Bodywork alone or along with the use of other modalities can alleviate pain.
Common complaints- acute and chronic
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Nerve compression related pain
Potential cause 1
Thoracic Outlet Syndrome:
The nerve roots involved: The Brachial Plexus is made up of the Cervical nerves C5-C8 and Thoracic nerve T1 which relay information for movement and sensation to your arm and hand. Compression of one or more of these nerves can trigger nerve pain, muscle weakness, and a tingling sensation.
Some of muscles that may contribute to compression of these nerves include your pectoralis muscles, your teres muscles, and your supraspinatus. By performing the muscle actions in-office, we can better tell which muscle may be contributing to the complaint.
Potential cause 2
Radial Tunnel Syndrome
Compression of the Radial nerve as it travels through your forearm.
Overuse of muscles surrounding this nerve can lead to compression and inflammation
Potential cause 3
Carpal Tunnel Syndrome
Compression of the Median nerve as it moves from your forearm to your wrist.
Over use of the wrist- typically in the direction away from your palmar surface can lead to irritation, inflammation, and compression of the median nerve.
Action:
1) If muscle tension is the cause, then releasing the muscles compressing the nerves relieves the pain. Therefore, manual therapies will be used to ameliorate the pain and restore muscles to their optimal tone.
2) If the action causing the muscle compression is a daily action we will likely use biofeedback to help you learn to reduce the action and apply manual therapy as needed.
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Potential cause: When you only have the weekend to fit it in all of your activities, that extra activity weekend after weekend can leave you with painful feet.
Solution: the fastest solution can be getting deep massage of the feet and calf, and along the muscles located around the hip.
Experience: I have experience ameliorating plantar fasciitis pain afflicting daily runners, long thru hikers, and easy does it walkers.
Goal: Get back on your trail.
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So you are experiencing sciatica.
Some causes:
You started going for longer trail runs.
You sit working for long periods of time with your legs crossed or your foot under your buttocks.
You have a long commute to work and you are tightening your gluteal muscles during traffic without realizing it.
Why you want help: You are feeling the pain and you are ready for it to go away.
Treatment: I will create a plan to bring more awareness around the cause of your pain and suggest tools for you to reduce the cause of your pain.
Manual therapy: typically centers around releasing tension in the gluteal muscles and any excess piriformis muscle compression of the sciatica nerve.
Sciatic pain is generally ameliorated within 3-5 sessions and most people feel a lot better after 1.
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Ankle sprains are common and the symptoms of the sprain often last longer as we age. According to the National Institutes of Health, 40% of people who experience ankle sprains note chronic inflammation. instability, and pain. These chronically experienced symptoms lead people to reduce the number of days and duration they participate in physical activity.
It is important for people experiencing these chronic symptoms to find options to heal their tissue more quickly. People who stay injured often begin to gain weight and lose their optimal state of physical fitness increasing their risk for development of poor cardiovascular health.
Therapies:
Kinesio taping improves fluid movement and decreases swelling at the site of injury
Botanical applications decrease pain at the site of injury and improve healing of the tissue.
Manual therapies for addressing overstressed areas supporting the injury.
Nutritive supplements to support collagen synthesis for tendon recovery.
Type I collagen is found in tendons. It contains around 33% glycine (glycine is in every third amino acid residue) and 21% proline and hydroxyproline (vitamin C is needed for this step). The hydroxyproline residues are required for stabilization of the triple helix contributing to the strength of collagen.
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Shoulder pain is common among those using a computer mouse for long periods of time. Mouse shoulder is another name for repetitive shoulder strain in this particular population. Pain is noted in the shoulder joint and often associated with weakness of the hand and/or tingling or numbness of the fingers.
Combing this repetitive strain with throwing the baseball to your kiddo after work daily or swimming laps to train for a race can leave you feeling frustrated.
Repetitive shoulder strain is often ameliorated with manual therapies, lifestyle changes, and by balancing inflammatory processes.
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Which knee pain causes can be improved by manual therapies?
1) IT band syndrome: if you look this up you will see a lot of images suggesting you feel pain on the lateral side of the knee which is true. However, people suffering from IT band syndrome can also note pain behind the patella and this pain when related to the IT band is often ameliorated once the areas affecting the IT band are corrected. Likely the pain behind the patella is a result of inflammation.
I will attempt to give one example of tug of war between areas that can contribute to downstream IT band pain in the following paragraphs.
The glut max or gluteus maximus is a large muscle that attaches to areas of the hip and tissue running along the back (thoracolumbar fascia). It inserts into both the upper bone of the leg and the iliotibial (IT) fascia (or IT band).
Another large muscle that inserts into the thoracolumbar fascia is named latissimus dorsi. This is the muscle you feel most strongly stretch (or refuse to) when you put your arm over your head and lean to the side.
The latissimus dorsi and gluteus maximus are strongly active in coordinating the pendulum swing (arm and leg movements back and forth) when in motion (walking, running, swimming).
You may have observed that some people have an unbalanced runners gait. There can be many causes for this but for this example we are looking at a result of an imbalance in strength and tension between two large muscles and the fascia connecting them. The areas are playing tug of war.
By reducing tension in the muscles compensating for other weak or damaged muscles, improving strength of weak muscles, and increasing flexibility we can correct the knee pain associated with IT band syndrome long term.
By reducing tension in the muscles you can feel relief immediately and if the IT band syndrome was a result of an acute injury that has healed then it is unlikely to be a chronic problem.
2) Adductor tension
The adductor muscle group of the thigh. The group of muscles that run along the inside of the thigh. They are responsible for moving the thigh toward the midline of the body. The gracilis is the only adductor muscle to attach on the lower bone (tibia) of the leg. This muscle additionally helps out in bending the knee and turning it inward. Overuse and excess tension applied to the gracilis muscle can result in knee pain.
As you might imagine, playing soccer incorporates a constant use of the gracilis muscle.
Working to improve flexibilty and relax this muscle will help to decrease associated knee pain.
Services offered
Biofeedback Training to address chronic pain either related to habitual physical patterns or habitual brain patterns no longer serving a beneficial purpose.
Manual therapies including therapeutic site-specific massage therapies
Kinesio Taping
Nutritional supplements to balance inflammation and/or restore tissue
Botanical medicine to reduce pain and balance the immune system response
Pain pathway
The pain pathway consists of transduction, transmission, modulation, and perception.
Peripheral nocicpetive receptors receive messages (pertaining to insult from temperature, pressure, and certain chemicals) and send signals through specilaized fibers to the spinal cord and up to the thalamus.
The information from the thalamus is then relayed to the brainstem reticular formation, hypothalamus, and higher cortical centers (areas with more complex cognitive functions such as decision-making).
Cortical circuitry involved in perception, localization and modulation of pain stimulation consists of information sent to the anterior cingulate cortex, insular cortices, and somatosensory cortices.
Khera T and Rangasamy V (2021) Cognition and Pain: A Review. Front. Psychol. 12:673962.
Research suggests, chemical messengers involved in turning pain perception off and on are relayed to multiple areas of the brain though the medulla (part of the brain stem).
Chronic pain
Pain persisting for longer than 3 months.
Information regarding pain relayed by the interconnection of the amygdala, prefrontal cortex, cingulate cortex (including the ACC), and basal ganglia, and cortico-limbic reverberating loops is implicated in some chronic pain conditions.
Goals for Chronic Pain Management
Musculoskeletal chronic pain from an injury can often be ameliorated. When the pain does not completely resolve, the perception of pain and quality of life can be improved. The goals of pain management are to improve the quality of life by improving sleep, increasing mobility, and regaining energy.
Research supports the use of medical massage, biofeedback, and lifestyle interventions for reduction of pain and improved quality of life.
When the pain pathway is more complex and there are multiple hurdles to eradicating pain, research suggests a change in perception is still beneficial. Researchers looking at the use of massage therapy in hospital settings noted that one of their more important findings was not the specific reduction in pain but the subjects change in perception concerning their pain. The suggestion was made that as opposed to researchers looking singularly at the subjective rating of pain ( a 1-10 scale looking at pain levels), the question of how a subject perceives their pain after the intervention may be a more important measurement. These researchers noticed that subjects post massage intervention would often note they were less concerned with the pain level and felt more comfortable in their bodies. These subjects noted they could be more active despite their level of pain.
This example suggests that once pain becomes chronic it may be more about redirecting neural circuitry as opposed to focusing on the pain itself to resolve the obstacle to cure. Neurofeedback training and massage therapy are modalities used to to work on achieving this outcome.
Peripheral Neuropathic Pain
Typically described as nerve pain with a burning, or shooting quality. More formally described as tissue that has been damaged within the somatosensory nervous system.
Other symptoms: tingling sensation and/or weakness of the area
Possible contributors to neuropathic pain
B12 deficiency
Vitamin B-12, otherwise known as cobalamin, is a water soluble vitamin. B-12, when ingested, is absorbed in the small intestine and transported to the blood stream from there. Possible causes of poor absorption are related to acid content of the stomach and intestines, medication interference with acid content, concerns related to the gallbladder or removal of the gallbladder (because reabsorption of B-12 for circulation is via the bile from the gallbladder).
Being a vegetarian limits sources of B-12 from your diet. Overgrowth of bacteria in the small intestine can cause B-12 deficiency as the bacteria use the B-12 for themselves decreasing what is available to your cells. Excess stress put on the body by either exercise or chronic medical conditions causes the body to use more resources for cell turnover and can decrease the amount of B-12 available for al your needs.
Highest sources of B-12 are beef, chicken/turkey, eggs, and cow’s milk.
Hyperglycemia ( high blood sugar)
High blood sugar increases reactive oxygen species which contributes to cellular oxidative stress and increases inflammatory chemicals via multiple pathways which damages neurons.
Dyslipidemia ( abnormal lipid levels)
Dyslipidemia is defined by increased levels of LDLs, decreased levels of HDLs, and increased triglycerides. Dyslipidemia appears to increase ones risk of developing nerve pain.
Kynuernine pathway dysregulation
The kynurenine pathway has recently been a source of interest due to its suspected role in the development and sustainment of chronic pain conditions. Dysregulation of this pathway and changes in the ratios of the pathway metabolites have been associated with numerous neurotoxic and inflammatory states, many of which present simultaneously with chronic pain symptoms.