Injury - Ask Dr. P - The Pain Doc

Treat Shoulder Joint Pain with Red Light and Infrared Therapy

by Pain Doc | Jul 29, 2015 | Shoulder Pain

Light in the visible red spectrum has noted therapeutic benefits, and it does this by enhancing cellular energy and signaling reactions involved in tissue healing. When an injured cell has more available energy, it can repair itself faster and activate certain other biological processes involved in healing. Red light in this wavelength does not generate heat, so heat isn’t doing the healing. It’s photobiomodulation at work– a human version of photosynthesis, the process by which plant life creates food for itself using sunlight.

Because of its wavelength range (about 620-880 nm) red light tends to get absorbed by water-dominant human tissue, especially red blood cells. Just beyond the visible red on the spectrum of light is infrared light (IR), which is not visible to the human eye, but still has therapeutic benefit (most of the heat radiating from the earth is infrared). Infrared has a higher wavelength and can penetrate deeper into human tissue. In fact, acupuncturists and physical therapists rely on infrared heat lamps to apply heat to deep joints such as the shoulder, hip and knee.

Since they are considered generally save for use, the FDA allows manufacturers of red light and infrared therapy devices to sell directly to the consumer, without a doctor’s prescription. Those who have photosensitive skin however my want to speak with their doctor first before trying red light therapy, as it may cause pigmentation.

There are numerous red light and infrared devices on the market for personal use; some better than others. They include hand held devices, mats and lamps. There are even portable infrared saunas. For small areas such as an ankle, wrist or shoulder, you can use a portable, hand-held red light device.. This is a stainless steel, high quality compact device resembling a small flashlight. It uses three (3) diodes; each putting out a different red light frequency, which means it penetrates to different depths in your tissues thus bathing a larger area with red light. 3-4 three- minute doses, twice a day for three days is a good protocol for most conditions.

For larger areas such as low back pain or spasm or leg pain after running, try an infrared lamp or sauna.

The Shoulder Joint – A Complex Joint Vulnerable to Breakdown

Ok, let’s talk about treating common shoulder joint pain. The shoulder joint, or glenohumeral joint is a ball and socket type synovial joint. Unlike the hip joint, the shoulder joint has a shallower articulation point with the scapula that allows it to move as it does — in wide arcs and in multiple planes (try doing that with your knee!). It is enclosed by the rotator cuff, which is basically formed by the several tendons attached to the humeral head (the proximal end of your humerus, or upper arm bone) and capsular ligaments that connect the humerus to the other end of the shoulder joint, the glenoid fossa of the scapula, a shallow bowl-shaped indentation.

There are six muscles that move the shoulder, and therefore six tendinous attachment points. Above and around the ball of the shoulder joint are bursae, which are jelly-like pads that serve to reduce friction during shoulder movement. Inside the shoulder joint capsule itself is the synovial lining (this is the tissue that gets inflamed in cases of rheumatoid arthritis), the cartilage lining the ends of the ball and socket surfaces and the labrum, a rigid cartilaginous support structure that helps position and stabilize the humeral head onto the glenoid fossa. As you can see, your shoulder joint has many structures involved in its function. This means there are more chances for something to go wrong– a tear, a strain, a malposition, compared to a simpler joint like a knuckle.

If you have pain and/or clicking noises (called crepitus) in your shoulder or have restricted movement such as limited ability to raise your arm above shoulder level, something is obviously wrong. It could be a rotator cuff tear (tear of tendons and or capsular ligament); labral tear, bursitis (inflammation of a bursa), thickening of the supraspinatous ligament due to shoulder subluxation (malposition of joint), arthritis or fluid build up. Stretching alone may not be feasible, especially in cases like adhesive capsulitis (frozen shoulder) due to the pain. This is where red light therapy and infrared can help.

How to Apply Red Light to Your Shoulder Joint Where It’s Needed

The challenge when applying red light to your shoulder joint is getting it to the damaged structures, which is not straightforward. The glenohumeral joint is covered by the deltoid muscle, which can be quite developed especially in men. It is thickest in the belly of the muscle (center, meaty part) but thinner on its tendinous ends where it inserts into the scapula and collar bone. Avoid the belly of the deltoid as red light cannot pass through it, and apply the red light over the thinner areas noted. Also, don’t forget that you can access the shoulder joint underneath, via your axilla (arm pit). This is a great technique, as there are no muscles obstructing it (see third image below).

Below is a diagram of shoulder anatomy to give you a better idea on how to target critical structures like the shoulder bursae, tendons and capsular ligaments when using red light therapy. You’ll want to use a hand-held red light therapy device that can focus the light over a small area of about 2 cm.

Palpate your shoulder and locate the locus of pain. Internally and externally rotate your shoulder joint and press in front, on top underneath and behind it with your index finger to find tender spots. Once you’ve found one, keep your shoulder in that position and apply the red light for 60 seconds. Do this 3-4 times. You may want to move to areas around the sore spot, for good measure. The thin, small space just under the “cliff” of the acromion process is an ideal spot to focus the light. It will get absorbed by the subacromial bursa and supraspinatous tendon, common sources of shoulder pain and stiffness. Do this over a week to ten days, and you should notice improvement. Avoid overly-stressing your shoulder joint during this time period to allow proper healing. Below is a video where I show you how to do it.

In summary, you can accelerate tissue healing in sprains, strains, bruises and minor cuts using red light therapy. These devices are a great addition to your home therapy devices, as they do not require a medical license to acquire.

Hamstring muscle strain from running

by Pain Doc | Jun 29, 2012 | Uncategorized

I have a patient who complains of acute pain right under the right butt cheek, and inner part of the thigh. It is a persistent pain that has been bothering him for weeks and also feels stiff. He is in his mid 50s, professional, and in good health other than “high” cholesterol, for which he takes Lipitor.

The pertinent history for this patient is that he is an avid runner, and has been running regularly since his 20s. He is one of those folks who enjoys the feeling of running, during and after. It is a form of stress relief for him. He also does Pilates using the reformer, and enjoys 3-4 glasses of wine on most nights.

The area in question is the biceps femoris tendon, which is part of the “hamstrings” of the leg. It functions as the major knee flexor of the leg (its agonist, opposing muscle is the quadriceps group). The biceps femoris muscle inserts into the ischial tuberosity, which is the bony part of the ischium (half of the pelvis) that we use to sit.

Without the benefit of an MRI or CT scan, and based mostly on the history and lack of other findings that would cause me to think otherwise, I diagnosed myofascial strain of the biceps femoris tendon, with possible tendinopathy (degradation of the tendon from overuse). Basically, something has happened to the muscle and tendon that is resulting in unrelenting pain.

Running is the repetitive, alternating contraction and relaxation of opposing muscles. The most stress occurs at the tendinous attachments to the anchor points on the bone. However, the spot where the tendon attaches to bone is stronger than the breaking point of the tendon itself, so when it is stressed, the body of the tendon will experience tearing (strain) first. It is rare for a tendon to separate from bone at the attachment site. This is the case for this patient, as his pain is described as about 2-3 inches from the attachment point on the ischial tuberosity.

I am treating his injury with a LiteCure deep tissue laser and have given him a nutritional prescription consisting of whey protein to provide the building blocks for repair; high potency fish oil and capsaicin to help reduce the inflammation, and bromelain supplements to serve as an enzyme to soften scar tissue formation. Today, I advised him to drink distilled water for 2-3 weeks. Distilled water may have a chelating-type of effect (binding) on dissolved, inorganic toxins or debris in tissues, which could help with the situation; it is often used for detox programs because of this quality. He was advised to rest, ice and compress the area for 3 days to help suppress the inflammatory reaction.

The case is a very interesting one that will hopefully have a good outcome. We should realize that a muscle is very much like an organ of the body, although it is rarely referred to as one. It has its own unique type of cells, blood supply, and plays an important function. As in all cases of disease of the body, a good strategy is to give it an edge in repairing itself. Diet modification, concentrated, high potency supplements, and non-pharmacological, manual therapy, when used in the right manner can oftentimes hasten recovery.

Whiplash Injuries and How to Treat One

by Pain Doc | May 28, 2011 | Uncategorized

Whiplash is the colloquial term for a neck sprain strain injury that comes about from the head and neck being “whipped” back and forth as the result of a short-lived acceleration and deceleration of the body. Perhaps the most common event that can create this is a car collision; specifically a rear end car collision. Other things that can cause it are roller coaster rides and other amusement park rides; bungee jumping; horsing around and similar types of accidents.

Let’s discuss whiplash from a car accident. You’re sitting in traffic, and all of a sudden you hear a loud screech and feel something powerful crash into the back of your car. You hear crunching metal, and maybe even shattered glass. Your back sinks into your car seat as your car is thrust forward from the impact, and your body suddenly stops and reverses direction. You instinctively grip your steering wheel and stiffen your arms to protect yourself, which braces your torso somewhat but because of the flexibility of your neck and the weight of your head, your neck bends back sharply and recoils violently forward, then back again until it rests. In that split second, your neck muscles, not having enough time to react do not protect your cervical (neck) spine and suffer microtears. Swelling sets in; then soon after, neck stiffness. Depending on the force of the impact and other factors such as the speed and mass of the car that struck you; the amount of denting/deformation of your car, and your body type other areas can experience injury as well. This includes the upper shoulders, mid and lower back, jaw, wrists, knees and ankles. Most pain in a whiplash, however, is centered in the neck, upper shoulders and upper back.

I made a video on what to do for whiplash that illustrates a good home care procedure to alleviate the pain and rehab the neck. If you’ve suffered a whiplash injury to your neck, and were cleared by the emergency room of any red flags, the goals will be:

Reduce pain and swelling
Reduce scar tissue build up by doing gentle, active stretches, even during the pain period
Restore joint (verbebral) biomechanics and neck range of motion
Strengthen surrounding muscles in the neck
Restore proper neck curvature

You’ll also want to get enough protein (whey protein is the best, followed by eggs and fish), foods high in anti oxidants, and drink enough fluids during your injury rehabilitation. Taking 2000 mg Vitamin C is also a good idea, as it has shown to be helpful in wound regeneration. Lastly, get out in the sun and expose your neck and back for about 20 minutes. Sunlight stimulates Vitamin D synthesis and may have other beneficial effects on the cellular level.

If you were in a car accident and want extra reassurance, find a chiropractor who has experience treating soft tissue injuries. Don’t just go with the office that has the loudest advertising– make sure you are comfortable with the office and the doctor first after asking a lot of questions. I have treated whiplash injuries in San Francisco for over 15 years and have had great success. One of my most useful pieces of equipment for treating acute sprains and strains such as whiplash is the Solaris phototherapy unit, which uses therapeutic light between 660-800 nm wavelength. Light at this frequency actually speeds up wound healing at the cellular level by increasing ATP production (basically, increasing cellular metabolism, which includes waste removal). Once the pain and swelling is down, I initiate manual therapies to restore joint biomechanics and to rehabilitate the surrounding soft tissues to reduce the risk of chronic pain.

If you happen to live or work near San Francisco and were injured in a car accident, you can contact my office at (415) 627-9077.

You can find more information on whiplash on my website.

Treating Chronic Repetitive Strain Syndromes

by Pain Doc | Mar 19, 2011 | Sprains and Strains

If your job, hobby, or recreational activities involve repetitive movement patterns you may develop a repetitive strain injury, or RSI. Also known as overuse injuries, cumulative trauma disorders, and musculoskeletal disorders these types of conditions are characterized by pain, inflammation, swelling, and reduced joint movement.

Some of the more well-know causes of RSIs include:

typing/data entry (wrist tendonitis, epicondylitis)
hair styling (wrist tendonitis)
using vibrational tools (wrist, hand tendonitis)
carrying small children (deQuervain’s syndrome)
tennis (lateral epicondylitis; i.e. tennis elbow)
golf (medial epicondylitis; i.e. golfer’s elbow)
running (achilles tendonitis)
bowling (medial epicondylitis, wrist tendonitis)

RSIs mostly affect tendons, ligaments, bursae, and neural sheaths but they can affect muscle fibers as well. What happens is the offending activity places unusually high demand on these structures resulting in microscopic tears to the tissues. A very gradual inflammatory response follows, which then takes a life of its own. At this point the patient notices that the pain is more frequent and doesn’t go away with rest, and he/she may reach for an over the counter non-steroidal anti-inflammatory like Motrin.

What makes repetitive strain injuries so persistent is that they are caused by an activity the individual needs ( job) or loves (favorite sport) to do, and essentially he/ she “re-injures” the condition with the activity until it gets to an advanced stage.

Most of the time a repetitive strain injury is transient; i.e. it appears for several weeks then disappears. The patient resorts to icing, rest, temporary discontinuation of the offending activity, over the counter meds, massage therapy, bracing, and in some cases, cortisone shots.

In some people, the pain turns chronic; i.e. doesn’t entirely go away even after weeks and months since the onset. If you are experiencing this, it can be due to improperly healed microtears causing abnormal muscle and tendon performance; and perhaps trigger points which are believed to be concentrations of nerve endings at an old injury site.

When the condition is chronic, you can attempt to do the therapy in the video above. You use a flat edged massage instrument to “strip” the muscle close to where it attaches to the joint. This can help loosen any fibrous adhesions (“stickiness”) that may be interfering with muscle and tendon movement. It also mildly agitates the area (be careful not to overdo it) and increases blood flow, which can stimulate repair by fibroblasts, special cells that synthesize collagen.

This therapy is not to be done when the condition is acute (recent onset, hot, red, swelling). Doing so will make it worse. Try it only when it has reached a chronic stage and inflammation is absent. If it causes an unusual increase in pain, discontinue and apply ice.

Whey Protein – Great Supplement for Healthy Tissue Healing

by Pain Doc | Sep 16, 2010 | Uncategorized

Image via Wikipedia

Whenever you suffer an injury to the musculoskeletal system, there is some degree of tissue damage. In minor sprains and strains, it is microscopic tears to the fascia, muscle fibers, tendons and ligaments; in major sprains and strains it is complete rupture or tearing of large groups of muscle, ligament and/or tendon fibers.

The first thing the body does at the onset of the injury is initiate the inflammatory response. Various biochemicals constitute inflammation; each having an important role. Inflammation confines the injury to the injury site and is actually the first step in tissue repair. It is only when it is overproduced that it becomes a problem in itself (which is why you should use ice therapy to mediate swelling the first few days after an injury).

At some point, the body sends special cells called fibroblasts to the injury site. These cells synthesize connective tissue comprised of collagen to close the tears of the injury.

Collagen is the main protein of connective tissue in animals, making up 25%-35% of the total protein content . It forms as elongated fibrils (long chain of amino acids in a strand formation) and is mostly found in fibrous tissues such as tendon, ligament and skin, as well as other places in the body.

Therefore, after sustaining an injury, the body needs a ready supply of protein in order to properly heal itself. If you recently sustained a soft tissue injury such as a sports injury to a joint, whiplash car accident, or sprained your lower back from heavy lifting, make sure you are eating enough protein. I recommend whey protein due to its ability to be digested very rapidly, making it available for use shortly after consumption. Whey is a protein-rich byproduct that is formed during cheese formation, usually from cow’s milk.

Body builders and athletes drink whey protein shakes after workouts to help increase amino acid levels in the blood, which are taken up by the muscles to ultimately increase mass. During exercise, whey helps improve blood flow by inhibiting an enzyme that constricts blood vessels; this allows better flow of nutrients to needed areas to help repair and rebuild muscle tissues.

Leucine is an amino acid found in whey protein shakes. When leucine is ingested in high amounts it stimulates protein synthesis, which may speed recovery and adaptation to the stress that occurs from heavy exercise and injuries.

Another good source of protein is eggs. Eggs are a complete source of protein, especially the yolk. Cook them at low heat; and if you have the stomach for it, eat them raw.