Using leading-edge technology and an innovative integrative approach to identify the true, underlying causes of pain

By Mitch Allen

For those experiencing chronic pain, finding lasting relief can be a lifelong struggle. Many patients have seen rheumatologists, neurologists, orthopedic surgeons, chiropractors, acupuncturists, P.T.s, M.T.s and D.P.M.s—the list of traditional specialists can seem like a bottomless bowl of alphabet soup.

But one local physician is taking an innovative and integrative approach, examining and treating body systems instead of body parts. She is Patricia Delzell, M.D., the founder of Advanced Musculoskeletal Medicine Consultants (Advanced MMC), and she is about as Cleveland as one can get: She grew up in Cleveland Heights, attended Laurel School, earned her medical degree from Case Western Reserve University, and did her residency at the Cleveland Clinic, where she served as the director of musculoskeletal ultrasound from 2009 until 2019—when she started her new practice.

What is the unique advantage of “Musculoskeletal Ultrasound”?
“The musculoskeletal system refers to the structure of the body,” Dr. Delzell explains. “It’s made up of muscles, bones, tendons, nerves, joints, fascia and connective tissue. It’s the entire system that allows us to stand, sit, move, walk, run, and do all of the activities we enjoy in life. If something goes wrong with this system, it can cause pain, stiffness, and a lack of mobility.”

With Dr. Delzell’s nationally renowned expertise in musculoskeletal ultrasound, she employs state-of-the-art ultrasound technology with higher spatial resolution to actually see tissue in motion. This enables her to capture how the multiple contributors to pain are intertwined and develop a more successful treatment plan.

“It’s frustrating when you have an MRI done and the doctor says nothing is wrong, but you are still in pain,” she says. “We see things that are happening in the fascia, the nerves, and the muscles that cannot be seen on an MRI, but are very well defined on ultrasound. For example, ultrasound can be used to see muscles and structures as they are moving and interacting in real time. We want to see how muscles are functioning. Are they contracting? If so, are they coordinated and effective? Interestingly, the brain can turn off a muscle causing surrounding muscles to have to take over and work harder—contributing to the perpetuation of pain. If you treat only the muscle strain that is the direct cause of the pain but not the nonfunctioning muscle, chronic pain ensues.”

Dr. Delzell also uses a similar approach to evaluate pain from tissue other than muscles, such as scar and entrapped nerves.

Searching for the Why
The complex biomechanical nature of the musculoskeletal system means it can be difficult to determine the true contributors to pain. “Five patients can present with similar hamstring pain and all five can have different contributors to that pain,” says Dr. Delzell, who integrates traditional medicine with complementary medicine to create a unique treatment plan for each patient. “Traditional medicine looks for the ‘what’—what part is causing pain—while complementary medicine looks at the ‘why’—why is the part still causing pain,” she says.

Dr. Delzell, who specializes in the diagnosis and treatment of musculoskeletal scar, looks at “kinetic chains.”

“A kinetic chain is a group of muscles working together for a purpose, such as sitting, standing or throwing a ball,” she explains. “With ultrasound, we can examine the specific structure of the chains and see fibers in muscles and overlying fascia. The fascia contains tiny nerve endings that send messages to the brain telling us how to position ourselves. Scarring, for example, can cause faulty messages to be sent to the brain and that can ultimately manifest as pain. Again, you have to look for the why.

“Sometimes the kinetic chains and fascial planes go straight. Sometimes they crisscross. That’s why we may discover that hip pain in the front is actually being caused by problems in the posterior kinetic chain or fascial restrictions in the back. This is also why we offer a highly customized treatment plan for each patient, featuring targeted injections—including scar hydrodissections—guided by the ultrasound to the problem area, not just the location of pain.”

A Three-Pronged Approach
At Advanced MMC, Dr. Delzell typically takes a three-pronged approach with her patients. First, she looks for what can be done to take the edge off the day-to-day pain as quickly as possible without the use of oral medications or narcotics. Second, she employs musculoskeletal ultrasound to determine the contributors to the pain and treats it as necessary. And third, she seeks to “optimize each patient’s healing potential.”

“The basic building blocks of muscles, bones and nerves are nutrition—including the status of certain vitamins and minerals—exercise and maximizing blood flow, stress management, and sleep,” she says. “Without addressing these issues, we cannot optimize the body to heal itself.”

In addition to doing limited bloodwork and offering an in-depth nutritional assessment, the practice also focuses on reducing stress. Stress raises cortisol levels and increases adrenalin.

“The fight or flight response our ancestors relied on to escape a saber-toothed tiger is alive and well in us today,” she says. “Although we may no longer have an imminent threat like that, we have the same response when we are worried, afraid or upset. So we focus on the parasympathetic nervous system, which helps the body relax, stimulates digestion, and activates the metabolism. We may collaborate with the patient and work on things ranging from simple breathing techniques to moving meditations. While people often hold stress in their neck and shoulders, it can also be held in the back, pelvis, hips, etc.”

Sleep, Dr. Delzell adds, is all about rejuvenating the body. “Proper sleep is important,” she says. “All the body’s processes as well as injuries are rejuvenated or healed during sleep. Stress in the brain is processed during sleep. Without a good night’s rest, pain can perpetuate. It can keep us awake at night, and that lack of sleep can exacerbate the pain. It’s an unhealthy cycle.”

Getting Started
Advanced Musculoskeletal Medicine Consultants exclusively treats pain related to the musculoskeletal system, including the shoulder, elbow, hand, wrist, chest wall, neck, back, hip, foot, knee, ankle, nerve pain, and more. In a growing trend among leading-edge healthcare providers, the practice does not accept insurance and there is a good reason for that. “Insurance is great for severe illness, surgery and severe trauma, but it is not as comprehensive for covering treatments for chronic pain unless the practice follows a standard algorithm,” Dr. Delzell explains. “According to the algorithm, Diagnosis A may call for Treatment B, and a treatment plan likely won’t be covered if it varies from the algorithm. As an integrative medical practice, we develop our treatment plans specific to the individual, not to the diagnosis.”

There are multiple ways Advanced MMC works with patients regarding payment, including accepting payments from health savings accounts (HSAs), and providing an itemized super bill that they may submit to their insurance company for potential partial reimbursement. In addition, there are consultation packages that decrease the overall cost of initial pain assessment.

Right now, Advanced MMC is offering an initial complimentary Chronic Pain Phone Consultation with Dr. Delzell (see the sidebar accompanying this story).

Advanced Musculoskeletal Medicine Consultants is located at 8398 Kinsman Road in Novelty, Ohio. For more information or to schedule your complimentary Chronic Pain Phone Consultation, call 440-557-5011. Visit AdvancedMMC.com for more information, including blogs and videos.