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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
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.
What can I do, I have back pain…?
The best things to do for a bad back pain episode has challenged people and medical doctors for generations. In the 1980’s bed rest and even a hospital stay was the best option in the USA. In England traction was thought to be the answer to a tight contracted back, that was to gradually stretch it out. Some people had two weeks of traction as the best medical care. Today in England the main medical approach is to provide anti inflammatories and mild over the counter pain killers, with a physiotherapy referral (within a few months). The physiotherapy approach to back pain is to provide reassurance at first. Typically an episode is bad for 3-5 days and can be felt to some degree for 4-6 weeks. People’s episodes are normally over by the time a hands on approach from the NHS is provided. The way the first back pain episode is cared for can have a knock on effect to future pain episodes. If you don’t get fixed at first it just keeps on coming back until you either get fixed or get used to having back pain episodes. 1-3% of back pains will have a sinister aspect eg a red flag such as a collapse fracture
It has been known for 15 years that anti inflammatories are enzyme inhibitors that alter the natural balance between cyclooxygenase (COX) and lipooxygenase (LOX) enzymes. Altering any natural balance creates a drive to re-balance leading to more COX enzyme increasing inflammation after 2 hours. Yes there is a decrease in inflammation in the first 30-60 minutes, then a rebound increase in inflammation begins to develop surpassing previous inflammation levels at about 2 hours after taking the NSAID (Ibuprofen). The marketing of anti inflammatories is highly suggestive having a strong impact on a lot of people.
Recommendations are now recognising that for acute low back pain the best approach is to rest for the first day, then allow yourself to move around as normally as possible, light duties and slow. Consider Chiropractic Care to help (not only this episode but also future episodes – having chiropractic care for your first episode can actually prevent the next episode form occurring).
According to advise from Harvard University medical Doctors, Chiropractic Care is a very good idea. See for yourself at http://www.health.harvard.edu/blog/heres-something-completely-different-for-low-back-pain-2017070611962
Fascia as a sensory organ
The connection between the tissues of the human body bring all body components together on the inside. This connection is known as fascia. Sensory nerves (pain fibres) are densely packed into the superficial fascial layer. This superficial layer lies between the dermis and the deeper fascia. One could paraphrase that the underside of the skin and the top side of the skin are both well innervated by nerves; with the underside being more densely packed with sensory nerves (pain receptors). Whilst the outside of the skin has a greater variety of specialised nerves.
The way the superficial fascia is innervated confirms the idea of Andrew Taylor Still (Father of traditional Osteopathy) that the fascia of the body is a ‘sensory organ’. More recently Helene Langevin wrote about ‘a body wide signalling network’. How information is relayed to the brain, about the body. Udup also showed an interaction between the endocrine system and fascia in his research on hormones and yoga. The human brain, seems to me, to be calculating the movement of your body based upon sensory information from fascial tissue. Thus the condition of the fascia in your body can aid or hinder how you move (proprioception), how you feel and what hormones are being produced.
If you have an inefficient (relative to your most efficient) body you might experience delayed onset muscle soreness (DOMS). Called ‘muscle soreness’ yet it is accepted that the soreness is in fact from fascial tissue. Soreness from within your fascia can mean abnormal loading and conflicting sensory motor signals are occuring within your nervous system affecting your proprioception. Abnormal loading of fascia can lead to pain of a variety of intensities. Making identifying what you are doing to bring on the DOMS or pain difficult to pin point. Adversely loaded fascial tissue can give rise to what is traditionally thought of as ‘nerve pain’ or nerve root pain. As well as other types of pain.
Next time you are thinking you have a stubborn old injury, nerve issue, strain or sprain, perhaps you need your fascia attended to? This is why with fascia first chiropractic fascia is included along with your other body tissues as a potential source of pain and discomfort. (Fascia information above was collected from JBMT 2015 No.19). (Picture above from ‘stroll under the skin’ by Guimberteau)
Working through it…
When you are a can do-er working through discomfort can be a part of your life. Pushing the envelope to grow toward your potential is commendable and I thoroughly recommend it. When you do work through a discomfort (or a pain) you can psychologically move to a new normal; no problem. Psychologically we have no boundaries. Physically we do; the most obvious being your skin less obvious being dysafferentation.
Due to the lack of knowledge that humans have about a human body we humans can sometimes create more problems than we solve when we push through it once. When we push through it more than once we can accumulate (learn bad habits) errors. As we move with error we abnormally load our body tissues. Abnormal loading of body tissues leads to degeneration. Normally loaded tissues last a lifetime. If you are broadening your horizons your body might just thank you now for regularly taking it to Fascia First Chiropractic. Your psychology can thank you later as you enjoy your body for years longer. This is of course my opinion but here’s a little of the why:
- The fascia of the human body talks to the brain telling it where and how your body is.
- The superficial fascia is densely packed with pain fibres.
- Fascia is the reason (not muscle tissue) why you get D.O.M.S. (delayed onset muscle soreness) after exercise.
- Fascia has more free nerve endings in it than your eyes; so the potential for pain is very high.
- Under abnormal loading fascia can grow in on itself creating an ‘in-growth’ of highly pain sensitive tissue. Perhaps how something seems to ‘go’ without due provocation.
- The fascia is responsible for housing nerves. The nerve sheath is innervated by the nervi nervorum and could be the cause of ‘nerve’ pain. Fascia can also mimic muscle pain….
- Increased adrenergic signalling in the fascia leads to a vasoconstriction of blood vessels slowing up nutrient delivery to your fascia. This could worsen an immune condition, a pain syndrome or a symptom that seems to be ‘stress related’.
- Autonomic tone can change fascial stiffness; When you are stressed your autonomic tone will change as will the stiffness of your fascia (body). This stiffness needs to be balanced not just worked out.
- The fascia feeds information into your insula nucleus in your limbic brain about the pH, temperature and ion content of your connective tissue. Your limbic system can alter your ability to handle stress, socially interact well, and alter your sensitivity to fear and pain.
- An immune response can also stiffen your fascia through a marker known as TGF-B1. Think of how you might stiffen up and get achy when you have a bad bout of the flu. Yes it needs balancing out afterward. An autoimmune condition is when you are stuck in a constant immune response and an allergy is an immune response to a given irritant.
Fascia First Chiropractic is more than a quick click. Fascia is behind the rate at which you are currently stiffening (ageing) over time.
Source: Tozzi P. (2015) Journal of Bodywork and Movement Therapies 19 310-326.
Stroll under the Skin A you tube video where you can see and learn more about fascia.
How might Back Pain run in families..?
Two recent studies seem to have conjoined in my mind; one is from Zurich University Chiropractic department showing brain activity relative to lumbar spine pressure such as might happen in low back pain syndromes. The other is about training mice to ‘fear’ a smell across their generations controlling for nurture. Answering the long debate of nature versus nurture. Researchers showed that without nurture the cue for a fear response can still be passed on.
The first study carried out in Zurich; showed that back pain is linked to a part (nucleus) of the brain involved in social pain. What if we as humans could pass on in our genes information that affects the life experience of the next generation? You may find yourself as an individual with a back symptom from ‘nowhere’ due to an ancestral social cue. In generations passed going out of favour with the group could have had deadly consequences.
The second study was published in Nature Neuroscience (2014; 17, 89-96) demonstrating a transference of a fear response genetically; without nurture. The mice were shown to pass on a (protective) smell memory to their children and their grandchildren (F2).
If we as a species can have an ancestral cue for a social stress causing back pain passed on from family member to family member and social stress is not considered in your care plan. You could be forgiven for thinking that you have to ‘live’ with pain. Identifying potential cues from your environment ‘stressors’ to your behaviours, thoughts and/or feelings can be methodologically worked through. Whilst you figure out the cues to your stresses consider having body work to help you with accumulation. Accumulation in my opinion can make your condition worse.
I think when human body tissues are abnormally loaded the tissues do not undergo a training effect and instead are strained. Having a genetic fear response in social conditions where I reflexively squeeze my back muscles from an unidentified cue, providing pressure on my vertebrae, would be an abnormal load; like a repetitive strain scenario on the low back tissues of the body. Choose fascia first chiropractic it is more than a ‘quick click’.
