First of all, I would like to say that if you are experiencing chronic pain, my heart goes out to you and the suffering that you experience. This post is meant to give you a different perspective on chronic pain and possibly new treatment options yet explored.
Most people that live with chronic pain have been to countless doctors with minimal results. Why is it that chronic pain is so difficult to treat? Mostly because the perspective that if a certain spot on your body is painful, then that is the spot that needs the treatment. Although it makes sense, being similar to a dysfunctional part on an automobile. Replace the part, and everything is fixed.
The problem is that the body’s systems are more interwined than simple parts. For acute injuries, where one part of the body is damaged, then yes, therapy to that part is essential. There are two schools of thought when it comes to assessing the body, and that is structural verses functional. Acute injuries often need the structural perspective, and chronic pains need the functional perspective.
The functional perspective takes into account all systems and how they work together. I have found that addressing parts of the body that seem asymptomatic are actually the root cause of pain. For example, a central nervous system reflex that is termed reflex inhibition, may account for many of the chronic pain syndromes. Reflex inhibition protects the body from injury by turning muscles off when others are activated. For instance, when you flex your bicep, the triceps needs to be turned off in order for the arm to bend, and this in summary, is reflex inhibition.
Another protective mechanism of the body is the ability of muscles to undergo spasm. Muscle spasms try to protect the joints by contracting the muscle and preventing movement. This system is not perfect and the spasm can be “on” chronically. So, chronic protective muscle spasms occur when the biomechanics are faulty. Furthermore, the chronic spasm inhibits its corresponding antagonist muscle (bicep/tricep) via reflexive inhibition, which triggers faulty function.
For example, if your shoe choice is suboptimal or have flat feet, there will be repetitive assault on the structures of the body. Chronic assault will show up as foot, knee, back, or neck pain. You take approximately 10,000 steps everyday, and if you are wearing shoes that do not firmly support the heal you run the risk of developing chronic protective muscle spasms. So, when the spasm is left on due to repetitive stress from faulty biomechanics reflex inhibition kicks in and keeps muscles turned off, which become weak and dysfunctional.
So, we have muscles that are chronically turned on and chronically turned off. This leads to tight and weak muscles and compensation patterns develop and pain appears in parts of the body where energy is “leaked”. This leads to postural abnormalities and a cycle of dysfunction begins and is possible that it will not end unless appropriately treated. If that is not enough, the dysfunctional cycle also creates an inflammatory soup that bathes your body, which if not treated can lead to systemic pain.
I have found through learning from other doctors, literature research, and experience that specific treatments can lift chronic pain syndromes.
Such treatments are always specific, but in general the following therapies will help; and include,
1. Restore foot biomechanics through orthotics, appropriate shoe choice, extremity manipulation
2. Releasing chronic protective muscle spasms via massage, ischemic compression, mechanical massage, muscle energy techniques
3. Spinal manipulation to restore function of the spine and to trigger co-activation of mechanoreceptors for nociceptive inhibition
4. Instrument assisted soft tissue therapy, such as graston or gua sha to the chronic “on” muscles
5. Exercise that addresses the weak and imbalanced muscles
6. Supplements to reduce inflammation
7. Diet to reduce inflammation
8. Proper sleep
9. Proprioception training – wobble board/balance board series
10. Proprioceptive neuromusclar training – D1, D2, etc.
In summary, acute injuries need to have structures addressed and treated. Chronic pains need to have the function of the body restored.
To Your Health,
I had the opportunity to provide chiropractic care to the participants at the Cherry Creek Sneak today, and in the process met some fabulous people. Besides the typical back and neck pain that can perhaps occur with running that I typically treat at an event like this, a small handful of people came to me wanting advice and help with foot and lower leg pain.
One risk that comes with running is to develop repetitive strain injuries or problems occurring due to faulty biomechanic and gait problems. A close inspection of the foot and how it interacts with the ground is crucial to understand any faulty biomechanics that might be occuring and contributing to the present foot and lower leg pain.
The foot has three arches; a medial arch, lateral arch, and transverse arch. If any of the three arches fail, the foot, leg, hip, back, and neck could potentially develop problems leading to pain. It can be misleading for a patient to present with pain in one area, but realize the true problem is in another area.
This is the case with the foot that overpronates, basically the arches that support the foot collapse and lead to a dysfunctional musculoskeletal system. The dysfunction will show up as pain in either of the areas previously mentioned.
I personally wear custom orthotics made by footlevelers, at my clinic I have a sophisticated scanner that analyzes the arches. The analysis made by the scanner is digitally sent to footlevelers where they make a custom orthotic that re-establishes normal biomechanics.
When I go without my orthotic, I develop sharp pain on the inside of my knee and develop anterior shin splints. Faulty foot mechanics predispose the person to host of conditions such as shin splints, achilles tendinitis / tendinosis, plantar fasciitis, mortons neuroma, tarsal tunnel syndrome, and several other named conditions along the kinetic chain.
Many stores sell orthotics off the shelf that many people buy, including myself (before my chiropractic education), but unresolved the issues. Closer inspection of the multitude of over the counter orthotics reveals that they lack heel posts, lack transverse arch support, lack lateral arch support. They all usually have medial arch support, but one arch support will not regain the proper mechanics needed.
To Your Health,
Dr. Trent Artichoker MS, DC
Denver Chiropractic, LLC
3890 Federal Blvd Unit 1
Denver, CO 80211