by Pain Doc | Jul 6, 2012 | Uncategorized
Delayed Onset Muscle Soreness, or DOMS is a condition where your muscles feel pain a day or two after hard or unfamiliar exercise. DOMS is thought to more likely be worse with exercises that emphasize eccentric muscle contraction, where the muscle lengthens as it contracts. Examples of eccentric contraction include negative weight lifting (like lowering a curling bar slowly, squatting, and lunges). It is believed to be the result of microscopic tears of muscle and fascia fibers and consequential inflammation. Pain from micro injury is generated by inflammatory biochemicals interacting with nociceptors (nerves that transmit pain signals). In DOMS, the injuries are so small that it takes 12-24 hours before the inflammatory response is enough to generate pain and stiffness.
The muscle pain from DOMS is different in nature than a typical muscle sprain/strain injury. It generally is more widespread, depending on the muscle groups that were worked out the most. Contracting the affected muscles will increase symptoms. For affected muscles that cross a joint such as the knee and shoulder, stiffness reduces joint range of motion.
DOMS, while it can be quite uncomfortable, usually self-resolves in about 7-10 days, with rest and a break from physical exertion. But for some people, that is too long.
So, what can one do to prevent and treat delayed onset muscle syndrome?
(1) Take it easy, tiger. If you do not exercise frequently and decide one day to make up for all the months you slacked off by going “all out” you are setting yourself up for pain, stiffness, and movement limitations. If you haven’t been exercising for months, your muscles won’t be acclimated to taking loads and repetitions and will likely incur microtears in the fascia, tendons, and muscle fibers. So, use the 10% rule, which basically is a scaling up of exercise over a week or two depending on how often you go, to re-acclimate your muscles to your normal, maxed workout. Let’s say you usually curl 40 pound dumbbells. Start day one with 5 pounds, day two with 10 pounds, day three with 15 pounds, until you get up to your max.
(2) Seek out a professional. A personal trainer can show you the right exercises to do for your goals, and the proper technique to get the most out of it, without injuring yourself.
(3) Warm up. Do about 15 minutes of cardio before you do strength or functional training like Boot Camp and similar, full body exercises. Jumping jacks, jump rope, treadmill with incline are good choices.
(4) Do some light stretching. Although recent studies showed that stretching before exercising did not significantly reduce injuries, stretching feels good and can put you in tune with your body.
(5) Hydrate 30 minutes before your workout, competition, or task that will involve heavy lifting (like helping a friend move out of his house). Most sports drinks are formulated to provide the major electrolytes (sodium, potassium, calcium) that muscle use to contract.
(6) Know your limitations. As you age, you lose muscle mass; and therefore strength. Adapt your workout routine accordingly: lighter weights, exercises that are easier on the joints; more rests in between sets.
Now, if you still get DOMS, congratulations, you weren’t cheating; way to go for it! But seriously… here are things you can do to minimize it:
(1) Get a Swedish style or lymphatic drainage massage (NOT a deep tissue or acupressure massage) from an experienced, skilled massage therapist. The long, light pressure strokes towards the heart will increase lymph circulation and help your body clear out the inflammatory products. If you can find a place in your town that does endermologie (cellulite treatment), that is even better. Endermologie is a type of negative pressure massage done with a special machine that can increase skin circulation by over 300%, for up to six hours.
(2) Rest, ice, compress, elevate (RICE). If your whole body is affected, try a cold water bath for 20 minutes. Epsom salts added to the water, and eucalyptus can be helpful.
(3) Do some light exercise– walking, stretching, yoga.
(4) Take fish oil supplements. This may reduce the inflammation somewhat.
(5) Get some protein in you: whey protein drinks, eggs, fish. This gives the body the amino acids it needs to rebuild torn muscle.
(6) Rest. Try to get at least an hour more sleep per day while you are recovering.
And of course, no smoking or over indulging in alcohol during DOMs. When you are ready to start up exercising again, work up to max gradually over a week.
by Pain Doc | Jul 2, 2012 | Uncategorized
It’s strange, but you would think that for someone experiencing neck, back, shoulder or any other type of musculoskeletal pain in his body, he would know exactly when it started, and how.
But surprisingly, this is not the case for a majority of patients I have seen over the years. Most cases of pain I see are idiopathic; meaning, “with no apparent cause (at least in the eyes of the patient).”
A typical history of such a patient goes something like this:
Me: “Ok Sue, I understand you are experiencing pain in your upper back, right side. When did it start, and how, to your knowledge?”
Patient: “At least the past five or so years. I don’t know what started it; it just seemed to have appeared gradually. It is good some days, then bad, and lately it has been getting worse, so I decided to get it checked.”
At this point, I continue with the history by asking questions related to the patient’s occupational, social/recreational, and past medical history. Usually there is something in the history that can be linked to the complaint, like a past car accident, a particular sports activity during college, or something about the physical requirements of her occupation. But in some cases, there still is nothing in the history that can explain the pain.
But where there is a problem, there is an answer. It’s just that sometimes the answer requires some smart detective work.
If you suffer from pain that can’t seem to be traced to a specific cause, realize that musculoskeletal pain, aside from systemic related disorders such as rheumatoid arthritis, lupus, bone disease, and others, develops from some kind of mechanical breakdown in the musculoskeletal system. It can be something obvious like a hard fall that injures and misaligns a joint; something seemingly innocuous like sleeping on your right side for most of your adult life; or something very subtle, like a subluxated heel bone that does its damage via a drip effect.
So, your best bet is to find a practitioner who is very experienced in human biomechanics. Chiropractors or physical therapists such as Craig Liebenson, DC who emphasize body kinematics and targeted exercise rehabilitation will typically have a keen eye for abnormal or dysfunctional movement. The course of treatment will involve identifying and acknowledging the problem; aggressive rehabilitative exercise regimen, and lifestyle modifications. Manual therapies may be employed, such as spinal manipulation; and orthotics may be required, at least during the initial phase of treatment.
This applies to conditions including unilateral hip or knee pain, TMJ pain, neck pain with right or left rotation, rib or sternum pain, and many others. Oftentimes the condition is secondary to a primary cause, so the doctor should not jump to conclusions and direct all treatment to the site of pain. A thorough investigation and inspection is required.
by Pain Doc | Sep 20, 2011 | Uncategorized
Low level laser therapy, or LLLT is the application of low-powered lasers or light emitting diodes for the purpose of pain relief and/or injury repair. The therapy is typically done transdermal; meaning through the skin into the target tissue, such as a sore shoulder joint (no surgical incisions). While some research studies show that LLLT can result in immediate pain reduction in rheumatoid arthritis, osteoarthritis, tendinopathies, acute and chronic neck pain, temporomandibular joint (TMJ) pain and other joint disorders there is currently a lack of consensus on the best parameters to use; i.e. power, dosage, time, pulsing, and type of laser. The therapeutic wavelength appears to be between 800-1,000 nm; and dose to be around 6-10 joules/cm2.
LLLT may reduce pain related to inflammation by lowering levels of COX-2 and tumor necrosis factor-alpha (enzymes associated with inflammation); oxidative stress, edema, and bleeding. It is also believed to cause cellular mitochondria to produce more ATP– a cell’s basic energy unit, resulting in increased metabolic activity.
Low level laser therapy is offered by some chiropractors, sports physicians, and acupuncturists. Lasers are classified according to how much damage they can do to the eye, which basically means how powerful they are in terms of wattage. The wattage rating of a laser determines how long it takes to deliver a dose, and how deep the light penetrates tissue (important if you are treating thick areas of the body such as the hip or knee joint). At 10 watts max output, the LiteCure and K-Laser are two of the strongest lasers in the market for this purpose. Lasers with output of 500mW or less will not penetrate as deeply, and will require a longer treatment time to administer a therapeutic dose.
A typical treatment regimen will be 10-15 minutes of laser; six to eight sessions. Sometimes that is all it takes to take care of an acute or chronic problem. Many practitioners including myself incorporate soft tissue therapy, joint mobilization and rehab exercises to fully deal with the painful condition.
So if you are experiencing a recent injury such as a sports injury; or have chronic pain such as tendinitis, sciatica, plantar fascitis, rotator cuff tear, or knee pain, consider trying low level laser therapy. It is generally safe, and faster-acting than manual therapies alone (chiropractic, PT, occupational therapy). Be cautious and tell your practitioner if you are taking photosensitive medications, or have light sensitive skin, as the treatment can be uncomfortable and may even cause pigmentation.
UPDATE ON THIS TOPIC: Can Red Light Heal Injuries and Lessen Pain?
Dr. Dan
by Pain Doc | May 12, 2011 | Uncategorized
When you think of a scorpion, the first thing that comes to mind is that scary, nasty poisonous tail. You really don’t want to have one of these things napping in your shoe.
But, looks like the nightmarish creature may be offering pain sufferers some hope in the future. There is ongoing research into the pain-reducing effects of scorpion venom, and it looks promising. This is a subject of great interest, as popular opiate-based pain medications like morphine and codeine have undesirable side effects; notably addiction and withdrawal symptoms.
Scorpion venom interacts with sodium channels in muscles and nerves, which are involved in the transmission of pain signals to the brain. Prof. Michael Gurevitz of Tel Aviv University’s Department of Plant Sciences is investigating new ways for developing a novel painkiller based on natural compounds found in the venom. According to Dr. Guervitz, these compounds have gone through millions of years of evolution and some show high efficacy and specificity for certain components of the body with no side effects. His research team is trying to understand how toxins in the venom interact with sodium channels at the molecular level, and whether or not they can be modified to make them specific to certain sodium channels associated with pain.
If successfully developed, this new class of drugs could be useful against serious burns and cuts, as well as in the military and in the aftermath of earthquakes and natural disasters, according to Dr. Guervitz.
I hope that the good doctor finds success with his research. Although this blog is about overcoming pain without the use of drugs (exercises, diet strategies, natural supplements, psychological techniques, lifestyle changes, manual therapy) there are those who simply need some form of quick and powerful pain blocking in order to live a normal life. If scorpion venom can help some people achieve this, it could mean a lot to those suffering from intractable pain. Bee venom apparently has some success in reducing arthritic pain; perhaps scorpion venom, being more potent, can some day be a more potent, safer pain killer alternative.
by Pain Doc | Apr 23, 2011 | Foot and Ankle Pain
As you age, the tendons and ligaments in your body get weaker/looser, which changes the dynamics of your joints. It’s probably related to the decrease in human growth hormone levels as we age.
Tendons attach muscles to bones, while ligaments attach the ends of bones forming a joint. The area that you will notice first when your ligaments weaken are your feet, as they bear all the body’s weight when standing.
I’ve noticed that my feet have flattened over the last ten years (I didn’t have big arches to start with). When your feet flatten, a couple of things can occur:
1. You will walk slower. The foot arch is like a mechanical spring device that is integral to bipedal locomotion: in mid-step, it loads up potential energy (using the plantar fascia– a broad ligament in the sole of the foot), and in toe-off helps push off the foot from the ground and initiates forward leg swing (think of a steam catapult on an aircraft carrier, assisting jets to take off and fly). When your feet flatten, you lose a lot of this ability and have to rely more on your leg muscles to walk.
2. You can develop calluses under your metatarsal joints (ball of the foot). The flattening effect places more pressure on these joints when you stand.
3. You can develop foot pain and fatigue.
4. You can develop ankle, knee, hip, and lower back pain.
#s 2, 3 and 4 are more likely if you are overweight.
If you have any of the above symptoms, and have flat feet, here are the things you can do to lessen the effects:
1. Take joint supplements that support healthy connective tissue.
2. Eat bone broth soup to give your body a ready supply of the building blocks of collagen, which is the main component of connective tissue.
3. Get foot reflexology treatment. I go to this local Chinese massage center that does Asian foot massage. It is one of those painful pleasures– after soaking your feet in a hot water tub for 15 minutes, the therapist kneads out all the sore spots under your feet, including the small muscles of the toes. My feet feel great afterwards.
4. Roll a golf ball under the sole of your feet: back and forth, and in circles. Do this while you’re sitting, and control the deepness of the massage by varying the amount of pressure you place on the golf ball. Great exercise to do while sitting at your desk; your co-workers won’t even know you’re doing it as they pass by.
5. Walk barefoot outside, as much as you can. This exercises the intrinsic muscles of the foot, and all the small joints. You do not get this benefit if your feet are constrained in a shoe.
6. Consider wearing a foot shoe, like the popular Vibram Five Fingers brand. This lets your toes move independently when walking, which exercises the foot muscles, and is the next best thing after going barefoot.
Low level laser therapy, or LLLT is the application of low-powered lasers or light emitting diodes for the purpose of pain relief and/or injury repair. The therapy is typically done transdermal; meaning through the skin into the target tissue, such as a sore shoulder joint (no surgical incisions). While some research studies show that LLLT can result in immediate pain reduction in 
When you think of a scorpion, the first thing that comes to mind is that scary, nasty poisonous tail. You really don’t want to have one of these things napping in your shoe.
