Chronic Pain

What is Fibromyalgia?

~ Dr. Robert Speirs DC ~ Leave a comment

Fibromyalgia, although often misdiagnosed and misunderstood, is the second most common musculoskeletal disorder behind osteoarthritis. The condition affects nearly 12 million Americans and is ten times more common in women.

The diagnosis of fibromyalgia is made when a certain set of symptoms has been present for at least three months. The most common symptoms include wide-spread muscle and joint pain, achiness or soreness- especially in the neck, shoulders, back, and hips. Your muscles may constantly feel overworked and tired. Fibromyalgia patients often exhibit a set of predictable “tender points” spread throughout the body. Some patients have trouble sleeping and feel as though they are in a “brain fog” most of the day. This can lead to fatigue or mood changes, like anxiety and depression.


Stress is a known contributor to fibromyalgia, and patients should seek ways to de-stress, including yoga or meditation. Fibromyalgia patients should minimize their caffeine intake, as this is a known stimulant for nervousness, anxiety, and insomnia. Breathing exercises are sometimes helpful.

Although your sleep may be restless, you should try to establish a bedtime routine that gives your body the best chance for recovery. Try to avoid late night electronics, like the television or computer. Keep your bedroom dark, quiet, cool, and distraction-free. Be sure to take time for yourself each day for relaxation or to do something you enjoy. Combat “brain fog” by carrying a notebook or a phone to make notes for important things. Some patients report decreased muscle tightness by applying moist heat or a taking warm bath. The American Pain Society recommends conservative treatment, including chiropractic, along with moderate aerobic exercise.

Trigger points in the piriformis muscle

~ bryancobb ~ Leave a comment

The piriformis muscle is a small muscle deep to glute max and lies over top of the sciatic nerve. It originates on the anterior sacrum, and inserts on the greater trochanter of the femur. It’s main action is to laterally rotate the femur. When trigger points developed in this muscle they will refer pain into the sacro-iliac region, across the posterior hip and down the leg. This muscle can also be a cause of sciatic nerve irritation if it gets tight, causing “sciatica” symptoms.

Scapular Dyskinesis (Yes, its a thing).

~ Dr. Robert Speirs DC ~ Leave a comment

Your shoulder is formed by three bones; the scapula (shoulder blade), the clavicle (collar bone), and the humerus (long arm bone.) These bones come together to form a shallow ball & socket that relies upon the surrounding muscles for support. All of your shoulder muscles must work in a coordinated fashion to have a healthy and stable joint. Disruption of the normal rhythm of your shoulder blade creates abnormal strain on your shoulder and rotator cuff called “Scapular dyskinesis”. This dysfunction crowds the area of your shoulder where your rotator cuff tendons live and may create a painful pinching of your tendons or bursa each time you raise your arm. Many shoulder problems, including sprains/strains, tendinitis, bursitis, or rotator cuff irritation, result from this often overlooked culprit.


Scapular dyskinesis most commonly originates from weakness or imbalance of the muscles that control your shoulder blade. Sometimes the problem is caused by other shoulder conditions like prior fractures, arthritis, or instability. Irritation of the nerves that control the shoulder muscles is the culprit in about 5% of cases.

Although scapular dyskinesis can cause a variety of shoulder problems, it may initially go unnoticed. Up to 75% of healthy college athletes show some form of abnormal shoulder blade movement. If the condition is left untreated, you may begin to notice pain near the top of your shoulder. Sometimes the discomfort can radiate toward your neck or into your arm. Patients will often complain of a tender spot on the front of their shoulder. Long-standing altered mechanics can lead to bigger problems, including rotator cuff injury, shoulder instability, and arthritis.

The good news is that we have recognized the underlying cause of your shoulder problems and have treatments to correct it. You will need to perform your exercises consistently. You should also be conscious of your posture and try to avoid sitting or standing in “slouched” positions, as this is known to aggravate your problem.

Osteoporosis and Compression Fractures

~ Dr. Robert Speirs DC ~ Leave a comment

Most of the tissues in our body are in a constant state of rejuvenation, wherein old cells are removed to be replaced by new. In our skeleton, when the production of new bone cannot keep up with the rate of tear down, our bones become progressively thinner and weaker in a process called “osteoporosis”.


Bone fractures occur when stress to a bone exceeds the bone’s ability to support that load. In healthy vertebrae, significant stress is required to cause a fracture. But in osteoporotic bones, the threshold for injury is lowered to the point that “compression fractures” may occur with seemingly minimal stress like bending, coughing, or sneezing. A compression fracture causes a wedge-shaped collapse of the front of the vertebral “body”- resembling what would occur after stepping on one edge of an aluminum can.

Compression fractures are two to three times more common in women, and the risk of developing the problem increases over time. People who have had a prior compression fracture are at greater risk for developing a subsequent fracture. Additional risk factors for compression fracture include a family history of osteoporosis, low body weight, recent weight loss, smoking, a sedentary lifestyle, poor dietary choices, inadequate calcium or vitamin D intake, excessive alcohol or caffeine intake, and scoliosis. The American Academy of Orthopedic Surgery recommends bone density screening for osteoporosis in all women over age 65 or post-menopausal women who have suffered a compression fracture. If you have not already done so, you should schedule a bone density screening.

Symptoms of a compression fracture include an “aching” or “stabbing” pain in the back, near the site of fracture. Symptoms can range from minimal to disabling. Often times, pain is referred to the ribs, hip, groin, or buttocks. Be sure to tell your doctor if you have pain or numbness that radiates into your legs, weakness, clumsiness, loss of bowel or bladder control, impotence, fever, unexplained weight loss, night sweats, excessive fatigue, or a history of cancer.

Symptoms from a compression fracture typically lasts for six to 12 weeks. Occasionally, patients will require surgical treatment of a compression fracture, but fortunately, most respond to conservative care. In general, you should maintain a relatively active lifestyle and try to avoid bed rest. If your pain prevents movement, you may talk to your doctor about wearing a brace to limit stress.

Our office will prescribe exercises to help you recover and reduce the risk of subsequent fracture. As your symptoms improve, you can begin incorporating some aerobic exercise, like walking on a treadmill. Studies have shown that light resistance training (i.e. weights and elastic bands) may help you maintain bone density and reduce the risk of future fractures. Supplements to help manage osteoporosis include daily intake of 800-1000 IU of vitamin D and 1000-1200 mg of calcium.

Did you know that you can breathe “wrong”?

~ Dr. Robert Speirs DC ~ Leave a comment

Your “diaphragm” is the dome shaped muscle beneath your lungs. When it contracts and flattens, you breathe in. When it relaxes, you breathe out. But do you know your diaphragm plays an important secondary role in protecting your trunk and spine by controlling abdominal pressure?

The muscles that support your trunk form a “canister.” The front and sides of the canister are created by your abdominal and rib muscles. The back of the canister includes those muscles attached to your spine. The bottom of the canister is formed by the muscles of your pelvic floor, while your diaphragm serves as the roof. Together, these muscles control your abdominal pressure and core stability.


A well-braced core provides a stable foundation for moving your arms, legs, and head – in much the same way that when firing a canon, a large ship serves as a better platform than a rowboat.

During normal breathing, your upper chest should remain relatively still. Patients with “dysfunctional” patterns frequently overuse their upper chest muscles instead of their abdomen and lower rib cage. This depressurizes and destabilizes your core, leading to other problems like back pain.

You should not need to always think about proper breathing – this should happen subconsciously. Unfortunately, many of us have “learned” poor mechanics and need to re-learn proper breathing. One of the easiest ways to re-train proper breathing is to sit or lie still with one head on your breastbone and the other hand on your abdomen. When you breathe in, only the hand on your abdomen should move, while the hand on your chest remains still. Your normal breathing rhythm should be about there seconds of inhalation followed by six seconds of exhalation. If you find that you are exhaling too quickly, you may try “pursing” your lips to gradually increase the length of your exhalation.

The exercises that follow are essential for your recovery. Once you have restored normal breathing mechanics, you will enjoy increased core stability and your treatment will be much more successful. It is important to perform your breathing exercises consistently, as repetitive exercise will allow your body “re-learn” to subconsciously move in a safe and a coordinated fashion- thereby reducing your risk of injury.

Trigger points in the gluteus minimus

~ bryancobb ~ Leave a comment

The gluteus minimus is a small but important muscle that lies deep to the gluteus medius. It originates on the gluteal surface of the ilium, and attaches on the greater trochanter of the femur. It’s main actions are to abduct and medically rotate the hip. Trigger points in this muscle refer pain into the buttock and down the lateral and posterior leg, mimicking sciatica. This muscle should be the first to be examined if a straight leg test turns out negative.

Foot Over Pronation

~ Dr. Robert Speirs DC ~ Leave a comment

Flat-Foot-Arch-Before

The normal walking or running cycle begins with your heel striking the ground. As you transfer your body weight onto the front part of your foot, the arch of your foot naturally flattens slightly. This is called pronation.

The tissues that help maintain the arch of your foot are exposed to tremendous stress and may eventually break down. The loss of the normal arch of your foot results in a condition called “overpronation” or flat feet. This condition most commonly develops over a long period of time from repetitive stress.

Overpronation by itself is not painful, but the problem often leads to secondary problems, which may be painful. Plantar fasciitis, foot pain, shin splints and problems in the knee, hip or lower back are all related to overpronation. Patients who carry excess weight are more likely to develop this condition.

To help support your foot, you should wear shoes with good arch supports consistently. In some cases, specially molded orthotics may be needed to help support your arch.

What Is Upper Crossed Syndrome?

~ Dr. Robert Speirs DC ~ Leave a comment

Your posture plays an important role in your overall health. Poor posture leads to chronic strain and discomfort. “Upper crossed syndrome” describes poor posture that results from excessive tightness in your shoulders and chest with weakness in your neck and mid-back. This combination forces your shoulders to roll inward and your head to project forward.

To help understand how upper crossed syndrome causes trouble, think of your spine as a telephone pole and your head as a bowling ball that sits on top. When the bowling ball is positioned directly over the top of the upright post, very little effort is required to keep it in place. If you tip the post forward and the ball begins to roll over the edge of the post, significantly more effort would be required from the muscles trying to hold it there. This effort results in chronic strain of the muscles of your neck and upper back.

The chronic strain is uncomfortable and may also lead to neck pain, upper back pain, headaches, TMJ pain, and ultimately- arthritis. This postural problem is exceptionally common in computer workstation users. Correction of this problem is accomplished by stretching the tight muscles, strengthening weak muscles, and modifying your workstation.

Trigger points in the gluteus medius muscle

~ bryancobb ~ Leave a comment

The gluteus medius muscle plays an important role in hip and pelvic stability. It originates on the gluteal surface of the ilium, deep to the gluteus Maximus. It inserts on the greater trochanter of the femur. It’s main actions are to abduct the hip and to assist in internal rotation of the hip. It also maintains pelvic stability during walking and running. Trigger points in this muscle will refer pain into the sacrum, the iliac crest, and down the lateral hip and into the thigh. This muscle is often a cause of lower pack pain.

Posterior Tibial Tendon Dysfunction

~ Dr. Robert Speirs DC ~ Leave a comment
The posterior tibialis muscle begins deep in your calf. The muscle is connected to the arch of your foot by a tendon that runs along the inside of your ankle, just behind the large bump called the medial malleolus. When you walk, the posterior tibialis muscle lifts the arch of your foot.

Posterior tibial tendon dysfunction is one of the most common foot and ankle problems. The tendon may be damaged from an acute injury, like an accident or fall. More commonly, problems arise from overuse or repeated strain. Ongoing irritation slowly damages the tendon’s fibers and eventually leads to weakening and degeneration. This decreases the tendon’s ability to support your foot when you walk. As the tendon becomes less effective, the arch of your foot is allowed to collapse, which further increases the strain on the muscle and tendon.

The condition is often triggered from overuse and/or training on excessively hard surfaces. Other factors that can contribute to posterior tibial tendon dysfunction include: obesity, diabetes, hypertension, prior surgery or steroid injections.

Symptoms include pain or swelling along the course of the tendon, particularly behind your inner ankle bone. Symptoms often begin following an increase in training intensity or duration. Standing, walking, or running will likely increase your discomfort. Your pain may be aggravated by spending prolonged periods of time on your feet, especially, when standing tiptoe and walking stairs or uneven surfaces.

Early diagnosis and treatment is important to slow progression of the disorder. You may need to temporarily limit weight-bearing activity to allow your tendon to heal. Using a stationary cycle, elliptical machine, or swimming can be good alternatives to walking and running. Your doctor will likely prescribe arch supports or orthotics to help support your foot. You will be given exercises to strengthen the posterior tibialis muscle. These exercises should be performed while wearing shoes with good arch supports. In certain instances, a walking cast or boot may be needed to temporarily protect your foot.

Here is a brief description of the treatments we may use to help manage your problem.

Joint Manipulation
Your chiropractor has found joints in your body that are not moving freely. This can cause tightness and discomfort and can accelerate unwanted degeneration i.e. arthritis. Your chiropractor will apply a gentle force with their hands, or with hand held instruments, in order to restore motion to any “restricted” joints. Sometimes a specialized table will be used to assist with these safe and effective “adjustments”. Joint manipulation improves flexibility, relieves pain and helps maintain healthy joints.
Therapy Modalities
We may apply electrotherapy modalities that produce light electrical pulses transmitted through electrodes placed over your specific sites of concern. These comfortable modalities work to decrease your pain, limit inflammation and ease muscle spasm. Hot or cold packs are often used in conjunction, to enhance the effect of these modalities. Another available option is therapeutic ultrasound. Ultrasound pushes sound vibrations into tissues. When these vibrations reach your deep tissues, heat develops and unwanted waste products are dispersed.
Myofascial Release
Overworked muscles often become tight and develop knots or “trigger points”. Chronic tightness produces inflammation and swelling that ultimately leads to the formation of “adhesions” between tissues. Your chiropractor will apply pressure with their hands, or with specialized tools, in order to release muscle tightness and soft-tissue adhesions. This will help to improve your circulation, relieve pain and restore flexibility.
Therapeutic Exercise
Muscle tightness or weakness causes discomfort and alters normal joint function, leading to additional problems. Your chiropractor will target tight or weak muscles with specific therapeutic stretching and strengthening to help increase tissue flexibility, build strength, and ease pain. Healthy, strong, and flexible muscles may help prevent re-injury.
Elastic Therapeutic Tape
Your chiropractor may apply a special elastic therapeutic tape in order to support injured areas or encourage better movement. This tape is thought to decrease pain and swelling, improve circulation and limit muscle soreness.
Foot Evaluation
Fallen arches and faulty foot mechanics are common problems that can perpetuate your condition. Our office will carefully evaluate your feet and consider the need for a change in shoe style, arch supports or even custom orthotics.
Ankle Brace
Our office may recommend using a support brace to protect your ankle from further injury. Your doctor will discuss the specific type of brace and provide instructions for use.
After this initial course of treatment we will reassess your progress. We will determine the need for any additional care after your reassessment.
Sleep Posture
Your mattress and the position you sleep in may affect your condition.
✓ Choose a mattress that provides medium or firm support, such as a traditional coil spring or adjustable airbed. Avoid waterbeds, thick pillow tops and soft, sagging mattresses.
✓ Always sleep on your back with a pillow either underneath your knees or on your side with a pillow between your knees. Avoid sleeping on your stomach.
✓ Keep your neck and back covered while sleeping to avoid drafts that could cause potential muscle spasms.
RICE
The acronym RICE can help you remember what to do after a new injury:
✓ Rest – Limit stress to the injured area for at least the first 48 hours.
✓ Ice – Apply for 10-15 minutes. Break for 30 minutes. Reapply. (Alternatives to the ice pack include Ziploc bags filled with ice, or a bag of frozen vegetables.)
✓ Compression – Wrap the injured area with an elastic ACE bandage if possible.
✓ Elevation – Elevate the injured area to limit swelling.
Standing
To avoid extra stress on your spine while standing:
✓ Avoid high-heeled shoes or boots
✓ Use a footrest
✓ If excessive standing can’t be avoided, consider shock absorbent shoes or an anti-fatigue mat.
Footwear
Improperly supported feet can affect the alignment of all of the structures above. To improve your overall comfort:
✓ Choose shoes with good arch support.
✓ Avoid going barefoot or wearing shoes that lack support (i.e. flip-flops). The following brands of sandals provide better than average arch support: Naot, Fit Flops, Orthoheels, Abeo, Vionic and Yellow box.
✓ Avoid high-heeled shoes or boots (keep heels to a maximum of 1½ inches, especially if you are going to be doing a lot of walking).
✓ “Cross-trainer” athletic shoes tend to provide the best all around support and shock absorption for daily activities.
✓ Patients with fallen arches should consider adding arch supports or orthotics.
✓ Repair or replace shoes with worn soles or heels.
Running Shoes
Running shoes need to be replaced every 250 miles. There are three basic options:
✓ Motion Control Shoes – Designed for people with low or no arches, these shoes are for runners who strike the ground on the outer edge of their foot. Avoid overly stiff shoes as these decrease you perception of ground strike and lead to new injuries.
✓ Stability or Neutral Shoes – Designed for people with normal or average arches and running mechanics. The shoe contains some cushioning to absorb shock and prevent injuries and some rigidity to avoid pronation.
✓ Cushioned Shoes – Designed for people with high arched feet. Their footprint will typically leave a thin band along the foot’s edge. As they run weight is distributed from heel strike to the outer edge of the foot and small toes that bear the brunt of “lift off.” This shoe is more flexible and absorbs the shock created by the lack or rotation (under-pronation) created by their running style.