This blog will introduce you to several basic concepts of how muscles function normally and what happens to them when they become involved in chronic pain. Before you can take any effective remedial actions to restore muscles involved in chronic pain to their normal healthy state, it is critical to understand exactly how muscles act under normal healthy circumstances.
All muscles attached to our bones and joints are called skeletal muscles. They act to move body parts by shortening, i.e., by contracting, followed by lengthening, i.e., relaxing. The distance between a muscle’s fully contracted location and its fully relaxed location is called its range of motion. When a muscle’s normal sequence of smoothly contracting and fully relaxing is disrupted, it loses part of its range of motion, develops focal sites of sustained contraction inside itself which makes it susceptible to injury.
If this situation is not remedied, by eliminating the sites of contraction inside the muscle and restoring its normal range of motion, the nerves inside the muscle and the nerve cells they connect with inside the spinal cord and brain can become damaged. If this happens, then our normal pain pathway circuits become permanently altered. It is through this sequence of events that a muscle can become a source of chronic pain.
Skeletal muscles for the most part fall into one of two categories, flexors and extensors. It is critical to understand the differences between them before being able to take effective remedial actions.
When flexors contract, they move the bones of a joint in such a way as to decrease the angle of the joint they act on. When extensors contract, they do the opposite, i.e., they move the bones of a joint to increase the angle of the joint. Many of the most powerful muscles of the body are flexors, for example, the biceps in the arm, the abs in the trunk, the hamstrings in the thigh, the closers of the jaw and the pectorals in the chest. If a flexor does not fully relax and remains in a somewhat contracted state it will not function properly and it will also adversely affect the extensor that works in opposition to it. In such a situation, the extensor will be under excessive tension because it will be unable to fully relax. This sets up a situation where, if it persists for a long enough time, the extensor will only be able to move through part of its range of motion and it will ultimately become chronically painful. In so many chronic pain situations, extensors held under tension become victims of shortened flexors who are the culprits.
Low back pain is an example of this situation. What typically happens in low back pain is that the abs become shortened and put the low back extensors, which run along the back of the spine, under excessive tension. If this situation is not corrected, the back extensors will begin to hurt and very soon become chronically painful. This example illustrates what is so frustrating and downright infuriating about chronic pain. No matter what you might do to the back extensors to get relief like, for example, applying heat or cold, massaging them, taking anti-inflammatory medications, the best that you can hope for will only be temporary relief. The pain will inevitably recur until the tension in the lower back extensors (the victims) is relieved. Fortunately, there is a way out of this situation as well as other chronic pain situations. They are described in detail in my Book (A Way Out Of Chronic Pain) and will be addressed in future Blogs.
The final point of this blog is get you to appreciate that all of the skeletal muscles of the body, and there are over six hundred of them, are in a two way, continuous communication with the brain. Information flows into the brain over sensory nerves and back out to muscles over motor nerves. It is the brain, acting through this two way communication, that sets the tension level in each muscle. The only way to permanently change the tension level in a muscle is to get the brain to reset it. It takes great effort and many repetitions of movements to make such changes happen. This is the reason that chronic pain is so frustrating and difficult to address because it does not lend itself to one step solutions. In future Blogs we will consider how to get the brain to reset the tension level inside of muscles and increase their range of motion.
If you have been experiencing pain that has lasted for a month or longer without it showing any signs of getting better or resolving on its own, you face a dilemma. And that is what to do about it? There are only two choices; either confront it and try to do something about it or try to avoid and just tolerate it. The first reaction of most of us is to try to live with it. Last month’s blog touched on the kinds of thinking that most of us go through as we try to live with the situation. Because this is such a critical decision in trying to alleviate chronic pain, it is worth examining what most of us go through in trying to decide what to do,
What follows is a very typical experience of a person in chronic pain and the decisions they make, in this case, living with chronic knee pain. A bunch of us including me, a physical therapist and the sufferer were sitting around having lunch and just chatting.
Sufferer: “You know, my knee is killing me”
Me: “Have you been through physical therapy?”
Me: Did it get better?”
Sufferer: Yes, but I haven’t kept up with my exercises.
Me: You know, you really should restart the exercises especially since they seemed to help you in the past.”
Sufferer: “ You’re right, but I just can’t seem to get them going again.”
Me: “Read my book. It will lay out a simple set of things you can do at home that will help you.”
Physical therapist: “Or if that doesn’t work, come back to the clinic and let the therapists work on you”
Sufferer: No response.
Sometime later in the conversation:
Sufferer: You know I recently went on a vacation and sitting on the plane for the four hour flight was hell. I ended up taking three ibuprofens and it still didn’t help.
Finally, as we got up from the table to leave:
Sufferer, vigorously shaking his leg: “My knee is killing me.”
This conversation embodies the kind of reaction that most people have to a chronic pain experience. Even though the pain is intense, unrelenting and has been going on for some time, there is tremendous amount of emotional inertia that gets in the way of trying to do something about it on a regular basis. The inertia reflects the despair and feelings hopelessness that is at the core of the chronic pain experience. It also so often reflects a lack of knowledge about what is causing the pain and exactly what to do about it beyond simply taking some pills which usually give only very temporary relief at best. What is so difficult to accept is that the conditions that have brought you to your current state of an ongoing chronic pain state have existed for some time and that there is no one step solution to it. What has to happen is that a sustained effort, lasting over weeks and probably months, will have to be undertaken to eliminate the conditions underlying the chronic pain.
Making a start is the toughest step you will have to take. Once taken, you will see that the pain is not destined to get worse. You will feel better emotionally because you have begun the journey back to a pain-free existence. After a few repetitions, it will become apparent to you that getting back to a pain-free existence or at least achieving a marked reduction in the pain intensity is possible with simple steps that you can take at home, without a lot of expensive equipment and without relying on drugs. What you will have to do is identify the muscle(s) causing the pain, eliminate sites of shortening inside of them and find ways to either lengthen them if they have shortened or relieve them of any excessive tension they might have developed. How to do this is explicitly laid out in my book entitled, “A Way Out Of Chronic Pain”.
Success is achievable!
WHAT KINDS OF NEGATIVE THINKING DO PEOPLE EMBRACE THAT PREVENTS THEM FROM CONFRONTING THEIR CHRONIC PAIN? WHAT CAN BE DONE TO CHANGE IT?
In a recent conversation I had with a physical therapist who had been in practice for over thirty-five years, the most frustrating thing he had encountered was that only thirty-five percent of patients presenting for treatment of chronic musculoskeletal pain would do their prescribed exercises at home between therapy sessions.
Sixty-five percent would not. This is astounding! After all, this group of people was in the midst of suffering with debilitating chronic pain that was severe enough that they were prescribed a course of professional treatment by their doctor.
What would explain why so many of them could not be motivated to regularly perform a group of what are relatively simple exercises that would relieve their pain and prevent future recurrences? Let’s look at some of the most common reasons and see if there are any solutions to them or at least some work arounds.
1. Cultural reasons: If exercising has never been a regular part of a person’s life, especially for people over fifty, it is difficult for them to start now, even in the face of debilitating chronic pain that is diminishing the quality of their life. Solution: Begin slowly. Try to devote five minutes each day to performing rehabilitative exercises. Keep increasing the amount of time until you are devoting enough time to be able to complete the entire prescribed regimen. Try not to backslide. If you miss a day, do not quit. Just pick it up again the next day.
2. “It hurts and I am afraid that by exercising, I will make it worse.” This is very logical thinking. However, despite being logical, it is wrong. If you do nothing, it will get worse. If one wants to get better, one has to find a way to confront the pain. Solution: Find a way to move the affected body part without increasing the pain. When first beginning, it may be that you can only move the body part a few millimeters and press only very lightly on the contraction spots inside the affected muscles. This is exactly what initial progress looks like. With daily repetitions, the body part will be able to move greater and greater distances without an increase in the pain.
3. “Maybe if I leave it alone, it will get better on its own and go away.” Just like reason 2, this thinking feels very logical. However, just the opposite is true. What current scientific research has shown, is that if the pain has not gone away in two to four weeks, it will not go away on its own and very likely will still be present months or even years later. Solution: A change in thinking will have to be made. A new attitude will have to be adopted; one that embraces sentiments that include the following: “I am entitled to live without chronic pain; I will do everything in my power to confront the pain; I will not get discouraged; and I will persist in trying to achieve this goal no matter how long it takes.”
4. “I can’t get down on the floor. It hurts too much.” Indeed, you may hurt too much and be too immobile to get down on the floor and get back up again. However, this is not a reason to do nothing. Solution: Every movement, exercise and application of pressure to contraction spots that calls for getting down on the floor can be done comfortably while lying on a bed.
5. And finally, the ultimate rationale for not confronting chronic pain: “I am a very busy and a very important person and I just don’t have the time”. Hmmm. Indeed, you may be! However, If you continue to neglect your chronic pain and continue to do nothing, you will find yourself becoming less “busy” and less “important” as your chronic pain inexorably robs you of your mobility, energy, vitality, sleep and your joie de vivre. Solution: Carve out the relatively small amounts of time from each of your busy days that is needed to stop the progression of the chronic pain. The gains in the quality of your life are simply to great to be neglected.
One way to get started is to read The Book entitled, “A Way Out Of Chronic Pain, How It Happened and What To Do About It” [https://store.bookbaby.com/book/A-Way-Out-Of-Chronic-Pain]. This book will show you how to identify which muscles underlie chronic pain states in all of the major body parts, how to eliminate sites of shortening inside of them, how to lengthen them if they have shortened and how to relieve excessive tension inside of them. If you can accomplish these goals, you will have taken an important step in regaining lost range of motion and eliminating sources of chronic pain that may be affecting you.
WHAT ARE THE CONSEQUENCES OF NEGLECTING OUR SKELETAL MUSCLES BY ALLOWING THEM TO SHORTEN AND LOSE PART OF THEIR RANGE OF MOTION?
Chronic pain, like so many other chronic conditions, is easier to prevent than to cure. If you are over fifty and lead the typical American sedentary lifestyle, many of your major muscle groups, like your abdominal muscles, lower back muscles, hip flexors, thigh muscles and chest and shoulder muscles are probably neglected. They are probably tight, harbor multiple contraction spots and function only through a small part of their normal range of motion. Consequently, they exert excessive tension on the joints they attach to and are susceptible to “pull” type injuries. If you do nothing about this and let this situation continue, you are highly likely to be on a glide path to a chronic pain episode if you have not already suffered one.
What is so often difficult to face is that we will have to devote part of our day to remedying this situation by engaging in some form of body maintenance of our skeletal muscles if we are to keep chronic pain at bay. It is ironic how most of us are quite willing to devote time trying to prevent other chronic diseases or at least keeping them in check. For example, we are quite willing to engage in some form of aerobic activity to avoid cardiovascular disease and we are quite willing to regularly brush and floss our teeth and have our teeth cleaned to avoid periodontal disease and tooth decay. However, when it comes to the biggest part of our body with at least half of our brain devoted to it, namely our skeletal musculature, we barely give it a thought, no less regularly tend to it.
There are many dire consequences to this neglect. Tight, shortened muscles are at the heart of so many chronic pain states that affect so many different parts of our body. If remedial steps are not taken, what is highly predictable, is that the situation will get worse and the muscles will continue to shorten and lose more of their normal, healthy range of motion. The consequences of this is that muscles will be placed under excessive tension, joints will be damaged and postural deformities will occur like rounded shoulders and bent over stances at the waist. In addition, changes will takes place in our normal pain circuits in our brain and spinal cord that will make us more susceptible to chronic pain. These changes, in turn, will lead to a decrease in our mobility and a loss of muscle strength. Such changes are at the heart of the state of age related decrepitude as well as the sense of not being able to get around much anymore like we used to and to feeling “old”.
What can we do to avoid riding down this dismal glide path? The answer is putting a daily three pronged approach together that will recapture and retain our muscles’ healthy, normal range of motion. Such a program will involve eliminating sites of contraction inside our muscles, trying to lengthen them by applying static stretches and moving them under load through their full range of motion. How to do this is for each of the major muscle groups in the body is outlined in detail in The Book which can be found at https://store.bookbaby.com/book/A-Way-Out-Of-Chronic-Pain
WHAT HAPPENS TO OUR PAIN CIRCUITS WHEN THE NERVES CONNECTING MUSCLES AND THE SPINAL CORD GET INJURED?
In 1984, while I was studying the effects of a nerve injury where an injured nerve was unable to repair itself and reestablish its former connections inside of muscles, it became apparent that, in addition to the injured nerve cells, the nerve cells that they connected to inside the spinal cord were also getting injured. This discovery indicated that the effects of nerve injury were much more serious and widespread than previously appreciated because they extended to the entire pain circuit of the injured nerve. This finding in part provides an explanation for why so often a chronic pain experience will long outlast an initial injury or traumatic event.
Since that time, many other changes in pain circuits following nerve injuries have been discovered. For example, injured nerve cells release several different chemicals like substance p and nerve growth factor into their affected muscles as well as from their endings in the spinal cord. In addition, the environment surrounding pain neurons in the spinal cord that transmit pain messages to the brain also changes. For example, glial cells surrounding injured spinal cord neurons start releasing chemicals around these neurons that increase their activity. All of these effects contribute to the continuation of the activity of nerve cells in pain pathways that contribute to the sustained, unrelenting quality of the chronic pain experience.
After nerves have been injured, there are two kinds of activities that contribute to this relentless quality of chronic pain. First, the nerve cells inside of the injured nerves begin to respond to events that were previously not considered painful, like light touch or pressure. They also begin to respond to new areas of the body that previously lied beyond the more limited areas that they used to respond to. These changes fall under what scientists call allodynia, i.e., injured nerve cells that now respond to events that were not previously painful but now are.
The second activity involves nerve cells inside the spinal cord and brain pain pathways that receive inputs from the injured nerves. These nerve cells now maintain their activity longer than they used to. They will often exhibit a behavior called windup where they will respond to successive inputs with higher and higher firing rates. Such changes are referred to as neuropathic pain by scientists, i.e., sustained activity in brain and spinal cord pain pathways that long outlast the injurious event that caused them.
Such sustained activities in altered pain pathways have a disastrous effect on the muscles of the body that they activate. What happens is that the sustained activity in the pain pathways is also maintained by the nerve cells exiting the spinal cord (motor nerve cells) that control these muscles. Because of the sustained activity, the affected muscles cells cannot fully relax. They develop contraction spots, shorten, are placed under excessive tension and cannot move comfortably through their normal, full range of motion. The result is chronic pain that comes from these muscles. If it goes on long enough, the joints that they are attached to will also get damaged and also become sources of chronic pain. At this point, all the elements of a full blown chronic pain experience are now in place. Without confronting such a chronic pain situation and taking some kind of corrective action, the chronic pain will continue for months and many times for years.
Is there a way out of this dilemma? There is. It involves a two part solution; first, stopping the affected muscles from continually sending painful messages along their nerves into the spinal cord and second, altering the pain circuits in the spinal cord and brain so that they stop firing continuously.
The first part involves identifying the muscles that have been affected, applying sustained pressure to all of the contraction spots in those muscles using the trapped ball method (detailed in The Book [https://store.bookbaby.com/book/A-Way-Out-Of-Chronic-Pain]) and applying sustained stretches of the affected muscles to relieve excess tension in them and recapture their lost range of motion. The second part involves returning each day to confront the contraction spots for at least two to four weeks to get them to stop their destructive effects on the brain and spinal cord pain pathways. If this can be accomplished, it will give them a chance to change their activity patterns and allow them to heal. Along with their healing, will come relief from the chronic pain.
HOW TO RELIEVE CHRONIC LOW BACK AND UPPER BACK PAIN BY ADDRESSING POSTURAL DEFORMITIES
The March 2022 blog explained how postural deformities can be underlying causes of back and shoulder chronic pain. The figure illustrates the two most common postural deformities that can affect us as we get older; one affects the lower back and the other affects the upper back.
When we see someone with such deformities, our first reaction typically is, “Oh, this is someone who has spine problems”. There are indeed problems with the spine. However, what caused them was not the spine per se, but the muscles acting on the spine.
In the case of the lower back deformity at the base of the spine, the lumbar curvature has been flattened out and the whole upper body has been pulled forward. The culprits are the abdominal muscles (arrow 1) which have become severely shortened and the victims are the back extensor muscles (arrow 2) which have been put under excessive tension and weakened so that they can no longer fully perform their antigravity function. Existing in this state, the back extensors at arrow 2 are probably full of contraction spots and may have been hurting for some time.
It is easy to see how the act of simply bending forward at the waist to pick something up off the floor would place the back extensors under additional tension and could lead to a sharp pain in the lower back. The way out of this postural dilemma is to lengthen the abdominal muscles at arrow 1 while simultaneously relieving the excessive tension in the back extensors at arrow 2. Eliminating any contraction spots inside the back extensors by using the trapped ball method is explained in detail in The Book. If this, along with lengthening the abdominal muscles, can be achieved, the lumbar curvature can be restored and the potential danger to the joints and disks between the vertebrae of the lumbar spine will be greatly diminished.
There are three ways to lengthen the abdominal muscles. The first way involves lying on your back and placing a rolled up towel under the back of your waist at the level of the belly button. The second way involves lying on your stomach and placing pillows under your chest. The third way involves lying on your stomach, but this time placing the pillows under the tops of your thighs. In each of these stretches, the abdominal muscles are being lengthened while the back extensor muscles are simultaneously unloaded and relieved of excessive tension. The details of these highly effective stretches are shown in The Book.
The second postural deformity shown in the figure involves the neck, upper back and shoulders. The shoulders droop excessively, curl forward and, along with the head, are held too far forward over the chest. In this position, the pectoral muscles (arrow 3) which flex the arms and shoulders forward have become shortened and the neck and upper back extensors (arrow 4) are under excessive tension and full of contraction spots.
Putting any additional demands on these extensors as we do, for example, when we reach forward or try to lift something heavy over our head makes us susceptible to neck, shoulder or upper back injury and pain. The keys to reducing these risks and improving this postural deformity is to lengthen the pectoral muscles, reduce the excessive tension in the neck and upper back extensors and use the trapped ball method to eliminate contraction spots inside these muscles.
A very effective way to stretch the powerful pectoral muscles is to sit on a chair that has been placed inside an open doorway and place both arms on the door frame. The amount of stretch is determined by how far inside the doorway the chair has been placed. While sitting in this position, the pectoral muscles are being stretched while at the same time the neck and upper back extensors have been unloaded and their excessive tension has been relieved. The Book illustrates three variations of this pectoral stretch along with detailed instructions on how to perform them.
By working on the muscles at the levels of arrows 1-4 that are causing these two destructive postural deformities, you can dramatically reduce the risk of a painful injury and relieve any existing neck, shoulder, upper and lower back chronic pain.
IS IT REASONABLE TO EXPECT THAT A THREE PART APPROACH FOR CONFRONTING CHRONIC PAIN WILL BE ACCEPTED BY THE PUBLIC? YES!!! WHY?
This question was at the heart of a dialog I recently had with a trusted colleague about the approach I have presented in my recently published Book entitled, “A Way Out Of Chronic Pain, How It Happened and What To Do About It”.
Her: “The average person will not embrace a three part approach because first, they will not be interested in the neurobiological explanations about the sensation of pain, and second, you are asking too much of them. People want either a simple one-step, one-repetition approach or they want to be told what pill they can take that will immediately cure their chronic pain”.
Me: “I agree that this is exactly what most people want. This is precisely what i would want if I was in the middle of a chronic pain episode.
Me: “However, the problem is, neither one exists!”.
As you may have already discovered in trying to deal with either an ongoing or past episode of chronic pain, it can be very stubborn and persistent. Here is the reason. Any ongoing chronic pain involves much more than what is going on in the affected body part. For example, when there is long standing pain that is coming from a knee, there is much more involved than just the knee. What is also involved is at least one of the muscles that is attached to the knee, the nerves that send information from the knee muscle(s) to the nerve cells in the spinal cord, the nerve cells in the spinal cord that receive this information and the nerve cells in the brain that receive the information from the spinal cord nerve cells. As a result of your long standing knee pain, all of these nerve cells have been altered from the normal way they handle pain inputs coming from the affected knee. My own research has documented some of the ways in which spinal cord nerve cells get damaged when there is a long standing nerve injury. Recent research has documented the many changes that brain nerve cells and their associated glial cells undergo that result in persistent activity in pain pathways from a body part affected with chronic pain. It is these changes in the altered nerve cells that maintain the chronic pain despite what corrective measures we may take at the site of the knee pain.
These neurobiological changes explain why attempts that are directed only at the affected knee can at best only provide temporary relief because they do not address the nerve cell changes that are sustaining the chronic pain. For example, today there are several substances that can be injected into a painful knee or other joint like steroids, hyaluronic acid, platelet-rich plasma or stem cells and these can provide some symptomatic pain relief. However, relief with such injections is usually temporary, typically lasting a few weeks or, if one is fortunate, a few months before they need to be repeated.
In order to have any chance to break the viscious cycle of chronic pain and for an approach to be successful, it has to address the affected joint, the affected muscles as well as the altered nerve cells. This is why a three part approach is needed. The three part approach involves eliminating sites of contraction inside of affected muscles, static stretches to lengthen these muscles and moving these muscles under load through their full range of motion. The details of the approach are presented in The Book [https://store.bookbaby.com/book/A-Way-Out-Of-Chronic-Pain]. For these reasons, once you come to the realization that there is no simple one-step solution to chronic pain, I hope you will embrace that approach because if you do, you at least have a chance for a long lasting solution to a chronic pain episode.
Blog # 5 June 2022 If you have been suffering from chronic pain for sometime, you have undoubtedly asked yourself two questions many times. Why is it that no matter what I do, the pain persists? And is there any hope for it to ever go away?
The answer to the first question is that if the pain has been going on for several months, it now most likely has three separate but interrelated sources. These are 1) muscles, 2) nerves and the brain and 3) joints They make up a Three Headed Monster of Chronic Pain. The reason that the pain has persisted, is that no matter what corrective action you may have tried to get relief, it probably has addressed only one of these three sources.
The answer to the second question is that something can definitely be done about the muscle and nerve and brain sources of the pain and maybe even the joint source of the pain.
If you can chop off even one head of this Three-Headed Monster of Chronic Pain even while the other two heads may still continue to breathe some of the fire of chronic pain, you can reasonably expect to see some relief in your chronic pain. This may be enough to significantly improve the quality of your life, see some improvements in your sleep, in your ability to move and to be more active, in your ability to sit more comfortably and in your posture.
The best place to start corrective steps is with your affected muscles. With daily effort, it is definitely possible to lengthen shortened muscles, relieve overly tensed muscles and to re-teach muscles to contract under load throughout their range of motion again. The first step is to try to eliminate sites of shortening inside of muscles. These sites have been called contraction spots, sore spots, knots or trigger points. Previous generations of scientists like Travell and Simmons have achieved dramatic reductions in patients’ chronic pain by eliminating these spots by either injecting them with local anesthetics or by applying coolant sprays to them, so there is reason to be hopeful. If some of them can be eliminated, then it will be possible to lengthen any shortened muscles using static stretches. Details about how to find, confront and eliminate contraction spots at home and lengthen shortened muscles with static stretches are presented in the Book. I highly recommend that you consult the Book https://store.bookbaby.com/book/A-Way-Out-Of-Chronic-Pain and attempt the approaches to confront and eliminate your contractions spots.
If your chronic pain has been going on for some time, it means that your nerve cells that carry information back and forth between your affected muscles and the spinal cord and brain as well as your nerve cells in the pain pathways inside your brain have been altered from their normal pain-free state to a hypersensitive, painful state. These alterations comprise the second head of the Three Headed Monster of Chronic Pain and are responsible for its persistent, ongoing quality. These changes are a big part of the reason that so many times, no matter what you do to address the pain at the site of the affected body part, the pain usually persists. Addressing this Second Head of the Monster of Chronic Pain is challenging because it requires multiple repetitions over an extended period of time. However, there is definitely hope for progress. Since these neuroplastic changes occurred in response to the destructive chronic pain inputs coming from the muscles in the affected body part, if they can be changed or eliminated, there is good reason to expect that the patterns of nerve activity in the altered pain pathways inside the spinal cord and brain can once again be changed back to their normal, pain-free state.
The best approach we have today to make these neuroplastic changes is by reducing or eliminating the ongoing neural inputs coming from the contraction spots inside the affected muscles. We know that these inputs can be changed because when scientists injected painful contraction spots with local anesthetics, they were able to shut them down with the patients often reporting dramatic improvements in their pain.
Most people over the age of fifty will show some osteoarthritic changes in their joints on x ray or MRI images. Yet many experience no pain. However, if these changes proceed far enough, the joints can certainly become sources of pain independent of any pain coming from the adjoining muscles and nerves. This is especially true if the joint cartilages and discs have been damaged to the point where adjacent bones are rubbing against each other and being abraded.
This is the third head of the Three Headed Monster of Chronic Pain. If the damage has progressed to this point, it may not be possible to completely eliminate this source of pain without a surgical intervention. However, short of this point, lengthening any shortened muscles around an affected joint, reducing their tension level and eliminating their contraction spots may be able to relieve the stresses on the affected joint enough to reduce the overall level of pain to the point where it becomes more tolerable and increases the overall quality of life.
So, while it may not always be possible to slay the Three Headed Monster of Chronic Pain, it is still possible to chop off its first head (muscles) and second head (nerves and brain) and sufficiently quiet its third head (joints) to the point of greatly reducing the amount of pain you are experiencing to the point of making significant improvements in the quality of your life. Give it a try!
Blog #4 May 2022
We live in a very health conscious society. We spend a great deal of time, effort and money taking care of our various body parts, for example, our skin, hair, nails and teeth. We run, we swim and we carefully watch our diet in order to take good care of our heart. However, for that part of the body that makes up half our body weight, most of us take it for granted and hardly give it a second thought. I am talking about our skeletal muscles. There are about 640 of them. About half of our brain and spinal cord are devoted to controlling them. If you are suffering from chronic pain, it is highly likely that at least one or more muscles are not healthy and have been neglected for a long time.
This brings us to trying to appreciate the difference between healthy and unhealthy muscles. A healthy muscle contracts smoothly to one end of its range of motion. It can do this under a load without any pain. After a contraction, it can relax fully to the other end of its range of motion. In comparison, an unhealthy muscle only contracts through a limited portion of its range of motion, experiences pain or discomfort when asked to contract under load and does not completely relax after a contraction. It is susceptible to “pull” type injuries especially while contracting under load.
Probably the most neglected muscle of the body is the rectus femoris. This muscle runs across the front of the hip joint, down the entire front of the thigh and ends in a strong tendon that enters the knee joint. it is part of the quad group of muscles and is shown in front view in figure A.
It serves two main purposes. It flexes the hip by lifting the thigh off the floor and extends the knee by straightening it from a bent position. If there is pain around the front of the thigh or in front of the knee, the rectus femoris is a prime suspect as a cause. Physical therapists will tell you that this muscle is shortened and tight in most adults that are referred for therapy.
The explanation for this is that no matter what exercise regimen we might follow, in any typical day, this muscle is never moved throughout is full range of motion. For example, when we sit in a chair with our feet on the floor, the knee is typically bent at ninety degrees so that the rectus femoris is being held at about the midpoint of its range of motion. Even worse, when we sit in recliner-type chair or when we lie in bed, the rectus femoris is held at its shortest length. So for the better part of every single day, this is how we hold this muscle. It is the unfortunate reality of our sedentary existence.
In a typical sedentary person, the upper end of the rectus femoris which lies across the front of the hip is also shortened. When we sit in a chair, the thigh is bent at a right angle so that the rectus femoris is held somewhere near the middle of its range of motion. Just like its lower end, in a typical day it rarely is fully flexed or fully extended to the ends of its range of motion. For example, to fully extend its upper end, either the thigh or the upper body needs to bent backward at about a thirty degree angle.
Without a conscious effort, the upper and lower ends of this muscle can spend years just existing in the middle of its range of motion. The end result of this existence is that the entire rectus femoris muscle becomes shortened, filled with contraction spots and is no longer capable of comfortably moving to the endpoints of its range of motion. In this unhealthy state, whenever it is put under load, it is highly susceptible to “pull” type injuries. And it is a leading suspect when there is chronic pain at the front of either the knee or the hip.
If there is chronic knee or hip pain, there is a way out of it! It involves working to eliminate the contraction spots and performing static stretches on both the lower and upper ends of the muscle so that the muscle can once again comfortably function throughout its normal range of motion. The Book clearly explains exactly how to comfortably do the stretches and how to eliminate the contraction spots by applying sustained pressure to them. Once the muscle has been successfully lengthened, the Book also illustrates dynamic movements that can be performed under load.
BLOG # 3 APRIL 2022
When someone is suffering with chronic pain, a natural reaction is to cut back on physical activity. This is understandable because it often hurts to move and there is a fear of making it worse. However, this is the worst thing you can do for six reasons.
1) If you do nothing, nothing good will happen and the pain will continue.
2) If you are suffering with chronic pain, it is highly likely that some key muscles have lost a good part of their range of motion. Such muscles are highly vulnerable to further injuries and we certainly have plenty of names for such injuries like pulls, twists, turns, strains, sprains, cricks, yanks, wrenches and tears. A typical scenario is one moment you are fine and a simple movement like bending over to pick something up off the floor or reaching overhead for something on a shelf and the next moment you are in excruciating pain. Sometimes it does not even require a movement to go from a pain-free state into a state of pain. For example, a very common experience is going to sleep without pain and waking up with low back pain.
3) When there is chronic pain, not only have muscles been adversely affected, but several harmful things have happened to the nerve cells (primary neurons) that connect them to the spinal cord and brain. These cells become sensitized. They begin to fire more intensely and frequently, they continue to fire long after the activity that started them firing has ended, and they begin to respond to stimuli that previously were not painful like touch and pressure. In addition, they release several chemicals from their endings into the muscles that keep the nerve cells firing. They also activate motor nerve cells in the spinal cord and brain that keep the muscles in a shortened state and under tension. In this state, the brain sends messages back out to the affected muscles that result in inflammation and swelling. Now all of the conditions are in place for a self-sustaining, vicious cycle of chronic pain that is not easily broken.
4) Once primary neurons become sensitized, they in turn sensitize the nerve cells that they connect with in the spinal cord and brain so that entire pain pathways become altered. Once such changes are in place, many nerve cells in pain pathways will have increased their firing rates and enlarged the areas of the body that they respond to. Interneurons that normally slow down or stop normal transmission in pain pathways become damaged and no longer perform their inhibitory role. Once such changes have occurred, all of the ingredients of a chronic pain state are in place Unfortunately, once such changes have occurred, there is no single drug or exercise that will undo them.
5) The longer muscles remain shortened and under excessive tension, the greater the possibility that they will damage the bones and cartilages of joints and, in the case of back and neck muscles, the disks that lie between the vertebrae of the spinal column. Once such osteoarthritic damage has occurred, it may not be possible to reverse them.
6) And most importantly, if you can regain lost range of motion and eliminate sites of contraction in affected muscles, the pain will lessen and you will feel better!
These six reasons point out why it is so important not to let chronic pain persist and go untreated. Left untreated, not only will the pain persist and diminish the quality of your life, but it will cause changes in your body that will not be easily reversed. To avoid this, the pain will have to be confronted by doing the work needed to regain lost range of motion in all of the muscles that have become either shortened or are existing under excessive tension.
Be assured that there is a way out of this. The steps are presented in detail in The Book and also will be presented in upcoming blogs.