December 21, 2006 

Aerobic exercise|pain|discomfort

 Aerobic exercise suggestions for cardiovascular fitness include moderate-intensity exercise for at least 30 minutes a day 5 days/week.  This can be achieved by walking 1.5 miles daily at 3-4 mph. Three 10-minute walks a day each day has also been suggested. Resistance training to help promote health benefits is also beneficial. 

How do you get chronic pain patients to have an aerobic exercise?  They are told by others around them to exercise whereas their bodies tell them to rest.  What is the best compromise? If they exercise there is exacerbation of pain. However some of them push themselves through pain believing in the "no pain no gain" trend of thinking.   A significant factor in nerve related muscle pain is lack of blood supply to the muscles and nerves.  Therefore taking extra pain medications to suppress the muscle pain during and after exercise will have little effect on the muscle spasms already formed inside the muscles.  These newly formed muscle spasms related to exercise will cause more pain from having a traction effect on the nerves and blood vessels within the muscle, and also pull on the bones and joints causing increased pain.  

Patients with chronic pain must keep mobile and cannot follow suggested or standard guidelines for aerobic exercise.  They must follow the guidelines given by their body.  They must not perform aerobic exercise continuously even for ten minutes if they have pain exacerbation.  They must rest immediately for the equal amount of time that they have exercised.  Therefore they must exercise in places where they have access to a seat so that they are able to sit down and rest immediately if need be.  Exercising in a controlled climate situation is essential.  Climbing up and down steps as part of activities of daily living must be incorporated into the aerobic exercise program.  Moving the arms and legs against gravity will act as resistive exercises.   

Tai Chi is the perfect aerobic exercise since it will involve also balance activities.  Performing tandem walking will also improve balance.  Standing on one leg at time while holding onto something solid will provide muscle contractions essential for prevention of osteoporosis.  The non-supporting limb can also be mobilized to exercise while standing on one leg.  The concept in exercising for chronic pain patients is to maintain and/or increase mobility and balance.  Increasing heart rate should not be the goal if it will exacerbate the pain such that they are miserable.  Patients with chronic pain or discomfort cannot exercise using rigid guidelines such as preset time, number of repetitions or distance. 

© 2007 copyright www.stopmusclepain.com Aerobic exercise|pain|discomfort

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Tingling, numbness or weakness in the ring and little fingers is common.  These problems manifest when there is ulnar nerve irritation.  The ulnar nerve is commonly irritated at the elbow since the nerve passes behind the elbow and can be stretched when the elbow is kept bent.  Apart from direct trauma to this nerve at the elbow, the nerve becomes more susceptible to injury when there is also pressure onto the nerve as in leaning on the elbow or by sleeping on the arm.  Sleeping on the sides with the arm under the pillow or under the body or sleeping on the stomach or sides with the elbows bent are common causes of self-induced injury to the ulnar nerve. 

Repetitive motion activities needing frequent bending and straightening of the elbow also injure the ulnar nerve.  In such activities, the triceps will be involved with frequent lengthening and shortening contractions that encourages triceps to go into spasm.  This muscle is already weakened from lengthening contractions associated with activities of daily living.  In addition, C7 nerve root level involvement with aging makes the ulnar nerve weak from pressure from the overlying shortened and tight triceps. Therefore when subjected to further trauma, the triceps will tug or pull further on the ulnar nerve giving rise to tingling or numbness or pain in the ring and little fingers.  When the ulnar nerve involvement is more significant, there will also be weakness of the hand especially for fine manipulation activities such as writing. 

Conservative treatments have to be applied before resorting to surgery where the ulnar nerve is translocated to the front of the elbow from the back of the elbow so there is more muscle protection during elbow bending. 

Motor point stimulation using the eToims Twitch Method is best applied to the triceps to release the pressure on the ulnar nerve.  In addition, to prevent recurrent injury, muscles that are constantly subjected to lengthening contractions supplied by the C6 and C7 nerve roots as well as the L5 and S1 nerve roots have to be included in the treatment.  Treating ulnar nerve problems involve treating muscles supplied by spinal nerve roots that are commonly involved with the aging process.       

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Tuesday, December 19, 2006 

Carpal tunnel syndrome

Carpal tunnel syndrome is an entrapment syndrome of the median nerve at the wrist level and can result from many disease conditions.  If you have been diagnosed as having carpal tunnel syndrome it is important to exclude other conditions that can cause problems of the peripheral nerves especially metabolic conditions such as diabetes.  The common mechanical cause for initiating the symptoms is from repetitive stress injury to the wrist.  

When there is carpal tunnel syndrome, the patient usually has symptoms of pain, tingling and or numbness in the thumb, index finger, middle finger and half of the ring finger closer to the middle finger. Many patients however complain of numbness in all the fingers.  If the patient has numbness also in the little finger and the ring finger this is an indication that the ulnar nerve is also involved.  When there are symptoms in all the fingers, the involvement is not only localized to the median nerve.   

The local pressure on the median nerve is usually from thickened and swollen flexor tendons that pass through the carpal tunnel under the ligament of the wrist called the flexor retinaculum.  Inflammation of these flexor tendons makes the carpal tunnel tight allowing the tendons to press on the nerve. If the goal of the treatment is to decongest the carpal tunnel using local injections or surgery, the patient's symptoms may not be alleviated.  Many patients continue to have symptoms with treatments that are directed only to the median nerve at the wrist level.   

To avoid having surgery as the first line of choice, treatments must involve the flexor tendons that pass through the wrist putting pressure on the median nerve.  Using the see-saw principle you will now understand that if the flexor tendons are the problem, their actions have been chronically unopposed by the presence of weak or lengthened extensor muscles on the back of the forearm. 

Patients with carpal tunnel syndrome especially those who have symptoms also in the last 2 digits have associated spinal nerve root aging at multiple levels.  When spinal nerve roots age or are subjected to sudden or insidious trauma, the muscles that they supply become shortened and tight.  The most commonly injured nerve roots are C6 and C7 spinal nerve roots.  Of all the muscles that these nerves supply, the muscles that will become weakened first are the muscles that are constantly subjected to lengthening contractions.   

In the upper limb, the muscles that will weaken first are the posterior deltoid, latissimus dorsi and the triceps muscles.  Since these big and powerful muscles are the first ones to be used in lengthening contractions in order to stabilize joints in most activities of daily living, when they become weak, the smaller muscles of the forearm are used to stabilize the joints.  The forearm extensor muscles arise from above the elbow joint and in the presence of weakness of the triceps, will be called into play to help the triceps in motions that require straightening the elbow. 

The forearm extensor muscles are primarily used for lifting the wrist upward.  When they become weak, the flexor muscles in the front of the forearm become tight and shortened due to the unopposed pull and will initiate not only the development of carpal tunnel syndrome but in maintaining the symptoms by continued pressure on the median nerve at the wrist level. 

Therefore, conservative treatment of carpal tunnel syndrome treatment is more complicated than one might think of.  To return optimal function to the posterior deltoid, triceps and latissimus dorsi muscles, the tightness and spasm in these muscles have to be released. To allow the strongest and biggest muscle supplied by the C6 and C7 roots, namely the latissimus dorsi, to function better release of muscle spasm and shortening within this muscle must be addressed. In addition, for this muscle to perform optimally, non-invasive electrical stimulation of the motor points with eToims, must involve the entire paraspinal muscles from neck to the lower back, scapular and upper limb muscles as well as muscles of the hip and pelvic girdle.    

© 2007 copyright www.stopmusclepain.com Carpal tunnel syndrome

Tags: upper body topics
Categories: Upper Body Topics
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Monday, December 18, 2006

Knee pain|thigh pain|crouching or squatting

Knee pain or hip pain after crouching or squatting is common in those with tight lower back, hip and knee muscles. Most of us who sit all day long have tight muscles in the lower back and lower limbs.  So when we perform crouching or squatting movements whether done in a prolonged fashion or repetitively, you may feel weakness, discomfort or pain in the hips, groins, front of the thighs as well as along the inner aspect of the thighs and perhaps even knee pain.  This should tell you that the muscles in these areas were abused by the crouching or squatting positions.   

The muscle responsible for discomfort or pain at the front of the thighs or pain in the front of the knees is the rectus femoris muscle and the muscle at the inner aspect of the thigh and knee that has been stressed is the adductor magnus muscle. 

If pain is in the outer aspect of the knees, the pain is likely to be from stress to the tensor fascia lata muscle and if pain is at the back of the knees, the pain is from the hamstrings muscles. 

Although the other quadriceps muscles are important for producing anterior thigh and knee pain, they are not the main muscles to be injured since the other quadriceps cross only one joint namely the knee joint whereas rectus femoris (which is also a quadriceps muscle), tensor fascia lata and hamstrings cross both the hip and knee joints and are thus more likely to be abused with crouching or squatting. 

Initially, anterior thigh and knee pain is more common than posterior thigh pain. Because of our sedentary positions involving sitting for prolonged periods, the muscles in the front of the hip such as rectus femoris, tensor fascia lata and psoas major may be chronically shortened while the muscles in the back of the hip, the gluteus maximus (buttock muscle), hamstrings and adductor magnus are chronically over- stretched and weakened. 

At the knee joint, sitting places the knees in a bent position, therefore the rectus femoris and the tensor fascia lata whose functions are to extend the knee are over stretched and weakened whereas the hamstring muscles whose function is to bend the knee become short and tight due to the imbalance of muscle power as in the see-saw  principle. 

Upon crouching or squatting, the sitting position is exaggerated with excessive hip and knee bending.  Therefore, the rectus femoris and tensor fascia lata muscles become shorter and tighter at the hip and more long and stretched out at the knee.  Excessive shortening contraction in bending (flexion) at the hip and excessive lengthening contraction in straightening (extension) at the knee injure both rectus femoris and tensor fascia lata muscles. 

To maintain the person in a crouched position or squatting position, muscles at the back of the hip have to undergo an excessive lengthening contraction in addition to an excessive shortening contraction at the knee. Since muscles at the back of the hip that have to undergo a lengthening contraction such as the gluteus maximus and adductor magnus are huge and very strong, the hamstring muscles which also does the same action at the hip can now have more concentrated power for bending the knee.  The stronger the pull of the hamstring muscles to actively bend the knee, the more power the rectus femoris and tensor fascia lata muscles have to exert to counteract this force. 

Therefore, when you try to stand erect after crouching or squatting, the first weakness, discomfort or pain will be felt in the front of the thigh and front of the knee giving rise to thigh pain and knee pain.

© 2007 copyright www.stopmusclepain.com Knee pain|thigh pain

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Sunday, December 17, 2006

Tension headaches

Tension headaches due to muscle tightness will be the only type of headache that will be in our discussion here. You must consult your physician to find out the cause of headaches before attributing it to just increased muscle tension.  Headaches may be a sign of many ominous problems.   

Muscle tension headaches can aggravate vascular headaches such as migraines.  Relieving the muscle tension type of headache can help to reduce the intensity, duration, interval between the vascular headaches. 

There are a lot of muscles which attach to the skull that when shortened and in spasm can put a traction effect on the skull bone giving rise to headaches. Pain in the back of the neck from muscle spasms can go up the back and top of the head as well as the sides of the head.  It may be severe enough to cause nausea and vomiting. 

The muscles most responsible for tension headaches are the trapezius, levator scapulae, splenius cervices, sternocleidomastoid and the small and short muscles that arise from the neck to attach to the head.  These muscles are commonly injured with whiplash, falls or lifting injuries. Usually, the force of the same injury that injures the nerves going to these muscles that initiate or aggravate the headaches will also simultaneously injure other spinal nerve roots in the neck, mid-back and low back.  Therefore treating just the neck muscles and other muscles mentioned above will not address the headache problem well. 

The trapezius muscles and other muscles mentioned above are not meant for lifting activities.   The strong muscles necessary for efficient lifting are the latissimus dorsi, deltoid, triceps, middle back, lower back, pelvic girdle and thigh muscles.  If these muscles are weak, tight, or inefficient, you will continue using a shoulder shrug to lift.  This will continue to injure all the muscles responsible for tension headaches.  Therefore, treatment of tension headaches can never be isolated to treating just the muscles in the local area of the head and neck. 

The treatments for muscle tension headaches must address also the muscles along the entire spine and all the large and powerful muscles of the upper and lower limbs.  

© 2007 copyright www.stopmusclepain.com Tension headaches

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Saturday, December 16, 2006

Chronic pain resulting from nerve irritation effects even the health of the skin.

Skin texture: Normally, the skin is supple and soft and can be lifted up from the underlying muscle.  You can even separate the skin from the tissue underlying it called the subcutaneous tissue.  In the area where the nerve is injured or irritated, the skin becomes thickened and smooth.  The skin may have a sheen to it and there is a tightness to the skin.   The skin overlying the area of nerve related muscle problems may become adhesed to the underlying subcutaneous tissue and muscle.  You will not be able to pick up the skin from the underlying tissue. 

Hair: There is less hair growth in the territory of the injured or irritated nerve. The area may also become devoid of hair.  The hair will also become brittle and break off easily and will be shorter than the normal areas.   

Vasomotor response: Impairment of regulation of the action of the nerves supplying the small blood vessels lead to skin color changes depending on the duration and degree of the nerve damage.  When the nerve problem is still acute, the skin is hyper-reactive and turns red very easily on manipulation.  The redness is suffuse and homogenous.  However when the nerve problem becomes chronic, there will be barely any color changes even when the skin is manually stimulated or squeezed.  The skin may also appear blotchy and mottled and may appear white, pale and toneless.  When the limb is kept in a dependent position, the skin may turn dusky red to red-blue color.  With chronic nerve problems, when the skin and muscle is electrically stimulated, there are no color changes or at best there is only a light pink color.  If there is some return of color, the color remains blotchy and is not homogenous. 

Pilomotor response: When there is significant tenderness in the muscles, pressure on the muscles will produce goose pimples.  These goose pimples tend to stay only on the side tested.  The size of the goose pimples is proportional to the degree of tenderness present in the muscles.  The more tenderness present in the muscles, the larger the size of the goose pimples elicited. 

Sudomotor response: Pressure on a tender area of the muscle will produce so much pain that the person will break out in a sweat.  This type of sweat is hot and sticky as opposed to being watery. 

Skin pores: Usually the skin pores are not visible.  The skin has to be squeezed to barely see these pores.  If on squeezing the skin you see enlarged pores, this is an indication of presence of nerve problems in the muscle underlying the skin.  If you can see the pores without squeezing or touching the skin the nerve related muscle problem is more significant and is also very chronic.  These enlarged skin pores indicate the presence of neurogenic edema. 

Neurogenic edema: When pressure is applied to the skin where there is a nerve problem, the skin will tend to maintain the pressure mark especially if the nerve problem is chronic.  This usually means that the lymphatic and venous drainage in the underlying muscles as well as the overlying skin is poor.  This is a sign of neurogenic trophic edema related to presence of chronic muscle spasms.  In acute nerve problems, the skin nerves are so hyper-reactive that on pressing the skin, there may be formation of wheals which is a sudden elevation in the skin similar to being bitten by a mosquito.

© 2007 copyright www.stopmusclepain.com chronic pain

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 Friday, December 15, 2006

Sports injuries|chronic pain

Sports injuries that result in chronic pain is due to injuries to the neuromuscular system from excessive and repetitive use of muscles during training and performing in the game.  Muscles which are exposed to excessive lengthening contractions and muscles which cross multiple joints are those which are prone to sports injuries.

If you have healthy muscles and nerves as a baseline, these tissues can heal very easily even when subjected to repeated trauma.  Genetic factors play the most major role in ability to withstand trauma and ability for tissues to heal, differentiating the common person from the elite athlete.  Even the elite athlete can withstand only so much cumulative trauma and once their reserves disappear and also as they age, the tissues have more difficulty in healing and they also suffer from chronic nerve related muscle and joint pain.  

The ordinary person however may just have one episode of sports injury such as a fall or lifting injury and they may progress into chronic pain.  If they have been injured before they are prime candidates for nerve related muscle pain that can become long-standing. Sports and other trauma related chronic muscle pain can begin even in childhood.  Indeed many children as young as 7-8 years old may suffer from sports initiated chronic disabling muscle pain.

Chronic pain is known as pain that will not go away.  The person who develops chronic pain may have pre-existent nerve related muscle discomfort or pain.  Since this type of person has little to no reserves in the nerve and muscle tissues to heal promptly, additional trauma leads to permanent nerve injury with resultant chronic pain. 

Many people will willingly admit that they have been tight in their muscles and joints for as long as they can remember and some will state that they have been tight since childhood.  When there is no pain, people usually do not seek medical help for discomfort related to tight muscles or joints.  They continue to perform competitive training for sports in addition to performing usual work, recreational, social or home related activities.  They live with some degree of discomfort or minor pain related to the muscle tightness but seldom seek help for muscle discomfort until it becomes significant pain. 

All movements associated with daily activities tend to injure nerves close to the spine known as spinal nerve roots and also the nerves within the tight muscles.  However, low grade injuries related to cumulative slow and insiduous trauma or aging are better tolerated and can heal better.  However, when many nerves are injured simultaneously at multiple levels on both sides of the spine as that occurs with sudden blunt trauma as with a whiplash injury healing to obtain a complete cure of the pain or discomfort is difficult.

 Due to the force of the sudden trauma, the spinal nerves are acutely and violently stretched, kinked or bruised against the spinal joints, bones or intervertebral discs.  The injured and irritated nerves then signal the muscles to go into spasm.  The resultant significant muscle spasms will have a vice-like effect on the nerves and blood vessels within them causing more nerves to be injured.  This self perpetuating cycle of spinal nerve root injury as well as the intramuscular nerves causing muscle spasms which in turn cause more nerve injury maintains the patient in the state of continued chronic pain. 

© 2007 copyright www.stopmusclepain.com Sports injuries|chronic pain

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Thursday, December 14, 2006

Many patients with chronic fatigue syndrome do not provide pain symptoms as a primary complaint but when asked, there are symptoms of nerve involvement such as muscle pain and tenderness, tightness, tingling and numbness in addition to fatigue and weakness. 

You must think over your past as to whether you have had a past history of sudden or insidious trauma that you may have forgotten about.   Nerve related muscle problems may be the cause of your fatigue if you answer yes to most of these following questions:

• Did your fatigue symptoms start after an auto accident, sports trauma, falls or a work related injury?
• Do you perform repetitive motion activities?
• Were the fatigue symptoms preceded by pain? 
• Even if you do not have pain, do you have discomfort while performing daily activities? 
• Is there a feeling of burning, throbbing, aching? 
• Do you have tingling and numbness in your limbs? 
• Is there a feeling of worms crawling under your skin ? 
• Do you have cold intolerance? 
• Does your skin appear blotchy and mottled? 
• Do you see or feel twitches in your muscles? 
• Do you get cramps easily?
• Do your muscles feel sore, swollen, tight and tender?
• Do your joints feel stiff?
• Can you feel bands, nodules or cords within your muscles?
• Has the hair in your arms or legs fallen off?
• Do you have irritable bowel and bladder syndrome?

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December 13, 2006

Chronic pain|lower back

Chronic pain patients often start initially with lower back pain or discomfort.  Many others will also have similar symptoms in the mid back, upper back and neck.  Have you figured out why pain and discomfort does not start with the muscles in the front of the body and why there is a predilection for pain to occur in muscles at the back of the body? 

The muscles in the front of the body are stronger because they are strengthened every day.  Because most of our daily work, chores, recreational and self-care activities are performed by muscles in the front of the body, these muscles are strengthened every day. Shortening contractions will make the muscles stronger.   

For example, when we lift a barbell and bring it toward the chest, the muscles in the front of the shoulder, arm, forearm and hand contract and they shorten.  The muscles in the back of these joints including the entire spine undergo a lengthening contraction in order to stabilize these joints so that the movement of the barbell toward the chest is smooth and continuous. Lengthening contractions however are injurious to the muscles.  Significant forces have to be generated by the muscles of the entire spine as well as muscles at the back of the shoulder, arm, forearm and hand to prevent the weight lifted from suddenly hitting the chest. Therefore these muscles that have to undergo lengthening contraction are subjected to injury which increases in proportion to the amount of weight lifted.   The most vulnerable time for these muscles that are performing lengthening contractions to get injured and to undergo spasm is when they are made to perform a shortening contraction in an abrupt manner.

Opening a heavy door or performing a throwing movement are typical examples of how the triceps and the latissimus dorsi muscles can get injured.  In these motions, the triceps and latissimus dorsi muscles are made to perform lengthening contractions first and the shortening contraction occurs immediately and abruptly without a transition for the muscle to prepare itself for the shortening contraction. Many of the other muscles including those in the spine, shoulder and pelvic and hip muscles can be similarly injured.

On a daily basis,the muscles that perform lengthening contractions become weakened since they do not also have a chance to perform shortening contractions that strengthen them as we rarely do any significant activities of daily living using muscles behind our back. 

The weaker these back muscles become, the more prone they are to injury leading to pain and discomfort. Therefore strengthening programs should begin with strengthening the muscles of the back before you try to strengthen the muscles in the front.  However, if there is pain and or tightness in the muscles that are subjected to lengthening contractions, relieving muscle pain and tightness are the first priorities before starting strengthening exercises. 

Strengthening exercises in the presence of pain and tightness of muscles will cause more reduced blood flow to these muscles aggravating the underlying pain.  In patients with chronic pain, all strengthening exercises should be done without joint movement and these exercises are known as setting exercises or isometric contractions.  The exercises should be perform at a pace that the patient is able to tolerate rather than by set time or number of repetitions. Progressive resistive exercises must be avoided for patients with chronic pain.

The upper body muscles that should be strengthened with isometric exercises include the latissimus dorsi, deltoid, triceps and trapezius.  For the lower body, strengthen the gluteus maximus, gluteus medius, tensor fascia lata, adductor magnus and quadriceps muscles.  Although the quadriceps muscle is in the front of the thigh, it is a group of muscles that are always subjected to lengthening contractions during walking or descending steps.

© 2007 copyright www.stopmusclepain.com Chronic pain|lower back

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Monday, December 11, 2006

Weight lifting|chronic pain

Weight lifting movements that can initiate chronic pain are the ones that are most injurious to the muscles that must perform lengthening contractions to stabilize the joint while the weight is lifted.

These weight lifting movements include overhead lifting and lifting while reaching out. These reaching motions are very injurious to the muscles close to the spine and at the back of the body since these muscles have to work harder to generate the force needed to lift whatever weight you carry in your hands.

The muscles at the back of the body especially those muscles close to the spine have to generate forces strong enough to stabilize the spine while the weightlifting is performed by the shortening contraction of the powerful muscles in the front of the body.  The heavier the weight that needs to be lifted, the more stressed are the muscles at the back of the body because they have to generate stronger forces to balance the forces generated by the muscles at the front of the body and thus stablize the joints.

Also, the further away the weight to be lifted is from the trunk, the forces that these muscles at the back of the body have to generate is equivalent to the weight of the object multiplied by the length of your arm. Therefore even if you think you are lifting only two pounds, the forces that the muscles close to the spine have to generate is two pounds multiplied by the length of the upper limb.

To avoid injuries, avoid overhead weight lifting as much as possible and lift as little weight at a time as possible. If you have to carry something in front of you, bring the weight as close as possible to your body.

Lift using both upper limbs with the elbows bent while keeping them close to the side of your trunk. Remember to keep the knees bent and the trunk straight while lifting.While carrying, keep the weight close to your chest and the elbows close to your trunk.

People who are in pain or discomfort already can exacerbate the symptoms with improper lifting techniques. Parents are commonly injured while lifting babies or young children overhead for play.  Lifting children in and out of car seats is difficult to avoid. As soon as the child can walk, you must stop lifting and be as creative as you can be so that the lifting episodes can be avoided to prevent you from getting injured.

For example, getting a child into the car seat can be broken down into many steps. If you place a step stool first on the ground and you can facilitate the child to get into the car without having to lift. You can then place the step stool on the floor of the car, then the child can step onto it while you support his back and buttocks and he can be made to crawl into the car seat. Similarly, you can reverse the steps to allow the child to crawl out of the car seat.You must always keep your spine as straight as possible,your hips and knees slightly bent and your elbows kept at the side of your trunk to have proper mechanics while weightlifting or in picking up any  thing at ground level.

All  weights and heavy objects should be positioned at waist level and be brought as close as possible to the body before lifting.

© 2007 copyright www.stopmusclepain.com weight lifting|chronic pain

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