Why Things Hurt: Explain Pain

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Brent Stevenson

This article has an accompanying video titled Why Things Hurt and a follow up article about the use of IMS dry needling

Reference: Dr Chan Gunn,  istop.org

If you experience an acute accident or injury, like spraining your ankle, it is easy to understand why your ankle may hurt.  You likely tore some of the ligaments and or muscles around the joint and experienced subsequent swelling, bruising and inflammation.  Over a four to six week period your body typically fills in the torn tissue with scar tissue and then slowly remodels it back to its original state.  Sometimes though the pain persists beyond six weeks even though all the swelling and bruising have long disappeared.  Other times pain appears for no apparent reason in the complete absence of an injury and you can't understand why or what you did wrong.

Nerves are the electrical wiring of your body.  They supply the energy for all your muscles and organs to do their jobs.  Your brain and spinal cord are like the electrical fuse box of your body and your spine and skull are their protective coverings.  Peripheral nerves extend out from your spine at every level on both the left and right sides.  The nerves that extend from your neck are responsible for most of the muscles in your shoulders, arms and hands, while the nerves that come from your low back enervate all of the muscles in your hips, legs and feet.  The nerves in the middle are responsible for your trunk and a lot of your organs.

Muscles are comprised of a whole bunch of stringy tissue that can stretch and contract.  The muscle should have a certain amount of resting tone in it, i.e. at rest it is slightly contracted, not flaccid or extremely tense; this is dictated by the input of the nerve.  If the nerve is irritated as it extends from the spine, or anywhere in the periphery it will result in an altered signal getting to the muscle.  This altered signal can create bands of tension in the muscle which will strain the joint, the tendons and likely create pain.  Muscles are attached to bones on either side of a joint by tendons.  Tendons are a tougher tissue that only stretch a small amount; when the muscle is in a banded state, the tendons will have to endure a lot more stress and strain when the joint is used and the result is typically tendonitis.


Nerve irritation:

To use your low back as an example, let's look at your L3, 4 and 5 nerve roots as they extend from your spine.  You will see that each nerve has its own hole to exit the spinal canal.  The size of these holes is dependent on the level of degeneration in your spine and discs as well as the postures and movement strategies you use.  Things like disc herniations, bone spurs and poor movement control lead to irritation of nerve roots as they extend from your spine.  This will typically create bands of tension in the lower body and significantly lower the threshold of what it takes to injure or irritate muscles and nerves in the hips, legs and calves.

There are a number of common points of muscular tension that lead to chronic pain issues like sciatica and tennis elbow.  The major nerve roots from your low back turn into your sciatic nerve which passes through the deep rotator muscles of your hip.  Too much tension in these muscles can torsion your pelvis, compress your SI joint and irritate the nerve.  The result can be pain and tension anywhere from your low back down the back of your leg to your calf and heel.

Similarly, the root cause of most chronic elbow pain stems from an irritation of your radial nerve due to tension in the back of the rotator cuff and some compression in the base of the neck.

Here again is a simple drawing illustrating a joint in a healthy normal state.  The muscle is resting in a gently contracted state with some elasticity between the two tendon attachments to the bones on either end.  The nerve is supplying a steady signal from the spinal cord and the joint should move freely and be pain free.

On the other hand, here we see a drawing of a joint in a painful state due to an underlying nerve irritation.  Something has annoyed the nerve which is causing it to send and altered signal to the muscle.  Imagine a flickering light bulb in a lamp when the wiring is off.  The annoyed nerve causes the muscle to create bands of tension like muscle knots.  The knots are typically tender to the touch and the area can be colder due to poor blood flow through the tightened muscles.  The increased tension in the muscle will compress the joint, ultimately leading to pain and potential degeneration over time.  It can even make the bones feel bruised from the constant tug of the tendons.

When nerves have been irritated for a long time, you will start to see subtle changes happen in the skin over the affected area, especially around the spine.  Here is a video of my father's back and neck (see member section).  He is a 65 year old life time athlete.  He has a history of some back discomfort and was consistently pulling his calf muscles while playing tennis.  You will notice as I run my two fingers up his spine, the skin and muscles in his low back seem thickened and the pores start to look like the rind of an orange peel.  Then I pass a certain level and my fingers can move freely.  This is a glaring sign of underlying nerve irritation and the chronic calf strains he experienced were due to tension coming from the nerves in his low back.

This is the back of my father's neck.  As you can see he has a big crease across the back right around C5.  This crease corresponded to significant degeneration in his neck at C4,5,6 on a CT scan and resulted in enough nerve compromise to make some of his shoulder muscles completely waste away.  IMS acupuncture kept him out of pain, but he ended up having surgery on his neck to clean up the degeneration and remove the strain on his nerve.

The muscle tension created by nerve irritations will typically make you feel like you want to stretch out the muscle.  Unfortunately, over stretching muscles in this state can actually just make them tighten up further.  You are starting a tug of war with your body and it is not a battle that you will win.  When muscles are in a banded, irritated state they will typically act functionally weak and the tendency of most therapists is to give a person strengthening exercises to correct the problem.  This can result in more pain by forcing the dysfunctional joint to do more work.  It is usually not that the muscle is weak, it's that it is not firing properly.  It is important to release the tension before attempting a lot of exercise.

IMS acupuncture can trick the nervous system into decreasing the nerve input and muscle tension in very specific areas.  It is an anatomy based, specific form of dry needling performed by physiotherapists and some doctors.  Please watch the What is IMS Acupuncture video for more detail.

If you haven't already please watch the video titled "Everything Your Mother Taught You About Posture is Wrong."  How you have learned to stand, sit, walk and breathe will affect the health and longevity of your spine and nervous system.  IMS acupuncture is great at eliminating pain, but people are also great at creating it.  Learn how to stand and move in a way that doesn't overly compress or hinge on your spine and you will experience far less pain throughout life.  Once you have figured out basic movement patterns, then adding strength can help make movement easier.

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