In this video I'm going to tell you why you should never get a radiofrequency ablation
for your back pain.
A radiofrequency ablation, also known as an RFA is commonly explained to patients as a
nerve burning procedure.
And it's offered to patients in pain management clinics specifically for lower back pain.
And you heard right it is a nerve burning procedure.
I'm going to tell you all about why you should not burn your nerves and there's just a few
situations where you might actually benefit from this procedure.
I'll explain that as well.
My name is Dr. David Middaugh fan I'm a specialist physical therapist at El Paso manual physical
therapy.
This channel is dedicated to helping people stay healthy, active and mobile without unnecessary
surgery, injections or pain medications.
Please consider subscribing to this channel so that you don't miss out on any of the helpful
videos we post each and every week.
Now when would a doctor offer you in RF a treatment?
Usually doctors offer this after over the counter pain medications have failed you as
well as prescription strength pain medications, including medications to treat nerve pain,
like Lyrica and Gabapentin.
Oftentimes people have had injections at this point.
And they have only temporarily worked and have not given any sort of long term Back
Pain Relief.
Now radiofrequency ablation is usually described as a non invasive technique.
It's not typically considered a surgery however, they are going into your body non surgically
and burning nerves.
So the reason why they don't say it surgery is because they don't actually use a scalpel,
they don't cut you open, they don't stick any cameras inside of your body typically.
So it's a minimally invasive procedure, usually done with some very thick syringes are some
very thick and needles where they can put in the tools that actually burn the nerves.
If you ask me It pretty much is surgery or a very tiny step away from having surgery.
I think it's a marketing ploy as to how they say the words about what they're doing to
your body to make sure that they don't scare you too much.
Now it is one step away from the more traditional surgery.
So at this point, if you've been offered an RFA treatment, then you're probably one step
away from getting some sort of spinal surgery.
Now a question we get all the time is which nerve is burned.
Let me just show you on the skeleton where the nerves are here.
So here's the lower back right in this area, and these nerves that come off to the sides
are what we call the nerve roots of the lumbar spine.
Now the nerve roots branch into what's called a medial branch and a lateral branch medial
just means it whips around the back towards the middle of the spine, but it goes towards
the back.
And that is the nervous typically burned in an RFA procedure that nerve innervates, the
facetted joint which is right there where I'm trying to stick my fingernail as well
as the deepest muscles in the area.
And then there's a branch that goes to the skin in the area as well.
So the median branch of the nerve is what's burned, and it typically innervates muscles,
skin and the joint in the area.
Now what is the downside of burning a nerve in your lower back?
Well, for one thing we don't know, if the nerve regrows patients are often told that
it might regrow, there's no certainty in the nerve regrowing at all.
People are doing this procedure in an effort to cut the nerve off to the area that's possibly
generating the pain.
So the theory is that if that nerve is burned off, then the joint that is innovating is
no longer innovated, which means you don't feel the pain anymore.
But along with the innovation to the joint, you also lose innervation to the muscle, the
deep muscles of the spine specifically in the multifidus muscle, which is one of the
deepest muscles of the lower back.
This could be setting you up for other problems like disc problems and stenosis issues.
And what you have to realize is, if your back pain is truly related to that specific joint
on that specific side, then this burning procedure may then help you but if it's more than just
that, it's more than just the set joint on that side of the spine.
If you also have a disc problem, a stenosis problem.
If you have a muscle problem, then you could be missing the rest of the issues that could
contribute to your back problem.
And it's because of the complexity of back pain that this procedure often does not solve
the entire back pain problem.
It is shown to reduce pain in research studies out there and there are patients that say
that they feel better as far as their back pain, but there isn't a lot of research showing
the long term effects of getting an RFA radiofrequency ablation for back pain.
Having lost the nerve in the lower back that would love to see this research to see if
there's a higher frequency of like disc problems.
Disc herniation surgeries spine fusion surgeries, there just isn't much out there at this point,
which doesn't mean that it doesn't happen.
It's just it's just that we don't have it documented in scientific research at this
point.
And what I can tell you as an expert physical therapist is I see people here in the clinic
all the time that have had failed radiofrequency ablation procedures.
In other words, they went and got the procedure done, and their back pain continues.
And we're stuck between a rock and a hard place here in treatment, because now as a
physical therapist, I'm trying to get them to use their muscles, and they don't have
good activity in those muscles because the nerves have been burnt to the area.
So what do you do instead of doing an RFA, what other treatment have you possibly not
tried to obviously, treating the muscle imbalance by getting the weakest muscles stronger is
the number one treatment that we do here in the clinic.
So number one, I would recommend going to physical therapy.
Now if you've already done physical therapy, and it did not work out for you, I urge you
to go back to a different clinic, try a different therapist, find an expert in your in your
area, what you must realize is that if you went to a clinic that specializes in, in treating
people right after having had surgery, that is probably not going to be the best clinic
to get you better if you're looking to avoid having a surgery.
If you're dealing with back pain, and you don't have a recent history of surgery, like
didn't have surgery within the last few months, and you're still recovering from that surgery,
then most physical therapy clinics are not going to be set up to help you out there.
Their clinics are usually set up to for people to do tons of exercises and run through a
circuit of exercises.
And that's best for people that have just had a surgery because they just need to kind
of get moving get going again, and treating a specific back problem isn't usually their
specialty.
So what you need to look for is a clinic that doesn't usually see people that have just
had surgery, that to be even more specific and what kind of treatment to look for.
Here at this clinic.
I'm looking to treat a muscle imbalance in the area.
If you've got back pain that you're looking to get a radiofrequency ablation procedure
for possibly, chances are the joint is what's affected and that joint is affected because
you've got an imbalance of muscle strength surrounding your lower back.
Usually, the back muscles are actually over dominance.
The abdominal muscles are weak and sore the glute muscles down here below the lower back,
those glute muscles often get weak and that's what needs to be treated the abdominals and
the glute muscles and sometimes it's even a specific part of the abdominals like the
lower abdominals.
It just depends on the individual.
Often when we see people here in the clinic for a back problem, and they've had a failed
radiofrequency ablation, we're just a couple of months away from strengthening their abdominals
and their glutes enough to have a reduction in their back problem.
I just want to let you know we have a program called the 28 day back health and wellness
boost program where we've packaged many of our exercises and teachings on how to help
a lower back problem over the course of 28 days.
That's a 100% online and on demand program so you can access it from anywhere that you've
got a screen and internet connection.
And you could find details on this program down in the description below.
Just look for the link for the 28 day back health and wellness boost program and you
can learn all about it.
Now when would a RFA be a good idea if you thoroughly strengthen your abdominals and
your glutes and you have seen absolutely zero improvement in your back pain and you know
without a shadow of a doubt that you've got stronger in your abs and your glute muscles
and that might be a situation where you might look to get this nerve actually burned.
Another situation could be if you for some reason cannot strengthen your abdominals and
glutes like you've got some neurological problem maybe you've got a you've had a stroke or
some other nerve problems and spinal cord injury and you just can't get strengthen your
abdominals and glutes for that reason.
Or another reason which I would think is valid is if you're lazy if you're admittedly lazy
I get patients sometimes to say you know what, I'm just not going to exercise and you know
that you're okay with you're okay with the long term effects, the side effects of having
a the muscles not working in your back because the nerves are burned, then a radiofrequency
ablation might be appropriate for you to get your back pain down just have an understanding
that it's only going to be a temporary improvement.
And now before going through with the radiofrequency ablation, make sure that your doctor does
do a nerve block test.
Now I haven't met a doctor that hasn't done this yet.
But I wouldn't be surprised if there's one out there.
So if you happen to run into a doctor that's looking to do an RFA, they should be doing
a nerve block test where they go into your spine and they get to that nerve that they're
looking to burn and they do what's called a nerve block, they do a little procedure
to numb the nerve.
And then they asked you is your pain better?
If your pain is better than they are more certain that that's the nerve that they need
to burn.
So when they go through the procedure, they don't miss they don't fail.
Hey friends, I really hope you don't have to get an RFA treatment, I hope you can get
stronger in the right areas and really break through this back problem.
Most people dealing with a failed RFA do get better here in the clinic, they just have
not found the right kind of treatment that they need for their back problem and go into
physical therapists can be very confusing because one might tell you one thing and another
might say another thing, and doctors don't typically know who's a good physical therapist
and who's not you've got to go try out the one that works for you.
And you might also be recommended a physical therapist that doesn't work out for you might
need to find another one that can guide you along in the right way.
And don't forget that we've got an online program that you can download right now just
go to the link in the description below.
If you're looking for more help with back problems, we've got more free help on our
channel, also linked in the description below.
I'll see you in the next video.
Bye