Whatever country you live in, you likely are seeing daily news on the novel (new) Coronavirus. Should you be concerned?
Here are the facts:
Coronaviruses (corona means crown which is what the virus looks like under electron microscope) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Coronaviruses are zoonotic, meaning they are transmitted between animals and people.*
The novel coronavirus (nCoV) that first appeared in December last year in Wuhan, China is a new strain, designated Covid-19, that has not been previously identified in humans. We are still learning about its life cycle; i.e. where it originates; ways it can be transmitted; its incubation period (the time it takes from acquiring it to noticing symptoms); specific effects on the human body, and recurrence (can you get re-infected after symptoms disappear?).
Common signs of infection include fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. Like with most infectious diseases the elderly, very young, and individuals with underlying disease (lung disease, HIV+, advanced diabetes, etc.) are the most susceptible to getting infected and experiencing severe reactions to the virus.
The mortality rate (death rate) of the novel coronavirus is much higher than the flu (influenza) virus. This is likely because of the lack of a vaccinated population, and people not having the antibodies (immune system defense) to the new virus. It does not necessarily mean that the virus is more dangerous/ potent than the influenza virus.
The novel coronavirus can be transmitted by touch and inhaling into the lungs. It’s not clear yet if it can be transmitted via contaminated food/ eating utensils.
There are cases of community spread, which means the virus is able to spread from person to person within a set community; meaning you don’t have to come into contact with someone who got the disease in another country in order to get the disease; you can get it from someone who is already in your community who did not travel outside the country but got it from someone who did or from a person several downlines from that original carrier.
Coronavirus in the media
Ok, those are the facts. Now, let’s talk about the way the virus is being reported on television and internet.
News stations across the country, and world, vary greatly in the way they report news. Typically, they draw information from a central source and press releases from authority centers. In the U.S., the Centers of Disease Control (CDC) is the official hub responsible for disease control. In the U.K. the responsibility goes to the Department of Health and Social Care (DHSC). If news reporters are doing their job properly, they just report the official statements coming out from these authority centers, and perhaps bring in local experts (having advanced education and training in infectious disease) for commentary. Regular news reporters should refrain from injecting their own analysis, opinions and predictions about the virus, but this is not always the case, and it often leads to conflicting and confusing messages to the public.
In the age of the internet and social media, practically anyone can spread misinformation. Some websites come across as official-looking news sites when in fact they are opinion outlets pushing an either left or right wing political agenda. Unfortunately, the traditional norms of proper, respectable journalism have been blurred, and these days some news reporters, or "talking heads" are taking liberties with their reporting, inserting their opinions instead of focusing on the facts and statements coming from the authorities—the scientists--who, also unfortunately, are being pressured by their government to report their findings a certain way, taking into consideration political calculations. This may compromise public safety, or cause undue panic depending on the intent of the public message.
Lastly, there is the issue of TV ratings. In the U.S., viewership translates to more money (advertisers buying commercial air time, or for the internet, view time). Journalists/ news reporters are being told by their bosses to make their reporting interesting so that people won’t change the channel or switch to another news website. Since it is well-known in advertising that people respond more strongly to messages that invoke emotion rather than those that appeal to reason, the tendency is to over-dramatize the narrative. This is OK when trying to sell things like cars and life insurance, but when it comes to serious things like infectious disease, it would be much better if reporters would just report the facts and advice put out by the experts. I believe that having 24/7 coverage on the coronavirus is not only unnecessary, it promotes hysteria, which creates secondary, harmful repercussions such as racism (prejudice against Asian people), hording food and supplies, and avoiding restaurants which hurts the local economy.
So what am I getting at? Here is the question I think everyone is wondering:
“How serious is the novel coronavirus, and should I be worried?”
My advice is to seek out the facts and filter out the drama as best you can. Take necessary precautions; the same ones you take during flu season which we are still in:
Wash your hands thoroughly under running water, for at least 20 seconds, periodically throughout the day.
Avoid touching your face: don’t give the virus a clear path to your respiratory system. Also, don’t touch your eyes, as viruses can enter the bloodstream through your eyes.
When in public, avoid direct contact with handles and objects meant to be touched/grasped: door knobs, toilet stall handles, backs of chairs, controls on machines, etc. Use a paper towel to cover it if you need to grasp/ touch it. As far as handshakes, use an alternative form of greeting such as fist or elbow bumps.
Cover your nose/mouth when sneezing: do it in your elbow; use a handkerchief.
Stay a good distance from people who are exhibiting symptoms. Think in terms of not breathing in air close to them (use a scarf; hold your breath if you need to pass near them, etc.).
Basically, be mindful of your surroundings and be diligent about these things, and go about your normal day. Remember, your risk of contracting the flu is much greater than contracting the coronavirus. CDC estimates that so far this season there have been at least 22 million flu illnesses, 210,000 hospitalizations and 12,000 deaths from the flu. Chances are, anyone reading this wasn't aware of these figures. This puts things into perspective.
By all accounts, if you do contract Covid-19 you will recover, as many already have, as long as you do not have any underlying disease/ health conditions that make you more susceptible. It will be very unpleasant, but the chances are excellent that you will recover. The coronavirus will fade, as all past viral outbreaks have, in the coming weeks and life will be back to normal.
In the meantime, check out this video I made a few years ago about avoiding the flu, because it is relevant to today:
*World Health Organization website. URL: https://www.who.int/health-topics/coronavirus
We’ve all experienced a bad night’s sleep, and know the results: low energy in the morning, mental fog, grumpy attitude, slow reaction time, difficulty concentrating and basically feeling crappy all day.
On the contrary, we know what a good night’s sleep does for us, which is the exact opposite: feeling energized upon waking, good attitude for the day, and mental clarity and alertness.
The way your body and mind feel communicates health information, so obviously sleep is essential to your health since you feel and function better when you get good sleep, and feel and function worse when you are denied sleep.
While the precise, biological relationship between sleep and physiology is still a mystery, we do know that sleep impacts nearly every tissue and system in the body: brain, heart, lungs, kidneys and gut; metabolism, immune function, learning ability, memory, mood, and disease resistance. Research shows that chronically poor quality sleep increases the risk of many disorders, including high blood pressure, cardiovascular disease, diabetes, depression, and obesity.
But can sleep problems also interfere with your body’s ability to heal itself, and therefore affect pain levels of an injury?
It stands to reason that the answer is yes. Let’s say you fell and broke your leg bone. Your body’s innate healing response immediately kicks in: a cascade of biochemicals spring to action, thanks to functional proteins present in your blood and tissues. These proteins initiate inflammation to quarantine the injury; limit movement by generating pain; activate immune cells to kill microorganisms and remove debris; stem bleeding, regrow blood vessels and patch the injury with scar tissue. While the exact mechanism is not known, sleep can influence the quality of this healing process at many levels.
One study evaluated the healing rate of oral ulcers in rats. The test group of rats was denied sleep and the control group was allowed to sleep. It found that sleep deprivation worsened oral ulcers and significantly delayed their healing, compared to the control group. Sleep deprivation resulted in elevated levels of tumor necrosis factor alpha, a pro-inflammatory substance, and a decrease in superoxide dismutase, which cells use to neutralize oxidative stress (damage). Together, these changes worked to interfere with tissue healing.
While chronic pain can cause poor sleep due to over-stimulation to the brain, there is interest in examining whether the reciprocal is true—if poor sleep can cause an increase in pain. A review of independent studies analyzing the effects of sleep deprivation on pain processing found that for most of the studies, sleep deprivation produced hyperalgesic changes; i.e. made pain perception worse.
The lesson here is that if you have recent pain (acute injury or onset) or even chronic pain, it is important that you get quality sleep every day. The research is clear that sleep is essential to optimal injury healing and minimizing pain perception.
Of equal importance is maintaining a healthy diet consisting of protein, good fats (i.e. nuts, seeds, olive oil, fish oil, avocado, egg yolks), and generous amounts of vegetables while minimizing sugar and grain carbohydrates. Your diet provides the proteins needed for structural repair and micro nutrients (vitamins and minerals) needed for critical biological processes, many related to tissue healing.
To take it a step further, I recommend you try intermittent fasting, where you don’t eat for long stretches during a 24 hour period. Check out this article I wrote to see how intermittent fasting can reduce inflammation and pain. Despite the conventional wisdom of “three square meals a day” and “breakfast being the most important meal of the day,” your body is actually optimized to go without eating for long periods of time. Lowering your caloric intake via intermittent fasting lowers oxidative stress, keeps blood sugar in check and burns excess body fat. This can have an overall effect of lowering chronic pain.
Set a schedule – go to bed and wake up at the same time each day.
Exercise 20 to 30 minutes a day but no later than a few hours before going to bed.
Avoid caffeine and nicotine late in the day and alcoholic drinks before bed.
Relax before bed – try a warm bath, reading, or another relaxing routine.
Create a room for sleep – avoid bright lights and loud sounds, keep the room at a comfortable temperature, and don’t watch TV or have a computer in your bedroom.
Don’t lie in bed awake. If you can’t get to sleep, do something else, like reading or listening to music, until you feel tired.
See a doctor if you have a problem sleeping or if you feel unusually tired during the day. Most sleep disorders can be treated effectively.
And let me share you a tip that helps me sleep when I’m having trouble sleeping: keep your eyes open as you lie in bed in the dark. It may sound counter-intuitive, but it works for me. After all, you can’t get drowsy if you are forcing your eyes closed when trying to sleep. Leaving your eyes open will eventually lead to the “drowsiness reflex,” which will transition you to sleep.
One more personal tip– use blackout blinds in your bedroom (not venetian blinds). These block 100% of light outside your room. Make sure to get the exact width to minimize light leaks around the perimeter. Even trace light that enters your eye can inhibit your pineal gland from producing melatonin, the substance that initiates sleep.
The Holistic Sleep Summit
If you have trouble falling asleep, or feel that you are not getting enough quality sleep and wish to do something about it, you might want to consider attending the Holistic Sleep Summitthis coming March 5-8. It’s a live webinar featuring 27+ leading experts in the science of sleep. You do not have to drive anywhere, just have a computer and internet connection, and make sure your speakers are on.
Discover Simple Ways To Sleep Quickly And Soundly
Learn How To Be More Alert And Feel Well-Rested
Sleep Soundly All Night Long, The Easy Way
How to Sleep On Demand
This online event is free. It is structured like a professional course, with each expert speaking on a topic related to sleep. There are no sales pitches, just pure content. If you have pain, or don’t feel your best, quality sleep will help you feel and function better–mentally, emotionally and physically.
If you do attend, as I will as I am a big advocate of telehealth, please do me a favor and comment below to let me know what you thought of it. The mission of this site is to bring together the best minds in self-management of common ailments, and the Holistic Sleep Summit is just another form of telehealth that has the potential to improve the lives of many people via online health education and guidance. If you are plagued by insomnia, restless sleep, sleep apnea or simply have bad habits or addictions that interfere with your sleep, I hope you check it out because you just might find the solution to your problem.
Did you know that by natural design, the human body is optimized for STANDING and WALKING, not sitting and lying down?
The evidence is longer and stronger legs for standing and walking compared to the arms. Your femur, tibia and fibula (leg bones) are longer and thicker than their counterparts; respectively the humerus, ulna and radius bones of the arm. Millions of years of evolution made our species homo sapiens develop this bi-pedal frame in order to survive and thrive. No other animal as far as we know has a frame like ours.
But there’s a problem: the bipedal design of man evolved during a time when there were no desks, computers and automobiles whose operation is better suited for sitting. Back then, there was only rough terrain to walk for miles in order to seek shelter and food. There was fast prey to subdue by foot in order to not starve.
Fast forward to today: just about all occupations these days involve using a laptop. White collar jobs, and increasingly blue collar jobs require sitting at a desk. Sitting is required for operating airplanes, trucks, and cars. To add to the problem, food is plentiful; overall less nutritious and higher in calories — no need to walk that much (expend calories) to get it while it packs on the pounds. Humans are much heavier than they were millions of years ago, on average, and it’s not due to muscle. This makes standing less tolerable, and makes sitting feel better on our feet.
So the combination of frequent sitting and weight gain, which places more pressure on your joints, is a harmful combination that leads to pain and injury, affecting tens of millions of people. Osteoarthritis is the gradual degeneration of the joints, particularly the weight-bearing joints (hips, knees, feet, lumbar spine) and it is hastened with obesity and sedentary living.
Here are the detrimental things that happen in your body when you sit for prolonged periods throughout the day:
The pressure to your lumbar discs increases. Sitting removes back support from your legs, pelvis and abdominal muscles, which contract less when you sit.
Your postural muscles turn off somewhat, and as a result you burn less calories. Some studies connect this to a rise in bad cholesterol levels in the blood.
When you bend your neck to look at a monitor screen while sitting, it creates forward head posture. This strains the neck and upper shoulder muscles, and compresses the neck vertebrae; hastening osteoarthritis in the cervical spine. It can even cause tension headaches.
Sitting is an inescapable part of life. The key is to compensate for it by standing and walking when you can. Neutralize its effects. There are many ways to do this while living a modern lifestyle: walk to work, walk during lunch breaks, take the stairs instead of escalator, and do 15-minute workouts right in your office or work area, to name a few.
Drs. Brent and Tiffany Caplan, integrative medicine practitioners based in Ventura, California recommend the following simple stretches to do to counteract sitting:
Let’s talk about creep. No, I am not talking about a person unwelcomely staring at you all night from across the bar. I am talking about a constant load of stress applied to soft tissues (muscles, ligaments, fascia, discs) over an extended period of time resulting in a progressive deformation of those soft tissues. This can lead to muscles or ligaments changing their functional resting length and adaptively shorten or lengthen. These imbalances will lead to degeneration of your spine and will also set you up for future injuries. Creep to your intervertebral discs, the cushion between each spinal segment, may cause them to deform eventually leading to a herniated disc.
A common position that we are constantly in, as working professionals or students, is sitting. The sitting position, especially if in a poor slouched posture, puts an overload of strain in your neck, mid back, and lower back. It may also affect how well you are breathing. Poor respiration will lead to a decrease in oxygen supply to your body and brain!
So now that we know about creep and sitting how do we prevent it? The answer is simple. You should not sit for more than 20 minutes without taking a micro-break. These include Brügger’s relief position and the standing overhead arm reach. No pain should be felt during these movements. These movements are beneficial if you have any back or neck pain or want to support your spine and prevent any degeneration or future injury.
Brügger’s relief position:
Do while standing or sitting on the edge of your seat.
Relax arms at side and turn palms outward, spread fingers, bring shoulders down and back, tuck your chin (attempting to make a double chin, not looking down but straight ahead).
Now exhale repeatedly as if trying to make a candle flame flicker but not go out. Be aware to make sure you are stomach breathing and not chest breathing. (To test this put one hand on your chest and one hand on your stomach. You should feel your stomach rising up and down as your inhale and exhale but your chest should remain still).
Do this for 10 seconds every 20 minutes.
Standing overhead arm reach:
Stand up and gently raise both arms above your head with palms facing forward and elbows slightly bent.
Take a deep breath in through your nose and hold the breath while reaching up as high as you comfortably can (a stretch should be felt in your lower back).
Hold for a couple seconds then release the breath through your mouth and go back to the starting position.
Do 10 repetitions every 20 minutes.
Now you’re done and your micro-break only lasted 30 seconds, totaling a mere 1.5 minutes per hour, to maintain your health and prevent spinal injuries.
Dr. Brent Caplan & Dr. Tiffany Caplan Central Coast Center for Integrative Health 1730 S Victoria Avenue, Ste 230 Ventura CA 93003
The human body has magnificent intelligence to monitor, maintain, and repair itself 24/7. These complex, biological functions are the result of millions of years of evolution and of course play a major role in the survival and thriving of our species.
But even nature has its faults. When it comes to injury repair, the body’s repair mechanisms can inadvertently create a new set of problems.
When you sustain tissue damage, whether from sudden trauma such as spraining your ankle or gradual trauma such as a cumulative/repetitive tendinous strain or joint wear and tear, your body initiates a cascade of events to heal the injured tissue.
First, clotting factors appear and thicken the blood to stop any bleeding (hemostasis). This is a complex chain reaction that involves many types of substances, each with a specific role. Some clotting factors make blood vessel walls more permeable, allowing fluids to exit around the area and accumulate into the extracellular (outside the cells) spaces. This is why edema, or swelling occurs following an injury. The purpose of swelling to quarantine the injury site by creating a wall of pressure around it. The swelling also contains noxious substances (“the inflammatory soup”) such as substance p and arachidonic acid that produce pain and therefore discourage movement, protecting against further damage.
While this is happening, cells called fibroblasts start laying down a net of protein fibers called fibrin around the damaged tissue, which could be skin, muscle, bone or organ.
This fibrous net catches red blood cells, which stack up and form a fibrous blood clot, plugging damaged blood vessels and filling in the space formed by the injury. The fibrous clot gradually contracts, hardens and pulls damaged tissues together. The blood clot material eventually thins out, falls off, and may even be picked off by the person. Underneath, the reparative collagen fibers remain, forming what we call scar tissue.
You can observe this process if the injury is superficial such as a gash in the skin, but this process also happens in ligament, tendon, muscle and bone tissue injuries where there is no damage to the skin above. If it was a paper cut, you may not see a scar, but if it was a gash/laceration, when it finally heals you will see a scar.
Upon close inspection, the scar is lighter in color, feels harder, and is raised. Now imagine this scar tissue in the ligaments and tendons of a healed sprained ankle, knee or shoulder where there is movement and proximity to other structures such as bone, muscle, bursae, and nerves.
Unlike the scar tissue of a skin gash, which does not take much physical stress to it, ligaments and tendons by nature are subject to frequent movement and stress (bearing a load). They are components of all joints in your body, and the function of joints is movement and generating force. So, excess scar tissue in deeper muscle, ligaments and tendons present potential problems, described next.
Going back to the repair process, as the fibroblasts continue to lay down strands of collagen, they do so in a random, criss-crossed pattern forming the scar tissue. It’s tough and dense, which is good for repairing, but can also pose a problem in a couple of ways.
First, the criss-cross pattern of scar tissue makes it less elastic (stretchable). So after it heals, and the area is later subject to substantial stress, the scar tissue will give, and you’ll have a re-injury. This explains why boxers easily get flesh cuts after getting hit in the right spot—it’s an area of scar tissue from a previous cut that “broke” upon absorbing stress forces. Fibrosis is a term that describes pathological scar tissue; i.e. abnormal scar tissue deposition that causes disease/dysfunction such as pain and restricted movement.
Second, the very dense nature of scar tissue can cause pain receptors to bunch up around it, as they cannot penetrate it. This makes the injury site sensitive after healing completes, and contributes to the pain becoming chronic (recurring). Small, focalized areas of pain are called trigger points, as they can trigger pain in other areas when pressed.
Third, scar tissue build up constricts blood vessels, which compromises waste removal from the area and inhibit oxygen delivery to the area. In some cases, this results in chronic, low-grade inflammation, which contributes to pain sensation.
Fourth, the body may try to stabilize scar tissue by calcifying it. Calcium ions in the blood deposit on the scar tissue, hardening it and making it have rougher edges, which can cause restricted and painful movement. This is common in chronic shoulder injuries.
The bottom line is that scar tissue is essential to healing, but due to the aforementioned reasons it may also lead to pain chronicity, whether it is an acute onset sprain/strain injury; a cumulative strain such as tennis elbow; or pain from tissue degeneration such as hip osteoarthritis.
So how does one fix chronic pain caused by excess scar tissue build up?
The Ideal Approach to Ensure Proper Soft Tissue Healing, Minimize Scar Tissue and Prevent Chronicity
The best defense is a good offense: immediately after an injury, follow the standard methods of treatment: apply cold directly to the area; add some compression, elevate the area if possible to help prevent excessive swelling/edema, and rest the injured area for at least two days. If the pain is unbearable, you can take over-the-counter anti-inflammatory medications (non-steroidal anti-inflammatories like Tylenol and Ibuprofen) but I recommend trying to just stick with ice if you can, and tough it out.
As the acuteness subsides, you can introduce passive movement of the injured area. This stresses the ligaments and tendons just enough which causes the fibroblasts to lay down the scar tissue collagen fibers in a more organized fashion, which will result in better healing/ quality of healed structures.
Then, perhaps on the third day do active movements of the injured area, then a week later, active-resistance movements (weights, resistance bands, swimming pool) to stress the structures in a controlled fashion, encouraging quality remodeling of scar tissue. You may need assistance from a rehab specialist to gauge how much resistance to use, and when.
And finally and ideally, your injury will be 100% healed, without loss of strength or range-of-motion.
What to Try if You Did Not Rehabilitate Your Injury Properly and Have Chronic Pain and/or Stiffness
But what if you didn’t do all of this, and now your pain is chronic, a year after the injury or onset of pain? Scar tissue could be the main culprit: limiting mobility, getting re-injured, attracting pain-sensing nerve endings (forming trigger points), and constricting arterial, venous and lymph flow to and from the injury site causing chronic, low-grade inflammation.
Will heat do the job? Heat such as that delivered by a hotpack vasodilates blood vessels close to the skin. If you use an infrared heat lamp, you could treat deeper areas such as the hip. This may help your chronic injury feel better, as more circulation means more oxygen, nutrients, proteins and other substances that benefit cells. But heat doesn’t do much to that hard, rigid scar tissue. Heat offers temporary relief.
Will electrical stim (TENS) help? Devices like TENS that deliver an electrical current to the skin transcutaneously (through the skin) can be helpful in temporarily reducing pain perception, but they do nothing to address scar tissue.
Will pulsed EMF help? Pulsed EMF uses magnetic fields to generate pulses of electromagnetic energy. PEMF has been used since the 1950s to help heal broken bones. Scientists know that biological tissue reacts to electromagnetic fields. They affect cell membrane permeability and gene expression, which can have beneficial effects such as reducing inflammation and synthesizing functional proteins. PEMF may make chronic pain feel better, but it does not have any therapeutic effect on scar tissue itself.
Will therapeutic ultrasound help scar tissue? Ultrasound (not the kind used for imaging) is the delivery of high frequency sound waves through the body to generate heat. Ultrasound is popular for treating deep joint structures, particularly the shoulder (glenohumeral joint), hip and knee joints. Unlike topically-applied heat, ultrasound heats from the inside of the body. Sound, physically, is reverberating pressure waves traveling through a medium. When the ultrasound waves pass through the skin and strike something of higher density; i.e. tendons, ligaments or bone, it generates heat, just as rubbing your skin really hard will generate heat. The pressure waves of the ultrasound may be strong enough to loosen some of the scar tissue fibers as well, making it a good choice for treating chronic joint pain.
Will massage therapy help? It can, depending on the nature of the scar tissue. It’s most effective in reducing fibrosis if started during the sub-acute phase, and continuing past the remodeling phase of tissue healing. Massage is known for its soothing/relaxing effect, but it is also appropriate for soft tissue injuries, particularly myofascial release/ trigger point release, deep tissue massage, instrument-assisted soft tissue therapy, and Active Release technique. These methods are more accurately described as “soft tissue mobilization” techniques and involve placing pressure into areas of scar tissue to break them up, stretch them as they are being laid down by fibroblasts, or to separate scar tissue adhesions—points where scar tissue binds to other structures.
There is another modality that is not well-known to most people that has a high success rate in treating chronic tendinopathies due to scar tissue fibrosis: extracorporeal shockwave therapy (ESWT), or shockwave for short. Shockwave uses pulsed, high energy acoustic (sound) waves delivered right through the skin to physically break apart/ thin out underlying scar tissue. You may have heard of how doctors can dissolve kidney stones using a machine that sends waves through the skin all the way to the kidney stone, without surgery, called lithotripsy. This is precisely extracorporeal (meaning “outside the body”) shockwave therapy.
Shockwave treatment is often described as “ultrasound on steroids” since it uses sound pressure waves, but at a lower frequency and higher energy. Think of thunder, clapping hands, and a jet breaking the sound barrier.
When a shockwave enters living tissue and encounters changes in tissue density or impedance (such as from fat to muscle) it will either be reflected, refracted, transmitted or dissipated just like any other wave. According to the site Shockwave Therapy Education, energy is released at these interfaces of different impedance values, creating compression and shear loads on the surface of the material with the greater impedance (mostly scar tissue, tendons, and ligaments), like very tiny explosions.
The energy released by shockwaves causes microtrauma (tissue destruction), which triggers the reparative process: new blood vessels form (neovascularization) and fibroblasts secrete collagen fibers in a more organized fashion, replacing the old, disorganized scar tissue. Blood flow improves, and the old, chronic injury undergoes new healing and heals more completely the second time around. The restructuring of collagen fibers results in less nociceptors than when fibrosis was present, and the result, after a brief soreness following the microtrauma, is less pain.
Conditions Extracorporeal Shockwave Therapy is used to treat include:
Plantar fascitis
Epicondylitis
Trochanteric bursitis
Dupruyten’s contracture
Carpal tunnel syndrome
Achilles, patellar and other tendinopathies
Post surgical scar tissue fibrosis
Below are video fluoroscopy images of ESWT breaking apart a calcaneous (heel) bone spur:
TYPES OF SHOCKWAVE MACHINES
There are two, main types of shockwave machines, ballistic and piezoelectric. In a ballistic machine, a small pellet is accelerated back and forth inside a metal tube by strong electromagnets or by compressed air. When the pellet strikes inside the end of the metal tube (strikeplate), it produces a radial shockwave. This type of shockwave is considered low-energy, as the shockwave dissipates and expands radially as it enters and travels through tissue.
A piezoelectric machine uses an array of tiny crystals at the end of a concave treatment head. An electric current is passed through the crystals, which causes them to quickly expand and contract, generating pulsed acoustic pressure waves. A silicone cone attachment is affixed to the treatment head to conduct, focus and direct the shockwaves produced by the tiny crystals.
The shape of the cone attachment and the output voltage determine the depth to which the soundwave travel. Piezoelectric machines are considered high-energy, as the acoustic wave is focused into a small area and does not dissipate much. These machines therefore are used with more caution.
BOTTOM LINE:
Scar tissue is like biological “glue” the body uses to repair injuries to itself, but it can cause problems long after the injury heals. Scar tissue fibrosis is a mass of hardened protein strands laid down haphazardly by fibroblasts at the injury site. It is often a factor in chronic musculoskeletal pain. It develops in injuries, such as shoulder and knee strains, and is worse if the injury is not properly treated/ rehabilitated. Scar tissue perpetuates chronic pain by inhibiting proper movement of soft tissue structures– tendons, ligaments, fascia and muscles, which can cause abrasion to adjacent tissues; inhibit vascular flow to the area; and cause sensory nerve endings to bunch together. Extracorporeal Shockwave Therapy (ESWT) is a treatment that uses high-energy pressure waves to break down scar tissue fibrosis so that new, organized fibers can replace it; abrasion and congestion are reduced, and movement and strength are improved. It is a highly-effective modality for tendinopathies and similar musculoskeletal diseases, with some studies finding an 80% success rate.
For more a more in-depth explanation of how extracorporeal shockwave therapy works, watch my interview with Dr. Ulyss Bidkaram, a chiropractor who uses ESWT in his practice:
Angela Notarnicola and Biagio Moretti. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles Ligaments Tendons J. 2012 Jan-Mar; 2(1): 33–37.
Semra Aktürk,1,* Arzu Kaya, et al. Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled study, J Phys Ther Sci. 2018 Mar; 30(3): 448–453.
I think we’ve all had an incident of one-sided jaw pain at some point, where it’s difficult to open and close the jaw without experiencing sharp pain. I’m not referring to chronic TMJ pain related to malocclusion (called TMD—temporomandibular joint dysfunction); I’m referring to those isolated incidents that happen to everyone on occasion. This condition can be caused by chewing hard/tough food requiring stronger than usual jaw muscle contraction; chewing a large piece of food on one side of your jaw; teeth grinding, and of course trauma to the jaw such as from boxing and other contact sports. The TMJ can also be misaligned from rear-end collision car accidents (acceleration-deceleration), as the force of impact is enough to violently hyper extend and flex the TMJ. Some cases of sudden onset TMJ pain self-resolve, but in other cases it can last for weeks, which can obviously be a nuisance as chewing food becomes uncomfortable.
The jaw, or temporomandibular joint is classified as a synovial, condylar joint. Joints are named after the two bones that comprise it, so the TMJ is formed by the articulation of the mandibular fossa (depression/pit) of the left and right temporal bones of the skull and the left and right condylar heads of the mandible (lower jaw), hence temporomandibular joint. It could have been named the “mandibulotemporal joint,” or MTJ, but someone long ago decided temporomandibular sounded better.
TMJ movement is very complex, involving flexion, extension, rotation, translation and oblique movements. These movements are accomplished by varying- magnitude, combined contractions of the temporalis, masseter, medial pterygoid and lateral ptergoid muscles controlled by the central nervous system, including nuclei in the brainstem. So, the simple act of chewing is neurologically complex; perhaps the most complex out of all the joints in the body.
Synovial means that the joint is encapsulated by ligaments and has an inner tissue lining called synovium that produces synovial fluid, a clear viscous fluid that reduces friction in the joint, very much like how motor oil reduces friction between a car engine’s cylinders and pistons. Not all joints are synovial, such as the acromioclavicular (AC) joint of the shoulder which is a fibrous joint; only the joints that are tasked to move frequently and have a comparatively larger range of motion i.e. knees, hips, shoulders, fingers, etc. The TMJ also has an articular disc, a thin slip of tissue that sits between the mandibular heads and temporal bone that provides cushioning/ shock absorption. Since the TMJ is a heavily used joint, nature added this extra protection. Just imagine the number of times the TMJ extends and flexes (opens and closes) in a typical day, from talking and eating!
So what is going on when you have one-sided jaw pain when you previously didn’t? The answer is that the jaw is slightly misaligned and the resultant, abnormal movement is pulling excessively on the soft tissues of the affected side and/or the condyle is pressing against the mandibular fossa excessively, firing surrounding nerve endings. Muscle spasm reflex of any of the aforementioned jaw movement muscles may also be contributing to the pain by maintaining the misalignment in place. TMJ misalignment is typically subtle and not usually visible, but sometimes you can see it if you open your mouth in front of a mirror. If you notice your mouth opening forms a tilted oval shape as opposed to an even oval shape, it means your mandible is deviating to one side due to TMJ misalignment. Usually, the mandible deviates to the same side of the misalignment/jaw pain, but not always.
To restore alignment and balance to your TMJ, try this:
Relax your jaw. This may sound easy, but for some people, especially those who subconsciously tend to clench their jaw, it is not. Just concentrate on your jaw and facial muscles, commanding them to let go. Your mandible should drop slightly so that your teeth are not touching at all.
Next, with your jaw still relaxed, using the palm of your hand on the side opposite to the painful side of your jaw, tap the opposite side of the jaw (the side of the jaw bone, not directly on the joint itself) firmly three times. Pause for ten seconds, then do it again. Wait for a couple more seconds, and see if you notice reduced pain. If pain is less, it means the TMJ settled back into alignment and the pain should start to go away and should be gone in about an hour or two. If not, tap obliquely at an upward angle towards the affected joint, then re-evaluate. If you notice the pain lessens, then that’s it—just wait a little longer, and the pain will disappear and your jaw will be back to normal.
If there is no change, try this: with your jaw still relaxed place your hand to the sides of your face with the tips of your index fingers directly on top of the protuberances of the condylar heads of the mandible and your thumbs cradling the back of the jaw bone (ramus). Alternately press gently inwards with your index fingers for a total of six times (three on each side). Then, using your thumbs gently pull the jaw forward three times. You can also gently push your jaw side to side alternating sides, three times per side. I need to emphasize that you must keep your jaw totally relaxed while you do this; otherwise it may not work.
Watch this video where I demonstrate these simple moves:
If you find that you get one-sided TMJ pain quite often, you may have malocclusion of your bite. Make sure to see your dentist/ orthodontist.
Sometimes TMJ can trigger headaches. If you have both, fixing the TMJ misalignment is likely to fix your headaches.
Do you notice that it takes more effort than before to do simple things like run, squat, or get out of your car? You can still do them, but not as fast and springy as when you were younger. If you’re over age 40, it’s likely you can identify with this.
The inevitable reality of being mortal is that our body starts to deteriorate after maturity, which is around age 21. For those who “age well” the deterioration rate progresses slowly and is hardly perceptible until the later years; for those who do not age well, the changes can occur relatively fast and are obvious.
The main musculoskeletal changes associated with aging are:
Muscle atrophy, especially in the upper leg and glutes
Decreased muscular strength and endurance
Decreased cardiovascular endurance
Decreased ligament and tendon elasticity
Decreased joint cartilage thickness and suppleness
Increased body fat percentage
The focus of this article and following ones will be on slowing down the gradual breakdown of the musculoskeletal system via exercises, stretches, diet, new habits and routines and other lifestyle modifications. Yes, slowing down the aging process and extending your “full functional” years is very possible if you have a good plan, and diligently stick to it. In other words, start developing good wellness/ life extension habits if you haven’t done so already.
In this article, the topic is joints. I previously wrote about the importance of keeping your joints strong by doing specific joint exercises during your workouts. This discussion is on doing daily joint stretches to counter the degenerative forces that come with aging.
One of things most people first notice as a sign of getting older is decreased ability to absorb and rebound from external forces and mechanical stress. You start to notice that it takes a bit longer to jump up from a seated position and get up after falling. You find it more difficult to bend, squat and maintain other awkward body positions. If you trip and fall to the ground, it takes more effort to get back up. And, when running you notice that you can feel the shock in your knees more, and therefore do not run as long, or give it up entirely. The reasons for this are decreased muscle strength, decreased ligament and tendon elasticity, and most of all, thinning cartilage in the weight-bearing joints. It takes more energy and effort to do these things because your body “hardware” has lost some of its youthful, structural integrity. Your mindset /motivation to move may be unchanged but your body isn’t responding as quickly and strongly.
As you get older, the cartilage lining your synovial joints (the joints encapsulated by ligaments) loses fluid content. To compound matters, when you are past the age of 40, human growth hormone (HGH) secretion by your pituitary gland practically ceases. HGH is the “fountain of youth” hormone that is largely responsible for the features associated with youth: energy, high metabolism, supple skin, thicker muscles and thicker, bouncier cartilage. It’s why younger people can bounce right back up after falling down, making it look effortless.
If you are over the age of 50 and your occupation or recreational interests involved placing pressure on your feet, knees, hips, spine, shoulders, elbows or hands chances are you are experiencing aches and stiffness. Your age, plus your history are not doing your weight bearing joints any favors. So what can you do?
If you are over the age of 40 and feel the slightest stiffness in your joints, I highly advise you start a daily routine to keep your cartilage healthy. Your goal is to effectively counter the natural progression of osteoarthritis—the disease that involves advanced thinning of cartilage, bone-on-bone contact, and resultant chronic inflammation and joint dysfunction (stiffness, pain, reduced range of motion). It plagues millions of people over the age of 50. Practically all former football players have osteoarthritis.
By investing just a couple of minutes a day every day, you can literally save yourself years of pain down the road, and perhaps preclude the need to take harmful anti-inflammatory medications and even the need to get knee and/or hip replacement surgery. Instead of pain, you will be able to squeeze out a decade or more of pain-free movement. That is a huge, quality of life issue because most of the enjoyable things in life require some degree of physical fitness—walking, bending, lifting etc. and joint pain can severely restrict your ability to engage in these activities.
In my view, in order for a preventive measure to be feasible, it must meet the following criteria:
It must be practical, with minimal preparation required
It must be realistic – no super-human feats required
It must address the problem and have close to immediate results
Here is the basic routine that I personally do every day to guard against cartilage deterioration. I will update this post with a video that illustrates these exercises, but for now, here is the description so that you can get started right away:
Arm propellers – slowly and with focused intent, make large circles with your arms, with the left arm moving counter-clockwise and the right arm clockwise, crossing in front. Keep the angle of your upper arm about 30 degrees relative to the coronal plane of your shoulder to avoid jamming your shoulder joints. Do about 20 rotations, and then reverse directions of both arms.
This exercise moves the glenohumeral (GH) joint, where your upper arm (humerus) articulates with your scapula. Many people don’t realize that in a typical day, they rarely raise their arms above shoulder level. This prevents areas of the GH joint to get proper lubrication, causing the cartilage to “dry out.” This exercise exposes all parts of the cartilaginous-lined humeral head to synovial fluid, the “motor oil” of joints and even stimulates production of it. The rigorous movement also stimulates lubricin production, a compound that further reduces friction inside the joint.
Elbow propellers – similar to the arm propellers, rotate your lower arm (forearms) in opposite circles by keeping your upper arm relatively stationary so that most of the movement is at the elbow joint. There is some movement in the GH joint, but also some in the radio-ulnar and humero-ulnar joint. Do 20; reverse directions.
Wrist stretches – interlace fingers as if to pray, then alternately pronate and supinate the hands while making a circular motion, stretching the wrist joints in all directions.
Finger flexion and extension – make loose fists with both hands, and then unfold the fists segmentally (extend the fingers) first at the metacarpal-phalangeal joints (knuckles), then proximal interphalangeal joints, and then the distal interphalangeal joints until your hands are flat, fingers fully extended. Then, reverse the process (flex the fingers segmentally) back into a fist. Repeat about ten times.
Collarbone stretches – this mobilizes the sternoclavicular (SC) joint, where the proximal clavicle articulates with the sternum (breast bone). The joints are identified by the two, large bony protuberances at the base of the neck. For this exercise, make a shortened swimming stroke with your arm: bring it backwards, raise it up for the stroke and with elbow bent about 90 degrees, make a big scooping motion downwards, reaching all the way back (palm of hand should be facing upwards), and then supinate your forearm and repeat the motion. You will probably hear some grinding noises in your SC joint as it moves. Do about 10 repetitions; switch sides.
Torso circles – This nicely moves the joints of the lumbar spine in a stirring motion—the facet joints and the intervertebral discs, forcing their hydration. Place feet about two feet apart and place your hands on the sides of your pelvis. Hinge at the hip joints (bend torso forward and down, being careful to contract your back muscles for support) and then move your torso in a large, counter-clockwise circle reaching the maximum lumbar active range of motion in all directions of the circle. Do ten circles; reverse directions.
Lumbar extensions – I recommend doing these especially if your job involves prolonged hours of sitting, such as a desk worker, airline pilot, or truck driver. Sitting flexes your lumbar spine, which encourages posterior disc migration, a risk for herniated discs. Simply place the palms of your hands behind you, just below your waistline. Then, lean backwards and bend over your hands (try to keep them stationary in space), arching your back and hold for two seconds. You should feel tightness in your low back. If not, bend back some more. Return to neutral. Do 10 repetitions.
Hula hoops – this targets your hip joints by moving your pelvic bowl around the femur heads. With feet shoulder length apart and hands on your sides, make big circles with your pelvis like a hula hoop motion. You should feel your hip joints moving even though your legs are stationary. By doing this, you bathe all areas of the femur heads and stimulate synovial fluid production.
Knee circles – the knees move mainly as a hinge joint (flexion and extension) but there is some ability to rotate and translate (move in a circular motion and side to side motion). With feet together touching, bend your knees bout 30 degrees and place your hands around them. Move your knees together in a clockwise direction 20 times; reverse direction.
Ankle circles – point your toes to the ground, and flex them against the ground by placing light, downward pressure. Then, move your ankle in a clockwise direction keeping your toes in place. This moves the many articulation points of the ankle, as well as the joints of the forefoot: metatarsal-phalangeal joints and interphalangeal joints.
BOTTOM LINE: As you age, your joint cartilage loses its fluid content and starts to get stiffer. If the joint doesn’t get much movement, it compounds the problem. You can arrest this process by diligently doing these exercises to ensure all your joints are tasked to move, which signals the body to produce more joint fluids.
Whole BodyCryotherapy (WBC) is starting to trend in the health and wellness arena. As a big proponent of non-medical self-care methods to achieve and maintain health, it piqued my interest when I first encountered it. No, it’s not a place that uses crying as a form of emotional therapy, as the name could suggest. Cryotherapy is the application of cold to the body for therapeutic effect. It is one of the two, basic modalities that have been used for centuries to reduce pain; the other, of course, being heat. Ice packs, ice baths, ice massages and frozen hand-held metal applicators are common ways to apply cryotherapy. Ice is 0⁰ Celsius (32⁰ F) so when it contacts your skin, which is about 91⁰ F plus or minus a couple of degrees depending on the outside temperature, heat flows out of your body since energy flows from high concentration to low (diffuses). It is the movement of heat out of your body that the brain perceives as cold (it is not “cold” moving into your skin).
But what happens if instead of 0⁰ C, you exposed your skin to -100⁰C (-148⁰ F)? That is what a cryotherapy center offers, and will be the focus of this article.
Does Cryotherapy Work for Pain?
We already have a good understanding of what happens when human tissue is exposed to such extreme cold temperature, since cryotherapy has been around for decades. Cryosurgery, a form of cryotherapy, is highly focused cold using liquid nitrogen or argon gas to treat dermatological conditions such as warts and benign tumors, as well as cancerous tumors of the liver, kidneys, bones, lungs and breasts. It is also used for anesthetic purposes to deaden irritated nerves. Since human cells are about 75% water, when you apply sub-zero temperature to them the water crystallizes and denatures the cells, effectively killing them. The body then replaces the dead tissue with new cells. Cryotherapy centers, however, do not offer cryosurgery. They apply extreme cold to the whole body not to kill cells, but to “shock” the body’s central nervous system, causing it to initiate physiological processes that benefit pain reduction and tissue healing (explained later).
There are many studies in the medical literature that support the use of cryotherapy for inflammation and pain. In one study, patients suffering from adhesive capsulitis of the shoulder were randomly divided into two groups. One group had whole body cryotherapy along with physical therhapy (PT), and the other only PT. The results showed that while both groups improved, the group receiving WBC plus PT experienced significantly greater improvement in shoulder range of motion, subjective pain, and functionality.1
Another study examined the effects of WBC on fibromyalgia, a systemic condition that involves heightened sensitivity to pain throughout the body. In the 100 person study, fibromyalgic patients treated with cryotherapy reported a more pronounced improvement of the quality of life compared to the non-treated subjects, as indicated by their scores on qualitative indexes (questionnaireson functionality/ quality of life). The researchers speculate that the positive result was due to cryotherapy’s effect on reducing pro-inflammatory mediators involved in the modulation of pain.2
My Experience at a Cryotherapy Center
I am fortunate to live in a city where cryotherapy is offered. Last week, I visited one called U.S. Cryotherapy to find out for myself what this new pain relief trend is all about. It’s a franchised business with locations in ten states including here in California, Arizona, Texas, and Florida. Upon meeting the owner, I discovered that you do not need to have a professional license (M.D., R.N.) in order to own or operate a center. Apparently, the corporate attorneys made sure that the services offered do not violate any laws regulating the practice of medicine in the state. This also suggests that the services are relatively safe to do without direct supervision of a doctor or nurse, which is reassuring.
I filled out a general medical history form on a wall tablet (touch screen). This lets the technicians know if you have any condition that might make cryotherapy risky, such as heart problems. After that, I got a tour of the facility and was shown the main cryotherapy services: whole body cryotherapy (WBC) and localized treatment cryotherapy. I decided to try WBC first. They have you remove your clothes and provide shorts (yes, you go in a freezing room bare skinned!). You put on a terry cloth head band that goes over the ears to protect them from the cold, a towel face mask to cover your nose and mouth, a pair of large wool mittens to protect your hands, and wool loafers. At this point, I am wondering what I have gotten myself into, as I have never experienced being in sub-zero temperature in bare skin!
Whole body cryotherapy chamber, -150 degrees F.
The WBC room resembles a meat locker,with a warmer holding room that you stand in prior to entering and a reefer-style heavy stainless steel door. The technician stands at the control console outside the room, which hasa large window so that you can be monitored constantly. H e sets the time and temperature, and when the temperature reaches 100 degrees below zero Celsius, he then gives the sign to enter.
I enter, and at first it doesn’t feel as cold as I thought—a crisp, dry cold enveloping my whole body. Later, I found out why. According to their website:
“Cold air therapy in the whole body chamber is a dry fresh, oxygenated air so you won’t experience shivering, goosebumps or other reactions that you might associate with being cold. Because of this technology, unlike an ice bath or immersion, cryotherapy is not painful. During the treatment, your skin temperature will decrease between 30-45 degrees over 2.5 to 3.5 minutes inside the chamber.”
Now this is interesting. With dry air (much of the water vapor removed) you can handle lower temperatures than if you were to soak in an ice bath. You see, heat travels faster through a liquid than it does through gas (air—CO2, O2, N, and H) which is why most people can’t handle more than a few seconds of being submerged in a bathtub full of ice water. The dry, sub-zero temperature air of WBC enables you to stay exposed for 2-3 minutes enabling more therapeutic effect.
At the one minute mark, I was getting really cold, and started to walk around and move my arms to generate some heat. But even then, it was a different kind of cold I haven’t experienced before. I wasn’t shivering. My teeth weren’t rattling, and I did not get goosebumps. It was just a sensation of homogeneous, intense cold. I noticed some small ice crystals forming on my arm, because as heat leaves the surface of the body it interacts with the air causing any remaining water vapor in the air to crystallize into frost. Was I going to make it?
At the two minute mark, I noticed my heart was beating faster. This is a sympathetic nervous system response to extreme cold and is a desired response as it stimulates the release of endorphins and norepinephrine by the brain. Endorphins are the “feel good” hormone that reduce pain and stress, and creates the sense of euphoria. Norephinephrine, also called noradrenaline, is a neurotransmitter released during times of stress that boosts focus, attention and mood. Scientists also found out that it suppresses the production of tumor necrosis factor (TNF), one of several inflammation-promoting biochemicals. This sequence of events occurs in response to what is called “cold shock,” and is the therapeutic goal of WBC. Cold shock is caused by a hypothermic event (a big, sudden temperature drop at skin, such as that caused by WBC) causing heat to leave the body much faster than usual, which vasoconstricts (tightens) the blood vessels of the extremities (another sympathetic nervous system response) and diverts blood from the arms and legs to the core to keep the vital organs warm.
As the effects of cold shock continue, any musculoskeletal pain present (strain, acute or chronic injury, or arthritis) is lessened. Blood vessels constrict, blood flow slows down, inflammation drops, and pain signals traveling from pain site to brain slow down significantly because action potentials (electrochemical charges) move slower in colder environments.
At 2:15 into the treatment, I sensed my cold tolerance quickly being reached and was ready to get out the chamber ASAP (but, this could partly be due to apprehension as it was my first experience). I reached 2:30, and eagerly exited the chamber. The technician used a laser thermometer on my skin and reported that my skin temperature dropped about 50 degrees.
Upon exiting the waiting room of the WBC chamber, I felt invigorated. Although I am in pretty good shape musculoskeletal-wise, I have minor aches in my feet and shoulders, mostly due to my age and years spent as a chiropractor. But after the cryotherapy session, these aches were significantly reduced, almost down to zero.
When you exit the chamber and return to room temperature, the heat from the warmer air moves into your colder skin, which is sensed by your central nervous system. This shuts off the cold shock response, and the body returns to homeostasis: the constricted blood vessels dilate back to normal and oxygen-rich blood moves into the extremities again. So if you have, let’s say, knee swelling and inflammation, the constriction and then dilation of blood vessels effectively “wrings out” inflammation and then draws in oxygenated blood and nutrients to the knee, much like squeezing out dirty water from a sponge and then releasing it, letting it soak up clean water.
Cold shock followed by room temperature helps to move stagnant blood and inflammatory chemicals out of an injury site, and bring in fresh, oxygenated blood, similar to wringing out dirty water from a sponge.
Here is a short video provided by U.S. Cryotherapy that explains how cryotherapy works:
Is a Simple Ice Pack Just as Good as Whole Body Cryotherapy?
WBC produces a much different effect than using localized ice, which also reduces pain by localized vasoconstriction and slowing down pain signals. The big difference between the two is that ice application does not initiate the systemic (body-wide) cold shock response like WBC does, so you don’t get the additional anti-inflammatory benefits previously described, or the endorphin and norepinephrine release. Local cryotherapy application is also superior to an ice pack because it is able to apply lower temperature to your skin. Most physical therapists will tell you to ice for 20 minutes max, but that is not possible with localized cryotherapy because of the much lower temperature it provides. Two to three minutes is the longest time human skin can take with cryotherapy.
How Often Should You Get Cryotherapy?
Whole body cryotherapy treatment guidelines for pain reduction depend on the goal. If you are post-surgery or have an acute (recent) injury, daily to multiple per day exposures for a week are appropriate. If you have chronic joint pain, a wellness routine is more appropriate, which can be once to twice a week treatments. Lastly, you can do it for general wellness on an as-needed basis. You’ll get a jolt to your circulatory system; increased heart rate (strengthens heart muscle like exercise), endorphin release, and according to the folks at U.S. Cryotherapy, improved sleep and mood.
Now with WBC under my belt, I decided to try localized cryotherapy on my chronic elbow strain and hand. For this procedure, I sat in a recliner while the technician used a machine to blow cold, dry air around my elbow. While he did this, he used a laser thermometer to monitor skin temperature. He directed the cold stream of air back and forth in quick, short strokes over the painful areas. The air is so cold that you cannot leave it in one spot for more than a few seconds; otherwise you can get tissue damage. Overall it felt as intense as the chamber, except localized. After the 3 minute treatment, the pain was reduced about 70%.
Localized cryotherapy treatment
After You Do Cryotherapy
After your cryotherapy session, you can engage in 20 minutes of exercise on a treadmill or stationary bike. This enhances circulation and flushes out of waste products. They also have a red light therapy chamber you can use immediately after doing WBC, as well as Pulsed EMF (uses pulsed magnetic waves) which can further reduce pain and even accelerate healing of tissues. I previously wrote about the benefits of both of these modalities as I have used them myself, with success. They make excellent home therapy devices.
What Health Experts Say About Cryotherapy
You may have heard of Wim Hoff, known as the “Iceman.” He is a Dutch athlete famous for being able to withstand extremely cold temperatures. He does this regularly because he believes exposure to cold is good for your health. According to Hoff:
“Proper exposure to the cold starts a cascade of health benefits, including the buildup of brown adipose tissue and resultant fat loss, reduced inflammation that facilitates a fortified immune system, balanced hormone levels, improved sleep quality, and the production of endorphins— the feel-good chemicals in the brain that naturally elevate your mood.”
Wim Hoff opines that modern living, where man is always wearing layers of clothes and living in temperature controlled environments dulls the body’s innate responsiveness and adaptability to its natural environment, which makes modern man more susceptible/ less resistant to disease. You don’t need to emulate Wim Hoff (the physical feats he does in cold would kill most people), but realize there are health benefits to exposing your body to cold.
Mark Sisson, a popular health blogger noted for his “primal” philosophy of mimicking prehistoric man’s lifestyle to strengthen your health (which I follow loosely), states that occasional, intentional exposure to cold will “improve your focus, confidence, and mental resilience…and that these benefits will carry over into all other areas of life.” He adds, “Anecdotal evidence from [extreme cold] enthusiasts also suggests that toughing out a cold shower or committing to a focused cold therapy regimen has profound mood elevating effects.” Those who endure the unpleasantness of being subject to extreme cold do so because they know that feeling good is just around the corner.
According to Dr. Rhonda Patrick, PhD., an expert in longevity science, just a 20-second immersion into freezing water a couple times a week can increase norepinephrine levels 200-300 percent. Imagine what 2-3 minutes would do. This will increase your heart rate, constrict blood vessels, and release glucose into the blood for your skeletal muscles. As previously mentioned, norepinephrine also acts as an anti-inflammatory by reducing tumor necrosis factor, a substance associated with practically all inflammatory-related diseases.
When you do whole body cryotherapy or other extreme cold practice, it basically conditions your body’s innate, adaptive mechanisms. Your body’s ability to handle large temperature swings is actually a health metric, like cardiovascular fitness and mobility. We tend to lose this as we age, which is why the elderly are more vulnerable to heat waves and are usually the first casualties when one strikes. Exposing yourself to very cold temperatures for short periods to increase your tolerance to cold is intuitively a good, health-promoting activity.
One thing that I should point out about cryotherapy is that it is not recommended post exercise. When you do an intense workout such as a marathon, the post-workout inflammation in the muscles should be allowed to run its course. This builds muscle adaptation to exercise by conditioning its restorative/recuperative mechanisms. Doing cryotherapy immediately after exercise, while it feels soothing, interrupts the process. It inhibits the “adaptation conditioning” of your muscles and you will not increase your endurance.
The Final Verdict
If you have any form of musculoskeletal pain and are fortunate to have a cryotherapy center nearby, give it a try. It’s one of those things that, while not a magic bullet for pain, has enough anecdotal evidence to validate its claim, as well as science. 100 degrees below zero Celsius while in your shorts can understandably intimidate some people, but it’s not that bad—you are in there for less than three minutes, and it’s dry cold, which your body is able to tolerate better. Whole body cryotherapy’s value is its ability to “comfortably” produce cold shock, reducing inflammation and pain and stimulating endorphin and norepinephrine release which improves mood, mental clarity and sleep. Do not use it post-exercise; rather, consider using it a couple of days after orthopedic surgery; after any recent soft tissue trauma (sprain/strain, whiplash from car accident, sports injury); if you have a chronic musculoskeletal conditionsuch as knee osteoarthritis or shoulder problem; or, for general wellness.
If you don’t have a cryotherapy center in your town, there’s another way to get the benefits of extreme cold therapy: get a freezer chest and fill it with water and ice so that the temperature is near freezing. Then, you’ll need to brave the initial shock of submerging yourself, and see how long you can tolerate it. Since it’s cold water and not cold air that you are using, it won’t be as comfortable as using a cryotherapy chamber; you will likely shiver due to the faster heat transfer properties of water vs. air. Here is a video of Brad Kearns, co-author (with Mark Sisson) of the Keto Reset Diet and cold therapy enthusiast, on how to set up your personal cold therapy center:
Lastly, if this isn’t an option for you, try turning your shower water to cold for a minute or two. It’s best to just go for it and not try to ease yourself into it—turn that knob and tough it out. Do it in the middle of your shower and finish with a couple of minutes of warm water, or finish your shower with two minutes of cold water. You will feel invigorated; trust me. Do it every time you take a shower, or every other time– the more you do it, the better you’ll adapt. Keep in mind all the health benefits of cold exposure you’ve learned here; hopefully this will motivate you to take some action.
1 Sang-Yeol Ma et. al, Archives of Physical Medicine and Rehabilitation. Volume 94, Issue 1, January 2013, Pages 9-16.
2 Lorenzo Bettoni et. al, Clinical Rheumatology. September 2013, Volume 32, Issue 9, pp 1337–1345.
If you’ve ever had a kink in your neck, or felt your upper or lower back needed some “cracking” because you sensed restricted movement, then you are probably familiar with the benefits of spinal adjustments; also called manipulation.
So what exactly is a spinal adjustment?
Basically, it is a hand-delivered force into an improperly moving joint done to make it move normally. Vertebrae can get “stuck” in a rotated or bent position by numerous ways, such as sleeping on your stomach with neck twisted or a sports injury. This can feel very uncomfortable and may even cause sharp pain, arm numbness or headaches.
It is roughly estimated that about one million adjustments are done in the U.S. every business day, mostly by chiropractors. It is their “bread and butter” treatment because chiropractic is based on the belief that abnormal spinal alignment contributes to poor health, and manually correcting the alignment can improve health. Because they do it the most, chiropractors are considered the specialists most proficient at spinal adjustments/ manipulation.
According to ShareCare, about 30 million people see a chiropractor each year, mostly for various types of musculoskeletal pain and dysfunction. The benefit is improved range of motion (flexibility) and decreased discomfort/pain. Some patients experience other symptomatic improvement such as cessation of a headache or clearance of congested sinuses (there are medical models to explain this, but this isn’t the focus for this particular article). While there are pockets of naysayers, it is fair to say that getting your neck and back adjusted can be good for you.
Are You Actually “Adjusting” Yourself When You Crack Your Neck Yourself?
If you or someone you know “crack” your joints by twisting your neck or low back until you hear a pop. I personally know someone who has a daily routine for this, using her hands to forcibly twist her neck by grabbing the top of her head and chin like in the picture above, and rotating her head far to the left, then right; and then twisting her spine while sitting. I noticed that she gets an unusual amount of popping when she does this; seemingly with little effort. This excessive popping indicates that the spinal facet joints have become hypermobile from overstretching—they’ve lost some of the ligamentous support, allowing the joint to move more than it was designed to. Hypermobility of joints accelerates wear and tear, leading to bone spurring and disc thinning, which can eventually press on nerves inside the spine causing pain and weakness in the extremities. Although, as far as I know, there are no conclusive studies on the benefits or harm of cracking your neck often, I believe that it is best not to do it for these reasons.
The next question is, if you are able to pop your own neck or low back by forcibly twisting it, are you essentially adjusting it? Are you getting the same benefit as an actual chiropractic adjustment?
This is not easy to answer, because in order to get a scientific-based answer to this, a large study (many people) is necessary, which hasn’t been done to my knowledge. Also, the outcome (result of cracking vs. adjusting) is difficult to measure. As a chiropractor myself, here is my explanation of the difference between “cracking” your own neck and getting a chiropractic adjustment:
When you “crack” your neck yourself, you are essentially twisting or bending (depending how you do it) all your neck vertebrae at the same time. At some point, you get cavitation—the popping sound made by collapsing pockets of dissolved gases in the small facet joints of the cervical vertebrae, due to the expansion of those joints as you bend your neck to the side. There is a sense of pressure release and improved neck flexibility afterwards. Sometimes it can be verified by checking range of motion before and after; sometimes not. People who do it will typically say “it feels good,” or “it relieves pressure.”
On the other hand, a chiropractic adjustment to the neck targets just one vertebrae—the problematic one identified by palpation and/or x-ray, so it is more precise. It also incorporates an external force—the hand thrust—that forces the vertebrae into the direction where it is deficient; i.e forces it back to its normal range of motion.
Most people will tell you that the feeling after a neck adjustment is very different that the one you get by merely twisting your neck: it is a focused, louder sound and you feel a heightened sense of things immediately afterwards, similar to having a wax earplug removed or clogged nasal sinuses suddenly cleared. This may be explained by improved nerve firing, better circulation and restored neck muscle balance.
So these are the differences between cracking your own neck and having a chiropractor adjust your neck. But again, there are no studies I can reference that proves the superiority of one over the other. Currently, the evidence is subjective, or anecdotal.
Is It Easy to Do Adjustments Yourself?
If you have ever been to a chiropractor, you know that it does not take long for the chiropractor to do an adjustment – about 5 seconds total, including the palpation (feeling for the joint’s movement) and set-up of the thrust. On the surface, an adjustment seems like a relatively simple procedure to do (although more subtleties are involved that you don’t notice). In other words, it’s not brain surgery. This apparent simplicity is what encourages some people to try it on themselves or their housemate, partner or friend. They take note of what their chiropractor does and perhaps watch YouTube videos of chiropractors adjusting patients to see how it’s done. I even made a video on chiropractic adjusting a couple of years ago which you can see here. I will venture to guess that a lot of “adjusting” occurs outside of chiropractic and physical therapy offices.
So, is self-adjusting, or adjusting a housemate safe? Can it be beneficial? Most would say no, for the obvious reasons—you need to get proper training, it could be dangerous and you could hurt someone, etc.
There can also be legal implications to this, such as practicing without a license.
Obviously, the best solution is to seek the services of a licensed, experienced chiropractor who knows the ins and outs of adjusting. However, I do understand that some people cannot afford to see a chiropractor, or don’t have access to one; or simply don’t want to see one for personal reasons but still desire to obtain the benefits of spinal adjustments. As a big believer and advocate of self-care for managing musculoskeletal pain, I have an atypical perspective on this, which I’m sure most chiropractors won’t agree with. My view is that, with proper guidance, every day people can learn to do modified adjustments, or joint mobilizations to relieve pain and discomfort on themselves and others. These are basically targeted stretches that have elements of joint mobilization. Before I describe them, I will explain the distinctions between adjustments, joint mobilization and stretches.
An adjustment is a short lever, high velocity manual thrust into a joint. Short lever means that you contact a small protuberance of a bone and use it as a lever to move the whole bone (see diagram below). If it’s a spinal vertebra, you can use the bone’s transverse processes or spinal process as a lever to move the whole vertebra. You locate these structures, contact them with your hands, decide which direction you wish to move the bone, and thrust in the appropriate angle and depth.
The term joint mobilization is used to describe longer lever, lower velocity force applied to a joint; for instance, using the femur bone for leverage to manually circumduct the hip joint.
Stretches of course apply to the soft tissues—muscles, ligaments and tendons. They are done to elongate contracted fibers to increase flexibility, and are done by isolating the muscle and elongating it with movement. Stretching ligaments requires you to move the joint to its end range of motion, and then a few degrees past it.
Together, adjustments, joint mobilization and stretches are the three, primary tools of manual therapy for the musculoskeletal system. Note, however, that soft tissue mobilization is a term used to describe various forms of deep tissue/sports massage, and can also be considered manual therapy.
In my opinion, it is fine for someone to learn how to do modified forms of adjustments. Manual therapy is one of the safest forms of therapeutic intervention; even safer than taking aspirin. So if you’re an athletic trainer, massage therapist, acupuncturist or anyone else who is interested in learning how to adjust yourself or someone else, know that there are options. I believe the time has come for people to learn how to do basic manual therapy for the benefit of others. The trend may lead to a dramatic decline in neck and back pain in the population, much like how the fitness craze starting in the 80’s made people more lean and fit.
In the coming days, I will explain how to do some basic adjustments and joint mobilization moves that you can try—on yourself, and others. The key to doing these is to do them slowly and stay focused on what you are doing. Avoid sudden jerks especially to the neck. It’s not an issue when people stretch themselves and help stretch others. The techniques that I believe are safe and appropriate for non-trained people to do are similar in scope and complexity, but with some focus on moving the joints. Stay tuned!
If you are on Facebook, you’ve probably seen the relentless advertisments for massage “guns.” These are heavy duty, hand-held vibrational massagers that sellers claim provide a number of benefits; namely increasing blood circulation to muscles, reducing muscle tightness, reducing pain and improving muscle recovery from sports activities. The ads suddenly exploded on the scene a couple of months ago. There appear to be multiple sellers selling the same device, with brand names including Halo Pro, G3, Hypervolt, XVan and Intellitop and most if not all are manufactured in China. The price ranges from about $100 – $225.
Below is a screenshot of the Amazon listings of these products. Apparently, they are selling like pancakes:
But are massage guns really good for you? Are they worth the money you spend? Or, are they just old technology being packaged as something new and innovative, using exaggerated claims and expensive marketing? Or perhaps…can massage guns be harmful to you?
Well, let’s break it down, piece by piece. First of all, there isn’t much medical technology involved in these massage guns. At the heart of these massage guns is a variable speed motor and armatures that together produce rapid oscillation of a rod, to which you can attach various treatment heads. That’s it. It’s essentially the same engineering as a jigsaw/ reciprocating saw, with a shorter depth of movement.
Typical massage gun sold on Amazon
You apply it to a large muscle, such as the quadriceps (thigh muscles), gastrocnemius (calves), erector spinae (back muscles), or if you are a bulky weight lifter, the biceps and triceps muscles. If you want to use it on the smaller posterior neck muscles, there is a horseshoe shaped attachment available.
Using a massage gun on the quadriceps
Mind you, the force generated by these massage guns is significant: people with smaller and/or more sensitive muscles will not be able to handle it, and may even get bruised. These massage guns, in my opinion, are better suited for those who have a larger muscle mass than most people; muscle that is well-conditioned from training; i.e hypertrophied muscle.
Are There Health Benefits to Deep Vibration?
The sellers of these hand-held massage guns instruct the user to place the treatment head over the belly of the muscle (thickest part; usually in the middle), applying a downward force as shown in the picture above. You can keep it stationary or slide it up and down the muscle, applying light to heavy pressure.
In order to get an idea of what happens to the muscle when you use a massage gun on it, it helps to understand the anatomy and physiology of muscle and surrounding tissue.
Starting from the top, your skin: is your skin firm or saggy? This depends on the quality and density of collagen and elastin fibers that form your dermis, or lower layer of skin. Younger people have firmer, resilient skin, thanks to dense and higher quality (less degraded from age) collagen fibers. People 50 and over, not so much. So if you are in your 30s, that’s a plus for you if you want to use a massage gun. Your skin is likely tougher and able to handle the force of those vibrations.
Anatomy of skin
Small blood vessels and nerve endings are present just below the dermis, or hypodermis. When these vessels dilate, you get hyperemia, or reddening of the skin.
Next in line, your subcutaneous fat. This is the fat directly underneath your skin, laying just above your muscle whose function is to provide a protective cushion for the body. Its thickness varies, depending on the location in your body; your age, sex (females tend to have more subcutaneous fat as a percentage of body mass), and health status. If the subcutaneous fat over your muscle is a good inch or more thick, this provides a barrier to the vibration and absorbs and dissipates some of that force. So, thicker subcutaneous fat is another plus for massage gun use.
Subcutaneous fat lies underneath skin
And third, the target of the massage gun– skeletal muscle. Muscle is denser and heavier than fat as it is comprised mostly of protein; specifically actin and myosin, the specialized fibrous protein that comprise the contractile units. Muscle is covered by fascia, a tough fibrous webbing that lends support to the muscle as it contracts.
Skeletal muscle covered in fascia (electron microscope)
Blood vessels penetrate the muscles, supplying them oxygen and nutrients and transporting waste products away. Below is an illustration of the vessels that service the upper leg muscles. It shows the large caliber vessels– the femoral artery and veins, and the smaller branches that attach to multiple areas of each muscle.
Lastly, be aware that there are nerves in the area. The femoral and sciatic nerves pass through the leg muscles, and smaller divisions branch off and attach to multiple areas of each muscle to provide direct stimulation from the brain.
Thigh muscles showing location of major arteries, veins and nerves
So, when you place the massage gun over the skin and press into the muscle, it pulsates rapidly and with each stroke the skin, fat, muscle, blood vessels and nerves get compressed and then rebound hundreds or thousands of times, depending on how long you apply the massager
Here are the physiological effects of the massage gun:
Blood in the vessels of the skin are repetitively blanched and dilated, reddening the surface of the skin. In some cases, capillaries may burst, and if enough of them burst you will get visible bruising (small volume blood leakage into the tissues).
Special sensory nerve endings in the skin fire. These nerve endings detect vibration, pressure, and light touch. Any neural input is sent to the brain for processing, and complex interactions with other nerve pathways may occur causing distal/secondary effects such as change in heart rate and blood pressure.
The collagen in your skin gets stretched/worked. This could loosen the skin over time.
The subcutaneous fat gets compressed. Fat is enclosed in tough, fibrous tissue so there is no effect on fat mobilization.
The muscle absorbs the force. While muscle cells are very durable, it is possible that some of the actin and myosin proteins could be damaged especially those with smaller and/or less conditioned muscles; or older people. This could affect muscle contraction and strength.
The nerves that cause muscles to contract by depolarizing the muscle membrane fire repeatedly, causing small muscle contractions and some fatigue (try curling a weight after using a massage gun on your biceps, and see if you have full strength). If you have an abnormally contracted muscle, this may help it regain normal tone by hyperpolarizing the nerves that stimulate it, causing them to deplete their neurotransmitter temporarily.
If there is scar tissue around your muscle or fascia, the repetitive force of the massage gun may help loosen it by stretching the shortened fibers. This could help regain some lost range of motion and improve flexibility of the muscle.
The deeper blood vessels in the legs may absorb some of the force, if you angle it just right. This could be a dangerous, especially for those who have blood coagulation problems. It could loosen a thrombus (blood clot resting in a vessel) causing it to detach. This could cause a stroke or pulmonary embolism, two potentially fatal conditions. So be careful if you use the gun on your legs, especially your calves.
So what’s the final verdict? Are massage guns worth it? Will they work as advertised?
As in many cases like this, it depends. My advice is that it wouldn’t hurt to get one if you know that this kind of massage makes you feel better– relaxed, invigorated, less muscle pain, or other perceptible benefit.
Secondly, don’t think these massage guns are a magical, new technology. They simply are another form of vibrating massage devices, which have been around for decades. However, they do have one good selling point, and that is ergonomics. They are much easier to handle, and lighter, than the old generation of vibrational massagers like the one below. This means you have better control on applying the massage.
Older generation portable, vibrational massager
These massage guns are also convenient for travel, as they take up a relatively small space in your luggage. For those who travel frequently, it could be a good way to reinvigorate your leg and feet muscles.
I can see the massage guns being a better choice for massaging a trigger point, or patch of scar tissue. The interchangeable heads allow you to focus the pressure over a smaller area, too.
And finally, don’t overdo it. Longer time does not always translate to better for you. Due to the massage gun’s power, I’d say two minutes maximum for any large muscle like the quadriceps group; and one minute max if you are massaging your neck muscles. Get the blood circulation going, and stimulate the muscle just enough to get it to loosen, and no more. If you take blood thinners to reduce blood clotting, I would avoid using it on your legs. Instead, opt for a Swedish style massage from an actual massage therapist. And warning, some people get nauseous from strong, high frequency vibration, and it’s worse the closer you are to your head (inner ear/ vestibular apparatus). The vibration generated by a typical massage gun is strong enough to move the fluid in your inner ear, which may cause nausea and vomiting in some people, so be careful.
Here is one of the better selling massage guns on Amazon. It seems good quality, and has many positive 4 and 5-star reviews, with over 3,500 reviews as of this writing.
A massage gun can be a good addition to your arsenal of home therapy tools. Make sure to visit our homepage, where you can find free self-care videos on the 15 most common presentations of musculoskeletal pain. You will discover the tools and equipment that I personally recommend for pain management at home. There are not many, because not all products are worth your time. As a chiropractor, I’ve tested nearly a 100 therapeutic products on my patients over 20 years, and based on their feedback and treatment results, these are the products I recommend. Opt in to my “Pain Relief Tips” newsletter to get great ideas o how to minimize pain and increase strength and flexibility in your body.
Musculoskeletal pain typically involves a movable joint—the articulation (connection) of two bones that, working with muscles, help generate movement and force. Common culprits are the knees, hips, spine and shoulder. The source of pain can be tendons, ligaments, cartilage, bursae, muscle tissue and/or bone.
Acute pain refers to pain that is sharp and intense in nature as opposed to diffuse and duller intensity. It comes from either a new injury or damage event, or an exacerbation (flare up) of a prior injury; i.e. re-injury. What I mean by “damage event” is that you do not have to experience an external injury such as a fall or sports accident in order to experience acute pain. It can be the result of gradual wear and tear of a joint, such as acute onset knee pain that starts the moment cartilage erodes down to the bone; or a lumbar disc that spontaneously bursts after many years of weakening.
When pain is acute, there is redness, swelling, heat and sharp pain. These are the four hallmarks of inflammation. Inflammation, while it gets negative press, is actually a life-saving, natural process when it occurs in response to tissue damage. Its purpose is to summon all the biological and biochemical agents that are necessary to limit tissue damage and initiate healing. Without going into too much detail, there are a host of biochemicals released by injured tissues and cells that (1) cause blood vessels to dilate and become more permeable, which produces swelling; (2) regulate blood clotting to stem bleeding; (3) initiate fibroblast activity—the cells that secrete fibrous, reparative tissue over the damage; and (4) summon macrophages to the area– large cells that clean up debris.
The goal of treatment during the acute phase of pain is to reduce pain intensity; reduce swelling, and stabilize the injured area to prevent aggravation. RICE—Rest, Ice, Compress, and Elevate the area– is a good guideline for managing acute pain. You need to be patient, as healing takes time; and do the things that help your body heal naturally on its own. This will determine how well your healing goes, and in some cases will mean the difference between healing 100% or developing chronic pain from the damaged tissue.
As a side note, be cautious using anti-inflammatory medications after you sustain an injury. Remember, the inflammatory process is part of the tissue healing process so you don’t want to suppress it entirely; just manage its intensity. Diligently applying cold therapy is a better option; use the NSAIDs and cortisone only when the pain is unbearable and you cannot afford to be without the use of that painful body part for very long.
The acute stage lasts 1-3 days and is followed by the sub-acute stage, which may last several weeks. During this stage, swelling subsides, fibrosis is finishing up, blood vessels are repaired and pain gradually decreases. The goal of treatment during the sub-acute stage is to introduce movement, reduce pain and enhance healing. This includes active and passive joint mobilization, massage/soft tissue work; and sometimes pro-healing modalities such as infrared, laser and pulsed EMF.
The last stage of an injury/damage event is remodeling. The newly formed tissue and fibers become more organized and stable as you move the damaged area through its normal range of motion. This can last several months, and even years. The goal of treatment during remodeling is strengthening and restoring range of motion. Therapies include joint mobilization, spinal manipulation, soft tissue work such as active release therapy; and resistance and coordination exercises such as weights, theraband, and balancing exercises.
Chronic musculoskeletal pain refers to pain that remains after an injury or damage event has gone through the acute, sub-acute and remodeling phases. Chronic pain is typically less intense and more diffuse (less focalized), and may be intermittent (comes and goes). For some people, chronic pain significantly reduces quality of life by causing impairment in the ability to engage in certain activities of daily living such as bending at the waist, lifting, and raising one’s arm above shoulder level.
Chronic pain can assume psychosomatic qualities, where the individual can actually perpetuate and even worsen the pain through his/her thoughts and beliefs; i.e. believing and accepting one’s pain to be catastrophic and life-changing. When this occurs, it negatively changes behavior in a way that inhibits pain resolution. The person becomes over-cautious and limits his/her activities to avoid pain, which promotes atrophy, weakness and loss of muscle coordination. Because of this, a standard of care for musculoskeletal pain is to encourage the patient to have a positive attitude during his recovery; continue with his everyday work and leisure activities as best he/she can, and work through the pain and try to tolerate it as the area heals, remodels and strengthens.
Is Chronic Pain a Life Sentence?
Since chronic pain has gone through the stages of healing, can it ever be resolved 100%? By definition, chronic pain is persistent, ongoing pain. But there are cases where chronic pain made a turn for the good, and totally disappeared, even after decades of pain. What is necessary for this to happen is the tissues–ligaments, tendons, muscles, or cartilage– need to have some regenerative capacity left, and those regenerative capacities need to be optimized so that the healing is enough to stop the pain generating areas. Pain that doesn’t go away at first is often a sign of sub-optimal healing. The key is to find out what is causing this; remove it, and do things to enhance your body’s ability to regenerate the damaged area such as changing your diet, doing prescribed, therapeutic exercises and even changing your mindset if necessary. Only then do you have a chance to eliminate chronic pain once and for all.
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The human body has magnificent intelligence to monitor, maintain, and repair itself 24/7. These complex, biological functions are the result of millions of years of evolution and of course play a major role in the survival and thriving of our species.
The jaw, or temporomandibular joint is classified as a synovial, condylar joint. Joints are named after the two bones that comprise it, so the TMJ is formed by the articulation of the mandibular fossa (depression/pit) of the left and right temporal bones of the skull and the left and right condylar heads of the mandible (lower jaw), hence temporomandibular joint. It could have been named the “mandibulotemporal joint,” or MTJ, but someone long ago decided temporomandibular sounded better.
