Musculoskeletal Pain Syndromes

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Except where there is failure of a joint or muscle due to significant external trauma, almost all musculoskeletal pain is the inevitable end of a build up of problems over time. Your back pain might be the result of a combination of the residues from an ankle sprain twenty years ago combined with an old ligament tear on the opposite knee, poor sleep and a low grade food intolerance. The body may well cope with any one of these alone but together they provide more challenge than the body can cope with and as such may constitute the underlying causes of your symptoms.

Musculoskeletal pain has three main presentations; acute injury, fatigue and muscular dissonance pain.

Acute Injury – This presentation is usually unambiguous. Most of us have rolled an ankle at some stage and the pain does not develop over time, it hits you with a severity and immediacy that makes it cause “painfully” clear. In these circumstances there is torn tissues which release chemical signallers called “cytokines” that start the process of repair with swelling, erythema (redness due to immune response) and pain to signal to us to be protective of this are. As a qualified sports chiropractor I have seen this many time. The initial first aid is summed up in the acronym RICE which stands for Rest, Ice, Compression, and Elevation. I would also add immediate care from a sports chiropractor as the joint surfaces are usually poorly aligned after such an injury and although it sounds a little scary, manipulation of the joint as soon as possible significantly speeds up recovery.

The next two presentations are usually the result of accumulated challenges that eventually add up to create a pattern that can no longer fully compensate for any additional challenge.  The patient then does something like move a cord of wood or play a game of touch and in the process creates a loading that is more than the reserve capacity of the body can cope with. This may result in a minor strain or sprain in which case the pain onset is sudden and associated with a discrete event. In this instant the pain is exacerbated by a specific movement and happens at the same point of motion every time. In this respect it is like the significant injury above except that there is no swelling or erythema.

Fatigue Pain – This pain is the pain or discomfort we feel when we are forced to carry a load some distance to the extent that out arms or back starts to ache.  Often the result of accumulated injuries that generate a compromised compensation pattern. The pain slowly builds up and may not fully emerge until a day or so after the putative causative event.  This pain has a deep seated aching character because the new pattern is putting too much load on a single muscle, or muscle set, causing them to fatigue. It is also associated with the protective muscle loading that is found with food intolerances and other visceral (internal organs) triggers.  In this circumstance you can usually slowly move through the point of pain.

Muscular Dissonance – The other way aberrant compensation patterns present is through a process I characterise as muscular dissonance, dissonance being a term borrowed from music indicating a lack of harmony.  In this presentation the pain onset is mainly associated with movement and has a sharp, stabbing, catching character and is usually associated with one particular movement.  If you move very slowly you can usually complete the movement and if you repeat the movement the pain often grabs at slightly different points in the range of motion.

The reason I have developed the neologism muscular dissonance is because like an orchestra with a rogue instrument the one actuator (muscle or muscle set) that’s lost connection with the coordinating neurological process destroys the harmony of the movement. All movement involves co-ordinated muscle activation and antagonist (opposite) muscle relaxation. In this presentation the neurological co-ordination is inadequate which I believe is why you can often do the movement in a slow, highly controlled, manner but not in the normal fluid unconscious manner.

All the musculoskeletal pain syndromes we will discuss under the other headings involve one or more of these presentations.

Digestive Problems

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Naturally digestive issues have gastrointestinal specific symptoms but it is important to note that they also usually have a specific associated musculoskeletal pain.  With bowel this most often involves the low back. The pain is often present in bed.  Is of a nagging character see Fatigue Pain and often improves with movement and intensifies with fatigue.  You may wake with it and then it gets better but returns with the end of the working day.  Another identifying characteristic is that you don’t like working semi stooped, such as working on a low bench or movements where you are stooped forward such as sweeping, shovelling and vacuuming. When not too severe, this pain is often relieved by hyperextension of the lumbar spine (bending backwards).

Irritable Bowel Syndrome

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Irritable Bowel Syndrome (IBS) is a functional illness of the gastrointestinal tract, that is, an illness in which the intestine (bowel) fails to function normally. To some extent it is a catch all designation as its causes and symptomatic picture cover a wide spectrum. The most common symptoms of IBS are constipation, diarrhoea, bloating, irregular bowel movements and abdominal pain.

In our experience we find the most common causes of IBS to be undiagnosed food intolerances, intestinal dysbiosis, and stress. To treat IBS we first identify the underlying causes using muscle testing. By this process of identifying and eliminating the underlying causes of IBS we have had good success with IBS.

Crohn’s Disease

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Crohn’s disease or regional enteritis is a form of inflammatory bowel disease. It can impact anywhere in the gastrointestinal tract but most commonly impacts the small and large intestine. Common symptoms include diarrhoea, abdominal pain, weight loss, blood in the stools and in severe cases vomiting.

Outside the gastrointestinal tract symptoms may impact on the skin, eyes, and joints and generate a generalised malaise. Its causes are unclear. A genetic predisposition has been identified, as have immune, environmental and microbial causes.

While it looks and behaves a lot like an autoimmune disorder, particularly at the non gastrointestinal sites of impact, there is some dispute as to whether it is autoimmune or an immune deficiency disorder. From our perspective this is to a large extent academic as both are a problem with immune targeting. We address them similarly as they share the same constellation of underlying causes.

When trying to identify underlying causes it is essential to look at all aspects of the patient’s lifestyle. In its acute phase Crohn’s disease often requires strong pharmaceutical intervention but once stabilised we find that by identify food intolerance and implementing lifestyle changes, particularly dietary changes, it is possible to have long term remission. For those who want to consider an alternative to medication or surgery we offer a real and safe alternative. We aim at changing the factors underlying your symptomatic picture so that you can discuss coming off medication with your medical practitioner.

Ulcerative Colitis

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Ulcerative colitis is an inflammatory bowel disease. Unlike Crohn’s disease it is usually confined in the GI tract to the large bowel.  It is treated medically as an autoimmune disorder using corticosteroids or immunosuppressant drugs. In extreme cases surgery is indicated, but we would hope that the patient has come to us long before things deteriorate to this stage. Biological therapy is also occasionally used but this can have significant risk depending on the agent used.

As with other inflammatory bowel disorders, the most common symptoms are diarrhoea which often consists of mucus mixed with blood and pain which varies from mild discomfort to significant pain associated with bowel movements. The loss of blood may result in anaemia. Outside the GI tract other symptoms normally associated with autoimmune disorders may occur including mouth ulcers, inflammation of the eye, arthritic pain, skin eruptions, and even deep vein thrombosis.

There is good clinical evidence supporting the use of herbs, diet and probiotics.  Some trials have produced results comparable to medications without the risks and side effects.   As with all illnesses that have in their spectrum of triggers, environmental factors, it is often by dealing with the underlying causes that the cycle of remission and exacerbation that characterises ulcerative colitis is broken.

Hay Fever, Eczema, and Asthma (Atopic Syndrome)

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These maladies are frequently found together having several things in common. Atopy is likely to have a genetic component as it tends to run in families. It presents as localised hypersensitivity to an environmental trigger, or allergen.  Commonly pollens, dander (particularly cats’ fur) and dust mites are triggers for an attack.  We see these as triggers but not the main underlying cause.  In our experience it is extremely rare to have a patient with atopy who does not also test positive for at least one food intolerance.  For this reason, the first steps we take is to test for food intolerances and often the condition can be brought under control by eliminating the offending food group.
It is important to remember that a trigger is something that may precipitate an outbreak, whereas a cause is often a deeper issue for which the body has established a compensation mechanism.

It is because compensation mechanisms strain the body’s resources that they contribute to functional problems. In this scenario, nearly any additional stress will precipitate an outbreak. In the short term avoiding the trigger(s) may be a solution, but lasting results only come from identifying the causative immune habits and correcting them.

Other Immune Problems

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The immune system is responsible for repairing damaged tissue, destroying rogue cells and fighting infection.  In the early stages of life, the immune system “learns” what is normal in the body and what is foreign and once imprinted this sets the scene for all future immune system action.

Critical to the integrity of this process is a healthy microbiome (the bugs that live on us and in us).  We are inoculated with these as we pass through the birth canal.  They cover our skin and are ingested into the gut.  Even before birth we are exposed to beneficial bacteria in utero (inside the womb). Breast milk is not sterile as it also contains beneficial bacteria.  Anything that interferes with these processes has implications for future immune function.

Most immune problems, and certainly functional immune problems, can be characterised as a failure of immune targeting. Cancer is a failure to recognise rogue cells that have started to replicate in an uncontrolled fashion. Atopic syndrome is the overreaction of the immune system to otherwise innocuous environmental triggers. A similar response is found in allergies and intolerances. Finally, there is a whole class of immune conditions call autoimmune diseases, these include rheumatoid disease, multiple sclerosis, type 1 diabetes, and lupus to name but a few.

We have never had any success with the cancers and only limited success with autoimmune disorders.  It is with allergies, intolerances and atopy that we have our best immune results. Often we can identify underlying causes, food and environmental triggers, that may impact on immune function and to this extend it may be worth consulting with us. In addition, the immune system is responsive to environmental and emotional stress, again our work may help in dealing with these.

Infantile Colic

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Being a father has been one of the most rewarding and educational aspects of my life. We know colic can be a very distressing disorder. We have found, as with so many functional problems, colic has many contributing components. We use muscle testing to find out if foods consumed by the baby’s mother are a contributing factor or if the baby’s formula is one of the problems. Mother’s stress can also be an underlying cause. Often it is a combination of factors most of which respond to treatment.

Baby Sleep Problems

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It is not uncommon for babies to initially sleep well and then after an infection, vaccinations or during teething, get out of this good sleep habit. This in turn leads to family stress which can affect everybody. Using Applied Kinesiology, we can often identify the triggers and re-establish good sleep habits.

Neck Pain

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Most people will suffer neck pain at some stage in their life. The causes are many and varied. As with most pain syndromes it is usually a cumulative process. The intrinsic (deep) neck muscles, particularly the ones at the base of the skull, the sub-occipital muscles, are critical to signalling to the brain as to where your head is in relation to the rest of your body. As such these are essential to normal hand eye co-ordination.

Commonly with neck pain; stress, computer work, old injury and toxicity which create a greater demand for chronic contraction of the neck’s intrinsic muscles.  In time this can lead to restricted movement which sustains the pain causing pattern. Through gentle chiropractic adjustments (manipulation) we can restore normal movement and improve signalling to the brain.  This can have a profound impact on musculoskeletal pain almost anywhere in the body.

Mid Back Pain

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This is pain between the shoulder blades or around the level of the bra strap. It is commonly associated with stress. When the diaphragm is involved the patient often takes deep sighing breaths and has sense that they “just can’t get a decent breath.” It is easily fixed once the underlying pattern is located.

In addition to general deconstruction of the aberrant pattern we usually also release the diaphragm which in most cases results in instant relief and improved breathing. We follow this with gentle manipulation to restore normal movement and reintegrate signalling to and from the brain.

Low Back Pain

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Low back pain presents in many variations. It may be just a low level ache or it can be searing pain right across the low back and in the upper leg. It must be distinguished from the rarer, and much more complicated disc protrusion/prolapse pain (about 1% of low back pain).

Most commonly low back pain presents as a developing problem which comes and goes doing certain work, while sleeping or other variable conditions. This suggests that it is not the particular event that is causing the problem, but rather the event is just the final straw so to speak that pushes the body into de-compensation which shows as low back pain.

Even when pain onset is sudden, unless the cause is spectacular, the cause is most likely a collection of smaller events that have a cumulative effect that resulted in minor injury (see underlying causes). Treatment must be aimed at the underlying causes that established the pattern that lead to functional failure or results will be short lived.

Having said this, there is the usual list of suspects that are associated with low back pain. These include, stress-induced diaphragm problems, jaw or cranial faults, fixated lumbar vertebrae, and visceral problems including food intolerances.

Leg Problems

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Plantar fasciitis, Morton’s neuroma, shin splints, ankle and foot pain, weak ankles, knee pain and hip pain are all treated similarly because they represent, in most cases, different focal representations of the same broad underlying causes. Most of the time we can fix these with no other intervention required. Occasionally, it is necessary to use an orthotic device. On the rare occasions where this is necessary we refer to a podiatrist.

Plantar Fasciitis

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The plantar fascia is a tough band of connective tissue that runs almost the full length of the sole of the foot. It functions as a tie-rod, stopping the long arch of the foot from flattening under load. Because it is intimately associated with the biomechanical stability of the foot, it is affected by anything that induces a biomechanical challenge to the foot.

Plantar fasciitis is inflammation of the plantar fascia and presents as pain either along the sole of the foot or the anterior aspect of the heel. It is often worse when standing, walking or running (under load).  While many professions find this a difficult condition to treat, we find it one of the easiest. To track the underlying causes is simply a matter of locking the patient into compromise and muscle testing to locate the various components that have led to the problem.

Morton’s Neuroma

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Although called a neuroma, this is probably incorrectly named. It presents as pain, tingling, and/or a cold or burning sensation between the toes, which is often worse on standing.  We find it is associated with an inferiorly displaced, or dropped, metatarsal head that compresses the nerve that runs between the toes. The most common metatarsal head to show this problem is the 3rd which is at the peak of the transverse arch of the foot.

A dropped metatarsal head is easy to manipulate into position but, if stability is to be achieved, it is essential to determine why it dropped in the first instance. It is a functional problem of the foot and as such there will normally be underlying causes that have set up this situation.

These are varied and many but include; weakness of the leg and foot muscles, fixation of other joints of the foot that lead to restriction in flexibility of the longitudinal arch, unresolved old ankle sprains, knee or hip problems on the same side or a problem with the other leg that has led to unreasonable strain on the involved leg.

Shin Splints

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Shin splints, (medial tibial stress syndrome (MTSS)). Presents as pain between the knee and the ankle in muscles that occupy anterior outer aspect of the leg.  It is usually caused by overloading the muscles or by biomechanical stress due to fixation of joints over which these muscles work. It responds well to treatment usually resolving within a few visits. As with other functional musculoskeletal problems it is just a matter of identifying the underlying causes and treating them.

Ankle and Foot Pain

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In addition to the specific syndromes that affect the foot there are a number of nondescript problems that can affect the foot.  Excluding pathologies such as inflammatory arthritides and fractures, most of these are the result of functional failure and as such will have underlying causes that more often than not are easily located by muscle testing.

Knee Pain

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Knees are odd structures if you just think about them. They are in effect two posts, one stuck on top of another held together by ligaments muscles and to a lesser extent skin. They would appear to be inherently unstable structures, yet this is not the case.

As with all joints, primary stability comes from the muscles keeping the joint surfaces in contact at exactly the correct orientation and position. This happens because the central nervous system (CNS) is aware of all the elements that make up the joint and its contiguous structures and is able to coordinate the necessary changes in muscle activity to keep the whole structure moving correctly. If there is poor data feeding into the CNS, then this coordination starts to fail and this problem is no more apparent in any part of the body than in the knees.

For this reason, treatment of knee pain – a consequence of underlying causes leading to functional failure, usually involves improving the input into the CNS by keeping all the joints that supply data on body position (proprioceptive information) working to their ideal capacity.

While there might be a history of injury with torn cruciate ligaments or worn joint surfaces, it is almost always possible to improve joint function by addressing the underlying causes.

Hip Pain

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Hip pain is in the groin. Primary hip pain in adults is most commonly a result of degenerative joint disease and as such can only be addressed by removing the factors that are leading to the degenerative change.  The hip joints provide most of the body’s ability to flex forward and are a pivotal point carry significant loadings. They are a very constrained joint and as such are not prone to dislocation. The trade-off is that they have little capacity to deal with direct translational forces except by taking a huge compressive load onto the joint surfaces. This is normally avoided by flexing the hip, knee and ankle together to produce a shock absorbing effect.

Where there is instability in the knee, foot or even the lumbar spine, the capacity of the body to take such impacts is reduced. This strongly suggests that in looking for underlying causes of hip dysfunction we need to ensure the knees, feet, ankles and spine are all functioning to capacity.

In addition, the joint surfaces, particularly the hyaline cartilage that coats the articulating surfaces, must be in good health. Although there is some dispute as to the benefits of glucosamine and chondroitin on joint health our experience is that in the context of our treatment there is considerable benefit.

The main benefits though come from addressing the underlying causes of dysfunction. Of most benefit has been remobilising adjacent structures and the hip joint itself.

Often what people describe as hip pain is in fact a variance on low back pain. If your pain is not located in the groin but in the outer upper posterior aspect of the hip bones (the innominate) over the lateral buttocks and upper outer leg then it is most likely coming from the sacroiliac joint and is not a hip problem. Having said this we would still like to see you because we can probably solve the problem.