What Causes Radiating Arm Pain?

by | Aug 31, 2015 | Hand and Wrist Pain

Just like how sciatica/ leg pain is usually caused by a bulging disc in the lower back or by a muscle pinching the nerve, arm pain and/or numbness & tingling is usually caused by a bulging disc in the neck or by a muscle pinching a cervical (neck) nerve root or plexus.

The nerve roots that come out from between your cervical vertebrae converge to form three main nerves that service the arm: the ulnar, median and radial nerves. If any of these nerve roots are pressed by a bulging disc, a bone spur or thickened ligament, it usually causes radiating (traveling) pain from the neck down the arm; usually all the way down to the fingertips.

The specific area of pain/tingling depends on which nerve root is being pinched. In fact, that is how doctors diagnose the precise problem area. For example, numbness down the medial (inner) side of the forearm down to the pinkie and ring finger can be produced by compression of the C8 & T1 nerve roots. Numbness in the outer forearm, thumb and first two fingers is associated with the C6 & C7 nerve roots.

arm dermatomes

Radiating arm pain can also be caused by thoracic outlet syndrome, where muscles near the neck and upper shoulder pinch the nerve plexus (where the roots converge). This will be next week’s topic.

Self Treatment for Radiating Arm Pain

If you have significant neck pain accompanying your arm symptoms, then it is likely you have a bulging disc in your neck. It feels like a focused, sharp pain deep inside the neck on one side. Massage does not help this kind of pain.

Most mild to moderate cases of cervical disc bulges resolve with exercises and manual therapy. The severe cases usually require surgery to remove the disc portion that is pressing against the nerve. If you have a severe case, get a consultation from a spinal surgeon and a second opinion. If done in time, surgery can resolve the arm pain, but if the entire disc is removed the surgeon will fuse the vertebrae above and below the disc which will reduce your neck range of motion somewhat.

If the disc bulge or offending structure is allowed to compress the nerve root for an extended period it may result in permanent injury to the nerve. This means after surgically removing the bulge, you still may have numbness down the arm. This is why, for nerve compression conditions, time is of the essence.

Non-surgical candidates can do exercises to reduce the bulge size. For typical posterior bulges (bulges that protrude towards the back and one side of the vertebral body) try this: while standing, use your posterior neck muscles to pull your neck straight back, as far as you can; hold for 3 seconds. It may feel uncomfortable if your disc bulge is acute. Keep your chin tucked in so that the top of your head is level. Do eight times, twice a day for a couple of weeks; note changes in your neck pain and arm pain. Discontinue if it aggravates your condition. This movement gently presses the backs of the vertebral bodies together, which pumps the disc bulge back to center.

If the exercises help but you hit a plateau, try side bending your neck towards the side of the pain, very slowly; repeat six times. Again, note changes; discontinue if it aggravates the pain.

Recommended Lifestyle Changes

Forward bending of the neck and anterior weight bearing of the head (forward head posture) tends to make the cervical discs more vulnerable to bulging because in this position the vertebrae press the front part of the discs, pushing the jelly center (nucleus) towards the back.

Axial forces (straight down through the spine) to the neck can also make disc bulges worse. Any activity that involves jumping creates axial forces — running, basketball, gymnastics, mountain bike riding, sky diving, etc. It’s not a concern unless you do it frequently.

If you have a bulging disc in your neck with arm pain, here are some suggested lifestyle changes:

  • Use a contoured neck pillow and sleep on your back.
  • Work on improving your posture: eliminate forward head posture.
  • Get a standing desk if your job requires a lot of sitting– it’s better for your back and neck.
  • Use the Cervical PosturePump device to hydrate your cervical discs
  • Strengthen your neck muscles so they offer more support to your neck.
  • Avoid excessive jumping. If you like running, consider getting Z-coil or Gravity Defyer shoes (see below).

Treatment Accessories to Reduce Arm Pain from Disc Bulge

posturepumpPosturePump Disc Rehydrator

This device uses specially designed air bladders, inflated by a hand pump to spread apart and extend neck vertebrae. This expands the discs, drawing in fluids and nutrients and also stretches the neck into its normal, ideal curvature.

 

 

zcoil2Anti-Shock Specialty Shoes

These specially designed shoes have powerful springs in the heel that significantly dampen the forces generated from running. Less shock to your feet, ankles, knees, hips, low back and neck.

 

 

 

standing_deskVari-Desk Height Adjustable Portable Desk

Place this lightweight desk on your traditional sit-down desk and switch its height between standing and sitting in less than five seconds. Choose to stand for as long as you like, then switch back– great for easing into standing while working, if you’ve been a desk sitter for many years.

Delayed Onset Muscle Soreness Treatment

by | Jul 6, 2012 | Uncategorized

Delayed Onset Muscle Soreness, or DOMS is a condition where your muscles feel pain a day or two after hard or unfamiliar exercise.   DOMS is thought to more likely be worse with exercises that emphasize eccentric muscle contraction, where the muscle lengthens as it contracts.  Examples of eccentric contraction include negative weight lifting (like lowering a curling bar slowly, squatting, and lunges).  It is believed to be the result of microscopic tears of muscle and fascia fibers and consequential inflammation.   Pain from micro injury is generated by inflammatory biochemicals interacting with nociceptors (nerves that transmit pain signals).  In DOMS, the injuries are so small that it takes 12-24 hours before the inflammatory response is enough to generate pain and stiffness.

The muscle pain from DOMS is different in nature than a typical muscle sprain/strain injury.  It generally is more widespread, depending on the muscle groups that were worked out the most.  Contracting the affected muscles will increase symptoms.   For affected muscles that cross a joint such as the knee and shoulder, stiffness reduces joint range of motion.

DOMS, while it can be quite uncomfortable, usually self-resolves in about 7-10 days, with rest and a break from physical exertion.  But for some people, that is too long.

So, what can one do to prevent and treat delayed onset muscle syndrome?

(1) Take it easy, tiger.  If you do not exercise frequently and decide one day to make up for all the months you slacked off by going “all out” you are setting yourself up for pain, stiffness, and movement limitations.   If you haven’t been exercising for months, your muscles won’t be  acclimated to taking loads and repetitions and will likely incur microtears in the fascia, tendons, and muscle fibers.  So, use the 10% rule, which basically is a scaling up of exercise over a week or two depending on how often you go, to re-acclimate your muscles to your normal, maxed workout.   Let’s say you usually curl 40 pound dumbbells.  Start day one with 5 pounds, day two with 10 pounds, day three with 15 pounds, until you get up to your max.

(2) Seek out a professional.  A personal trainer  can show you the right exercises to do for your goals, and the proper technique to get the most out of it, without injuring yourself.

(3) Warm up.  Do about 15 minutes of cardio before you do strength or functional training like Boot Camp and similar, full body exercises.  Jumping jacks, jump rope, treadmill with incline are good choices.

(4) Do some light stretching.  Although recent studies showed that stretching before exercising did not significantly reduce injuries, stretching feels good and can put you in tune with your body.

(5) Hydrate 30 minutes before your workout, competition, or task that will involve heavy lifting (like helping a friend move out of his house).   Most sports drinks are formulated to provide the major electrolytes (sodium, potassium, calcium) that muscle use to contract.

(6) Know your limitations.    As you age, you lose muscle mass; and therefore strength.   Adapt your workout routine accordingly:  lighter weights, exercises that are easier on the joints; more rests in between sets.

Now, if you still get DOMS, congratulations, you weren’t cheating; way to go for it!  But seriously… here are things you can do to minimize it:

(1) Get a Swedish style or lymphatic drainage massage (NOT a deep tissue or acupressure massage) from an experienced, skilled massage therapist.  The long, light pressure strokes towards the heart will increase lymph circulation and help your body clear out the inflammatory products.  If you can find a place in your town that does endermologie (cellulite treatment), that is even better.  Endermologie is a type of negative pressure massage done with a special machine that can increase skin circulation by over 300%, for up to six hours.

(2) Rest, ice, compress, elevate (RICE).  If your whole body is affected, try a cold water bath for 20 minutes.  Epsom salts added to the water, and eucalyptus can be helpful.

(3) Do some light exercise– walking, stretching, yoga.

(4) Take fish oil supplements.  This may reduce the inflammation somewhat.

(5) Get some protein in you:  whey protein drinks, eggs, fish.  This gives the body the amino acids it needs to rebuild torn muscle.

(6)  Rest.   Try to get at least an hour more sleep per day while you are recovering.

And of course, no smoking or over indulging in alcohol during DOMs.  When you are ready to start up exercising again, work up to max gradually over a week.

 

What Should You Do For Neck Pain?

by | Jan 8, 2012 | Neck Pain

A recent study in the Annals of Internal Medicine compared the effectiveness of chiropractic spinal manipulation, pain medications, and home exercise and advice in treating biomechanical neck pain.

The study participants were 272 people between the ages of 18 and 65 who complained of non-specific neck pain for 2-12 weeks.   They were divided into three groups, one of which took medicine only; one which received spinal manipulation to the neck only, and a third group that was just given home exercises and self-care advice.   Participants were asked to rate their pain at 2 weeks, 1 month, 2 months, 3 months, 6 months, and one year.    The method the study used to grade the pain was subjective rating (probably using a visual pain scale between 0 to 10, with 0 being no pain and 10 being the worst pain) and a Health Status questionnaire asking them their level of ability to engage in certain activities.

The patients treated by a chiropractor experienced the highest rate of success with 32 percent saying they were pain free, compared to 30 percent of those who exercised. Only 13 percent of patients treated with medication said they no longer experienced pain.

The conclusion of the study was that for participants with acute (recent onset) and subacute (usually meaning lasting more than two weeks) neck pain, chiropractic spinal adjustments were more effective than medication in both the short and long term. However, a few instructional sessions of home exercises and advice resulted in similar outcomes at most time points.

My comments:

Biomechanical neck pain can lower the quality of life significantly.  Imagine having to struggle to turn your neck all the time, and having to avoid exercise, sports and many recreational activities due to neck pain.  According to the researchers, neck pain affects 70% of adults at one point in their lives.

From my experience, biomechanical neck pain typically arises from some type of past trauma, and it doesn’t have to be major.   Examples include car accidents, sports injuries/impacts, horseplaying as kids; and hard impact generating activities such as running, horseback riding, parachuting, gymnastics, boxing, martial arts, and cheer leading.

A second, possible cause of biomechanical neck pain is ergonomic in nature; meaning, related to positioning of the body.  Long hours of desk work keeps the head relatively stationary (static) in a single position, allowing gravity to pull down on the head, over time altering the weight distribution on the joint surfaces of the bones that make up the neck.  Such an “activity” also promotes muscle deconditioning around the neck.  The term “deconditioned” means that the muscle is slower to respond to nerve commands, so it loses some ability to support,  guard and protect the cervical spine (neck).

The worst combination is someone who has a history of impact trauma to the neck who later gets a job that involves working at a desk for long hours at a time.  The trauma history sets the stage for neck pain, and the static positioning of the head accelerates the process over time.

The pain in biomechanical neck pain frequently originates in the joint surfaces of one or several cervical vertebrae, commonly the posterior facet joints (also called the zygapophyseal joints).  This is where most of the movement occurs when turning and bending the neck.    Orthopedic surgeons sometimes prescribe a facet block for neck pain, which is an injection of pain medications directly into the joint, usually guided by video fluoroscopy.  If the patient has degenerative disc disease, pain can emanate from the intervertebral discs, either as a disc herniation or internal tear of the disc.   If this is the case, neck surgery is typically the last hope.  The disc herniation may be able to be reduced by surgery, but if the surgeon feels that the  disc is beyond repair, discectomy (total disc removal) with surgical fusion is usually performed.  However, this is like trading one evil for another.  Surgeons know that when you fuse two vertebrae together, the vertebrae above and below the fusion bear an increased burden of providing the movement lost by the two fused vertebrae.  This will lead to accelerated degenerative changes to those areas as well, over time.

Neck pain can also emanate from the surrounding muscles and fascia.  Myofascial trigger points are focal, tender spots along a muscle that are believed to develop from trauma or microtrauma.  They may actually be a concentration of nerve endings on the muscle that developed following an injury.  These are best handled through manual therapies such as chiropractic, massage, exercises and stretches.

Some people get inexplicable muscle spasms of the neck.  This is usually accompanied with a migraine or tension headache.  A muscle spasm occurs when the nerves that control the muscle misfire, causing the muscle to maintain a constant state of hypertonus (involuntary contraction).  This results in muscle pain, fatigue and low grade inflammation.   Sometimes the spasm can be so intense that anti-spasmodic medications, ice, heat, and rest have no effect.  In cases like this, botox injections are sometimes used.  Botox injections are comprised of a weakened strain of the Botox bacteria, which has the effect of muscle paralysis.

Lastly, it should be mentioned that a poor, nutrient-deficient diet and smoking can make neck pain worse by denying the body critical nutrients needed for repair and maintenance of muscles, ligaments, tendons, nerves and bones.

The study, while emphasizing that chiropractic manipulation was superior to medications in reducing neck pain among participants, also mentions that home exercises and advice were just as effective.    It therefore seems natural that a combination of spinal manipulation and home exercises would be a good strategy to reduce or eliminate biomechanical neck pain.

If you are experiencing non-specific neck pain (don’t really know what caused it) for over two weeks and desire to try chiropractic, it’s important to choose a good,  qualified chiropractor.   Some of the signs of a good, reputable chiropractor are:

1.   Doesn’t try to convince you to purchase a long-term treatment program involving multiple adjustments per week.

2.  Asks you about your complaint:  the nature of your symptoms, how they started, how long you’ve had these symptoms,  how they affect your ability to do certain things; and questions regarding your general health.

3.  Gives you his/her diagnosis and uses standard orthopedic terminology that is consistent with what you are coming in for (doesn’t go off subject).   It meshes with the information you provided in #2 above.  You feel that the chiropractor listened to you, and responded with a meaningful solution that is clear to you.

4.  Gives you a treatment recommendation the same day:  the type of treatment and a brief description of it (spinal adjustments, modalities, supports); what to expect from the treatment, and approximately how long it will take.   The chiropractor should also disclose potential  risks and side effects of the treatment.   In my opinion, six treatments followed by a re-evaluation is a sensible treatment approach for most cases of subacute, musculoskeletal pain.

A chiropractor like this may or may not have a lot of reviews on the internet.  Use your judgement, ask friends and co-workers for referrals, and by all means, don’t be afraid to change chiropractors if your first choice turned out to be bad.

Regarding home exercises and advice for treating biomechanical neck pain, stay tuned!  I will be putting up an information-packed neck pain relief video on this topic shortly.

 

Related articles

Chronic Pain Affects Approximately 116 Million Americans

by | Aug 2, 2011 | Uncategorized

Woman with hip pain

Woman with hip pain

The Institute of Medicine (the medical branch of the US National Academies of Science) released a report brief on June 29, 2011 on the state of chronic pain in America, entitled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.  The purpose was to assess how pain affects people of different socioeconomic backgrounds, and what can be done on the national level to improve awareness and treatment.

Chronic pain affects at least 116 million American adults—more than the total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity.   It is  a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.

The toll documented in the report is staggering. Childbirth, for example, is a common source of chronic pain.  The institute found that 18 per cent of women who have Caesarean deliveries and ten per cent who have vaginal deliveries report still being in pain a year later.

Ten per cent to 50 per cent of surgical patients who have pain after surgery go on to develop chronic pain, depending on the procedure, and for as many as ten per cent of those patients, the chronic postoperative pain is severe.

The risk of suicide is high among chronic pain patients. Two studies found that about 5 per cent of those with musculoskeletal pain had tried to kill themselves; among patients with chronic abdominal pain, the number was 14 per cent.

For patients, acknowledgement of the problem from the prestigious Institute of Medicine is a seminal event. Chronic pain often goes untreated because most doctors haven’t been trained to understand it. And it is isolating: family members and friends may lose patience with the constant complaints of pain sufferers. Doctors tend to throw up their hands, referring patients for psychotherapy or dismissing them as drug seekers trying to get opioids. “Most people with chronic pain are still being treated as if pain is a symptom of an underlying problem,” said Melanie Thernstrom, a chronic pain sufferer from Vancouver, Washington, who wrote The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering (Farrar, Straus & Giroux, 2010) and was a patient representative on the committee. “If the doctor can’t figure out what the underlying problem is,” she went on, “then the pain is not treated, it’s dismissed and the patient falls down the rabbit hole.”Among the important findings in the Institute of Medicine report is that chronic pain often outlasts the original illness or injury, causing changes in the nervous system that worsen over time. Doctors often cannot find an underlying cause because there isn’t one. Chronic pain becomes its own disease.

“Having pain that is not treated is like having diabetes that’s not treated,” said Ms. Thernstrom, who suffers from spinal stenosis and a form of arthritis in the neck. “It gets worse over time.”

Ms. Thernstrom compared the effect of chronic pain on the body to the rushing waters of a river carving out a new tributary. Pain, she says, also changes the body’s landscape.

“My pain is at the level where it’s manageable,” she said. “I do wish I had gotten aggressive treatment in the first year. There is a window of time to intervene, because pain changes your nervous system and pain pathways develop.”

“When pain becomes chronic, when it becomes persistent even after the tissue and injury have healed, then people are suffering from chronic pain,:” Mackey said. “We’re finding that there are significant changes in the central nervous system and spinal cord that cause pain to become amplified and persistent even after the injury has gone away.” The pain report is only a first step for the community of medical professionals who treat pain. It will be up to medical schools to begin better education of doctors in the treatment of pain, and the National Institutes of Health to decide whether to promote research into chronic pain.

——

My comments:

This report is an important milestone in creating a national awareness of the “epidemic of pain” in this country.   Chronic pain is a very difficult problem to treat, because in most cases, there is nothing left for the doctor to do.  It truly frustrates doctors to see patients not getting any better over time.  Many primary care doctors dread having to see their chronic pain patients come in, because of the reasons stated in the article– suspicions of exaggerated symptoms, assumptions of pain reliever drug addiction, psychological problems, etc.

More attention is needed in formulating a strategy to prevent chronic pain from happening, and ways to better manage it.  This study is a good first step towards that direction.

If you have chronic pain, it still is a good idea to do the things that make the body healthier overall:  give it the building blocks to regenerate and repair tissue (high nutrient density foods); avoid ingesting toxins such as smoke, alcohol, preservatives, and pesticides; drink pure, clean water; get a good dose of Vitamin D every day by going outside in the sun; do short workouts that engage all body parts in unison every day, avoid negative people, negative media, and negative thoughts as best you can; engage in activities that require concentration; socialize with positive people; laugh to your heart’s desire, and get enough rest each and every day.  These activities may not cure chronic pain, but can make it more manageable.

 

References:

The New York Times, Giving Chronic Pain a Platform of Its Own

The Institute of Medicine, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research

Whiplash Injuries and How to Treat One

by | 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:

  1. Reduce pain and swelling
  2. Reduce scar tissue build up by doing gentle, active stretches, even during the pain period
  3. Restore joint (verbebral) biomechanics and neck range of motion
  4. Strengthen surrounding muscles in the neck
  5. 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.

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