The Problem of Radiating Pain

The Problem of Radiating Pain

Chiropractic Care and Radiating Pain

Although a few problems involving radiating pain require further investigation, the large majority of cases involving neck pain with arm/hand pain or low back pain with leg/foot pain can be addressed by your chiropractor. Your chiropractor will take a thorough history, do a detailed examination, and order tests if needed, with the overall goal of designing the most effective care plan to help solve your specific problem. Chiropractic adjustments may be part of the care plan. Chiropractic care may also include a rehabilitative stretching and exercise program, as well as recommendations for improved posture, safer lifting habits, and ergonomic enhancement. Your personalized comprehensive chiropractic care plan will help you return to improved health as quickly as possible.

Many people experience radiating pain as a component of neck pain or low back pain. A person with neck pain might have pain that radiates down her arm, possibly into the hand.¹ A person with low back pain might have accompanying leg pain, possibly traveling into the foot. Such arm/hand pain or leg/foot pain can represent a serious underlying health problem. However, not all types of radiating pain are of equal importance. The key is to be able to identify which patterns require prompt attention and which merely appear to be significant but are not.
Authentic radiating pain is most often caused by pressure and/or irritation of a spinal nerve root.² The spinal nerve becomes inflamed and sends pain signals to the brain that are interpreted as pain in the region of the body supplied by that nerve. Inflammation of a certain spinal nerve in the neck region will result in the experience of pain down the outside of the arm and forearm and into the thumb and possibly index finger. Inflammation of a certain spinal nerve in the low back causes the person to feel pain traveling along the back of the thigh and calf and into the fifth toe.
Specific patterns of radiating pain are associated with inflammation of specific spinal nerves. Such inflammation may be typically caused by pressure from a herniated intervertebral disc. Other disorders which may create local space-occupying pressure need to be considered as well. A thorough history and physical examination will help to identify the cause of the problem. X-ray studies may be needed, as well as an MRI scan. The underlying problem, including the pattern of pain radiation, may be termed a radiculopathy or radiculitis.
But most cases of what appears to be radiating pain are not, in fact, related to pressure on a spinal nerve. Most patterns of radiating pain are not associated with a radiculopathy or radiculitis. Rather, the large majority of pain patterns involving the arm/hand or leg/foot are caused by normal, everyday aches and pains. Our run-of-the-mill physical problems involve relatively large muscles such as the trapezius (overlying the upper back, shoulder, and mid back) and relatively small muscles such as those that overlay the spinal bones themselves and help move the spinal column. Ligaments that hold bones together and tendons that attach muscles to bones may also be involved in these everyday ailments.
Irritation and inflammation of muscles, ligaments, and tendons may cause more difficulty than mere soreness and tightness. Such inflammation may also cause radiating pain, but in broader, more diffuse patterns than those caused by inflammation of a nerve root. A person might experience neck pain with arm and hand pain, or back pain with leg and foot pain, but in a broad pattern not associated with a spinal nerve. This is actually good news for the patient, as such forms of radiating pain (known as scleratogenous patterns), are usually more easily treated than those associated with a radiculopathy or radiculitis.
The bottom line is that your chiropractor is experienced in the diagnosis and care of such problems. Your chiropractor will be able to determine if your radiating pain is associated with muscles, ligaments, and tendons or if it is related to pressure on a spinal nerve.³ Your chiropractor will make specific recommendations for care of your specific health problem and help guide you in the process of returning to good health.
¹Caridi JM, et al: Cervical radiculopathy: a review. HSS J 7(3):265-272, 2011
²Magrinelli F, et al: Neuropathic pain: diagnosis and treatment. Pract Neurol 2013 Apr 16 [Epub ahead of print]
³Mena J, Sherman AL: Imaging in radiculopathy. Phys Med Rehabil Clin North Am 22(1):42-57, 2011

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Strength Training for Beginners (and Experts, Too)

Strength Training for Beginners (and Experts, Too)

Chiropractic Care and Strength Training

Regular vigorous exercise is a requirement for good health. Ideally, every adult is exercising for at least 30 minutes five times per week. Regular chiropractic care provides fundamental support for this necessary level of physical activity. Regular exercise requires optimal functioning of muscles, joints, and bones. In turn, such optimal performance requires full and free functioning of your nerve system. The nerve system sends timely instructions to all the rest of your body systems, informing cells, tissues, and organs as to when to do their jobs and exactly how much of a job to do. Regular chiropractic care removes irritation and inflammation from spinal nerves and other critical nerve tissue, helping ensure that exercising muscles receive the information they need to do their jobs well. By helping keep your nerve system healthy, regular chiropractic care helps you get the most out of your investment in exercise.

Strength training, otherwise known as weight training, is one of those activities that provides a wide range of benefits for the person who does it regularly. Like yoga, strength straining makes all your muscles stronger, enhances flexibility, and improves cardiovascular capability and capacity. In fact, two strength training sessions per week combined with one or two yoga classes per week will lead to super-fitness for most people within only a couple of months.
Strength training is beneficial for teenagers, young adults, and older adults.¹ Many strength training exercises are done in a weightbearing position, and the process of doing reps and sets with a modestly or moderately heavy load makes your bones stronger. Not only muscles, but also the soft tissues of the musculoskeletal system, including tendons, ligaments, and joint cartilage, are made sturdier by receiving increased supplies of oxygen and other nutrients. Engaging in a regular program of strength training will provide more restful sleep, rid your metabolism of accumulated toxins, add sparkle and tone to your skin, and improve your overall sense of well-being. All at the low price of two to three hours per week.
The key question is how to begin. Many books and online training videos are available. Most fitness centers offer a complimentary lesson or two with a personal trainer to enable you to learn the basics. Simply put, you want to train all of your major muscle groups once per week. For example, you can exercise your chest and back muscles on one day and your shoulders and arms on another day. If you're also doing one or two yoga classes per week, or one yoga class and two walking or running days per week, your leg muscles are covered.²
Let's say this is your chest and back day. Ideally you'll do three different exercises per body part. For your chest you could do lying-down (supine) bench presses with dumbbells, supine flies (in which you hold the dumbbells overhead and then open your arms out to the side), and incline bench presses with dumbbells. For your back, you could do one-arm rows, supine dumbbell pullovers (in which you use both hands to hold one dumbbell overhead and then lower the dumbbell all the way behind your head), and lat pulldowns on a machine. All together, doing these six different exercises, three sets per exercise, should take about one hour.
Then, two or three days later in the week, you do strength training for your shoulders, biceps, and triceps. Shoulder exercises could include seated overhead presses, standing lateral raises, and seated bent-over rows. Bicep exercises could include seated alternate incline curls, machine bicep curls, and seated concentration curls. Tricep exercises could include push-ups, lying (supine) tricep extensions, and machine tricep pressdowns. Again, these nine different exercises, three sets per exercise, should take about one hour.
There are many video clips available on the internet that demonstrate the mechanics of each of these exercises. Good form is critical. In fact, making sure your posture is balanced and your abdominal muscles are activated is more important than the amount of weight you are lifting.
Beginners, especially, need to know how much weight they should be using on each exercise.³ Importantly, lifting too much weight too soon will usually lead to injury. Of course, we want to work-out as safely as possible. Choose a weight at which you can comfortably do eight repetitions. If you can't do eight, the weight is too heavy. If eight repetitions with a particular weight seems ridiculously easy, try again with a weight that is 10% heavier. Repeat the process until you find the starting weight that is comfortable for you. There are many types of weight progression programs that you will employ as you become accustomed to the weight-training process. The main point is to begin to engage in this highly beneficial form of exercise. As your mastery of these techniques slowly improves, a new world of fitness, fun, and satisfaction will be revealed.
¹Conceicao MS, et al: Sixteen weeks of resistance training can decrease the risk of metabolic syndrome in healthy postmenopausal women. Clin Interv Aging Epub Sept 16 2013
²Karavirta L, et al: Heart rate dynamics after combined strength and endurance training in middle-aged women: heterogeneity of responses. PLoS One 2013 Aug 27;8(8):e72664. doi: 10.1371/journal.pone.0072664
³Van Roie E, et al: Strength training at high versus low external resistance in older adults: Effects on muscle volume, muscle strength, and force-velocity characteristics. Exp Gerontol Epub ahead of print

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Getting Fit at Fifty and Beyond

Getting Fit at Fifty and Beyond

Chiropractic Care and Returning to Fitness

Chiropractic care is an important component of any exercise program and is especially important for those who are beginning a fitness program or returning to exercise after a long absence. Regular chiropractic care helps ensure spinal fitness, which is the starting point for all aspects of health and well-being. Your spinal column is the mechanical center of your body. Major muscle groups involved in strength training, such as the latissimus dorsi and rhomboids, and major muscle groups involved in aerobic exercise, such as the quadriceps and hamstrings, attach directly or indirectly to the spine and pelvis. Regular chiropractic care helps ensure optimal functioning of your spinal column, which in turn helps ensure a full range of motion and mechanical availability of muscles critical for successful exercise. By helping you get the most out of your exercise, regular chiropractic care helps you achieve your long-term goals for good health.

What if you used to be really fit and now you're not? What if, as the years have gone by, you've added a couple of pounds here and there, and you suddenly notice you're 30 pounds heavier than you were at your 10th high school reunion? Or, what if you've never enjoyed the idea of exercising, exercise was never part of your world-view, but you're not feeling as good as you'd like to feel and think that exercise might help improve your overall health and sense of well-being?
Many people want to get fit or want to regain a former level of fitness for a variety of considerations, including the above scenarios.^1,2 But most of us need guidance in the process of getting fit. We need information and even instruction on what to do and how to do it. For example, it would be a serious mistake for someone older than 50, and even older than 40, to simply go out and try to run 4 miles if he had never run before. Muscle strains, shin splints, or even a stress fracture of one of the bones in the foot would be a likely and unwanted result. Similarly, going to the gym and trying to "work heavy" would assuredly create various problems for an out-of-shape person who wanted to "get fit" as quickly as possible. The injured tendons and sprained ligaments resulting from trying to rush would set back your hoped-for progress by at least four to six weeks, further delaying achievement of improved health.
The best way to get fit or return to fitness after a long period of inactivity is to start slowly, progress in small increments, and gain an authentic, long-lasting level of fitness over months and years. Being a smart exerciser means not doing too much too soon, in other words, respecting your body's capabilities. Also, smart exercise involves engaging in a blend of activities, usually on alternating days. Persons who only bike or run and persons who only lift weights will never be as healthy and fit as those who do both aerobic activity and strength training.³ Developing a two-week schedule will provide a thorough, balanced fitness program. In week A you do aerobic exercise (walking, running, biking, swimming laps) on Monday, Wednesday, and Friday. You do strength training on Tuesday and Thursday. In week B you reverse activities, doing strength training Monday, Wednesday, and Friday and aerobic exercise on Tuesday and Thursday. This alternating pattern ensures you are getting the full benefit of your valuable time spent exercising.
It is important to remember that what works for you, works for you. Each of us needs to find his or her best way forward. Some methods of exercise will be experienced as intuitive and enjoyable. Others will be experienced as the opposite. You probably won't want to continue any of the latter. For example, the exercise program suggested by your friend may not be effective for your physical makeup and may even be harmful. Your chiropractor is an expert in healthy exercise and will be able to recommend fitness activities that will be right for you.
¹Johanssen NM, et al: Categorical analysis of the impact of aerobic and resistance exercise training, alone and in combination, on cardiorespiratory fitness levels in patients with type 2 diabetes mellitus: results from the HART-D study. Diabetes Care 2013 July 22 [Epub ahead of print]
²Stanton R, el al: Is cardiovascular or resistance exercise better to treat patients with depression? A narrative review. Issues Ment Health Nurs 34(7):531-538, 2013
³Lorenz D, Reiman M: The role and implementation of eccentric training in athletic rehabilitation: tendinopathy, hamstring strains, and acl reconstruction. Int J Sports Phys Ther 6(1):27-44, 2011
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