Stop Muscle Pain

Lower back pain|Work Days

2007-11-13T08:34:00.000-08:00

The major cost associated with chronic low back pain is the patient's inability to work that may culminate in chronic permanent disability.

Therefore, reducing sick days is essential. Research must therefore show whether patients exposed to functional rehabilitation does better in keeping patients at work compared to those patients who receive pain centered rehabilitation.

Functional rehabilitation emphasizes activity despite pain by work simulation, strength, endurance and cardiovascular training. Work hardening and slowly progressive activity programs encourage patients to continue the activities even if pain increases.

Pain centered rehabilitation emphasizes pain reduction using passive and active mobilization, stretching, strengthening and back school with education and exercise. Such programs may use exercises of moderate intensity together with supportive treatment such as hot packs, electrical stimulation therapy or massage. Activities and exercises that increase pain are avoided.

A recent study with long term follow-up of one year showed that patients with chronic lower back pain who were exposed to functional rehabilitation did better by having more work days than patients who underwent pain centered training.

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Neck pain| Low back pain|Massage

2007-11-13T08:33:00.002-08:00

There are many people with neck and or lower back pain. Many patients may not have any pain but they have stiffness that develops gradually with gradual loss of range of motion.

Since arthritis commonly irritates the nerves supplying the muscles of the spine, shoulder and pelvic girdle, these muscles become stiff and tight. Patients with neck stiffness will find it difficult to look up or look sideways. This will create problems when driving a car, in changing lanes or to back the car. When there is associated weakness or pain in the neck muscles, the patient will have difficulty looking up and will find it more comfortable to have the head hang down.

Lower back stiffness and or pain creates difficulty with walking on level surfaces, up and down inclines or steps and there is significant loss of balance. This predisposes the patients to fall especially when their legs buckle while walking or even standing. Many patients have sustained fractures due to these sudden falls.

Thus, neck and lower back pain and or stiffness will limit the patient's ability to perform the routine activities of daily living.Patients will feel less frustrated when they can do something for themselves that is within their control.

Massage is a very useful adjunct for helping patients with neck and lower back pain. Although it is easier for someone else to massage you, patients must learn how to massage themselves. This is the most practical and realistic way for patients who have chronic pain who will need effects of massage on a long-term basis.

The effects of massage last longer when it can be done multiple times every day. Since massage means manipulation of the tissues causing them to be moved, you should be massaging your self daily since it is a passive exercise. When your muscles become less tight, you will become more mobile allowing you to be able to do things through active exercise movements.

To mssasge, you can pound, pat, tap, squeeze or rub the muscles with your fist. For the back muscles, you can use your knuckles or massage knobs or a J-cane. You can lean against a one pound bar bell placed between you and a high backed chair. You can use the corner of walls or doors to lean against to stretch your back muscles.

The important muscles to massage for the upper spine problems is to massage the neck, between the shoulder blades and the upper limb muscles. For the arm and forearm muscles, you can twist the muscles across the bone shaft as if you are wringing a piece of cloth. Also try to massage your hands especially in the first webspace.

For lower spine problems, it is important to massage the muscles of the middle back, lower back, buttocks, hips, thighs and calves. In the thighs, it is essential to massage them circumferentially. Many people also like to massage their feet and find it to be very relaxing.

If you find an area in the muscle that is too painful, do not do deep massage in those areas since you will aggravate your pain. You must find pleasurable and relaxing points for these are the trigger points that when massaged can help the muscle to come out of spasm.

In my treatments of patients with chronic pain using Electrical Twitch Obtaining Intramuscular Stimulation (eToims), such trigger points are systematically sought serially in each muscle treated and many muscles are treated in one session. This is to stimulate the trigger points to create twitch contractions.

The twitch contraction is the ultimate scientific massage since it can stretch the muscle from within the depths of the muscle. Thus, the twitch contraction relieves the muscle from spasm ending pain. The twitches which are muscle contractions, have an exercise effect that allows blood flow to the tight and stiff muscle tissues helping to heal muscles and nerves.

The effects of the eToims treatments can be helped by using massage on a daily basis regularly. Manual massage is certainly a powerful tool to help relax muscles since it can weakly create twitches within the muscle especially if you spend time to find those relaxing trigger points.

© 2007 copyright all rights reserved www.stopmusclepain.com Neck pain| Low back pain| Massage

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Low back pain | Driving

2007-11-13T08:33:00.001-08:00

Driving a car is a risk factor for low back pain. Our society is dependent on automobiles for both work and leisure. This leads to a corresponding increase in time spent seated in the car with a greater risk of low back pain and absence from work.

Occupational driving especially those whose driving time is >4 h/day has often been associated with a high prevalence of back pain. The factors that contribute to cause the pain are diverse and might include:

- prolonged sitting

- poor driving postures

- exposure to whole-body vibration

- frequent bending/twisting activities while driving

- self-perceived job stress

- job dissatisfaction

- cumulative effects of the duration of daily professional driving

- other non-driving factors such as heavy lifting, poor diet or other psychosocial factors.

It has been found that the chances for lower back pain increases with the number of miles driven and number of working hours.

The prevalence of low-back pain was noted to be higher in those not using lumbar support. As for backrest inclination, those who choose 105 degrees as opposed to those who chose 120 degrees tend to have a greater incidence of low back pain.

Studies have shown the beneficial effects of lumbar massage systems in increasing muscle blood flow and oxygenation in thoracic and lumbar erector spinae musculature during a 1 h simulated driving task. Using massage systems while driving can thus be beneficial.

The shortening of working hours and taking of rest breaks while working should be considered to reduce the incidence of low back pain in those who must drive long hours professionally.

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Low Back pain| Shoe effects

2007-11-13T08:31:00.000-08:00

Wearing high heels can increase pressure in the knee joint by at least 26% causing knee pain. The entire spine can be thrown out of alignment causing neck pain and lower back pain.

The pressure on the forefoot increases as the height of the heels increases. You are walking on your toes when wearing high heels and if done chronically, the calf muscles tighten and shorten. This will increase the chance of developing lower back pain or aggravate the underlying low back pain.

Also, pain and numbness can occur in the toes due to pressure on the digital nerves. Occasionally, the digital nerve between the third and fourth toes can develop a neuroma called Morton's neuroma.

Deformities of the joints of the toes can also occur because of tight and ill fitting shoes. This can result in the formation of bunions and hammertoes which will produce pain in the toes and foot by constant irritation.

Foot pain and resultant limping will put a stress on the spine further perpetuating the irritation of the spinal nerve roots.

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Low back pain| Posture

2007-11-12T09:33:00.000-08:00

The spine posture plays a significant role in creating lower back pain or maintaining lower back pain. Normally, prior to a voluntary arm movement, there is usually a small spinal movement (preparatory movement) that occurs opposite to the direction of the arm movements.

In patients with lower back pain there is a tendency to reduce spinal motion and this is associated with decreased preparatory motion to arm movements. Thus when the arm actually moves, there is increased displacement of the trunk leading to compromised quality of trunk control and subsequent increase in low back pain. Modification of spinal mechanical load can be beneficial for preventing acute exacerbation of lower back pain.

Also, low back pain subjects exhibit compensatory movements and altered load sharing strategies during the sit-to-stand and stand-to-sit activities. Exercise therapy must be directed to these changes so that the normal movement characteristics of the spine and hips can be restored.

Surface EMG studies indicates significantly preferential activation of anterior core muscles during prone (facedown) bridging exercises and posterior core muscles during supine (face up, lying on back) bridging. Normal subjects were able to hold the bridge exercise for longer durations in both the supine and prone positions than in patients with back pain.

Bridging exercise is easy to learn and can be reliably reproduced by the patients. Prone bridging preferentially challenges core flexors, whereas supine bridging recruits primarily the core extensors. In patients with lower back pain, since the core muscles are weak, teaching them bridging exercises can help in lumbar spine-stabilization and increase the endurance capability.

© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| Posture

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Neck pain| low back pain| posture

2007-11-12T09:31:00.000-08:00

Those suffering from chronic neck pain and low back pain will have a poor posture and poor posture will aggravate neck and lower back pain.

Beginning at about age 40, there is loss of height by about half an inch each decade, and this loss of height becomes rapid after age 70. About two inches of height loss can occur between ages 30 and 80 in males, and about three inches in females.

A hunched back can occur because of vertebral fractures due to osteoporosis (bone-loss). However most of the hunched backs or kyphosis is related to poor posture.

Most of the activities of daily living are performed in the front of the body leading to strengthening of the muscles in the front from constant and frequent shortening contractions. This together with a poor posture of keeping the shoulders rounded or hunched with a head forward position during work and activities of daily living, places a tremendous stress on the muscles which extend the spine.

The spinal extensors must perform lengthening contractions to stabilize the spine in a certain posture and this type of contraction is very injurious to the extensor muscles. As aging progresses, the concomitant presence of multiple spinal nerve root irritation that causes neck and lower back pain also gets worse.

The nerve root irritation may not be associated with pain symptoms if the sensory dorsal spinal nerve roots are not irritated. However, due to ongoing irritation of motor ventral nerve roots that supply the muscles, the muscles of the spine and the limbs become weak and tight.

The spinal nerve roots that get commonly irritated with aging includes the C6 and C7 nerve roots in the cervical spine and the L5 and S1 nerve roots in the lower spine. The most important muscles that help extend the spine are the latissimus dorsi (supplied by the C6 and C7 nerve roots) and gluteus maximus supplied by the L5 and S1 nerve roots.

The head forward position also stresses and weakens the trapezius muscles which aid as a spinal extensor muscle. As the spinal extensors become weaker, the tendency to prevent a poor posture gets more diminished.

All of us must be aware and be conscious of our postures. We must correct bad postures by keeping the head erect over the shoulders so that a straight line from the bottom of the ears fall straight down to the angle between the neck and the shoulder slope. The shoulders must be held back as if to the brace the shoulders. Clasping the hands behind the back and lifting them off the back is a great way to actively exercise the latissimus dorsi muscles through out the day.

Lying on your stomach and then lifting your head and shoulders and keeping your arms stretched out in front will exercise the spinal extensors. Bridging will strengthen the gluteus maximus muscles and pelvic tilt exercises will strengthen the gluteus maximus, spine and abdominal muscles. Pelvic tilt exercises are very useful since they can be performed while lying down, sitting, standing or walking.

© 2007 copyright all rights reserved www.stopmusclepain.com Neck pain| Low back pain| Posture

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Myofascial Pain|trigger points

2007-11-12T09:30:00.000-08:00

Myofascial trigger point as defined by Travell and Simons includes “a hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle fascia which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena”.

The autonomic phenomenon on palpation of the trigger point consist of skin redness (vasomotor response), sweating (sudomotor response due to pain is characteristically hot and sticky sweat as opposed to thin sweat from nervousness or just being cold ) and goose pimpling (pilomotor response). Usually with pain due to trigger point palpation, the goose pimples do not cross the midline.

When the trigger point is pressed, there is an area of referred pain. This is the feature that differentiates myofascial pain syndrome from fibromyalgia. The tender spots in fibromyalgia do not produce referred pain.This pain is reproduced reliably on palpation of the trigger point in myofascial pain. The referred pain does not coincide with dermatologic or neuronal distributions, but follows a consistent pattern.

Trigger points may develop after an initial injury to muscle fibers. This injury may include a noticeable traumatic event or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. As the stress increases, the muscles become fatigued and more susceptible to activation of additional trigger points. When predisposing factors combine with a triggering stress event, activation of a trigger point occurs. This theory is known as the “injury pool theory”.

Gunn’s theory for myofascial pain is that of shortened muscle fibers due to injury to nerve roots leading to denervation of muscle fibers. The denervation is related to aging, blunt trauma insidiously or acutely from whiplash injuries, sports, work and repetitive injuries. The shortened muscle fibers produce pain from compression of intramuscular nerve terminals and small blood vessels. There is also a tugging effect of the tight muscles on its own tendon with a pulling or tugging effect on ligaments, bones and joints. The covering of the bones called periosteum or the annulus fibrosus of the intervertebral discs is painful since they are richly innervated with pain fibers.

Electromyography at the trigger point shows spontaneous electrical activity with presence of endplate potential, and the active loci probably are related closely to motor endplates. T

Treatments used traditionally include spray (freeze) and stretch, physical therapy, transcutaneous electrical stimulation, ultrasound, massage , ichemic compression therapy, trigger point injections with local anesthetics, corticosteroids, botulinum toxin, dry needling and/or acupuncture.

The most effective treatment for myofascial pain syndrome is Electrical Twitch Obtaining Intramuscular Stimulation (eToims). The trigger points have to be systematically searched for and electrically stimulated. The characteristic forceful twitch on trigger point stimulation is strong enough to effect movements of the joint over which the treated muscle crosses. When such twitch forces are elicited, it treats the root cause of the pain which is the shortened muscle. The skin resistance to electrical stimulation is lowest at the trigger point allowing effective stimulation of the intramuscular terminal nerves using the least current. However, the stimulus strength has to be supramaximal to ensure effective stimulation of the trigger point (s).

Pain relief results from the release of the tight muscle fibers on the entrapped intramuscular terminal nerve fibers and blood vessels. The exercise effect which retores circulation to the exercised areas as well as deep stretching effects produce a reduction of the tugging effect on tendons, ligaments, bones and joints.

Unlike medications given orally or through injections, eToims is not a pain suppressant but by treating the root cause of the pain, is curative. There is accompanied increases in range of motion and improvement of function with eToims leading to a better quality of life. There are no side effects from eToims and can be done repetitively over the life time of the patient for treating new trigger points that will continue to be formed due to the presence of ongoing nerve root irritation.

The trigger points that are treated with eToims are permanently gone. However, the ongoing pain is from formation of new trigger points that can occur even with activities of daily living. The regularity of eToims treatments allows the treatments to heal new trigger points as soon as they occur.

When trigger points are allowed to accumulate, it adds to the intensity of the underlying pain. When the muscle tightness is significant and when pain levels are high, the trigger points are difficult to find and stimulate and pain reduction is harder to achieve.

The best time for eToims to achieve maximum effects pain relief or improvement in range of motion and hence function is when the pain levels are low. Many patients who have no pain continue eToims treatments for relieving muscle tightness. Muscle tightness interferes with function and produces discomfort rather than pain. Release of muscle tightness even without pain is an indication for eToims.

© 2007 copyright all rights reserved www.stopmusclepain.com myofascial pain| trigger points

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Myofascial pain| Trigger points| Eccentric exercise

2007-11-12T09:29:00.000-08:00

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, eToims: The Twitch Method 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 myofascial pain| trigger points|eccentric exercise

Low back pain| Falls

2007-11-12T09:26:00.000-08:00

Patients with chronic low back pain have had experienced sudden buckling of the knees and have experienced near falls or actual falls. During heel strike moment of ambulation, lengthening contraction of the gluteus maximus aided by the hamstring muscles occur. If there is pain and or spasm or weakness in the gluteus maximus and hamstring muscles due to irritation of the S1 nerve root, these muscles cannot react fast enough as the center of gravity shifts forward. This allows the hip and knees to go into flexion causing the patient to fall as both the hip and knee buckle.

As the body weight is shifted forward and before the foot can be planted flat on the ground, lengthening contraction of the quadriceps muscle especially that of rectus femoris muscle occur. Lengthening contraction of the tensor fascia lata which is also a knee extensor muscle also occurs. This is the other phase of stance where falls can occur if there is pain and or spasm or weakness of the rectus femoris (L3, L4) and tensor fascia lata (L5, S1) are present.

Most patients with lower back pain are prone to be sedentary and tend to have tightness or shortening of the hip and knee flexor muscles. Thus a hip flexion contracture will also cause significant tightness of the rectus femoris and the tensor fascia lata muscle at the hip. Since sedentary positions especially that of sitting where hip and knee flexion are involved, constant flexion of the knees make the rectus femoris and tensor fascia lata muscles to be stretched out at the knee.

Additionally, hamstring muscles are tight at the knee and stretched out at the hip which aid the hip and knee instability during the stance phase of ambulation.

Training for balance is very important for patients with chronic lower back pain to prevent falls. Within the home in a clutter free environment, patients can also practice walking backward. When doing these exercises, they should hold onto a wall to prevent falls in case of loss of balance.

Patients should also practice walking on the toes and heels. They must practice walking in a straight-line with the heel of one foot following the toes of the other foot as in the drunken test.

Train oneself to be able to stand on one foot while moving the unsupported limb in flexion, extension, abduction, adduction, internal and iexternal rotation movements with knee in flexion as well as knee in extension.

© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| Posture

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Neck Pain | Hand Pain| Finger Pain

2007-11-12T08:47:00.000-08:00

Patients with neck pain and/or neck stiffness without pain may not associate that their hand and finger pain is related to neck problems. Usually they attribute the hand and finger pain and/or stiffness to arthritis. Initially, self treatments are usually applied to the fingers in terms of using balms, ointments and lotions. Patients may also take analgesic medications and anti-inflammatory medications to help ease the pain. When the pain is severe, they may receive injections into the fingers or wrists and sometimes even surgery to release trapped tendons and nerves in the wrist and hand.

Sometimes patients may exercise the hand against resistance such as squeezing a rubber ball or some gadget hoping to strengthen the hand muscles. If the pain is chronic, these resistive activities will make the pain symptoms worse and can accelerate the progression into bony deformities in the fingers.

One might notice early arthritic deformities such as swelling and formation of soft nodes especially at the tip of the fingers called Heberden's nodes which begin with sub chondral bone formation as a reaction against inflammation. Eventually, these will become more calcified forming bony deformities. A recent survey has shown that one in 12 United States adults have symptomatic hand arthritis and incidence increases with age (Dillon CF. Hirsch R. Rasch EK. Gu Q. Symptomatic hand osteoarthritis in the United States: prevalence and functional impairment estimates from the third U.S. National Health and Nutrition Examination Survey, 1991-1994. [Journal Article] American Journal of Physical Medicine & Rehabilitation. 86(1):12-21, 2007 Jan).

In the early stages before hand deformities occur, pain in the hands can be helped by helping to relax the muscles on the dorsal aspect of the forearm. Neck pain due to spondylotic radiculopathy (arthritis) usually involves the C6 and C7 nerve roots. These roots supply the muscles on the dorsal aspect of the forearm among other large muscles in the shoulder and arm such as the latissimus dorsi and triceps muscles.

When these dorsal forearm muscles which move the wrist and fingers into extension become shortened due to nerve root irritation at C6 and C7 levels, they will pull and tug on the joints of the wrist, knuckles and fingers causing pain in these joints. Additionally, shortening of the dorsal muscles of the forearm places an overwork syndrome to the flexor muscles of the forearm and hand since now the long flexor muscle must work harder to counter-act the resistance provided by the tight and short dorsal forearm muscles that not only cross the wrist but extend to the fingers (extensor digitorum communis, extensor pollicis longus and brevis extensor indicis, extensor digiti minimi and others).

These flexor forearm muscles also eventually become tight and stiff making it difficult for the fingers to bend. Initially, finger bending may be slow due to stiffness but eventually it can progress to the stage of significant pain when there is development of a trigger finger. Triggering of the finger means that there is a tenosynovitis of the flexor tendon (inflammation of the synovial covering of the tendon) such that the tendon becomes thickened. There is a size mismatch between the tendon and the tunnels through which it must pass through at the level of the palmar aspect of the knuckle or the finger joints. A nodule on the flexor tendon may prevent the thickened tendon from passing through the tunnel. The finger may stay locked in flexion at the knuckle joint and there will be significant pain on trying to release it out of its locked position using the other hand. A click may sometimes be heard as the tendon is able to pass through the tunnel.

Significant tightness of the long finger flexors can also lead to tenosynovitis of the long flexors causing compression of the median nerve. This develops into carpal tunnel causing not only pain but tingling and numbness and eventually weakness in the fingers especially in the median nerve distribution (the thumb, index and middle fingers and the thumb ½ of the ring finger) interfering significantly with activities of daily living.

In the early stages, relaxation of the muscles of the forearm especially those on the dorsal aspect can be obtained by constant massaging of these muscles. Relaxation of the muscles can also be helped by using heat over the dorsal aspect of the forearm. Massage should also extend to relax all the muscles of the neck, shoulders and arms. This approach will help to treat the root cause of the finger pain rather than focus the treatments only to the fingers and hand. Activity modification must accompany all treatments in order that progressive healing can take place.

© 2007 copyright all rights reserved www.stopmusclepain.com Neck Pain | Hand Pain| Finger Stiffness

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