Health Features

Health: Pain Management

First there’s the physical hurt, then there’s the emotional toll. Constant discomfort wears you down, body and soul. According to the Institute of Medicine, an unbelievable 100 million Americans suffer from chronic pain. Managing it is a full-time job. Fortunately, the treatment arsenal is no longer limited to drugs and surgery. Experts say physical therapy is a great way to treat many types of pain, and alternative therapies such as acupuncture, chiropractic and myofasical release offer many patients hope, too.

[neck pain]
Neck pain is among the most commonly reported types of pain. It comes either from muscular strain in the shoulders and arms or arthritic changes to the spine. The good news is we can do a lot to mitigate it simply by strengthening the neck with therapeutic stretches and exercises and by making healthy lifestyle changes.

Arthritic changes in the neck, including degenerative disc disease, herniated discs and pinched nerves, are a normal part of the aging process, says Dr. Devyani Hunt, associate professor of orthopaedic surgery at Washington University School of Medicine. “We all get some type of degenerative changes as we age. Those changes don’t always hurt, though. When the disc becomes inflamed, typically because of abnormal mechanics, then the neck can be more painful.”

“There is an old saying that you can’t unboil a hard-boiled egg,” says Alethea Eller, D.C., a natural health doctor specializing in Chinese medicine nutrition and chiropractic care at Innovative Health Partners. “While it’s true there is a certain level of damage that cannot be undone, that doesn’t always mean that pain is permanent.”

Six out of 10 patients with arthritic changes in the neck improve with physical therapy alone, according to Dr. Manish Suthar, a pain management and rehabilitation specialist. “In individuals who do not respond, medications, injections and —in more debilitating cases—surgery can offer relief,” he says.

pay attention
Never underestimate the importance of good ergonomics. When the issue is not linked to arthritic degeneration, muscular pain is either caused by major traumas (such as whiplash or falling) or repetitive micro trauma—the stuff you do on a daily basis like slouching at the computer or looking down at a smartphone, Eller says.

So if you’re experiencing neck tightness or soreness, first look at your daily habits: are you tensing your shoulders to stay warm in the cold? Watching TV from a funny angle? Holding the phone with your head against your shoulder? And let’s not forget tension, which naturally causes us to raise our shoulders and neck muscles, Eller points out.

bad habits die hard
“Our spines are designed to move. Avoiding a sedentary lifestyle or one position for too long, as well as sitting for prolonged periods of time, all can decrease the chance of developing neck pain,” Hunt says. She also recommends regular aerobic activity and avoiding cigarette smoke. And Suthar advises getting up and moving around every 20 or 30 minutes, for those whose occupations involve sitting for long periods of time. Also gently roll your neck and shoulders to loosen and release tension, he adds. And always pay attention to your posture: Avoid slouching or flexing forward, which is very hard for the muscles of the spine. “A lot of neck pain stems from the stress response. Identifying your stress triggers and managing balance in your life is super important,” sums up Eller.

Have neck pain evaluated earlier rather than later to keep it from progressing to a chronic issue, Hunt says. “Sometimes little changes in sitting, standing or sleeping posture can make all the difference. However, these changes have to be lifelong, and a maintenance program of therapeutic exercises and stretches also is key to long-term success.”

For neck muscle pains and strains, Hunt says ice is a great anti-inflammatory option without side effects. Acupuncture, massage techniques and certain muscle techniques used by chiropractors can help, too. In addition to chiropractic adjustments and physical therapy to strengthen the muscles of the neck and back, Eller recommends magnesium supplements, which can relax the muscles and reduce tension. Homeopathic Traumeel is one of her favorite natural remedies for pain.

“Pain is a normal part of the inflammatory process. If there is one way to incredibly affect your level of pain, it is to eat nourishing, low-inflammatory foods,” she adds. “Consume plant-based foods and avoid processed foods. You will find that your body will do what it was designed to do—heal!”

[foot injuries]
If you’ve ever had chronic foot pain, you know all too well that when the foot hurts, nothing seems right. An intricate structure of 26 bones, 33 joints and five ligaments, the foot is prone to injury not only because of its complexity, but also because it has to support our entire body weight. Something can go wrong internally, or we can sustain an injury from some external factor.

it’s the shoes, stupid
Bones, ligaments, tendons, muscles, nerves, blood vessels, skin and even toenail beds can lead to foot pain. But the most common cause is not the foot itself, but poor shoe choices, says Kirkwood podiatrist Dr. Colette S. Weber. “Most pain or injury is caused by either poor shoe choices for the activity or wearing shoes that are past their usefulness but still appear in good condition,” Weber says. She recommends athletic shoes for walking and running shoes for high-impact activity.

It’s also important to make sure your shoes fit properly. “Have your feet measured and use this size as a starting point for selecting a shoe. I recommend shopping for shoes at the end of the day when your feet may be slightly larger,” Weber says. A shoe should fit the length and width of your foot and the shape of your toes. And salespeople assurances notwithstanding, increasing a shoe length will not always compensate for needing a wider width, she says.

weak feet
Another avoidable cause of pain is the overuse of orthotic devices, according to Dr. Michael Horwitz, a podiatrist at Feet for Life. He says orthotic devices can cause the feet to be more susceptible to injury. “Orthotics are grossly overrated and tend to weaken the intrinsic muscles and decrease proprioception (the sense of relative position of neighboring parts of the body and strength of effort employed in movement) necessary for a strong foot that would resist injury,” he says.

Many common foot and ankle injuries, including stress fractures, ankle sprains and plantar fasciitis, are caused by weak muscles in the foot and ankle, Horwitz says. Plantar fasciitis, the most common cause of heel and arch pain, occurs when the plantar fascia, a band of tough tissue connecting the heel bone to the toes, is strained and becomes irritated or inflamed.

“All three of these problems can better be avoided by minimalist footwear—footwear that is flat and loosely constructed—at least 20 hours per week,” Horwitz says. “This allows the foot to actually be a foot and not enter into a situation where it is over-padded and not allowed to function the way we were born to function and feel.” Balance exercises like yoga also may help strengthen the foot and ankle to prevent injury, Horwitz adds.

the road to relief
Foot problems usually appear gradually, with mild symptoms that don’t last very long but over time become more frequent and longer, Weber says. They also can appear suddenly, most commonly from overuse injuries. Most people can treat their foot pain at home with rest, elevation, compression, ice and intermittent heat, Horwitz says.

If the condition lasts for more than three or four weeks, though, see a podiatrist. Depending on the injury, treatment options may include oral or topical medication, custom inserts or physical therapy, which consists of gentle stretches like rolling your bare foot on a can. Because your shoes may be the cause of your foot pain, Weber recommends bringing a pair of shoes that are making your symptoms worse to your appointment and try to recall the shoes you were wearing and your activity immediately before your symptoms began.

[myofascial release]
We all know about the kind of massage that is a relaxing treat. But not many understand myofascial massage, a deeper technique that addresses the fascia, or densely woven connective tissue that covers all parts of our body, down to the cellular level. With the right training, a myofascial massage therapist can treat all kinds of pain, from herniated discs to migraines.

what is it?
“Myofascial release is the application of gentle, sustained pressure and movement into the fascial system in order to eliminate connective tissue restrictions, and pain and restore motion,” says Elizabeth Diebold, a massage therapist with Avalon 8 Wellness. Unlike massage techniques, which focus only on relieving symptoms, myofasical release focuses on releasing the cause of the symptoms.

The fascia is a tough connective tissue that spreads throughout the body in a three-dimensional web from head to toe, Diebold explains. “It is densely woven, covering and interpenetrating every muscle, as well as all our internal organs and more.” In a normal healthy state, the fascia is relaxed and has the ability to move without restrictions. Physical trauma, scarring or inflammation can cause the fascia to lose its pliability and become a source of tension for the rest of the body. Myofascial release techniques help remove these restrictions and restore equilibrium.

when it’s right for you
Jason Bennett, assistant professor of physical therapy and athletic training at Saint Louis University, says release is one of several soft tissue techniques used to address myofascial mobility, “depending on the type of pain and restriction, the patient’s tolerance and underlying pathology. Having a practitioner who is able to perform a comprehensive neuromusculoskeletal exam that identifies potential sources of myofascial pain will increase the likelihood of prescribing or performing an appropriate intervention.”

An initial visit with a physical therapist begins with a thorough neuromusculoskeletal examination that includes an assessment of myofascial mobility. “The assessment may identify active trigger points that are painful to palpate (taught bands in the muscle) and/or restrictions in tissue mobility,” Bennett says. Myofascial treatments do not hurt, per se, but they are more intense than the typical massage. And individuals might experience discomfort for 24 to 72 hours after the treatment, while the fascia continues to release and the body continues to readjust to new healthy patterns and release toxins, Diebold says.

what to expect
The number of treatments required will depend on the underlying pain mechanism and the condition. Chronic conditions may require longer duration, and anytime repetitive stress injuries are involved, treatment might have to continue as long as the patient is participating in the movement that causes the stress (think computer work and arm or neck pain). But after a few sessions, clients generally notice less pain, less stress and better posture, Diebold says.

Myofasical release is typically provided by licensed massage therapists, physical therapists and other practitioners licensed to do bodywork. Because no professional governing body certifies myofasical release practitioners, Diebold recommends inquiring about the training. “When looking for a practitioner, find one you feel comfortable with and who has experience in addressing your unique needs and concerns. Word of mouth or a referral from someone you trust is usually a great place to start,” she says.

Bennett and Diebold both say myofasial release is a safe, noninvasive and non-pharmacological approach to treating myofasical restrictions and pain. “The goal with this therapy is to help treat the source of pain and help clients feel less pain, less stress, increased range of motion, increased flexibility and improved posture,” Diebold says.