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Old Scars Can Pain Your Hip

In one of the surprising interconnections in human physiology, a scar above the pubic bone from a hysterectomy can be the primary cause of unremitting hip pain. Lawrence D. Cohen, M.D., who practices in Danbury, Connecticut, explains, through the case of Delia, 42, how this connection works.

Delia reported having problems in flexing her left hip (although there was no pain) since earliest childhood. The problem became worse at age 35, growing more aggravated, and after the birth of her second child (at age 36), the sensation in her hip progressed to steady arthritic pain.

Before seeing Dr. Cohen, Delia consulted an orthopedic surgeon who, after x-raying her hip, concluded it showed signs of degenerative joint disease. He gave her cortisone injections, prescribed anti-inflammatory drugs, and said if the pain got so bad that she couldn't stand it, "we'll replace the hip."

Delia was not impressed with that prospect, knowing that hip replacements usually fail after a decade, requiring further surgeries and rehabilitation. And the drugs she was taking weren't helping much. Her range of motion was so constricted that after walking a short distance, she would start limping with severe pain. She was fortunate to hear about Dr. Cohen who offered a more effective, less invasive alternative.

Upon examining Delia, Dr. Cohen noted that she had surgical scars in her lower abdomen from two gynecological surgeries for ruptured ovarian cysts. Understanding scars is at the heart of neural therapy, one aspect of Dr. Cohen's medical approach. Most people think of a scar as a gristly strip of essentially inert flesh. Not so, says Dr. Cohen.

According to the principles of neural therapy, a medical system developed in Germany and now practiced in the U.S. by a smattering of physicians, scars are electrically active and can disrupt the bioelectrical activity of cells, tissues, and muscles in the immediate area and even elsewhere in the body.

"The normal voltage of tissues and organs in the body is around -70 millivolts," explains Dr. Cohen, "but the voltage in a scar can be as high as 1 or 2 volts. That's 14 to 28 times stronger." Delia's two pubic-region scars were acting as electrical irritants to her pelvis, generating what neural therapy calls "interference fields" throughout that body region, Dr. Cohen says.

During his first treatment with Delia, he injected both abdominal scars with a local anesthetic (procaine, known by its trademark name Novocain). The change was instantaneous, he says. "Delia got up and immediately felt almost full relief of her hip pain and was able to lift her leg above her waistline, something she had been unable to do for years."

The local anesthetic deactivated the electrical charge emitted by the scar; this cancelled the irritation it was generating and the muscle triggers it was evoking; so the hip pain disappeared. "When I 'turned off' the scar, it allowed the hip to calm down," Dr. Cohen says.

A week later, in his second treatment, Dr. Cohen injected procaine into Delia's pelvic floor (the area surrounding her uterus) to "bathe" the nerves with anesthetic. It is not that the anesthetic cures anything; rather, it gives the charged area a respite, during which it can rebalance itself, electrically and biochemically, and eliminate the irritation it causes, says Dr. Cohen.

He fitted Delia with a flexible orthopedic device (an arch support) to stabilize her arch when she walked. Dr. Cohen also got her started on glucosamine and chondroitin, which are supplements commonly given for relief of arthritic pain and joint degeneration.

A few weeks later, he began the next phase of Delia's treatment, using prolotherapy to stabilize and tighten the ligaments in her pelvic girdle. Like neural therapy, prolotherapy involves injections, but this time it's not with an anesthetic but a substance (often sugar) that will produce a localized, beneficial irritation in muscle, tendon, or joint tissue. Inducing a controlled inflammation by reinjuring the damaged or degenerating tendon can stimulate the body to heal itself, even to grow new tissue, says Dr. Cohen.

As an additional measure to eliminate the last vestiges of Delia's hip pain, Dr. Cohen injected a small amount of bee venom with Novocain into the hip joint. Bee venom, formerly disparaged as a "folk remedy," is now under increasing consideration by North American physicians for its ability to reduce pain and inflammation associated with arthritis, multiple sclerosis, and other painful conditions.

"What little pain was left from her remaining arthritis resolved with that treatment," says Dr. Cohen. "Today, from this combination of therapies, Delia is pain free, back to walking up to 11/2 miles four times weekly, doing gym exercises three times weekly, and lifting weights."

Results like Delia's are common, says Dr. Cohen, when you remove the source of the electrical imbalance producing the pain. "I inject scars all the time and I often get phenomenal responses." He relates the recent case of Mira, 72, who complained of severe back pain, had back surgery and did not get better, because the problem actually stemmed from her right big toe. Mira would be golfing or walking the links and the pain would start spreading up her leg and then her back. An orthopedic surgeon said she had spinal stenosis-narrowing of the spine from arthritic spurs on the bone compressing the spinal cord, thereby pinching nerves. Learn to live with the pain was his advice. A neurosurgeon's diagnosis was a damaged vertebral disc; he recommended back surgery.

She had the surgery (called a discectomy, the partial or complete removal of a disc), but it made no difference and the pain came back again. Mira consulted another specialist who gave her an epidural steroid (injected into the dura mater, or outermost layer of the spinal cord) but this had no pain-reducing effect either.

Dr. Cohen didn't waste Mira's time with fruitless surgeries. He examined her feet. "I always check the patient's feet," he says. He often finds that back problems originate with problems in the feet. Mira had never mentioned pain in her feet, but when Dr. Cohen probed her right big toe, she winced. There was arthritis in that toe, he observed. Then he watched Mira walk. He saw that with each step she twisted her right ankle and turned her right leg out to avoid bending, and thus hurting, her right big toe. But every time Mira did this, her hip muscles had to contract to compensate for the imbalance in posture, and this produced the back pain.

"In other words, the low back pain was the result of her body's adaptation to avoid pushing off on that big toe with every step," says Dr. Cohen. He injected the tender foot joint with procaine and had Mira walk again. The leg and back pain were gone and Mira could walk freely, without pain.

Back Pain Caused by Depleted Kidneys and Adrenal Glands As with the modalities of the last two practitioners, traditional Chinese medicine offers a view strikingly different from the conventional explanation of back pain as a mechanical (muscular, skeletal, and/or vertebral) problem.

According to acupuncturist and herbalist Michael Tierra, L.Ac., O.M.D., of Santa Cruz, California, numerous factors-fatigue, overwork, feebleness caused by prolonged illness, aging, emotional stress-can deplete the kidneys and adrenal glands of basic life force or vitality. Put in simplest terms, an energy balance can upset the metabolic (energy-converting) and hormonal activities of the body, which in turn destabilize the physical structure and produce pain and discomfort.

In the language of acupuncture, a person's inherited energy potential, called essence, is stored in the kidneys, Dr. Tierra explains. This essence can be depleted through lifestyle choices and it is hard to replenish. If the level of energy in the kidneys or adrenal glands is low, it can develop into a deficiency of kidney qi and/or essence. This in turn makes them more susceptible to cold or dampness, and this then starts to weaken the spine and bone tissue and produce low back pain. In other words, Dr. Tierra says, the structural misalignment and pain follow the energy deficiencies.

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