Trigger points in the trapezius muscle.

The trapezius muscle is a large diamond shaped muscle located in your back. This muscle is often overloaded due to poor sitting posture or excessive exercise. When this occurs trigger points will form. These points can cause back, neck, and shoulder pain. Trigger points in the upper traps are a leading cause of headache.

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Fibromyalgia Diet?

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Folks suffering with fibromyalgia (FM) commonly complain that certain foods can make their symptoms worse. How common is this? One study reported 42% of FM patients found that certain foods worsened their symptoms!

Because FM affects each person differently, there is no ONE FM diet or, “…one size fits all” when it comes to eating “right” for FM. Patients with FM usually find out by trial and error which foods work vs. those that consistently don’t. However, remembering which foods do what can be a challenge so FIRST, make a three column FOOD LOG with the following headings: BETTER, NO CHANGE, WORSE. This will allow you to QUICKLY review the list as a memory refresher.

According to Dr. Ginevra Liptan, medical director of the Frida Center for Fibromyalgia (Portland, OR) and author of Figuring Out Fibromyalgia: Current Science and the Most Effective Treatments, there are some common trends she’s observed through treating FM patients. Here are some of her recommendations:

PAY ATTENTION TO HOW FOOD MAKES YOU FEEL: It is quite common to have “sensitivities” to certain foods, but this is highly variable from person to person. Examples of problematic foods/ingredients include: MSG (commonly used in Chinese food), other preservatives, eggs, gluten, and dairy. Dr. Liptan HIGHLY recommends the food journal approach! She also recommends including a note about the type of symptoms noticed with each “WORSE” food, as symptoms can vary significantly.

ELIMINATE CERTAIN FOODS: If you suspect a certain food may be problematic, try an elimination challenge diet. That means STOP eating that food for six to eight weeks and then ADD it back into your diet and see how you feel. Remember, FM sufferers frequently have irritable bowel syndrome, also known as IBS, and this approach can be REALLY HELPFUL! Food allergies may be part of the problem, and your doctor may refer you for a consult with an allergist and/or a dietician. They will also discuss the “anti-inflammatory diet” with you.

EAT HEALTHY: In general, your diet should emphasize fruits and vegetables and lean protein. Pre-prepare food so you have something “healthy” to reach for rather than a less healthy snack when you’re hungry and tired. Consider “pre-washed” and pre-cut up vegetables; try quinoa rather than pasta. Consume anti-fatigue foods and eat multiple small meals daily vs. one to two large meals. Protein snacks (like a hardboiled egg or oatmeal – GLUTEN FREE) help a lot! Eat breakfast and include protein. Also, GET ENOUGH SLEEP (at least seven to eight hours and be consistent)!

SUPPLEMENTS: Consider a good general multi-vitamin, calcium and magnesium, omega-3 fatty acids, vitamin D3, and Co-Enzyme Q10. There are others, but this represents a great place to start. Remember to check any medication you may be taking with these/any suggestions before taking supplements!

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

Fibromyalgia and Sleep

Is there a connection between fibromyalgia (FM) and sleep disturbance? Let’s take a look!

FM is a condition that causes widespread pain and stiffness in muscles and joints. Patients with FM often experience chronic daytime fatigue and some type of sleep problems like getting to sleep, staying asleep, and/or feeling restored in the morning upon waking. The National Institutes of Health estimates between 80-90% of those diagnosed with FM are middle-aged women, although it can affect men and happen at any age. As little as 10-20 years ago, it was hard to find a doctor who “believed” in FM, and it was common for the patient to be told that their pain “was all in their head.” FM has now been studied to the point that we know it is a real condition, and it affects between 2-6% of the general population around the world.

It is well established that sleep disturbance frequently occurs after surgery, which usually normalizes as time passes. One study used a group of healthy women who were deprived of sleep (particularly slow wave sleep) for three days to see if there was a link between sleep disturbance and pain. Results confirmed that the women experienced a decrease in pain tolerance and increased levels of discomfort and fatigue after three days—the same symptoms found among FM sufferers!

Fibromyalgia may have NO known cause, or it can be triggered by other conditions such as repetitive stress injuries, car crash injuries, and other forms of trauma. FM also appears to run in families though it’s still NOT clear if this is a true genetic link or caused by shared environmental factors. Some feel FM is a rheumatoid condition, and though FM is NOT a true form of arthritis, it has been found that people with arthritis are more likely to have FM.

FM sufferers frequently suffer from conditions such as irritable bowel syndrome, chronic fatigue syndrome, migraine headaches, arthritis, lupus, and major depressive disorders. Approximately 20% of FM patients have depression and/or anxiety disorders, and a link between chronic pain and depression exists and seems to play a role in people’s perception of pain.

Because conditions such as sleep apnea can result in symptoms similar to FM, it’s recommended that patients suspected of FM keep a sleep/sleepiness diary in order to rule out sleep apnea as a cause for their condition.

There are many “tips” for improving sleep quality, which we will dive into next month, as these may prove VERY HELPFUL in the management of FM!

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

Trigger points in the gluteus Maximus muscle.

The gluteus Maximus muscle makes up your buttock. It’s is a powerful hip extensor and thus used heavily during activities such as walking, running, and climbing up stairs. Most atheletes abuse this muscle. When overworked trigger points will form, and these points will cause pain to be felt in the hip, sacrum and the as well as deep in the gluteal area. Litterally a pain in the butt!! Trigger points won’t release on their own and require interventions like trigger point massage.

Fibromyalgia sleep tips

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Last month, we discussed the connection between sleep disturbance and the presence of widespread pain found with fibromyalgia (FM). This month’s topic will center on how we can improve our sleep quality with the goal of feeling restored upon waking in the morning!

1)  NOISE & LIGHT: Block out noise with earplugs or a sound machine and light with window blinds, heavy curtains, and/or an eye mask. The light emanating from the LED or LCD from TVs, DVRs, or stereos has been found to suppress the pineal gland’s melatonin production (the “sleep hormone”) and thus can interfere with sleep, so try to keep them away from the bedroom. However, a small night light can assist for nighttime bathroom callings!

2) FOOD: Avoid large meals at least two hours before bedtime. Try a glass of milk, yogurt, or a small protein snack if hunger overcomes you. Milk is unique as it contains the amino acid L-tryptophan, which studies show, helps people sleep!

3)  EXERCISE: Aerobic exercise during the day is HIGHLY therapeutic. It reduces stress, reduces pain, reduces depression, and wakes us up! Avoid heavy exercise within three hours before bedtime. Exercise on a REGULAR basis to promote high-quality deep sleep.

4)  SLEEP HABITS: Develop good sleeping habits by going to bed at a regular time. Avoid napping in the late afternoon. A “POWER NAP” of no more than 10-15 minutes, ideally about eight hours after waking, is a GOOD THING as it can help you feel refreshed.

5)  MENTAL TASKS: Avoid mentally stimulating activity one hour before bedtime to calm the brain.

6)  MENTAL CLARITY: Avoid bedtime worries. Try NOT to think about things that are upsetting. Substitute positive thoughts, experiences, and/or visualize favorite hobbies that free up the mind. Try to avoid discussing emotional issues before bedtime.

7)  PETS: They are GREAT companions but NOT in the bed at night! Not only can pets kicking and moving disturb rest, their dander can stir up allergies and interfere with sleep.

8)  TEMPERATURE: A well-ventilated and temperature controlled (54-74° F or 12.2-23.3° Celsius) bedroom is “key.”

9)  BEDROOM “RULES”: The bedroom is for two things: physical intamacy and sleeping. If you wake up in the middle of the night, go to another room and read a book or watch TV until you feel sleepy.

10)  AVOID STIMULANTS: AVOID nicotine, caffeine, coffee, chocolate, tea, soft drinks, and various over-the-counter or prescription medications in the late evening, unless under instruction from your physician.

11)  RELAXATION TECHNIQUES: Try one (there are many) and practice it at bedtime.

12)  REFRAIN FROM DRINKING ALCOHOL: Alcohol is a nervous system depressant and can HELP you fall asleep, BUT a rebound withdrawal can cause nightmares and night sweats. Avoid this close to bedtime (switch to water!).

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

How can I make my WRD less severe?

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Whiplash is really a slang term for the rapid back and forth whipping of the head on the neck, usually associated with motor vehicle accidents. The title “Whiplash Associated Disorders”, or WAD, describes it best because it includes ALL of the MANY signs and symptoms of the disorder.

WAD basically comes in three sizes based on the degree of injury. A WAD I is present when there is pain but no physical examination findings; WAD II occurs when there are exam findings but no neurological loss (numbness or weakness); and WAD III includes loss of neurological function.  There is also a separate WAD level that includes fractures and dislocations (WAD IV).

There are many things that can be done by the patient to assist in the healing process for WAD. The first well-studied recommendation is to “continue with your usual activities.” Try to keep active and not change your routine. The good news is that WAD (especially types I and II) usually resolves without complication, and recovery is even more likely to occur if you don’t deviate much from your routine.

For those whose symptoms are more severe and/or not resolving, mobilization and manipulation of the neck and back are very effective treatment options. In addition to treatments you’d receive in a chiropractic office, there are MANY things you can do at home as “self-help strategies.” Some of these include (“PRICE”):

1)  PROTECT: Though it’s important to continue with your usual daily activities, this is dependent on both the degree of tissue injury and your pain tolerance. So do as many of your usual daily activities as possible, but AVOID those that result in a sharp, lancinating type of pain or those where recovery from the pain is delayed.  Therefore, this category may require modifying your ADLs (activities of daily living). A cervical collar (hard or

soft) should NOT to be used UNLESS you have an unstable injury (fracture or a grade III sprain).

2)  REST: Doing too much is like picking at a cut (which can delay healing) and doing too little can lead to a delayed healing response as well. Staying within reasonable pain boundaries is a good guide.

3) ICE > HEAT: Ice reduces swelling, and your doctor will typically recommend it over applying heat, especially on a recent injury. Heat draws fluids in, and while it may feel good, it can make your symptoms worse.

4)  COMPRESS: We can basically ignore this when referencing neck pain. This pertains better to wrapping an ankle, knee, wrist, or elbow with an elastic compression orthotic or brace.

5)  ELEVATE: This too is meant for the acute stages of an extremity injury like a foot or ankle.

Exercises unique for neck pain in the acute, subacute, and chronic stages of healing are perhaps the most important of the self-help approaches. In the ACUTE phase, try these…

1)  Range of Motion: Once again, stay within “reasonable pain boundaries” as you move your head forwards, backwards, side to side, and rotate left and right. These can be done either with or without LIGHT resistance applied using one or two fingers placed against your head. Limit the repetitions to three slow reps in each direction and emphasize the release of the movement.

2)  Chin/head Glides: Tuck in the chin (think of creating a double or triple chin) followed by poking the chin/head out.

In the SUBACUTE and CHRONIC phases of healing, the importance of strengthening the deep neck flexors cannot be over emphasized. Please refer to last month’s article for a description of this (see #3 of the 6 recommendations listed).

MRI Truths & Myths

Arthritis

Low back pain is a very common complaint. In fact, it’s the #1 reason for doctor visits in the United States! The economic burden of LBP on the working class is astronomical. Most people can’t afford to be off work for one day, much less a week, month, or more! Because of the popularity of hospital-based TV dramas over the past two decades, many people think getting an MRI of their back can help their doctor fix their lower back problem. Is this a good idea? Let’s take a look!

Patients will often bring in a CD that has an MRI of their lower back to a doctor of chiropractic and ask the ultimate question, “….can you fix me?” Or, worse, “…I think I need surgery.” Sure, it’s quite amazing how an MRI can “slice” through the spine and show bone, soft tissues, disks, muscles, nerves, the spinal cord, and more! Since the low back bears approximately 2/3 of our body’s weight, you can frequently find MANY ABNORMALITIES in a person over 40-50 years old. In fact, it would be quite odd NOT to see things like disk degeneration, disk bulges, joint arthritis, spur formation, etc.!

Hence, the “downside” of having ALL this information is the struggle to determine which finding on the MRI has clinical significance. In other words, where is the LBP coming from? Is it that degenerative disk, bulged disk, herniated disk, or the narrowed canal where the nerve travels? Interestingly, in a recent review of more than 3,200 cases of acute low back pain, those who had an MRI scan performed earlier in their care had a WORSE outcome, more surgery, and higher costs compared with those who didn’t succumb to the temptation of requesting an MRI!

This is not to say MRI, CT scans, and x-rays are not important, as they effectively show conditions like subtle fractures and dangerous conditions like cancer. But for LBP, MRI is often misleading. This is because the primary cause of LBP is “functional” NOT “structural,” so it’s EASY to get railroaded into thinking whatever shows up on that MRI has to be the problem.

Here is how we know this, when we take 1,000 people WITHOUT low back pain between ages 30 and 60 (male or female) and perform an MRI on their lower back, we will find up to 53% will have PAINLESS disk bulges in one or more lumbar disks. Moreover, we will find up to 30% will have partial disk herniations, and up to 18% will have an extruded disk (one that has herniated ALL the way out). Yet, these people are PAIN FREE and never knew they had disk “derangement” (since they have no LBP). When combining all of these possible disk problems together, several studies report that between 57% and 64% of the general population has some type of disk problem without ANY BACK PAIN!

Hence, when a patient with a simple sprain/strain and localized LBP presents with an MRI showing a disk problem, it usually ONLY CONFUSES the patient (and frequently the doctor), as that disk problem is usually not the problem causing the pain!  So DON’T have an MRI UNLESS a surgical treatment decision depends on its findings. That is weakness, numbness, and non-resolving LBP in spite of 4-6 weeks of non-surgical care or unless there is weakness in bowel or bladder control. Remember, the majority of back pain sufferers DO NOT need surgery!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.