Acute Ankle Sprain Recovery: A Comprehensive Guide

Sports Performance Corner with Dr D 

Acute Ankle Sprain Recovery: A Comprehensive Guide

Acute ankle sprains are one of the most common sports injuries and can happen to anyone, regardless of age or level of physical fitness. Understanding the process of recovery from an acute ankle sprain can help you return to your favorite activities quicker and safer.

The Commonly Injured Tendons

 

Two sets of tendons are most frequently injured in an ankle sprain: the lateral ligaments (including the anterior talofibular ligament and the calcaneofibular ligament) on the outer side of the ankle, and the deltoid ligaments on the inner side. These ligaments connect bones to each other and provide stability to the ankle.

 

Grading of Ankle Sprains

 

Ankle sprains are graded on a scale of I to III:

 

Grade I sprain refers to a mild sprain where the ligament is slightly stretched but not torn. Recovery time ranges from 1-3 weeks.

 

Grade II sprain is moderate, with the ligament partially torn. It often takes 3-6 weeks for recovery.

 

Grade III sprain is severe, involving a complete tear of the ligament. This may require several months to recover, sometimes even up to a year.

Stages of Recovery

 

Ankle sprain recovery typically follows three stages:

 

Acute Stage (1-3 days): This stage involves swelling, pain, and limited mobility. The primary goal is to reduce swelling and manage pain.

 

Subacute Stage (3 days-3 weeks): During this phase, the focus is on regaining mobility, strength, and proprioception (your sense of body position).

 

Functional Stage (1-6 weeks): This final stage focuses on gradual return to sports and activities.

 

Swelling generally goes down within the first few days to a week, although this may vary depending on the severity of the injury. 

 

RICE Protocol

The RICE (Rest, Ice, Compression, Elevation) protocol is a popular first aid treatment for ankle sprains. This should be initiated as soon as possible after the injury and continued for the first 24-72 hours.

 

Role of Medications

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and swelling. However, they should be used sparingly and under the advice of a healthcare professional.

 

Possible Complications

If not treated properly, an ankle sprain can lead to chronic ankle instability, prolonged pain, and an increased risk of re-injury. Severe sprains may even cause damage to the cartilage or bone within the joint.

 

Return to Sports

Returning to sports should be a gradual process that begins once pain-free movement is possible. Generally, a return to sports may take anywhere from a few weeks to several months, depending on the severity of the sprain.

Complementary Therapies

Physical therapy, acupuncture, and massage can aid recovery by improving mobility, reducing pain, and enhancing the body's natural healing processes.

 

Consequences of Improper Rehabilitation

An improperly rehabilitated sprain can lead to decreased functionality, chronic pain, and a heightened risk of re-injury, which might result in long-term disability or the need for surgical intervention.

 

Regular vs High Ankle Sprain

Regular ankle sprains typically occur when the foot twists inward, damaging the lateral ligaments. High ankle sprains are less common and involve damage to the ligaments above the ankle that connect the two lower leg bones (tibia and fibula). These sprains typically take longer to heal and may require more intensive treatment.

 

Ankle sprains might seem straightforward, but they need proper care and rehabilitation. Remember, everyone's body reacts differently to injury and treatment, so while these are general guidelines, individual recovery times and experiences may vary. Always consult with a healthcare professional for the best advice tailored to your specific situation.

 

 

The Rehabilitation Process

 

Rehabilitation is a critical component of recovery from an ankle sprain. This process often involves a variety of exercises aimed at restoring strength, flexibility, and balance.

 

Strength: Resistance exercises using bands can help rebuild strength in the ankle muscles.

 

Flexibility: Stretching exercises improve flexibility and range of motion.

 

Balance: Balancing exercises, such as standing on one foot, help restore proprioception and reduce the risk of future sprains.

 

Physical therapy might be recommended, particularly for severe sprains. Therapists use techniques such as manual therapy, electrical stimulation, and therapeutic exercises to speed up recovery and prevent complications.

 

Complementary Therapies for Ankle Sprain Recovery

 

Beyond the traditional methods of treatment, several complementary therapies can aid the healing process:

 

Cryotherapy: The application of cold therapy can help reduce pain and inflammation.

 

Hydrotherapy: The use of water, especially in a heated pool, can be beneficial. It allows exercise without putting too much stress on the ankle.

 

Massage: This can help to improve circulation, facilitate the removal of waste products from the healing tissues, and relieve pain.

 

Acupuncture: Some people find relief from pain and swelling with acupuncture. However, more research is needed to understand its effectiveness in ankle sprain recovery.

 

Remember, it's essential to discuss any complementary therapies with your healthcare provider to ensure they are safe and suitable for your specific circumstances.

 

 

Conclusion

 

An ankle sprain might seem like a minor setback, but without proper care, it can lead to serious long-term issues. By understanding the mechanism of the injury, its grading, and the process of recovery, you can manage an acute ankle sprain effectively and safely return to your active lifestyle.

 

Finally, prevention is always better than cure. Incorporate ankle strengthening exercises into your regular workout routine, maintain a healthy lifestyle, and wear appropriate footwear, especially when participating in sports. Being proactive about your health can help prevent not only ankle sprains but also other potential injuries.

 

This guide aims to equip sports enthusiasts with the knowledge needed to handle acute ankle sprains. However, every injury is unique, and it's essential to consult with healthcare professionals for personalized advice. Your journey towards recovery is a marathon, not a sprint, so be patient with your body as it heals.


Overuse Sports Injuries : Mastering the Comeback

Sports Performance Corner with Dr D 

Overuse Sports Injuries : Mastering the Comeback

Sports and physical activities bring joy, camaraderie, and numerous health benefits. However, excessive strain on your body can lead to overuse sports injuries, potentially hindering your athletic pursuits. This article delves into the reasons behind these injuries, provides preventive measures, and offers guidance on effective treatments. Whether you're an amateur athlete or a seasoned pro, understanding the causes and taking appropriate precautions can help you avoid unnecessary pain and downtime.

Overuse Sports Injuries: An Inevitable Consequence of Passionate Pursuits

Overuse sports injuries are an unfortunate reality for many athletes, but why do they occur? Let's explore the main factors contributing to these injuries:

 

The Repetitive Motion Predicament

Repetitive motions place strain on specific joints, tendons, and muscles. Engaging in activities that involve repetitive movements, such as running, swimming, or playing tennis, can gradually wear down tissues and lead to overuse injuries.

 

Insufficient Rest and Recovery

The Role of Sleep

Quality sleep is a critical component of rest and recovery. During sleep, the body undergoes essential restorative processes that support tissue repair, hormone regulation, and cognitive function. Lack of sleep or poor sleep quality can hinder these processes, impairing an athlete's ability to recover effectively.

 

3. Quality Sleep

Prioritizing quality sleep is crucial for optimal recovery. Establish a consistent sleep routine, create a sleep-friendly environment, and limit exposure to electronic devices before bed. Aim for 7-9 hours of uninterrupted sleep each night to support the body's healing processes.

4. Nutrition and Hydration

Proper nutrition and hydration are essential components of recovery. Ensure you consume a well-balanced diet that includes an adequate amount of protein, carbohydrates, and healthy fats to support tissue repair and replenish energy stores. Additionally, staying hydrated throughout the day helps optimize bodily functions and aids in the removal of metabolic waste products.

 

5. Active Recovery Strategies

Incorporate active recovery strategies into your routine. Gentle exercises, such as swimming, cycling, or yoga, can promote blood flow, reduce muscle tension, and enhance overall recovery. Active recovery helps flush out metabolic waste products, decreases inflammation, and promotes faster healing.

 

By prioritizing rest and recovery, athletes can support their body's natural healing processes and minimize the risk of overuse sports injuries. Remember, recovery is not a sign of weakness but an essential aspect of athletic performance and longevity.

Inadequate Conditioning and Training Errors

Improper training techniques, inadequate warm-up routines, and neglecting strength and flexibility training can predispose athletes to overuse injuries. Insufficient conditioning fails to prepare the body for the demands of the sport, leaving it susceptible to strains, sprains, and other injuries.

 

 

Prevention Is Better Than Recovery: Safeguarding Against Overuse Sports Injuries

Taking proactive measures to prevent overuse sports injuries is essential for athletes of all levels. By implementing the following preventive strategies, you can minimize the risk of sustaining these injuries:

 

Gradual Progression and Training Modifications

One of the keys to preventing overuse injuries is gradually increasing training intensity and duration. Gradual progression allows your body to adapt to new demands, reducing the likelihood of strain or injury. Additionally, incorporating cross-training and varying your workouts can help prevent overuse injuries by promoting balanced muscle development.

 

Proper Warm-Up and Cool-Down Routines

A thorough warm-up before engaging in any physical activity prepares your body for the forthcoming strain. Dynamic stretches, light cardio exercises, and joint mobility drills can enhance blood flow, improve flexibility, and reduce the risk of injuries. Similarly, cooling down with gentle stretches after your workout helps alleviate muscle tightness and aids in recovery.

 

 

 

Adequate Rest and Recovery

Rest and recovery play a vital role in maintaining a healthy and balanced athletic lifestyle. When engaging in physical activities, your body undergoes stress and strain, resulting in microscopic damage to muscles, tendons, and ligaments. This damage, in turn, stimulates the body's healing response, leading to stronger tissues and improved performance. However, this restorative process requires time and resources.

 

Cellular Repair and Adaptation

During periods of rest, your body initiates various cellular processes to repair the damage caused by intense physical activity. These processes include protein synthesis, where new proteins are produced to repair and rebuild damaged tissues. Additionally, rest allows for the restoration of energy stores, such as glycogen, and the elimination of metabolic waste products, aiding in the recovery process.

 

Appropriate Equipment and Technique

Using appropriate sports equipment and ensuring proper technique are crucial for injury prevention. Ill-fitting shoes, worn-out gear, or incorrect posture can contribute to overuse injuries. Seek professional guidance when necessary to ensure proper form, technique, and equipment usage.

 

Treating Overuse Sports Injuries: Nurturing Your Body Back to Health

Even with preventive measures, overuse sports injuries can still occur. If you find yourself dealing with such an injury, it's essential to take appropriate steps for effective treatment and recovery. Here are some common treatment approaches:

 

Rest and Activity Modification

Rest is often the first line of defense when recovering from an overuse injury. Reduce or temporarily cease activities that exacerbate your symptoms, allowing your body time to heal. In some cases, your healthcare provider may recommend alternative forms of exercise or cross-training to maintain fitness while avoiding further injury.

 

 

Physical Therapy and Rehabilitation

Physical therapy plays a crucial role in rehabilitating overuse sports injuries. Skilled therapists employ a range of techniques, including stretching exercises, strengthening exercises, and manual therapy, to improve mobility, reduce pain, and facilitate healing. A personalized treatment plan designed to address your specific injury can accelerate recovery and prevent future occurrences.

 

 

Medications and Pain Management

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help manage pain and reduce inflammation associated with overuse sports injuries. However, it's essential to consult with a healthcare professional before using any medication to ensure proper dosage and minimize potential side effects.

 

 

FAQs:

Q: How can I differentiate between a normal ache and an overuse sports injury?

A: Distinguishing between a regular ache and an overuse sports injury can be challenging. If the pain persists for an extended period, worsens during activity, or affects your performance, it's advisable to consult with a healthcare professional. They can evaluate your symptoms and provide an accurate diagnosis.

 

Q: Can overuse sports injuries be prevented entirely?

A: While it's impossible to prevent all injuries, you can significantly reduce the risk of overuse sports injuries by adopting appropriate preventive measures. Prioritizing rest, incorporating cross-training, and gradually increasing training intensity can help minimize the likelihood of sustaining these injuries.

 

Q: How long does it take to recover from an overuse sports injury?

A: The recovery time for overuse sports injuries varies depending on the severity of the injury and individual factors. Mild injuries may require a few weeks of rest and rehabilitation, while more severe cases can take several months. Adhering to the prescribed treatment plan and seeking professional guidance can facilitate a faster and more complete recovery.

 

Q: Can I continue to exercise with an overuse sports injury?

A: Continuing to exercise with an overuse sports injury can worsen the condition and delay the healing process. It's essential to listen to your body and give it the necessary time to heal. Consult with a healthcare professional to determine appropriate modifications or alternative exercises that won't exacerbate your injury.

 

Q: Are overuse sports injuries limited to professional athletes?

A: Overuse sports injuries can affect athletes of all levels, from recreational enthusiasts to professional players. Regardless of your skill level, it's crucial to prioritize injury prevention strategies and take proactive steps to protect your body from the strains of repetitive motion.

 

Q: When should I seek medical attention for an overuse sports injury?

A: If you experience persistent or severe pain, swelling, loss of function, or limited range of motion, it's advisable to seek medical attention. A healthcare professional can evaluate your condition, provide an accurate diagnosis, and recommend appropriate treatment options.

 

Conclusion: Stay Active, Stay Injury-Free

Overuse sports injuries can be a setback for any athlete, but they don't have to derail your passion for sports and physical activity. By understanding the causes of these injuries, implementing preventive measures, and seeking appropriate treatment when necessary, you can maintain an active and injury-free lifestyle. Remember, prevention is always better than recovery, so prioritize rest, gradual progression, and proper conditioning. With a mindful approach, you can enjoy the benefits of sports while minimizing the risk of overuse sports injuries.


Sports Injury Recovery: Effective Strategies for Quick Rehabilitation

Sports Performance Corner with Dr D 

Sports Injury Recovery: Effective Strategies for Quick Rehabilitation

In this article, we will delve into various methods for sports Injury recovery that can aid in your rehabilitation journey. By incorporating these practical tips, you can boost your recovery process, minimize the risk of overuse injuries, and maintain a strong and resilient body. Remember, it's important to listen to your body and seek professional guidance when necessary. Let's embark on this journey to enhance your recovery and well-being.

Foam rolling

 

Foam rolling is a self-myofascial release technique that involves using a foam roller to apply pressure to specific areas of the body. By rolling over tight or sore muscles, you can help release tension, improve blood circulation, and enhance recovery.

 

Focus on the major muscle groups involved in your sport or activities, such as the calves, quadriceps, hamstrings, and glutes. Spend a few minutes each day foam rolling to help alleviate muscle tightness and promote optimal recovery.

 

Sports Massage

 

Professional sports massages are a valuable tool for athletes to enhance recovery and prevent overuse injuries. Sports massage therapists are trained to target specific muscle groups, alleviate muscle tension, and improve blood flow.

Regular sports massages can help reduce muscle soreness, increase flexibility, and promote overall relaxation. Consider scheduling regular sports massage sessions to support your recovery and keep your muscles in peak condition.

 

 

Active Stretching and Mobility Exercises

 

Incorporate active stretching and mobility exercises into your warm-up and cool-down routines. Dynamic stretches, such as leg swings, arm circles, or walking lunges, help prepare your muscles and joints for activity.

 

These movements enhance flexibility, increase range of motion, and promote better movement mechanics. Similarly, static stretches held for 20-30 seconds can be performed after workouts to improve flexibility and reduce muscle tightness.

Cold and Heat Therapy

 

Cold and heat therapy are effective modalities for promoting recovery and managing muscle soreness. After intense workouts or activities, applying an ice pack or cold compress to the affected area can help reduce inflammation and numb pain.

 

Cold therapy is particularly beneficial for acute injuries or when there is significant swelling. On the other hand, heat therapy, such as using a heating pad or taking a warm bath, helps improve blood flow, relax muscles, and relieve muscle stiffness.

 

Alternating between cold and heat therapy can be beneficial in some cases, but it's essential to follow proper guidelines and consult with a healthcare professional if needed.

 

 

Proper Nutritional Support

 

Proper nutrition is essential for optimal recovery and injury prevention. Ensure you consume a well-balanced diet rich in lean proteins, whole grains, fruits, and vegetables.

 

Protein is particularly important for muscle repair and growth, so aim to include protein sources in each meal. Additionally, hydrate adequately before, during, and after exercise to support cellular function and aid in the removal of metabolic waste products.

 

 

Adequate Sleep and Rest

 

Sleep is a critical component of recovery. Aim for 7-9 hours of quality sleep each night to promote tissue repair, hormone regulation, and overall recovery.

 

Establish a consistent sleep routine and create a comfortable sleep environment to optimize your restorative sleep. Additionally, incorporating regular rest days into your training schedule allows your body to recharge and rebuild, reducing the risk of overuse injuries.

 

By implementing these specific and practical tips, such as foam rolling, sports massage, active stretching, and proper nutrition, you can enhance your recovery and minimize the risk of overuse injuries.

 

Remember to listen to your body, be consistent with your recovery practices, and seek professional guidance when needed. Your body will thank you by staying strong, resilient, and injury-free."


Hot and Cold Therapy: Accelerate Your Sports Injury Healing

Sports Performance Corner with Dr D 

Hot and Cold Therapy: Accelerate Your Sports Injury Healing

Cold and heat therapy are widely recognized modalities that can significantly contribute to recovery and alleviate muscle soreness. This article delves into the mechanisms behind cold and heat therapy, provides guidelines on usage duration and frequency, highlights the benefits of each, and offers essential tips to maximize their effectiveness.

Understanding Cold Therapy:

 

Cold therapy, also known as cryotherapy, involves the application of cold temperatures to the body to reduce inflammation and alleviate pain. After intense workouts or in the presence of acute injuries and swelling, cold therapy can be particularly beneficial. It works by constricting blood vessels, reducing blood flow to the area, and numbing nerve endings, which helps to mitigate inflammation and provide temporary pain relief.

 

Mechanism of Cold Therapy:

 

When cold is applied to the affected area, it causes vasoconstriction, narrowing the blood vessels and reducing blood flow to the region. This constriction limits the release of inflammatory substances and reduces swelling. Additionally, the numbing effect of cold therapy helps to alleviate pain by decreasing nerve conduction and temporarily desensitizing the area.

Benefits of Cold Therapy:

 

Inflammation Reduction: Cold therapy effectively reduces inflammation by limiting blood flow and the release of inflammatory substances.

 

Pain Relief: The numbing effect of cold therapy provides temporary pain relief by decreasing nerve conduction and sensitivity.

 

Swelling Reduction: Cold therapy helps minimize swelling by constricting blood vessels and reducing fluid accumulation.

 

Acute Injury Management: Cold therapy is particularly beneficial for acute injuries, helping to mitigate swelling and provide immediate pain relief.

 

 

 Understanding Heat Therapy:

 

Heat therapy involves the application of heat to the body to improve blood flow, relax muscles, and relieve muscle stiffness. It is commonly used for muscle relaxation and promoting tissue healing. Heat therapy can be applied through various methods, such as using heating pads, warm baths, or warm towels.

 

 

Mechanism of Heat Therapy:

 

Heat therapy works by causing vasodilation, expanding blood vessels and increasing blood flow to the targeted area. This improved circulation helps deliver oxygen and nutrients to the tissues, promoting healing and relaxation. Heat therapy also enhances the elasticity of soft tissues, making them more pliable and reducing muscle stiffness.

Benefits of Heat Therapy:

 

Improved Blood Circulation: Heat therapy increases blood flow, promoting nutrient delivery and waste removal for enhanced tissue repair.

 

Muscle Relaxation: Heat helps relax muscles, reducing muscle tension and stiffness.

 

Pain Relief: The soothing warmth of heat therapy can alleviate muscle pain and discomfort by reducing muscle spasms and promoting relaxation.

 

Flexibility Enhancement: Heat therapy increases tissue elasticity, allowing for improved range of motion and flexibility.

 

 

Practical Tips for Cold and Heat Therapy:

 

Duration and Frequency: Apply cold therapy for approximately 15-20 minutes at a time, ensuring there is a barrier between the cold source and the skin to prevent frostbite. Repeat every 2-3 hours, if necessary. Heat therapy can be applied for 15-20 minutes as well, with a minimum of 1 hour between sessions.

 

Avoiding direct Contact is not necessary: Contrary to common believe, you can place ice pack directly on the skin. In fact if you don’t, you will significantly reduce the effectiveness of the cold compresses. However make sure you do not keep it on the skin for more than 10-15 minutes!

 

Consult a Healthcare Professional: If you have any underlying health conditions or concerns, consult with a healthcare professional before incorporating cold or heat therapy.

 

Alternate Applications: In some cases, alternating between cold and heat therapy can provide additional benefits. Begin with cold therapy to reduce inflammation, followed by heat therapy to enhance blood flow and promote relaxation. Always consult with a healthcare professional before using this approach.

 

Individual Sensitivity: Everyone's response to cold and heat therapy may vary. Pay attention to your body's signals and adjust the duration or intensity accordingly.

Caution for Acute Injuries: Avoid using heat therapy on acute injuries, as it can potentially exacerbate inflammation. Stick to cold therapy in these instances.

 

 

Conclusion:

 

By understanding the mechanisms and benefits of cold and heat therapy, individuals can effectively incorporate these modalities into their recovery routine. Adhering to the recommended guidelines, listening to the body's feedback, and seeking professional advice when needed, will help maximize the effectiveness of cold and heat therapy in promoting recovery, managing muscle soreness, and supporting overall well-being.


Foam Rolling: The Ultimate Guide to Speeding Up Sports Injury Recovery

Sports Performance Corner with Dr D 

Foam Rolling: The Ultimate Guide to Speeding Up Sports Injury Recovery

Foam rolling has gained popularity as an effective self-myofascial release technique for athletes and fitness enthusiasts. This article explores the mechanism behind foam rolling, its benefits, and practical tips for optimizing its effectiveness.

Understanding Foam Rolling:

 

Foam rolling involves using a cylindrical foam roller to apply pressure to specific areas of the body. The technique targets the fascia, a connective tissue that surrounds and supports muscles, helping to release tension and tightness. By applying controlled pressure through rolling movements, you stimulate the nervous system and promote relaxation in the muscles.

 

Mechanism of Action:

 

Foam rolling works by exerting pressure on trigger points, areas of tension or knots in the muscles. The pressure applied helps break up adhesions and increase blood flow to the targeted area, facilitating the removal of metabolic waste products and promoting the delivery of oxygen and nutrients. This process aids in muscle recovery and reduces post-exercise soreness.

Key Benefits of Foam Rolling:

 

Release Muscle Tension: Foam rolling helps alleviate muscle tightness by targeting trigger points, allowing muscles to relax and restore their optimal length-tension relationship.

 

Improved Blood Circulation: The rolling motion enhances blood flow to the muscles, improving nutrient delivery and waste product removal, which supports tissue repair and recovery.

 

Enhanced Recovery: By incorporating foam rolling into your routine, you can accelerate the recovery process by reducing muscle soreness and promoting efficient healing.

 

Increased Flexibility: Regular foam rolling can enhance flexibility and range of motion by breaking down fascial restrictions, allowing muscles to move more freely.

 

Injury Prevention: Foam rolling helps identify and address muscle imbalances and tightness, reducing the risk of overuse injuries.

 

Practical Tips for Effective Foam Rolling:

 

Target Major Muscle Groups: Focus on rolling the calves, quadriceps, hamstrings, and glutes, as these areas are commonly prone to tightness and soreness.

 

Slow and Controlled Movements: Roll slowly over the targeted muscle group, allowing the foam roller to apply pressure and gradually release tension. Avoid quick movements or rolling over bony areas.

 

Spend Adequate Time: Dedicate a few minutes each day to foam rolling. Pay attention to specific areas that feel tight or restricted, spending more time on those regions.

 

Adjust Pressure Intensity: Modify the pressure by adjusting the weight you place on the foam roller. Begin with lighter pressure and gradually increase as tolerated.

Breathe and Relax: During foam rolling, focus on deep breathing and consciously relaxing the muscles being targeted. This aids in promoting a greater release of tension.

 

Listen to Your Body: Be aware of any discomfort or pain during foam rolling. Avoid rolling directly on areas of acute injury or inflammation, and seek professional advice if necessary.

 

Conclusion:

Incorporating foam rolling into your recovery routine can be a game-changer in promoting muscle recovery, improving flexibility, and preventing injuries. By understanding the mechanism of foam rolling and following practical tips, you can maximize its benefits and support your athletic performance and overall well-being.


Myofascial Trigger Points: Hidden Culprit Behind Back Pain

Musculoskeletal Health with Dr D. 

Myofascial Trigger Points: Hidden Culprit Behind Back Pain

Back pain is a prevalent disorder, and more frequently than not, we tend to blame a pinched nerve, herniated disc or arthritis as the cause of the pain. Clinically, however, the majority of back pain is a result of muscle dysfunction and imbalance. A large proportion of back pain is, therefore, the result of the presence of myofascial trigger points (MTrPs). When MTrPs are the cause of muscle pain, we refer to this type of pain as myofascial pain syndrome. In rare cases, the pain may be a result of the problem in the spine itself. However, even in this scenario, the presence of myofascial trigger points in the surrounding musculature is seen as one of the significant contributors to worsening back pain.

 

Clinical experience and research suggest that the presence of trigger points leads to muscle shortening. When muscles shorten, they become less flexible and less responsive to daily demands during physical activities. The affected individual becomes stiffer, and tension begins to build up in the muscles of the back. The pressure will eventually transfer to the discs in the spine. Maintaining muscle tension over the spinal discs may ultimately result in the rupturing of the disc or disc herniation. The presence of trigger points in the shortened muscles can, therefore, be the very root cause of the spinal problems. Additionally, muscles that become short and tight can displace vertebrae and cause compression of nerves.

Lower back pain   

Treatment of the lower back pain can be a very frustrating experience for the patient, but also their provider. In most cases, it is the area of the most intense pain that tends to bear the blame for the origin of the pain. Therapies are, therefore usually aimed at the most painful areas. In reality, however, that is not always the case. In many instances, the presence of trigger points in the area of the mid-back or the buttock muscles is the primary cause for the lower back pain or pain in the sacrum. If the trigger points in these muscles are not appropriately addressed, treatment modalities focusing on the muscles in the lower back will not successfully relieve the back pain.

 

Additionally, trigger points in the abdominal muscles and a muscle called Iliopsoas are very frequent causes of back pain. Unfortunately, these muscles are usually ignored by many health care professionals as a potential cause of back pain. Treating back pain can be therefore challenging and should always include a search for the trigger points not only in the back muscles but also in the buttock muscles and some cases even in the abdominal muscles and the iliopsoas muscle.

Buttock and hip pain

Individuals experiencing pain in the buttock and hip muscles are usually concerned only with the muscles in the buttock and the hip joint itself. Knowing that the referral pattern of the trigger points in the back muscles includes the buttock and the hips may help to identify the real source of the pain in the buttock or the hip joint.

  

Sacral pain

Many patients present to the clinic with lower back pain pointing to the base of their spine. Pain in the sacrum or tail bone is another joint presentation of back pain. While the pain can originate in the tail bone, frequently, the source may originate from muscles located much higher. Quadratus Lumborum, superficial spinal muscles as well as the gluteal muscles are frequent harbingers of trigger points which tend to refer pain to the area of the sacrum. The trigger points in these muscles can be very tender to palpation. If the pressure over these trigger points further aggravates the pain in the sacrum, it is yet another reason for considering them as the main culprit.  Massaging these trigger points can, therefore, bring significant pain relief in the sacral area.  When massaging trigger points in these muscles do not completely resolve the pain or the pain tends to reoccur, chiropractic adjustment of the sacrum may be needed. In this case, massaging the trigger points in the Quadratus Lumborum, Superficial Spinal Muscles and the Gluteal Muscles before the chiropractic adjustment will make the chiropractic adjustment more effective.

The basic approach to self-acupressure

Self-acupressure targeting trigger points is a non-invasive, free of side effects, and straightforward treatment method. It can be adopted and used by every person suffering from back pain. Self-acupressure can be applied to affected muscles several times a day at home or in the workplace. Carrying a lacrosse ball, tennis ball or baseball ball along with you can, therefore, allow for short and frequent treatments throughout the day to ease the pain and promote faster recovery. Targeting the most painful trigger points several times a day with short self-treatment sessions is the most effective way to treat trigger points. Successful management of back pain should, therefore, include the regular application of self-acupressure.

 

You can find more information about acupressure , other treatment modalities and learn the complete home treatment protocol for the management of myofascial pain in the section Treatment Options.

 

To learn more about complementary therapies. Visit National Center for Complementary and Integrative Health

The information provided on these pages is not intended to treat or diagnose any condition and should be viewed solely for education purposes. By no means is this information replacing evaluation by a qualified health care provider. For full Terms and Conditions, as well the use of cookies by this website, please see the sections “Terms and Conditions” and “Privacy.”


Gluteus Medius and back pain: The Muscle that may cause your back pain

Buttock Muscles

Gluteus Medius

Location 

The gluteus medius muscle is one of the three gluteal muscles in the buttock. The other two gluteal muscles are gluteus minimus and gluteus maximus. Gluteus medius is located more in the outer part of the buttock and for the most part, it is covered by much larger Gluteus maximus. Gluteus medius is not covered by gluteus maximus at the upper outer portion of the buttock. This is the area where injections are usually administered.

Function

Gluteus medius is not a very big muscle, but it is a thick and strong muscle that plays an important function in allowing us to walk upright. With each step, the gluteus medius muscle on the supporting leg has to contract, to keep the opposite side of the pelvis from dropping down when we lift the opposite leg to make the next step. That translates to generating a force twice the bodyweight every time we take a step. It is not hard to imagine that this muscle tends to get severely overworked when we carry additional weight for prolonged periods of time. This is one of the reasons why many people present with worsening of their back pain after hiking with a heavy backpack or when ruck marching with full gear without proper train up. While it is not intuitive to associate buttock muscles with back pain, this muscle is one of the most important players in the low back pain.

 

Gluteus Medius and back pain

When gluteal muscles get severely overworked, they become tight and develop trigger points. At this point many people begin to waddle to transfer their body weight fully over the supporting leg when taking a step. This is simply a protective and compensatory mechanism since the gluteus muscles cannot fulfill their function of contracting and relaxing when walking.  The reason why we may feel back pain when gluteus medius is affected, is because the trigger points in the gluteus medius refer pain into the lower back. (please see the images). Certainly, gluteus medius is not the only muscle responsible for back pain. More frequently than not, another muscle called Quadratus Lumborum is affected along with gluteus medius. These two muscles work in tandem and the referral pattern from their respective trigger points overlap. Therefore it is important to always check for presence of trigger points in both of these muscles. Quadratus Lumborum will be discussed in a separate section, but you may remember that one of the hallmarks of involved Quadratus Lumborum is pain when turning in the bed, when coughing or sneezing.

Most characteristic pain caused by trigger points in Gluteus Medius

The pain referred from trigger points in the gluteus medius is mostly felt right above the beltline, but strong sensation can be also felt in the sacral area (please see images). In many cases, pain in the outer part of the hip, known as trochanteric bursitis, has a strong component of involved gluteal muscles, and gluteus medius being one of the main muscles involved.

 

 

 

Location of trigger points & Acupressure tips

To locate the trigger points in the gluteus medius, please refer to the detailed description below. In general, however, they can be found along the iliac cress which is the top part of the pelvic bone. The best way to deactivate the trigger points in the gluteus medius is by leaning against the wall and using a baseball or a tennis ball. Alternately, you can place the ball on the floor and lay down on top of the ball to create more pressure. Using a foam roller is not the best method to address these trigger points, because the foam roller cannot deliver the specific pinpoint pressure through the layers of the fat tissue in the buttock muscles.

Summary

Symptoms

Pain in the lower back just above and below the beltline

Pain often extends into the buttock and hip

Pan in the hips can make it hard to find a comfortable sleeping position

Pain in both the hips & lower back can make walking almost impossible

 

Location of trigger points

Find the bony prominence above your groin (ASIS)

The first trigger point is about 2” behind ASIS

Locate the 2nd trigger point about 1 hand breath behind the 1st one

Find the 3rd trigger point next to the sacrum

 

Pain radiation

To the sacrum

The outer part of the hip

Buttock and lower back above the sacrum

Occasionally along the IT band & back of the thigh

Causes for development of trigger points

Obesity or pregnancy

Carrying heavy weight while walking

Weight lifting

Sitting on a wallet in the back pocket

Habitual weight bearing on one side

Carrying a child on the same hip

Trigger points self-acupressure

Locate the 1st  trigger point

Place the ball between the wall & the buttock

Move the ball horizontally over the tender spot

Find a new tender spot  behind the 1st spot

Repeat rolling over the tender area

Find the 3rd spot next to the sacrum & repeat

General recommendations

Move ball over the tender area 15-20 times

Find a new spot & repeat the process

Apply this massage at least 2-3 x a day

Several short daily sessions are preferable

Do not apply very strong pressure

Follow up after trigger point massage

The benefits of acupressure can be greatly enhanced with a few additional techniques applied after completion of acupressure. One of the most important modalities in the treatment of myofascial pain is heat. Application of moist heat to the area of trigger point after trigger point massage will dilate local blood vessels and improve blood circulation. Improved blood circulation helps to flush out the inflammatory substances which irritate local nerves and cause pain. Improved blood circulation will also promote healing and loosen up tight muscle tissue.  Apply heating pad for 10-20 min, take a hot shower or bath. After massaging and warming up the muscles, you can gently stretch them. Stretching is another essential aspect for recovery from and prevention of muscle injuries. Lastly, apply topical analgesics such as Bengay or Tiger balm.

Acupressure

Stretching Exercises

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Dried Reishi mushroom

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Optimizing Back Pain Recovery: Best Practices

Musculoskeletal Health with Dr D. 

Optimizing Back Pain Recovery : Best Practices

In this article we will look at the best practices for optimizing back pain recovery. Despite the fact that back pain can cause a significant amount of pain and discomfort, it usually recovers spontaneously on its own. The speed of recovery depends on many variables. There is no one single magic remedy to speed up the recovery process.  However there are certain strategies that can be used for optimizing back pain recovery to help you recover faster. Understanding that you may not have control over certain aspects of your recovery process, will also allow you to create more realistic expectations and avoid undue frustrations.

Physical fitness and age

Individuals who are more physically fit and do not have other major medical conditions, generally tend to recover much faster. The body can fully focus on the healing of the injury when there are no other chronic conditions that also require attention, energy, and resources.

 

The smaller the number of raging fires present at the time of injury, the faster and more efficient the recovery process can be. Since most chronic conditions tend to accumulate over the years, age becomes an important player in the recovery process.

 

For the most part, healing is much faster in younger and healthier individuals. That is not to say, however, that growing old is always plagued with long term recovery process. A healthy and active 60-year-old individual with back strain may recover much faster than a 30-year-old sedentary obese office worker.

Prior injuries

History of prior back pain or the presence of other chronic musculoskeletal injuries plays a significant role in the recovery process. Individuals who suffer from chronic pain which is not well controlled, have gone through a process of so-called sensitization.

 

In other words, their nervous system has become more sensitive to any pain stimulus. Any new injury will, therefore, cause a lot more intense pain and take much longer to subside, despite the fact that the area of injury may be already healed.

 

Importance of early mobilization

When significant acute injury develops, bed rest may be necessary. It should be, however, limited to no more than 24 - 48 hours. Numerous studies have demonstrated the detrimental effect of prolonged bed rest on the recovery process.

 

Motion is the lotion and muscles need to move to heal. While you should not push through the pain to further aggravate your condition, gentle exercises focused on a pain-free range of motion and stretching will allow the muscles to become less stiff and maintain their flexibility.

 

Muscles that are not used, start to deteriorate very rapidly. They lose flexibility, mass, strength and become stiff. Intense pain with even small movements may then result from any attempt to use the stiff muscle since it will be pulling on the injured area.

 

Movement also creates important muscle pump which helps to increase local blood circulation. Increased blood circulation helps to flush out the inflammatory chemicals present at the site of the injury. The accumulated inflammatory chemicals irritate the nerve endings at the site of the injured area.

 

These chemicals are the primary reason for sensation of pain. Increased blood circulation also helps to supply the injured area with nutrients, oxygen and white blood cells that help to heal the injured tissue. Getting an early referral to a physical therapist to start the rehabilitation from acute injury is important for fast recovery and preventing the development of chronic conditions.

 

Application of heat versus cold

Using cold compresses for the injured muscles may be soothing in the first 24 – 48 hrs. This should be, however, followed by the application of heat to promote local blood circulation and to relax the muscle spasm.

 

Moist heat is preferred over dry heat, and moist heating pads, hot showers or baths work great. Heating pads can be applied to the injured area several times a day, but no longer than 20 minutes at a time.

 

You should never sleep on the heating pad. Exposing the injured area to the heat longer than 20 minutes at the time leads to overheating. This will trigger a protective mechanism, which may cause changes in the local vasculature and eventually decrease blood circulation in the injured area.

 

If pain prevents you from getting good night restful sleep, talk to your provider about prescribing short course of pain medication that can decrease the intensity of pain at night, while at the same time help you get better sleep.

 

Taking a muscle relaxant 30 minutes to one hour before sleep is generally a good option. However, your medical provider will be able to make more specific recommendations based on your particular condition.

Sleep and Depression

Getting a sufficient amount of sleep is important for everybody, but it is critical when recovering from an acute injury. The body heals and tissue regenerates when we sleep.

 

Insufficient sleep promotes systemic inflammation within our body, which slows down the healing and contributes to more pain perception. A minimum of seven, but preferably eight hours of sleep is recommended for optimal functioning and recovery.

 

Additionally, an insufficient amount of sleep combined with new intense pain has a strong effect on mood and may lead to depression. Whether depression results from sleep deprivation and pain or the depression has been present prior to the injury, it’s presence further intensifies pain and interferes with sleep, thus creating downward spiral leading to worse outcomes.

Complementary medicine, pain medication, and acute pain

An increasing number of patients do not wish to take any pain medication when they develop acute pain from fear of their side effects. There is an ongoing battle and numerous initiatives to fight the opioid crisis around the world.

 

Additionally, it is also true that every medication carries a risk of side effects. This, however, doesn’t mean that taking pain medication is bad and should be avoided by all means.

 

It is important to understand that there is a role for pain medication in particular when it comes to severe pain. Getting pain under control as soon as possible will prevent altering the way in which our brain deals with pain.

 

Any uncontrolled pain lasting longer than several days can sensitize the brain to pain and lower the pain threshold. This ultimately translates to experiencing painful sensation at much higher intensity with much lover stimulus. A simple gentle touch over the painful area could, therefore, lead to severe pain.

 

Complementary and alternative medicine modalities have been used successfully for the management of pain and injuries for hundreds of years. Many of them have been extensively studied and their effectiveness proven in rigorous trials.

 

Despite their popularity, however, their role is primarily in the management of chronic pain and injuries. This is largely because their main mechanism of action, by which they help to control pain and promote recovery, is through stimulating body own healing processes and pain control.

 

In other words, their primary role is to restore the body homeostasis. The subtle changes they produce over time are sufficient to create a noticeable difference when treating chronic pain or injuries.

 

It is, however, usually not enough to promote lasting pain relief in severe acute pain Click here to read more about the complementary medicine, pain medication and acute pain.

The role of Nutrition

The importance of nutrition cannot be emphasized enough when it comes to recovery from an acute injury. Providing our body with a sufficient amount of lean protein which is important for building tissue, as well as getting enough vitamin C to promote formation of collagen, is the very minimum.

 

Minimizing the intake of vegetable oils by decreasing consumption of fried foods and pastries and replacing them with monounsaturated fats from olive oil, canola oil, and avocados helps to decrease inflammatory process in the body.

 

Eating a wild salmon or other fish high in omega 3 fatty acids at least 2-3 times a week, or taking 1000- 2000 mg of mercury-free omega 3 fatty acids daily in the form of a supplement, has been also shown to decrease systemic inflammation.

 

Having fresh vegetables at least two times a day and eating 2-3 pieces of seasonal fruits will add much-needed vitamins and phytochemicals to act as powerful antioxidants.

Topical analgesic creams

Topical analgesic creams, ointments, and plasters have been used in many traditions to treat injured muscles and bones for millenniums. They have been made from a variety of herbs and other natural substances.

 

Their use not only soothes the pain but also promotes healing. A number of topical analgesic creams have been developed by the pharmaceutical industry based on these old folk remedies.

 

Most of these products contain some combination of menthol, capsaicin and salicylic acid. While these products have been marketed primarily to help to soothe the pain and aches, they also promote local blood circulation by stimulating special receptors on the skin.

 

As mentioned throughout this article, increased blood circulation in the area of pain promotes healing. The use of these products should be therefore encouraged for any musculoskeletal injury where application of topical creams is not contraindicated.

 

Before rubbing any of these products to the skin, try to apply only a small amount to observe for any skin reaction. You should also never apply these creams right before or after hot shower to avoid intense burning sensation.

 

In summary

Recovering from an acute musculoskeletal injury is a complex process. There is no one single recipe since everybody has a unique combination of factors that may either promote or hinder the recovery process.

 

In this article, we have covered only few of the most important aspects that exert a major influence on the recovery process. Optimizing sleep, physical activity, nutrition, and appropriate use of heat/cold and topical creams, can have significant effect on the speed of your recovery.

 

To learn more about complementary therapies that can be used for recovery from acute back pain, visit National Center for Complementary and Integrative Health


Back Strain: Symptoms, Causes and Treatment Strategies

Musculoskeletal Health with Dr D. 

Back Strain: Symptoms, Causes and Treatment Strategies

Back strain is probably the most common form of acute back pain. It affects the muscles and their tendons which attach them to various structures in the back. In general, muscle strain refers to a small tear in the muscle or its tendon. Most muscle strains tend to develop in the lower back area where the muscle changes into the tendon, but they can develop anywhere.

Symptoms

A strain of the back muscles mostly causes localized pain in the area of the muscle/tendon injury accompanied by stiffness, limited range of motion and difficulties maintaining straight posture. Timing is very important when it comes to muscle strain.

 

Most muscle strains usually happen while lifting something very heavy or doing a sudden movement. Many individuals experiencing back pain due to muscle strain may feel a popping sensation at the moment of the injury which usually prompts them to seek medical attention.

 

They may have difficulties straightening their back up after the onset of the pain and usually maintain a semi bent position to avoid severe pain. That is not to say that muscle strain cannot come gradually. Even in this case, however, the individual can usually remember the moment when he felt sudden uncomfortable pain in the back which became progressively worse with activities.

Most individuals will also complain of muscle cramps in the area of their lower back. Additionally, coughing and sneezing usually brings on bouts of severe pain during acute back strain. The back muscles which tend to be the most affected by muscle strain are those right next to the spine.

 

Frequently, however, the pain can also be felt around the base of the spine and in the buttock area. Occasionally, pain may radiate into the buttocks. Under normal circumstances, pain due to back strain does not radiate down to the legs.

 

Pain radiating down to the legs is usually associated with nerve compression, but it is also frequently seen as a result of trigger points in the gluteal (buttock) muscles.  Back strain is not a serious condition and most individuals with acute back strain recover spontaneously within 1 to 2 weeks.

Causes

When muscle strain is caused by a sudden movement, it is generally a result of preexisting tightness in the back muscles which has developed over a period of time. Tight muscles are less flexible. Decreased flexibility results in limited ability to respond to sudden demands for muscle extension beyond the normal daily activity.

 

Therefore when the muscle is required to suddenly extend beyond its limits, such as when catching a falling object or catching ourselves from falling down, a strain can develop in the muscle or the tendon. To prevent further injury, the body triggers protective mechanism which manifests as muscle spasm.

 

The final outcome is stiffness and significantly limited range of motion with great amount of pain when trying to move in any direction.

Back strain can, however, develop also due to muscle overuse. In this case, the muscles and/or their tendons become strained due to repetitive movements in absence of sufficient time for recovery and repair.

 

Activities involving excessive forward bending of the spine constitute one of the most common misuses of the back leading to increased vulnerability to a variety of injuries. The forward bend position stretches the muscles and tendons of the back to a point where very little control can be exercised over the spine’s position.

 

Therefore lifting objects in forward bend positions can easily strain these muscles and their tendons. Additionally, forward bend position creates an uneven pressure on the spinal discs making them significantly more prone to injury.

 

Poor posture

Poor posture is one of the main underlying causes for the development of back strain. It generally refers to either too large or too small curvature in the area of the lower back. Over a period of time, poor posture leads to muscle imbalance and strain of the muscles/tendons in the back.

 

Spending extensive period of time in uneven position such as being twisted sideways or bent forward, also puts great stress on the spinal discs predisposing them to injury.

 

Poor physical fitness

poor physical fitness, excessive weight, sedentary lifestyle and lack of flexibility are also among the leading factors predisposing individuals to back strain. The result is poorly conditioned back muscles that lack sufficient strength and endurance to respond to increased physical demand when called upon.

 

This is why sudden unexpected movement, or performance of new repetitive task requiring the use of back muscles, easily result in back strain.

 

More information is available on this page.

Summary

Main Symptoms

Sudden onset

Localized pain  & stiffness

Limited range of motion

Difficulties maintaining straight posture

Muscle cramp in the area of the lower back

Causes

Sudden movement

Tight muscles and lack of flexibility

Muscle overuse

Activities involving excessive forward bending of the spine

Lifting objects in forward bend position

Poor posture

Working in uneven position - twisted sideways or bent forward

Poor physical fitness,

Excessive weight

Sedentary lifestyle


Back Strain: Accelerate Your Recovery with These Tips

Musculoskeletal Health with Dr D. 

Back Strain: Treatment Guidelines for Back Strain

Most back strains do not require specific treatment, because they usually recover spontaneously in relatively short period of time. There are, however, certain strategies that may help you recover faster and make the process less painful. For full list of detailed recommendations on optimizing your recovery process please follow this link.

Mobility: swimming and walking

One of the most important things to keep in mind, is that during the acute phase, it is of outmost importance to stay mobile. While short term bed rest may help to relieve some of the pain initially, staying in the bed more than 24-48 hrs leads to worse outcomes and prolongs the recovery time.

While becoming more mobile is important, you will need to initially modify your daily routine to avoid high impact activities, lifting heavy objects and twisting movements. The best way start increasing physical activity is walking for few minutes several times a day and eventually transitioning to recreational swimming in a slow pace. Swimming is excellent exercise for recovery from back injuries. It’s weightless nature eliminates gravity and pressure on the spine and takes the muscles and joints through full range of motion. Both activities will keep the muscles engaged without additional strain, and get them slowly ready for more physically demanding exercises.

Heat

Heat plays important role in the treatment of back pain. It improves local blood circulation which enables the injured tissue to heal faster while decreasing muscle stiffness and pain. Applying heat to the painful area after the initial 48 hrs from the onset of the injury also helps with stretching. Additionally, heat reduces pain and makes movement easier when getting out of the bed in the morning. Heating pad should not be applied directly on the skin. While it can be used  several times a day, it should never be applied for longer than 20 minutes at a time. Never sleep on your heating pad!!

Stretching, Massage and Acupuncture

Gentle stretching of the back muscles after using heating pad is important to slowly start elongating the tight muscles. Never push beyond the level of gentle stretch. If stretching is painful, you need to pull back. Gentle massage around the painful area can be very relaxing and soothing. You do not need to spend money on massage therapist, but if you can afford it, this might be a good time to splurge on couple sessions. Getting a simple massage from your partner at least once a day for the first few days can be equally if not more effective. Alternately, you can try self-acupressure using a tennis ball while leaning against the wall and finding the tender spots in your back. Both massage and acupressure help to promote local blood circulation and loosen up the tight muscles which results in increased mobility and less pain. If acupuncture is available to you, getting few treatment sessions can be very helpful to promote relaxation of the tight muscles, increase local blood circulation and decrease pain. For more information about acupuncture please follow this link.

The role of pain medication

While pain medication will not help you to recover faster, they can help to make the process more bearable. Motrin, naproxen or Alleve can be used in mild to moderate pain, to take the edge off the pain. Stronger pain medication, prescribed by your provider, may be necessary when pain is more severe.

 

Goals for pain management

It is very important to understand, that complete pain relief is neither realistic, nor the goal of pain medication or any treatment modality discussed in this article. Pain is a protective mechanism. It makes us start paying attention to our body and prevents us from causing further damage. Additionally, there is no single best remedy. Patience in combination with several treatment strategies placed in the context of a comprehensive treatment protocol, has been shown to lead to the best and fastest recovery.

 

To learn more about complementary therapies, visit National Center for Complementary and Integrative Health


Sciatica, Symptoms, Causes and Treatment strategies

Musculoskeletal Health with Dr D. 

Sciatica

Sciatica is a type of back pain that affects the sciatic nerve. The sciatic nerve is a large nerve that exits from the spine in the area of the low back, travels down to the buttock and continues down along the back of the thighs into the feet. It is an important nerve that branches in several places in the legs and provides nerve innervation to the legs and feet.  A disc in the spine can herniate and compress the sciatic nerve causing symptoms of sciatica.

Symptoms

Patients with sciatica usually experience the familiar electric jolt like sensation propagating along the back of the thighs sometimes all the way to the feet. The sensation of pins and needles or ants crawling under the skin of the legs is also frequently described by patients experiencing sciatica. The intensity of the pain varies among the patients. Some individuals experience excruciating debilitating pain that causes them to become bedridden for a couple of days, while others have only mild pain in their back and legs. While the sciatic pain usually starts in the low back and continues down the leg along the path of the sciatic nerve, the pain is usually more intense in the legs than in the back. Sciatica generally affects only one leg at a time. It is rare to see the involvement of both legs at the same time. If this is the case, it is important to seek medical evaluation to rule out other causes for these symptoms.

Most patients complain of more significant pain when they sit down. Standing for extended periods of time is also very painful and most people prefer to lay down or slowly walk around to ease their pain. Numbness and weakness in the leg are also frequently associated with sciatica. If the sciatic nerve becomes compressed in the buttock by a muscle called piriformis, it is called piriformis syndrome. The main differentiating symptoms between sciatica and the piriformis syndrome is that painful sensation caused by piriformis syndrome propagates down the leg along the back of the thighs and only up to the knees and not past the knees. The quality of the pain is also different. Pain radiating down the legs due to the Piriformis Syndrome generally feels like a dull, achy sensation unlike the electric-like, burning sensation caused by a pinched nerve in the spine causing sciatica.

Causes

There are many reasons why someone may develop sciatica. The risk factors are similar to developing any back pain. The excessive weight which creates too much pressure on the spine, sedentary occupation with lack of movement or carrying heavy objects are some of the most important causes. Aging is an independent factor that compounds any of the above risk factors because most people become more sedentary as they get older, gain weight and become less flexible. Sciatica is however not exclusive of young healthy individuals. Many individuals in the 30s present to their health care provider’s office with symptoms of sciatica after sustaining injury from doing exercises at the gym. This is usually related to lifting heavy weights, not stretching before and after exercising, as well as not getting enough rest to allow body fully recover and regenerate.  To prevent flare-ups of sciatica it is, therefore, crucial to maintaining healthy weight and stay mobile.

Treatment Guidelines

While sciatica can be rarely caused by a bone spur or a tumor, in most cases of sudden onset of sciatica, it is related to a disc herniation.  The treatment for sciatica is therefore essentially the same as for disc herniation since both share the same underlying cause. Treatment guidelines for disc herniation can be found here.

Summary

Symptoms

Electric jolt like sensation in the back & back of the leg

“Pins and needles” sensation

Numbness and weakness in the leg

Burning sensation

Affects usually only one leg

More pain with sitting or standing

Pain is better when laying down or walking slowly

Causes

Excessive weight

Sedentary occupation & lack of movement

Carrying heavy objects

Advanced age

Lifting heavy weights


Spinal Stenosis: Causes, Symptoms and Treatment

Medicine Corner with Dr D 

Spinal Stenosis

Chronic back pain can be a result of spinal stenosis. Spinal stenosis is usually seen in individuals over the age of 50 who developed significant degenerative changes in their spine from wear and tear. The medical word for these degenerative changes is osteoarthritis. Spinal stenosis is a result of the narrowing of the spaces within the spine where the spinal nerve roots are located. When the spaces get too narrow, excessive pressure on the nerves in the area develops.

Symptoms

People affected by spinal stenosis may experience a variety of symptoms. Some individuals may have no symptoms at all, especially in the initial stages, while others may experience significant amount of pain. It is not known why some people experience more or less pain. Spinal stenosis is a degenerative disease and therefore develops slowly over period of time with gradually worsening symptoms. Most individuals experience tingling and numbness in their buttocks, legs, and calves, especially after prolonged walking. Walking up the hill or up the stairs is particularly painful, but even walking down the stairs can lead to significant amount of pain. In more advanced cases, weakness of the legs, pain, and cramping in one or both legs and feet can present with prolonged standing or walking.  In severe cases, an individual may not be able to walk more than few blocks before severe pain develops.

Urination and bowel movement can also be occasionally affected as a result of the pressure on the spinal nerves that control these two essential physiologic functions, and the individual may develop urinary urgency and incontinence. In general, the back pain from spinal stenosis gets better with sitting down for a few minutes. Sitting flexes the spine and this relieves some of the pressure on the nerves. Many individuals with severe spinal stenosis, therefore, walk stoop forward and keeping their torso slightly flexed to lessen the pain while walking.

Causes

There are several reasons why spinal stenosis may develop. The most common causes include osteoarthritis and bone spurs. Osteoarthritis is one of the forms of arthritis. It is a result of wear and tear that affect the protective cartilage on the ends of the bones. When osteoarthritis is present in the spine, it can cause over time narrowing of the spinal canal, which eventually results in spinal stenosis. When bone spurs develop as a result of long term wear and tear, the spurs may grow inside of the spinal canal and cause pressure on the spinal nerves. Less frequent causes of spinal stenosis include a spinal tumor and a car accident. In both of these cases, there are usually several other prominent symptoms that point out to that diagnosis.

Treatment guidelines

In mild cases of spinal stenosis, a conservative treatment approach is recommended. This may consist of physical therapy and strength training, stretching, short term course of acupuncture, daily stretching, swimming, Tai Chi or Yoga exercises. The goal is to keep the back muscle flexible and relaxed as much as possible. Building core strength is also important to properly distribute the weight and decrease the load on the spine. Losing excessive weight is crucial for the successful management of back pain. Carrying less weight translates to less pressure on the lumbar area of the spine from the excessive forward pull of the abdomen.

 

In more severe cases when the benefits of conservative treatment have been maximized, but pain continues to significantly affect the quality of life, surgery may be necessary. This should be however the last resort since there are inherent risks to any surgical procedure. It has been recommended, that only when all other treatment options have been exhausted, and the individual’s quality of life as it is now is poor, surgery should be considered as a possibility to improve current quality of life.

 

For more information about spinal stenosis you can visit the Mayo Clinic Spinal Stenosis page


Disc Herniation: Understanding Symptoms, Causes, and Treatments

Musculoskeletal Health with Dr D. 

Disc Herniation

Disc herniation is a result of a disc protruding out of the spine. The disks in the spine are important structures for providing space and cushioning between the individual bones (vertebras) in the spine. The disk is a round soft cushion which has a soft jelly-like consistency in the center and tougher outer part providing for the structural integrity. When too much pressure is generated on the disc, the tough outer part can break and small tear develops. The inner soft part can protrude outside of the disc and irritate or push against the nearby nerves causing pain and other symptoms. Herniated disc doesn’t always cause pain, and there are some individuals who only find out about disc herniation accidentally when imaging of their torso is done for other purposes. Studies indicate that 41% of disk protrusions and up 71% of more severe disk extrusions eventually resolve spontaneously.

Symptoms

The symptoms related to disc herniation can vary not only in intensity but also in presentation. The major differentiating factor is whether the herniated disc touches the spinal nerve or not. If the disc is not touching the nearby spinal nerve, the affected individual may only experience low-grade back pain which is worse with certain movements. If, however, the disc is touching a spinal nerve and causing impingement of the nerve, the pain is typically more intense. There will be also other associated symptoms based on the level of the spine where the herniation occurred. In most cases of disc herniation in the lower back, when the herniated disc is impinging on the spinal nerve, the pain will be mostly felt in the buttock and in the legs rather than in the low back. Radiating pain may, in some cases, reach all the way down into the foot. This is usually described as sciatic pain.

The symptoms of electric shooting pain radiating down the leg usually resolve fairly soon with or without any treatment, however, the numbness may be present for several months. In severe cases of herniation, the numbness can become permanent, and it may never completely resolve. Many individuals also develop weakness in the leg supplied by the affected nerve and may have difficulties maintaining a steady gate. It is important for the individual developing this type of back pain, to contact their provider immediately if they notice new changes in their bowel movement or urination. A condition called Cauda Equina can result from impingement of the nerves controlling bowel movement and emptying the urinary bladder. The affected individual may develop difficulty emptying their bladder and present with loss of sensation in the area of the buttock that would be in contact with a horse saddle- hence called saddle anesthesia.  This is a serious complication of disc herniation that requires a surgical intervention to prevent permanent nerve damage.

Causes

While the exact cause of disc herniation is usually hard to elicit, it is generally associated with more advanced age and activities involving heavy lifting and or twisting movements. As we age, the tough outer layer of the disc becomes more fragile as it undergoes degeneration. The disc also loses some of the inner soft cushioning jelly-like substance. This makes the disc more fragile and prone to rupture when it is exposed to sudden twisting movement or excessive load.   Young individuals engaged in strenuous jobs or sports activities that require heavy lifting, especially when combined with twisting movements, are at great risk for disk herniation due to the instability that this combination of pressure and twisting movement creates in the spine. Additionally, having tight muscles that attach to the individual vertebras above and below the disc, can also predispose the individual to disc herniation by keeping the disc under constant pressure. In such cases, a small innocent movement such as picking up a pen from the floor can be the final hit for rupturing the disc and causing herniation.

Treatment guidelines

Pain due to acute disc herniation can be very debilitating. Unless there are, however, any so-called red flags, which your provider will rule out during his physical exam, there is no need for any invasive procedures to treat acute disc herniation. Most patients will feel significantly better in 4-6 weeks, and they will fully recover in 3-4 months. Conservative treatment is therefore recommended as first-line therapy. There are a number of treatment options and all of them help to some extent in the recovery process. Their selection depends on availability and personal preference. Making certain changes to your daily routine can also speed up the recovery process. You can read more about optimizing your recovery process here. During the acute onset of symptoms, bed rest can be helpful for one to two days. Being inactive and staying in bed longer than two days has been associated with worse outcomes. Motion is the lotion, therefore early referral to physical therapy to learn appropriate mobilization and stretching exercises is very important for successful rehabilitation. Pain medication such as Motrin or Naproxen can help ease some of the pain, but if this is not sufficient, talk to your provider about using additional pain medication for short period of time. After initial 24-48 hrs from the onset, hot baths or heating pads applied for no more than 20 minutes can also help loosen up the muscle spasm and relieve some pain. This should be followed by gentle stretching. Avoid sitting for extended periods of time and walk slowly avoiding any sudden movements. If heated pool or larger Jacuzzi tub is available, stretching for 15- 20 minutes in the warm water and doing gentle ranges of motion can also be very helpful.


Facet Joint Syndrome: A Silent Cause of Chronic Pain

Medicine Corner with Dr D 

Facet Joint Syndrome

Back pain can be caused by degenerative changes and inflammation in the facet joints which is commonly referred to as a Facet Joint Syndrome. The spine is made up of individual vertebral bodies which are stacked one on top of another. On each side of the vertebral bodies are tiny joints called facet joints. Their primary role is to allow the spine to move and make twisting and bending movements. They also keep the individual vertebras from moving too far forward or twisting without limits.  Most facet joint-related pain is seen among individuals over the age of 60 secondary to osteoarthritis. It is, however, not uncommon for younger very active individuals to experience the same pain after engaging for several years in exercises that put lots of stress on the facet joints.

Symptoms

When the facet joints become inflamed because of injury or arthritis, they will generate pain. Acute presentation of facet joint pain may resemble those caused by a herniated disc and at this stage it may be difficult to differentiate between these two. In most case the individual can pinpoint the area of pain indicating involved facet joint. At time, however, the person may experience diffused poorly localized pain in the lower back, hips, and buttocks on both sides. Most patients presenting with pain due to facet joint inflammation have difficulty bending backward which may help to establish the diagnosis. In some cases, the facet joint pain may project pain down to the legs and mimic the sciatic pain. Unlike sciatica, where the pain may project all the way down to the feet, facet joint pain usually terminates at the level of the knees. Only in rare cases the pain may project all the way down to the feet. This is usually seen when osteophyte is causing pressure on the nerve root.

Causes

The major cause for the development of facet joint syndrome appears to be osteoarthritis of the facet joints. Osteoarthritis is generally a consequence of wear and tear. It is characterized by narrowing of joint spaces, loss of joint cartilage and local joint inflammation. This process is similar to the more familiar knee osteoarthritis which is a well-known cause of knee pain among the elderly population. It has been shown that younger individuals suffering from facet joint syndrome tend to have history of strenuous jobs prior to the age of 20 which puts them at high risk for early osteoarthritis of the facet joints.

Diagnosis & Treatment guidelines

Inflammation of the facet joints is generally not well diagnosed by MRI or X-Rays. There is also a poor correlation between the findings on the images, physical exam by the provider and the symptoms that the patient experiences. In most cases injection of an anesthetic medication into the vicinity of the painful facet joint can help to make the diagnosis. If the patient experiences immediate pain relief after the injection, the condition can be diagnosed as facet joint syndrome and steroid injections can then be administered to decrease the local inflammation. The steroid injections are usually administered by pain specialists under fluoroscopy which helps to guide the needle placement. The patient may receive these injections every 3-6 months based on the duration of symptoms relief.

Acupuncture treatment can also be beneficial since needling the musculature in the affected area can improve local blood circulation and decrease the inflammation and muscle tension. Referral to physical therapy to learn appropriate core strengthening and stretching exercise is important in long term management and prevention of further exacerbation.

Avoiding activities that put undue stress on the spine is as important, if not the most important aspect of any long term management of facet joint syndrome. No treatment will be effective if these perpetuating factors are not effectively addressed and appropriate modifications incorporated into daily lifestyle.


Chest Stretching Exercises

Chest Stretching Exercises

The videos on this page demonstrate several exercises that help with stretching chest muscles.  Shortened chest muscles result in rounded shoulders and upper back AKA "hunching". Rounded shoulders lead to increased stress on the low back muscles due to excessive pull on the back muscles.

 

If you have tendencies to hunching, add a couple of these exercises to core stretching exercises for specific muscles involved in your back pain. Learn the proper technique as demonstrated in the videos and perform them daily as part of your regular routine.