The Cycle of Injury to Joints

Why joint injuries need to be addressed in order to make sure they don’t become chronic.

When you injure a joint (for example, common places to injure a joint include your spine, your shoulder, hip, knee, wrist, elbow, or ankle) there is also damage to the ligaments that help that joint function properly. Before I explain what exactly ligaments do, let’s quickly go over some terminology:

Joints – this is a place where two bones meet and they can move in relation to each other.

Muscles – these go from one bone to another bone, and when a muscle contracts it brings the two bones closer together.

Tendons – muscles attach to bones with tendons. As the muscle nears the bone it transitions into tendon, which physically attaches the muscle to the bone.

Ligaments – ligaments go from one bone to another bone, but they do not have the ability to stretch like muscles and tendons. They are used to reinforce a joint, to prevent motion in certain directions, and to guide movement in the correct direction.

So, when a joint is injured there is a good chance that the ligaments that hold it together were also injured. To illustrate this, when you sprain your ankle, the actual injury is to the ligaments of the ankle joint. When there is a sprain it is an injury to a ligament.

That injury to the ligament always initiates a process beginning with two things: joint instability and proprioceptive deficit.

1.       Joint instability – as explained above, the ligaments guide and limit the movement of the joint, and without stable ligaments you will not have a stable joint.

2.       Proprioceptive deficit – this is a fancy way of saying that your nervous system will have a decreased ability to monitor and control the movement and position of that joint and the bones that the joint includes.

a.       This proprioceptive deficit then causes decreased neuromuscular control. That means that your body has a decreased ability to properly control your muscles. It is called decreased “neuromuscular” control because the nervous system deficit means that the brain and body aren’t properly communicating and that perfect control of your muscles you usually have is lost. Your brain and the nerves in your joint just can’t get the messages across with 100% accuracy if there is an injury to the joint.

Now, all the issues I mentioned above lead to a common result: functional instability. An unstable joint and a decrease in nervous system control over that joint will combine to cause a loss of functional stability. Functional stability is the overall stability of your body or your body part as it does what it is supposed to do. Using the example of the ankle again, functional stability would show itself as trouble with walking correctly, putting more weight on one foot, or tip-toeing around to avoid pain. These are all changes in how the joint is functioning due to the injury.

We are talking about a cycle, and this is the important part. If you are getting by with an injured joint, but it is not healed correctly, then you are forcing your brain and body to utilize coping strategies like limping or leaning (or avoiding activity altogether). All these strategies are meant to help you avoid re-injuring the joint, but they all predispose the joint to re-injury quite often.  After all, using a joint or a body part incorrectly is a good way to injure it in a new way or just plain exacerbate the existing injury. As a chiropractor I quite often have patients who describe things like severely injuring a disc in their back because they were trying to shovel snow without standing up straight all the way…because they already had back pain to begin with!

So, now we have an injured joint become a repeat injury. Once you re-injure the joint it is typically more difficult to resolve and get back to 100% pre-injury status. You can see this entire process I just described in the picture below:

Cycle of Injury to a Spinal Joint

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So, why is a chiropractor talking about this? Because chiropractors manipulate joints. At Park Bench Chiropractic we work on all the joints in your arms and legs as well as adjusting spines. By locating and correcting vertebral subluxations we help your entire body function better. When we find problems in how other joints are working, such as wrists, ankles, and jaws, we will manipulate those areas as needed. Call our office at (01) 378-0334 to schedule an examination or consultation with Dr. Matt or Dr. Rob in our friendly Frederick office.

Corticosteroid Therapy Side Effects

Corticosteroid therapy has been in use for 70-plus years to treat inflammatory conditions in the body.  Corticosteroids are natural anti-inflammatory hormones produced by the adrenal glands, which are under control of the hypothalamus.  Synthetic corticosteroids (cortisone or dexamethasone) are used to treat a wide range of inflammatory musculoskeletal conditions ranging from certain types of arthritis to sports injuries.  These synthetic hormones can have undesirable adverse effects from short-term use and long-term use.  Below is a list of some of these effects categorized under short-term and long-term effects.

Side Effects of Short-Term Corticosteroid Use:

Acne

Easy bruising

Inhibition of Fibroblast growth and collagen synthesis – leading to decrease structural stability of connective tissue.  This can effect your ability to heal cuts or scrapes properly leading to noticeable scarring of the injured tissue.

Decrease Immune Function – More prone to succumb to infections like the common cold or flu.

Hypokalemia – a decrease in potassium in the blood.

Myopathy – where the muscles do not function correctly.  This is thought to be due to the decreased amount of potassium in the blood.  Muscle weakness does occur.  Most importantly, corticosteroid use is associated with an increase in serum creatinine phosphokinase which indicates muscle necrosis (death).

Glucose Intolerance – hyperglycemia (high blood sugar levels) may occur in individuals not predisposed to diabetes mellitus.  It is unclear why hyperglycemia develops with corticosteroid use.

Pancreatitis – Inflammation of the pancreas, rare effect though.

Psychologic Effects – these include mood alterations, insomnia, hyperactivity, and even psychosis.  These effects are rare and are directly related to the amount of steroid dose given.  Dementia, decreased attention, concentration, and performance may persist after withdrawal.  Withdrawal from corticosteroid use may include depression, irritability, apathy, insomnia, memory problems, and fatigue.

Neurologic Effects – Seizures have been described with corticosteroid use.  Possible causes include fluid shifts and electrolyte imbalances.

Hypertension – Increased blood pressure due to sodium retention.

Side Effects of Long-Term Corticosteroid Use:

Osteoporosis – The major affected areas are the ribs, vertebrae, and long bones like in the arms, legs, feet, and hands.  This causes a significant increase for the chance of breaks in these areas.  Corticosteroids directly inhibit bone formation by stopping osteoblast (the cells that build bone) formation.  It also decreases calcium absorption and increases the loss of calcium through urinary excretion.  As we all know calcium in essential for healthy bone density and fracture prevention especially in post-menopausal women.

GI Disorder – In rare instances corticosteroid use has been associated with peptic ulcer formation.

Ophthalmologic Effects – An increase in intraocular pressure has been noticed, better known as glaucoma.  Those with a history of diabetes are more at risk.  Cataracts have also been associated but the incidence is low.

Hyperlipidemia – High levels of triglycerides (fats) in the blood, and as we all know increased levels of fat in the blood is a leading cause of high cholesterol which in turn is a leading cause of heart disease.  Heart disease is the leading cause of death in America.

Growth Supression – Corticosteroids interfere with collagen, bone formation and nitrogen retention, all responsible for growth.  Growth hormone and insulin-like growth factor levels are also decreased.  This is very concerning to individuals who are serious about working out and body image because you cannot have muscle growth without these hormones.

Birth Defects – Corticosteroid use while pregnant has been linked to increase incidence of cleft lip and cleft palate.

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Why is a chiropractor talking about corticosteroids?  The doctors at Park Bench Chiropractic feel that you are not able to make wise decisions about you and your family’s health unless you have all the information about the different treatment plans for each specific condition.  If you would like information on how chiropractic can safely help reduce pain and inflammation without the use of drugs, feel free to contact Dr. Matt or Dr. Rob at Park Bench Chiropractic.

BuchmanAL. Side Effects of Corticosteroid Therapy. J Clin Gastroenterol 2001;33(4):289-294

Dr. Matt is a chiropractor at Park Bench Chiropractic located at 1780 N Market St Frederick, MD.  He is a member of the ACA and ICA.  He is a graduate of Appalachian State University in Boone, NC and Life University in Atlanta Ga.  Contact the office at 301-378-0334 to schedule a consultation or exam.

Beating Chronic Pain with Mind Over Matter

Now, don’t get me wrong. It’s not like I am saying you can just wish chronic pain away. It’s not that easy. But the right attitude can really help you cope with, or even move beyond, your pain.

Moving well helps you feel well. Feeling well helps you move well. Not feeling good and not moving well will perpetuate you not feeling well, and will make you in fact feel worse. All of that is downright depressing. All of this plays into a vicious cycle. Having a positive mental attitude is a conscious choice you make to be optimistic and to avoid anxiety. It is easier said that done some days, but it will pay dividends.

Can your mind overcome your pain?

2007 research from the University of Toronto showed that chronic back pain patients were more likely to recover more fully, and sooner, when their doctors appeared confident and reassured the patient that they would get better.

“Pain is always subjective and is defined by the person who experiences it”.

-The International Association for the Study of Pain

When you do feel pain, instead of letting your anxiety make your decisions, utilize a coping strategy like enjoying a glass of wine or spending a few moments in your favorite chair, or maybe both at the same time.

Pain, as a form of sensation, stands out from the other senses somewhat because it is subjective.That means that you can cut three people with the same razor in the same place on their arms, and they will describe the pain differently, and likely they will describe the level or pain differently. This means there is a mental component to pain. While that mental components is not well understood, it does exist, and we should all try to harness that to deal with our pain.

Cognitive Behavioral Therapy it is a goal-oriented and systematic way of thinking. It can be used as a method to help out-think the pain with strategy:

  • When pain is chronic, your goal should either be to stop the pain or learn to manage living with it.
  • When you pain makes you want to avoid activity, instead be as active as the pain permits. Make the choice to stay active.
  • Make a plan on how to maintain a bright outlook on your situation, and remain optimistic about resolving it and enjoying your life. This plan should be a REAL PLAN, in writing, with a step-by-step process and it should include a reward system to reinforce progress in meeting your goals.

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Dr. Romano is a board certified and licensed chiropractor in Maryland. He practices in Frederick, Md at 1780 North Market Street. He has an interest in the science of pain and it’s relationship to chiropractic. He has a Bachelor’s Degree in Psychology and a Doctorate in Chiropractic. Dr. Romano and Dr. Schooley are available to speak to groups about pain, the psychology of health, the importance of a healthy nervous system, and other health topics.

Beating Chronic Pain with Stress Reduction

There are 3 types of stress: physical, chemical, and emotional.

  • Physical stress can be from poor posture, hard labor, injuries, etc
  • Chemical stress is due to environmental toxins, unhealthy diet, etc
  • Emotional stress results from a bad time at work, unruly kids, deadlines, etc

When you are stressed your adrenal glands pump cortisol into your bloodstream. This causes increased blood pressure. Cortisol has different effects on the body when short term vs. long term.

Short periods of elevated cortisol: “fight or flight”, decreased pain, burst of energy. This is to help the body cope with emergency situations – the proverbial lion encountered in the wild.
Long periods of elevated cortisol: decreased cognition, suppressed thyroid function, blood sugar imbalance, decreased bone mineral density, decreased muscle mass, increased blood pressure, decreased immune function, increased abdominal fat deposition.

The body’s “fight or flight” response is the opposite of the “rest and digest”/”feed and breed” response. This is regulated by the nervous system – which is made of two separate parts: the sympathetic and parasympathetic nervous system. They act at each other’s expense so that the more of one response, the less of the other – there is only so much nervous system to go around and the body must choose between rest and digest or fight or flight. That means that you can’t rest your body and repair damage, or even properly digest your food, when you are in a stressful state.

And that is why we will now talk about stress reduction.

Physical relaxation – think about each of your body parts, from your toes to your head, relaxing one-by-one.
Mental relaxation – focus on calming thoughts, play relaxing music, and avoid stressful triggers.

Try not to let things you can’t control make you anxious. If you can’t change it, then worrying about it isn’t going to do any good.

You can relax in two ways: by doing something you enjoy doing and that puts your mind at ease or by doing absolutely nothing – turning the TV off, clearing your mind of troubling thoughts, and purposefully shifting your attention to something like your breathing rate or your heartbeat.

Breathing
Contrary to popular belief, breathing isn’t very simple. To be more precise, breathing efficiently isn’t very simple. To relax you need to take deep, slow breaths from the belly and not from the upper chest. Put your hands across your belly and feel your belly stick out as you breathe in nice and slowly. Breathe with your diaphragm, not your ribs. Many stressed out people, or people with poor posture, breathe with their neck muscles or upper chests.

Breathe in through your nose, and out through your mouth. Feel your lower lungs fill with air first, then your middle lungs, then your upper lungs. This will take 5-10 seconds. Once you have fully inhaled through your nose take a 1 or 3 second pause and then gently let the air out. Repeat until you’re relaxed or asleep. If you are getting dizzy, you’re overdoing it.

Imagery

Try to totally surround yourself with your own relaxing imaginary environment. Close your eyes. Imagine yourself at this place, maybe the beach. Feel the warm sand under your nice, clean towel. Feel your body relaxing on the sand, and it’s contouring to support you comfortably. Imagine the hot sun heating your skin with a gentle sea breeze keeping you cool. Hear the wind rustling through the trees in the distance, and hear the tide moving towards you on the beach then pulling back into the waves. Hear sea gulls somewhere far away. Focus on that for a few minutes and you have no choice but to be relaxed…unless you don’t like the beach!

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Dr. Romano is a board certified and licensed chiropractor in Maryland. He practices in Frederick, Md at 1780 North Market Street. He has an interest in the science of pain and it’s relationship to chiropractic. He has a Bachelor’s Degree in Psychology and a Doctorate in Chiropractic. Dr. Romano and Dr. Schooley are available to speak to groups about pain, stress, the importance of a healthy nervous system, and other health topics.

Beating Chronic Pain with Natural Anti-Inflammatory Remedies

Omega-3 Fatty Acidstalked about them already.

White Willow Bark – The use of white willow bark medicinally goes back far. Ancient Egyptians used white willow for inflammation. The Greek physician Hippocrates wrote about white willow’s medicinal uses in 5th century B.C. White Willow Bark’s active ingredient, salicin, is the same active ingredient as in Aspirin. People take white willow bark instead of aspirin because it does not appear to be as irritating to the stomach lining. It may be because the salicin found naturally in white willow bark is only converted to the acid form after it is absorbed by the stomach. Aspirin is absorbed by the stomach lining.

Turmeric – lots of research has come out recently showing turmeric can reduce inflammation and has some properties which make it a drug that can possibly help to prevent certain types of cancers. It can be found in Indian and Pakistani foods, foods with curry. It’s a spice.

Green Tea – anti-oxidant, anti-inflammatory.

Kava Root Drink – Calming, muscle relaxant, and sleep aid.

Valerian Root – anti-anxiety, sedative effects. This can be a natural alternative to prescription sleeping pills.

As with all things, take caution if more than one herb or supplement, or other medications, are being used at once. All treatments have side-effects, including natural alternatives. Of course, you should make sure you are using the recommended amount and for the right reasons.

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Dr. Romano is a board certified and licensed chiropractor in Maryland. He practices in Frederick, Md at 1780 North Market Street. He has an interest in the science of pain and it’s relationship to chiropractic. He has a Bachelor’s Degree in Psychology and a Doctorate in Chiropractic. Dr. Romano and Dr. Schooley are available to speak to groups about pain, the importance of a healthy nervous system, and other health topics.