Is My Hand Pain from Carpal Tunnel Syndrome or Something Else?

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Article featured on Spine-Health.
We all wake up sometimes with a numb and tingly hand. But ongoing hand pain and numbness can be a disabling problem that requires diagnosis and treatment.
Here are 3 of the main causes of hand pain and numbness—and tips for how you can tell them apart.

Medical illustration of the palmar view of the hand. Transverse carpal ligament, flexor tendons, and median nerve are labeled.

Carpal tunnel syndrome

When hand pain is experienced, it’s common to first suspect carpal tunnel syndrome. This condition is caused by the narrowing of a bony passageway in your wrist, which irritates or compresses the median nerve that runs through it.
Symptoms tend to be in the thumb, index finger, or middle finger, along the path of the median nerve. The pain may wake you up at night or be worse in the morning. In the early stages, shaking your hand may bring relief.

Rheumatoid arthritis

Another possible cause of hand pain and numbness is rheumatoid arthritis.
Hand pain from rheumatoid arthritis tends to be different from carpal tunnel syndrome in 2 main ways:

  1. It causes pain and stiffness in the large knuckles or joints of the wrist, rather than along a nerve path.
  2. Its pain is symmetrical, meaning it will affect both hands simultaneously.

Cervical radiculopathy caused by spine conditions

While it may not seem obvious, your hand pain and/or tingling may actually be caused by a problem in your neck.
The nerves that give sensation to your hands originate in your cervical spine. When one or more of the 8 nerve roots that exit the cervical spine become irritated, it causes pain and other neurological symptoms down the nerve path. This is known as cervical radiculopathy.
The most common conditions that can trigger radiculopathy include:

  • Cervical herniated disc
  • Cervical spinal stenosis
  • Cervical degenerative disc disease
  • Cervical osteoarthritis

Cervical radiculopathy pain can be mildly achy or sharp and stabbing. It can also cause numbness and/or pins-and-needles tingling sensations. Symptoms can affect different sections of the hand depending on what level of the spine is the source of the irritated nerve.
Since carpal tunnel syndrome and cervical radiculopathy can both affect the median nerve, it’s important to note one key difference: Carpal tunnel syndrome pain will only affect the hand and wrist. Cervical radiculopathy from the C6 spine level (where the median nerve originates) will often cause pain and symptoms along the arm and in the bicep, as well as in the hand.
Aside from these 3 causes, hand pain can also be caused by a variety of other conditions, including diabetes and nutritional issues.
The best way to tackle hand pain that doesn’t resolve is to see your doctor, who can diagnose the correct cause and start a treatment plan. Many conditions that cause hand pain are more easily treated if they’re caught early.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Spring Sports Injury to Be Aware Of

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Article featured on Boys Town National Research Hospital
​Spring is approaching and children are preparing for spring sports mania! From running, baseball, golf, softball and more, there are plenty of spring activities for your child to enjoy. Whether recreationally or competitively, this is a great time for kids to get back in shape a​nd so is taking the necessary steps to prevent injuries.
Spring is also the time of year when we see more injuries. Common spring injuries include ankle sprains, groin pulls, hamstring strains, shin splints, knee injuries, and Little League elbow or tennis elbow. Injuries usually occur due to lack of conditioning the muscles and joints, and many of these injuries are preventable.

How to Prevent Sports Injuries​

Warm up consistently:

Always have your child take time to warm up and stretch properly before any physical activities. Have them stretch muscles and allow at least 30 seconds in each stretching position. Once the muscles are properly stretched, have them warm up with jumping jacks, walking or running in place for about three to five minutes. They should try to get at least 30 minutes of moderate physical activity every day. This could include walking, cycling, swimming, weight lifting, yoga or martial arts.

Proper equipment:

Selecting the proper equipment such as shoes, clothing, a helmet for your child’s specific sport and using the equipment properly for each activity is important. Each sport has unique clothing and sports equipment that can help your child reach his/her highest potential during physical activity and help prevent injuries. Always remember to replace worn or old equipment, especially as your child grows.

Train and condition:

If your child has not been consistently active this winter, condition the body and start training the muscle groups used in his/her sport in the weeks before playing. For example baseball and tennis players can work on shoulder strengthening and flexibility exercises and golfers can work on lower back flexibility and stretching.

Body awareness:

Have your child learn to recognize when his/her body is fatigued. Muscles that are fatigued lack the protective mechanisms in the body and increases risk for injuries. Rest and take a break. He/she can use this time to get some much needed hydration.
Make sure to remind your child to always cool down and stretch all the muscles used. Stretching at the end of physical exercise is just as important stretching before. If your child is experiencing an injury it is time to consider contacting your doctor right away.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Shin Splints Prevention

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Article featured on Humpal Physical Therapy & Sports Medicine Centers
A shin splint, which is medically referred to as tibial stress syndrome, is a painful injury to the shin that commonly affects runners, but also dancers and other athletes.
Shin pain most often occurs on the medial side of the shin (termed medial tibial stress syndrome, or MTSS) but can also occur on the lateral or anterior side of the lower leg. Shin splint pain develops due to the overexertion of pressure on muscles in the lower legs causing stress on the tissues in that region. If left untreated, shin splints can lead to lower leg compartment syndrome or even a stress fracture.
Several risk factors have been identified to increase the likelihood of developing shin splints, particularly in runners.  These factors include:

  • being of female gender
  • previously experiencing shin pain, having fewer years of running experience
  • previously using orthotics
  • having high body mass index
  • having a dropped foot bone (the navicular bone)
  • in males, the likelihood increases if you have excessive external rotation in your hips

Obviously some of these risk factors cannot be changed (such as your gender!) but many of these factors as well as others can be addressed by your Physical Therapist in order to lower your chances of developing shin splints.
Unfortunately there are no proven methods available to definitively prevent shin splints. There are several strategies, however, that may help in preventing shin splints.  These strategies include wearing appropriate fitness shoes, warming up before engaging in recreational activities, gradually increasing activity so the body can adapt, discontinuing the activity if you start experiencing pain in the shins, keeping your body weight in check, and seeking the attention of a Physical Therapist before pain arises in order to assess your running or sport biomechanics.
For active individuals such as runners, it is important to take time to find a comfortable shoe that protects the foot and promotes normal mobility. Bulky and ‘shock-absorbing’ shoes may not be the ideal type to allow body’s natural foot and ankle placement.  If you do not have any foot injuries or complications, minimalist type shoes, which replicate the movement of a bare foot are highly recommended.  However, you will likely need to seek advice on transitioning from your current footwear to minimalist shoes to avoid injuries from sudden change.
Minimalist type shoes improve the strength of the feet over time by allowing the feet to bear more of the impact force that is experienced during physical activity. In addition, they promote an increased cadence (step frequency), which subsequently decreases the strain on your lower extremities. There is also reliable evidence available on prevention of shin splints by using shock-absorbing insoles within your shoes, however, more quality research is certainly required before this advice becomes universal. You can assess your running and walking pattern, as well as assess your foot and lower extremity alignment and biomechanics to help you determine the best footwear. Taking adequate time for the feet to adjust to new shoes and gradually increasing the level of physical activity, along with replacing your shoes regularly in order to maximize their function will also help to prevent injury.
Taking ample time to properly warm up before engaging in physical activity can also reduce the occurrence of injuries. A warm up that includes a short activity to get the heart rate up followed by dynamic stretching is best.  Dynamic stretches are stretches that involve quick movements of the limbs and body and, for best results, should simulate the activity you are about to engage in. When athletes perform dynamic warm-ups, they typically demonstrate enhanced flexibility and improved performance. Runners, for example, may do dynamic stretching by swinging their legs back and forth to simulate running or do several jumps on the spot. These quick stretches stimulate the nervous system and increase the range of motion in the muscles and joints.
If you start experiencing pain in your shins during physical activity it is important to discontinue the activity and allow the muscles in the legs adequate time to rest and recover. Simple icing can be very effective in this early stage of pain. Continuing to exercise when pain is felt in the shins can cause overexertion, which may lead to chronic shin splints, or a compartment syndrome or stress fracture developing.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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That Tension Headache May Be a Pain in the Neck

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Article from Brigham Health Hub, Written by Thomas P. Mecke, DC

One very common cause of tension headaches is rooted in the neck, resulting from muscle tension and trigger points.

What causes tension headaches?

At the base of the skull, there is a group of muscles called the suboccipital muscles. They can cause headache pain for many people. These four pairs of muscles are responsible for subtle movements between the skull and first and second vertebrae in the neck.

The suboccipital muscles may become tense and tender due to the following:

  • Eye strain
  • Wearing new eyeglasses
  • Poor posture
  • Grinding teeth
  • Trauma (such as a whiplash injury)

Pain from the suboccipital muscles commonly feels like a band wrapping around the head. Also, tension in these muscles may cause compression of a nerve that exits the base of the skull. This can trigger pain that wraps over the head and above the eyes.

How can you relieve tension headache pain?

Here are some tips to help you manage the cause of your tension headaches:

  • Get an eye exam. If you’re straining to read, or keep tilting your head up and down to use those off-the-shelf glasses, you may need a new pair of glasses.
  • Redesign your workstation. Simply raising your computer monitor or getting a document stand can help reduce repeated head tilting that can strain the occipital muscles.
  • Avoid slouching and practice good posture. Consider trying yoga, Pilates or Tai Chi. All of these disciplines are great forms of exercise and all can help to improve posture. Also, you may want to consult a physical therapist, chiropractor, or movement therapist for exercises that are tailored to your need.
  • Get a 30-minute massage that concentrates on the neck and upper back. This can help relax your muscles and relieve your headache pain.
  • Try applying a hot pack to the base of the head. Do this for 15-20 minute intervals.
  • Stuff two tennis balls into a sock and tie it off tightly. Lie on your back on the floor. Place the tennis balls under the base of your skull and allow your head to compress against them. Gently rock your head back and forth and side to side for a few minutes.

When does a headache indicate a serious health problem?

Most headaches are painful but not dangerous. However, headache pain can be a warning sign of a more serious health problem. Learn when you should contact your health care provider to find out if your headaches are a sign of a more serious problem like a brain tumor.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What to know about lower back pain when sitting

What to Know About Lower Back Pain When Sitting

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Medically reviewed by Emelia Arquilla, DO— Written by Hana Ames on October 14, 2020. | From Medical News Today

The cause of pain in the lower back while sitting may involve posture, an injury, or a health condition.

Back pain is one of the most common medical problems in the United States. About 1 in 4 adults in the country have at least 1 day of back pain in any 3-month period.

Here, we describe the causes, treatments, and prevention of lower back pain while sitting.

What does it feel like?

Back pain may be acute, in which case it comes on suddenly and usually lasts a few days or weeks. Or, the pain may be chronic, lasting longer than 12 weeks.

Pain in the lower back may be sudden and sharp or a dull, constant ache.

Causes

A variety of factors can cause pain in the lower back while sitting, and the best approach to treatment depends on the cause.

The treatment plan might include over-the-counter pain relief medication, physical therapy, a new exercise routine, surgery, or a combination.

Posture

Poor posture can cause or worsen lower back pain. Improving posture involves changing a person’s position as they sit or stand. It can often ease or relieve the pain.

Injury

A person might injure their lower back while lifting something incorrectly, leading to a strain or sprain in the area.

The injury might instead result from trauma, sustained during sports or from a car accident, for example.

Sciatica

Sciatica happens when something presses on the sciatic nerve, which travels through the buttocks and extends down the back of the leg, and the issue can cause pain throughout the area.

The pain may be intense and feel like an electric shock or be a dull ache.

Herniated disk

A herniated disk refers to a disk in the spine bulging outward and pressing on a spinal nerve. Any disk in the spine can be affected.

Treatment for this condition usually involves medication and physical therapy.

Lumbar disk disease

Lumbar disk disease, also known as degenerative disk disease, is not actually a disease. Usually, it results from aging.

It occurs when the disks between the vertebrae of the spinal column wear down.

Spondylolisthesis

Spondylolisthesis involves a vertebra of the lower spine slipping out of place and pinching nearby nerves.

Home care strategies

A person may not need professional treatment for lower back pain while sitting.

Often, a person can take steps at home to relieve the pain and keep it from returning. Some strategies include:

Staying active

It can be tempting to rest as much as possible, but the medical community recommend keeping active to ease lower back pain.

Try not to do too much at once, however. Instead, try coupling physical therapy or a recommended form of exercise below with other home treatments.

Using heat and cold

Alternating between heat and cold can often help ease lower back pain.

Taking a hot bath or using a hot water bottle may help alleviate the pain. Heat can also increase blood flow to the area and promote healing in the muscles and tissues of the back.

Applying ice packs or bags of frozen vegetables to the area can also ease pain, but ensure to wrap them in a cloth first.

Heating or cooling sprays are also available over the counter, and they can stimulate the nerves in the area.

Taking pain relief medication

Nonsteroidal anti-inflammatory drugs, or NSAIDs can help ease pain in the lower back. Many, such as ibuprofen, are available without a prescription.

People tend to take these medications orally, but they also come as creams, gels, patches, and sprays.

Stretching and exercising

Exercises and stretches can help strengthen the lower back and prevent the pain from occurring.

Routines that focus on working the core, or abdominal, muscles may also help speed recovery from chronic lower back pain.

Yoga, for example, can help relieve pain in the lower back and neck, and other forms of exercise that may help include:

  • swimming
  • walking
  • Pilates

Stretches that can help alleviate lower back pain include:

  • Deep lunge: Kneel on one knee, with the other foot in front. Facing forward, lift the back knee up. Hold the position for 5 seconds.
  • Back stretch: Lie on the stomach, using the arms to push the upper body off the floor. Hold the position for 30 seconds before allowing the back to relax.
  • Sagittal core strengthening: Standing 3 feet away from a wall with the feet should-width apart, tighten the abdominal muscles, then reach through the legs to touch the wall, keeping the hips and knees bent. Use the hips to push the body back to a standing position, then extend arms and reach over the head and slightly backward.

Prevention

Lower back pain is more common in people with obesity and people who smoke.

Also, people who are infrequently active are more likely to have lower back pain, as are people who tend to be inactive but occasionally engage in strenuous exercise.

The best sitting position

The Department of Health and Human Services warn against slouching and recommend sitting up straight, with the back against the back of the chair and the feet flat on the floor.

They also recommend keeping the knees slightly higher than the hips when sitting.

Diagnosis

To determine the cause of back pain, a healthcare provider will ask the person about their medical history and perform a physical examination.

If the pain is acute, further tests are usually not necessary, unless the pain results from an injury.

The treatment for chronic pain depends on the cause, and surgery may be an option.

When to see a doctor

Seek medical attention if lower back pain is severe, lasting, or does not improve with stretches, exercises, and other home care techniques.

Also, contact a doctor if the pain results from an injury.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Breast Cancer Awareness Month: 3 Steps to Early Detection

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A bit of a departure from our typical post,  we feel it is important to share important health information from a variety of resources on relevant topics beyond Orthopedics and bone health. In honor of National Breast Cancer Awareness Month, we’d like to share a few tips regarding early detection. There’s a good chance you or someone you know will be affected by this disease in their lifetime and early detection is the key to better outcomes. Please share this information with the women in your life.

From the National Breast Cancer Foundation 

Help Detect Breast Cancer Earlier  

This year, over 250,000 women will be diagnosed with breast cancer. The good news is that when breast cancer is detected early, it can be treated more successfully, increasing the chances for survival.

It is important to know the signs and symptoms of what could potentially be breast cancer. To help with this, National Breast Cancer Foundation has identified three steps you can take to be proactive about your breast health and help increase your chances of detecting breast cancer early.

This potentially life-saving information can be found in our free guide, 3 Steps to Early Detection. This free resource helps you answer three important questions:

  1. What should I look for if I examine my own breast?
  2. When should I see my doctor?
  3. When and how often should I get a mammogram?

 

From  Atrio Health Plans

Three Steps to Early Detection

If there are eight American women in a room, one will develop invasive breast cancer over the course of her lifetime. In 2016 alone, it’s estimated that more than 246,000 new cases of invasive breast cancer will be diagnosed in the United States, along with 61,000 new cases of non-invasive breast cancer.

There also are incredibly encouraging breast-cancer statistics. For example, when breast cancer is detected early and in a localized stage, the five-year relative survival rate is 100 percent.

October is National Breast Cancer Awareness Month, and ATRIO Health Plans wants women to know that there are proactive steps they can take to detect breast cancer when it’s most treatable.

Step One: Be Aware of Potential Symptoms

Step one is being aware of potential breast-cancer symptoms. If you have any of the symptoms listed below, contact your healthcare provider promptly; chances are good that cancer is not the cause, but it’s worth your time to make an appointment if you notice:

  • unusual nipple tenderness;
  • changes in areola, nipple, or breast-skin texture, including enlarged pores, pitting, or reddened scaling;
  • a lump in/near the breast or underarm;
  • any unexplained change in the size or shape of a breast;
  • swelling of the breast, particularly if on only one side;
  • decrease in breast size, especially if just one breast is impacted;
  • a nipple that has turned slightly inward or become inverted;
  • Skin of the breast, areola, or nipple has become scaly, red, or swollen; also may have ridges or pitting resembling the skin of an orange;
  • nipple discharges, particularly if they’re clear or bloody.

Step Two: Self-Exam

A woman’s next line of defense is performing monthly breast self-exams:

  • In the shower – Move the pads of your fingers in a circular pattern from the outside to the center of each breast and armpit area. If a lump, thickening, or a hard knot is detected, contact your healthcare provider.
  • In front of a mirror – Visually inspect your breasts, first with arms at your sides, then raised overhead. Keep an eye out for changes in breast as well as nipple shape, swelling, and skin dimpling; pay particular attention to changes occurring in just one breast.
  • Lying down – With a pillow under your right shoulder and your right arm behind your head, move the finger pads on your left hand in a circular motion over the entirety of your right breast and armpit area; gently squeeze the nipple to test for discharge. Follow the same steps on your left breast.

Step Three: Mammogram and Clinical Exam

Women’s most effective early detection weapons are regularly scheduled mammogram screenings and clinical breast exams.

Mammograms often can uncover a breast lump before it can be felt. They also can point to potential abnormal cells. Current guidelines are:

  • Women 40 and older should have mammograms every one or two years.
  • Women who are younger than 40, and have breast-cancer-risk factors, should ask their healthcare professional how often they should have a mammogram.

A clinical breast exam is performed by a healthcare professional trained to recognize breast abnormalities. Most often, this exam is conducted by your primary care physician or gynecologist as part of an annual assessment.

October is the ideal month for women to empower themselves and take proactive steps to preserve their breast health.

Sources:

http://www.breastcancer.org/symptoms/understand_bc/statistics

http://www.nationalbreastcancer.org/early-detection-of-breast-cancer

http://www.nationalbreastcancer.org/breast-cancer-symptoms-and-signs

http://www.nationalbreastcancer.org/breast-self-exam

http://www.nationalbreastcancer.org/clinical-breast-exam

http://www.nationalbreastcancer.org/breast-cancer-stage-0-and-stage-1

 

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

All About Foot Pain- Causes and Treatments

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Foot Pain

Feet. They carry you from here to there every day. But you may not think much about them until they hurt. And when they do, you want relief. To get the right treatment, you need to know the problem. The first thing to consider is where your pain is located.

Heel Pain

If your pain is in your heel, you may have plantar fasciitis. That’s an irritation or inflammation of the band of tough tissue connecting the heel bone to the toes. Usually, it hurts the worst in the morning when you’re getting out of bed. You can feel it in your heel or in your arch.

To treat it:

  • Rest your foot.
  • Do heel and foot muscle stretches.
  • Take over-the-counter pain relievers.
  • Wear shoes with good arch support and a cushioned sole.

Heel spurs are another source of foot pain. These are abnormal growths of bone on the bottom of your heel. You can get them from wearing the wrong shoes or from an abnormal walk or posture, or even from activities like running. The spurs may hurt while you’re walking or standing. Lots of people have them, but most don’t have pain. People with flat feet or high arches are more likely to have painful heel spurs.

To treat them:

  • Wear a cutout heel pad.
  • Use a custom-made insert (called an orthotic) worn in the shoe.
  • Wear shoes that fit well and have shock-absorbing soles.
  • Take over-the-counter pain relievers.
  • Rest your foot.
  • Try physical therapy.
  • If you still have pain, ask your doctor about medical procedures.

A stone bruise is a deep bruise of the fat pad of the heel or ball of the foot. It’s often from an impact injury, but it can also happen after stepping on a hard object. The pain feels like you’re walking on a pebble. It will gradually go away on its own.

In the meantime:

  • Rest your foot.
  • Ice the area.
  • Take over-the-counter pain relievers.

A heel fracture is usually a high-impact injury such as from a fall or car accident. Your heel bone may not just break, it could also shatter. Heel pain, bruising, swelling, or trouble walking are the main symptoms.

To treat it:

  • Don’t put pressure on the heel. You can use crutches.
  • Protect the heel with pads.
  • Wear a splint or cast to protect the heel bone.
  • Ask your doctor about over-the-counter or prescription pain relievers.
  • Try physical therapy.
  • If you’re still in pain, ask your doctor about surgery.

Ball of Foot Pain

Metatarsalgia. You feel this pain and inflammation in the ball of your foot. Ill-fitting shoes are the usual cause. But you might get it from strenuous activity, such as running or jumping. It’s sometimes called a stone bruise as well.

To treat it:

  • Take pain relievers.
  • Ice and rest your foot.
  • Wear comfortable footwear.
  • Try shoe inserts to relieve pressure on the ball of your foot.

Morton’s neuroma causes a thickening of the tissue around the nerves between the bases of the toes (usually between the third and fourth toes). You typically feel pain, odd sensations or numbness over the ball of your foot. Women have it more often. It can be a result of wearing high heels or tight shoes.

To treat it:

  • Wear shoe inserts to reduce pressure on the nerve.
  • Get a steroid or other injection into the foot.
  • Take pain relievers.
  • Don’t wear high-heeled shoes or ones with a narrow toe box.
  • Avoid activities that put pressure on the neuroma.
  • Ask your doctor about surgery.

Sesamoiditis. Near your big toe are 2 bones that are connected only by tendons. They’re called sesamoids. You get sesamoiditis when the tendons surrounding them become injured and inflamed. It’s a form of tendinitis, common with runners and ballet dancers.

To treat it:

  • Rest your feet.
  • Ice where it hurts.
  • Wear a foot pad under the toe in a comfortable shoe.
  • Tape the big toe to immobilize the joint and allow for healing.
  • Wear low-heeled shoes.
  • Ask your doctor about steroid injections.

Arch Pain

Plantar fasciitis. This is the most common cause of arch pain. Plantar fasciitis can affect the heel, arch, or both. Treatment is the same regardless of the location. For persistent plantar fasciitis, an injection with a mixture of a steroid and local anesthetic can be helpful.

Fallen arches , or flat feet, happen when the arches of the feet flatten out (often when standing or walking), causing foot pain and other problems. Flat feet can be treated with shoe inserts, shoe adjustments, rest, ice, using a walking cane or brace, or physical therapy. Sometimes surgery is necessary.

Toe Pain

Gout , which is a form of arthritis, can causes pain in the toes. Crystals collect in toe joints, causing severe pain and swelling. The big toe is often affected.

To treat it:

A bunion is a bony bulge along the edge of the foot, next to the base of the big toe. It’s associated with misalignment of the first toe joint. Anyone can get them, especially if they wear ill-fitting or uncomfortable shoes. It often shows up as people age. People with bunions often also have hammertoes as well. Try changing to more comfortable shoes or wearing shoe inserts. If you’re still in pain, your doctor may suggest surgery.

A hammertoe is when your second, third, or fourth toe bends at the middle joint, creating a hammer-like appearance. It can come from a muscle imbalance, but it can also be brought on by wearing ill-fitting shoes.

Your doctor will likely recommend you wear shoes with a wide, deep toe bed. She may also give you exercises to stretch your toe muscles. If you still have problems, you can talk to your doctor about surgery.

Claw toe is when your toe points down or up and is unable to straighten. It’s often the result of nerve damage from diseases like diabetes or alcoholism, which weakens the muscles in your foot. Without special footwear to accommodate the claw toe, you may develop irritation and calluses.

To treat it:

  • Change to better-fitting footwear. Avoid high heels and tight shoes.
  • Do stretches for your toes and toe joints.
  • Try shoe inserts.
  • Ask your doctor about surgery.

An ingrown toenailis when skin on one or both sides of a toenail grow over the nail. It can be painful and may lead to infections.

To treat it:

  • Soak the foot in warm water four times a day.
  • Once daily, wedge a piece of gauze between the nail and wet skin.
  • If these treatments don’t work, see a doctor.
Turf toe is when you feel pain at the base of the big toe. It’s an overuse injury usually caused by strain. Turf toe may also be a form of sesamoiditis or a sesamoid fracture.A toe sprain may happen when you jam or stub your toe, damaging the tendon or soft tissues of the toe. If you don’t have a fracture, the pain and swelling should go away within days.A toe fracture, or broken bone, can happen in any of the bones of the toes. Minor fractures may only require rest, ice, and pain relievers. Serious fractures may need surgery. Go to a doctor to be sure.

Hallux rigidus (stiff big toe) is a type of arthritis at the base of the big toe. Symptoms are pain and stiffness of the joint that worsens over time. Treatment can include pain relievers and stretching exercises. Surgery may be needed in some cases.

Corns and calluses. Corns are thick buildups of tough skin on a point of irritation or pressure on the foot or toe. They sometimes look like horns. Calluses are wider areas of tough skin buildup on the toes or feet. They happen as a result of irritation or pressure. Calluses and corns are generally caused by poor-fitting footwear.

To treat them:

  • Wear better-fitting shoes.
  • Soak the foot and use a pumice stone to wear down the extra skin.

A sesamoid fracture is a break in the small bones (sesamoids) that are embedded in tendons attached to the big toe. Pain in and around the big toe is the main symptom.

To treat it:

  • Rest, ice, and elevate your foot.
  • Wear stiff-soled shoes or foot pads to relieve pressure.
  • Take pain relievers.
  • If you’re still in pain, talk to your doctor.

Pain on the Foot’s Outer Edge

The outer edge of your foot, the fifth metatarsal bone, is a commonly broken bone in the foot. Pain, swelling, and bruising along the outer foot edge after an injury are symptoms. If you think you may have broken a bone, see a doctor and have an X-ray.

To treat it:

  • Take pain relievers.
  • Rest, ice, and elevate your foot.
  • Don’t walk on it.
  • Ask your doctor if surgery is necessary.
  • A cast may be necessary in some circumstances.

Foot Pain That’s Anywhere or Everywhere

Neuropathy, or nerve damage in the feet, is most often caused by diabetes. The pain can be burning, stinging, or feel like electricity. It can happen anywhere in the feet. Ask your doctor about pain relief options and ways to prevent further worsening.

Tendinitis is inflammation and irritation of tendons, the bands attaching muscles to bones. Tendons run along all the surfaces of the foot and can cause foot pain in many different locations.

To treat it:

  • Rest your foot.
  • Take pain relievers.
  • Steroid injections can help.
  • Surgery is rarely needed.

 

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Muscle Dysfunction in Head and Neck: Pain Causes, Osteopathic Options

Muscle Dysfunction in Head and Neck: Pain Causes, Osteopathic Options

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Article Featured on PPP

OMT can play a pivotal role in mitigating degenerative changes in the posterior neck, treat acute and chronic head and neck pain, and combat modern ills, such as text-neck syndrome.

Neck pain is a common complaint that patients have when visiting a healthcare office. Its prevalence ranges from 15% to 50% and was the ninth leading cause of missed workdays according to the Global Burden of Disease (GBD) 2017. In addition, neck pain causes 20% of chronic headaches, and if these were included in the amount of missed work hours, neck pain would rank closer to second in the leading causes of missed workdays. It is essential for the healthcare community to address the issue of neck pain and headaches, especially for the working-age groups in which the burden of disease is heaviest.1-4

Further, while the burden of disease falls mainly on the working-age groups, GBD does not take into account the teenage and young adult population. The prevalence of neck pain in this group is likely to rise with the increase in cell phone and tablet use as duration of such use has been positively correlated with neck pain severity in college students.5 The flexed forward position strains the neck extensors and rhomboids, weakens the flexors, stiffens the chest muscles, and shifts the center of head gravity anteriorly.6 The compensatory positioning compromises the surrounding nerves and vasculature, which can cause headaches.

Due to the expected increase in neck pain and subsequent headaches in the younger population, this paper will focus on specifically the negative effects of prolonged cell phone and tablet use and how osteopathic manipulative treatment (OMT) can aid in the management of those effects.63

Mechanism of Injury

Portable Device Use and Improper Ergonomics

The use of portable electronic devices, which include mobile phones, laptops, and tablets, has become practically ubiquitous as the accessibility and practicality of these devices have increased. In 2018 alone, 1.56 billion phones were sold worldwide.7 As a result of this technological deluge, people are spending more time using their phones. In 2016, Statista reported that people in the United States spent, on average, 2 hours and 37 minutes per day on smartphones, with 1 hour and 40 minutes being spent on social media,8 and in Brazil, average use increased to almost 5 hours a day in 2017.9 However, excess phone use comes at an injurious cost.

Increased screen time on portable electronic devices is not only correlated with depression, sleep interruption, and poor food choices, but also rising rates of neck pain, especially in adolescents and young adults.10,11 Neck pain, including dysfunction of C1 and altered mechanics of the cervical spine due to poor posture, can lead to headaches, which is one of the most common reasons for healthcare office visits as stated above.1

When studying 56 young adults’ texting techniques and posture while texting, Gustafsson et al, found differences in technique, posture, muscle activity, and kinematics between young adults with and without musculoskeletal symptoms.12 Young adults without musculoskeletal problems sat in positions with back and/or forearm support and held their head in a neutral position while texting. It was also determined that musculoskeletal symptoms did not cause the differences in technique and posture between the two groups, but rather the approach to texting may predispose an individual to having musculoskeletal symptoms. Although the connection between posture, neck pain, and phone use is well established as text-neck syndrome, only 21% of young adults are aware of measures to prevent it, and merely 8% know it exists.13

To combat neck pain, healthcare providers frequently recommend one or more of the following: muscle relaxants, non-steroidal anti-inflammatory medication, manual modes of therapy, physical therapy, transcutaneous electrical nerve stimulation (TENS), anesthetic blockades, botulinum toxin injections, radiofrequency thermoneurolysis, as well as more invasive surgical options such as joint fusion and nerve ablation.4 As reported in a previous PPM article, the PostureJac (SomatoCentric Systems, Inc.) may also be beneficial in improving dysfunction of the musculature that commonly causes neck pain.14,15 Another treatment modality shown to be effective in the management of neck pain is OMT.4

OMT for Neck Pain and Neck-Related Head Pain

Osteopathic manipulation treatment uses a detailed knowledge of anatomy and physiology to augment treatment of bones, muscles, nerves, visceral organs, and circulatory vessels including blood vessels and lymph vessels. In terms of neck pain, the nearby musculature, nervous, and/or vasculature systems are described below to demonstrate the key role they play in the development of pain in the head and neck.

The Posterior Neck Anatomy

The posterior neck is comprised of a superficial and deep layer of musculature. The superficial cervical muscles include the trapezius, splenius capitis, semispinalis, and levator scapulae. However, it is in the deep layer of the neck where other structures, such as vasculature and nerves, play a less obvious, but large, role. The deep muscles in this region, which is commonly the cause of cervicogenic headaches, are those that make up the suboccipital group: rectus capitis posterior major and minor, and the obliquus capitis superior and inferior.4 Directly overlying these muscles are the greater occipital nerves on either side. Irritation of this nerve causes pain along the posterior scalp and vertex of the head. Directly deep to the suboccipital triangle runs the vertebral artery/vein, deep cervical vein, and the suboccipital nerve, which innervate the deep cervical muscles.

When the suboccipital muscles are hypertonic, these nerves are compressed, further activating the muscles and creating a loop that sensitizes the muscle to pain. Inferior to the triangle is the third occipital nerve. This nerve courses down to the upper trapezius where it innervates the skin, and agitation causes pain in the caudad portion of the back of the neck. Therefore, if any of these muscles are hypertonic or if the tissue is tight, it can constrict the blood flow and impinge the nerves, causing cervicogenic headaches and pain.

General Facilitation

Deep cervical muscles that are dysfunctional can also cause restricted and/or altered motion at the related vertebral segment.16 The deep cervical muscles (rotatores brevis, interspinales, intertransversarii, and rectus capitis posterior minor) are short restrictor muscles that span across one or two vertebral segments.16 Because of their orientation and proprioceptive feedback, these muscles allow for balance of the spinal column and rapid response to segmental spinal cord facilitation. Facilitation involves the perpetuation of neurons (premotor neurons, motor neurons, or preganglionic sympathetic neurons in one or more segments of the spinal cord) in a state of partial or subthreshold excitation in which less afferent stimulation is required to trigger impulse discharge.17 In those with dysfunctional deep cervical muscles, pain may be produced even with minor insult. This facilitation leads to feedback that causes changes in the tissue and deep cervical musculature near the dysfunctional segment(s), which can be attributed to a change in hysteresis, ultimately creating a continuous and chronic loop of altered spinal mechanics.18

Hysteresis Changes

Hysteresis is defined as a characteristic of tissue texture. It describes the amount of recoil/response a tissue has after deformation. When the tissue is edematous and boggy, the recoil time will lag compared to normal, and in an opposite manner, fibrotic tissue will recoil faster than normal. Barnes et al, used a durometer that measured motoricity, mobility, frequency, and fixation in 240 participants to analyze the effects of OMT.19 Motoricity was defined by the overall dysfunction of a cervical vertebra; mobility corresponded to range of motion; frequency indicated the time it took to meet the end of range of motion; fixation measured resistance within tissues. Participants were divided into six groups (five different OMT modalities and one sham OMT group). Results showed significant changes in motoricity, fixation, and frequency for all OMT treatments but no change in the sham group from baseline, thus showing OMT having an appreciable effect on cervical tissue, which can improve the hysteresis of patients with neck pain.

Chronic neck pain and facilitation of cervical vertebral segments not only cause hysteresis changes and decreased range of motion but also suboccipital muscle atrophy.20 In a study by Greenman, irreversible atrophic changes to the rectus capitis major and minor muscles were observed in participants with chronic head and neck pain as compared to controls.20 Magnetic resonance imaging demonstrated increased high signal intensity for suboccipital muscles in patients with chronic head and neck pain indicating increased fatty tissue in place of atrophied suboccipital skeletal muscle. The authors hypothesize that decreased proprioceptive afferent activity in the affected muscles may lead to increased facilitation, which is ultimately perceived as pain. OMT can play a pivotal role in mitigating these degenerative changes by preventing or treating long-term chronic head and neck pain.

In the Acute Setting

In addition to chronic pain, OMT effectively treats neck pain in the acute setting. McReynolds et al, studied the impact of OMT on patients with acute cervical pain of less than 3-week duration in an emergency room setting.21 Participants were enrolled in one of two treatment groups and were treated with either one 30-mg intramuscular ketorolac injection or OMT. To assess pain intensity, participants reported their level of pain before and after treatment using an 11-point scale. To assess perceived overall benefit of either treatment, they reported pain relief on a 5-point Likert scale. Within one hour of treatment, OMT provided perceived pain relief equal to that of a 30 mg intramuscular ketorolac injection.21 Additionally, those participants who were treated with OMT experienced a statistically significant reduction in pain intensity as compared to the ketorolac group.21 Therefore, OMT may be utilized to provide relief for neck pain, reduce facilitation of cervical vertebrae, and potentially prevent long-term chronic neck pain and suboccipital muscle atrophy.

Conclusion

Neck pain is prevalent in the working-age and young adult populations, which leads to missed workdays and decreased productivity.3 Additionally, this issue negatively impacts social interactions and relationships. People with neck discomfort feel more isolated due to perceived incomprehension of their pain from family and co-workers.21 Those with chronic pain report decreased participation both socially and at work due to fatigue, lower concentration, and psychological struggles due to pain.22

Therefore, the burden of neck pain extends beyond the cost of missed workdays. Healthcare providers seeing patients suffering from neck pain should support them with a proper work-up, that includes investigating and adjusting lifestyle habits, especially portable electronic device use. They should also recommend available resources, including osteopathic manipulative treatment as an option for musculoskeletal causes of neck pain.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.