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1st Dec


Persistent Peripheral Pain- Is the Spine Involved?

It is not uncommon to see people suffer from chronic muscle or tendon problems which don’t respond as well to treatment as you would expect, because these people also have painful conditions or abnormal function in the neck or back, which negatively affect the peripheral conditions.  Examples of this would be stubborn tennis elbow or rotator cuff tendon problems, or for others hip tendinitis or persistent hamstring muscle pain with activities.  Yet others may in the long run develop painful joints and arthritis, such as in the hip.

 The mechanism by which this can occur is as follows: Spinal joints have nerve receptor organs imbedded in surrounding ligaments and capsules.  When we are subjected to abnormal strain or compressive forces on joints, either due to low grade forces that result from normal daily activities over a long period, or due to a sudden trauma or tissue irritation, certain nerve pain receptors respond by sending impulses out to select muscle groups, which increase their muscle tone, which we refer to as muscle guarding.

 The muscles that respond in this reflex manner are predominantly slow twitch fiber muscles, whose main function is to stabilize our joints.  However, it is not only the deep stabilizing muscles right by the spine that contract when the joint nerve receptors fire.  It is also often distant muscle groups, which get their nerve supply from that same level in the spine, or are interpreted by the brain to “belong to that spinal segment”. 

 Common problem levels in the neck are the C4-5, C5-6 and C6-7 levels.  Frequently this leads to increased muscle tension of certain muscles around the shoulder blade, the rotator cuff in the shoulder, and even wrist extensor muscles which attach to the outside of the elbow.  This predisposes the person to getting e.g. rotator cuff tendinopathy or impingement, or tennis elbow. 

 In the lower back, the L4-5 and L5-S1 segments are involved in ≥ 80% of all low back conditions, which often leads to muscle guarding of deep buttock and hip muscles, and hamstrings or deep calf muscles.  This may over time result in strain or tendinopathy of such muscles, or cause bursitis of related bursa sacks,  and because of long-term contraction of hip musculature, the hip joint may get too compressed and even develop arthritis.

 Sometimes, these peripheral problems are the most obvious, and treatment is prescribed only for them.  However, if there is an underlying spinal condition, even if not  at first obvious, which continues to cause reflex contraction of the distant muscles, this must be treated as well in order to get good and lasting results.

 The orthopedic manual physical therapist must evaluate for this, and when called for treat both the peripheral and the spinal condition.  By applying specific joint and soft tissue mobilization techniques to the spine, and to the peripheral region, we can most effectively reduce the abnormal muscle tone, and allow for the tissues peripherally to heal better. 

 We also want to take it a step further, by prescribing specific exercises not only for the peripheral condition, but also for the spine to establish normal joint mobility and stability, in order to silence the activity of the joint pain nerve receptors, and thereby prevent recurrence of pain in the peripheral region.

 Over the years, we have seen many patients who get well only after applying such a treatment method.  If you know of anyone who this could apply to, please feel free to forward this letter on.  

With that, I want to wish you a wonderful Holiday Season and end of 2013.

 All the best,


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