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Muscle Pain
Commonly muscular pain is talked about when a person considers their pain to be a non serious pain. However muscle pain can be intense, constant, long lasting, and out of proportion with the severity of actual tissue damage.
One component of muscular injury is hypo-perfusion of blood. Anything that can cause a reduction of blood to the muscle can give rise to pain. This could be a magnesium to calcium ratio imbalance, a short term increase in muscle use, normal regeneration of muscle tissue (we break down and build muscle every day), exercise induced break down and build up of muscular tissue (over done it or DOMS), poor posture, or disuse atrophy (yes doing nothing can give rise to a pain experience!).
Mechanisms of Myofascial Pain were further elaborated in a recent paper (1). In which trigger points were talked about. I have worked to understand trigger points for the last 20 years, including seeing a paper written by an Orthopeadic Surgeon in a prominent Journal that trigger points do not exist. If I find a prominent point that triggers pain then I’ll call it a trigger point, controversially, even when no twitch response exists. Trigger points are well established in their pain referral. A quick Google and you’ll see the images of where muscles can refer their pain.
When looking to resolve muscular pain approaches of paracetamol, ibuprofen, codeine, capsaicin amongst others are all products to help you cover up the experience of having pain. A Chiropractor may be able to offer a muscle a way of not only resolving the cause of muscular dysfunction and hypo perfusion but also to aid the rehabilitation of training your muscles to ‘centrate’ around your joints. AKA Muscular Balance. If you believe you have muscular pain and it has lasted more than 3 days then consulting with a Chiropractor may be just what your body ordered. Before you get used to it and your symptoms die away anyway. Leaving you thinking that you’ve gotten over the issue yet future re-occurrences will inform you that you did not.
The question to ask yourself is when my muscle pain symptoms ‘settle down’ have I gotten used to it or have I healed it? The phenomenon is called ‘accommodation’ in Neurology. Accommodation is what happens when you are in a bad smell- you get used to it, and it is, as if the bad smell had gone away…
(1) Saleet-Jafri, M (2014). Mechanisms of Myofascial Pain, A Review Article. doi: 10.1155/2014/523924
Morning Stiffness..
Morning stiffness can change with age! The stiffness I refer to is of joints and muscles, the commonly accepted symptom of ageing, that doesn’t make sense from a purely chronological perspective.
Muscles and joints can become stiff for many reasons (see last post). One of those reasons is linked with the activity of the immune system. I’m sure being stiff and achy in muscles and joints during a bout of influenza is a common experience that most adults will have known at some point in their life. Here’s the science. When I become sick the autonomic nervous system up-regulates activating smooth muscles in fascia. As a consequence of the smooth muscle activity fascia restricts muscular activity preventing full range of joint movement. Stiffening fascia also produces TGF-B1, which increases T cells, a type of white blood cell, aka the soldiers of the immune system.
Immune system soldiers are mobilised during the defense to something in the (inner or outer) environment (perceived and/or real).
Your Chiropractor’s job, when you are under the weather, is to know the likely source of muscle and joint stiffness and to check your muscles and joints have returned to their most efficient normal once your ‘influenza’ or illness has passed. It is possible for your muscles and joints to stay stiff after your immune system has switched off the defense.
A Chiropractor can re-boot your muscular tone and your joint mechanics helping your muscles and joints to healthily communicate with your brain. Lessening the phenomenon where your muscles and joints learn to have a stiffer and stiffer normal over time. An accumulated progression or adaptation.
Yes there really is a muscular component to an immune response. Whilst your chiropractor can’t magically cure your illness they can help you with the muscle and joint component to what you are going through.
What it means to have a sensation of stiffness…
When you have a lot to get done, people relying upon you, demanding work, a busy social life, family expectations and the mundane of the everyday tasks that ‘need’ doing one can paraphrase this experience as stressful. Stress as a word has so many meanings it may as well be equivalent to no content. When we are running the health gauntlet of life with so much on, it is easy to forget how to be one’s self, the nervous system up regulates to help meet the psychosocial demands of life. Meeting the demands of life like increasing the heat from a fire by placing paper on it our nervous system turns up the sympathetic drive. Not as in something approaching empathy a part of the nervous system so called because of its anatomical placement adjacent to the spine. How much we are using our sympathetic nervous system or in other words how stressed or in another way how much we have on in our life can have a bearing on how stiff we notice our body to be. A fascially astute chiropractor can help with this.
Fascial Tension can be regulated by the sympathetic nervous system through the activation of smooth muscles causing a contraction of fascia. Another more confusing scenario is when smooth muscles go into spasm which is a flaccid situation and thus not hold tension in the fascia at a certain place displacing tension to another ‘normal’ area. A note to body workers: do not presume that the pain stiffness or restriction is a primary in need of intervention until you are sure what you have found is not a compensation. Furthermore adrenergic nerve fibres cause a vasoconstriction reducing blood supply to the area facilitating the steady incremental ‘drying up’ and degeneration of fascia.
Bringing to the fore the question; is a virtuous busy life, without chiropractic care, attributing to your stiffness? The likely answer it seems is yes and without a fascially astute chiropractor in your corner you may well be heading toward a stiffer experience of your body.
Tozzi P (2015) Journal of Bodywork and Movement Therapy 19 310-326.
Psychosocial Determinants of Musculoskeletal Pain
Musculoskeletal pain is essentially pain felt in the body or thought to be coming from muscles and joints (tendons, ligaments and fascia also). Psychosocial describes factors in a persons life that affect, impact, alter or change the way a person thinks and socialises.
I joke in my practice that the cause of back and neck pains, headaches and migraines is work! Therefore curation of such pains would occur if work was given up. In reality it is the perceived control, support and satisfaction of a person within their role at work, the spending of their time as well as inconsistencies between effort and reward that have been highlighted as features of psychosocial (pain) factors in the workplace. (1)
The interaction we have with our pain and the common brain states that we reside in will also affect our experience of pain. Disproportionate pain, where pain is intense yet tissue damage is minimal, can trigger fear avoidance behaviour which is a strategy in real life to keep an experience. Replace pain with pleasure and take a moment to consider how much effort would need to be diverted to your strategy of living a life to avoid all pleasure. A strategy that would inevitably make you hyper-vigilant about pleasure experiences drawing your attention to, not away from, pleasurable experiences.
Chiropractic Care includes the advice and knowledge passed to you by your chiropractor about your symptom experience. Gaining insight into why you might have a painful body can relieve the intensity and duration of your pain. Facilitating improved muscle and joint balance through Chiropractic adjustments complements your insight derived from talking to your knowledgeable chiropractor. Chiropractic Care is an opportunity to learn a new normal whilst unlearning the unwanted, old (painful) normal.
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Vargas-Prada S and Coggon D Psychological and Psychosocial Determinants of Musculoskeletal Pain and Associated Disability. Best Practice and Research: Clinical Rheumatology 2015 June; 29(3) 374-390.
When deep pain is not deep trouble
Croton Oil an old psychiatric punishment for patients being held at a psychiatric hospital and is these days used for skin exfoliation. When Croton oil is topically applied it can give us an idea of the type of pain that originates at the dermis, the most superficial section of fascia in the human body. Croton Oil brings on a sharp pain experience coupled with a deep pain experience when applied to the skin. This fact enables us to imagine the pain pathways from fascia that relay the sharp and deep pain experiences. Deep pain does not necessarily mean a deep structure is in play or injured. Neither does sharp pain, often called an acute pain, mean that we have active damage and a nerve entrapment. Fascia can give rise to both deep and sharp pain experiences and thus should be a first port of call for people who have these experiences before their logical mind starts to relay to themselves that they have a nerve problem or a deep seated defect within their body.
Keeping on top of your fascial condition can be done with regular variety of movement (Tai Chi, yoga and Pilates) and with regular chiropractic care, in my humble opinion. don’t let it build up keep treatment simple and virtually painless and keep yourself well.
Fascia.. ‘I’m over it’..
Tom Myers is well known to have disseminated knowledge of human anatomy whilst attempting to tie into his Rolfing practice the felt experience of having a human body. Myers has been touted as the Father of Fascia, quoted by a Canadian Masseur come science writer as being ‘over it'(1).
The architecture of the cell is remarkable for many reasons, the one of importance here is that when a cell is under tension from its environment as opposed to tension within its inner environment a change in genetic expression occurs. Yes! The nucleus of a cell alters the expression of its available genes from external tension placed upon the cell. If my body to some degree is a collection of cells that exist within the medium of my connective tissue. Then differences in connective tissue tensions have a genetic difference in how my cells within my body express the 23,000 (ish) genes I possess.
Allowing for markedly different function(s) to occur in adjacent areas of the body. Undoubtedly in my mind having an effect upon the mechanics of the area and the felt sense of the area and of the inner experience of the area; not to mention a different physiology of the area. A different genetic expression may give rise to a strength, or a vulnerability, altering ones health.
Is the falling rate of male fertility in modern society a result of immune system dysfunction? eg leukocytospermia. The dysfunction of white blood cells has been linked to MMP signalling proteins which also interact with c fibres of the nervous system (a route to give a pain signal). To summarise genetic expression, immune function and pain levels are all linked by science to connective tissue tension (aka fascia).
Are the rising levels of immune dysfunction (demonstrated by an over reliance upon antibiotics), the rise in autoimmunity disease rates and the rise in medically unexplained symptoms all a function of a change in the tensions placed upon our body tissues, because we just do not move as much as we did?
Fascia is one view of the body and in itself is not representative of the entire conglomerate of the human body and tells us nothing of the human (interoceptive) experience of having a body. A professional body worker (dancer yogi Qi Gong instructor included) would be well advised to have an adaptable view of the human body and not become any one tissue centric about their approach. After all as a teacher, instructor, therapist, chiropractor, osteopath or physiotherapist the outcome of a patient is not a function of how right you are!
Keep going science you have a long way from which to ‘catch up’!
(1) Ingraham P Does Fascia Matter? A Science Review of Fascia
How Not To Utilise Chiropractic Care!
Chiropractic Care includes the interventions and advice given to you by your Chiropractor in your treatment session. I don’t really know why but some people save up a long list of things for their Chiropractor to ‘fix’ during a session. Perhaps it is value for money or not feeling as though you need much help until there are a lot of things to get fixed. You’ll have to decide for yourself…
When something for whatever reason goes wrong in your body, your body in another area will compensate or try to help and this process of help will continue until you die unless the original problem is ‘fixed’. Leaving it a longer time frame just means more compensations and more compensations make it harder to find the start of the chain of compensations (the real problem).
Getting the best from your Chiropractor would involve the 3 day rule (if you are not fixing your symptom within 72 hours then you are incorporating it into a new normal and not fixing it. This is why most niggles clear up in a few days. getting an appointment on day 4-10 is optimal.
To get value for your money have a check up / treatment 1-4 times a year and get an appointment for a new symptom between day 4 and 10 of when it first started as long as it lasts more than 3 days. If it went away in less than 72 hours there is no need to see your Chiropractor.
Rib Pain…in Pregnancy…
Muscle and joints are a relatively common cause of chest pain¹. Costochondritis a condition that is characterised by point tenderness over the rib and sternum join that reproduces the pain complained of combined with the same side arm movement reproducing that pain too, usually the point is at the 2nd to 5th ribs and sternum join². Not to be confused with Tietzes Syndrome which includes swelling and more likely in older persons and does not get aggravated by same side arm movement. Medical training tells one that costochondritis is a self limiting problem that will go away on its own with advice to take pain killers and do nothing, even if you are pregnant.
The arm movement and a recreation of pain can be indicative of nerve involvement that is unable to slide due to unco-ordination of intercostal musculature. Notably Obliques and Transversus Muscles, but Latissimus and Serratus Anterior can also play a part in faulty rib movement patterns. Yes underlying myofascial imbalance can give rise to costochondritis and can be brought on by the development of the bump in pregnancy. accentuating previously asymptomatic myofascial imbalance.
Treatment of costochondritis has been successful with manual therapy³. The over riding concern of continuing on with muscular imbalance is that our brain will adopt your myofascial imbalance as normal. If you don’t use it you lose it; you lose the body component you do not use from the map of the body in the brain. This map is competitive and neuroplastic meaning it is adaptable and does not have any ideal or starting reference. There is no factory reset or blueprint of ideal / perfect movement of your intercostal, latissimus or serratus muscles. Your normal is what it is.
Having a myofascial imbalance that leads on to chostochondritis during pregnancy can have knock on effects during delivery. Intercostal muscle function has been shown to be predictive of delivery experience and likely complications from the expulsion phase of birth (4).
In my opinion the best interests of any women who is pregnant with costochondritis would be to resolve the issue with manual care as soon as possible. Don’t worry your bump need not get in the way.
References:
- Smythe H and Fam. A (1985) Musculoskeletal Chest Wall Pain. Canadian Medical Association Journal 133(5) 379-89
- Proulx A and Zyrd T (2009) Costochondritis: Diagnosis and Treatment American Family Physician 80 (6) 617- 620
- Rabey I (2008) Costochondritis: Are the Symptoms and Signs Likely Due to Neurogenic inflammation. Two Cases that Respond to Manual Therapy Directed Toward Posterior Spinal Structures. Manual Therapy 13(1) 82
- Demaria, F., Porcher, R., Ismael, S. S., Amarenco, G., Fritel, X., Madelenat, P. and Benifla, J.-L. (2004), Using intercostal muscle EMG to quantify maternal expulsive efforts during vaginal delivery: A pilot study. Neurourol. Urodyn., 23: 675–678
Is a Stiff Spine really Stiff?
A recent Scientific Report published by Nature looked into perceived stiffness of the spine and actual stiffness of the spine and found that when people feel as though their back is stiff it is a lack of sensory motor integration and not directly due to stiffness in the back. The prediction system of the brain uses multi sensory information to predict the movement parameters of our body. When multiple sensory inputs are not integrating then the parameters can be confining felt as a stiffness in the back. The ability to co-ordinate the sensory information of the body in the brain can result in a stiffness perception that is independent of actual stiffness.
The integration of multiple sensory signals, is what can be confused or muddled that result in back stiffness problems. When integration occurs it means that Sensation A and Sensation B are needed simultaneously to understand the body in the brain map of the body. When Sensation A occurs out of sync with Sensation B then the back can feel stiff but not actually be stiffer.
I like this paper because it may help people to step out beyond the ageing model of back problems, the lingering injury / degeneration models and the useless ‘out of place’ and ‘symmetrical’ models.
When the sensory motor experience of our body goes out of kilter we can become better at feeling changes in force generated by muscles having the knock on effect of heightening protection mechanisms because we are not expecting that much effort to move in a comparatively small way.
Regular (Annual or biannual) checks of your back by a Chiropractor is important whether you are in a sense of stiffness, or not. A Chiropractor can help to re-integrate the sensory motor experience of your body.
Nature Scientific Report 7: 9681 (August 2017)
Abdominal Pressure
Symptoms associated with abdominal pressure dysregulation can include back pain, hip pain flank pain (kidney region), bloating, heartburn, vomiting and diarrhoea. The abdominal musculature should fire in response to lower limb movement. Notably the transverse abdominus muscle, but also the obliques, rectus abdominus and lower multifidus (back muscles) are active, ready for lower limb movement (The core). When the transverse muscle doesn’t work with the multifidi muscles then the quadratus lumborum (QL) tries to take over. The QL (a back muscle) is a notoriously overactive muscle in the experience of acute and chronic back and hip pain. The QL can also be found commonly involved in chronic recurrent lower back and or hip pain. Essentially the QL tells us that our core is not functioning well, in particular the automatic readiness of the transverse, obliques, and multifidus muscles to our normal lower limb movement is dysfunctional.
The QL is the help or aka compensation. Treatment to reduce the tightness of the QL is in fact taking away ‘the help’ the body is providing for itself and thus unhelpful in the long run. However such a strategy may be symptomatically relieving in the short term.
‘Abdominal Pressure Dysregulation’ Symptoms were published in the New York State Journal of Medicine 54:1324-1330, 1954
