Hip Pain - Ask Dr. P - The Pain Doc

How to Strengthen Your Joints and Avoid a Life of Chronic Pain

by Pain Doc | Jul 21, 2021 | Arthritis, Hip Pain, Knee Pain

When I talk about the nature of joint aches and pain such as hip pain, knee pain and shoulder pain, I explain that the human body is basically a biological (living) machine. Like a machine, it has moving parts comprised of levers connected by some kind of mechanism that redirects force. Think car engines, certain power tools and watches.

In the human musculoskeletal system, those levers are the long bones such as the femur and ulna, and the connecting mechanism/ force redirectors are the joints. Like a machine’s mechanical components, joints will gradually wear out with use. The more hours/years of use, the more likelihood of breakdown. Think football players and those in heavy labor jobs.

When a moving part of a machine gets prematurely damaged from an accident like dropping or overloading, it gets repaired—a replacement part is installed and/or a mechanic puts things back together and makes necessary adjustments. However, the machine is never the same. The accident typically causes moving components to misalign ever so slightly, which results in more friction and accelerated wear and tear, leading to impaired efficiency and eventual breakdown again.

Similarly, if you twist and injure your knee, hip or other joint and get it repaired surgically, or by a chiropractor or physical therapy/ rehabilitation it is never quite the same—most people will lose some degree of functionality because the natural alignment has been permanently altered. You may lose a few degrees of arc of motion; hear some clicking sounds with movement (called crepitus), and lose some strength in the affected joint. Worst case, you will experience chronic pain.

Your joint health obviously plays a huge role in your quality of life. The good things in life involve movement, which depends on joint function. Your joints must be able to first of all exist without pain. They must be able to move your body in the manner you wish to move, without mechanical limitations. And, they must be able to withstand forces while they move your body parts– jumping, climbing, lifting, carrying, etc. That’s the best case scenario.

But what if you are one of the millions of people who have some form of joint pain; either from wear and tear, or from an accident such as a sports injury, work injury, fall, or car accident? These things happen to almost everyone at some point.

It depends first of all on how bad it is. How much structural damage occurred will determine the extent to which your joint can be rehabilitated/ returned to normal.

Unfortunately, the tissues that comprise joints are of the type that do not regenerate very well. This includes tendons, ligaments, cartilage and muscle. As I wrote before, tendons, ligaments and cartilage are classified as connective tissue, which does not contain many living cells, per unit mass. They are mostly protein filaments (collagen, elastin) embedded in a special matrix whose main function is structural. The few cells found in connective tissue are mostly dormant (chondrocytes, fibrocytes) and can effect minor repairs and maintenance: tiny tears of collagen can be repaired, but large tears cannot. Tears/injury to cartilage, such as a meniscal tear or rotator cuff tear, are either repaired by surgical reattachment, or left alone to become chronic leaving the individual with a certain percent loss of function.

Compare this to skin tissue, classified as epithelial tissue, which can heal relatively fast due to the high density of cells (they divide in number to create new tissue) and blood supply. Think of the last time you got a cut– how relatively fast it healed, and is no longer noticeable.

So if you are fortunate to not have joint pain, think proactively now to keep it that way.

If you are experiencing any level of joint pain and/or dysfunction, learn things that you can do to reclaim some of that function AND slow down the progression, which is what I can help you with. Even chronic cases of joint pain can be improved, so don’t give up hope. You may not be able to make the pain go away entirely, but if you can reduce the severity of your pain by 50% and/or increase range of motion by a couple of degrees, that can translate into a dramatic improvement in your quality of life.

The Two Main Approaches to Maintaining Joint Health

Let’s review the main joints involved in everyday movement patterns.

First of all, the weight bearing joints of the lower extremities: hips, knees, ankles, foot joints. We can also include the lumbar spine (low back). These joints have the dual task of bearing the body’s weight (and more than your weight if you do high impact activities) while allowing ambulation—running, walking, climbing, etc. and are therefore larger in terms of surface area contact and number of ligaments.

Secondly, the non-weight bearing joints of the upper extremities: shoulder complex, elbows, wrists, and hands. While they don’t bear as much weight as the hips, knees, ankles and feet, these joints are involved in anything you do with your arms/ hands. They are smaller and generally have more moving parts, so these joints are vulnerable to degeneration as well, especially the glenohumeral joint of the shoulder.

The first course of action in preventing joint degeneration, which tends to start in most people around age of 40, is through diet and nutrition. Eat a wholesome diet rich in phytonutrients; i.e. plants. Phytonutrients are vitamins and minerals naturally found in plants that are important co-factors in numerous biological functions, such as enzymatic activity, tissue repair and anti-inflammation. Some like turmeric are strong anti-oxidants. Think of oxidation, or oxidative stress, as the body’s version of rust. Oxidation is what causes rust and decay in metals; oxidation in the human body damages cell membranes, proteins and DNA. It is caused by excess free radicals— oxygen-containing molecules that have an unpaired electron, making them highly reactive. They take electrons from tissues in order to return to a stable state, which damages them. In fact, oxidative stress is a leading theory of aging and joint wear and tear. Eating a diet rich in phytonutrients—green, leafy plants and plants with hues of blue, purple, and orange equips your body with the nutrients it needs to counteract oxidative stress. Thus, think of a plant-based diet as being protective of your joints.

On the contrary, eating a diet rich in processed foods and added sugar can place a burden on your body. Not only is there a lack of nutrients, there are ingredients that can raise your triglycerides and bad cholesterol; form plaque in your arteries, and even cause toxicity. They must also put a strain on your liver, lymph system and kidneys, the organs involved in detoxifying your body.

Next, move those joints! You’ve got to find the right balance between helpful movement that exercises and strengthens your joints, and the ones that can cause damage. I’m not saying to avoid things like weight lifting and running, because when done properly, they benefit your joints.

Basically, repetitive jumping activities and wrong running technique that “pounds” your knees, hips, feet and spine joints have the potential to cause tiny cracks in your cartilage, which can expand into pits and eventually tears. An example of the movement you should avoid is playing basketball often, where you run on a hard court and jump and land hard to do layups numerous times; often landing on one leg first.

Running is a great aerobic exercise, and I do it myself, being in my mid-50s. But do it wrong, and you are setting yourself up for hip, knee and foot pain. With running, first of all, I highly advise running no more than 20 miles a week. You don’t need that much cardio from running, and running beyond this point every week turns the tables, as the cardio benefit is at the expense of your hip, knee and feet joints. Long distance running is especially not advisable, as it can generate excessive free radicals, causing oxidative damage to your body. Repetitive pounding especially if you are over the age of 40 when cartilage loses its thickness and pliability can cause micro-tears which can expand as you keep doing it, like a tiny, 2mm crack in a car windshield that gradually grows into a really big crack with every bump in the road.

Also with running, definitely do not use a jumping type movement. Think more in terms of really fast walking. Keep your feet close to the ground as you run, and land on the forward half of your foot (toes, ball and arch) rather than your heel. Your head should not bob up and down as you run; or it should be minimal.

Do closed kinetic chain exercises. This means the levers involved in movement (i.e. for lower extrmities, your lower leg and foot) are secured to the ground during force generation. A perfect example are squats and lunges. With this type of exercise, you have more control, and you isolate the muscle better because your leg is secured to the ground with your weight.

For upper extremities, an example is planks and push ups. Chin ups as well — same concept, the levers are firmly secured as you exercise the muscles and joints in a controlled fashion.

Remember, joints are comprised of two bones connected by ligaments. A tendon (the ends of a skeletal muscle) crosses over the joint and connects somewhere on both bones (origin and insertion points). So when you do squats, you are strengthening the ligaments and tendons of the joint, giving it more support. With more support, the joint is more stable and able to withstand forces better; i.e. it will last longer. How does it happen? Wolf’s Law of physiology states that connective tissue increases in mass in response to repeated loads. It’s one of the body’s many survival and environmental adaptation mechanisms. The mechanical stress signals to the brain to mobilize cells to secrete more matrix and collagen to handle the load. This is why resistance exercises are highly recommended for women who are at risk for osteoporosis—it builds up bone mass and turns down bone loss.

Conversely, being sedentary leads to muscle, bone, and connective tissue atrophy. Weak joint components will increase your risk of injury.

But again, be careful not to overdo it. Do the movements slowly and controlled, and focus your mind on controlling the primary mover muscles rather than your rep goal. This will maximize joint strengthening and minimize injury.

Summary of Main Points

Proper joint function is necessary for everyday movements, and therefore is critical to quality of life.
Joints are prone to injury and degradation due to their daily use.
It is advisable to be proactive to ensure your joints stay healthy throughout your life because joint components are comprised of tissues that do not regenerate well. One major injury can mean lifetime dysfunction.
The recommended approaches to maintaining joint health are a plant-based diet rich in phytonutrients, and closed kinetic chain exercises to strengthen your joints so that they are more durable and resistant to injury and degeneration.

Next time, I will discuss more ways to keep your joints healthy, and if you already have chronic joint issues, things you can do to reclaim function.

How to Manage Hip Stiffness and Pain

by Pain Doc | Jun 14, 2021 | Hip Pain, Pulsed EMF

The hip joints are a key component to stabilization and ambulation of the human frame, so if you are experiencing problems with one or both of your hips, it is going to cause some loss of basic movements required by common activities of daily living, which translates to a reduction in quality of life. It is therefore imperative that you be mindful of your hip health at all times: take care not to place excessive shock trauma and repetitive stress to your hips; engage in exercises and stretches that condition your hip stabilizers.

Hip bone, or os coxae

The hip joint, or acetabulofemoral joint is a ball and socket type joint that supports the weight of the body in a static (standing) position and ambulatory position (running, walking). Its two articulating parts are the femoral head of the femur (upper leg bone) and the acetabulum of the pelvis (coxae), a bowl-like depression lined with cartilage.

Your hips bear quite a bit of repetitious force every day, and if you run and/or play sports that involve jumping and landing such as basketball or gymnastics, then those hip joints are really taking a pounding.

mountain bike shocks

The hip/pelvis complex, like a $10,000 mountain bike, is designed to absorb shock from multiple planes while simultaneously enabling movement. A high-end mountain bike can be ridden over uneven ground and can withstand shock forces from bumpy terrain, drops and jumps thanks to a multiple- jointed frame outfitted with shock absorbers. Like the mountain bike, the hip/pelvis complex enables the human body to absorb shock while ambulating.

The hip joints are balanced under the coxae, with the femoral heads partially inserted into the acetabulae and held in tightly by strong but stretchable capsular ligaments. Smooth, nearly frictionless cartilage lines the femoral head and the acetabulum. Comprised mainly of water molecules bound by proteins, cartilage is able to absorb shock and rebound, since water is incompressible. In youth, cartilage is thicker, suppler and more resilient than in those past age 40 but as you age your cartilage thins and is less capable of absorbing repetitive shock; hence the difficulty of running for exercise as you age.

Major hip muscles

Rear view of the hip muscles.

The Ilia and ischia of the pelvis serve as broad attachment points for the hip stabilizer muscles: gluteus maximus and minimus, psoas, adductor brevis and longus, and the deep hip rotator muscles (gamellus, piriformus). These are the hip mobilizers and shock absorbers that give the hip joints their main function of propelling the body on flat and uneven ground, and stabilizing them when the upper body needs a stationary anchor such as during heavy lifting.

So what are the main types of hip problems?

The most common problem that affects the hips is osteoarthritis. With so much pounding forces absorbed daily, the hips are prone to degenerative changes more so than other joints with the exception of the knees. Tiny fissures appear in the cartilage and gradually expand over time, like a windshield crack that grows longer from the constant dips and bumps of driving. The cracks turn into pits, and the hip joint starts to lose its smooth, fluid movement; giving way to clicking, stiffness, and limited range of motion. Although osteoarthritis is often referred to as a “degenerative joint disease,” this term is not entirely accurate. There is indeed a degenerative process involving progressive loss of articular cartilage, but there is also a reparative process in response to this degeneration that involves new bone formation, osteophyte growth, and remodelling. The dynamic process of destruction and repair determines the final disease picture.

In advanced hip osteoarthritis, the pit erodes all the way down to the bone, and at that point you start getting pain in your hips, and where there is pain there usually is inflammation. The hip capsule may fill up with inflammatory exudate, increasing the internal pressure of the hip joint and adding to the stiffness.

Normal hip joint vs. osteoarthritic hip

Risk factors, or things that will increase your chances of prematurely developing hip osteoarthritis are:

Previous injuries to one or both of your hips – a fall, sports injury, car accident, etc.
Participating in sports or other activities that involve high impact landings
Being overweight for much of your adult life
Smoking, as smoking restricts oxygen to tissues which is needed for maintenance and repair
Genetic factors – having a parent who got premature hip osteoarthritis

The genetic factors likely involve protein mutations that render the cartilage’s ability to bind water less efficient, making it extra vulnerable to shocks. They may also involve abnormal production of synovial fluid by the cells of the synovial tissue that surrounds the joint. Synovial fluid is analagous to motor oil in a car’s cylinder– it minimizes friction between the moving parts, so if production of synovial fluid is low, you will get erosion of the articulating surfaces; i.e. the cartilage on the femoral head and the acetabulum, accelerating the disease process.

Iliotibial band syndrome

Another form of hip pain and stiffness may be from iliotibial (IT) band syndrome. The IT band is a broad ligament that originates on the iliac crest of the hip bone; passes over the greater trochanter of the femur (that hard bump you can feel on the sides of your hips, right underneath the skin); and then inserts into the lateral epicondyle of the proximal tibia (lower leg bone). This is a condition that some runners get, and involves strain to the ligament and tenderness at its insertions points. It most often causes pain on the side of the knee, but can also cause diffuse, broad pain over the entire hip. Tenderness and pain at ligament insertion points (into the bone) typically involve micro-tears from mechanical stress, and/or inflammation to the periosteum, the thin layer of tissue where the fibers attach to the bone.

Xray of an aneurysmal bone cyst affecting proximal femur

Aneurysmal bone cysts, a benign but potentially destructive bone tumor may occur in the femur near the hip. It involves the growth of a tumor inside the bone, filled with fluid and blood. Normal bone is replaced by the tumor, which deforms and weakens the bone, making it prone to fracture. ABCs typically start in the first 20 years of life and can remain into adulthood if not dealt with. Make sure to rule this out before doing any physical therapy for hip pain; aneurysmal bone cysts are easily identified on X-ray.

There are other pathological conditions that affect the hip that can cause pain and stiffness, such as slipped capital femoral epiphysis (another pathology common to youth), fibrous dysplasia and other bone disorders but won’t be discussed in this article. Just know that these can be a long-shot cause of hip pain, and can be usually ruled out on X-ray.

Those with hip pain or discomfort due to progressive hip osteoarthritis know the consequences:

Very stiff hips upon waking in the morning, that improves up to a point as the day goes on.
Laborious walking; takes extra effort to move your legs
Aggressive movements like jumping and running are out of the question
For some, burning pain in the hips
Can’t stand for very long; have to sit

For those who have medical insurance, it’s a matter of time before they elect to have an artificial hip inserted.

So what should you do if you have hip pain from osteoarthritis, and are years away from considering hip replacement?

Here’s what I recommend:

Change your Diet: what you choose to eat day to day has the biggest influence on your health. Make 80 percent of your diet plant-based; and of that amount, about half of it raw (uncooked). Suggestions: green leafy vegetables such as chard, collard greens and spinach for the cooked; red leaf and green leaf lettuce, red cabbage, and endive for the raw. Basically, vegetables with purple and red hues are the best as they are rich in anti-oxidants.

Include protein, about 10 ounces per day. Organic grass fed meat, deep water fish, sardines, and pastured eggs are good choices. Whey protein and pea protein powder are also good.

Include fats high in Omega 3 fatty acids, and some saturated fat. Fats are a component of cell membranes especially in nerves, and they are a needed energy source for your body. Salmon, mackerel, eggs, nuts and seeds are good choices.

And of course, drink water throughout the day to stay hydrated. We humans are almost 80% water, and you lose water from your body with every exhalation.

Reduce daily stress in your life: if your life is stressful, make an effort to remove the stress. Stress has an adverse effect on your health and well-being. It can raise blood pressure, blood sugar, cholesterol and cortisol levels, which promote fat weight gain.

Get some negative ions: negative ions are abundant in nature; i.e. the outdoors. They can neutralize harmful positive ions that are plentiful where there is pollution and electronics; i.e. cities. Take off your shoes and socks, and walk on grass in a nearby park. This will “ground” your body, discharging some of your positive ions and equalizing your electrical charge with the Earth’s.

Do low-impact exercises for fitness: you don’t have to go crazy to get a good workout. Using your body’s own weight is sufficient. Planks, squats, pushups, crunches, and lunges are great. For weights, use kettlebells. Cycling can be a good exercise for those with early osteoarthritis of the hip, as the pedaling moves the hip in a non-weight bearing position.

Lastly, use a Pulsed EMF mat daily. Pulsed EMF is considered “energy medicine.” It is the external application of electromagnetic fields similar to those produced by your body, to augment the potential energy the body uses to help drive biological activity; i.e. molecular movement such as blood flow and nutrient transport. This can improve blood circulation and cell membrane transport of nutrients, proteins and wastes; thus improving cell function. In weak tissues, Pulsed EMF can stimulate healing by energizing reparative cells. Can Pulsed EMF help cause worn cartilage to regenerate? Several studies such as this one found that pulsed EMF can upregulate the expression of a gene that controls cartilage production in chondrocytes. It’s definitely worth a try.

Some studies show that Pulsed EMF can help cartilage regenerate.

Go here for more info on Pulsed EMF.

To recap, your hip joints are essential to a high quality of life. They serve to ambulate you, and enable your body to perform basic movements required of daily living such as lifting, carrying, and bending. They are also prone to degeneration, so be mindful of the health of your hip joints – avoid repetitive, high-impact activities that may accelerate degeneration. If you like running, change your running stride to one that more resembles fast walking, where there is minimal to no change in height of your head as you run and therefore minimal impact to your knees and hips upon heel strike when running. In fact, if you run, focus the impact of your foot on the ball of your foot as it contacts the ground, not the heel. Running can be good for health, and your bones, when done right – not too aggressively; with moderation.

The 30 Day Pain Relief Challenge Kick Off

by Pain Doc | Jan 4, 2021 | Foot and Ankle Pain, Hand and Wrist Pain, Hip Pain, Knee Pain, Leg Pain, Low Back Pain, Neck Pain

It’s 2021 and time to kick off the 30 Day Pain Relief Challenge!

But first I want to acknowledge what’s on everyone’s mind.

2020 began with an unexpected crisis, the COVID-19 pandemic. A new corona virus strain emerged; highly contagious and deadly for certain individuals, and for which there was no vaccine. As of this writing, over 85 million people worldwide have contracted the virus, with 1.85 million dying from it. The United States is being hit the hardest, with 20.8 million cases and 352,000 dead. The numbers are expected to spike following the holiday season, thanks to many people choosing to get together in large groups and ignoring the risk. So please, remain extra vigilant the next two weeks because chances are, there are more viruses around you than there were a month ago, ready to find a new host.

As we navigate through COVID-19 in 2021, life must still go on. I know many have been hurt economically, and their number-one priority is to find a way to get back on their feet. It is not an easy thing to do, especially if you lost your job and the life skills you possess are in an industry that has been permanently impacted by the pandemic. If this describes your situation, I sincerely hope you find a way to re-position or re-invent yourself, to get back to earning a living.

While COVID-19 dominates the news and peoples’ attention, we must not lose focus on the many other challenges life presents that also need our attention. How would you rate your health at the start of the new year? How about your energy levels and endurance?

Quarantining and social distancing have a way of discouraging exercising and promoting over-eating, a terrible combination to health. When one is restricted from going outside and going to a gym (although a gym is not necessary for staying fit, but I digress…) and constantly bombarded by news of doom and gloom, the tendency is to stay home, surf the web, and eat, more than you typically do (what else is there to do in such a scenario?). And for many, the choice is high-calorie comfort food. This can lead to unwanted weight gain, muscle atrophy, joint pain, and so on.

If you are not feeling 100%, then I encourage you to open all the emails I’ll be sending over the next 30 days—the 30 Day Pain Relief Challenge is about to kick off, and email is how it will be executed.

And what exactly is the challenge? It’s about challenging yourself to get out of your comfort zone and do all the things I will suggest in the coming days so that you can get out of pain, or significantly knock it down to levels you haven’t experienced in a long time.

The other reward may be that you will lose 10 pounds or more; will have more energy, and will notice that your mind/ thinking is clearer. This is because the methods I’ll go over target your body and all its systems; not just the area of pain. It is wholistic.

But first let me explain how you will be measuring your results. After all, pain is subjective. You need some kind of tool to quantify your improvement, so read on.

Pain, aches, discomfort or whatever you want to call it affects your health. There is mental health and physical health; both important to happiness in different ways. Your physical and mental health are impacted, even just a little and perhaps unnoticeable to you, if you have chronic pain/aches/discomfort. Less-than-optimal physical and mental health impacts quality of life. Quality of life in this sense refers to your ability to physically do what you need or want to do; whether it be your job; recreational activity such as playing golf or swimming; or activities of daily living; i.e. taking care of yourself and your personal needs.

Why You Might Have a Disability if You Have Pain

If you live with chronic pain, you likely have some degree of disability.

“Me disabled?” you might be thinking. “No way!”

The word “disability” is often misconstrued. Disability doesn’t necessarily mean “disabled” and in a wheel chair. It simply means not being able to perform a certain task without some degree of difficulty or impediment; or not being able to do it at all.

Doctors (medical examiners) who issue disability certificates or write medical-legal reports are tasked to determine the degree to which someone is disabled. Their findings determine the patient’s disability compensation from the insurance company or government agency. They use observation, physical exam procedures, diagnostic tests like X-rays and nerve conduction; and instruments to measure strength, pain perception, reflexes, coordination, and range of motion. Any deficiency is expressed as a percent disabled, and there are laws that define levels of disability.

For example, in the insurance industry, the loss of both eyes, or the loss of two limbs equates to “100% disability.” Not being able to maintain a tight grip could be rated as 20% disability if the person’s occupation requires power gripping machinery.

Disability can also be subjectively quantified using Disability questionnaires where the patient rates his/ her ability to perform certain tasks on a scale of zero to some number; and the level of pain. In some questionnaires, the zero rating means you have zero difficulty doing the task (best score), while in others the zero rating means you cannot do the task at all (worst score).

For example, the following is one section of the Oswestry Low Back Pain Disability Questionnaire. Imagine having low back pain and rating yourself (0 to 5) on your ability to lift things:

LIFTING:

0 – I can lift heavy weights without extra pain

1 – I can lift heavy weights but it gives extra pain

2 – Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, i.e. on a table

3 – Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned

4 – I can lift very light weights

5 – I cannot lift or carry anything at all

When rating yourself, you must try to be as objective as possible—don’t over rate your ability; nor under rate it. Give each question some thought.

Then, you add up the numbers, divide it by the total number of points and multiply by 100 to get a percentage score.

If the zero rating is assigned to “full ability to do the task” (like the Oswestry above), then the score is interpreted as “percent disabled.” So, an individual with no low back disability whatsoever will score zero out of 50 and his rating will therefore be zero percent disabled; i.e. 100% functional. If his score is 30, then 30/50 x (100) = 60% disabled.

Below is an example of an Oswestry Low Back Pain Disability Questionnaire completely filled out:

oswestry low back pain disability questionnaire

In the above example, the total points out of all ten questions is 19, which is considered a Moderate disability, out of No, Mild, Moderate, Severe and Total Disability. In this case, 19/50 x 100 = 38% disabled due to low back pain. Now this person has a baseline for his condition, and can set goals to lower it each time; perhaps to 20% after a month, then 10% after three months of therapy.

If the zero rating is instead assigned to “no ability to do the task,” the score is interpreted as “percent functional.” This is how the Upper and Lower Extremity Disability questionnaires are designed. So a score of zero in this case means zero percent functional (totally disabled), and 30% means you are 30% functional (you lost 70% function in that limb).

Please note that Disability questionnaires are used as tools to quantify and set baselines for pain and functional capacity; your scores do not officially establish any disability you may have, they simply provide a more tangible interpretation of pain.

Quantifying pain/disability, even if subjective, gives you a sense of how significant it is; i.e. how much it affects your life. Secondly, it can be used as a tool to measure your improvement over time, after doing some therapy and/or rehabilitation (strength and coordination exercises). This lets you know if what you did works for your condition, and therefore, whether to continue or discontinue it.

For example, if your baseline Oswestry score was 60%, and you were prescribed some McKenzie exercises for one week and a follow- up score was 40%, it suggests that those exercises improved your condition and you should continue or progress to the next level. If it was 60% or higher, you should discontinue the exercises and try another approach.

You don’t have to see a doctor to use Disability questionnaires to subjectively assess your disability. They are fairly straightforward to use and you can download the forms from the internet (see below; I’ve done it for you).

Determine Your Pain/Disability Baseline

If you have low back pain, neck pain, shoulder pain, or lower or upper limb pain then I suggest monitoring your condition using the appropriate disability questionnaire. If you are getting therapy, your doctor should be having you fill these forms (or something similar) out each visit and going over the results with you. It’s substandard care if you don’t know if the therapy you are getting or exercises you are doing is helping; these questionnaires will prompt you to think about the change or lack of change in your functional capacity, and will help you assess your care so that you can take appropriate action.

Below you will find forms to assess any musculoskeletal pain you are having. If you wish to participate in the 30 Day Pain Relief Challenge, print out the appropriate disability questionnaire; rate your abilities as objectively as you can and calculate your score; set it aside, and be ready to fill out a new questionnaire after 30 days of diligently doing the things I will cover over the next 30 days.

My goal is for participants to experience at least a 50% improvement in their pain/ disability scores. If you have any friends who might be interested in participating, please refer them to my site, https://PainandInjuryDoctor.com and have them enter their email in the opt in form.