Neurogenic pain

Nervous system basics

The nervous system is an electrical system that carries information and messages throughout the body.  It can be grouped into two very broad categories:

Central nervous system (CNS): Brain and spinal cord

Peripheral nervous system (PNS): Branches from the spinal cord to the limbs and internal organs.

The brain is the computer, the body is the machine.  All information is sent from the CNS out to the PNS, and in turn the PNS feeds back information to the CNS about what’s happening at the periphery (i.e stepping on a nail = danger signal)

Symptoms of the nervous system

  • Numbness/tingling
  • Burning, sharp pain
  • Reduced strength
  • Loss of balance/coordination
  • Headache
  • Visual disturbances (blurriness, eye fatigue)
  • Poor reflexes
  • Severe pain

Common injuries

Neuropathic pain differs to neurogenic pain as it is the direct disease or damage of a nervous system structure (such as the thalamus in stroke victims).
Neurogenic pain is more common and much more treatable by an Osteopathic Practitioner.

Osteopathic Practitioners treat a range of neurogenic pain syndromes such as:

  • Nerve root compression (fig.1)
    • Pain radiates from the spine into the limbs
  • Neuropraxia
    • Blunt force injury – hockey stick to forearm causing pain/loss of sensation
  • Peripheral weakness
    • Information from the brain to the periphery isn’t being conducted adequately – generally unaccompanied by pain
  • Headaches
    • Many sources but often related to compression of nerves under the base of the skull or a source within the brain (such as the eyes)
  • Digestive issues
    • Broad diagnoses of IBS or other digestive “syndromes” that have varied symptoms without any evidence of pathology (such as a stomach ulcer) can often be attributed to a range of nervous system dysfunctions that reduce the function of the parasympathetic nervous system responsible for digestion.

Fig.1

Illustration of compression of the spinal cord by a herniated disk that will commonly cause pain to travel down the leg.

Treatment and recovery

The nervous system is incredibly complex and is still not fully understood. Testing the reflexes, muscle strength and ocular function are useful and reliable tools in identifying underlying problems that are directly related to pain production.

Conservative treatment including both osteopathy and physiotherapy can reduce symptoms (4-6 weeks) and improve function (6-12 weeks) through both manual treatment and rehabilitation programs that educate and train the sufferer to avoid future injury or relapse.

Is this a serious condition?

Treatment of the underlying cause of pain is paramount and must be assessed for severity.  Often a low-grade injury can cause severe pain if affecting the nerves.  Further investigation such as imaging (x-ray, MRI) may be warranted depending on examination findings.

Long term compression or untreated nerve damage may result in permanent loss of function and extended periods of pain.

Management

  • Initial Phase (weeks 1-4)
    • Reduce inflammation and pain. Anti-inflammatory medication may be advised.
    • Treating pain generating structure (such as a disk bulge)
  • Intermediate phase (weeks 4-6)
    • Once pain has subsided, increase load bearing and exercises as tolerated
  • Advanced phase (weeks 6-12)
    • Return to full capacity exercise, challenging injured structure (with physiotherapist monitoring)

 

 

Dr. Marvin Shedletzky Joins the Ace Sports Clinic Team

At Ace Sports Clinic we’re dedicated to providing the best experience and inspiring high performance for all our clients. Collaboration is a cornerstone to the success our clients are able to achieve and we would like to welcome Dr. Marvin Shedletzky to our team of skilled knowledgeable experts.

Dr. Marvin Shedletzky is highly experienced and well known Doctor of Chiropractic. He takes a personal interest in the health and wellbeing of all his patients, including players on every NHL team, Leafs, Raptors, as well as high-profile celebrities, actors and musicians. Over the years he has developed a very gentle, specific chiropractic adjustment to allow maximum nervous system flow and functional performance. He also utilizes the DRX9000 Spinal Decompression machine to help reduce pain and slow down degenerative changes caused by bulging/herniated and/or degenerating discs. Several neck and back surgeries have been cancelled due to the combination of the DRX and Dr. Shedletzky’s therapies. For a full bio click here.

 

“I’m excited to join a growing multidisciplinary team of professionals that are truly interested in the best for their patients. The ability to collaborate together regarding the health and wellbeing of a patient excites me. With this approach we’ll be able to help the most difficult patients, who have spent months or years with pain and degenerating functionally, with limited understanding of why their symptoms continue to wax and wane. We’ll not only communicate the root issues that lead to the symptoms in a way the patient can understand but we’ll also help them feel and function better. Everything is connected to the central nervous system flow and your self talk.” – Dr. Marvin Shedletzky

Visit us at acesportsclinic.com to learn more about our team and approach to helping you achieve your health and wellness goals.

Live well. Keep Playing.

Thoracic spine: The root of all evil

The Spine

The spine is comprised of 33 vertebrae: 7 cervical vertebrae (your neck), 12 thoracic vertebrae (your mid-back), 5 lumbar vertebrae (your low back), 5 fused sacral vertebrae and 4 fused coccygeal vertebrae.  The spine consists of natural curvature throughout its length, and the structure of the vertebrae help to contribute to natural movements of the spine.  These include flexion (bending forward), extension (bending backward), side flexion (bending to both sides) and rotation (turning to both sides).  Joints between each vertebral segment should contribute to these movements to effectively move the spine and contribute to movements of the pelvis and limbs as well.

The 21st century necessitates that we spend most of our time in excessive thoracic flexion or bending forward.  Think how much time you spend sitting at a desk, at your computer, commuting, driving, texting, watching Netflix (who doesn’t love Stranger Things??), compared to how much time you spend moving your spine.  There is likely a huge imbalance!  This is NOT to say that bending forward is bad inherently, but repetitively prolonged forward flexion of the thoracic spine can and will result in structural adaptations over time.

Limitations in thoracic mobility can limit many things:

Shoulder movement: try excessively bending your upper back forward as if you have terrible posture, and then raising your arms all the way overhead. Now try the same movement with your back straightened upright.  Feel the difference?  Imagine what a difference this can make in overhead work, serving in tennis or volleyball, throwing a ball, and many more!

Neck movement: excessive rounding or forward flexion of the thoracic spine commonly contributes to forward head posture and the multitude of dysfunctional issues that come along with this like headaches.

Squat: excessive rounding or forward flexion of the thoracic spine can limit movement of the lumbar spine, hips, and pelvis, which can affect squat technique and depth.  This, in turn, can limit the amount of weight you are able to safely squat.

Breathing: your lungs lie within your ribcage, which attaches to the vertebrae in the thoracic spine.  Excessive thoracic flexion can limit the depth to which lungs can be filled with air when taking a deep breath.

Many more!  Limitations in thoracic movement can lead to many more dysfunctional issues throughout the body, which can be discussed with your healthcare provider at Ace Sports Clinic!

What should we do?

The short answer is move!  Schedule yourself short breaks throughout the day to move your spine and body into different positions than sitting in thoracic forward flexion all day.  More specifically, here are a few mobility exercises you can include daily for thoracic spine mobility:

  1. Cat and Cow: a useful mobility drill for moving between spinal flexion and extension. Allow yourself to feel each vertebrae contributing to the movement, rather than the entire spine moving as a block.
  1. Quadruped Thoracic Rotation:
    in quadruped position, movement must come from the spine rather than the hips or pelvis. With one hand behind your head, rotate through your spine to bring your elbow across your chest, and then up towards the ceiling; repeat on both sides several times.
  1. Hang! Not only does hanging result in thoracic extension (slight bend backwards in mid-back), gravity also causes a traction force on the spine, which helps to create a bit of space between your vertebrae. You can hang from a pull up bar, tree branch, door frame, or monkey bars at the park for 10 seconds.  Ever see an orang-utan with back pain?

For further information about thoracic spine, and spinal mobility, speak to your healthcare provider.

Author: Hilary Mallinger, Registered Physiotherapist & Acupuncture Provider – Ace Sports Clinic, Toronto

Picture sources:

  1. source: http://www.firstaidforfree.com/first-aid-for-spinal-neck-and-back-injuries/
  2. source: http://www.bodiempowerment.com/neck-stiffnes/
  3. source: https://www.popsugar.com/fitness/Back-Workout-Routine-31023713
  4. source: https://redefiningstrength.com/quadruped-thoracic-rotation/
  5. source: https://blog.paleohacks.com/pull-up/#
  6. source: http://www.dive-the-world.com/creatures-orang-utans.php#prettyPhoto

 

Don’t let snow shovelling break you

Winter weather can pack a punch and, with the season’s heavy snowfalls, injuries often result. Improper snow shovelling is often to blame.
But shovelling out after a storm doesn’t have to leave you stiff and sore. With a little know-how, you can clear your driveway without the all-too-common back, neck and shoulder pain cramping your style. Here’s how, courtesy of our friends from Ontario Chiropractic Association (OCA):

Before You Start

  • Drink plenty of water. Dehydration is just as big an issue in the winter months as it is in the summer.
  • Dress in several layers so you can remove a layer as you get warm.
  • Wear proper footwear. Shoes and boots with solid treads on the soles can help to minimize the risk of slips and falls.
  • Pick the right shovel. Use a lightweight, non-stick, push-style shovel. A smaller blade will require you to lift less snow, putting less strain on your body. An ergonomically correct model (curved handle) will help prevent injury and fatigue. Also, if you spray the blade with a silicone-based lubricant, the snow will slide off more easily.
  • Before beginning any snow removal, warm up for five to 10 minutes to get your joints moving and increase blood circulation. A brisk walk will do it.

All Set to Go

PUSH, DON’T THROW.

Push the snow to one side and avoid throwing it. If you must throw it, avoid twisting and turning — position yourself to throw straight at the snow pile.

BEND YOUR KNEES.

Use your knees, leg and arm muscles to do the pushing and lifting while keeping your back straight.

WATCH FOR ICE.

Be careful on icy walkways and slippery surfaces. Intermittent thaws and subsequent freezing can lead to ice building up underfoot, resulting in nasty slips and falls. Throw down some salt or sand to ensure you have a good footing.

Once you’ve mastered safe snow shovelling techniques, you’ll be free to have fun and stay fit all winter.

Contact Ace Sports Clinic in case you have questions regarding an injury as a result of snow shovelling.

 

What kind of pain do you have?

Outlining 3 Types of pain

Definition

We commonly treat pain without its definition. This is because a majority of pain patients (over 90%) will have their pain resolve and be fully functioning within eight weeks.
However, in some cases pain persists and is not responsive to medication, massage, traditional physiotherapy, or other treatments. Additional angst and frustration can be caused when medical examination does not yield any meaningful diagnosis.
Pain is commonly misunderstood, because traditional medical diagnosis presumes that pain is only caused by a signal from an injured tissue to the central nervous system. This is true, in part.

Three types of pain: Nociception, Inflammation, and Neuropathy.

  1. Nociception – this type of mechanical pain occurs when you stub your toe, where the immediate response of the body is to convey a signal from the injured tissue to your brain.
  2.  Inflammation – this type of chemical pain occurs in an acute ankle sprain, where there is a local response in the injured cells resulting in redness, heat, swelling and loss of function.
  3.  Neuropathy or Radiculopathic Pain – this type of pain is ongoing with no obvious signs of injury and is caused by suboptimal performance of the peripheral nervous system as it exits the spinal column, leading to super-sensitivity and chronically shortened muscles.

The central nervous system (spinal cord and brain) are well protected by the spine and skull. However, the peripheral nervous system (the nerves leaving the spinal column) is much more vulnerable to damage, often due to age related changes.

Characteristics of Neuropathic Pain:

  • There is pain in the absence of ongoing tissue damage.
  • There is a delay in the onset of pain after a precipitating injury.
  • Mild stimuli are very painful.
  • There may be a stabbing component.
  • Pronounced summation and after-reaction from stimuli (ie. the pain gets worse with exercise).


(source: ubcgunnims.com)
This in part, can explain why you may feel fine after a car accident, but develop whiplash 2 weeks later. Neuropathic based persistent pain could be caused by chronic muscle shortening producing pain by the extra force it puts pulling on tendons, joints and other structures. Constant strain can press on and irritate nerves, leading to a condition now recognized as super-sensitivity.

Significance
The significance of categorizing neuropathic pain is that disorders such as low back pain, whiplash, frozen shoulder, tennis elbow, fibromyalgia, myofascial pain, and Achilles heel are potentially all physiologically the same and may have a neuropathic component.

Treating Neuropathy with Intramuscular Stimulation Needling (IMS)
IMS uses acupuncture needles to help penetrate deep within muscle tissues to help release contracted and shortened muscle fibres, provide pain relief and improve muscle and neurological functioning. Each treatment relaxes shortened muscles, stimulates healing and desensitizes the irritated nerves.


(source: ubcgunnims.com)

Intramuscular stimulation (IMS) is an effective treatment tool for some acute conditions and chronic pain, where medication, massage, traditional physiotherapy, osteopathy, or chiropractic treatments have not given lasting relief. Persistent pain could be caused by chronic muscle shortening producing pain by the extra force it puts pulling on tendons, joints and other structures. Constant strain can press on and irritate nerves, leading to a condition now recognized as super-sensitivity.

Visit us today: Ace Sports Clinic

 

Common Causes of Lower Back Pain

..and some quick, easy things to try at home to help settle it down

Low back pain is one of the most common injuries we see at Ace Sports Clinic. Often it’s of gradual onset, creeping in slowly, starting as occasional discomfort and eventually being a consistent uncomfortable or painful niggle. Sometimes it’s a full-blown crisis where we can barely move without intense pain.

In all of its forms, low back pain is often multi-faceted in its origins and while it’s rare to identify only one cause, there are common culprits that we see. Often when one area is functioning poorly, we find that the body compensates and shifts the blame elsewhere; meaning the source of the pain and the problem area may not be the same. This is why we can’t just look at the back when it comes to low back pain.

Below are three of the most common things we see which contribute to low back pain and some gentle exercises you can perform to try to help settle down the pain.

1. Tight hip flexors / Too much sitting

Your hip flexor, or your iliopsoas, is an incredible and powerful muscle. Made of two muscles which share a common insertion, the psoas major originates in a spinal attachment in your mid-low back. Psoas major makes its way forwards through your abdomen where it picks up the iliacus muscle at the front of your pelvis and together they descend into a shared attachment on your femur.

The massive iliopsoas has many attachments, including those at the lumbar spine, the hip and pelvis.
The massive iliopsoas has many attachments, including those at the lumbar spine, the hip and pelvis.

Since we spend so much of our time sitting, the hip flexor is often in a contracted or shortened position, which means, it can become tight without you even realizing. Due to its attachments, when your hip flexor is tight, it can have ramifications not just at the hip, but also in your lower back. Tight hip flexors often manifest in an excessively arched lower back, or flexion through the hips. Over time these postures put stress on the joints and muscles of your lower back and result in pain.

This can be common for those who participate in exercises or sports which cause us to lean forward such as hockey, cycling, tennis or squash as these activities tend to shorten our hip flexors

Hip Flexor Stretch

We often find that a correctly performed hip flexor stretch, is one of the most effective ways to settle low back pain contributed to by a tight hip flexor.

  • Begin by comfortably kneeling on one leg on the floor – place a towel/mat under your knee
  • Ensure you are straight and not twisted through your hips. Tuck your tailbone under to flatten your low back
  • The purpose of this stretch is to lengthen your hip flexor. If you have any excessive arching in your low back, you are effectively shortening your hip flexor because of its attachments to your spine.
  • Hold for 30 seconds. The sensation you feel should be a gentle stretch and not discomfort.

2. Lazy glutes

Your gluteal muscles are collectively one of the most powerful muscle groups in your body… when they work. A common finding in low back pain is overactive and tight quads, hip flexors and/or hamstrings and poorly functioning gluteal muscles. This can put strain on the joints and muscles of your lower back and alter your mechanics resulting in pain. If your quads are on fire after a leg workout and you feel nothing in your buttocks, this one is probably for you!

Why are the glutes lazy? As with all questions regarding the body, it can be for various reasons. Sitting is a huge contributor because it shortens the structures at the front, which re-positions your pelvis and inhibits the proper functioning of your glutes. Over time this results in the glutes becoming lazy and turning off.

Often poor workout technique or imbalance in your workout routine can be to blame. You should ensure that you balance exercises which target the front of your body with those which target the back 1:1.

In terms of technique, if you are finding exercises that are supposed to target your glutes aren’t making you ‘feel the burn’, come and speak to one of our exercise specialists and get some advice on how to make your exercises more targeted.
Some general advice is to avoid over-arching your back and to make sure your weight is in your heels rather than your toes.

Hip Bridge

The hip bridge is an excellent exercise to both open up your hips and also target your glutes and hamstrings. This is one of the most commonly prescribed exercises for low back pain where the gluteal muscles are one of the culprits

  • Start by lying on your back with your knees bent up and feet hip distance apart
  • Breathing in to prepare, on your exhale, press through your heels to evenly lift your buttocks off the ground to make a straight line with your body
  • Ensure that you do not over-arch your lower back to lift your buttocks higher.
    Slowly lower your body and repeat.
    Start with 2 sets of 10 repetitions

3. Poor Mobility

Mobility is an essential component of any healthy spine. When one area of your back is tight, it will impact other areas. It’s very common for anyone who spends a lot of time sitting to have poor mobility in their upper and mid-back, which can put excess pressure on the muscles and joints of your lower back, causing pain.

Poor seated posture is a huge contributor to poor spinal mobility. We recommend that desk workers or anyone who spends a lot of time in their car, have an ergonomic assessment done every 12 months at a minimum.

A major predictor of poor spinal mobility is previous low back injury. If you have a history of low back pain, you may be habitually protecting your low back by avoiding movement in that region, which could in fact be contributing to your pain. A lack of movement may be causing over-activity in the muscles of your back (and elsewhere), which can cause them to be tight and sore. It can also cause compensation patterns which can result in problems elsewhere.

Mobility is one of the most important things for a healthy body and we should all be including it as a regular part of our exercise routine. Including a weekly Pilates or yoga session as a regular part of your routine is a wonderful way to get some movement in your body.

Low Spine Twist & Arm Openers

Below are two gentle, easy mobility exercises which target your upper and lower back respectively. They can both be done in bed or on the floor and are an excellent way to start or end your day. We often encourage people to use these as a warm up exercise for sport as a way to gently get your body moving before launching into higher energy movements.

Low Spine Twist

  • Lying on your back, cross one knee over the other.
  • Take a deep breath in and as you exhale, drop your knees towards the side which is crossed over i.e. if you have crossed your left knee over your right, drop to the left hand side.
  • Keep your head, neck and upper body and hands flat to the floor to feel a stretch through your lower back and side.
  • As you inhale, bring your knees back to the starting position.
  • Repeat for 10 repetitions before swapping your legs over and performing 10 on the other side.

Arm Openers

  • Begin by lying on your side with your head supported by a pillow. Your knees are bent and your hands are stretched out at shoulder height with hands stacked one on top of the other
  • Ensure your shoulders are relaxed
  • Take a deep breath and as you exhale, float your top arm up and keeping the elbow straight, rotate through your rib cage to reach out to the opposite side
  • Allow your eyes to follow your hand to feel a gentle stretch through your rib cage and upper-mid back.
  • Remain in the stretch for a breath, before returning on the following inhalation. Repeat for 10 repetitions before swapping sides and starting again.

Conclusion

Any back pain is often a multi-faceted and complicated issue. Rarely is there one single cause and every person will have a different cause and different needs, however, we do know that mobility in your spine and equality in your movements are two of the things which reduce the re-occurrence and incidence of low back pain.

* If you feel any pain while performing these exercises, you should stop immediately and seek the opinion of a medical professional.

Victoria Chambers is an Australian trained osteopathic manual practitioner who is currently completing her certification in applied functional science and has previous dry needling qualifications. Victoria believes in empowering her clients to take their health in their own hands by giving them the tools to manage and prevent injury through effective education, hands on treatment and rehabilitation.

Osteopathy is a holistic, hands-on approach to healthcare which addresses the whole body’s needs to aid in pain, injury management and prevention. Osteopathy recognizes the important link between the structure of the body and the way in which it functions.
Your Osteopathic practitioner will utilize a variety of hands on techniques, alongside exercise prescription and education to work with you to achieve your health goals.
At Ace Sports Clinic we also collaborate as a team with our other expert health professionals towards the optimal well-being of our clients.
Call us today on 416 792 4223 to experience “The Ace Difference”