Lower Body TopicsAnatomical and physiological approach for understanding lower back, hip, knee, tarsal tunnel syndrome, chronic fatigue,myofasical and fibromyalgia pain.
|
||||||||||||||||||||
 |
Knee Pain| Arthritis| Nerve Related Muscle Pain
Friday, January 05, 2007
On having knee pain, people will commonly say “My knee hurts. It must be old age, I guess”.
Arthritis does set in from the wear and tear from aging but you don’t even have to be old to have knee pain. With normal aging or accelerated aging due to trauma, the cartilage that is inside the knee joint wears out. When there is associated nerve related tightness and shortening of the muscles that surround the knee joint, the thigh bone and the leg bones that make up the knee joint have more chances to grate against each other, exacerbating the knee pain.
The strong muscles that pass across the knee and affect knee function mainly come from above the hip. Therefore in treating knee pain, local treatments focused to the knee may not be enough especially if the pain and discomfort does not improve with local treatments. Thus, conservative treatments should be performed first before using invasive procedures such as surgery since the knee pain may be stemming from nerve related muscle conditions.
The main muscles responsible for knee pain are as follow: Gluteus maximus (S1) and tensor fascia lata muscles (L5) through the iliotibial band. When these muscles are in pain, there will be pain on straightening the knee.
When the hamstrings (L5 and S1) muscles are very tight and short due to pain and spasm, there will be knee pain with straightening of the knee from contraction of the quadriceps muscles.
Pain and spasm of the quadriceps (L3, L4) muscles will produce knee pain on straightening the knee. In patients with knee pain, it is thus important to examine and treat as appropriate muscles supplied the L3 through S1 spinal nerve roots in the limbs as well as in the lower back.
When treating the back muscles, it is essential to treat on the spinal muscles from the neck down to the base of the spine as well as the latissimus dorsi (C6, C7).
© 2007 copyright www.stopmusclepain.com
Go to new postings at StopMusclePain.com News Desk
Lower Back Pain| Arthritis| Tarsal Tunnel Syndrome
Saturday, January 06, 2007
Lower back pain commonly causes foot, heel and ankle pain from spinal nerve root irritation of the L5 and S1 nerve roots. However, the lower back pain may be minimal or absent at the time the foot, heel and ankle is most bothersome.
Therefore, if you have pain and discomfort with tingling/numbness also in the heel, the problem is not related to tarsal tunnel syndrome. Commonly, the diagnosis then will shift over to that of arthritis, heel spur or plantar fasciitis.
When the tibial nerve is irritated, there is pain and discomfort in the foot and ankle with numbness in the toes. There is also numbness in the sole of the foot but does not include the heel. Before invasive procedures such as surgeries are performed to the foot, heel and ankle region, a thorough neuromuscular examination needs to be performed.
Tarsal tunnel syndrome is a condition in which there is pressure and compression on the tibial nerve at the ankle giving rise to foot and ankle pain. There is a tunnel on the inner aspect of the ankle through which the tibial nerve passes, known as the tarsal tunnel. The tunnel runs between the lower end of the shin bone (tibia) on the inner aspect of the ankle and the heel bone. The tunnel is covered by a ligament known as the tarsal ligament which can press down on the tibial nerve. This is a condition similar to the carpal tunnel syndrome in the hand in which the median nerve is irritated or injured because of pressure by the wrist ligament.
Pain and discomfort related to L5 nerve root will be more distributed to the top of the foot and toes (toward the big toes side) whereas S1 nerve root irritation will be felt in the sole of the foot, side of the foot toward the little toe and heel. With S1 nerve root irritation leading to tightness and shortening of the buttock muscle (gluteus maximus) there can be further pressure on the sciatic nerve leading to symptoms of pain and discomfort in the foot.
To relieve pain and discomfort in the foot, motor point stimulation using eToims Twitch Relief method can be very easily applied to the spine muscles, and muscles such as the buttock muscles (gluteus maximus), muscles at the side of the hip muscle (gluteus medius and tensor fascia lata), muscles in the inner thigh (especially adductor magnus), muscles in the back of the thigh (hamstrings), muscles in the front of the thigh (quadriceps, especially rectus femoris), calf muscles (gastrosoleus) and muscles in the front and sides of the leg. The foot muscles usually will not need treatment but can be done.
If the muscles twitch well, pain relief can be immediate and substantial. However in chronic situations with chronic nerve root irritation, the muscles will not twitch well and without strong force twtiches, the results take loner to achieve. The more long standing your probelms are and the number of complications you have had such as fractures and surgeries, the less will be your results. If you do get results from eToims, this type of patient will need repeated and ongoing treatments to maintain the gains made in pain relief and improvement in quality of life.
© 2007 copyright www.stopmusclepain.com
Go to new postings at StopMusclePain.com News Desk
Chronic Pain| Fatigue
Thursday, December 14, 2006
Chronic pain|fatigue
Chronic pain fatigues the muscles easily. However, if only the motor spinal nerve root is involved, there may be no associated pain and the patient’s primary complaint is that of fatigue. In such a situation, it is important that you be examined by a physician for evidence of disorders of the central and peripheral nervous system, autoimmune diseases, rheumatological diseases, blood diseases, hormonal disorders, infections, cardiovascular diseases etc. When these diseases have been ruled out and the symptoms still persist, presence of myofascial problems (nerve related muscle problems) need to be considered even if you have no symptoms of pain.
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?
Once you have a diagnosis of myofascial pain syndrome related fatigue, you can help your muscles by performing self massages as described in my earlier blogs. Although getting other people to massage you is an option, to get consistent massage effects of improving circulation, relaxing muscle spasm, and muscle stretch effects, you must do the massages yourself.
Self- massage allows you to receive the massages as many times as possible on a daily basis. Electrical stimulation of motor points to obtain strong force twitches is the scientific form of massage and is the treatment of choice for nerve related muscle problems.
© 2007 copyright www.stopmusclepain.com
Go to new postings at StopMusclePain.com News Desk
Myofascial Pain| Trigger Points| Eccentric Exercise
Friday, October 26, 2007
Myofascial pain with formation of trigger points occurs when muscles are subjected to lengthening contractions especially if the motion is repetitive. There is evidence that eccentric exercise (lengthening contraction) provides a useful model for the understanding myofascial trigger points.
Lengthening contractions are usually performed by the spinal extensor muscles, trapezius, rhomboid major and minor, latissimus dorsi, posterior deltoid, triceps, wrist extensor muscles in the upper limb. The lower limb muscles that routinely perform lengthening contractions are gluteus maximus, adductor magnus, quadriceps especially rectus femoris and the ankle dorsi flexors. These are the muscles which are commonly injured on a daily basis through work activities, sports and activities of daily living.
Studies in rats show that reduced mechanical withdrawal threshold occurs the next day after the exercise in both young and old animals. However the recovery is faster in young animals compared to old animals. The recovery in the older rats was at least two days longer than the young rats which recovered within three days. The sensitivity is due to changes in neurons of the dorsal horn of the spinal cord.
After an eccentric contraction, the sensitivity to pain on palpation of the muscles as well as to electrical stimulation is increased. In addition it is also easier to produce the referred pain induced from pressure on trigger points after eccentric contraction. This is due to sympathetic nervous system facilitation of local and referred pain as well as the sensitivity to pain.
In treating myofascial trigger points, The eToims® Technique addresses all these issues. eToims’ principal focus is on finding, locating and stimulating the trigger points in muscles subjected to eccentric contractions. By eToims stimulation of the trigger points, the twitches produce a local exercise effect to the muscle fibers surrounding the trigger points as well as deep stretching effects and improvement of circulation. These combined effects help to heal the trigger points instantaneously.
Muscles subjected to eccentric contractions are retrained with eToims to perform shortening contractions known as concentric contractions. In this manner, there is a return of balance in pull between previously weakened eccentric muscles and the stronger muscles on the opposite aspect of the joint which are routinely subjected to concentric contractions. This immediate resetting of the imbalance in pull of the muscles together with the instantaneous healing of the trigger points lead to pain reduction. Pain relief leads to less sympathetic activity and this can be noted as a reduction in heart rate immediately after an eToims session.
The advantage of eToims over ordinary exercise is that eToims can exercise one muscle at a time when the trigger point is located and stimulated. Routine exercise involves moving many muscles and joints simultaneously and patients with pain are unable to do exercise because the exercise not only cause more pain but also create more active trigger points. Many patients with chronic pain suffer from more pain after exercise or more than usual activity.
© 2007 copyright all rights reserved www.stopmusclepain.com
Go to new postings at StopMusclePain.com News Desk
Myofascial Pain| Fibromyalgia| Fatigue |Gluteus Maximus
Sunday, February 04, 2007
The most powerful muscle in the body is the gluteus maximus. We have previously discussed its origin, insertion, nerve supply and its actions. We should now discuss the concept and importance of this muscle in creating chronic myofacial pain especially how it can develop into producing total body pain (fibromyalgia) and chonic fatigue with or without pain.
Low back pain due to L5 and S1 nerve root irritation is very common and starts young. So by the time the patient presents with lower back pain in middle or old-age, even though the pain may be acute due to sudden trauma or insidious trauma, the pain symptoms may progress to develop into a chronic pain stage, many times involving the whole body as in fibromyalgia with accompanying fatigue. This is because the L5 and S1 nerve roots may have had chronic changes for several decades prior to the onset of acute symptoms.
Gluteus maximus comes into play in shortening contractions such as the act of standing up, squatting down, bicycling or swimming as the hip and thigh moves backwards (hip extension), etc. Although these movements strengthen the gluteus maximus, the fact that there are reciprocal movements of hip extension into hip flexion that calls for its lengthening contraction, makes it prone to injury.
Its actions are most important during lengthening contractions to stabilize the hip in flexion such as walking, sitting, lunging forward, maintenance in the squat position, hip flexed position during bicycling etc. predisposes it to injuries.
These frequent lengthening contractions in the presence of L5 and/or S1 nerve root irritation (gluteus maximus has very strong S1 nerve root supply) causes weakness in this most powerful muscle in the body.
Pain and spasm in the gluteus maximus will add more weakness to the underlying nerve related weakness in this muscle due to spinal nerve root irritation. Incoordinated contraction of the gluteus maximus due to pain and spasm can lead to buckling of the hip and knee causing the person to fall causing more injuries to other segments of the spine.
Shortening contractions of the gluteus maximus with very little reciprocal movements into hip flexion can be encouraged by walking backwards. This is an exercise activity that is extremely useful for strengthening the gluteus maximus since it does not call for reciprocal hip flexion.
The most optimal method to have shortening contractions of the gluteus maximus without reciprocal hip flexion movements is the eToims Twitch Relief Method. The twitch contractions produce internal stretch exercise and encourage local blood flow allowing nerves to heal.
The importance of treating gluteus maximus properly relates to the myofascial connection to the midback and neck through the thoracolumbar fascia and to the other lower limb muscles such as the tensor fascia lata through the iliotibial tract.
Muscles supplied by the cervical nerve roots such as the latissimus dorsi and the trapezius muscles are connected to the gluteus maximus through the thoracolumbar fascia.
Concurrently or eventually, patients with lower back problems especially at the L5 and S1 levels will develop neck, midback and lower back pain due to tightness of the thoracolumba fascia.
Often there will be pain down the upper limbs from cervical nerve root irritation and lower limbs from lumbosacral nerve root irritation. This picture of total body pain results in fibromyalgia and fatigue from presence of multiple focal muscle spasms in many muscles supplied by many cervical and lumbosacral nerve roots.
© 2007 copyright all rights reserved www.stopmusclepain.com
Go to new postings at StopMusclePain.com News Desk
 |
Lower Body Pain* Treatment for Nerve Related Muscle Pain * Pain Management: StopMusclePaing.com offers information about back pain treatment in Philadelphia, Manhattan and Washington DC
Go to new postings at StopMusclePain.com News Desk
 |
||
 |
eToims® News |
|
|
||
