Referred pain is the interpretation of feeling pain in a different location than the actual cause. For example, a pinched nerve in the spine/back causes pain not to show up not where it is pinching but further down in the buttock, leg, calf, or foot. Similarly, a pinched nerve in the neck could translate to shoulder or elbow pain. Referred pain is often caused by the muscles overcompensating weaker ones, like feeling pain outside the knee, with the actual injury stemming from hip joint dysfunction caused by weakened lateral hip muscles. The athletic referred pain could have been brought on by an acute sports injury, an overuse injury from the repetitive motion/s.
Athletic Referred Pain
Somatic referred pain originates from the muscles, skin, and other soft tissues and is not to be confused with visceral pain, which refers to the internal organs/viscera. However, the pain presents in regions supplied by the same nerve roots. Damaged or injured body structures can cause referred pain. This includes the muscles, nerves, ligaments, and bones.
Common Sites
Individuals can experience referred pain almost anywhere. Athletic referred pain commonly occurs in these areas:
The neck and shoulder where pain can be felt in the elbow, arm, and hand or cause headaches.
The back where pain can be felt in the hips, buttocks, and thighs.
The hip/s area, where pain can be felt in and around the low back and abdominal regions.
The groin, where pain can be felt in and around the abdominal region.
Problems with the vertebral discs, nerve root compression, muscle spasms, osteoarthritic changes, spinal fracture, or tumor/s can affect the body’s ability to transport sensory information, which can cause strange sensations and weakness of muscle tissues, and sometimes problems with coordination and movement. Part of an accurate diagnosis is knowing the patterns of referred pain in all the muscles and internal organs.
Pain Activation
Many nerve endings come together and share the same nerve cell group in the spinal cord. When signals travel through the spinal cord to the brain, some signals follow the same path as the pain signals from a different body part. Pain awareness is felt in a deeper center of the brain known as the thalamus, but the sensory cortex determines the perception of where the pain is coming from and the location of the pain. The intensity and sensation of the athletic referred somatic pain vary for different structures and depend on the inflammation level. For example:
Nerve pain tends to be sharp or shooting.
Muscle pain tends to be a deep dull aching or a burning sensation.
However, muscles can give a sensation of tingling where referred pain is presenting, but tingling is more commonly associated with a nerve injury.
Diagnosing referred pain injuries can be complex as there are various areas where the pain can show up. The source of damage needs to be identified; otherwise, achieving lasting pain relief will not last. A biomechanical analysis can help to find movement/motion patterns that may be causing pain and help identify the source.
Treatment
Athletic performance and spinal health are interconnected. Chiropractic treatment involves whole-body wellness that involves the spine and nervous system. Routine chiropractic care relieves neck, shoulder, arm, back, leg, and foot conditions/injuries and helps prevent disorders of joints and muscles. It calms the mind, provides pain relief, and educates individuals on being more aware of the body. Chiropractic adjustments improve blood flow and nerve function to increase agility, reaction times, balance, strength, and expedited healing of the body.
DRX9000 Decompression
References
Kapitza, Camilla, et al. “Application and utility of a clinical framework for spinally referred neck-arm pain: A cross-sectional and longitudinal study protocol.” PloS one vol. 15,12 e0244137. 28 Dec. 2020, doi:10.1371/journal.pone.0244137
Murray, Greg M. “Guest Editorial: referred pain.” Journal of applied oral science: Revista FOB vol. 17,6 (2009): i. doi:10.1590/s1678-77572009000600001
Weller, Jason L et al. “Myofascial Pain.” Seminars in neurology vol. 38,6 (2018): 640-643. doi:10.1055/s-0038-1673674
Wilke, Jan, et al. “What Is Evidence-Based About Myofascial Chains: A Systematic Review.” Archives of physical medicine and rehabilitation vol. 97,3 (2016): 454-61. doi:10.1016/j.apmr.2015.07.023
Back pain for no reason that is non-specific is also known as idiopathic, meaning there is no definitive cause like a herniated disc, vehicle accident/crash, falling accident, work, school, or sports injury. An aching sore back that came out of nowhere can be baffling. However, there are reasons for pain, including age, unhealthy posture, work occupation, muscle spasms, lifestyle habits, family medical history, and viscerosomatic reflexes.
Back Pain No Reason
Individuals will trace back their steps and often find that there was no heavy lifting of packages, overdoing it working out, or bending, twisting awkwardly, but the pain is present.
Age
Age is a primary cause of back pain. After the age of 20, the discs in the spine begin to dehydrate, shrink, and compress/flatten out. This can cause everyday activities to generate back strain and pain as the discs begin to slip, slide, and rub against each other. This is known as degenerative disc disease and is a process that continues as the body gets older.
Back Muscle Spasms
Muscle spasms are a common manifestation of back pain and occur when the muscles involuntarily contract. Spasms often happen from bending, heavy lifting, or other physical activities.
Lifestyle Factors
Lifestyle factors can be a causation factor for back pain that comes out of nowhere.
Smoking increases the risk as nicotine increases the wear and tear on the discs as well as other organs.
The smoke/nicotine causes the discs to age faster because it breaks down the collagen, an essential part of the discs.
Individuals that are out of shape, overweight, and/or obese are more likely to have back pain from the added weight.
Unhealthy Posture/Mechanics
Practicing unhealthy postures will no doubt begin to cause back or some type of pain from the strain and awkward positioning placed on the muscles being used. Strains, twists, pulls, or tears can occur if repeating the same motion.
Viscerosomatic Reflex
Viscera means organ, and somatic refers to the body or musculoskeletal system. A viscerosomatic reaction happens when a pain signal from an organ is transmitted via the spinal cord, where neurons and motor structures like the muscles, blood vessels, and skin are interconnected. The body’s organs can become distressed or suffer an infection/disease that causes signals to be sent that there is something wrong. However, the signal could be pain that materializes in the spine/back muscles but is not a spinal injury or condition.
Diagnosis and Treatment
The first step to successfully treating back pain is scheduling an appointment with a spine specialist or chiropractor. A series of specific questions will be asked to gain insight into the underlying cause of the pain. These include:
Location of the pain
Intensity of the pain
Frequency of the pain
Medical history
Diet habits
A careful examination is necessary for the doctor to identify the reasons in any individual patient. Once the physician has learned about the symptoms and history, they can determine a possible cause and create a personalized treatment/rehabilitation plan to get the body back to optimal health.
Decompression Patient Testimonials
References
Koes, B W et al. “Diagnosis and treatment of low back pain.” BMJ (Clinical research ed.) vol. 332,7555 (2006): 1430-4. doi:10.1136/bmj.332.7555.1430
Lankhorst, G J et al. “The natural history of idiopathic low back pain. A three-year follow-up study of spinal motion, pain and functional capacity.” Scandinavian journal of rehabilitation medicine vol. 17,1 (1985): 1-4.
Walker, Bruce F et al. “Combined chiropractic interventions for low-back pain.” The Cochrane database of systematic reviews vol. 2010,4 CD005427. 14 Apr. 2010, doi:10.1002/14651858.CD005427.pub2
Even though it is not officially summer, the heat says otherwise. Individuals with neuropathy can experience flare-ups when out in the heat for extended periods. Avoiding discomfort and having fun with family and friends can be stressful. This could be graduations, park festivals, family gatherings, weddings, etc. Here are some neuropathy summer tips/recommendations to maintain a healthy, fun, and pain-free season.
Neuropathy
Neuropathy results from damaged or destroyed nerve cells and is often a side effect associated with diabetes, autoimmune diseases, infections, tumors, and/or hereditary conditions. Also known as peripheral neuropathy, symptoms range from tingling sensations, burning pain, muscle spasms, difficulty moving the arms or legs, feelings of light headiness, and sometimes atrophy. The symptoms depend on the damaged nerves, ranging from autonomic, motor, and sensory nerves. As neuropathy progresses, individuals may begin to feel a loss of balance.
Neuropathy Summer Tips
Research and Prepare
Preparation and planning are highly recommended to prevent a flare-up. For long outdoor ceremonies:
Wear sunscreen
Stay fully hydrated
Dress in cool clothes
Make sure footwear has proper arch/sole support and breathing room.
Wear a hat and sunglasses
Stand periodically to ensure proper circulation if sitting for a while.
Shift weight back and forth during the event to pump circulation throughout the body.
Bring snacks like fruits, veggies, or gluten-free bars.
Know where cool resting areas are located.
If cooling down accommodations are not available, get there early to find a place in the shade, or in the case of bleachers, bring a more comfortable chair, umbrella, and misting fan.
Listen to the body
Listen to the body when engaged in activities, don’t try to push through where you don’t feel comfortable.
Take breaks
The goal is to ensure comfort during the activity, as being uncomfortable can exacerbate symptoms.
Self-care
The body needs thorough rest after a long day in the sun. It is recommended to ice any areas where pain presents to decrease inflammation and neuroplasticity and help with any symptoms of itching, pressure, numbness, or pins and needles.
Start with icing for three minutes, take the ice off and see how it feels.
If the area feels better, continue icing for a full ten minutes.
Remove the ice if irritation occurs or do not feel a difference.
Foods
Watching what you eat can be difficult at summer events. Specific foods like bread, gluten, and high-sugar products can cause symptoms.
If it causes an upset stomach or swelling, it is recommended to avoid it.
Go with fresh seasonal fruits and vegetables.
A little planning can ensure you eat the food that’s best for you.
Call ahead to let friends/family know of any food sensitivities.
Gluten apps allow the ability to scan an item to see if it contains gluten.
Consult a nutritionist to set up an enjoyable diet.
Chiropractic Care and Prevention
Chiropractic care for neuropathy focuses on the underlying conditions causing nerve pain and inflammation.
Treating the inflammation alleviates the pain in the joints and extremities.
Each treatment plan is personalized to meet the needs of every patient.
Treatment will focus on massage, adjustments, decompression, exercises, therapies, and nutrition that expedite healing throughout the body.
Spinal Decompression Non-Surgical
References
Campbell, James N, and Richard A Meyer. “Mechanisms of neuropathic pain.” Neuron vol. 52,1 (2006): 77-92. doi:10.1016/j.neuron.2006.09.021
Asthma, coughing, and heavy breathing can contribute to back muscle strain, soreness, and pain. An asthma attack can cause the body to heave during intense gasping, leaving the back muscles physically exhausted. Chiropractic adjustments and decompression can bring back pain relief, strengthen and stretch the spine and spinal muscles, and prevent it from returning, along with asthma management.
Asthma
The bronchial tubesdivide into smaller passages called bronchi and then into bronchioles. The bronchioles have tiny air sacs called alveoli, where inhaled oxygen is delivered to the blood. After absorbing the oxygen, the blood leaves the lungs and travels to the heart. Asthma is a lung condition that can affect anyone at any age. Asthma narrows the lungs’ airways causing inflammation in response to respiratory triggers, making it harder for air to travel out of the airways when exhaling. Symptoms include:
Wheezing
Difficulty breathing
Gasping to get air
Coughing
Tightness in the chest
Triggers can include:
Hot and/or humid weather
Exercise
Cold air
Pollen
Pets
Viral infections
Respiratory infections
Asthma Coughing and Back Strain
Asthma symptoms can take a toll on the back muscles and spine. Asthma attacks that cause gasping and heavy breathing cause the primary muscle (diaphragm) that supports breathing to weaken and strain. The diaphragm helps the spine but cannot do so effectively when under constant strain.
Constant Coughing and Spinal Health
Coughing is the body’s way of expelling unwanted foreign bodies. Chronic coughing stresses, strains, and overexerts the spinal support muscles and impacts posture. Individuals unconsciously take on a tense, forward-leaning posture/position that can cause:
Neck and shoulder stiffness, upper/lower back tightness, disc herniation, and pain.
Vertebrae subluxations/spinal misalignments can interfere with circulation and nerve function.
For short-term back pain following an asthma attack or coughing episode, it is recommended to rest, apply heat or ice, and take over-the-counter pain medication.
Massage therapy and myofascial release can stretch and relax the muscles.
Chiropractic manipulation relieves the stress on the nerves and muscles and stimulates the spinal cordand nerves to regain proper functioning.
Breathing Exercises and Yoga
Strengthened and conditioned core muscles can help to breathe more efficiently. When breathing normally it is usually a shallow inhale/exhale that does not fill the lungs to the total capacity. Diaphragmatic breathing is a technique to fully engage the diaphragm and abdominal muscles to fill the lungs with air more efficiently. Using the diaphragm correctly will:
Strengthen the diaphragm.
Use less energy to breathe.
Slow down the breathing rate.
Decrease the work of breathing hard.
Decrease the demand for continuous oxygen.
Yoga is another core-strengthening technique that encourages focused breathing that can help improve asthma control.
Decompression Neurosurgeon
References
American Lung Association. Breathing Exercises. (https://www.lung.org/lung-health-diseases/wellness/breathing-exercises) Accessed 3/29/2022.
Lunardi, Adriana Claudia, et al. “Musculoskeletal dysfunction and pain in adults with asthma.” The Journal of asthma: Official Journal of the Association for the Care of Asthma vol. 48,1 (2011): 105-10. doi:10.3109/02770903.2010.520229
Rasmussen-Barr, E. et al. “Are respiratory disorders risk factors for troublesome low-back pain? A study of a general population cohort in Sweden.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 28,11 (2019): 2502-2509. doi:10.1007/s00586-019-06071-5
Solakoğlu, Özge, et al. “The effects of forward head posture on expiratory muscle strength in chronic neck pain patients: A cross-sectional study.” Turkish Journal of physical medicine and rehabilitation vol. 66,2 161-168. 18 May. 2020, doi:10.5606/tftrd.2020.3153
Forearm pain refers to soreness, aches, or discomfort between the wrist and the elbow. An injury or inflammation can affect any tissues, including muscles, bones, blood vessels, tendons, and the skin. The causes usually include overuse injuries, pinched nerves, accidents causing trauma, lifting or heaving heavy objects, sports injuries, and fractures. If left untreated, issues like chronic muscle pain and decreased and disrupted blood/nerve circulation can develop, leading to numbness and weakness. Chiropractic treatment can release tension, massage, reset, and stretch the muscles to expedite healing.
Anatomy
The forearm comprises the radius and ulna, which extend the forearm’s length and cross at the wrist.
The Radius
This bone starts at the elbow and connects to the wrist on the thumb side.
Ulna
This bone begins at the elbow and connects to the wrist on the side of the little finger.
Muscles
Several muscles operate to rotate the forearm up/supination and down/pronation and flex and extend the fingers.
Causes
Forearm pain can happen to anyone and is usually related to traumatic or repetitive use injury. In other cases, pain may be associated with a benign growth, like a cyst or possibly a malignant tumor. Common causes include:
Pulled and/or strained muscles
Muscle ruptures or small tears
A direct blow, fall, or any extreme twisting, bending or jamming action.
Tendonitis from tennis or golfers elbow.
Tennis elbow is caused by inflammation or tiny tears in the forearm muscles and tendons outside the elbow.
Golfers’ elbow is on the inside of the elbow.
Carpal Tunnel Syndrome is a repetitive stress disorder that affects the nerves and tendons of the wrist and forearm.
Musculoskeletal Causes
The musculoskeletal causes involve issues in how the forearm components operate together.
Repetitive actions like lifting, gripping, and typing can compress nerves and blood vessels throughout the forearm.
Forearm problems like dislocations or sprains can also lead to chronic inflammation and pain.
Traumatic Causes
Traumatic causes include those that result in injury to components of the forearm.
Anything that causes a direct injury to the forearm, including an automobile crash or accident, fall, or a direct hit, can fracture bones in the forearm.
A sprain can twist or stretch a ligament or tendon.
Activities that cause bending, twisting, quick sudden movement or direct impact can result in sprained multiple ligaments in the forearm.
Chiropractic Treatment
Healing forearm pain depends on the type of injury, location, and cause of the pain. Chiropractic addresses arm pain, tingling, and numbness in ways often overlooked by general physicians.
A chiropractor will perform a physical examination to determine if there are any underlying causes.
They may apply an ice pack to help control inflammation before the massage.
The chiropractor will perform gentle adjustments to the wrist, arm, and shoulder.
They may recommend a forearm brace to help retrain positioning and movement.
They will recommend exercises and stretches to strengthen and maintain the adjustments.
Carpal Tunnel Pain Treatment
References
Ellenbecker, Todd S et al. “Current concepts in examination and treatment of elbow tendon injury.” Sports health vol. 5,2 (2013): 186-94. doi:10.1177/1941738112464761
Shamsoddini, Alireza, and Mohammad Taghi Hollisaz. “Effects of taping on pain, grip strength and wrist extension force in patients with tennis elbow.” Trauma monthly vol. 18,2 (2013): 71-4. doi:10.5812/traumamon.12450
Suito, Motomu, et al. “Intertendinous epidermoid cyst of the forearm.” Case reports in plastic surgery & hand surgery vol. 6,1 25-28. 28 Jan. 2019, doi:10.1080/23320885.2018.1564314
Claudication is muscle pain that presents when the body is active and stops when the body is at rest, also known as intermittent claudication. Individuals typically report dull aching, cramping, tingling, and/or numbness. Vascular claudication is caused by circulatory problems like poor blood circulation and peripheral artery disease. Still, spinal conditions can also cause neurogenic claudication caused by problems with the spine and nervous system.
Neurogenic Claudication
Sciatica is the usual suspect when thigh, hip, buttock, calf, or total leg pain or other sensations are present; however, it could be spinal stenosis with neurogenic claudication. Spinal stenosis is sometimes called pseudo claudication, a narrowing of the space around the low back, which can put pressure on the spinal cord directly and compress the blood vessels around the spine, cutting off oxygen-carrying blood. Pain can start in the lower back and circulate down the legs and cause weakness, tingling, or numbness in the legs and feet. The most common areas of spinal compression include:
The foramen are the openings on the sides of the spine where nerves exit and connect to the peripheral nervous system.
The narrowing can occur in any of these areas, with the most common cause being lumbar spinal stenosis brought on by lumbar degenerative disease.
Symptoms
The most common symptoms of neurogenic claudication include:
Pain in the lower extremities, including the buttocks, thighs, and calf, only manifests with activities like walking or standing around.
Pain that shows up equally on both sides.
There is no pain when sitting or not walking around.
Radiculopathy or nerve pain that radiates down an affected limb. Sciatica is a typical example.
However, the symptoms of claudication and radiculopathy are different.
Claudication will be felt all along the length of the nerve.
Radiculopathy pain is more localized to the buttock, thighs, and calves and can get worse with activity and is generally present even when at rest.
Treatment
Non-surgical treatment of neurogenic claudication includes medication to help control pain, chiropractic manual therapy, non-surgical spinal decompression, physical rehabilitation therapy, and steroid shots to reduce inflammation. A doctor will recommend stretching, strengthening exercises, and types of activities to help improve the body’s ability to support itself. This could include swimming, walking, and stationary cycling. However, conservative treatment might not be an option for individuals with more severe cases. If conservative treatment options don’t work, surgery could be recommended. A healthcare provider can help explain treatment options. Successful outcomes have been seen in cases that are diagnosed and treated early.
Non-Surgical Spinal Decompression Chiropractor
References
Colak, Ahmet, et al. “A less invasive surgical approach in the lumbar lateral recess stenosis: a direct approach to the medial wall of the pedicle.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 17,12 (2008): 1745-51. doi:10.1007/s00586-008-0801-z
Munakomi S, Foris LA, Varacallo M. Spinal Stenosis And Neurogenic Claudication. [Updated 2022 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430872/
Dehydration affects the body physically and mentally but also affects the health of the spine’s discs. Spinal discs that lack proper hydration begin to compress, collapse between vertebrae, or cannot refill correctly, causing further compression and increasing the risk of spinal injury. Dehydrated discs can cause injuries like herniated disc/s, degenerative disc disease, and spinal stenosis. Chiropractic treatment offers spinal decompression that will restretch and realign the spine allowing the injury/s to heal and proper disc rehydration.
Spine Support
As crucial as the spine is within daily activities, it is vital to understand its mechanics. The spinal vertebrae discs work to absorb shock when bending, twisting, or flexing to ensure the bones do not rub together. Within each disc is the nucleus pulposus, made up of 85 percent water that provides movement when the spine rotates and moves in various directions. This high water content in the discs helps the spine function. The discs naturally lose some water as the body ages, but dehydration can also occur when individuals do not intake enough water from drinking or in food. If the dehydration is severe, the risk of injury increases or can aggravate existing spine conditions. The loss of hydration in an adult spine can cause a loss of disc height daily. Without proper rehydration, other medical issues can begin to present.
Symptoms
Depending on which discs are affected, the pain or numbness can travel from the neck into the shoulders, arms, and hands or from the lower back down through the legs. Symptoms can include:
Back stiffness
Burning or tingling sensations
Reduced or painful movement
Back pain
Weakness
Numbness in the low back, legs, or feet
Changes in knee and foot reflexes
Sciatica
When the body is dehydrated, it can be difficult to replenish the water in the discs thoroughly, as well as nutrient levels through a consistent loss of fluid. Dehydration disrupts the balance which can lead to an increased risk of injury and increased degeneration. Causes of disc dehydration include:
Trauma from an auto accident, fall, work, or sports injury.
Repeated strain on the back from consistent lifting, reaching, bending, twisting, etc.
Sudden weight loss can cause the body, including the discs, to lose fluid.
The entire body relies on proper hydration with direct water consumption to rehydrate the body but also incorporating fruits and vegetables to aid in hydration. These foods include:
Watermelon
Cantaloupe
Lettuce
Tomatoes
These foods are made of more than 90% water and contain essential nutrients and help the spine function more efficiently. Proper water consumption is based on age, body size, and activity level. However, to fully heal desiccated discs, spinal injuries, or back pain, chiropractic decompression, and manipulation adjustments are recommended. Non-surgical motorized spinal decompression treatment is gentle. The therapy lengthens and decompresses the spine reversing the pressure within the damaged disc/s creating an intradiscal vacuum that relieves the pressure off the nerve and helps reshape and rehydrate the damaged disc/s.
DOC
References
Djurasovic, Mladen, et al. “The influence of preoperative MRI findings on lumbar fusion clinical outcomes.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 21,8 (2012): 1616-23. doi:10.1007/s00586-012-2244-9
Karki, D B et al. “Magnetic Resonance Imaging Findings in Lumbar Disc Degeneration in Symptomatic Patients.” Journal of Nepal Health Research Council vol. 13,30 (2015): 154-9.
Twomey, L T, and J R Taylor. “Age changes in lumbar vertebrae and intervertebral discs.” Clinical Orthopedics and related research,224 (1987): 97-104.
Videman, Tapio et al. “Age- and pathology-specific measures of disc degeneration.” Spine vol. 33,25 (2008): 2781-8. doi:10.1097/BRS.0b013e31817e1d11
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
