Joint pain in an arm or a leg (including the shoulders, hips, knees, elbows, wrist, ankles hands and feet) is among the top 10 reasons people seek care from a physician. Diagnosing the cause of joint pain is clear when it starts suddenly after a specific movement or activity. It is not unreasonable to expect pain in a shoulder after raking an entire yard or pain in a knee after falling on it. Overuse pains from painting trim for several hours is also easily explainable; however it becomes unclear when the pain comes on gradually or more "out-of-no-where." Sometimes the cause is not so easily detected. The onset of pain may be so gradual that you aren't able to identify when the pain began; it may also be due to a very old trauma that seemed minor at the time or multiple traumas from playing sports several years ago.
When it comes to pain in the extremities that starts gradually, the most common reasons are repetitive strain and post-traumatic osteoarthritis. The pain can be caused by a more serious problem, such as nerve compression at the spinal level traveling down the arm of leg but this is rare. Generally, the pain can be attributed to: muscle, tendon, ligament, nerves, fascia, bones and joints, or a combination of these structures.
MUSCLE/TENDON INJURY “STRAINS”
Muscles are made of thousands of individual muscle fibers that align vertically. Much like a rope, muscle fibers all run in the same direction in a tight bundle with each other. Muscle pain is commonly due to overuse and sudden pulls. When a muscle or tendon is pulled too hard and injured it is called a strain. A strain can be either complete where the muscle is completely torn (rare) or incompletely torn where just a few or many individual muscle fibers are torn or frayed (common). Tendons attach the muscles onto bones. With enough trauma the tendon can be torn from the bone. In adolescents, often the tendon is stronger than the bone it attaches to and may result in an avulsion type fracture where a piece of the bone is pulled away. Mild to moderate strains generally feel better after getting up and moving around so light use or activity is generally recommended.
ACUTE OR CHRONIC STRAIN
Acute muscle strains are divided into 3 categories.
Grade 1: Incomplete mild muscle strain
Grade 2: Incomplete moderate muscle strain
Grade 3: Complete tear categories. Incomplete is then subdivided into mild or moderate.
A grade 1 strain is a simple overstretch or tearing of a few muscle fibers (0-5%) which generally clears up on its own in 2-3 days’ time. Grade 2 or moderate are the majority of strains and are everything between 5-99% of muscle fibers tearing. Grade 3 or severe is a complete (100%) tearing of the muscle or tendon away from the bone and is generally surgically repaired. It is difficult to tell how many fibers have been torn and often you can only determine how bad it was after the healing process has finished. The majority of incomplete tears can be managed without surgery.
Chronic strains are older (symptoms for greater than 4-6 weeks) strains that have been left untreated either from neglect, denial, improper treatment or were undetected. An imbalance has resulted and the symptoms either remain steady, slowly worsen or come and go depending on activity levels.
REPETITIVE STRAIN
Repetitive strains are overuse syndromes. If the activity was done once an injury would
be unlikely. However when the stress to the tissue is consistently repeated it slowly wears away at the strength and integrity of the tissue. The most common “injury” causing overuse syndrome is poor posture coming from either poor ergonomics or weak core muscles. The chiropractors near you in Cedar Falls at Cedar Valley Chiropractic are experts in identifying these types of "injuries", providing conservative drug-free pain relief for the muscle pain, and getting you to the right specialist if they believe surgery may be needed to help.
TENDONITIS/TENDINOSIS
Tendons are an extension of the surrounding fascia and connective tissue of the muscle fibers that come together to form a tough connection of the muscle to the bone. Tendons have some elasticity, but become tougher the closer to their attachment at the bone. The fibers are very densely compacted and have less blood supply than muscles which causes them to heal more slowly.
In the stage of injury where swelling ("Inflammation") is present the injury is termed “tendonitis or peritendonitis”. When the injury includes the sheath surrounding the tendon it is called “tenosynovitis”. Tendonitis and tenosynovitis, when caught early enough, can be treated and improved within 2 days to 2 weeks; if not caught early it can take up to 6 weeks to fully resolve.
Tendon injuries past 6 weeks do not show inflammatory changes and are degenerative in nature; these types of injuries are termed “tendinosis”. Tendinosis takes longer to treat due to the chronicity of it. The typical time to recovery with early detection can be 6-10 weeks and if not caught early can easily take 6 months for recovery. Tendonitis can be treated by chiropractors that are trained in the right treatment methods. Graston for tendonitis is extremely helpful in reducing pain and heal tissue.
LIGAMENT INJURIES “SPRAIN”
Ligaments are composed of many individual fibers that like muscles and tendons that align all in the same direction. Ligaments do not have the elasticity that muscles and tendons do. Unlike tendons that attach muscles to bones, ligaments attach one bone to the adjacent bone. They are an integral part of the joint. While most muscles have only one tendon that attaches it to the bone, most joints have multiple ligaments that attach the bones together. Ligament injuries are called “sprains”.
They are also divided into 3 categories.
GRADE 1 SPRAIN
A stretch or very partial tear of a few of the fibers of the ligament is a Grade 1 Multiple grade 1 strains may allow too much movement in a joint which may lead to instability.
GRADE 2 SPRAIN
An incomplete tear from just a few fibers up to 99% of the fibers is a Grade 2 and can also lead to chronic instability. The grade 2 sprain may take several weeks to manage as it is difficult to determine just how many fibers are torn. Imaging such as MRI and ultrasound are often used to try and determine how severe the injury but do not always provide an accurate image.
GRADE 3 SPRAIN
A complete tear of the ligament off the bone is a complete or Grade 3 sprain which causes immediate instability and may need to be surgically repaired.
FASCIA
Fascia is a thin flexible tissue that connects individual muscle fibers to other fibers, connects one muscle to another, continues on to underlie the skin, surround bones, blood vessels, organs, nerves and all components of the body. If every other structure was removed except the fascia we would still have an exceptionally clear 3D image of the body. When fascia undergoes disruption by stretch or trauma, it easily forms adhesions. Adhesions can lead to fibrosis and scar tissue which severely restricts normal movement. Pain from fascia may be felt locally or quite a distance from where the problem is occurring. When one experiences what seems to be pain that shifts and moves randomly from one location to another and is difficult to pin down, there is often a fascial component to the condition. Fascial pain can be difficult to diagnose if a doctor isn't experienced in it and don't have the right tools to treat it; thankfully, fascial pain treatments area available at Cedar Valley Chiropractic and both Dr. Rasmussen and Dr. Dugger have vast experience in conservative fascial pain treatments.
BONE
Bones are the framework of our body. Calcium is taken from the bones when the body needs it and the diet is deficient or when the small intestine cannot absorb it. Calcium is deposited into the bones in times of physical demand or constant stress. The body does an amazing job of balancing when calcium is needed to be taken out of or put into the bones. Sometimes however, that balance is disrupted. When the bones are deficient in calcium fractures can occur more easily. Fractures may occur when abnormal stresses are put into normal bone (stress fractures or acute traumatic fractures) or when normal stress or trivial trauma is put on abnormal (weakened) bones (pathological fracture.) Increased deposition of bone can be caused with exercise (good to prevent osteoporosis) or due to repetitive irritation (like a callous on your foot) or as a response to previous severe trauma (spurs). Bone pain can be caused by infection (rare without invasive procedure near the bone) or tumors (rare but may need to be ruled out for example in a patient with a previous history of cancer). Bone pain from a fracture is often felt as a sharp pain that is deep and worsened with movement. Bone pain may also cause symptoms that are deep boring pain that is unrelenting and does not change with position or activity.
JOINTS
Joints are composed of 2 bones, a cartilage covering at the end of each bone, a capsule like a sock that surrounds each end of the bone and fluid that fills the capsule. The 2 ends of the bones are held together by ligaments as described above. Muscles pull on the bones to create the movement that occurs at the joint. If a muscle pulls too hard on one side of the joint, the ligaments become too loose or tight, the cartilage that helps to separate the two bones is compressed, the fluid becomes too thick and the movement of the joint becomes restricted. The joint capsule has many nerve endings, especially nerves that create a sense of position called “mechanoreceptors.”. These are the nerves that will give you the feeling that "something is out of place."
JOINT DYSFUNCTION/"SUBLUXATION COMPLEX"
The description above regarding dysfunctional joints, along with tightness of the muscles, compression of or irritation to the nerves, poor centration ( position ) and inflammatory response compose what many in the chiropractic profession term the "subluxation complex." It was previously thought that a bone went out of place and pinched a nerve and that chiropractors put the bone back in place releasing the pressure on the nerve. It is now well accepted that it is much more complicated than a “bone out of place” and that relieving all the components surrounding this dysfunction is the key to the remarkable results seen with chiropractic care. Adjusting the joints for proper function and mobility in the extremities is a key component of successful care in the extremity injury.