Have you been suffering with chronic pain? Have you seen a few doctors, chiropractors, bodyworkers and/or physical therapists that don’t seem to be able to find or reslove the source of your pain? If this is familiar, the origin of your pain may be in your nerves (not your head).
Chronic pain is no joke. As a physical therapist, I find chronic pain is often a result of the dysfunction of one of many systems in the body; skeletal (joint pain) muscular, myofacial, or neural (nerves). Of those systems, nerve pain is often the most challenging to find and treat.
Nerves are the hard wiring that allows our body to move. Like an electrical circuit, our brain sends impulses (signals) down the spinal cord and into neural pathways that run into our arms and legs and organs. Those signals tell our muscles to contract or release, depending upon the movement your body is trying to achieve.
Like a muscle strain or a ligament sprain, nerves can also overstretch or partially tear and become injured. Due to their delicate structures, Inflammation (swelling) inside the injured nerve can be difficult to resolve . They are small but mighty and will continue to cause chronic pain or symptoms if not directly addressed.
Symptoms of a nerve injury can be felt anywhere from its origin at the spine (neck or low back) and often run down an arm or a leg into hands and/or feet. Neural symptoms may include sharp pain, burning, aching, tingling and/or numbness. Those symptoms are usually found in the neck, shoulder, forearm or hand in the upper body. In the lower body, nerve symptoms are felt in the low back, hip or buttocks and down the leg and occassionally feet. The achiness or pain can feel as though you’ve strained the spine or a muscle but is more elusive and global (as opposed to hard or sharp pain in one spot).
There are specific joint mobilization (passive gliding of the joints to restablish healthy movement) or neural stretching techniques that target nerve injuries. The treatment you receive may or may not work unless specifically focused on opening up, taking pressure off and/or gently and specifically stretching the nerve pathways through the extremities. For instance one may have an achy neck, shoulder or forearm from overworking at a computer or other repetitive motion type job or activity (driving, gardening, walking or a sport). If the focus of treatment only covers a specific muscle and/or joint in the body, the pain may not be resolved or get worse. Specific techniques and home exercises are needed to target the nerves. Injured nerves can be tricky to treat as they are very small structures and will respond negatively to overstretching or positions that impinge or put pressure on them.
Knowing how to differentiate (tell the difference between) nerve injuries from muscle and joint injuries is very important for any practitioner attempting to help a patient resolve chronic pain. Be sure you communicate that concern to your health-care practitioner.
If you are interested in help to understand or evaluate whether or not you have pain as a result of a nerve injury or irritation, please contact Core Connections Physical Therapy and Pilates.
I have often discussed the concept of getting or being in shape as we age. As part of that discussion, I encourage people to redefine what “being in shape” looks like. In my view, the priority is to be PAIN-FREE.
When joints, muscles, or nerves send out a pain signal to the brain, it is because we are doing something to hurt that area. It is often a warning signal to change a movement strategy or position. If we ignore that warning, a temporary, small pain signal may become a progressively louder signal. If we continue to ignore or push through the pain signal, we can do deeper damage to the tissue that is in distress. This often will lead to continual pain signals and thereby chronic (relentless) pain.
By the time a client comes to me for relief, they have frequently been in chronic pain for months or even years. To unwind the pain, I work backwards in history, unraveling the series of injuries or poor movement strategies that have led up to it.
The question of “How long do you think it will take to get out of pain?” is common when evaluating and treating my clients. My answer is usually “Tell me, how long ago did you first recognize that you had pain?” Interestingly, the answer is not straightforward. That initial pain signal someone feels is subtle, and we as a society are taught to “push through” pain, or doctors may say it’s a sign of aging. We are encouraged to discontinue the sport or activity that causes it and mask the symptoms with painkillers.
I have made a successful career out of unraveling chronic pain with a precise client history intake and evaluation, manual therapy to get joints, muscles, and nerves moving properly again, and re-education of movement patterns that likely have contributed to the chronic pain. I include a systematic introduction of healthy, basic movement patterns such as regular walking or hiking, progressing to increasingly more complex movement patterns such as Pilates or yoga. Finally, personal goals of returning to sports and activities PAIN-FREE can be realized! This process typically will take 5 to 15 visits to complete, however even one or two visits can make a world of difference to getting relief or starting to see the way out of chronic pain.
As a physical therapist working with people in chronic pain, I work to teach strategies and exercises that will reduce pressure and unnecessary movement in vulnerable or painful joints. The concept of moving from the “core” is at the forefront of this work.
There are generally two types of muscles in the body that contribute to movement: large, superficial muscles that move bones (e.g., biceps, quadriceps, hamstrings, hip flexors, buttocks, etc.) and those usually smaller muscles that lie deep in the body (e.g., pelvic floor, diaphragm and tranversus abdomnus, and multifidi) acting to stabilize bones with functional movement. Functional movement may include shifting from sitting to standing, squatting, lifting, pushing, or pulling for instance. As a group, those stabilizing muscles are defined as “core” muscles in the body.
Quite often, chronic pain of the low back, neck, knees, or shoulders is a result of poor movement patterns. The way out of chronic pain resulting from poor movement is to increase awareness of and begin to use the core muscles, consciously engaging in activities that will strengthen them.
We are a society of sitters and slouchers. We sit more than we stand or lie down. Long-term sitting puts the core to sleep. Eventually, the core gets weaker and we begin to slouch in sitting and round in standing. As time goes on, we gradually function less from the stabilizing core and depend more on the larger, superficial muscles to take over. These poor movement strategies can be the beginning of a chronic cycle of joint pain and dysfunction.
What can we do then, to help ourselves get out of pain? Getting back to using core muscles will be a good way to interrupt the cycle. There are many options, but you can start at home with some easy exercises. Simply standing or sitting tall will activate the core immediately. Remember the adage about “Balance a book on your head when you walk, for good posture”? Try that and then, with that same book balancing on your head, try to sit and then stand back up without the book falling. As a further challenge, try to get down onto your knees and then back up to standing without losing the book. You will find your core immediately. The feeling of having to tighten your belly and activate your pelvic muscles to do the work is an excellent way to feel the core muscles I am referring to.
An even more challenging movement to activate the core is to hold a plank position for 10 to 30 seconds: balance on your hands (or elbows) and toes. The key here is to line up your ear, shoulder, hip, knee, and ankle without sagging in the low back or letting your head drop below your shoulders. As you work to keep still in that position, you will find you need to use those deeper core muscles.
I am a big believer in simplicity. These are simple, everyday activities to get connected to your long-lost core and help yourself back into a healthier body awareness.