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Treat Shoulder Joint Pain with Red Light and Infrared Therapy

by Pain Doc | Jul 29, 2015 | Shoulder Pain

Light in the visible red spectrum has noted therapeutic benefits, and it does this by enhancing cellular energy and signaling reactions involved in tissue healing. When an injured cell has more available energy, it can repair itself faster and activate certain other biological processes involved in healing. Red light in this wavelength does not generate heat, so heat isn’t doing the healing. It’s photobiomodulation at work– a human version of photosynthesis, the process by which plant life creates food for itself using sunlight.

Because of its wavelength range (about 620-880 nm) red light tends to get absorbed by water-dominant human tissue, especially red blood cells. Just beyond the visible red on the spectrum of light is infrared light (IR), which is not visible to the human eye, but still has therapeutic benefit (most of the heat radiating from the earth is infrared). Infrared has a higher wavelength and can penetrate deeper into human tissue. In fact, acupuncturists and physical therapists rely on infrared heat lamps to apply heat to deep joints such as the shoulder, hip and knee.

Since they are considered generally save for use, the FDA allows manufacturers of red light and infrared therapy devices to sell directly to the consumer, without a doctor’s prescription. Those who have photosensitive skin however my want to speak with their doctor first before trying red light therapy, as it may cause pigmentation.

There are numerous red light and infrared devices on the market for personal use; some better than others. They include hand held devices, mats and lamps. There are even portable infrared saunas. For small areas such as an ankle, wrist or shoulder, you can use a portable, hand-held red light device.. This is a stainless steel, high quality compact device resembling a small flashlight. It uses three (3) diodes; each putting out a different red light frequency, which means it penetrates to different depths in your tissues thus bathing a larger area with red light. 3-4 three- minute doses, twice a day for three days is a good protocol for most conditions.

For larger areas such as low back pain or spasm or leg pain after running, try an infrared lamp or sauna.

The Shoulder Joint – A Complex Joint Vulnerable to Breakdown

Ok, let’s talk about treating common shoulder joint pain. The shoulder joint, or glenohumeral joint is a ball and socket type synovial joint. Unlike the hip joint, the shoulder joint has a shallower articulation point with the scapula that allows it to move as it does — in wide arcs and in multiple planes (try doing that with your knee!). It is enclosed by the rotator cuff, which is basically formed by the several tendons attached to the humeral head (the proximal end of your humerus, or upper arm bone) and capsular ligaments that connect the humerus to the other end of the shoulder joint, the glenoid fossa of the scapula, a shallow bowl-shaped indentation.

There are six muscles that move the shoulder, and therefore six tendinous attachment points. Above and around the ball of the shoulder joint are bursae, which are jelly-like pads that serve to reduce friction during shoulder movement. Inside the shoulder joint capsule itself is the synovial lining (this is the tissue that gets inflamed in cases of rheumatoid arthritis), the cartilage lining the ends of the ball and socket surfaces and the labrum, a rigid cartilaginous support structure that helps position and stabilize the humeral head onto the glenoid fossa. As you can see, your shoulder joint has many structures involved in its function. This means there are more chances for something to go wrong– a tear, a strain, a malposition, compared to a simpler joint like a knuckle.

If you have pain and/or clicking noises (called crepitus) in your shoulder or have restricted movement such as limited ability to raise your arm above shoulder level, something is obviously wrong. It could be a rotator cuff tear (tear of tendons and or capsular ligament); labral tear, bursitis (inflammation of a bursa), thickening of the supraspinatous ligament due to shoulder subluxation (malposition of joint), arthritis or fluid build up. Stretching alone may not be feasible, especially in cases like adhesive capsulitis (frozen shoulder) due to the pain. This is where red light therapy and infrared can help.

How to Apply Red Light to Your Shoulder Joint Where It’s Needed

The challenge when applying red light to your shoulder joint is getting it to the damaged structures, which is not straightforward. The glenohumeral joint is covered by the deltoid muscle, which can be quite developed especially in men. It is thickest in the belly of the muscle (center, meaty part) but thinner on its tendinous ends where it inserts into the scapula and collar bone. Avoid the belly of the deltoid as red light cannot pass through it, and apply the red light over the thinner areas noted. Also, don’t forget that you can access the shoulder joint underneath, via your axilla (arm pit). This is a great technique, as there are no muscles obstructing it (see third image below).

Below is a diagram of shoulder anatomy to give you a better idea on how to target critical structures like the shoulder bursae, tendons and capsular ligaments when using red light therapy. You’ll want to use a hand-held red light therapy device that can focus the light over a small area of about 2 cm.

Palpate your shoulder and locate the locus of pain. Internally and externally rotate your shoulder joint and press in front, on top underneath and behind it with your index finger to find tender spots. Once you’ve found one, keep your shoulder in that position and apply the red light for 60 seconds. Do this 3-4 times. You may want to move to areas around the sore spot, for good measure. The thin, small space just under the “cliff” of the acromion process is an ideal spot to focus the light. It will get absorbed by the subacromial bursa and supraspinatous tendon, common sources of shoulder pain and stiffness. Do this over a week to ten days, and you should notice improvement. Avoid overly-stressing your shoulder joint during this time period to allow proper healing. Below is a video where I show you how to do it.

In summary, you can accelerate tissue healing in sprains, strains, bruises and minor cuts using red light therapy. These devices are a great addition to your home therapy devices, as they do not require a medical license to acquire.

Can Your Pain and Aches be Partly Due to Oxidative Stress?

by Pain Doc | Jul 29, 2015 | Nutrition

If you have pain or aches in your joints, tendons or muscles that varies in intensity but never seems to go away, you might be experiencing oxidative stress to these areas. Oxidative stress is the cumulative effects of oxidation, a chemical reaction where electrons are stripped off tissues by reactive oxygen species (ROS). ROS or free radicals are atoms or group of atoms that have one or more unpaired electrons. When an atom or molecule has an unpaired electron, it is unstable, and since nature likes stability the radical will seek out electrons elsewhere to “balance” itself. Free radicals are highly reactive to molecules they come in contact with and are therefore dangerous to them. They can destroy them or change their shape and therefore function by altering their molecular structure.

Radicals can have positive, negative or neutral charge. They are formed as intermediates in normal biochemical reactions in cells (cell metabolism), but when generated in excess or not appropriately controlled/ neutralized, radicals can damage adjacent cell structures and tissues. ROS types includes superoxide anion (O2-), hydrogen peroxide (H2O2) and the hydroxide ion (OH-). Think of these things as the cell’s equivalent of noxious exhaust gases generated by an internal combustion engine.

Now, imagine a bunch of these free radicals roaming inside your knees. It’s akin to termites eating away at the frame of your home. At some point, a structural failure will occur; and in the case of the knees, damage to cartilage or synovium (joint inner lining) followed by knee pain and stiffness.

Your body also makes and uses reactive oxygen species for good things. White blood cells generate them to kill bacteria and other pathogens. ROS also influence cell signaling (such as signals to divide, increase membrane permeability and repair membranes) and activate (up-regulate) genes to produce needed substances during certain times. Only when they get to unacceptably high levels, and/or when they aren’t adequately neutralized do ROS become harmful.

Some of the scenarios that can cause excessive ROS formation include:

Hypoxia (low oxygen levels), hyperoxia (high oxygen levels) and excess heat exposure
Ionizing radiation — UV rays, gamma rays trigger massive ROS formation
Prolonged, physical exertion— marathon running, extreme races, hard labor under grueling conditions generates massive amounts of ROS. Oxygen consumption increases by multiples, generating large amounts of free radicals and making it difficult for cellular anti-oxidant defenses to keep up.
Pollution ingestion. This includes smoking, chemical fumes, carbon monoxide, organophosphate pesticides and other substances toxic to humans.
Electromagnetic field exposure. Some studies suggest EMF can cause biological changes that result in excessive free radical formation.

Anti-Oxidants to the Rescue

Anti-oxidants are substances that act as reducing agents, where they donate an electron to a reactive oxygen species; thereby neutralizing it.

There are two main categories- enzymatic anti-oxidants and non-enzymatic anti-oxidants.

Enzymatic anti-oxidants include glutathione peroxidase, superoxide dismutase and catalase. Basically, these components are inside or adjacent to cells (water soluble) and degrade superoxide and hydrogen peroxide by-products of cell metabolism.

Non-enzymatic anti-oxidants include Vitamins A, E, and C, and glutathione. Vitamin E is the major fat soluble anti-oxidant that is responsible for degrading hydrogen peroxide radicals that form along lipid based cell membranes. Glutathione is an important anti-oxidant present in the cell cytoplasm that attracts free radicals, becomes radical itself but then recycles into an anti-oxidant via a special pathway and scavenges again for more free radicals.

Polyphenols, of which there are thousands, are substances (phytochemicals) found in plants that have anti-oxidant properties. This includes blueberries, pomegranate, citrus, green vegetables, apples, cantaloupe, cherries, grapes, plums and other dark and colorful plants. Tannins, quercetin and flavonoids are types of polyphenols.

Turmeric, the rhizome of the flower Curcura Longa contains a well-known powerful anti-oxidant called curcumin. Since it is fat soluble (doesn’t stick to water molecules for transport), it has a hard time getting into your cells. Scientists found that if you consume it with piperine, a natural compound found in black pepper, it increases absorption into your cells by 2,000% which is why most curcumin supplements contain black pepper. A fat soluble anti-oxidant, curcumin is believed to protect the lipid-containing cell membrane from free radical damage.

The Bad News

So, at this point you might be thinking that fixing the oxidative stress problem is simple– just take a bunch of anti-oxidant supplements every day, and good bye free radicals, right?

Unfortunately, most of the research done to test this is inconclusive. This means that, at the present, we cannot say that taking anti-oxidant supplements reduces the risk for any type of disease.

While it’s true that people who eat lots of vegetables and fruits in their diet tend to be healthier than those that do not, the causative factor may be something other than anti-oxidant content in the fruits and vegetables. It could be that people who eat more vegetables and fruit are more health conscious overall and take better care of themselves in other ways (avoid smoking, drinking in moderation, avoiding junk food, etc.) that might explain their longevity.

And for some people, anti-oxidants can act as anti-nutrients by binding with essential minerals in the digestive tract such as iron and zinc, preventing them from being absorbed. They may also interfere with post-exercise trauma repair to muscles, as white blood cells use ROS during repair of muscle tissue; anti-oxidants may inhibit this.

So what is the solution if you’re being constantly attacked by reactive oxygen species?

The Solution

The solution is to do what you need to do anyways in order to be healthy in the long-term:

eat in moderation (less food to metabolize means less free radical generation)
make at least 80% of your diet naturally occurring foods emphasizing green vegetables and to a lesser extent colorful fruits
avoid sugary drinks
exercise in moderation regularly
avoid “chronic cardio” exercises such as long-distance running and ultra-workouts as they are counter-productive.
get adequate rest
remove stress in your life (or find a counter to your stress)

Secondly, be aware of the exogenous sources of ROS generation and avoid them as best you can. This means:

avoiding environmental pollution in the air, water and food
staying away from second-hand smoke
minimize your exposure to commercial electromagnetic fields especially when you sleep (see how to counter this here).
minimizing exposure to strong, mid-day sun rays
If you work near an X-ray machine or other radiation source, make sure to wear adequate protection

Lastly, avoid binge eating and gorging on food, especially on an empty stomach! This stresses your digestive system and generates a barrage of free radicals over several hours as your digestive cells stay fired up to metabolize all that food. Those free radicals that weren’t zapped by glutathione and other anti-oxidant defenses roam throughout your body, snatching electrons from cell membranes, DNA, proteins and other important structures. Keep those buggers down; don’t stir up the ant nest.

When you turn off oxidative stress in your body, your body will be able to heal itself faster and those achy muscles and joints will actually start to feel better and stay that way.

Can Red Light Heal Injuries and Lessen Pain?

by Pain Doc | Jul 21, 2015 | Red light therapy

The color of red has a psychological connection to stopping– stop signs, stop lights, red warning signs and so on. And, it turns out that visible light in the red bandwidth may stop pain to some degree.

The use of red light to reduce pain, inflammation and swelling and to promote wound healing has been known for almost forty years now when a scientist doing a laser experiment on mice discovered that the ones that were irradiated with a red laser grew their hair back faster. But how exactly does red light accomplish this? What are the mechanisms of action? And, can it be dangerous?

I’ll attempt to answer these questions in a way that hopefully makes sense.

When white light travels through a prism, it is dispersed into the colors of the visible electromagnetic spectrum; that is, the component colors that collectively comprise what the human eye perceives as white light. The component colors have wavelengths between about 380 nanometers (1 billionth of a meter long) to about 750 nanometers (nm) and are, from left to right: violet, blue, green, yellow, orange then red.

Just to the left of the visible spectrum is ultraviolet (UV) light and to the right is infrared light (IR); both of which are not visible to the human eye (although some animals can see IR).

spectrum

While the the therapeutic effects of red light are still being researched, there is evidence that light in this wavelength range (620-750+ nm) can in fact trigger physiological changes in cells, called photobiomodulation that have beneficial effects for injury healing and pain suppression.

The first law of photobiology says that for a low power visible light to have any effect on a living, biological organism the photons (light particles or energy units) must be absorbed by the organism via some type of molecular photo-acceptors, which scientists have given the name chromophores. (Photochem Photobiol. 2002 Aug;76(2):164-70). While the mechanism of action are still being researched, experiments show that human tissue absorbs visible light and undergoes biological changes as a result.

The Plant and Animal Connection

You probably forgot that you were introduced to the phenomenon of photobiomodulation way back in the 3rd grade. Remember in science class when you studied photosynthesis? The name says it all: photo (light) + synthesis (to make something out of other things). Sunlight strikes a plant leaf, gets absorbed by tiny structures in the leaf called chloroplasts which contain chlorophyll (the substance that makes plants green), which creates the energy the plant needs to convert carbon dioxide in the air and water into sugars for its food. Without sunlight, plants would starve to death, and so would every life form that depends on them.

Can it be that mammals have their own version of photosynthesis, or something similar to it? It sure looks that way, considering the tissue healing effects of red light.

How Red Light Influences Cellular Activity

The leading hypothesis of how red light creates photobiomodulation is by increasing cellular energy. Red light gets absorbed by a cell membrane enzyme (a protein) called cytochrome c oxidase, or cox for short. This enzyme influences the electron transport chain, the biological process that occurs in cell mitochondria and determines the rate of ATP (adenosine triphosphate) production and thus available energy in the cell.

Adenosine triphospate is every cell’s “fuel” molecule. Basically, cells trap free energy released from the breakdown (metabolism) of glucose– the basic unit of carbohydrates. The trapped energy is stored in the ATP molecule’s chemical bonds. Mitochondria are the structures in all animal cells where energy is created and can be thought of as the animal version of chloroplasts in plants. The energy released in the bonds of ATP molecules enables the cell to do the things it needs to do, such as repair membranes, remove waste and even multiply.

Another theory on how red light produces beneficial benefits is enhancing gene expression. More ATP production results in more reactive oxygen species production (ROS). In high concentrations this is bad, as excessive ROS can damage tissue and DNA (free radical damage). But with red light therapy ROS production is low level, local to the injury and has beneficial effects. ROS alters the cell’s state of oxidation, or redox state (basically, its electrical charge). Changes in a cell’s redox state induce intracellular signaling pathways such as nucleic acid synthesis, protein synthesis and enzyme activation. This activity then activates changes in transcription factors, which are the substances that up-regulate or down-regulate gene expression. Genes in DNA determine an organism’s physical features and influences its biological processes.

For example, red light activates factors involved in gene expression related to cell proliferation, remodeling, DNA synthesis and repair; ion channel and membrane potential, and cell metabolism. All these processes can benefit wound healing.

Proof of Red Light’s Healing Power

A 2014 Chinese study that involved compressing/ injuring spinal nerves in rats found that LLLT (Low Level Laser Therapy, which uses red and infrared light) “was able to enhance neural regeneration in rats following [the injury] and improve rat ambulatory behavior (ability to crawl and move).” The study’s authors concluded that the therapeutic effects of LLLT in this experiment may be exerted through suppression of the inflammatory response and induction of neuronal repair genes (increased expression of the genes involved in nerve repair). This suggests potential clinical applications for LLLT in the treatment of compression-induced neuronal disorders such as nerve root compression from disc bulges, stenosis and frank injury.

Another study concluded that low-level exposure to 980 nm laser light (near infrared) can accelerate wound healing. Exposure to low- and medium-intensity laser light accelerated cell growth in damaged fibroblast cells, whereas high-intensity light negated the beneficial effects of laser exposure.

So, it appears that the evidence on the therapeutic effects of red light therapy is convincing and the models appear plausible. More research is needed to get a better handle on how to best use light for therapeutic purposes. What we know is that light in the red visible spectrum (620-750 nm wavelength) and infrared (700 – 1000 nm) are preferred because they are better absorbed in human tissue. Shorter wavelengths (blue) scatter and are less absorbed. Red light is believed to be more appropriate for superficial areas (skin surface to a few millimeters below) because the light is quickly absorbed by the red hemoglobin of the blood and carried away; whereas the longer wavelength infrared (IR) and near infrared (NIR) light is appropriate for thick muscles and deeper joints since they are able to penetrate deeper into the body.

Factors that can influence therapeutic effect of red light besides wavelength include power output (watts), frequency, pulse rate, dosage and treatment area. Typical dosages used are 0.5 – 60 Joules/cm2, but there is no consensus among researchers on what constitutes the best dosage for any particular conditions.

Using Red Light Therapy

Red light can be delivered by “cold” lasers (lasers with minimal heat production) or diode (phototherapy) machines. The difference between the two is that lasers produce light of only one wavelength that is collimated (focused and organized), enabling deeper penetration but at a fixed depth and smaller area; whereas a red light diode generates a range of red light in different wavelengths, covering more area and depth levels due to the varying densities of human tissue (skin, fat, muscle, ligament, water).

Medical grade lasers and phototherapy devices can cost a few hundred up to thousands of dollars. These therapy devices can be found in some physical therapy, chiropractic and sports medicine clinics. There are low power, consumer level portable red light and infrared devices that get good results as well. Currently, I am not aware of any studies that compare the effectiveness of the expensive medical lasers with the cheaper consumer devices, but one must realize, light is light! If you have a soft-tissue injury or joint pain, I suggest you try a consumer level red light device before you try the more expensive options. They are available for sale direct to the consumer; no doctor’s prescription needed. So far, the studies indicate that red light therapy is safe to use although it is best to protect your eyes from scattered light during its application by wearing protective lenses.

The red light therapy device I use at home and on patients is the handheld red light therapy device, shown below:

tendlight

It is simple to use and gets surprisingly good results (and it doesn’t cost an arm and a leg). Use it for TMJ, epicondylitis, trigger points; pain in the hand and wrist joints and anywhere there is musculoskeletal pain and/or inflammation.

The Bottom Line: Yes, red light therapy can help heal injuries and lessen pain and is generally safe to use. This includes sprains, strains, bruises, burns and minor lacerations. You may even try it over your peri-orbital sinuses to help with tension headaces.

The ideal treatment protocols are not defined, but a good starting point is 2-3 minute applications of red light directly for every two square centimeters, twice a day.

Watch below how I use the red light therapy device to treat chronic tendonitis:

Back Pain from Pregnancy – New Study Finds Spinal Manipulation Dramatically Reduces Pain

by Pain Doc | Jul 9, 2015 | Low Back Pain

According to a new study published in the July issue of the Journal of the American Osteopathic Association, German researchers found osteopathic manipulative therapy (OMTh) decreased postpartum low back pain by over 70 percent in women who had given birth at least three months before beginning treatment.

On average, women who received osteopathic spinal manipulation reported a 73 percent decrease in pain, compared to only seven percent in the control group. Pain was evaluated by a 10-point Visual Analogue Scale (VAS) and functional disability as measured by the Oswestry Disability Index. The Oswestry Disability Index is a battery of questions that asks the subject to rate on a scale of 1-5 how difficult it is to do common, daily activities (such as getting dressed). It is a popular tool doctors in physical medicine use to measure a person’s improvement to treatment, since pain is very subjective in nature. After all, what matters most is not the level of pain but rather the level of physical functioning the person is capable of, despite the pain.

But what exactly is osteopathy, and how different is it from chiropractic?

This requires a bit of a history lesson. Both disciplines had their start in the mid to late 1800s in the U.S., an era characterized by experimentation in various alternative healing methods. Diseases like syphilis, small pox, polio and other maladies plagued the population and there was very little doctors at the time could do. Vaccines and antibiotics were not discovered yet, and people were desperate to find a cure. This period is also when the term “snake-oil salesman” was coined, as some unscrupulous individuals used the crisis as an opportunity to make money.

Osteopathy has its origin in 1874 when Andrew Taylor Still, a medical doctor was dissatisfied with the limitations of conventional medicine. He theorized that disease originated in bone tissue and could therefore be treated by manipulating bones and tissues. Still developed the discipline of osteopathy and created the first school in Kansas that offered the “D.O.” degree – Doctor of Osteopathy.

Chiropractic has its origin in the 1890s when D.D. Palmer, a magnetic healer theorized that mechanical dysfunction of the spinal joints could influence nerve and blood flow throughout the body, making conditions ideal for disease. He and his son B.J. Palmer developed chiropractic in the early 1900s, emphasizing “adjustments” to the spine using the hands.

As both disciplines grew in popularity, the medical profession took notice. As in big industry today, when such competition arises there is either a buy-out, merger, or attempts to dominate the market (and public opinion) and put the competing entity out of business. Osteopathy eventually got absorbed into the medical (allopathic) model, and today D.O.s are physicians on par with M.D.s. Many D.O.s do not do manual therapies in their practice since drug prescription became the primary treatment methodology among allopathic medical practitioners especially toward the latter half of the 1950s, continuing today.

Chiropractic, on the other hand, blazed its own trail and is an independent specialty outside of the medical umbrella. There used to be significant professional conflict between chiropractors and medical doctors, but these days there is more more cooperation. Physicians are more confident in referring back pain cases to chiropractors, as patients attest to its benefits for helping reduce musculoskeletal pain.

Pregnancy and Back Pain

The Germany study is not surprising. Spinal manipulation, whether osteopathic or chiropractic adjustments, is helpful in restoring alignment and movement in the pelvic structure and lumbar spine following birth. During the last trimester of pregnancy when the mother gains the most weight, the center of gravity of the abdomen moves outwards, placing a greater strain on the lower back. The lumbar spine arcs more acutely, increasing pressure within the facet joints during standing. The weight of the baby can also rotate the pelvis anteriorly over the femur heads which can cause sacral and hip pain, due to it being a weaker stability position..

If after three months of giving birth you still have back pain, consider getting spinal manipulation. The goal is to free up any restrictions that may be present anywhere in the spine, pelvis and hip joints and strengthen surrounding muscles. A good practitioner will show you exercises to do at home to rehabilitate the area.

Below is a video that will give you an idea of what to expect:

One note you should be aware of: Spinal manipulation or “adjustments” is a fine dexterity, complex skill that needs a lot of practice in order for one to become proficient in it. Unlike osteopaths, chiropractors cannot prescribe medications so the bulk of their practice involves delivering spinal manipulation. Chiropractors therefore tend to be more skilled in this area.

Read this article by the American Chiropractic Association on 5 Conditions Chiropractic Care Can Improve During Pregnancy.

For more information on the Germany study that shows the efficacy of spinal manipulation for postpartum low back pain in women.

Golf Injuries and Pain – How to Protect Yourself and Have Fun

by Pain Doc | Jun 27, 2015 | Low Back Pain

If golf is one of your favorite recreational activities, you likely are aware of the unique demands the game places on your body. Perhaps you even sustained an injury or developed pain related to your golf game. Let’s take a closer look at the physical demands of playing 18 holes.

First of all, let me start out by saying that besides being a popular sport, golf is a good opportunity to exercise (especially if you carry your own clubs and don’t use a cart).

Number one, it involves a lot of walking. The best part about walking is that it keeps you away from sitting. It may not sound like a big deal, but it is. Excessive sitting, science is finding, is associated with deleterious health outcomes regardless of physical activity. This means too much sitting is so bad for your health that exercising later cannot recoup the damage it does.

Secondly, you are outdoors exposed to sunshine. Getting adequate sunshine is essential to maintaining normal Vitamin D levels, which promotes strong bones, teeth and supports the body’s immune system. Being outdoors among trees and grass on the weekend is especially beneficial to your health if you have a high-stress office job during the week.

So if you abhor exercising in a gym, perhaps you should investigate the game of golf, if you haven’t already.

Now, back to the topic. Here are the potential problems that can come with playing golf:

Driving. Each hole starts out with a driver, the longer clubs with bigger, heavier heads. These clubs are designed for distance and therefore require a big swing radius (a big wind-up).

Well, that wind-up involves over-rotation of your lumbar spine. That feeling of discomfort when you swing a driver is occurring at the lumbar facet joints, the small joint surfaces behind the vertebral bodies that interlock with adjacent vertebrae above and below.

Most rotation movement of the torso is produced by the thoracic vertebral joints, from the base of the neck down to the beginning of the lumbar (low back) spine. This is because facet joints of thoracic vertebrae are relatively flat and in the same rotational plane, as illustrated below:

Lumbar vertebrae, on the other hand, have deeper, concave facet joint surfaces that act as limiters to rotation. Basically, lumbar vertebrae do not like to twist.

You can feel the pressure in your low back when you have the driver at the top of back swing position and again towards the end of the swing. The rotational (twisting) force is reduced when you lift and turn in your rear foot as you follow through the swing, but if that foot motion is delayed the lumbar spine absorbs more of the rotational force.

Over time, repeated over-twisting of the lumbar spine can cause the lumbar facet joints to degenerate and even develop fractures. This can lead to other problems, like pinched nerve roots from foraminal stenosis (narrowing of nerve passageway due to bone and/or ligament occlusion). Tiger Woods used extreme lumbar rotation in his swing and it caught up to him; he had four low lumbar surgeries over his careerr and now suffers from chronic low back pain.

The lesson here is to make sure you lift your trailing foot at the appropriate time of the swing to avoid excess rotational pressure to your lower back (and be mindful not to over rotate, otherwise risk having back problems in the future).

Another joint that bears a lot of stress during driving is the lead knee. As you follow through with the swing, your pelvis rotates with your spine. Tightly connected to each side of your pelvis are the femoral heads– one half of the hip joint. When you lift your trailing foot, it reduces rotation to your lumbar spine by removing a stabilizer, but at the price of putting a greater rotational burden on the lead knee and ankle. As the pelvis rotates and reaches end-range, it pulls the femur with it. But the femur and tibia remain stationary (golf shoe spikes dug into the turf ensure this; plus more of your weight shifts to the lead leg towards the end of the stroke). This results in a torsional force generated through the lead leg, internally rotating the hip, knee and ankle. This can cause strain to the hip joint, meniscal tears in the knee and sprain to the ankle ligaments.

So the lumbar spine and leading hip, knee and ankle are joints that absorb significant rotational stress during a driving swing.

To a lesser extent, the leading shoulder joint and wrist absorb stress due to their awkward positions; the shoulder with acute internal rotation and the wrist acute radial deviation. This can strain the shoulder rotator cuff and ligaments and tendons of the wrist.

Putting (and driving). It may not seem like a lot of movement is going on during putting, but the putting position is indeed strenuous to the lower lumbar discs. You are bent at a 30 degree angle or so at the waist for an extended time (most people concentrate and take their time before their putt attempt). This is one of the worst positions for your low back as it places tremendous pressure on your L4 and L5 discs. especially if you have a weak core (abdominal and low back muscles).

The hydrostatic pressure builds up in the disc, enough to cause a disc herniation in some people.

In the picture above, the golfer is preparing to hit the ball with a driver. Notice the angle of the torso relative to the legs. The fulcrum is exactly at the L5-S1 joint and the lever is the torso, with the load being the gravity vector of the torso (weight). The force (F) is partially distributed to the back muscles, but the discs still bear significant pressure in this position.

The Solution

If you’re an avid golfer, a little sore back isn’t going to stop you from playing, right? That is usually the case in those who love their sport or hobby.

So my advice to you is:

Always use proper form and good posture. When driving, emphasize generating power from your core muscles– abdominals, especially obiques–then your latissimus (“lats”) muscles. Lift your trailing foot at the precise moment to lessen lumbar rotation during a wide swing.
If you are prone to low back pain, modify your driving swing to protect your back. You may have to use less lumbar rotation and more power from your arms and shoulders. Practice your custom swing and hone it so it becomes natural during game time. For example, if you are getting low back pain, shorten your lumbar rotational arc by 30 degrees and generate more power from your latissimus muscles to compensate.
Minimize rounding (flexion) of your low back during putting and driving. A straighter or even concave low back is stronger than a flexed low back. This is called “hinging.” You keep your lumbar spine and pelvis locked, and hinge at the hip joints to lower your torso to the ground.
Exercise and stretch the swing muscles. The muscles you should target for stretching are the trapezius, latissimus dorsi, rhomboids and triceps.
Strengthen your shoulder joints by lifting light dumbbells in all directions/angles (from 12 o’clock position to 6 o’clock position) with palm facing down. Starting position of arm is down to your side; ending is as high as you can go.
Stretch your shoulder joints using a 5-10 lb dumbbell or kettle bell, letting it hang straight down as you lean over and stabilize with the other hand on a chair or your opposite, bent knee. Make small circles with the weight, increasing in size; then reverse directions.
Strengthen your core: abdominals and low back, using medicine ball exercises.
Seek out an Active Release Technique (A.R.T.) therapist in your area. This is a special form of massage that involves engaging certain muscles while the therapist works them and is great for improving range of motion.

And last but not least, my standard mantra: your body will work better for you if you feed it well and give it enough rest. Make at least 80% of your diet naturally-occurring foods (as opposed to processed and prepared foods) emphasizing colorful vegetables, animal protein (grass fed/ pastured when you can) and healthy fats (olive oil, nuts, seeds, eggs, coconut, avocado, fish). A well-nourished body can heal injuries quicker and more completely, which is especially important if you play any kind of sport.

Also, don’t expect to be sedentary all week and be able to do activities physically demanding on the weekend. Excessive sitting/ lack of exercise de-conditions muscles. It makes them less coordinated, smaller and weaker. This is a recipe for injury (“weekend warrior” injuries).

A simple hack to passively get more exercise if you are a desk jockey is to get a standing desk. It’s better for your back, and your overall health (see below).

Now, go and have fun on the golf course! (with this information in mind).

Curcumin – Hype or New, Natural Pain Reliever?

by Pain Doc | Jun 10, 2015 | Uncategorized

Lately, you may have seen or read news articles about the use of curcumin to treat inflammation and pain. Is curcumin the latest fad supplement to hit the scene, or does this herb actually have any therapeutic benefits?

Curcumin comes from the root stalk (rhizome) of the curcuma longa, better known as turmeric, a perennial plant from the ginger family. Turmeric is native to India, and also occurs in Australia. It has been used for centuries as a spice in South Asian cuisine (curry) and as a food dye. The root stalk is heated in an oven, then ground into a fine powder.

In folk medicine, curcumin is believed to have a wide range of biological effects including anti-inflammatory, antioxidant, anti-tumor, antibacterial, and antiviral activities. However, according to the National Center for Complementary and Alternative Medicine, “there is little reliable evidence to support the use of turmeric for any health condition because few clinical trials have been conducted.”

This is a common disclaimer for herbs, vitamins and other natural supplements. In order to say with certainty that a supplement achieves its claimed therapeutic benefit, a “double-blind, controlled” study involving a large number of people with the same health issue that the supplement targets is required. The study group is divided into two groups, the test group and the control group. The test group is given the nutrient being tested, while the control group is given a placebo supplement (fake). In a double-blind study, which carries the most weight as far as credibility of results is concerned, none of the test subjects are aware of what they are getting (the nutrient or the placebo), and neither do the scientists administering them.

The study goes on for many months; sometimes years, and various metrics are taken of both groups. If there is a statistically significant, positive difference in the test group for a given metric (for example, much lower pain rating), then it’s fair to assume that the nutrient was responsible for it. If there are none, then the supplement is basically bogus.

So, how does curcumin stack up to the challenge?

Here are some research studies on curcumin worth mentioning:

A 64-person study testing curcumin for mastitis, a painful condition involving inflammation of the breast, showed that a topical solution containing curcumin successfully decreased pain, breast tension and erythema (redness due to pain) within 72 hours of administration, without side effects.

A Japanese study of 50 patients with knee osteoarthritis found that at 8 weeks after treatment initiation, knee pain scores were significantly lower in the curcumin group than in the placebo group, except in the patients who had the lowest pain score to start, with no major side effects. The study concluded that curcumin shows modest potential for the treatment of human knee osteoarthritis.

A 17-person study was done to determine the effects of curcumin on muscle damage, inflammation and delayed onset muscle soreness (DOMS) in humans. Participants did “unaccustomed, heavy” leg exercises to point of pain and enough to generate blood markers for muscle damage. The conclusion was that oral curcumin likely reduces pain associated with DOMS with some evidence for enhanced recovery of muscle performance, and that further study is required.

A study involving 30 breast cancer patients receiving radiation therapy found that orally taking 6.0 g of curcumin daily during radiotherapy significantly reduced the severity of radiation dermatitis.

A preliminary intervention trial that compared curcumin with a nonsteroidal anti-inflammatory drug (NSAID) in 18 rheumatoid arthritis patients found that improvements in morning stiffness, walking time, and joint swelling after two weeks of curcumin supplementation (1,200 mg/day) were comparable to those experienced after two weeks of phenylbutazone (NSAID) therapy. Since NSAIDs are associated with stomach, renal and liver damage, this is a very promising finding.

A placebo-controlled trial involving 40 male test subjects who had surgery to repair an inguinal hernia or hydrocele found that oral curcumin supplementation (1,200 mg/day) for five days was more effective than placebo in reducing post-surgical edema, tenderness and pain, and was comparable to phenylbutazone therapy (300 mg/day).

As of this writing, this is the extent of human studies that test curcumin’s effects on inflammatory processes. It isn’t much, but the positive effects and demonstrated potential of curcumin to improve inflammatory conditions is unmistakable.

It should also be noted that there are many rat and mice studies in the medical literature that suggest curcumin can reduce pain and inflammation by suppressing oxidative stress and “down regulating” factors (cytokines) that create the inflammatory response. This means that curcumin may tone down gene expression of genes involved in generating and sustaining the inflammatory process.

A number of other studies on curcumin’s potential therapeutic effects on colorectal cancer, Alzheimer’s disease, cystic fibrosis, asthma and other disorders have been completed with no published results at the moment, or are still in progress.

My Advice on Curcumin:

So, should you try curcumin supplements if you have an inflammatory condition? Based on this small sample of studies, my opinion is that it wouldn’t hurt to include curcumin regularly in your diet if you have arthritis, type 2 diabetes, cardiovascular disease, an inflammatory dermatological disorder, fibromyalgia or other, chronic inflammatory disease. You don’t have to buy supplements, although they are convenient; just get the curcumin powder sold in grocery stores and sprinkle it on your food as you would salt. Studies suggest that this herb is generally safe in large doses (6 mg) with minimal side effects; but just don’t over do it. Be careful of the source, as unscrupulous manufacturers may be mixing curcumin powder with the much cheaper lead oxide, which looks very similar to curcumin powder, although more reddish in color. Lead oxide mixes with hydrochloric acid in the stomach, bioaccumulates and can cause lead toxicity.

By the way, I recommend you do not keep spices for more than a year or two, as they can not only lose their taste but can also form mold.

Inflammation and Pain – The Good and the Bad

by Pain Doc | Jun 2, 2015 | Uncategorized

If you recently injured yourself, or had a sudden onset of low back or neck pain, take note: inflammation is responsible for creating your pain sensations.

I didn’t say this was good or bad– just that inflammation, or the inflammatory response to injury/ tissue damage is maintaining the sensation of pain.

Understand that despite its negative connotation in the media, inflammation is a natural, protective response to injury that is necessary for healing.

Inflammation:

triggers the proliferation of white blood cells that attack microorganisms and remove debris;
dilates local blood vessels and increases their permeability (swelling) to bring more oxygen to the area (more oxygen is needed for the high metabolic activity of damaged tissue);
produces heat which speeds up activity and makes it difficult for germs to thrive;
results in pain to discourage you from using the injured area while it is vulnerable.
quarantines the damaged site from the rest of the body

Normally, after an acute injury such as an ankle sprain, inflammation goes through three phases:

lots of swelling, redness and pain initially for the first 72 hours (acute phase);
followed by a gradual reduction in swelling and pain as debris is cleared and special cells called fibroblasts lay down collagen fibers for repair (sub-acute, repair phase); then
remodeling and strengthening of the new collagen fibers over several weeks (post-acute, remodeling phase).

Eventually, everything gets back to normal.

So for most cases of straight-forward joint sprains/strains R.I.C.E.– Rest, ice, compression and elevation is all you need.

Rest it– don’t splint it unless necessary; just avoid placing a load on the injured joint, or avoid moving it through its full range during the acute phase
Apply ice in the beginning only to keep the swelling from getting excessive/ out of control and to reduce pain; about every two hours for 15-20 minutes a session.
Compress it– this is the least necessary, but some people find it helpful to compress the area to help encourage the swelling to go down.
Elevate it — use gravity to assist the flow of blood back to the heart. If it’s your ankle, lie down and place the injured ankle on a pile of sofa pillows so that it is above your heart.

Let the inflammation take its course and trust in your body’s wisdom to heal; helping it as needed. Unless the pain is so bad that it’s preventing you from doing things you need to do, avoid taking NSAIDs like Tylenol, Motrin or Ipuprofen. Although NSAIDs can reduce pain, they do interrupt the body’s natural attempts to heal a damaged area and may even delay healing.

When inflammation is not so good

Now, if all goes well your injured body part will be back to normal before long. But what if it is six months later, and you still feel pain?

It could mean a number of things.

Perhaps you have a bone fracture. Fractures take longer to heal.
A torn ligament or tendon takes longer to heal, as these tissues are not directly vascularized.
Infection can complicate healing.
The nature of the injury is causing a joint to be abrasive to adjacent tissue during movement.

In these cases, the cause needs to be addressed with a secondary treatment regimen.

But another possibility is that the inflammatory response has gone haywire. It continues at high levels long after the injury has completed its healing. Why this happens is unclear. In rheumatoid arthritis, it’s attributed to the body’s immune system attacking joint surfaces, which creates a continual state of inflammation and pain.

In cases of excessive inflammation, you may need to take NSAIDs to dampen the process and essentially tell your body “it’s time to stop producing inflammation.”

The other possibility is that you have a pre-existing state of systemic inflammation that is driving the process. “Systemic” in this sense generally means “widespread throughout the body.” This can be interfering with the local inflammation of your injury site.

Causes of systemic inflammation include:

allergic reactions
obesity
exposure to pollutants
diet comprised of highly processed food

In most cases it’s difficult to “feel” systemic inflammation because it is usually sub-acute/ chronic. But despite this, systemic inflammation wreaks havoc on your health. It is associated with most chronic, degenerative diseases such as type 2 diabetes, cancer, cardiovascular disease, arthritis, Chron’s disease/ colitis, and Alzheimers disease.

Blood tests that can indicate the presence of systemic inflammation include C-reactive protein (CRP), erythroctye sedimentation rate (ESR), tumor necrosis factor (TNF) and homocysteine. If your levels are high in any one of these, it is prudent to assume you have an inflammatory condition and take the necessary precautions.

First and foremost is to see your doctor to rule out pathologies/ disease processes.

Second, switch to a low calorie diet centered on whole, naturally-occurring plants and protein.

Next, increase intake of the following herbs/ supplements/ superfoods:

Curcumin
Ginger
Fish oil
Dark cherries
Nattokinase
Green leafy vegetable juice

Drink adequate amounts of water throughout the day, reduce your stress and get eight hours of restful sleep. As your inflammation resolves, you will notice faster healing, more energy and strength, clearer mind and a leaner body.

Often it’s the simple things that are within your control that have the most powerful healing effect on your body.

As Hippocrates said, “make food your medicine and medicine your food.”

If you experience chronic pain, check out my book on Amazon, Erase Your Chronic Pain: Unleash Your Body’s Full Healing Potential.

Is There Anything Besides Drugs for Chronic Pain Treatment?

by Pain Doc | Mar 30, 2015 | Lifestyle Modification

Chronic pain is a complex, physiological process involving specialized sensory cells, nerves, your brain and spinal cord and a multitude of biochemical substances..

Chronic means the injury/damage/disease of the affected body region has gone through the normal stages of healing, but some degree of pain still remains. This can be due to incomplete healing, permanent physical damage to structures, continual re-injury/ aggravation of the area or even “imprinting” into the spinal cord where the central nervous system literally “memorizes” the pain signals, causing them to be ever-present.

Musculoskeletal conditions arising from trauma or gradual wear and tear dominate chronic pain cases (pain originating from bones, joints, muscles, soft tissues). Diseases affecting the nerves such as shingles, advanced diabetes, trigeminal neuralgia and other peripheral nerve diseases often become chronic in nature as well.

Research suggests that one’s conscious reaction to pain (how you respond to it) influences the severity of pain; that is, the perception of it. Someone who embraces his pain and defers to its presence out of excess fear or worry is less likely to improve than someone who resists giving in and “moves into” the pain by not focusing on it too much as he goes about doing what he desires. This strongly suggests that pain has both physiological (body) and psychological (mind) components to it, and therefore, treatment for it should incorporate methodologies that address both.

Options for Treating Chronic Pain

Treatment for chronic pain includes acetaminophen (Tylenol), non-steroidal anti-inflammatories (aspirin, ibuprofen), anti-depressant drugs used “off label” for pain (amitriptyline, Cymbalta), anti-convulsant drugs used off-label for pain (Lyrica), corticosteroids (Prednisone) and opiate drugs (morphine, codeine). They work in different ways to decrease pain; some not fully understood. And, they all come with side effects, which differ from person to person.

TENS units and spinal cord stimulators are instruments used to block or interfere with pain signals as they travel through the central nervous system.

So between strong drugs with unpleasant and often dangerous side effects and devices designed to block pain, the medical options for treatment are disappointing. These interventions are not intended to cure the problem at its source, but rather interfere with its manifestation via chemical and electrical means.

However, two instruments I have come across are in a “gray area” in that the mechanism of action involves stimulating actual, natural healing of injured cells. The first one is red light therapy, which works on human cells very much like how sunlight causes photosynthesis and energy production in plant cells. I recommend red light therapy for joint pain from osteoarthritis and sprains/strains. You can also use it to heal minor cuts and lacerations faster.

The second one is Pulsed Electromagnetic Field Therapy, or PEMF. PEMF uses low frequency, low power magnetic fields in the range of frequencies that is naturally produced by the human body, to normalize cells whose membrane charge, or voltage, has been disrupted by disease processes and strong environmental electromagnetic fields such as those from power cables and electronics. When the cell membran charge is normalized, the cell’s metabolism and respiration is boosted which results in faster healing of disease; especially inflammatory disorders. Pulsed EMF can be used to treat many types of chronic disorders including chronic pain, fibromyalgia, pulmonary disease, heart disease and headaches. Watch the video below where I explain how PEMF works:

If you suffer from chronic pain, I suggest you direct your attention to creating conditions in your body that optimize health. This may not “cure” chronic pain entirely due to its complex nature, but a healthy body is in a much better position to heal and regenerate than one that is not.

Know that:

Your body is a community of interconnected, living cells that affect one another. For example, an intestinal cell and a muscle cell have a functional relationship. This cellular relationship can be influenced via lifestyle changes, primarily through your diet, activities and thoughts/attitudes to reduce pain.
Cells are the basic unit of the human body, and like the human body your cells consume food, breathe oxygen, perform work, burn energy stored in food and produce waste.
What enters your body via your mouth, lungs and skin gets into all of your cells (with the exception of those substances that cannot cross the blood-brain barrier).
Areas of chronic pain are where cells are in a state of distress. They may be producing inflammation, abnormally firing nerves, and/or not getting rid of their waste products properly.
You can greatly influence the functional state of all your cells by what you think, what you eat and drink, and what you do with your body.

When it comes to pain it is better to think in wholistic terms — the whole body, not just where it hurts. This is how your body is designed; how your body functions; and how it heals itself. Your starting point is your mindset and attitude. Use it the create health in your body by all means available to you; and there are many. Use Pulsed EMF for maintenance to enhance energy in your cells and enable efficient cell function and healing. This is your best bet for overcoming chronic pain.

Chronic Neck Pain or Stiffness? Get Your Neck Curvature checked

by Pain Doc | Feb 27, 2015 | Neck Pain

The cervical spine is the thinnest and most flexible part of the human spine. It is tasked with supporting the weight of the head in the upright position while allowing turning in multiple planes — looking left, right, up, down and behind. It also contains structures directly tied to life sustenance, which is why the neck is a logical target when it comes to martial arts/ self-defense and restraint (and unfortunately, murder).

Given all these vital functions, it is wise to take good care of your cervical spine in a proactive way.

The cervical spine is naturally designed to curve, where the apex is at about the level of the Adam’s apple.

This curve behaves much like a spring in a car’s suspension; or the slight upwards curve you see in any bridge design. Long ago, architects discovered that the load capacity of bridges could be dramatically increased simply by integrating curves or arcs into the design. Like a neck curve, a bridge curve or arc distributes weight over a greater area so that gravity cannot concentrate over one small area and cause structural failure.

neck_xr_flat If the neck curve helps distribute the weight of the head in the upright position, what do you suppose might happen if the curve straightened out or started to bend in the opposite direction like the one to the left?

If you lose your cervical curve over time, which could happen from years of poor posture or trauma like multiple rear-end car collisions, you will probably not notice it until several years pass. The change in biomechanics shifts a greater burden of support to your cervical discs and vertebral end plates. This promotes disc degeneration. The once thick and healthy discs lose fluid content, lose strength, allow the center material to bulge out (herniate, protrude or rupture) and cause bony protuberances called osteophytes to form all around the edges of the vertebrae and facet joints.

For some unfortunate people, the bony projections narrow the passageways where the nerve roots and spinal cord pass through (a condition called spinal stenosis) and neck surgery is necessary to prevent nerve tissue from permanent damage, paralysis and severe paresthesias (numbness, tingling) in both the arms and legs.

So the bottom line: be conscientious about the importance of the health of your cervical spine. Don’t get blind-sided by an MRI diagnosis of “multiple-level, severe degenerative disc disease with advanced neural encroachment.”

I’ve seen such cases where patients were oblivious to what was developing inside their necks. They dismissed their neck stiffness and aches to “getting older” or simple muscle strain. When massage and chiropractic provided only temporary relief, they had a cervical MRI done which revealed the formidable origin behind these symptoms, and the next step was neck surgery. Neck surgery of this nature involves removing the damaged disc, shaving off the osteophytes and inserting a bone graft to promote fusion of adjacent vertebrae.

Prevention is the best approach. You don’t have to have neck problems to start preventive measures. In fact, the vast majority of patients who have early to moderate stage degenerative disc disease have no complaints. It’s like a cavity — you don’t feel anything as the pit erodes the tooth enamel, but as soon as it hits a nerve, you will definitely be aware of its presence. But by that time, you’ll need invasive procedures. In the case of a cavity, it means either a filling or tooth extraction; in the case of a cervical disc, it might mean cervical decompression surgery.

Below is a video that summarizes the importance of maintaining a healthy cervical curve (“lordosis”) and exercises to maintain or restore your neck curve so that it can better withstand the physical demands placed on it and hopefully preclude the need to visit an orthopedic surgeon years down the road.

Also, make sure to check out this site’s Self-Care for Neck Pain video, which demonstrates home care procedures for managing musculoskeletal neck pain and/or stiffness.

Do Topical Pain Relieving Creams Work?

by Pain Doc | Feb 25, 2015 | Uncategorized

Icy Hot. Ben Gay. Tiger Balm. These are just a few of the many over-the-counter topical (meaning, applied to the skin) pain relieving products (TPRPs) on the market. They vary by type, and of course active/ therapeutic ingredients.

There are also prescription TPRPs that contain medications like ibuprofen, aspirin or opioid derivatives (Rx TPRPs are not necessarily more effective than OTC ones).

These products generally are OK for aches and pains affecting muscles, tendons, joints and sometimes nerves; not so much for acute injuries involving swelling. And, they are effective only for superficial areas such as elbows and wrists, as depth of penetration is limited.

So far, research shows some benefit in reducing pain, but nothing dramatic. Anecdotal evidence on their effectiveness obviously differs wildly from person to person. This is mostly due to the fact that pain has both physical and mental components to it, and different people perceive pain differently.

Topical pain relief products come in creams, gels, ointments, patches and sometimes sprays. They are usually manufactured with a “delivery agent,” a substance that binds to the active ingredient and penetrates the skin where it diffuses down to the target tissue. The delivery agent, therefore, is critical to the products potency.

There are three basic ways TPRPs work:

(1) analgesia – reducing inflammation

(2) nerve signal inhibition

(3) counter-irritant

The medicinal products use analgesia to reduce pain; this includes those that contain ibuprofen or aspirin (acetylsalicylic acid). Botanicals such as arnica, boswellia serrata, devil’s claw and comfrey are herbs associated with pain relief and are found in many TPRPs. Their mechanism of action is probably via inflammation reduction by acting as a blocking agent in inflammatory reactions.

Capsaicin is the compound that gives hot peppers their perceived heat. Products utilizing this as the active ingredient are more suited for nerve-related pain (neuralgias) like post-herpetic neuralgia, trigeminal neuralgia or a peripheral nerve entrapment condition like carpal tunnel syndrome. What it does is bind to the ends of nerves that send chronic (slow) pain signals which causes them to discharge their neurotransmitter substance P (the substance that transfers the pain signal from nerve cell to nerve cell along the nerve) until it is depleted, effectively deadening the nerve temporarily.

The counter-irritants use menthol and/or camphor, substances that seem to affect cold receptors in the skin. Like ice, it sends a cooling sensation to the brain which may “scramble” or interfere with the pain signal coming from the painful area, thus reducing the perception of pain even though the skin temperature remains the same. Rubbing a sore wrist is basically the same thing — creating more nerve signals (pressure, friction) to compete with the pain signals, thus diluting their impact.

So should you try topical pain relief products? The obvious benefit is that they target only the area of pain. With oral pain relief medications, Rx and OTC, the reach is systemic as the medication is delivered in the blood stream to all body tissues except the brain. This creates a new set of problems (side effects) like nausea, muscle cramps and even renal damage.

On the other hand topical pain relief products don’t reach the target area as well as oral medications. The skin is designed to be impregnable to most external substances, so even if the medicine is able to penetrate, it is at a much lower dosage. This is significant only for the analgesic TPRPs, as they have to reach all the way down to the painful tissue. With the counter-irritants, penetration is not so much an issue as they work on sensory nerve endings that are close to the surface of the skin.

One product that I ran across seems to be effective for a lot of people, at least anecdotally, based on its reviews. It is called Penetrex and contains arnica, boswellia extract, MSM, vitamin B6 and a special delivering agent. If you have chronic pain affecting tendons, muscles and/or superficial joints, it’s worth giving it a try. As a matter of fact, it wouldn’t hurt to try the different TPRPs you find OTC at your nearest drugstore; it’s preferable to oral pain relief products (pills, tablets and liquids) any day, as far as safety is concerned.