Shoulder Pain During A Workout

A few days ago I was working out at Equinox here in the Back Bay with a friend of mine who's a trainer and we got to talking about his shoulder.  He said "when I work my chest or shoulders I get pain in the front of my shoulder, so I just avoid doing shoulder work."  And since this is something that I see a lot of in the office I thought we could discuss it here in this post.  After a few weeks of treatment to his shoulder he was back doing military press after avoiding it for months.  But shoulder pain can be complex, so lets run through a few of the common causes.

First we have to look at the major muscles of the shoulder area itself.  The main ones, that you can find on yourself, are the trapezius and the deltoid.  Basically the trapezius is the large muscle going from the shoulder up to the neck, and the deltoid is the actual shoulder muscle itself.  These are the primary movers of the shoulder.  When performing military press, lateral raises, or shoulder shrugs these are the muscles doing the most work.  These will cause pain when they are either too tight, too weak, or torn.  But even though these are the main movers of the shoulder they are rarely the cause of shoulder pain.

Another cause is an actual torn tendon, muscle or cartilage in the shoulder, which can happen but most often occurs after a trauma like being tackled, or launching a football when you haven't thrown one for years.  There could also be arthritis in the shoulder joint itself which can cause significant pain.  Irritation to a nerve in your neck can also cause pain into the shoulder.  But these are all more rare and more severe than what most people experience in the front of the shoulder.

One of the main reasons that shoulder pain comes about a problem with the rotator cuff, which is composed of four muscles; Supraspinatus muscle, Infraspinatus muscle, Teres Minor muscle, and the Subscapularis muscle.  Try to picture your scapula, or your wing bone on your back, this is where your rotator cuff is located.  These muscles all turn into tendons, the way any muscle does, and these tendons travel through the shoulder area and attach near the outside and front of the shoulder.

Picture Source: http://www.nlm.nih.gov/medlineplus/ency/imagepages/19622.htm

This attachment is why most people who have rotator cuff problems will feel the pain in the front of their shoulder.  When a rotator cuff muscle becomes too tight, too weak, enflamed, or torn the body feels the pain in the front, and not normally in the back.  The primary goal of the 4 rotator cuff muscles is to keep the scapula close to the rib cage, and to provide stability to the shoulder.  Most people think of a baseball pitching injury when they hear rotator cuff, but these muscles can become dysfunctional just by sitting too often.  The more we sit, the tighter the rotator cuff becomes, and the more it will pull on the front of the shoulder.

So what can we do about this anterior shoulder pain?  First you should try to loosen up that area.  Get a tennis ball and lie on the ground with the tennis ball touching the muscles near you shoulder blade.  If you're doing this correctly you'll start to feel pain in the front of your shoulder, where the tendons attach.  Now just lay there for a few minutes until the pain subsides.  Repeat this a few times a day for a few weeks and see how the shoulder pain decreases.  If that doesn't help you'll have to see your chiropractor, physical therapist, or massage therapist to get these muscles evaluated for you.  If you find someone who knows what they're doing they'll be able to figure out what muscles are tight, which are weak, and which may be actually injured.  Then a plan of strength and stretching can be created to help ease the pain.

Doctors Note:  If you suffer from pain in the front of your shoulder it may be an easy fix.  More often than not the problem is in the rotator cuff.  Try lying on a tennis ball directly on the muscles of your rotator cuff for 5 minutes each day to see if this decreases the pain.  If it doesn't then have someone evaluate the shoulder.   And avoid the urge to just lift weights through the pain... you'll probably just end up tearing something... which can put you out for months.

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Hip Pain While Running in Boston

As the summer flies by here in Boston we're seeing more and more people come into our Copley Square Chiropractic office with a common running injury which can only be described as hip pain.  The hip is a hard area to define for most of us because it combines many different parts of our anatomy.  Most of us think of the outside part of our hip or butt area when we think of the hip, but others think of the internal structure, where our leg connects with our pelvis.  It all depends upon who you talk to.  The main point of this post is how to deal with pain felt more externally, on the outside of the hip area, or the "jamming" internal feeling that is primarily caused by a tight and tender Tensor Fasciae Latae muscle.

Picture Source: http://www.bcnlp.ac.th/Anatomy/page/apichat/muscular/page/Tensor-fascia-latae.html

Your TFL runs essentially from the top of your hip bone (iliac crest) to the outside of your femur.  It's not very long, only a few inches in most people, but is essential for proper walking and running.  Along with your gluteus medius muscle it helps to stabilize the leg and hip area during one legged movements, such as the push off phase of running, or standing on one leg.  It's an area that tightens with sitting, but to this point we don't have a great stretch to ease the tightness.  Eventually the TFL "turns into" your iliotibial tract (or IT Band) which connects to the outside of the knee, as seen in the picture above, and may cause knee pain.

Common symptoms of TFL issues are low back pain, outer hip pain, pain going from sitting to standing, outer knee pain, a "jamming" feeling inside the hip joint, and pain during or after running.  Tightness in the TFL often leaves the athlete feeling as if the hips are "twisted" or that they need someone just to pull their leg away from their hip.  It's an annoying problem that can last for months and in some cases years.

Luckily for runners of all ages there is a way to treat this problem.  The first step is to work on the TFL muscle yourself.  This can only be done with self trigger point work, which means you get some sort of a ball (tennis ball, golf ball, softball) and lie directly on your TFL.  It will look as if you're on your side, with the ball jamming into your TFL.  It's always recommended that you find exactly where the TFL is located before performing this movement, because if you end up lying on your hip bone or femur you're going to be in more pain than when you started.  Once you find the TFL you can lie on the ball for 2-5 minutes.  This should decrease some of the pain, and after a week should take the pain away completely.

If you're an avid runner or athlete who has tried this approach and aren't getting the results you're looking for it probably means you need some outside help.  Here in the office we see many people, and not necessarily runners, who just can't seem to get relief on their own, so they need our  help.  What we do is deep muscle work on the TFL itself and also we can adjust the femur so that it's not so tight in the hip joint.  This takes away the "jamming" feeling and enables the TFL to relax.

Doctors Note:  Hip or outer glut pain is often caused by a tight TFL.  TFL tightness is caused by sitting or squatting too much.  Stretching hardly ever helps... and this is NOT something that just goes away on its own.  Try self trigger point therapy for a few days to see if you get relief.  If not, call either your chiropractor, physical therapist, or massage therapist (whoever knows how to do deep tissue work) to have them work the muscles on a deeper level.

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Numb Hands and Tingling Fingers

Many people have experienced the symptoms of numbness in the hands and fingers. The typical symptoms are described as pins and needles and most people describe it as if their fingers or hands have gone to sleep. This usually occurs during sleeping, after sitting for prolonged periods, or when someone holds their hand above their head during activities such as changing a light bulb. Most people will self diagnose themselves with either carpal tunnel syndrome or with something much more dire. But for most people, neither assumption is true.

If you look at the anatomy of our hands you will notice that all the nerves and blood vessels come from further up. They don't start at your hand and end at your hand. They actually start at your neck and end up in the tips of your fingers. They must travel through your shoulder, below your pectoral muscles, through your elbow, underneath your forearm muscles, through the 8 bones in your wrist and then into each one of your fingers. That's a long way to travel. It also presents numerous opportunities for an obstruction to occur.

Think of the nerves and blood supply in your arms as if it were a river. And think of your neck as being the reservoir. Now, normally the river runs from the reservoir out to the surrounding areas(your fingers). However, sometimes a tree falls across the river and prevents most of the water from running down the river. So the areas at the end of the river(your fingers) don't get much water(nerve and blood supply). At this point most people notice that they have numb or tingly fingers and decide that they have a hand or wrist problem. But most of the time the problem lies with the tree that fell over the river, not with the areas downstream.

There are numerous places that the nerves and blood supply that go to your fingers can become restricted. These places are your neck, shoulder, pectoral muscles, elbow, forearm, 8 bones of the wrist, or the muscles of your hand. Therefore, be careful in assuming that your problem is in your hand just because you feel symptoms in your hand. To get the best diagnosis for your tingly hands you must find someone who will inspect all the areas between your neck and fingers.

One of the most common places for a restriction is in your neck and pectoral muscles. This is because most people sit at a desk for a living. This causes us to roll our shoulders forward and stick our heads out, usually to see a computer. When our shoulders roll forward our pectoral muscles shorten and eventually become extremely tight. This then presses on the nerves and blood supply that run directly underneath your pectoral muscles. If these muscles get tight enough we start to feel numb or tingly hands. Stretching of the pectoral muscles can usually prevent this problem. 

Even though one of the most common sites for a restriction is your pectoral muscles there are many other places where you may have issues. I would urge your to have a qualified practitioner look at your entire arm for restrictions. Since your wrist has 8 different bones you should have a chiropractor make sure that each one is moving properly. If there is a bone that isn't moving correctly it can put pressure on a nerve and give you carpal tunnel syndrome. They will also make sure that the muscles and bones of your arm are moving properly and allowing the nerves and blood vessels to flow freely.

Doctors Note:  Numb hands can mean many things, but the simplest reason is usually the right one.  Most the time it's just muscles of the chest pinching something off.  Try this first:  Find a doorway, pin both your arms on either side of the doorway and take a small step through the doorway so you feel a stretch in you chest muscles.  Then hold this stretch for 3 minutes.  Repeat this twice daily for 2 weeks.  If this doesn't improve your symptoms then go have someone take a closer look.

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What's TMJ? And what you can do about it.

People come into the office on a daily basis and say "I'm here to see the chiropractor because I have TMJ" so this post is for those of you who have experienced the jaw pain, neck pain, headaches, or inability to chew that is associate with "TMJ."

The first thing to look at is the acronym "TMJ"... what does it stand for? The medical name is Temperomandibular Joint. If we break this down further into its separate parts we have three separate terms. The first word is Tempero, which truly means Temporal. The temporal bone is part of your skull. The second word is Mandibular, which means mandible...which means Jaw. The third word is Joint which simply means the area where bones come together. So if we look at them all together we get the Joint where your Jaw meets your Skull.

When someone walks into the office and says "I have TMJ" its the same thing as saying "I have elbow" which is kind of funny when you think about it.  But what these people actually mean is that they have TMJ pain, and it can be quite debilitating. The symptoms range from pain during eating or chewing, to massive headaches, to neck or ear pain.

Many people start to develop TMJ pain randomly, without any injury or trauma. Others develop this pain after dental work, such as surgery, which forces their jaw to be open for a prolonged period of time. There's numerous other reasons people will develop TMJ pain such as problems in the neck, imbalances in the muscles of the face, and chewing gum. But regardless of what the cause may be there is always a solution.

Causes of TMJ Pain:
The true causes of pain in the jaw are muscle or joint related. It's very rare to get TMJ pain because of your teeth, or because of how you bite down. Many people will experience TMJ pain after dental work and will logically head back to their oral surgeon for help, who then fits them for a mouth guard. Unfortunately the TMJ pain isn't caused by a lack of a mouth guard, you didn't have the pain before the work was done so something must have happened to the actual jaw. So these people may get a little relief by using a mouth guard as a crutch but it's usually not permanent or dramatic.

When you are forced to hold your jaw open for a prolonged period of time the muscles in your jaw get very tired, and they will normally get very tight or go into a small spasm. This is because they aren't used to being worked in such a manor. When these muscles become overly tight it becomes painful to open or close the mouth, chew food, yawn, or talk. Jaw and facial muscles need to be evaluated by someone who specializes in muscles and joints to see where there may be tight and spastic muscles.

Other causes of TMJ pain are related to tight muscles in your neck or joint tightness in your neck and jaw. Some people who slump at their desk all day or who have forward head posture will develop jaw pain. As we sit for long periods of time the muscles in the back of our necks gets fatigued and the muscles in the front of our neck become short and tight. Specifically the Sternocleidomastoid(SCM) muscles in the front of the neck can be problematic. Sometimes people will get jaw pain because the back of their necks get fatigued and the neck itself become very stiff and rigid. This doesn't allow for normal motion in the neck and this can irritate the nerves coming from the neck and going to the jaw. Chiropractic care can help these issues. Also, people who have been in car accidents and experienced whiplash will be more prone to TMJ problems due to the stress on the neck. This presentation is almost always a case for your chiropractor because they deal with car accidents and whiplash on a daily basis.

Some strategies to try:

1. Sleep on your back with a cervical pillow. A cervical pillow is one with a dip in the center. It enables your neck to get back into alignment while sleeping and may take pressure off the neck and jaw.

2. Test your SCM muscles by squeezing them. Some parts of these muscles may refer pain into the jaw or ear during squeezing. Apply pressure for 2 minutes to relieve these trigger points.

3. Visit your chiropractor to have them check your SCM muscles, your posture, and the back of your neck for areas that may be too tight and may be causing irritation.

4. Don't chew gum.

Doctors Note:  Remember, the next time you go into your doctors office and say "I have TMJ" it's just like saying "I have elbow."  :)

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Why Does My Head Hurt?

"Why does my head hurt again? I didn’t do anything, I didn’t drink too much, I didn’t hurt myself, but my head is still killing me… why?"

This is an extremely common complaint that I hear in my office. People dealing with constant headaches and not understanding why they won’t go away. Fortunately, there is always a cause of headaches and it’s not because “it’s just how I am” as many people think. There are skeletal, muscular, hormonal, nutritional and neurological causes to headaches and once we find out where the headache is coming from we can take steps to fix them.

The most common type of headache is the tension headache which is caused by muscle tightness, skeletal joint tightness or nerve irritation. These headaches are normally seen in people who are stressed out, have a demanding job or personal life, and in people who sit in an office all day. They are caused by the body being under constant stress. If the body is always under stress, physical or emotional, it usually responds by causing muscle spasms or tight spinal joints in the neck. Luckily for people who suffer from tension headaches we can quickly find the cause and fix the problem. Here’s a quick test for you to perform to find out if you suffer from tension headaches:

With your thumbs, find the base of your skull. You should feel 2 bumps on either side, now push on those bumps and then move an inch lower and push on those spots as well. If either spots are tender or give you a headache you probably suffer from tension headaches. Another way to test is by pushing on your shoulder areas, if they are very tight, painful, or cause you to get a headache then you may be suffering from tension headaches.

Another very prominent type of headache is a migraine headache. These are normally caused by lack of oxygen getting to the brain. Here’s how it works: When your brain doesn’t get enough oxygen the blood vessels expand to allow more blood flow into the brain and thus more oxygen. This is how your body reacts to a decrease in oxygen, it tries to open things up and get more oxygen to the area, it’s a normal and highly effective process. However, wrapped around those expanding blood vessels are nerves which don’t appreciate being pushed on and they react with pain. This is how you get a migraine, the blood vessels are doing their job and expanding but they’re expanding into nerves that give you a migraine. So what’s a person to do? Well the easy answer is to get more oxygen throughout the day… but how?

In the office we deal with migraines by enhancing the amount of oxygen each person takes in. This is normally done by adjustments to the thoracic spine and rib cage. These adjustments allow the lungs to expand more than they normally would, thus increasing the amount of oxygen in the system. After a few adjustment the body can start to take in more oxygen with each breath and the frequency of migraines will decrease.

Other causes of headaches and migraines are hormonal or nutritional. Both can be dealt with in a similar fashion. For some people it’s just finding out what food triggers the migraine. For hormonal migraines, such as those felt during certain times in a woman’s menstrual cycle a more advanced treatment is usually needed. These women normally need to balance out the hormones in their bodies (many menstrual migraine sufferers also suffer from fibrocystic breast disease, fibroids, endometriosis or acne, all signs of a hormonal imbalance). Luckily there is emerging evidence that diet can help to balance hormones. When we put these people on a diet filled with micronutrients, vitamins, and minerals they experience amazing results.

Doctors Note: You don’t have to live with headaches. Drugs don’t cure your headaches, they just make them manageable. But they can be fixed when we find out where they’re coming from. Everyone should be able to live pain free and if you suffer from chronic headaches there is hope.

HBO Special Says Nutrition Is Key To Obesity

If you tuned into the HBO special last night, The Weight Of A Nation: Confronting America's Obesity Epidemic, you probably noticed 2 major themes. The first, and most crucial, is that obesity is killing more people and ruining America's Healthcare system faster than any other health issue... and it's not even close. The money it takes to take care of obesity related diseases such as diabetes and heart disease is disturbing to say the least. No other health related issue has the ability to drain our healthcare system to the extent that obesity does. And as the special clearly laid out, if we don't do anything to curb the appetites of America's youth our healthcare system will be all but useless in the near future. But this is information we've all known for the past ten or so years... it's not pretty but most health experts have known for quite some time that obesity is more harmful to america than any other health issue.

The second major theme that came out of the special was the fact that most health authorities haven't known what to do about the obesity epidemic.  And as the show stated repeatedly, exercise is not the answer. Let's repeat that one. Exercise is NOT the answer to the obesity question.  As a former personal trainer it took me years to understand this so I can only imagine how difficult it will be for most Americans.  And do we all know what is the answer? Wait for it... wait for it... it's nutrition! The answer to obesity is proper nutrition! Shocking I know!

Another interesting part of the special was when they explained about the amount of calories burned during exercise, and how we have an inflated notion of how many we're actually burning.  For example, they said that running 1 mile burns about 100 calories. It's something I knew back when I was a personal trainer but hadn't given much thought to for quite some time. Let's see what else contains 100 calories. 1 light beer, 1 soda, 1/2 bag of M&M's, 1/2 a bagel, 1 very large banana, 1 small handful of peanuts, and many many more. 100 calories is almost nothing! So the point here is that exercising 45 minutes a day may only burn 300 calories, but a change in your diet may make a difference of up to 1,000 calories! So the quickest, and most effective, way of losing weight is with your fork... not your running shoes.

Think about it this way. If you never worked out but you ate properly what would happen to your weight? You'd stay nice and skinny right? I mean how couldn't you? Now what would happen if you ate like crap but worked out a lot? Which is what most people do. Well you'd be skinny, for a while at least. And this is why you see people start to pack on the pounds as they age. The body isn't able to process all those extra calories, plus the fact that people get more sedentary as they age, and the weight just piles up. The easiest, healthiest, and most efficient way to lose weight and stay thin is by eating real food.

That's the last point the documentary made, which has been echoed in just about any nutrition best seller you can think of within the past 10 years. Eat Real Food. If you can't find it growing out in a field then don't eat it. That means no bagels, pasta, bread, crackers, soda, candy, etc, etc, etc. It seems strange to have to tell our nation to eat "real food" but that's how crazy our view of food has become. People look at macaroni and cheese as if it were real food. But if we all just followed that one rule, to eat real food, nobody would be overweight. It's not about your metabolism or your grandmother or the pull of the moon... it's all about eating real food.

Doctors Note: The point here is this; we all have to stop relying on exercise for weight loss. We've got to start eating real food again.  Try eating only real food for one month and you'll be amazed at how much weight you lose and how much better you actually feel... and you may just help solve our health care crisis... so don't just do it for yourself... do it for America! :)