By all standards, Brianna Brown has quite a lot going on professionally. The 29-year old actress has been seen in two of Judd Apatow’s recent comedies, “Knocked Up” and “The 40 Year Old Virgin,” and co-starred in the independent film “Conversations with Other Women” with Aaron Eckert and Helena Bonham Carter.

Brown has also made herself known on the small screen, with notable appearances on the sci-fi series, “Smallville,” and the TNT network series, “The Closer,” as well as recurring roles on both the HBO Emmy-winning show, “Entourage,” and the CBS legal drama, “Shark.”

With a leading role – alongside esteemed science/fiction actor, Lance Henriksen – in director Roel Reiné’s recently released horror/thriller, “The Lost Tribe,” Brianna Brown is steadily making her mark as Hollywood’s newest star.

However, it was an ascent almost cut tragically short when Brown became entangled in a protocol sinkhole between the therapeutic and general healthcare systems.

One More Night in Hollywood

Nine years ago, a fresh-faced Brianna Lynn Brown left her native Minnesota for Los Angeles, intent on pursuing a career as an actress.

However, as anyone who has worked for that kind of industry knows, stars are not made overnight, and the endurance trial of the acting circuit is usually enough to weed out those actors with only a passing fascination for the work. While attempting to establish herself as an actress, Brown took up a shift as a food-runner at a large restaurant because it allowed her more flexibility with her auditions.

After some time at her job, Brown began to notice irregular flashes of intense pain along her back and legs, a sensation akin to a torn muscle that she hoped would go away if given enough rest between shifts and auditions. However, the condition only worsened.

“It was really quite horrible because I was always very athletic growing up, and because of this pain in my body, I couldn’t run, I couldn’t work out. I couldn’t even take the dishes from the dishwasher to the cabinet without pain,” says Brown.

A Jungle of Cross-Diagnosis

When Brown finally went to a referred physician through the restaurant’s insurance company, she found that there was much more to her diagnosis than her assumed quick trip to the doctor, follow-up imaging scan, and recommendation for some form of therapy treatment.

Rather than refer Brown for diagnostic testing, the physician simply followed a fairly standard healthcare protocol intended to locate the exact source of the pain, whether anatomical, psychological or neurological.

Although he did not treat Brown, Peter Ullrich Jr., MD, of Appleton-based NeuroSpine Center of Wisconsin says that “the medical diagnosis of a patient’s lower back pain, leg pain, or other symptoms is based on more than just the findings from a diagnostic test, such as an MRI or CT scan.

Instead, the spine care professional arrives at a clinical diagnosis of the cause of the patient’s pain by synthesizing findings from a thorough review of the patient’s medical history, a complete physical exam, and, if appropriate, the results of one or more diagnostic tests.”

After taking Brown’s medical history, the physician found no prior occurrences of lower back pain or sciatica. And Brown’s descriptions of her pain, the inconstant duration, and its flare-ups during certain activities, seemed to suggest muscle injury. The physician continued with the physical exam, testing nerve function and muscle strength in Brown’s limbs and back, checking for a sign of pain in certain positions as she went through a series of mild exercises.

The initial physician came to the conclusion that Brown’s complaints of back pain must be resulting from something other than spinal injury – if she was experiencing pain at all. The physician had her return for a follow-up with another doctor, and then another. But as the months wore on, juggled between one specialist and another, Brown’s back pain grew less manageable.

“Every time I went to their office, they would rotate what [physician] I would see, and each time I’d have to repeat exactly what happened … show where the pain was, and they’d have me do these basic movement tests that I would be able to do a little. But, at the end of the exercises, they’d basically say that I must be exaggerating the pain,” says Brown. “At the same time, the restaurant I was still working at was not giving me many shifts and were trying to get me to quit.”

While being bounced around between physicians, Brown’s acting career began taking serious hits. Her back pain began to come on unprovoked, during something as simple as sitting through auditions, which prevented her from trying out for more physical roles.

“I knew my back injury was holding me back with what I wanted to do with my career. It was so much of what I identified myself with – being an athlete with a love of dancing,” says Brown. “A part of me was missing, and I needed for it to be resolved.”

Despite Brown’s urging that the physician perform a scan to eliminate the possibility of other back injuries, the rotation of specialists continued to deny her request. They insisted that her symptoms of unsubstantiated back pain did not warrant a diagnostic imaging test, leaving Brown in a healthcare loop that is still experienced by many spinal injury patients.

The MRI Crossfire

In the years since Brown’s initial brush with spinal injury, there has been little progress made to assist those who fall into this narrow sinkhole between referring physicians and therapeutic professionals.

As back injuries are among the most common U.S. health problems, and diagnostic imaging scans are a swiftly mounting expense, many healthcare systems have instituted the three-tier protocol mentioned earlier, in which the physician takes into account the patient’s medical history and a series of physical exams before referring for an MRI.

This approach often weeds out the innumerous musculature problems without the use of costly imaging scans and assists in narrowing the list of possible causes of back pain. Using this three-tier protocol, the MRI is used sparingly as an observational tool to either confirm the physician’s diagnosis or to search for a problem that could not deduced by the combined medical history and physical exam.

“While the MRI scan represents a very sensitive and accurate assessment of spinal anatomy, it cannot distinguish between painful and non-painful structures in the spine,” says Philip Shalen, MD, a neuroradiologist at Plano, Texas-based PRS Group.

“In fact, a patient may have severe back pain and an MRI scan that shows a relatively normal spine, or, conversely, may have no back pain but the MRI scan reveals a lot of anatomical problems. Thus, the findings on MRI scans do not constitute a diagnosis, and the MRI findings must be correlated with the patient’s physical exam and symptoms of back pain to arrive at a clinical diagnosis. It is not usually necessary to obtain an MRI scan at the onset of spine-related pain, as most cases of back pain and neck pain will resolve within two to 12 weeks with proper conservative treatment.”

On the flip side, in cases such as Brown’s, the three-tier system effectively prevented her from receiving the MRI that would have validated her pain to her physicians.

During one of her last meetings with the insurance company’s array of health practitioners, the physician flat out told Brown that she was lying, to which she broke into a tearful outburst, claiming that she was not after the money, merely that she was in pain, and pleaded for an MRI scan. Apparently moved by her sincerity, the physician ordered an MRI, which would later reveal what Brown had spent months trying to convince the doctors: She had three bulged discs in her spine, one in her neck, and two between her shoulder blades.

Blind Leading the MRI

A bulging disc, which is also known as a contained spine disorder, is an ailment that occurs in the spinal or lumbar section, and in rare cases like Brown’s, the neck region. The jellylike discs of the spine, which are compacted between the vertebrae and contained within a slender casing, will eventually, due to age and a variety of stress factors, begin to bulge away from the spine.

Unlike a herniated disc, in which the spinal disc ruptures and pushes against other structures, bulging discs are actually quite common ailments. For the most part, bulging discs pose no health risk or discomfort, unless it bulges in a particular direction, such as pressing up against the nerves of the spinal column, which causes numbness and/or pain. Unfortunately for Brown and others like her, the rarity of a troublesome, hard-to-detect bulge also makes it difficult to diagnose and highly susceptible to professional scrutiny.

“Take 100 normal people who appear to have nothing wrong with their spines and perform an MRI on each. The results may reveal that 20 percent to 25 percent of asymptomatic participants have a herniated or bulging disc, or arthritic condition. These patients are pain-free and their lives go on without interruption at that particular time,” says Stewart Eidelson, MD, assistant professor at the University of Miami School of Medicine at Florida Atlantic University.

“The disadvantage is the results of an MRI may create a false positive. The point is this – the clinical symptoms must coincide with test results,” Eidelson concludes.

A Star Back on the Rise

Once officially diagnosed with a bulging disc, Brown was referred to orthopedic specialists, who were able to recommend a variety of spinal recovery treatments to assist in her rehabilitation. Physical therapists working with bulging disc patients typically make use of different methods, including traction, in which the therapist pulls the vertebrae so the blood can flow into the damaged disc and promote healing.

Another common therapy for bulging disc are massages, which also improve blood circulation in the affected area. Stretching exercises are also usually included in a therapy regimen for bulging disc, and some therapists eventually incorporate core strengthening exercises into the patient’s therapy program to strengthen the muscles in their back.

Other therapeutic approaches of easing this chronic condition include ice therapy, heat therapy, ultrasound therapy, and even mild electrical stimulation. Some therapists also recommend muscle relaxants and pain relief medication in combination with therapy regimens and at-home exercises for these patients.

While undergoing these therapy treatments, Brown also incorporated facets of Eastern medicine, such as acupuncture, yoga, and Qigong, into her personal exercises. Qigong, in particular, has been shown in studies to strengthen the immune system, lower blood pressure, and even reduce anxiety and depression.

In traditional Eastern medicines, disease is caused by disruptions and imbalances in the movement and patterns of the body’s dynamic life energy – or Qi. Stress in a person’s life is believed to disrupt Qi movement and cause symptoms, such as pain, stiffness, anxiety, depression, and fatigue. The goal of Qigong is to restore Qi balance and movement in the body.

While medical Qigong treatment has been officially recognized as a standard medical technique in Chinese hospitals since 1989, it has remained a hot topic of debate among therapy professionals. Although many professionals dismiss the idea of life energies surrounding the body, there is little argument over the notion that Qigong can improve and, in many cases, maintain health by encouraging movement, increasing range of motion, and improving joint flexibility and resilience.

After more than two years of these collaborative therapies, Brianna Brown returned to the acting circuit with a reaffirmed drive for her career. Most recently in 2008, she has appeared in the CBS crime drama “Without a Trace”.

In her off time, Brown facilitates a women’s support group comprised of a few of her friends. There, the women discuss excerpts from Jinny Ditler’s book, Your Best Year Yet! (Thorsons, 2001) and talk about their personal goals in all areas of their lives, whether it be financial, health, relationship or career-related.

Because, Brown says, “especially in Los Angeles, it’s great to have a group of other women who have your back and are supporting you.”

— Bob Stott is a staff writer at Therapy Times. Questions and comments can be directed to bstott@therapytimes.com.