Chronic Pain

What is scoliosis?

~ Dr. Robert Speirs DC ~ Leave a comment
Your spine is made up of 24 bones that stack on top of each other- normally in a straight line. “Scoliosis” means that your spine is curving from side to side, rather than being straight. Scoliosis affects between 1-3% of the population. Scoliosis may begin at any time between birth and adulthood but is most common during times that your skeleton is growing rapidly. Most cases of scoliosis begin between the ages of 13 and 18. Researchers are not completely certain why some people develop scoliosis, but they have found that the problem tends to run in families.

The curve of your scoliosis may be measured with an x-ray. Although some curves get worse, most do not. In fact, only ¼ of all adolescent idiopathic scoliosis curves will progress. Small curves in mature patients have a low risk of progression (2%), while large curves in younger patients progress more frequently. (70%) Curve progression is more common in girls, especially those with larger curves (greater than 20 degrees). Your doctor may need to monitor your scoliosis for progression by performing x-rays every 6-18 months.

Scoliosis may cause your shoulders, hips, or waist to be unlevel. Most curves are classified as “right thoracic”, which means that the peak of your curve protrudes toward the right. This is often accompanied by a forward rotation of your right shoulder and “winging” of your right shoulder blade. Many patients have a secondary curve in their lower spine that helps to balance their body. The majority of patients with mild to moderate scoliosis have no symptoms, but approximately ¼ report back pain. Unfortunately, scoliosis increases your risk of developing back pain later in life.

The primary goal of treatment is to stop curve progression. While many cases can be slowed or even reversed through appropriate management, it is important to recognize that others may progress in spite of the best care. Conservative care, including spinal manipulation (like the type provided in our office) has been shown to help some patients with scoliosis. Exercise is another effective treatment for scoliosis. It is important that you clearly understand your home exercise program and that you perform it consistently.

Patients with larger curves (30-40 degrees), or those who are at high risk for progression may benefit from wearing a brace. Braces have been shown to decrease the need for surgery in about three out of four patients. Fortunately, less than 0.3% of all scoliosis cases will ever require surgery.

You should avoid carrying heavy back packs and consider switching to a wheeled version, if necessary. Sports and exercise will not worsen most cases of scoliosis, and you should continue to participate in the things you enjoy unless directed otherwise by your doctor. The diagnosis of scoliosis is always discouraging, but you must focus on what it is really most important. Be confident in who you are! Don’t let something like a curved spine (or any other medical condition) define you as a person.

Put the shovel down and read this!

~ Dr. Robert Speirs DC ~ Leave a comment

Your low back consists of 5 individual vertebrae stacked on top of each other. Flexible cushions called “discs” live between each set of vertebrae. A disc is made up of two basic components. The inner disc, called the “nucleus”, is like a ball of jelly about the size of a marble. This jelly is held in place by the outer part of the disc called the “annulus”, which is a tough ligament that wraps around the inner nucleus much like a ribbon wrapping around your finger.
Your low back relies on discs and other ligaments for support. “Discogenic Low Back Pain” develops when these tissues are placed under excessive stress, much like a rope that frays when it is stretched beyond its normal capacity. Most commonly, disc pain is not the result of any single event, but rather from repeated overloading. Your lumbar discs generally manage small isolated stressors quite well, but repetitive challenges lead to injury in much the same way that constantly bending a piece of copper wire will cause it to break. Examples of these stressors include: bad postures, sedentary lifestyles, poor fitting workstations, repetitive movements, improper lifting, or being overweight.

Approximately one third of adults will experience pain from a lumbar disc at some point in their lifetime. The condition is more common in men. Most lumbar disc problems occur at one of the two lowest discs- L5 or L4. Smokers and people who are generally inactive have a higher risk of lumbar disc problems. Certain occupations may place you at a greater risk, especially if you spend extended periods of time sitting or driving. People who are tall or overweight have increased risk of disc problems.

Symptoms from disc pain may begin abruptly but more commonly develop gradually. Symptoms may range from dull discomfort to surprisingly debilitating pain that becomes sharper when you move. Rest may relieve your symptoms but often leads to stiffness. The pain is generally centered in your lower back but can spread towards your hips or thighs. Be sure to tell your doctor if your pain extends beyond your knee, or if you have weakness in your lower extremities or a fever.

Repeated injuries cause your normal healthy elastic tissue to be replaced with less elastic “scar tissue.” Over time, discs may dehydrate and thin. This process can lead to ongoing pain and even arthritis. Patients who elect to forego treatment and “just deal with it” develop chronic low back pain more than 60% of the time. Seeking early and appropriate treatment like the type provided in our office is critical.

Depending on the severity of your injury, you may need to limit your activity for a while, especially bending, twisting, and lifting, or movements that cause pain. Bed rest is not in your best interest. You should remain active and return to normal activities as your symptoms allow. Light aerobic exercise (i.e. walking, swimming, etc) has been shown to help back pain sufferers. The short-term use of a lumbar support belt may be helpful. Sitting makes your back temporarily more vulnerable to sprains and strains from sudden or unexpected movements. Be sure to take “micro breaks” from workstations for 10 seconds every 20 minutes.

TMJ dysfunction

~ bryancobb ~ Leave a comment

Temporomandibular joint dysfunction is a blanket term that refers to pain and dysfunction of the jaw muscles and the tempomandibular joints which connect the mandible to the skull. The most common symptoms are pain and restricted mandibular movement as well as grinding noises coming from the joint. This condition is more common in women then in men, and affects a large portion of patients suffering from fibromyalgia. Trigger points in the muscles of mastication are frequently involved in TMJ dysfunction. Trigger points in the pterygoid and masseter muscles for example will not only refer pain into the tempomandibular joints, but will also cause a dysfunctional movement pattern that can restrict range of motion. Trigger point therapy can be an effective modality to treat TMJ dysfunction.

I smoke and I sit; does that matter?

~ Dr. Robert Speirs DC ~ Leave a comment

Your thoracic spine is made up of 12 individual vertebrae stacked on top of each other. To allow for flexibility and movement, there is a cushion or “disc” in between each level. As we age, these discs can wear and become thinner over time. This leads to additional changes, including bone spurs and narrowing of the opening where your nerves exit your spine. This process is called “thoracic spondylosis”, or simply, “arthritis”.

How quickly you develop back arthritis is largely a trait you inherited from your parents. Other factors may play a role, including a history of trauma, smoking, operating motorized vehicles, being overweight and/ or performing repetitive movements (i.e. lifting, twisting, bending or sitting). Men seem to be affected slightly more often than women.

Symptoms often begin as back pain that gradually worsens over time. Stiffness may be present upon arising in the morning. Pain is relieved by rest or light activity and aggravated by strenuous work. Sometimes your nerves can become “pinched” in narrowed openings where they exit your spine. This can cause pain, numbness, or tingling radiating around your trunk along the path of the irritated nerve. Be sure to tell your doctor if you notice any weakness or if you have a rash (running along your rib), fever, abdominal pain, change in bowel or bladder function, or pain in your groin crease.

Arthritic changes can be seen on x-rays, but interestingly, the amount of wearing does not seem to correlate directly with the severity of your symptoms. People with the same degree of arthritis may have symptoms ranging from none to severe. Most researchers believe that the symptoms of osteoarthritis are not the direct result of the disease, but rather, from the conditions that preceded the disease and those that develop after it, like joint restrictions and muscle tightness. Fortunately, those conditions are treatable and our office has a variety of tools to help relieve your pain.

In general, you should avoid repeated lifting and twisting and take frequent breaks from prolonged sitting, especially in motorized vehicles. Avoid any position that causes an increase in radiating pain. Light exercise, like walking, stationary cycling, water aerobics, and yoga may be helpful. Smokers should find a program to help them quit and overweight patients will benefit from a diet and exercise program.

Trigger points and fibromyalgia

~ bryancobb ~ Leave a comment

Myofascial pain syndrome (trigger points) and fibromyalgia are often confused to be the same condition and while there is a lot of interrelatedness between the two they are not quite identical. The clinical definition of a trigger point is “a hyper irritable spot associated within a taut band of skeletal muscle that is painful on compression or muscle contraction, and usually responds with a referred pain pattern distant from the spot”. Trigger points form from an overload trauma to the muscle tissue. This is contrasted with fibromyalgia which is defined as “a medical condition characterized by chronic widespread pain and a heightened pain response to pressure. Other symptoms include tiredness to a degree that normal activities are affected, sleep problems and troubles with memory. Some people also report restless leg syndrome, bowel and bladder problems, numbness and tingling and sensitivity to noise, lights and temperature. It is also associated with depression, anxiety, and post traumatic stress disorder”. Fibromyalgia will also present with localized tender points which are often mistaken for trigger points. Where these two conditions become somewhat interrelated is via the nervous system. Fibromyalgia patients suffer from a super-sensitization of the nervous system causing hyperirritability and pain. Myofascial trigger points can be caused by,or be the cause of, super sensitization. An active trigger point will irritate the sensory nerves around it eventually leading to super-sensitization. Trigger points have also been showed to form of become active due to super-sensitization. Both of these conditions can perpetuate the other, leading to layers of pain and symptoms. This being the case, trigger point therapy can have a very positive effect on decreasing the severity of pain and symptoms in patients suffering from fibromyalgia.

Mobility Myth #1

~ Dr. Robert Speirs DC ~ Leave a comment

what-is-mobility-mobility-myths-foam-rolling

Great stuff from our friends at Shape.com:

Myth: Stretching and foam rolling will address all of my mobility problems.

Truth: Stretching and soft tissue work (like foam rolling and massage) may seem like the bread and butter of mobility, but there’s more to know. “If you have a true mechanical mobility problem, soft tissue work and different stretching techniques are definitely great options,” says Ardoin. But you might experience tightness or a loss of motion that doesn’t have anything to do with tissue restrictions like tight muscles or joint stiffness.

“In these particular people, they actually have the mobility needed, but their brain doesn’t know how to access it,” says Ardoin. This sort of muscle-brain disconnect could be because of current pain, previous injuries, or, “sometimes people just forget how to move,” he says.

In this case, your muscles are working against each other instead of synergistically—and it’s not something stretching or foam rolling will fix. The good news is that there’s not actually anything physically wrong. The bad news: This is tough to diagnose on your own. “If you have a loss of motion while you perform the motion yourself but have full ROM when performed passively, then it’s safe to assume that you have the ROM available but your brain doesn’t know how to access it,” says Ardoin.

For example, let’s say you have a “tight” shoulder. Make a large, slow circle with your right arm. Then totally relax your arm while someone else rotates your arm in a circle for you. Did it go farther while you let the motion happen passively? Ding, ding! Could be a brain problem, not a muscle problem. Think this might be you? Seeing a trainer or physical therapist to confirm it (and help you work on the issue) can’t hurt.

The Thoracic Disc Lesion

~ Dr. Robert Speirs DC ~ Leave a comment

Your spine consists of 24 individual vertebrae stacked on top of each other. Flexible cushions called “discs” live between each set of vertebra. A disc is made up of two basic parts. The inner disc, called the “nucleus” is like a ball of jelly about the size of a marble. This jelly is held in place by the outer part of the disc called the “annulus,” which is wrapped around the inner nucleus,

much like a ribbon wrapping around your finger. The term “thoracic disc lesion” means that one or more of the 12 discs in the center section of your spine has been damaged.

Disc problems start when the outer fibers of the disc become strained or frayed. If enough fibers become frayed, the disc weakens and when compressed, may “bulge” like a weak spot on an inner tube. If more fibers are damaged, the nucleus of the disc may “herniate” out of the disc.

Surprisingly, thoracic disc bulges are present without any symptoms in almost half of the adult population. Disc bulges that cause pain commonly occur in the neck or lower back but are relatively infrequent in the thoracic spine – accounting for less than 1% of all symptomatic disc problems. The condition is most common between the ages of 40 and 60. Certain occupations or activities place you at greater risk, especially physically demanding activities that involve repetitive twisting, awkward postures.

Pain can range from dull, localized discomfort to sharp, radiating pain. Your symptoms may change unpredictably. If the disc bulge is bad enough to compress your nerve, you could experience sharp, burning, or shooting pain in a band-like distribution around your rib cage. Thoracic disc herniations commonly mimick other conditions like heart or lung problems. Be sure to let our office know if you notice chest pressure; shortness of breath; pain radiating into your arm, face, or jaw; pain with deep breathing; clumsiness; loss of bowel or bladder control; unexplained weight loss; night sweats; pain that awakens you at night; fever; indigestion; nausea; flu-like symptoms or if you notice a rash following the margin of one of your ribs.

You should avoid excessive bed rest while recovering. Researchers have shown that disc bulges may be successfully managed with exercise and conservative care, like the type we will provide.

Trigger points in the adductor longus and brevis.

~ bryancobb ~ Leave a comment

These muscles are located in the groin. The longus originates on the pubic body just below the pubic crest and inserts on the middle third of the linea aspera.The brevis muscle originates on the inferior ramus and body of the pubis and has its attachment to the lesser trochanter and linea aspera of the femur. Trigger points in these muscles are the most common muscular cause of groin pain. Distal trigger points refer pain to the upper medial knee and down the tibia. Proximal trigger points refer into the anterior hip area.

A weak lateral chain will stop you in your tracks.

~ Dr. Robert Speirs DC ~ Leave a comment

One very important job of your hip muscles is to maintain the alignment of your leg when you move. One of the primary hip muscles, the gluteus medius, plays an especially important stabilizing role when you walk, run, or squat. The gluteus medius attaches your thigh bone to the crest of your hip. When you lift your left leg, your right gluteus medius must contract in order to keep your body from tipping toward the left. And when you are standing on a bent leg, your gluteus medius prevents that knee from diving into a “knock knee” or “valgus” position.
Weakness of the gluteus medius allows your pelvis to drop and your knee to dive inward when you walk or run. This places tremendous strain on your hip and knee and may cause other problems too. When your knee dives inward, your kneecap is forced outward, causing it to rub harder against your thigh bone- creating a painful irritation and eventually arthritis. Walking and running with a relative “knock knee” position places tremendous stress on the ligaments around your knee and is a known cause of “sprains”. Downstream, a “knock knee” position puts additional stress on the arch of your foot, leading to other painful problems, like plantar fasciitis. Upstream, weak hips allow your pelvis to roll forward which forces your spine into a “sway back” posture. This is a known cause of lower back pain. Hip muscle weakness seems to be more common in females, especially athletes.

You should avoid activities that cause prolonged stretching of the hip abductors, like “hanging on one hip” while standing, sitting crossed legged, and sleeping in a side-lying position with your top knee flexed and touching the bed. Patients with fallen arches may benefit from arch supports or orthotics. Obesity causes more stress to the hip muscles, so overweight patients may benefit from a diet and exercise program. The most important treatment for hip abductor weakness is strength training. Hip strengthening is directly linked to symptom improvement. Moreover, people with stronger hip muscles are less likely to become injured in the first place. The exercises listed below are critical for your recovery.

Bryan Cobb RMT.

~ bryancobb ~ Leave a comment

Since 2005, Bryan has been dedicated to helping all people with chronic and acute pain caused by soft-tissue damage.

His training and experience make him uniquely qualified to treat a wide variety of pain and dysfunction and to give instruction on prevention and self-care.

Bryan is the only Massage Therapist in Manitoba — and one of the few in Canada — to be certified by the Certification Board for Myofascial Trigger Point Therapists (CBMTPT).

Bryan holds a degree as an Advanced Remedial Massage Therapist (ARMT) from the Massage Therapy College of Manitoba.  Course work at MTCM includes
• over 2,000 hours of practice, as well as
• intensive course work,
• a supervised clinical practicum, and
• community outreach placements.

MTCM has a credit transfer affiliation with the University of Winnipeg, ensuring that its courses are held to the highest level.  When Bryan studied at MTCM, the college was the only massage therapy college in western Canada accredited by the Commission on Massage Therapy Accreditation.  Today, the college is a member of the Canadian Council of Massage Therapy Schools.

Bryan is a member in good standing of the Natural Health Practitioners of Canada.

Bryan also has a background in Anatomy, Exercise Physiology, and Sport Sciences from the University of Manitoba, and he has worked as a personal trainer and fitness leader.

He is an avid natural bodybuilder and fitness enthusiast, and has a blue belt in Brazilian jiu-jitsu.