
• Penalties of inappropriate examinations
• Beginnings of chronic pain
• The medical ideal
• The Pain Pandemic and its internationality
• The responsibility of orthopedic surgery
• The need to rethink the problem

She was frail, elderly, bent in severe pain. Her near-frantic children towered closely protective, gaunt ebony saplings anxiously arched high over her like an awkward cathedral. Reverently reaching down, they struggled to support her as they shuffled slowly into the emergency room of The University of Southern California / Los Angeles County Medical Center where I was standing the late night watch as Chief Admitting Physician.

She could only take a few short wracked steps before she froze with a tremor as their frustrated hands trembled to relieve her while realizing that their grasping also aggravated their mama's grimaced spasms.

I was standing close by the entrance as they entered. The stark poignancy struck me as they slowly inched towards the admitting desk and were immediately directed to the closest examination cubicle. Standing at the curtain, I heard “heart” mentioned because the pain was in her left anterior chest, but her jolts were synchronized to her breathing and the touching I had observed about her rib cage.

The tired “moonlighting” resident commenced the usual chest pain work-up as I took one of her children aside.

"Please tell me exactly what your mother was doing when the pain started."

"She was just sitting on the couch, watching TV"

"Is the couch firm, or is it soft?"

"…Soft."

"How long had she been sitting?"

"For a long time."

"Exactly what was she doing as the pain started?"

He paused. " She was turning around to reach for something."

I moved close behind her and ran my fingers gently down her upper back.

"Please," I said softly, "lean back against me."

Carefully crossing her arms over her chest, I cupped her elbows into my hand and drew her closer. “Please, just relax completely against me… Just open your mouth and lie back and trust me."

I lifted gently, paused and waited… then eased my chest against her mid-spine. There was a barely perceptible release, and it was all over. Immediately, she took a long, deep pain-free breath then turned slowly and easily to look up into her closest son's anguished face.

"It doesn't hurt any more,” she said softly.

In the first minutes of an initial examination, as a safe therapeutic trial, an intensely painful injury was instantly relieved, totally confounding the traditional expectation. It was accomplished with a well-founded suspicion, a focused observation, a directed history and manipulative maneuver. Not a single laboratory test had been done – not an x-ray or electrocardiogram or blood panel. All astronomic medical expenses had been avoided. No prescriptions were written. And her loved ones were spared the relentless uncertainty that regularly disrupts the lives of so many under such circumstances. In her case, there were no weeks lost, no repeated series of puzzling negative tests while the process possibly persisted and insinuated itself towards chronicity.

What had happened to her? What had I done?

After sitting for a long time on the soft sofa, her vertebral column had developed a focal impairment of its normally coordinate flexibility. Then, the usual glide and slide had "jammed" as she twisted. The spinal reflexes act literally. Any perceived threat to its vital contents instantly results in whatever it takes to prevent any further movement. The ribs lock in the “jam,” and trying to breathe becomes self torture.

Lifting her had eased the tension. The pressure asserted from my chest into the dysfunction had manipulated it free. It is all in the timing. Performing it so soon after the injury had prevented the secondary changes of tissue congestion and major spasm. Furthermore, if it hadn't worked, nothing would have been lost.

I left the cubicle and was behind a partition reviewing a chart when one of the daughters approached the resident who happened to be standing on the other side. In an awed voice she asked, " What kind of doctor is he - that all he did was put his hands on my mother...and the pain was gone?" Why should what I had done be so out of the ordinary?

Touch is the most fundamental, the most primitive of the senses. Yet traditionalism's denial of its value in applied biomechanics – the essence of manipulative principles - is among the most costly tragedies in Westernized medical history. While the manipulative therapies are essential to competent and efficient care in virtually all its aspects, allopathic doctors (M.D.s) have been denied virtually all education about them for more than a century despite that they are at least as essential as a stethoscope.

---

Could there possibly be a worse nightmare than instantaneous, total, permanent paralysis with all other functions fully preserved? Except for being able to grunt, move one's eyes and wrinkle one's forehead, all other voluntary movements are irretrievably lost while full consciousness of thought, sensibility, imagining, desire remain intact in unimaginable frustration and helplessness for the remainder a normal life expectancy.

It is called The Locked -In Syndrome (LIS) and occurs because there is one minuscule site high in the spinal cord where virtually all the nerve tracts that transmit the commands for voluntary motion exit from the two sides of the brain and merge as they cross to innervate the opposite side of the body. A blood clot that precisely obstructs the circulation of that remarkably tiny territory of only a few millimeters can inflict such total and irrevocable havoc.

I was involved for only one afternoon with such a patient when I was requested to examine him during a special court hearing at the world famous Rancho Los Amigos Hospital , in Downey , California . He was a man in his mid-thirties. He had been at work swinging a sledgehammer when he suddenly experienced sharp pain in his upper back radiating into his left anterior chest. Just a glance at his chart revealed all the elements of a probable musculoskeletal injury. However, his doctor didn't pursue it, and there is no charitable explanation for why he promptly scheduled a diagnostic cardiac catheterization. The doctor wasn't skilled in the procedure, and as he fumbled with the catheter for over an hour, a blood clot formed in the man's heart, entered his circulation and did its devastation.

I was asked to examine the patient predominantly because of the insurance company's untenable position that a conscious being could not exist in such a condition, from which they contended that their liability was limited. It was a court proceeding, and a large group including the jury and representatives of the involved companies stood at the foot of the bed. Just my asking him to blink his eyes a specific number of times easily contradicted the insurance company's contention, but I then asked him to subtract one seven-digit number from another. As I called them off, his eyes widened in horror until he realized they were actually only four digits apart, and, with a series of rough grunts, his pitiable equivalent of a laugh, he blinked four times correctly, and the show was over. The remainder of my examination was only for completeness.

In the end, the patient most needed acknowledgment . I gave him what I could by dictating my report at his bedside to at least let him know that his torment was understood, as his wrenching sobs tragically communicated his appreciation. His case was promptly settled, and he was provided with lifetime assistance.

EPILOGUE

Some twenty years later in the early cool of a California August evening, I was walking across my daughter's back lawn for a Jacuzzi. As I lay there relaxing in the wonder of what hot water does, however such things happen, in my imaginings I was there again, and I began to reminisce about him and what I might otherwise have dictated:

‘By the cruelest of fates this man was permanently and terribly victimized by the purposeful propagation of ignorance and the cavalier misuse of technology. It was then intended that his condition be maliciously misrepresented within the system that was supposed to protect him.

The clot that so terribly damaged him didn't need to be of any size at all as one ordinarily thinks of things, but it was sufficient to fully enforce its fateful reality.

This is an otherwise normal man, with normal desires and needs who will continue to experience them increasingly for their failure to be satisfied in any normal way until some time, prayerfully, when Higher Grace may relieve him of want of them in some measure.

He will always be totally dependent on others to meet even his most basic needs, and he will have to struggle to receive even a small measure of satisfactions others so naturally take for granted.

For the remainder of his time, which should be a normal span by any normal measures, his primal challenge will be somehow to preserve his sense of purpose of self. And that is how he will spend his life until he dies.'

He will never even be able to sit up, or get out of a bed, or walk to a window, or take anyone into his arms, or talk, or move even a finger. He will have to endure every minute totally helpless for the remainder of his life.

This tragedy would less likely have happened if traditional medical training taught that any joint can dysfunction from a sudden disadvantageous, uncoordinated movement and that its characteristics can, at least, be easily suspected.

Pain from the structures of the body frame - the muscles, joints, ligaments, fascia and associated tissues – is different from pain originating in internal organs like the heart. Pain from dysfunction is not likely to be vague and oppressive. It is sharper and is altered by movement. Cardiac pain is not! Gently rotating the torso left or right usually instantly increases dysfunctional vertebral pain, from which the pain may radiate along the course of a nerve to the anterior chest. Deep breathing can do the same as the ribs are increasingly engaged. Cardiac symptoms are not influenced by such challenges. Localized vertebral tenderness in the midline chest area occurs with both conditions.

Those simple tests and a few which examine segmental movements easily reveal such dysfunctions. All practitioners involved in chest pain - which is virtually everyone - need to be at least familiar with the possibility of such occurrences. Most are not. So, too many people with precordial (anterior chest) pain are quickly suspected of having cardiac disease, which traditional medicine is quite comfortable to investigate.

Over the years, I have instantly relieved fifteen patients - cured their “heart attacks” after they had been hospitalized in intensive care units for as long as five days. During that time, many studies, electrocardiograms and other "grams," serial blood tests and others, had been repeatedly performed while patients and their families were unnecessarily subjected to the anguish of uncertainty. Each episode was the result of a thoracic dysfunction. Each was relieved with a single manipulative procedure after an on-the-spot diagnosis was made exactly as I have described. In each, the distinction between musculoskeletal pain and cardiac pain was clear. And, once more, if the manipulative attempt had been unrewarding, nothing would have been lost. Performed skillfully, this manipulative procedure is virtually risk free, although it must be remembered that any treatment that is sufficiently potent to cure, may also afflict. No manipulative procedure should ever be used casually.

I once received a surprise visit from a college acquaintance. He was about to be admitted to St. Vincent's Medical Center across the street from my facility, at that time in Los Angeles, because he had been experiencing pain in his high abdomen each time he swallowed. The likely diagnosis is called cardiospasm (referring to the esophageal sphincter into the stomach, not the heart). It had been going on for weeks.

As he visited, without really a conscious intent, my fingers moved along his mid back and discovered an area of unsuspected mid-thoracic tenderness and spasm. Surprised, he asked me what I could do about it. I manipulated it, and incredulously to him - and a delight to me - his symptoms completely disappeared in less time than it took to write this. Once again, if it hadn't worked, nothing would have been lost.

Throughout their training, medical students are constantly reminded of Hippocrates' first principle: Primum non nocere ( Above all do no harm.) The manipulative principle asserts the other hand : sometimes, it is the not doing that is harmful – a result of the manipulative procedures being selectively excluded from the medical methodology. X

Whatever else is the marvel of the living body, it is also machinery. The joints are levers; the muscles are motors. When function is impaired, often the body responds with pain, which is among the commonest of life's complaints.

As manipulation seeks to realign dysfunctional structures, it simultaneously tends to accomplish considerably more because the procedure intrinsically influences numbers of other activities through the body, predominantly mediated through nerves. There is hardly a discipline in medicine that may not, in some way, be more effective with manipulation's knowledgeable application.

The pages through the first three chapters are sequenced: 1 | 2 | 3 | 4 | 5 | 6