Myofascial Pain - Ask Dr. P

Are Massage Guns Good For You?

by Pain Doc | Oct 11, 2019 | Myofascial Pain

If you are on Facebook, you’ve probably seen the relentless advertisments for massage “guns.” These are heavy duty, hand-held vibrational massagers that sellers claim provide a number of benefits; namely increasing blood circulation to muscles, reducing muscle tightness, reducing pain and improving muscle recovery from sports activities. The ads suddenly exploded on the scene a couple of months ago. There appear to be multiple sellers selling the same device, with brand names including Halo Pro, G3, Hypervolt, XVan and Intellitop and most if not all are manufactured in China. The price ranges from about $100 – $225.

Below is a screenshot of the Amazon listings of these products. Apparently, they are selling like pancakes:

But are massage guns really good for you? Are they worth the money you spend? Or, are they just old technology being packaged as something new and innovative, using exaggerated claims and expensive marketing? Or perhaps…can massage guns be harmful to you?

Well, let’s break it down, piece by piece. First of all, there isn’t much medical technology involved in these massage guns. At the heart of these massage guns is a variable speed motor and armatures that together produce rapid oscillation of a rod, to which you can attach various treatment heads. That’s it. It’s essentially the same engineering as a jigsaw/ reciprocating saw, with a shorter depth of movement.

You apply it to a large muscle, such as the quadriceps (thigh muscles), gastrocnemius (calves), erector spinae (back muscles), or if you are a bulky weight lifter, the biceps and triceps muscles. If you want to use it on the smaller posterior neck muscles, there is a horseshoe shaped attachment available.

Mind you, the force generated by these massage guns is significant: people with smaller and/or more sensitive muscles will not be able to handle it, and may even get bruised. These massage guns, in my opinion, are better suited for those who have a larger muscle mass than most people; muscle that is well-conditioned from training; i.e hypertrophied muscle.

Are There Health Benefits to Deep Vibration?

The sellers of these hand-held massage guns instruct the user to place the treatment head over the belly of the muscle (thickest part; usually in the middle), applying a downward force as shown in the picture above. You can keep it stationary or slide it up and down the muscle, applying light to heavy pressure.

In order to get an idea of what happens to the muscle when you use a massage gun on it, it helps to understand the anatomy and physiology of muscle and surrounding tissue.

Starting from the top, your skin: is your skin firm or saggy? This depends on the quality and density of collagen and elastin fibers that form your dermis, or lower layer of skin. Younger people have firmer, resilient skin, thanks to dense and higher quality (less degraded from age) collagen fibers. People 50 and over, not so much. So if you are in your 30s, that’s a plus for you if you want to use a massage gun. Your skin is likely tougher and able to handle the force of those vibrations.

Small blood vessels and nerve endings are present just below the dermis, or hypodermis. When these vessels dilate, you get hyperemia, or reddening of the skin.

Next in line, your subcutaneous fat. This is the fat directly underneath your skin, laying just above your muscle whose function is to provide a protective cushion for the body. Its thickness varies, depending on the location in your body; your age, sex (females tend to have more subcutaneous fat as a percentage of body mass), and health status. If the subcutaneous fat over your muscle is a good inch or more thick, this provides a barrier to the vibration and absorbs and dissipates some of that force. So, thicker subcutaneous fat is another plus for massage gun use.

And third, the target of the massage gun– skeletal muscle. Muscle is denser and heavier than fat as it is comprised mostly of protein; specifically actin and myosin, the specialized fibrous protein that comprise the contractile units. Muscle is covered by fascia, a tough fibrous webbing that lends support to the muscle as it contracts.

Skeletal muscle covered in fascia (electron microscope)

Blood vessels penetrate the muscles, supplying them oxygen and nutrients and transporting waste products away. Below is an illustration of the vessels that service the upper leg muscles. It shows the large caliber vessels– the femoral artery and veins, and the smaller branches that attach to multiple areas of each muscle.

Lastly, be aware that there are nerves in the area. The femoral and sciatic nerves pass through the leg muscles, and smaller divisions branch off and attach to multiple areas of each muscle to provide direct stimulation from the brain.

Thigh muscles showing location of major arteries, veins and nerves

So, when you place the massage gun over the skin and press into the muscle, it pulsates rapidly and with each stroke the skin, fat, muscle, blood vessels and nerves get compressed and then rebound hundreds or thousands of times, depending on how long you apply the massager

Here are the physiological effects of the massage gun:

Blood in the vessels of the skin are repetitively blanched and dilated, reddening the surface of the skin. In some cases, capillaries may burst, and if enough of them burst you will get visible bruising (small volume blood leakage into the tissues).
Special sensory nerve endings in the skin fire. These nerve endings detect vibration, pressure, and light touch. Any neural input is sent to the brain for processing, and complex interactions with other nerve pathways may occur causing distal/secondary effects such as change in heart rate and blood pressure.
The collagen in your skin gets stretched/worked. This could loosen the skin over time.
The subcutaneous fat gets compressed. Fat is enclosed in tough, fibrous tissue so there is no effect on fat mobilization.
The muscle absorbs the force. While muscle cells are very durable, it is possible that some of the actin and myosin proteins could be damaged especially those with smaller and/or less conditioned muscles; or older people. This could affect muscle contraction and strength.
The nerves that cause muscles to contract by depolarizing the muscle membrane fire repeatedly, causing small muscle contractions and some fatigue (try curling a weight after using a massage gun on your biceps, and see if you have full strength). If you have an abnormally contracted muscle, this may help it regain normal tone by hyperpolarizing the nerves that stimulate it, causing them to deplete their neurotransmitter temporarily.
If there is scar tissue around your muscle or fascia, the repetitive force of the massage gun may help loosen it by stretching the shortened fibers. This could help regain some lost range of motion and improve flexibility of the muscle.
The deeper blood vessels in the legs may absorb some of the force, if you angle it just right. This could be a dangerous, especially for those who have blood coagulation problems. It could loosen a thrombus (blood clot resting in a vessel) causing it to detach. This could cause a stroke or pulmonary embolism, two potentially fatal conditions. So be careful if you use the gun on your legs, especially your calves.

So what’s the final verdict? Are massage guns worth it? Will they work as advertised?

As in many cases like this, it depends. My advice is that it wouldn’t hurt to get one if you know that this kind of massage makes you feel better– relaxed, invigorated, less muscle pain, or other perceptible benefit.

Secondly, don’t think these massage guns are a magical, new technology. They simply are another form of vibrating massage devices, which have been around for decades. However, they do have one good selling point, and that is ergonomics. They are much easier to handle, and lighter, than the old generation of vibrational massagers like the one below. This means you have better control on applying the massage.

Older generation portable, vibrational massager

These massage guns are also convenient for travel, as they take up a relatively small space in your luggage. For those who travel frequently, it could be a good way to reinvigorate your leg and feet muscles.

I can see the massage guns being a better choice for massaging a trigger point, or patch of scar tissue. The interchangeable heads allow you to focus the pressure over a smaller area, too.

And finally, don’t overdo it. Longer time does not always translate to better for you. Due to the massage gun’s power, I’d say two minutes maximum for any large muscle like the quadriceps group; and one minute max if you are massaging your neck muscles. Get the blood circulation going, and stimulate the muscle just enough to get it to loosen, and no more. If you take blood thinners to reduce blood clotting, I would avoid using it on your legs. Instead, opt for a Swedish style massage from an actual massage therapist. And warning, some people get nauseous from strong, high frequency vibration, and it’s worse the closer you are to your head (inner ear/ vestibular apparatus). The vibration generated by a typical massage gun is strong enough to move the fluid in your inner ear, which may cause nausea and vomiting in some people, so be careful.

Here is one of the better selling massage guns on Amazon. It seems good quality, and has many positive 4 and 5-star reviews, with over 3,500 reviews as of this writing.

A massage gun can be a good addition to your arsenal of home therapy tools. Make sure to visit our homepage, where you can find free self-care videos on the 15 most common presentations of musculoskeletal pain. You will discover the tools and equipment that I personally recommend for pain management at home. There are not many, because not all products are worth your time. As a chiropractor, I’ve tested nearly a 100 therapeutic products on my patients over 20 years, and based on their feedback and treatment results, these are the products I recommend. Opt in to my “Pain Relief Tips” newsletter to get great ideas o how to minimize pain and increase strength and flexibility in your body.

A Little Known and Underrated Way to Relieve Pain, Naturally

by Pain Doc | May 19, 2017 | Myofascial Pain

If you experience ongoing pain; perhaps an arthritic hip or remnants of an old injury, a little-known and underrated way to lessen its impact is through fasting—the temporary avoidance of food, about a half day to two days straight, done periodically.

The word “fasting” causes apprehension in some people, which is unfortunate because once you get used to it, it’s not as bad as it seems. Fasting isn’t about making yourself gaunt, thin, weak and unable to stand up. It is completely natural and compatible to the human body; even more so than eating three meals a day.

Sound a bit outrageous? Well, let’s look to science to see if there is evidence for this.

Scientific Support for Fasting

When it comes to evaluating what is healthy and what is not, I like to bring science into the equation; particularly evolutionary biology.

A main concept of the Theory of Evolution is that nature optimizes all living creatures’ anatomy and physiology to increase the odds of survival. This is the basis of natural selection – where nature determines or “selects” which traits, visible and not visible, an organism will have. Traits that support survival are passed on to future generations; traits that threaten survival are eliminated from the gene pool through predation and other means.

For example, there is a species of frog that lives in an area that freezes over during the winter. This frog developed an amazing ability to stay frozen in hibernation—entombed in ice for the whole winter—and then thaw in the spring, awaken and carry on where it left off!

Camouflage is another example of natural selection. An animal that is well camouflaged in its environment does a better job hiding from predators than one that contrasts with its surroundings, so nature often selects appearances that blend in with the environment.

So how can evolutionary biology be used to justify the benefits of fasting to humans?

Observing predators in the African savanna offers clues. A predator such as a lion or leopard, when it attempts to take down prey, fails most of the time. It doesn’t always get to eat when it wants to. Prey is elusive, so predators go for days without eating.

Homo Habilis, a relative species of Homo Sapiens.

Early humans, who were predators themselves, faced a similar situation. And, they weren’t as fast or strong as top predators that lived with them during that time such as sabre toothed tigers (they did, however, have an advantage in intelligence). Early humans walked for miles each day, stalking their prey, failing most of the time just like the lions of today. Days could go by before they had a solid meal. Sound like fasting?

Early humans foraged for edible plants and ate their roots and leaves, too. Like prey, this wasn’t easy either, as many of the plants that lived during that time were poisonous or basically inedible.

When early man did manage to take down a beast like a Mastodon, he and his tribe gorged on it; probably for several days. They ate the organs, tendons and muscles and used the hide for clothing and shelter. Then it was another couple of days without eating until they had success again, repeating the cycle.

Hence, fasting, although not by choice, was a natural part of early human life, for millions of years. It was an “evolutionary pressure” that caused adaptive, physiological changes to develop in our species homo sapiens. This means that the human body can not only handle prolonged periods without food, it has a preference for it.

These ancient survival mechanisms are present in your own body to this day. Your body takes some calories from your diet and stores them in your liver and skeletal muscle as glycogen, which can carry you for about half a day as long as you don’t over exert yourself.

Excess calories are stored in fat cells. This includes calories from sugar, protein and fats. Your liver converts this stored fat back into sugar, as needed. This is how your body is able to maintain a relatively stable fasting blood glucose level regardless of your energy expenditure; kind of like how your car’s cruise control keeps your car the same speed even when going uphill.

Bottom Line:

Increasing the time interval between meals in an irregular pattern is better for your body than eating breakfast, lunch and dinner at the usual times.

OK, so I think you get the point. Now let’s entertain the converse question:

Since the human body is designed to go without food for many hours to a few days, is it less healthy, or even harmful to eat frequently throughout the day?

The short answer is yes: eating frequently is less healthy than eating on an intermittent fasting schedule, and is even damaging.

The Problems With Eating Multiple Times a Day

Here are the problems associated with frequent eating (multiple meals every day vs. fasting):

Stress to gut: Eating multiple times a day stresses your stomach, gall bladder and intestines. Your stomach has to constantly produce and churn out digestive enzymes. If your meals lack fiber, the intestines have to strain to push it along.
Stress to pancreas: If you frequently eat high-carb foods like a rice burrito and soda, the surge in blood sugar stresses the pancreas as it has to pump out lots of insulin to lower your blood sugar.
Can trigger inflammation: Some food additives trigger an inflammatory reaction which can increase pain; unbeknownst to the individual.
Worsens leaky gut syndrome: If you have this condition, the more you eat, the more macromolecules leak into your system causing systemic inflammation.
Diverts energy needed for tissue repair: If you’re eating processed food frequently, your liver has to expend extra energy detoxifying those additives for elimination.
Massive free radical generation: When you eat frequently, tissue-eroding free radicals are generated in the cells—muscle cells, liver cells, brain cells, everywhere. Free radicals, or reactive oxygen species (ROS) are unstable molecules generated during metabolism that can react with your DNA and cell membrane and cause damage. Damaged cell membranes can interfere with toxin removal from cells.

Most people know by now that eating wholesome, naturally-occurring foods emphasizing green plants, healthy fats and moderate protein is much healthier than eating sugary, processed food and wheat-based food.

Eating this way on an intermittent fasting schedule is the absolute best option for your body because it mimics how early human ancestors ate – an animal or plant every other day or so, with nothing in between except water. It is what your body and all its parts–muscles, brain, heart, liver, gut, etc.– are “engineered” for.

Free radical damage

Fasting Helps Reduce the Intensity of Pain

Can you see how fasting can lessen pain? With fasting you are essentially turning down the furnace in all your cells, reducing free radical generation and “quieting” pain-producing inflammation.

By fasting, your organs aren’t straining to process this food, enabling available energy to go towards cellular repair and regeneration—very helpful if your pain is still acute or sub-acute.

Fasting reactivates body fat burning, producing ketones for energy. Ketones suppress the activation of a protein that drives inflammation in chronic diseases like arthritis, inflammatory bowel disease and diabetes. This is a direct link between fasting and pain reduction.

If you are experiencing daily pain, definitely try intermittent fasting. Eat whole, naturally-occurring foods on an intermittent fasting schedule, and notice how your pain decreases dramatically. It could lessen your dependency on medications. You may be able to reduce your dosage, or eliminate them entirely!

Make sure you only drink WATER, too. A can of soda or fruit juice will negate some of the health benefits of fasting.

How to Do It

One approach to intermittent fasting is to eat your last meal of the day at 6:00 PM, and your next meal around noon or later the next day. That’s an eighteen hour fast.

Alternatively, eat a big breakfast around 10 AM, skip lunch and eat an early sizable low-carb dinner at around 4:00 PM.

P.S. If you’re not willing to part with carbs like pancakes, potatoes and cereal; rice, bread and pasta, then strive to eat most of them during your first meal of the day– the 10:30 am or noon meal in the proposed schedules above. Limit the second meal (dinner) to meat, fat and lots of greens.

Keep in mind your early human ancestors who lived for millions of years before you, and how they ate: thanks to them, your body is hard-wired to handle hours and hours without food. If you feel hungry starting out, it’s because you were accustomed to eating three meals a day all your life. Your brain anticipates these frequent meals, and when it doesn’t get it, it triggers the feeling of hunger unnecessarily, like a false alarm because you aren’t in danger of starving.

You will be surprised that in just a week or two on this schedule, those hunger attacks will cease and fasting will come naturally to you. You will be less hungry as intermittent fasting becomes routine for you (strange, but it’s true!); have less cravings for sweets; have less brain fog and will not feel lethargic. Instead, your mind will be sharper, your energy level will be higher and your mood will be better.

And, if you have pain, it will dissipate. Remember, nothing is as powerful and knowing as Mother Nature!

DOMS: That Nagging Soreness You Get Two Days After Rigorous Exercise

by Pain Doc | Oct 15, 2015 | Myofascial Pain

small-runners legs male If long distance running, long hikes and/or doing leg presses or squats are things you do often, you likely notice soreness and stiffness in your legs. I mean intense soreness where you actually feel deep pain in your muscles, and your legs feel like solid lead (the metal), making walking a chore. This condition is called Delayed Onset Muscle Soreness, or DOMS for short.

The delayed nature of muscle pain after hard exercise is due to the time it takes for offending biochemicals to build up to levels that are irritating to sensory nerves surrounding your muscles. These biochemicals are creatine kinase or creatine phosphokinase (CPK), hydroxyproline and lactate dehydrogenase. They are normally released in response to muscle breakdown, which occurs with rigorous exercise. This process is called catabolism. It used to be thought that lactic acid was the culprit, but further studies doubted that association, as lactic acid is a normal byproduct of anaerobic metabolism and is quickly cleared out as it forms.

The prospect of being sore all over can discourage exercise, which you don’t want to do as exercise improves numerous health metrics such as blood pressure, insulin sensitivity, lean body mass, aerobic capacity and stronger bones and joints. Instead of being discouraged from exercise, take steps to minimize DOMS and manage it so that it isn’t a problem.

Self Treatment for Delayed Onset Muscle Soreness

1. Immediately after your exercise, fill your bathtub with cold water and soak in it for 20-30 minutes. This dampens the low-grade inflammatory reaction occurring in your muscles from arduous exercise. If your water isn’t cool enough, add some ice cubes.

2. Re-hydrate your body with a quart of coconut water.

3. When you feel DOMS approaching (about 12-18 hours after your activity), soak in cold water again and then follow it up with a warm Epsom salt bath, with some boswellia and lavender essential oils added in.

4. Follow your bath with a 20 minute infrared sauna or red light therapy session.

5. Use compression boots to help drive stagnant fluids in your legs back into your circulation. These are great to use after a leg workout even if you don’t get DOMS.

Do not aggressively stretch your legs during DOMS, just wait for the pain to go down, and then do light stretches.

7. If you want the soreness to go away even faster, apply Pulsed EMF to your legs after your event, to minimize the effects of DOMS. PulsedEMF uses low frequency magnetic fields which normalizes muscle cell membrane charges, which restores membrane permeability and allows the cells to return to equilibrium faster. One of the effects of normalized cell membrane charge is reduced inflammation and increased ATP/ energy production. Watch the video below where I explain how this works.

Recommended Lifestyle Changes

1. Exercise regularly to keep your muscles toned and conditioned. Engage in short distance running, aerobic exercises, and functional exercises.

2. Consume complete protein six hours and two hours before your activity. I recommend a whey protein or pea protein smoothie (blend with almond milk or coconut milk). Throw in a raw egg as well. Whey and egg protein have high bioavailability compared to meat, and therefore can be assimilated easier for your body’s use.

3. Take Curcumin and Astaxanthin supplements. These are potent anti-oxidants that can help your body neutralize free radicals generated by exercise. Make sure to take with a meal that contains some fat, as curcumin is not water soluble.

4. Warm up for ten minutes before you do the extreme stuff: stretches, squats, jumps, running in place.

The Origins of Musculoskeletal Pain – Which Describes Yours?

by Pain Doc | Mar 7, 2014 | Hand and Wrist Pain, Low Back Pain, Myofascial Pain

Musculoskeletal pain refers to pain affecting the muscles, ligaments, tendons, joints and sometimes bones. Sometimes it is straight-forward; other times it is not. Before you convince yourself that you know the origin/cause of your musculoskeletal pain, consider the following:

Pain can be due to trauma/injury where the tissue itself is generating the pain due to ruptured cells and the effects of inflammation. This is the most unambiguous case because it is connected to an identifiable event. This pain can be acute, meaning relatively recent onset; sub-acute, referring to a state where the injury still is healing but pain and some swelling is still present; and chronic, which basically means symptoms that remain after the body has done all it can at the moment to heal the injury.

Pain can manifest in one area of your body due to abnormal movement in a distal location. The abnormal movement might be caused by a previous trauma event like a car accident or sports injury, it can be congenital (developed at birth) and it can be from repetitive movements required by a certain occupation or hobby/sport. Abnormal movement (called dyskinesia) can also arise from muscle imbalances, where one muscle loses strength due to inactivity, decreasing joint stability and facilitating excessive, restricted, or other abnormal movement of that joint, forcing distal joints to make up the difference in lost movement or compensate to create more stabilization. The distal muscle(s)/joint(s) then work in a fashion that they were not designed for, leading to strain, spasm and even injury to the muscle or joint.

This is the most tricky type of pain manifestation because it is often mis-diagnosed resulting in the wrong treatment approach and lack of resolution. An example of this is sciatica (pain in the buttock) from a spasmed piriformis muscle scissoring the sciatic nerve due to an unlevel pelvis coming from hyperactive same-side erector spinae musculature. If the back muscle and pelvic imbalance is not corrected and the patient simply gets massage to the piriformis muscle, you can see how this pain will never go away with this type of treatment.

Pain can be referred pain. In referred pain, the brain senses the pain to be in one area of the body when the abnormal site is actually in another area. Despite an increasing amount of literature on the subject, the mechanism of referred pain is still unknown. Going back to the heart attack example, myocardial infarction can cause referred pain to the left jaw and left arm. The image below illustrates commonly observed types of referred pain and their true source (credit to Wikipedia).

Pain can arise from hypoxia (insufficient oxygen to the tissues). An extreme example of this kind of pain is a myocardial infarction, or “heart attack” where a major artery to the heart muscle is blocked, preventing oxygen from reaching a section of the heart. Biochemical reactions take place when this happens, which generate pain.

Thoracic outlet syndrome is a condition where the nerves and blood vessels supplying the arm get compressed in the neck region by tight scalene muscles or the collar bone. The resulting hypoxia can contribute to pain in the arms and hands.

Pain can come from trigger points, also known as trigger sites or muscle knots, are described as “hyper-irritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers.” Trigger points are usually only a few centimeters in diameter.

Clinical textbooks on the subject establish the following requirements to meet the definition of trigger points:

Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.
The painful point can be felt as a nodule or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point.
Palpation of the trigger point reproduces the patient’s complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point.
The pain cannot be explained by findings on neurological examination.

As in referred pain, the mechanism of trigger points is still being debated. Trigger point tissues have been biopsied, and findings indicate the presence of hyperactive muscle spindles, special cells whose function is to detect the rate of lengthening in a contracting skeletal muscle and initiating the firing of complementary muscles to complete the desired goal.

Wikipedia gives a nice summary of what causes trigger points to form:

Activation of trigger points may be caused by a number of factors, including acute or chronic muscle overload, activation by other trigger points (key/satellite, primary/secondary), disease, psychological distress (via systemic inflammation), homeostatic imbalances, direct trauma to the region, collision trauma (such as a car crash which stresses many muscles and causes instant trigger points) radiculopathy, infections and health issues such as smoking.

Finally, there are more highly-complex causes of pain related to dysfunction of the central nervous system, sympathetic nerves, biochemical and hormonal issues, and even psychosomatic. These types of cases are difficult to diagnose and are often treated using pharmacological agents, and on the other side of the spectrum, holistic approaches with mixed results.

NO MATTER what pain you may be experiencing, know that it always, always helps to detoxify your body as best you can via a nutritionally-dense diet centered on naturally-occurring, non-GMO, organic unprocessed food sources; reducing your processed sugar and grain intake; regular exercise, getting enough sunshine to your body; targeted supplementation, meditation or other relaxation methods, and even nurturing social support. This is the theme of this blog, because there is no shortage of treatment methods for pain and not enough emphasis coming from doctors or the government on prevention, wellness and health optimization; i.e. Healthy Lifestyle Education.

In the next couple of blog posts, I will talk about real, practical ways you can reduce your pain without the help of your doctor by making strategic lifestyle modifications. Your body has a potent array of disease-fighting systems and has an innate ability to repair and regenerate itself. The problem is that in many pain sufferers, these systems are burdened by unhealthy habits and are not running at their full potential. Imagine what can happen if those systems were brought back on line, constantly doing what they are naturally programmed to do– protect you and keep you alive; fighting germs, cancer cells and developing diseases; and repairing injured sites so that you can function better. Isn’t this a goal worthy of your efforts?

More to come, stay tuned!

Dr. Perez

Severe Neck Muscle Spasm of Unknown Cause

by Pain Doc | Aug 3, 2013 | Myofascial Pain

It’s been a while since I posted my last entry, as I have been busy launching a new authority site, painandinjurydoctor.com. This particular post, as luck would have it, is a case study in a rare condition that I only recently became aware of.

Last June, I experienced a severe case of cervical (neck) muscle spasm. It had a prodrome characterized by soreness around the left side of my left neck; the type that typically is associated with “sleeping in a funny position” or using a bad pillow. That’s what I attributed it to, so I was not concerned, thinking it would be gone in a day or two.

Boy was I wrong. The following day, the soreness quickly turned into unusually severe pain and muscle spasm. Unusual in the sense that I could not think of anything physical I did to trigger it. I certainly did not get injured in the days leading up to the prodrome. The neck spasm and pain took a life of its own.

The pain got so bad that it caused my neck to laterally flex to the left about 25 degrees, and rotated it downward about 10 degrees. The tilt caused mild nausea, as my vestibular system became affected. I was able to walk around gingerly, with head tilt and rotation firmly fixed. Lying down was the only thing that reduced the pain, but I had to use my hand for support when lifting/moving my head on the pillow, as recruitment of the neck muscles was excruciating. When I went to bed that night, I thought to myself “one long night’s sleep should reduce the pain to 50%.” I was still hopeful that my neck spasm was just an ordinary muscle contraction that would resolve on its own.

Wrong again. As I woke up the next morning, I realized to my dismay that the pain was even worse. Normally I would ice and rest it and do passive stretches, but I had a trip planned for the family that involved driving in just two days. I needed to be able to turn my head fully; I needed to be out of pain, and fast.

I drove myself to the emergency room, hoping that prescription medications (which I avoid unless it’s an emergency like this) would be able to calm the muscle. I was prescribed a muscle relaxant and anti-inflammatory, which had no effect. I iced, tried a TENS unit I happened to have at home; and tried a phototherapy (infrared, near infrared therapeutic light) unit; all of which had no effect. I saw an acupuncturist, which did not help.

Determined to knock down the pain, I went to a dentist I knew and had some anaesthetic injections directly into the posterior neck muscles (I originally thought of getting Botox, which he did not recommend). By this time, the pain was so severe that it created referred myofascial pain in the left hemisphere of my scalp, especially the occiput region. The anaesthetic shots did nothing. That evening, I consulted with my colleague, and we decided to try a kenalog (cortisone) injection the next day.

I received three kenalog injections (about 5 cc) along my left upper trapezius. I felt nearly immediate relief (but partial). This was the first thing that seemed to dampen some of the pain. I estimate that it reduced the pain by about 33%.

In the coming days, the pain gradually reduced, and I was able to turn my neck better. But there was more reason for concern. I noticed that my left sternocleidomastoid muscle was flaccid. I could not get it to respond with neck movement, and even resistance exercise. It was as if it weren’t there. I was still able to rotate my neck to the right, because other muscles that are used for this were normal.

What could cause it? My first thought was the Spinal Accessory Nerve, a cranial nerve that controls the sternocleidomastoid muscle and part of the trapezius muscle. I wondered if it was possible that I somehow injured it and snapped it off my neck muscle (I lift heavy weights regularly). But this was not likely, as significant force is required to detach a nerve from a muscle, and I did not sustain any traumatic injury that would explain my symptoms. Then I thought of possible brain lesions. A tumor could affect the neurons that form the spinal accessory nerve. However, a brain MRI ruled that out.

I spoke to three MDs, including an experienced orthopedic surgeon, who were basically stumped by this presentation.

So, let’s go over the facts: severe neck spasm with no apparent physical etiology; no response to medications and electrotherapy; no response to anesthetic; some response to kenalog; negative findings on brain MRI, and flaccid left sternocleidomastoid muscle but normal neck range of motion (active and passive).

I spent the next couple of days researching the internet, trying to find information that would explain my condition. And, I believe I found the answer to this perplexing problem.

My research led me to a rare condition known as hyperkalemic periodic paralysis. You can read more about it by clicking the link, but basically it is a condition caused by a faulty gene that makes a protein that plays an important role in muscle contraction. In order for a muscle to contract, the electroytes sodium (Na+) and potassium (K+) flow along channels within the muscle. The faulty protein in hyperkalemic periodic paralysis plays a role in the structure of these channels. If you want detailed information on mechanism of this condition, this article does a good job.

Some people with HPP have high levels of potassium (K+) in their blood during a spasm attack and shortly thereafter; some have normal levels. Factors that can trigger attacks include rest after exercise, potassium-rich foods, stress, fatigue, and periods without food (fasting). Muscle strength improves between attacks, although many affected people continue to experience mild stiffness (myotonia), particularly in muscles of the face and hands.

Why it would be very specific to one muscle and not affect other muscles is unknown. At least I could not find any information that would explain this.

One month after the attack, my left SCM is showing early signs of making a comeback. There is slight definition of the distal portion that attaches to the collarbone when doing active resistance (stressing the muscle). Hopefully, it will return to normal, and this nightmare will not happen again.

So, lesson learned: if you have a severe muscle spasm and notice that it is flaccid after the pain is gone, you might have hyperkalemic muscle paralysis. The current medical advice is to determine if you have the hyper or hypo kalemic variant. If you have hyperkalemia, the recommendation is to avoid foods high in potassium. Avoid fasting, and make sure to eat carbohydrates. Also, avoid strenuous exercise (this is one I have to ignore, until I am proven otherwise). Apparently, rest after strenuous exercise is a trigger for this condition.

P.S. There is more to the story to this (that involves the Kenalog injection). More on this later.

Delayed Back Strain

by Pain Doc | Aug 24, 2010 | Low Back Pain, Myofascial Pain

Updated 3/29/2021

If you ever went to bed feeling fine but woke up with muscular back pain, it could be a number of things.

1. Your mattress : Cheap spring mattresses deform at the level of the body’s center of gravity when lying down, which is at the pelvis (buttocks/hip level). Remove your sheets and take a look at your mattress: is there a slight depression in the center? If so, when you lie on your side, your pelvis sinks and forces your lumbar spine to arc downwards, compressing the joints and discs on the opposite side.

If you sleep on your stomach it puts your lumbar spine into hyper-extension (arcs sharply) forcing the facet (rear) joints of your lumbar spine together. It also forces you to twist your neck, which rotates all the vertebrae all the way down your spine.

Sleeping on your back is the best position because it allows your spine to be in the most neutral position. But if your mattress is old and has that pit in the middle, that can be enough to put a prolonged stretch on your back muscles as your pelvis sinks downward. This can make your back feel sore in the morning.

Solution: Get a new mattress. I recommend the TempurPedic viscoelastic mattresses, which resist deformation (always spring back) and last a long time. Basically, the mattress material pushes proportionally to the weight placed on it (more under the pelvis and upper back; less on the waist and lower legs) and rebounds so that it can do this every time.

If TempurPedic isn’t your thing (some users report feeling too hot in the summer on these mattresses), a high-quality spring mattress should work.

2. You may have strained your fascia while exercising or engaging in other intense physical activity that required heavy use of the back muscles, such as rock climbing. The fascia is the sheath that encases a muscle, protecting it as it lengthens and shortens inside the body, rubbing against adjacent muscles. It may take longer for fascial strains to be noticeable as they don’t release as much inflammation as a strained muscle. So, if you wake up and you have a very focal, sore spot on one of your back muscles that gets progressively worse, chances are you have a myofascial strain. You probably incurred it the previous day doing a back exercise or other type of heavy exertion.

Solution: Like all types of strains, fascia strains eventually resolve on their own, but it could be a couple of days and sometimes weeks of discomfort and problems with back mobility. If you wish to eliminate your back pain sooner than later, consider getting a Pulsed EMF coil.

Pulsed EMF, PEMF for short, is the external application of a body-compatible electromagnetic field that energizes injured/ sick cells and one of the few medical devices cleared for home use that I highly recommend. The magnetic field helps with molecular transport in and out of cells, which enables them to carry out their biological functions more efficiently; including healing, repair and protein synthesis.

Pulsed EMF has a number of reported health benefits such as pain reduction, faster fracture/injury healing, and better sleep. Whole body PEMF devices are not cheap, but are a sound investment in your health.

More information on how Pulsed EMF can help you >>

3. Your potassium levels are low. Hypokalemia, or low potassium can occur if your diet is deficient in potassium, and/or you engaged in strenuous activity such as hard labor, a long hike or a long run and sweated quite a bit. It is known to result in severe muscle spasms, sometimes involving one, particular muscle. Potassium in ionic form (K+) is involved in nerve transmission and muscle contraction, so if you are low, it can cause dysfunction that manifests as a muscle contraction abnormality.

Solution: Take Potassium supplements, about 500 mg/ day for several days until your muscle pain is resolved.

Bottom line, you don’t have to noticeably injure yourself to feel muscle pain. Muscles are complex organs that can get damaged just like any other organ in your body if they are stressed in a way that interferes with their proper movement. Potassium and other ionic imbalances, specifically calcium and sodium, can cause abnormal muscle function, and are therefore another possible cause of muscle pain.