The following statement may be the most important concept you will ever learn when it comes to overcoming your pains and injuries.....Ready?
Most muscle / joint pain and injury is the result of 2 very correctable causes:
1. Abnormal body mechanics (muscle and joint imbalances, posture/alignment, movement), and
2. De-conditioning (out of shape, not specifically physically prepared for the stress that the body encounters).
Injuries can result from a large, one time macro-stress (slip, fall, lift, crash), or from smaller repetitive micro-stresses that build up over time (posture and movement abnormalities, or fatigue). Regardless of the type, injury occurs because your body cannot withstand the stresses that are imposed on it. Sometimes it is your level of strength and endurance that fails to stand up to the stress (physical conditioning). At other times, it is muscle imbalance, posture, or incorrect movement (body mechanics) that fails to stand up to the imposed stress.
All of these many varieties of stress cause the same end result- a tearing or breaking of some body soft tissue (muscle, ligament, tendon, cartilage, disc, fascia, nerve, etc.). Even in cases of degenerative conditions such as arthritis, stenosis, degenerative discs, spurs, and re-aggravations of previous conditions, the result is the same- torn or broken tissue fibers. When most tissue fibers break, nerves are stimulated which causes pain to be experienced. Pain is the first reaction to injury. It is the natural warning system of the body to avoid more damage. Listen to this warning and avoid any aggravating activities! The next reaction of the body is to begin a "protect and repair response". The protection comes in the form of muscle spasm to avoid any additional movement that may further aggravate the damage. The repair comes in the form of a 3 phase response known as the inflammatory process.
Inflammation is the initial phase during the first 3-5 days after you injure yourself. Here, the body attempts to break down and remove damaged tissue. The increased blood supply and this initial process causes swelling, while local muscles tighten in an attempt to brace and protect the injured area. The next phase (repair) of the damaged body part begins with the laying down of new soft tissue fibers by fibroblast cells over the next 2-6 weeks, as the broken parts are mended together with new fibers. These new fibers are laid down both in the same direction as the original damaged fibers, and also in many other directions, which results in a local thickening or "scar" known as fibrosis. Tiny new nerves and blood vessels grow inbetween the dense fibers of the scar (angiofibroblastic proliferation), which can become irritated when you move the injured area causing more pain. The final phase of repair (remodeling) may take up to two years, as the body breaks up all the fibers in the scar that are not oriented in the same direction as the original tissue. This breaking up of excess fibers occurs through daily motions of the injured body part. For optimum healing, these motions must be in the correct direction of movement, done with proper body mechanics, and they must occur through an optimum range of motion. If these motions are dysfunctional, or too great for the healing fiber's current strength level, they may tear again.
This 3 phase inflammatory process is what is actually happening with your ongoing pains. It is the same, regardless of your diagnosis: strains, sprains, tendinitis, tendinosis, neuropathy, radiculopathy, sciatica, carpal tunnel, arthritis, arthrosis, degenerative discs, herniated discs, meniscus tears, bone bruises, stenosis, facet syndromes, spurs, plantar fascitis, shin splints, stress fractures, impingement syndromes, bursitis, and practically every type of injury and pain you can think of.
It is important to note that discs, cartilage and menisci do not have deep internal blood vessels and nerves, so some may argue that they can't be painful, but they do have peripheral ones, as well as associated soft tissues that are susceptible to the above inflammatory process. All sensitive tissues are sensitive because they are in some stage of the healing (inflammatory) process.
Another concept of musculo-skeletal pain is understanding that injury is an absorbed force that cannot be properly handled by the body tissues. The increased energy that is absorbed by the damaged tissue alters the arrangement of molecules within the tissue protein fibers, causing the fibers to become stiff and rigid. The body's tissues are made up of proteins, which act as semi-conductors, storing and conducting electrical charges through the body. A rigid tissue has a different electrical frequency than a flexible tissue. The more energy imparted with the injury, the more energy will be stored by the damaged tissue, the greater its electric charge, and the more rigid it will be. This area of rigidity will also be more likely to become re-injured because rigid tissues absorb more force than do flexible ones. Healing is associated with the release of this stored energy, and a normalizing of the tissue's electric charge and frequency.
Ideally, all goes well in the above healing process, and chronic, long standing pain, as well as recurrent pain never happens. Realistically, this is rarely the case. Re-aggravations to the injury are frequent before the damaged tissue is fully repaired. These re-aggravations begin a whole new inflammatory process. Multiple re-aggravatioins result in multiple phases of the inflammatory process occurring at the same time in the same region. The end result is the damaged area has excess fibrosis (scarring), increased rigidity and electric charge, excessive tiny nerves and blood vessels growing in it (which are ultra pain sensitive), decreased flexibility, and decreased strength and endurance (from not using the body part in an effort to avoid pain). It is also common for these damaged tissues to be under ongoing, aggravating stresses due to the same faulty body mechanics (posture, alignment, muscle imbalance, faulty movement habits) that may have caused the injury in the first place. As your body is trying to heal, the same stresses that caused the injury are still stressing the injury, making it impossible to heal. Add to this the common decreased threshold for feeling pain in the central nervous system (central sensitization), that develops due to the constant bombarding of the nervous system with pain signals- and is it any wonder that so many people suffer ongoing pains? With constant stress, congestion of phases of healing, and a nervous system that feels pain easier with less stimulus, you now have the picture of most chronic pain conditions.
What then is the answer to resolving pain?
The answer is not to mask the pain with medications and alcohol. These don't permanently solve any of the above problems. Anti-inflammatories (injectable and oral), as well as muscle relaxants are usually temporary solutions as well. That is not to say they do not have their place in managing pain short term. However, long term effects of any medication are well known and many are quite dangerous. You don't want more health problems as a result of your present problems. Discuss the risks of any medication with your doctor, especially those suggested for long term use.
Electrical stim units can relieve spasm, reduce swelling, and decrease pain sensation, but usually are best used early in the injury process. "Rub on" ointments can irritate the skin surface , which stimulates certain nerves that "fool" your nervous system into feeling the skin sensation more than pain. If your goal is to mask the pain, then they are an option. Rest from aggravating activities is wise, but complete or excessive rest is a common problem that causes deconditioning and a lack of local circulation to the injured area, both of which stunt the healing process.
Surgery is the right choice if your pain requires a piece of damaged tissue to be removed (torn cartilage, nerve compression, impinging spur, etc.), or if you have a third degree tear of your tissue, which means the ends no longer meet, and conservative care has not helped. Other reasons for surgery include severe instability of a joint, or severe joint erosion (hip replacement), as well as joint infection, or autoimmune damage and bone destruction. However, the vast majority of most musculoskeletal pains do not fit these criteria, and as previously mentioned are related to improper body mechanics, de-conditioning, and a congested multi-phased inflammatory process, where the body is "stuck" in its healing.
You must get to the root of your problem for lasting relief and a full return to the activities you enjoy. Even if you use any of the above options for pain treatment, they usually do not solve your real underlying problem that set the stage for injury and pain in the first place.
The real answer is a two step process that allows your body to fully heal itself. First, the excess fibrotic scarring must be removed, which will decrease the painful pulling on local nerves and blood vessels. Second, and more importantly, you have to correct the two inital causes of pain and injury that caused the entire problem in the first place- these being abnormal body mechanics and de-conditioning.
It is very important to stay away from any aggravating activities while you begin to address these two steps. Healing requires a balance between doing the right things, and avoiding the wrong things. It makes no sense to begin gentle stretches and exercises if you are still participating in activities that are aggravating your pain. Healing is impossible if you keep doing the things that are tearing your soft tissue fibers.
Rest from offending activities and typical rehabilitative exercises which include stretching the fibrotic scar, decreasing local rigidity, and strengthening the damaged tissues are not enough. I have an entire practice filled with patients who have been through deep tissue massage, soft tissue and joint manipulation, and tons of physical therapy /sports rehab only to still have pain, and not be able to engage in the physical activities they once enjoyed.
That is not to say that all of these are not helpful, but they are not fully addressing the above mentioned two main causes of most pain and injury. The real answer that most people need is to correct their unique body mechanical problems, and condition their body through individualized exercises that address their specific physical needs.
By analyzing a person's unique posture and alignment, muscle imbalances, movement patterns, and physical conditioning (including strength, coordination, flexibility, stability, balance & endurance), a proper individualized healing exercise program can be created which corrects all of these issues. The injured and painful body can be brought back to a pain free and fit state of well being.
What can you do to help yourself?
Any muscle or joint pain that is not resolving on its own in two weeks, is severe, or progressively worsening, is associated with a major trauma such as an accident, or is associated with a fever, weight loss, significant swelling or discoloration, nerve or circulatory symptoms, change in bowel or bladder function, or genitourinary symptoms should be checked by a licensed health care professional. It is important to rule out infection, cancer, organ and systemic problems, as well as surgical emergencies first. Remember that for some conditions, surgery is the proper route. However, body mechanics and deconditioning need to be addressed post-surgically.
Ice applications (cryotherapy) for 15-20 minutes on a painful area is indicated during the first phase of the inflammatory process (first 3-5 days after injury or reaggravation) in an effort to limit inflammation and swelling. Pain free (gentle) motion during the ice applications is an old technique for treating sports injuries that decreases healing time by maintaining motion (avoiding some of the deconditioning that occurs with pain induced immobility). These ice/motion applications can be done every hour if needed. Avoid direct ice contact with the skin to limit the possibility of ice burn.
Moist heat applied from 20-30 minutes at a time is an excellent pre-exercise or pre-stretch modality. It can be used after the first 3-5 days of injury as a means of increasing local circulation. Do not use heat if swelling is still visible as the dilated blood vessels that occur from heat can enhance swelling. Ice applications should continue for swelling. Moist heat is excellent for chronic stiffness as well. Dry heat does not deliver as deep a temperature effect as moist heat does, and therefore is not recommended.
Alternating 5 minutes ice and 5 minutes moist heat for 30 minutes total duration is known as contrast therapy. This is good for pumping an area of chronic swelling in an effort to resolve it. It can be done with a comfortable amount of compression to the area, along with elevating the involved body part higher than heart level for an enhanced anti-swelling effect. This may be done several times daily. Certain types of medical conditions such as neuropathy, diabetes, and Raynauds syndrome cause altered temperature sensations and would be contraindications for both ice and heat therapy.
Braces, splints and taping all immobilize the injured area which is necessary if the injury has produced excessive motion at the involved joint (hypermobility or instability). This is usually not the case, and therefore immobilization is actually the wrong approach for most injuries. By bracing or taping a joint without excessive motion, you will prolong healing time by increasing local stiffness and inducing weakness. With the artificial support of the brace or tape, the local muscles do not get the normal stimulus they need. Subsequently, the local region become weak from disuse, and un-necessarily tight due to the lack of motion. This causes a decrease in local circulation and prolonged healing. Bracing, splints and taping should only be used for those injuries which have instability, or for athletes/workers wishing to protect against injury by adding artificial support to a joint during sporting events or physical labor.
Nutrition is an important aspect of healing any injury. The best exercises for low back pain, neck and shoulder pain, knee injuries, elbow tendinitis and hip pain will be limited if you don't support your healing exercise with good nutrition. What you eat can have an effect on pain and inflammation, as well as provide the nutrients that are needed to rebuild new tissue. Of course, any change in nutrition or diet should be undertaken with caution if you have a medical or nutritional issue. Check with your doctor before changing your diet if this is the case, as medications can be affected by dietary changes, and depending on your unique situation, some changes may be dangerous for your condition. Generally however, the following holds true for those who are looking to decrease pain and inflammation through better nutrition:
Decrease the amounts of meats and grains, while increasing vegetable and fruit consumption. Meats and grains are sources of potential tissue acids, which can activate inflammatory chemicals, and stimulate nerve receptors to pain. Vegetables and fruits have the opposite effect. Increase potassium and magnesium (if deficient), and decrease sodium, refined sugars and fats. Add an antioxidant (vitamins, minerals, enzymes) supplement to your diet. Antioxidants neutralize the harmful effects of free radicals, which promote inflammation. Antioxidant vitamins are Vit. A, C, E, and the minerals zinc and selenium are important. Antioxidant enzymes are found abundantly in sprouts (particularly wheat sprouts) and stimulate your body's production of the same. Alpha lipoic acid and Co-Q10 are other helpful antioxidants for healing. Avoid hydrogenated fats (packaged snack foods esp.) as they promote inflammation. Substitute olive oil (extra virgin is best) and omega 3 cold water fish oils for most other fats and oils to combat inflammation. Increase water intake as proper hydration can help to control inflammation. Add bromelain (pineapples), ginger, garlic, tumeric, flavinoids (citrus fruits), lycopene (cooked tomatoes) to decrease inflammation. Sea vegetables are also a great source of many microminerals and nutrients that may help. Consider adding hyaluronic acid, chondroitin sulfate, glucosamine sulfate, and MSM as joint health supplements. Always be sure to check the purity of these commercial products as many have additives or fillers that, while decreasing price, may also decrease effectiveness because there is less of the actual nutrients per serving.
Check your mental attitude. Chronic pain can be worse than it has to be when you are focused on the pain, disability, and all the negatives you can find. A positive mental outlook that there is hope for your condition, and that it WILL improve is very important to the healing process, as well as to your overall quality of life. Chronic pain is often part of a negative mental and spiritual complex that derails you from being the best that you can be. Life is too short (and way too important) to be wasted on the negative, and not fully matured and developed. Prayer and faith, as well as practicing positive visualization and meditation, can be helpful to aiding your healing. Most long term sufferers need to address this, as being pain free and fit is much more than symptoms- it is a healthy/positive physical, mental and spiritual lifestyle that is meant to be enjoyed.
Early motion is key with any injury that is not a fracture or dislocation. There are many benefits of moving the injured area gently through as many different non-painful directions of motion as possible. This should be done multiple times throughout the day. If weight bearing hurts the injured region, try moving the body part in a non-weight bearing way. The hip, knee or ankle can be moved while lying on your back to decrease the weight bearing stress. Moving frontwards, backwards and sideways, as well as in circles and figure 8 shapes are typical motions that will help. Try moving in each direction as far as comfortably possible, holding the end point for 2 seconds. Repeat 5-10 times in each direction. You can do this every 30 to 60 minutes. This can be done while applying ice during the first 3-5 days, or moist heat after 5 days. Moving to the point of feeling a slight pull, but not pain, is the key to avoiding re-injury with these mobilization motions. Range of motion usually improves as your practice sessions advance over days and weeks. Realize that in the morning you will be stiffer than later in the day, so don't expect that you will end with as much range of motion after your first few morning mobilization sessions. Early and frequent non-painful mobilization will aid in local circulation, stimulate your body's healing process, and help retain or increase flexibility and strength. It also helps to prevent excessive scar/fibrosis formation early after an injury, and helps to break up scar and fibrosis in longer standing cases. This gentle mobilization is the most important first step in successfully handling pain and injury.
Massage therapy, manipulation, and other soft tissue therapies can be sought from licensed health care professionals such as massage therapists, chiropractors, physical therapists, and osteopaths to aid in the reduction of scar fibrosis. Chiropractic adjustments of the spine and extremities are a highly specific form of manipulation which help re-establish normal neurologic function and joint mechanics, which are essential to healing. Some of these practitioners may also offer various modalities such as ultrasound and laser therapy which can also help in the resolution of fibrosis and pain.
Remember that after you control the initial swelling and begin mobilization of your injury, the next (and most critical) step is to address the two probable root causes of your injury- faulty body mechanics and de-conditioning. While several exercises are presented on this website to help you begin your pain relief, correct body mechanics, condition injured body parts, and prevent future injury and pain, realize that this is only a "scratch on the surface" of what you probably need. Specific exercises designed to restore your unique de-conditioning and body mechanics can only come from a thorough analysis of your individual issues, and an individualized program of healing exercises.
This is best accomplished with the help of a specialist in soft tissue injury treatment and rehabilitation. As you can imagine, there is a world of difference between poor, good and great health care providers and trainers. Choose a specialist from personal recommendations, not from a list. Chiropractors, physical therapists, osteopaths and massage therapists who also specialize in rehab are the best to choose from, as they can not only provide the soft tissue therapy needed to resolve the fibrosis and joint dysfunction associated with pain and injury, but can also help you correct faulty body mechanics and recondition your injured area. Realize that most of these practitioners may not specialize in all of these needs, but a few will. Another option is to find a great personal or athletic trainer who specializes in rehab of faulty body mechanics and posture, and use someone else for the soft tissue therapy. Make sure that any rehab is based on an analysis of your unique body mechanics and conditioning levels. If your motions are not being carefully monitored and corrected as you perform your exercises, you are probably only strengthening dysfunction and inviting more pain and injury. There are plenty of doctors, therapists and trainers who unknowingly are providing this type of "rehab". Remember that your goal should be to strengthen proper function, not dysfunction. Get a thorough body analysis first, and then follow a program based and monitored on that analysis. If you can't find a highly qualified professional, our website offers various products that can help you achieve your goals on your own.
Our various products can show you in detail how to analyze and correct your faulty body mechanics, relieve pain, and recondition your injury. The Pain Free & Fit TM Self Help Series are digital books that can get you started today. Separate books are dedicated to lower back, neck, shoulder and knee pain. We even have a full body 5 Minute Pain Free & Fit TM Healing Program e book. Our newest and most exciting option is our Pain Free & Fit TM Online Workout Program, which is a monthly subscription based healing exercise program that delivers easy to follow along pain relieving and preventing workouts which can be done at home or the gym, at your own pace, and at any time of the day or week. This program streamlines your analysis and corrective exercises, ensures your progress at any level, makes your healing stimulus easy with short (8-20 minute) workouts, and gives you plenty of variety and inspiration with constant updated exercises and techniques. It is a dynamic, fun and super effective way to enjoy the pain free and fit lifestyle without having to make much effort. You simply follow along with the workout descriptions and videos that are sent to you each week at your own pace, and according to your time schedule. We "hold your hand" with this online workout program, and make healing and conditioning easy.
Regardless of how you address your body mechanics and conditioning, realize that the most important part is that you do address them, because they are most likely at the root of your problem. So many people needlessly suffer for years from a pain or injury that could be corrected, but because of ignorance, or their doctor fails to tell them of other options, never seek true lasting solutions. No matter how long you have been suffering, or what you have been led to believe about your condition up to this point, realize that the majority of musculo-skeletal pain and injury can be improved by restoring proper body mechanics and conditioning.