Mapping pain: Where does it hurt?

Pain science is a complicated and growing field of research. Pain is not a one-size-fits-most experience; not only does it vary from person to person, but it is very common for pain to be felt in a different area than where the actual cause is!

Furthermore, pain is deeply subjective; what one person may consider a moderately difficult experience could significantly impact, or even halt, another person’s activities of daily life. Pain is an individualized experience varying from person to person, body part to body part, and condition to condition, depending on what
is causing the pain to occur in the first place.

Pain and discomfort are tremendous driving forces for a person to seek a doctor. In fact, according to the Centers of Disease Control, between 11% and 40% of US adults are living with chronic pain,1 and pain is one of the most common reasons adults seek medical care.2 Not to mention the existence of pain is debilitating over time; the overlap of chronic pain and depression is undeniable, with neural mechanisms of the brain both impacted and aggravated by the presence of both.3

Chiropractors are trained to help diagnose and treat musculoskeletal pain Chiropractors have a keen understanding of muscle, joint, and bone conditions that cause pain and discomfort to a patient. One of the biggest differentiators that a well-trained chiropractor will look for is the type of pain. Certain conditions follow certain patterns, or presentations, of pain, and by asking the right type of questions, a chiropractor can discern if the pain is coming from a treatable condition or if the person needs to see another medical provider for more
help.

A trained chiropractic physician can help differentiate when pain is coming from musculoskeletal or by visceral (organ-related). Sometimes pain can masquerade as musculoskeletal pain. In instances like these, your chiropractor will ask a series of questions about your activities of daily living including eating and sleeping habits, lifestyle management, pain quality, aggravating and alleviating factors, and more. A physical exam be performed next. It will include a neurological exam, orthopedic exam and chiropractic. After the thorough history and physical exam, the doctor will make the decision if your case can be treated with chiropractic care or be referral to another provider best equipped to treat the condition.

Not all pain is the same Nerve-type pain, also called neuralgia or neuropathic pain, is an example of one condition a chiropractor can assess and treat. Nerve pain is also known as radiating pain because the pain travels in specific patterns along the route of the nerve.

Imagine a river or a stream with its origin somewhere in the mountains. Similarly, the beginning of the nerve starts at an important peak within our body – the central nervous system – located within the brain and spinal cord (spine). From the spinal cord, the nerve roots exit the spine, branch off and interweave with other nerves and travel to other parts of the body. Radiating pain follows the course of these rivers, or nerves, and radiating pain coming from a nerve will follow the path of the nerve with sharp, shooting, or even electric-like sensations.

Nerve pain can be due to problems in the central nervous system (brain and spinal cord), or in the nerves that run from there to the muscles and organs.4 It is usually caused by disease or injury. Another pain pattern can come from muscle conditions such as trigger points or spinal joint segmental dysfunction. A trigger point is a spot that is sensitive to pressure, mainly in muscle tissue, and is often associated with aching and stiffness.5 Trigger points cand be likened to “hot spots” of muscles tightness and pain that should not normally be sensitive to pain. Trigger points have common location s that, when aggregated or pressed, can recreate certain patterns.

Spinal Joint segmental dysfunction6 is a long phrase for a short problem: a joint in the spine is “stuck,” or not moving correctly. Both myofascial (muscle) trigger points and segmental dysfunction
conditions create a type of pain known as referred pain. Unlike radiating pain, referred pain patterns are less focal and more generalized to the affected body part, with pain that is proximal to the location of the cause.
An important distinction between radiating and referred types of pain is the type of pattern and traveling nature.

These elements aid a physician in correctly diagnosing and treating the condition within an expected timeframe for response. Some conditions, such as myofascial
trigger points, can resolve in just a few treatments. Other conditions, such as nerve compression creating radiating pain, may take longer.

A good exam is instrumental to provide the correct treatment and outcome Some patients may consult a quick internet search for pain and other symptoms. The overlapping nature of symptoms and key phrases used in the search bar can make search engine results confusing and misleading. As a result, patients can inadvertently misdiagnose themselves.

One example is a patient with a sharp pain that sometimes goes from his low back, down into his hip, and into his posterior thigh. His internet search reveals a condition called “sciatica,” which is a condition resulting from a pinched nerve in the low back. He may self-diagnose a pinched nerve when, in fact, his pain is referring from a myofascial trigger point in his lumbar erector muscles and quadratus lumborum muscle.

This is where a good doctor is invaluable. A trained chiropractor will palpate (feel) the affected area to determine if palpation can reproduce the pain pattern. However, if other components of the physical exam, including orthopedic tests, revealed a tracer type pain down the leg with potentially associated numbness, tingling, and weakness all the way down to the back of the heel, that patient could in fact have a nerve irritation of the sciatic nerve. The nerve compression could have a myriad of causes, ranging from irritation by a lumbar disc herniation, thickened spinal ligament, osteoarthritis, and osteophyte formation, or
from a muscular entrapment at the piriformis or hamstring area.

Evaluating those areas with a patient exam is vital in determining the root cause.

When to seek a chiropractor for help a thorough musculoskeletal assessment can reveal whether further imaging such as X-ray, MRI,
or other tools are required to accurately assess the pain generating cause. Seeing a chiropractor is wise if the pain does not go away in several days to several weeks.

Chiropractors are conservative providers that are well-positioned to assess and treat musculoskeletal complaints.

Chiropractors utilize rehabilitation research and pain science education and advocate for guided exercise and activity, appropriate muscle and tendon loading, spinal and joint mobilization, and other forms of physical interventions that conservatively assist a patient in their healing process. In years past, a well-intentioned doctor might prescribe just rest and medication. Rest and medication alone are not a supported treatment approach. Harvard Medical School advocates conservative approaches that have become a mainstay of musculoskeletal intervention.7

In addition to advising patients to stay active rather than rest, clinical guidelines also de- emphasize imaging and opioids to diagnose and treat pain in most patients. This leads to better outcomes for both the provider and the patient: no matter the type of pain.

References

1. Centers for Disease Control and Prevention (2018). Prevalence of Chronic Pain and High-Impact
   Chronic Pain Among Adults — United States, 2016 [Online]. Available from:
   https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6736a2-H.pdf [Accessed 30 May 2022].
2. Yasaei, R., Peterson, E., & Saadabadi, A. Chronic Pain Syndrome. [Updated 2022 May 2]. In: StatPearls
   [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
   https://www.ncbi.nlm.nih.gov/books/NBK470523 [Accessed 30 May 2022].
3. Sheng, J., Liu, S., Wang, Y., Cui, R., & Zhang, X. (2017). The Link between Depression and Chronic Pain:
   Neural Mechanisms in the Brain. Neural plasticity, 2017, 9724371.
4. “Nerve pain (neuralgia).” Retrieved from healthdirect.gov.au on 30 May 2022.
5. Gerwin, R.D., Dommerholt, J., & Shah, J.P. An expansion of Simons’ integrated hypothesis of trigger point
   formation. Curr Pain Headache Rep. 2004 Dec;8(6):468–75.
6. Licciardone, J.C., & Kearns, C.M. Somatic dysfunction and its association with chronic low back pain, back-
   specific functioning, and general health: results from the OSTEOPATHIC Trial. J Am Osteopath Assoc. 2012 Jul;112(7):420-8

7. Shmerling, R. “Some medications don’t help back pain as much as we thought.” Harvard Health Medical, March2 2017. Available from: https://www.health.harvard.edu/blog/medications-dont-help-back-pain-much-thought-2017030211208 [Accessed 30 May 2022].

Accidental injury is among the leading causes of death in the developed world. In fact, it’s the fourth leading cause of death.

The pattern is all too common: an elderly person in relatively good health falls, breaks a hip, and never seems to recover fully. Health and quality of life declines precipitously, and within a year or two, it’s game over.

There is something you can do about the risk of falling when you age. working out can help prevent you from losing muscle and keep your strength so if you do trip you have the strength in your legs to stop you from falling.

There are two types of strength that can be trained Concentric and Eccentric. Working on both types of strength is important to prevent falls.

Eccentric strength is the strength associated with muscle lengthening, as opposed to concentric strength, which is the strength associated with muscle contraction. To illustrate what this means, imagine a bicep curl: we use concentric strength to contract the bicep and raise the dumbbell, but in order to lower the dumbbell in a controlled fashion, we need eccentric strength. Without it, gravity would cause the dumbbell (and forearm) to collapse down rapidly and without control.

In the video below I will demonstrate a simple but effective exercise I show my patient to build strength in their legs.

Dr. Steve, your local Elgin Chiropractor * Squatting* exercise. – YouTube

Go to our YouTube Channel to learn more about squatting.

Breathing is so easy how can we do it wrong. Well, you can, and it can lead to neck pain. I have found that most patients who have neck pain have some form of breathing function. Most show 90% of my neck pain patients breathing exercise to help them breath better.

Here’s the finding from a study; Patients with chronic neck pain have reduced respiratory muscle strength and pulmonary function compared with asymptomatic individuals, and this difference could be clinically meaningful.

• IMPLICATIONS FOR REHABILITATION
• Respiratory dysfunction has been observed in patients with chronic neck pain.
• Patients with chronic neck pain present a decrease in respiratory muscle strength and pulmonary function compared with asymptomatic individuals.
• Respiratory pattern disorders should be considered in the clinical context of chronic neck pain.
• Interventions focused on respiratory muscle training could be helpful for this population

Call Sikorsky Chiropractic Clinic at847-695-0464 or schedule online!

López-de-Uralde-Villanueva I, Del Corral T, Salvador-Sánchez R, Angulo-Díaz-Parreño S, López-Marcos JJ, Plaza-Manzano G. Respiratory dysfunction in patients with chronic neck pain: systematic review and meta-analysis. Disability and Rehabilitation. 2022 Jul 6:1-2.

Do you have leg pain, pain in the buttock?

You could have Piriformis syndrome.

Piriformis Syndrome: It’s not about the tennis ball

Pain in the buttocks? Then you may have heard about placing a tennis ball in a chair and sitting on it. The pressure from the tennis ball helps to relax gluteal muscles and relieve pain. But why is this? The answer is something called piriformis syndrome.

Piriformis syndrome

Piriformis syndrome is a common neuromuscular problem traditionally caused by spasm or enlargement of the piriformis muscle, resulting in compression or pressure on the sciatic nerve.

1 The sciatic nerve starts in your low back and travels near the piriformis, which is a deep muscle in your buttock.

2 The piriformis muscle attaches from the lowest part of your spine (sacrum) and travels across diagonally to your hip. And chances are, if you’re sitting while reading this blog, you’re sitting on your piriformis muscle right now!

As the sciatic nerve travels down toward your leg, it has a chance to become compressed underneath the piriformis muscle.2 In most people, the sciatic nerve travels deeply and safely beneath the piriformis muscle.

However, approximately one-fourth of the population is more likely to suffer from piriformis syndrome because their sciatic nerve passes through the muscle.

When the piriformis muscle is irritated or goes into spasm, it may cause painful compression of the sciatic nerve.

Think of a tightening noose around someone’s neck – that’s how the sciatic nerve feels when compressed by an overly tight or injured piriformis muscle.
The piriformis is the powerhouse of our buttocks and a wonderful companion to the rest of the gluteal muscles unless injury, muscle spasm, or anatomical anomalies occur.2,3 If this occurs, piriformis
syndrome can result.

What does Piriformis Syndrome feel like?

This neuromuscular condition is a genuine pain in the rear: Tenderness, numbness, and pain in the buttocks that extends down the back of the leg are the most common symptoms.

Other symptoms of piriformis syndrome include:
· Discomfort while sitting
· Pain while climbing stairs or walking
· Restricted motion in the hip
· Pain, numbness, or tingling traveling toward the foot
· Pain or burning-like sensation that worsens with flexion, adduction, and internal rotation of the hip

Symptoms often increase when you are sitting or standing in one position for longer than 15-20 minutes. Changing positions may provide temporary relief. You may notice that your symptoms increase when you walk, run, ride a bicycle, climb stairs, ride in a car for long periods of time, sit cross-legged, or get up from a chair.

What is NOT Piriformis Syndrome?

Piriformis can be mistaken for sciatica, an inflammation of the sciatic nerve that comes from the low back and travels down the back of the leg toward the foot.

Piriformis syndrome pain may be burning or aching in nature like sciatica symptoms, with pain in the posterior gluteal region migrating down the back of the leg.4 However, the cause of sciatica compared to the cause of piriformis syndrome is distinctly different.

There are various reasons why sciatic nerve entrapment occurs, but when it is caused specifically by the piriformis muscle, it is called piriformis syndrome.

There can be other conditions that happen alongside piriformis syndrome. Although these secondary conditions do not directly cause the piriformis to tighten along the sciatic nerve, they can contribute to
or complicate the problem.

These include:
· Sacroiliac pain. Because the piriformis muscle also arises from the capsule of the Sacroiliac (SI) joint, the association between piriformis syndrome and SI joint pain exists.4
· Femoroacetabular impingement (FAI).5 This distinct hip joint problem is caused by a change in the shape, or anatomy, of the major hip joint. The result is decreased internal rotation of the hip, which may contribute to contracture (tightening) of hip and gluteal muscles, and subsequent compression of the sciatic nerve.

What causes Piriformis Syndrome?

The onset of Piriformis syndrome may begin suddenly because of an injury or develop slowly in response to repeated irritation. Common causes of piriformis irritation or spasms can result from a strain, a fall
onto the buttocks, or catch oneself from a “near fall.”

In other instances, the process may begin following repetitive microtraumas such as long-distance walking, stair climbing, or sitting on the edge of a hard surface or a wallet. In many cases, a specific triggering event cannot be pinpointed.

The condition is most common in 40-to-60-year-olds and affects women more often than men. Your Doctor of Chiropractic is the best person to take a history and perform a physical and orthopedic
examination to determine if you have piriformis syndrome.

If you or someone you know is diagnosed with piriformis syndrome, the good news is, most cases are best and easily treated with conservative,
non-invasive interventions.

What is the best way to treat Piriformis Syndrome?

Pain and discomfort arising from piriformis syndrome is one of the most treatable varieties and is relieved by the type of treatment provided in our office.

Treatment may include stretching, myofascial
release, and correction of underlying biomechanical dysfunction.
You may need to temporarily limit activities that aggravate the piriformis muscle, including hill and stair climbing, walking on uneven surfaces, intense downhill running, or twisting and throwing objects
backward.

Changes in body position and ergonomics may include changing your sitting posture, not sitting on one foot, and taking frequent breaks from prolonged standing, sitting, and car rides. Other
forms of treatment may include aquatic therapy, physiotherapy, or a referral and co-management with another provider for NSAID medication or injections.

Thankfully, surgical release of the piriformis
muscle and decompression of the sciatic nerve is the last resort, and for good reason – most cases respond well to conservative care.4,5
References

1. Martin, H. (2017). Deep gluteal space syndrome. Chicago Sports Medicine Symposium: World Series of
   Surgery. Session XV: Hip Session II- Extra-Articular Hip and Pelvis Pathology.
2. Cass, S.P. (2015) Piriformis syndrome: a cause of nondiscogenic sciatica. Curr Sports Med Rep.
   Jan;14(1):41-4.
3. Fishman, L.M., Dombi, G.W., et al. (2002). Piriformis syndrome: diagnosis, treatment, and outcome–a
   10-year study. Arch Phys Med Rehabil. Mar;83(3):295-301.
4. Carro, L.P., Hernando, M.F., et al. (2016). Deep gluteal space problems: piriformis syndrome,
   ischiofemoral impingement, and sciatic nerve release. Muscles Ligaments Tendons J. Dec 21;6(3):384-
   396.
5. Newman, D.P., and Zhou, L. (2021). Piriformis Syndrome Masquerading as an Ischiofemoral
   Impingement. Cureus. Sep 16;13(9):e18023.

The answer is yes. Sitting on something like this can cause lower back pain. 

 This can cause you to become lopsided with a rounded, banana-shaped spine.   This hunch-like position puts more stress on the back and spine and can even cause a slouchy posture with slumped shoulders.   Muscles work harder to compensate, and joints become stiff and achy.  

The sciatic nerve gets pinched between your wallet, your gluteal muscles, and your hip. Even after a short time, the sciatic nerve can become irritated, causing discomfort that ‘zings’ down the back of the leg and into the heel. 

This condition is so commonplace that it has earned the nickname, “wallet neuritis,” describing the inflammatory response that happens to the sciatic nerve due to sustained compression.

What to do? 

Your best bet is to remove it from your back pocket
entirely before you sit down or get in your car.  You could switch your
wallet to your front pocket – but be warned that prolonged use of a wallet in this position can also pinch a nerve between the thigh and torso, especially when you’re in a car.  This can create discomfort as well. While at work, place the wallet in your desk, locker, or somewhere safe. You should also avoid anything bulky and stick to slim wallets or money clips that hold only the essentials.

If you’re having lower back pain call or click to make appointment.

The answer is…….. Yes. Foam rolling helps decreases soreness by decreasing muscle stiffness

Here’s a great study showing the effectiveness of foam rolling. Foam rolling is a great way to do some self-care. Whether you’re working out, gardening, or doing household chore. Muscles can get sore and tight.

Foam rolling is an easy and effective way to help break up and relieve. You can foam roll after a workout or in front of the tv at the end of the day.

Foam Rolling Prescription: A Clinical Commentary – PubMed (nih.gov) The Acute and Prolonged Effects of Different Durations of Foam Rolling on Range of Motion, Muscle Stiffness, and Muscle Strength – PubMed (nih.gov) Effects of 5-Week Foam Rolling Intervention on Range of Motion and Muscle Stiffness – PubMed (nih.gov)

A question I get all the time is: do Inversion tables help with back pain?

This study finds that Inversion tables can help lower back pain & spinal traction. Spinal Traction is a form of stretching. Inversion table provides pain relief in your lower back. An inversion table is not for everyone.

The 2-year surgery rate in the inversion participants in the registry (21%) was significantly lower than in the matched control group (39% at two years and 43% at four years). It was also lower than the surgery rate in the other 2 control groups. [Conclusion] Inversion therapy relieved symptoms and avoided surgery.

Lower back pain can be treated by a variety of treatment. Chiropractic, physical therapy, medication, home exercise. Inversion tables might also be part of your treatment. It can’t hurt and might help you improve your pain.

INVERSION LOWERS DISC SURGERY RATE BY NEARLY HALF 

Mendelow AD, Gregson BA, Mitchell P, Schofield I, Prasad M, Wynne-Jones G, Kamat A, Patterson M, Rowell L, Hargreaves G. Lumbar disc disease: the effect of inversion on clinical symptoms and a comparison of the rate of surgery after inversion therapy with the rate of surgery in neurosurgery controls. Journal of Physical Therapy Science. 2021;33(11):801-8. Link 

Can a wallet or a purse cause back pain?

“Purses are for girls, and back pockets are for boys.”

If you grew up with this train of thought for how to carry your wallet, then you might also know it’s a tough habit to break. 

Yet, despite being taught that wallets go into our bags or back pockets, we weren’t told that stashing our stuff could be bad for our backs or joints.  Who knew that sitting on a bunch of folded bills or stashing coins and lip balm in a shoulder bag can wind up causing aching shoulders, back, and neck pain?

Rather than teach us how to live better, we had consumerism marketing masquerading as advice.  The result: new purses were bought to help alleviate shoulder pain, and new jeans were purchased whenever the back pocket wore out.

How does using a purse or sitting on my wallet affect me? 

Carrying heavy shoulder bags, sitting with a wallet in your back pocket, and even heavy backpacks have one major consequence in common: lopsided posture.  Slipping your wallet into the back of your jeans or into your shoulder bag (which can also carry emergency bandages, spare pens, and the weight of a thousand other things to do) causes uneven weight distribution on the spine, hips, and shoulders.  Sitting with one hip higher than the other due to the bulk of a wallet creates a lopsided tilt of the pelvis or the sitting bones.  Something similar happens with a heavy purse: lopsided weight is consistently carried on one shoulder, weighing down one side compared to the other.  

The result is a person sitting lopsided with a rounded, banana-shaped spine.  This hunch-like position puts more stress on the back and spine and can even cause a slouchy posture with slumped shoulders.   Muscles work harder to compensate, and joints become stiff and achy.  

Sitting on a wallet or carrying a shoulder bag can also affect the nerves of our body.  Carrying a heavy bag over the shoulder can strain the muscles and nerves of the neck in an area called the brachial plexus.  Pinched nerves in this area can result in tingling and numbness down the arm, into the hand, and down to the fingertips. 

A similar effect happens from sitting on a wallet: the sciatic nerve gets pinched between your wallet, your gluteal muscles, and your hip. Even after a short time, the sciatic nerve can become irritated, causing discomfort that ‘zings’ down the back of the leg and into the heel.  This condition is so commonplace that it has earned the nickname, “wallet neuritis,” describing the inflammatory response that happens to the sciatic nerve due to sustained compression.

Even the thinnest wallet and lightest of shoulder bags can create these symptoms.

What can I do about it?

If you love your wallet or carrying a bag, however, all is not lost!  Some simple changes in your daily routine will help you keep using your cute clutch, nifty clip, or the leather wallet you received as a birthday gift.

If you must carry a bag, keep it to just the essentials: pare down your carrying case to make it more lightweight.  If you can, invest in a bag with a wide-banded strap that crosses diagonally over the torso.  This design helps balance weight between your shoulder blades, chest, and pelvis, and even helps prevent theft by making your bag harder to steal.  Consider switching to lighter gauge materials such as nylon, long-strand cotton, or canvas that are also durable with wear and functional to use.  At the very least, alternate shoulders to prevent one side from maintaining the bulk of the weight.

Waist bags (or fanny packs as some call them) are fantastic to avoid the shoulder region altogether.  Plus, there are many fashionable styles that are also functional!

For wallet users, your best bet is to remove it from your back pocket entirely before you sit down or get in your car.  You could switch your wallet to your front pocket – but be warned that prolonged use of a wallet in this position can also pinch a nerve between the thigh and torso, especially when you’re in a car.  This can create discomfort as well. 

While at work, place the wallet in your desk, locker, or somewhere safe. You should also avoid anything bulky and stick to slim wallets or money clips that hold only the essentials.

The bare minimum advice is to alternate back pockets to carry your wallet if you must use the back pocket to carry your wallet (or a similar object) at all.  This helps evenly distribute the lopsidedness when sitting as well as wear-and-tear on your pants.

What if that’s not enough?

We can take care of you at Sikorsky Chiropractic and Fitness. We perform a detailed history of your injury, followed by a functional movement assessment and examination.

If you have been carrying a purse or sitting on your wallet for many years, this may be a cause of shoulder pain, low back pain, and even pelvic imbalances. We recommend scheduling a chiropractic visit to evaluate any muscle aches, imbalances, or joint problems you may have.  We can help identify postural compensations or spinal fixations that result from wallet and shoulder bag ergonomics and provide other alternatives to keep you functioning, feeling great, and your belongings safely stowed where you need them.

References

1. Siddiq, M., Jahan, I., & Masihuzzaman, S. (2018). Wallet Neuritis – An Example of Peripheral Sensitization. Current rheumatology reviews, 14(3), 279–283. 

2. Lutz, E.G. Credit-card-wallet sciatica. JAMA. 1978;240(8):738.

3. Viggiani, D., Noguchi, M., Gruevski, K.M., Carvalho, D.D., and Callaghan, J.P. The Effect of Wallet Thickness on Spine Posture, Seat Interface Pressure, and Perceived Discomfort During Sitting. IISE Transactions on Occupational Ergonomics and Human Factors. 2014;2:83–93.

4. “Heavy backpacks and children.” Southwest Scoliosis Institute. Retrieved from https://scoliosisinstitute.com/heavy-backpacks.

5. Rempel, D.M., and Diao, E. Entrapment neuropathies: pathophysiology and pathogenesis. J. Electromyogr. Kinesiol. 2004;14(1):71–75.

6. Mwaka, E.S., Munabi, I.G., Buwembo, W., et al. Musculoskeletal pain and school bag use: a cross-sectional study among Ugandan pupils. BMC Res Notes 7, 222 (2014).

7. Amyra Natasha, A., Ahmad Syukri, A., Siti Nor Diana, M. K., Ima-Nirwana, S., & Chin, K. Y. (2017). The association between backpack use and low back pain among pre-university students: A pilot study. Journal of Taibah University Medical Sciences, 13(2), 205–209.