NO !! Your leg pain is not just SLIP DISC...

It won't be wrong if I quote that BACK PAIN is second most common condition after common cold which makes people suffer affecting their daily life. Every third person has faced atleast one episode of back pain in their life. Our SPINE encloses and protects spinal cord which carry information from brain to the body via nerves. Without such information the body cannot control, move or feel anything effectively making you senseless and motionless.

"Are you suffering from back pain? 

Or

Do you get a pain travelling down your one or both legs? 

Or

Is it difficult to walk few minutes or few steps without a back or leg pain? 

Or 

Do you know someone who is facing such a complaint?"

Read the article carefully to understand what is going wrong inside your body. Read it as you will get to know things beyond your doctor might have missed to share with you.

You may have a leg pain travelling down along with back pain or sometimes without any back pain. The reason for leg pain can be nerves compressed from the spine or even at your hip. Sometimes muscular pain mimics like a nerve pain in the leg which makes you and your doctor confused. The difference between leg pain due to nerve or muscles is that former causes sharp shooting or electric current like leg radiation whereas the latter creates a continuous dull achiness in the affected leg along with pain in the muscle involved.

If you have seen a human spine, it looks like a curvy snake formed by multiple bones called vertebrae arranged in a manner to give it "S SHAPE " when looked from side view. But from front or back view it looks like a straight vertical spine. Any deviation in these curves can put the spine structures under stress causing lot of muscle imbalances or vice a versa.

When your muscles doesn't support the spine symmetrically it can cause excessive stress between couple of vertebrae causing reduced space for the nerves exiting from the spine. Hence, leading to compressed nerves causing painful radiation in the leg. These imbalances can even create severe muscular spasm putting heavy pressure on your affected nerve and the result is your painful suffering again.

Interestingly, the above mentioned reasons can put the disc under pressure and making it appear like a bulge or on MRI Scan. This should be called as false or pseudo disc prolapse causing nerve irritation and leg pain. This type of bulging can disappear or improve once the pressure between vertebrae goes away.

   

I have come across patients who comes with a dull pain in the hip which also radiates down the leg but does not behave like sharp shooting pain. And the reason is not your spinal disc or nerve but a muscle around the hip known as GLUTES MEDIUS (the HIP Abductor) which may have a TRIGGER POINT - muscle knot causing nerve like pain which people often confuse with sciatica due to nerve compression. 

 A deep muscle of the hip known as PIRIFORMIS (the HIP Rotator) is placed right on top of your sciatic nerve and in some cases this nerve pierces from within the piriformis muscle. If this muscle becomes tight it can cause a similar nerve pain but thankfully then the reason is not your spine. This is more common in people who keep purse in their back pocket and also when people sit with scissored legs (Cross Leg Sitting).

A disc is a doughnut like structure with hard outer shell filled with jelly like material inside. Disc is found between the vertebrae of the spine adding shock absorbing effect. In case there is a sudden trauma or repetitive wrong movement pattern in daily life, the disc wall gets weakened and starts bulging mostly backwards and outwards. If the nerve gets compressed by this bulging disc as it is lying very close to it, you can get a sharp shooting pain radiating down the leg. This condition is popularly known as SLIP DISC OR SCIATICA. The people describe this feeling as painful electric spark travelling down the leg. Your bulging disc or slip disc cannot cause leg pain if it is not pressing on to a nerve.

Bulging discs are very common and not everyone who has a bulging disc go through pain. Infact, after 30 yrs of age, every 10 years increases the chance of finding one or more bulging discs with or without leg pain. So when disc bulge is so common then what is causing your leg pain. Careful examination can reveal whether your nerves are compressed due to muscular imbalance, a mis-alignment in the spine or a disc compression on your nerve.

This information is totally in contrast with MRI reports showing disc prolapse as the possible cause of your pain. Trusting the MRI reports without careful examination can misguide you towards unnecessary treatments not required for your stage of the disease.  If you are better informed then you can reduce your suffering by heading towards the effective treatment for your condition.

The information on this blog is helpful in creating awareness related to different problems which produces similar symptoms and often confuse against reaching better treatment approach. 

Please do not consider this blog as a medical advice and do visit your doctor or physiotherapist whenever you experience such symptoms.

Feel free to explore more information by commenting here anytime.

Regards,

Dr. Kunal Vashist,PT

MPT(Ortho), Manual Therapy

DryNeedling Practitioner

Email ID - kvashist.physio@gmail.com

Contact No. 9968302757

More Than Physio... Clinics                       

Shoulder Pain Is Beyond Arthritis, Tendonitis or Muscle Tear

(Do not blame the name, Understand the game)

Br J Sports Med bjsports-2016-096772 Published Online First: 2 November 2016 doi:10.1136/bjsports-2016-096772

Shoulder is a complex joint as it moves along with other structures. Shoulder can produce a powerful movement almost in every direction making it susceptible to numerous injuries. A lot has been said about diagnosing shoulder pain where the focus is too much on identifying the structural damage. Whereas when it comes to managing pain, it has been seen that the symptoms are produced by multiple factors including posture, mobility and muscular strength in and around shoulder joint.

A shoulder joint (Gleno-Humeral joint) is a ball and socket joint between humerus (arm bone) and scapula (triangular flat bone behind shoulder). The collar Bone (Clavicle) connects to scapula  through Acromio-Clavicular joint and chest bone (Sternum) via Sterno-Clavicular joint. A full shoulder Range of motion is a collective effort of all three joints along with good mobility from thoracic spine and ribs.

The muscles responsible for shoulder functions, like Pectorals, Trapezius,  Deltoid Rotator cuff, lattisimus dorsii etc. are not just limited to the above mentioned joints in shoulder complex but also to ribs and thoracic spine via different muscles. It even includes your core and pelvic stabilizers to form the basis of effective and dynamic movements of shoulder. Lower body strength and balance are equally contributing to generate proper force transmission through ground reaction force during a powerful movement from the shoulder.

If you look at the anatomy and function of shoulder region, the arm is almost hanging to the torso via scapula and various muscles enabling it to do large movements but keeping it also at risk of injuries. No matter if you are a high performance athlete or a sedentary person, a poor posture (static or dynamic) leads to loss of mobility in concerned areas and creates muscular imbalances around spine and shoulder joint.

The scapula (triangular flat bone) behind the upper back plays a crucial role in dynamic motion of the shoulder. During a shoulder movement, scapula stabilizes itself on ribs with some degree of movement to produce a strong dynamic movement of humerus (arm bone). The poor muscle control around scapula changes the movement pattern of humerus which leads to impingement of musculature passing from under the shoulder region.

Some various common diagnosis in shoulder pain are supraspinatus tendonitis, bursitis, labral tears, muscle tears, Painful Arc syndrome, shoulder impingement etc. Why we are so keen on naming these diagnosis? Now we already know that there must be multiple events which has gone biomechanically wrong to create the basis for an injury. The investigations such as MRI or CT scan always direct us towards the local structure which is injured but is not usually the source of pain. The injured structure is only one of the source which is creating trouble during the painful movement.

When there are so many events involved in a painful shoulder, it is not feasible to label it with one diagnosis. Rather we should physically assess for muscular imbalances and biomechanical changes which are the root cause of current injury. We should make a physical diagnosis rather than a diagnosis based on mere investigations. The physical diagnosis helps in planning and implicating conservative management mainly corrective exercises to restore the muscular imbalances. 

There is a very limited role of surgeries in managing shoulder pain considering the cost required and risk involved in shoulder repair. Saltychev M et al said there was moderate evidence that surgical treatment is not more effective than active exercises on reducing pain intensity caused by shoulder impingement.

Neck Pain - Three Things To Think Beyond MEDICINE

In the world of technology, the machines are becoming advanced and addictive up to a level that nearly 70% of your active daily time goes into it. Neck pain is as common as Low back Pain since both of them mainly originates from poor lifestyle and reduced physical activities. I see number of patients suffering from Bad Neck Pain and still keen on wanting an X-RAY or MRI scan because they really wants to see what has gone wrong with them. And the kind of reports which comes out after scans keeps them scared for life.

"So many studies have shown that Xray or MRI changes are normal after a certain stage of life even in people with NO PAIN"

Most people consider X-RAY or MRI Scan reports as their diagnosis further complicated by their doctors because they almost stamp the reports to be true. And you start believing in the terms like Cervical Spondylosis, Degeneration, Reduced disc space, loss of cervical curve etc.

What else can be done in 5 min checkup time with your doctor?

You can only prove me wrong if your doctor has examined you thoroughly and tried looking for reasons beyond what investigations are pointing towards. Remember, your reports always quote in the end " This is not a diagnosis, Please correlate clinically". A thorough checkup easily needs 30 min duration to carefully examine all possible reasons which may cause you pain. Identifying the source of pain is as important as your treatment so that you are not misguided towards ineffective solutions to your neck pain.

If you are wondering what else can cause you pain other than what your investigations had so far revealed, then read further down as this can be an eye-opener article for you.

My First question to you, if you have a NECK PAIN :

HOW bad you are with your sleep?

 

DO you feel stiff and painful with your neck in the morning?

 

DO you find your pain worse on the days when you do not sleep enough?

Your sleep quality is directly linked to pain and stiffness in the neck. Good sleep is almost like a restart to your body system ( including hardware- joints and muscles / software- mind and nervous system). Sleep helps recovering from all day stress which your body and mind has gone through. Minimum 7 hours sleep is the baseline for healthy sleeping time including minimum 2 hours of deep sleep.

My second question to you to observe carefully:

Does your pain aggravates from long hours of prolonged sitting at home or work? 

Do you think your bad posture is responsible for your pain?

Is your pain better on the days when you are active with less sitting?

From years doctors have blamed your poor posture for your neck pain. Blaming your bad posture is overrated as no one can sit in good posture for long as it requires enormous strength from the muscles to keep you upright nonstop.

If you do not move enough then even an upright sitting can trouble you equally.

"Your muscles need more blood to survive better"

Keeping yourself inactive for so long makes your muscles stressful and then it doesn't matter even if you try attaining a good posture. So it is not your posture which makes you suffer with strained NECK. Blame your long hours of sitting which reduces blood flow to the muscles and makes your joints feeling stiff.

My third and the last question you need to think about: 

Do you feel your mind gets stuck with thoughts making you worry constantly about random things?

Do you find increased neck pain on the days when your mind is overworked?

Does your neck pain has started giving you emotional response like crying, tensed, irritated etc?

Stress has started bugging our daily life and it has become almost epidemic. We all try to hide our disturbing thoughts and keep them alive in our mind. Generally we all are forgetting / hiding to share as we are scared of letting people know what we think. This huge collection of disturbing thoughts gives emotional response but also a physical response which we don't believe it can. Your neck pain can be an expression of stressful thoughts running in your mind (oh! sorry stuck in mind because running is still better).

If you have a bad disturbing neck pain even more so if it is chronic; you should consider the following factors which alone or in association of your diagnosis and treatment can help you recover better:

SLEEP, PHYSICAL ACTIVITIES AND STRESS

If you want to find more about your neck pain or looking for a solution to resolve your condition effectively, feel free to comment below or contact me on below mentioned details:

Regards,

Dr. Kunal Vashist, PT

MPT (ORTHO), Manual Therapy

Dry Needling Practitioner

Movement Specialist (USA)

Conservative Pain Management Specialist

Email id : kvashist.physio@gmail.com

Contact Number: 9968302757

More than physio... Clinics