In a world where we have so much access to information, I find that when it comes to diagnoses, there are some overly-simplified patterns. If there is pain in the foot, it is plantar fasciitis, pain down the leg is labeled sciatica, and elbow pain is tennis elbow. Not that these conditions are not common; just not that common. Tennis elbow is particularly over-diagnosed. Pain in the elbow is common. Tennis elbow, however, is specifically pain resulting from injury to the extensor tendons which insert at the lateral epicondyle causing inflammation and dysfunction. Simply put, to be tennis elbow, the pain must be right around the little knob on the outside of the elbow and get worse when trying to extend the wrist with resistance. It is called tennis elbow presumably because repetitive backhand swings in tennis will cause such a condition. Incidentally, pain on the inner knob is known as golfers elbow.
I have found that neither tennis elbow or golfers elbow are more common than just a regular subluxated elbow. As a hinge that rotates and pivots and is made up of three bones and two joints, dysfunction is easy to come by. Often, the radial head will get stuck farther back than it should be. This will cause a strain on the muscles that insert in that area and mimic or create tennis elbow. The good news is that with an adjustment or a few, the condition typically responds quickly. If it is, indeed, tennis elbow, the best thing to do is to make sure the elbow is adjusted and functioning properly, then focus on the tendons with ice, stretching, and myofascial massage or active release. So, the next time somebody complains of tennis elbow, tell them to see their local friendly chiropractor.
Have you ever bent over to pick up something only to experience a pain like someone shoved a hot poker into your low back and then started pulling your muscles apart? Yeah, most of us have felt that at some point. Hopefully, it never happens to you, too, but if it does, here is what you do.
Abraham Lincoln once said, “You cannot escape the responsibility of tomorrow by evading it today.” The same is true for addressing your health concerns. Several times each day I have patients come in who tell me they have been hurting for days, weeks, months, or even years. The story is usually that they just thought it would get better on its own but it never did. Inevitably, they express their remorse at waiting to come in.
The truth is that with any injury, the body starts the healing process immediately. The concern is whether you will heal correctly. The body will compensate in whichever way it can to stabilize. If muscles are tight or ligaments are overstretched, it will alter the proper movement of joints. Such improper movement causes the nervous system to become confused and ultimately desensitized. Consequently, the body will lay down scar tissue that will promote the new and improper movement patterns which leaves the body susceptible to reinjury or to injury of surrounding tissue.
As a chiropractor, if I can help move the joints in a proper manner before inflammation and scar tissue sets in, then the healing process is a much easier ordeal. If you wait until scar tissue repair has set in when you come in to see me, the first step will be for me to tear down most of that process so the healing can start over. As with remodeling kitchens, the demolition can be ugly. The old adage of getting worse before it gets better is often in play and can lead to a few days of discomfort.
Another caveat to waiting is establishing movement patterns that can be difficult to retrain. Old habits are harder to change than simply making new ones in a fresh environment. Chronic conditions can take years to correct for this very reason. Muscles and joints have memory locked in to the nervous system. In my experience, it typically takes around three months of consistent treatment to change that memory.
Finally, with altered movement, the the body will degenerate quicker. At a joint level that means that tissues will dry up and bone spurs will form. Once a bone spur has formed, everything changes. No amount of adjusting, taking supplements, acupuncture, or whatever is going to remove that. Tissues can be rehydrated but they are never as good as they used to be. This is mortality. However, we can help slow down the degenerative process. At the end of the day, if we just improve the function it is worth it.
All conditions will change over time. The body will strive to compensate but that compensation can lead to issues down the road. If you have an injury or if dysfunction has been brewing for too long, get in! Better yet, come consistently and do your best to maintain good health and function.
Whenever I get several patients who come in with the same ailment, I always feel like the universe is telling me to write about it. When that same ailment happens to me, the hint is as subtle as a two by four to the head. Such is the case with this article.
I have had a lot of patients come in with sprained ankles lately. For me, I didn’t think it was possible to sprain my ankles anymore. The ligaments in my ankles are pretty much gone from spraining them several times playing soccer in high school and college. So much for that. I rolled it jumping on the trampoline with my kids yesterday. It usually smarts initially and that is about it. This time it continued to hurt and started swelling a little, too. So, “Doctor, heal thyself!”
Here is the protocol: First you have to remember the mnemonic PRICE. P=protect, R=rest, I=ice, C=compress, E=elevate. I stopped jumping and walked it off. I rested with it elevated. Then, I put it in an ice bucket (protocol details below). I planned on wrapping it up but it felt stable and the swelling was down when I woke up this morning so I thought I would be alright. In fact, I walked to work today and it felt just fine.
The most important thing to do if you sprain an ankle is ice it. Ice packs on an ankle are almost useless. You just don’t get enough surface contact to penetrate to the joint. If you are going to do it, be sure to leave it on for 20 minutes. However, the best way to ice the ankle is to put it in an ice bath. Here are the steps:
1.As soon as possible after a sprained ankle get a bucket big enough to fit your foot
2. Fill it with ice about 4 inches deep
3. Fill the bucket with water deep enough to reach just below the calf muscle (higher for high ankle sprains)
4. Cover the toes with a sock if needed
5. Immerse foot for 6-10 minutes until numb.
This is not exactly fun (unless you are a masochist) so, be tough. The stages of icing are intense cold followed by aching then burning then numbness. You have to get to numbness to benefit. Some people cheat a little and put on a sock covered by a baggie. This is ok as long as the sock is not too thick and there is not an air barrier in baggie. It still has to get to numb!
If you chronically sprain your ankles like I used to, you will have to rehab them. The more you sprain a joint, the worse the proprioception or the communication between the brain and the joint. In short, it becomes dull and you are much more likely to sprain it again. I recommend standing on a wobble board for several minutes each day. That will improve the proprioception and dramatically decrease the likelihood of future sprains.
In this world of instant gratification, realistic expectations are often scarce. We have instant coffee, fast food, automatic deposit, etc. We demand results quickly and for most things we get them. Unfortunately, healing is not an instantaneous event. It takes time. Don’t get me wrong. I am as impatient as anyone. I like to see or experience improvement quickly. However, when it comes to healing, there is still a process.
This article was written to help you understand the healing process and what to expect on your road to recovery.
The healing process has several stages. They can be broken down into three major steps:
1. Inflammation: Whenever an injury occurs there is damage to tissue. Tissue damage causes a reaction in the body that brings chemicals to take care of the damage. It causes swelling which keeps the affected area from moving too much. The reaction also generates heat, hence the term. I like to compare inflammation to firefighters putting out a fire. They arrive quickly and start shooting water onto the fire. Though necessary, often times the damage from the water is just as bad as the damage from the fire itself. This is even more true of inflammation. If not taken care of quickly, inflammation will begin to destroy the good tissue and cause a host of other problems. For this reason, ice is a powerful tool. Controlling the swelling with compression and an anti-inflammatory diet can also be very valuable.
2. Scar Tissue Repair: After a 2-6 days of inflammation, the body starts to lay down scar tissue. Scar tissue is weak and it complicated by the fact that it is laid down quickly and haphazardly. To further the analogy of a home damaged by fire, imagine a crew going in after the water has mostly dried and quickly supporting the overall structure with whatever wood they can find. They make it more stable than it was but it is not as functional and it is certainly not as stable. Scar tissue is supposed to be a temporary process that takes 6 weeks to 6 months depending on the damage. Unfortunately, many people do not do what it takes to get beyond this stage. As a result, they easily tear the scar tissue and the process starts again. This is the cause of chronic injury.
3. Remodeling of Tissue: When scar tissue starts to act like the original tissue, the remodeling process has begun. It is critical to get to this stage if true healing is to occur. This stage can last for a long time. For some tissues, like the nervous system, the process can be so slow it is almost imperceptible. For such tissues, support therapies like hyperbaric can help. In joint, muscle, bone, ligament, tendon, etc., proper motion and function dictate this process. You have to train the scar tissue to line up all in the same direction and act like and be in sync with the surrounding tissue. Only at this point will true healing occur.
Unrelated topic: when you make a comment on this blog, you will automatically be entered into a drawing to win free chiropractic care for April.
Pardon my rant for moment and please consider what I am about to say. Pain is a symptom or an indicator. Pain is annoying. Pain can be frustrating. Pain can even be debilitating. Treating for pain, however, is a terrible way help someone get out of pain.
The origins of pain are not well understood and can be a very deep topic. That saying, from my study, most of our pain is distributed through the limbic center of the brain. The limbic system is really the emotional center of the brain. So, to me, pain is an emotional response. Ever notice that some people have a high pain threshold and others have little to none? Likewise, some cultures are very stoic about pain while others are extremely passionate. The very same stimulus can be applied but the reaction is completely different.
Don’t get me wrong. Pain is very real. I am not suggesting we write off anyone in pain with the idea that it is all in their head. What I am suggesting is that we keep pain in perspective. Bad pain does not always mean horrible damage. Likewise, some of the most serious damage to the human body can display very little pain. Furthermore, pain can be a good thing when it gives a warning that something can be harmful. Have you ever stepped on hot sand and immediately pulled away so you didn’t burn your feet? What if you were a diabetic with poor blood circulation and therefor poor feeling in your feet. Would you say that it was a good thing to burn your feet because you couldn’t feel it? Of course not!
Rather than focus on the pain of an injury, I like to focus on the rehabilitation or function. If we only treated for pain, very few people would ever recover. Rehabilitating an injury whether chronic or acute can be painful. Let me say that again, TREATMENT CAN BE PAINFUL! Sometimes we have to break down a lot of scar tissue. This will be painful. When you are dealing with functional and physical medicine, like chiropractic, the end result is to get you functional which will eventually lead to less pain. By the way, this takes time.
Please don’t kid yourself that you can rehabilitate an injury without pain or discomfort. It is just not how the body works. Would you expect to work with a personal trainer to get in shape and never feel soreness or fatigue? Instead, focus on improving function and accept pain for what it is. In the words of the Dred Pirate Roberts aka Westley from The Princess Bride, -“Life is pain, your highness. Anyone who tells you differently is selling something.”
I get asked quite frequently whether to use ice or heat on an aching joint. When in doubt, use ice but use it properly. I have outlined protocols for icing below. That is not to say that there are not times when heat is appropriate, but icing is almost always beneficial if done right, whereas heat can cause problems on a new or inflamed injury.
The rule of thumb is that if the injury is acute or new within the last 6 weeks or if it is an exacerbation of an injury, use ice. Heat is good for loosening up sore muscles and stiff joints. If you need to get things moving, heating for 20 minutes can be very therapeutic. Be careful though. If you heat an inflamed joint, it will feel better while it is on but the heat will increase the inflammation and not only cause more discomfort but also prolong your healing. As a precaution, I typically recommend using heat only if you are going to be moving around (ie. never before or during bedtime). If you are going to use heat before bed, follow it up with ice. That way you won’t wake up feeling like you were hit by a train.
Icing is not as simple as just putting something cold on you for a little while. If done properly, it can be extremely beneficial. If done improperly, it will have little to no benefit. So, here are the rules to using ice properly.
1. Cover the affected area. Not using enough ice will not drive the inflammation away enough to make it worth the pain of icing. A nice big ice pack for big areas like the back, legs, and arms is critical. Conversely, for feet and hands, an ice pack might not be good at all. I usually recommend an ice bucket if the body part fits. ***I will explain those protocols below.
2. Make sure the ice penetrates. Too often, people will put a bath towel between the ice pack and the affected area. Their excuse is usually that it is too cold. They are missing the point. It is supposed to be cold! You should only use a paper towel or thin t-shirt in between.
3. Let it go numb. If the area you are icing doesn’t get numb you really haven’t done it right. When icing you should feel it get cold which should then start to burn. (Be careful not to get an actual ice burn. On rare occasion, if the ice pack is too cold and it is up against sensitive skin it can burn the skin. This shouldn’t happen with most ice packs if you have a paper towel in-between.) After the burning feeling, the area should start to ache until it goes numb. Once it is numb, you are done!
4. Never ice longer than 20 minutes. After 20 minutes the body sends out a signal that the area is developing frostbite and will send more blood to the area. As icing helps to drive blood/inflammation away, sending more blood in is a bad thing. If after 20 minutes the area never got numb, take it off and wait 40 minutes to ice again.
5. Wait 40 minutes before you can ice again. Make sure the affected area is back to regular body temperature before you shock it again with ice.
***Ice Bucket Protocol: Use an ice bucket for ankles/feet and hands/wrists. This is by far the best way to drive out inflammation from these areas.
1. Get a bucket big enough.
2. Put as much ice in it that will cover your affected extremity.
3. Fill it with water to the same level.
4. Cover fingers or toes with a sock.
5. Immerse the extremity.
6. Keep it moving gently to keep the water immediately surrounding from warming up.
7. Ice until numb (usually around 5 minutes).
8. Repeat once the limb is back to body temperature.