Musculoskeletal Pain

Pain involving the ligaments and muscles is often seen in athletic injuries. When the ligament is torn, the injury is called a sprain. This often occurs in the ankle, the knee, the low back, or shoulder. Muscles that are bruised often become painful and when the injury is considerable, that is called a strain. These small ligaments and muscle fibers may actually be torn, but heal without any residual weakness, after a short period of rest. Inflammation of the bursa (bursitis) may occur as the result of trauma, arthritis, infection or other disorders. Common locations include the shoulder, hip, knee, elbow and heel. Severe local pain and tenderness is often present. Sometimes calcium deposits are seen on x-ray. Immediate application of cold in the form of snow or an ice bag is one of the most helpful remedies, followed by mild exercise and gentle hot and cold compresses, after the acute inflammation subsides.
The tendon sheath of the hand or wrist may become inflamed, Some of these are due to constriction of tendons or nerves, and may require surgery. In the wrist this is called carpal tunnel syndrome. Others are seen in conjunction with rheumatoid arthritis, discussed in chapter five. A number of metabolic problems can produce skeletal pain, muscle cramps, or deep visceral pain. The sudden restriction of oxygen supply, disorders of the adrenal glands, and the so-called autoimmune diseases, may produce severe weakness or muscle pain.
Three forms of vascular obstruction particularly deserve mention. Arteriosclerosis of the large and medium sized arteries is the most common vascular disease of man. This often leads to pain in the muscles, particularly in the legs induced by exercise (intermittent claudication). Diabetic patients are particularly susceptible. Often the pulses in the lower extremities are reduced.
Changes occur in the skin with hair loss, deterioration of the nails, and even gangrene. Buerger’s disease (thromboangiitis obliterans) is a disease of young and middle-aged male cigarette smokers. This hypersensitivity to tobacco produces spasm in the small vessels of the hands and feet. Sometimes a smoker is so addicted to nicotine, that he continues to pursue the habit, in
spite of progressive gangrene and amputation of fingers, feet, legs, and even hands. I have often seen these unnecessarily handicapped patients suffering the terrible sequels of nicotine addiction. Raynaud’s disease is often caused by cold. Women are most commonly afflicted. With exposure to cold, their fingers become white, then blue, and finally red. Pain and tingling are common during this crisis, due to the lack of blood supply. Exercising by whirling the arm in a windmill motion can help to bring blood to the involved areas. Another occupational complication of a similar nature may produce ulceration in fingertips or toes. These are more commonly seen in smokers and those with auto-immune disorders. Obstruction of the lymphatic return may produce a type of edema, associated with pain. Also, thrombosis of the veins is usually painful,
involving the overlying skin with redness and swelling. When larger veins are involved, the muscle and entire extremity is very painful. Most of these pain syndromes can be approached effectively by the intelligent home health observer. With a knowledge of anatomy and
physiology, and a few simple remedies, they can bring relief to many cases. It is important first to ascertain the cause of these pain responses. Wrong habits may need to be corrected. Then nature is assisted in her efforts to restore right conditions within the nerves, muscles, and other involved organs. The relief of pain will always evoke profound gratitude from chronic sufferers. Its study can challenge the layman or specialist for at least a lifetime.

BACK PAIN

Pain in the lower back, as well as the neck is very common in America. Many related, but distinct conditions can produce discomfort here. Disease of the spine, although less common than other problems, is often related to injury. An auto accident or sudden fall, causing acute flexion of the back, may compress and fracture one of the vertebral bodies. It may be an early sign of osteoporosis, thinning of the bones due to calcium deficiency. X-ray is often necessary to diagnose this condition accurately. Immobilization on a straight board, with the avoidance of any flexion, standing, or walking is extremely important First Aid in dealing with these acute injuries. Braces, which keep the back in extension, are often worn for several months in the treatment of a fractured spine.
Local pain in the low back can be caused by any process, which irritates nerve endings. Straining of the muscles, protrusion of a disc, rupture of a ligament, and many less common problems can injure the tissues and aggravate this pain. Tenderness is usually found upon pressure in the region involved. Associated muscle spasm may produce pain around the involved area. At times, the pain may be referred or projected into regions lying in the area of the associated nerve roots. For example, pain produced by diseases in the upper part of the lumbar spine is usually referred to the front of the thighs and legs. That from the lower part of the lumbar spine, is referred to the buttocks, posterior thighs, and calves. Radicular or root pain has some similar characteristics, but usually is much more intense and is often aggravated by a cough, sneeze, or strain. Any motion, which stretches the nerve, such as straight leg raising, may have a similar effect.
Proper examination of the back is an art requiring considerable knowledge of muscle, nerve and skeletal anatomy. Often tenderness over the lumbosacral junction, the sacroiliac joint, the costovertebral angle over the kidneys, or a specific vertebra can help the examiner in accurate diagnosis. The usual testing of the blood, urine, and x-rays of the back are often adjuncts in understanding the cause. Appropriate exercises may then be used, together with rest or the use of moist heat in bringing relief to all but the most stubborn condition. Special problems may be treated effectively in a lifestyle center.

HEADACHE

The term headache encompasses all aches and pains associated in the head. Along with fatigue, hunger, and thirst, headache represents man’s most frequent discomfort. It must always be kept in mind that headache is a symptom, not a disease, and its cause should always be ascertained. Some types of headaches are quite easy to diagnose. Infection or blockage of sinuses is usually accompanied by pain over the sinus area and in the forehead. It is often associated with tenderness of the skin in the same area.
Sometimes the head seems to throb. Often headaches tend to return at the same hour of the day. Headache originating in the eye is usually located near the eye or in the forehead. It is of steady, aching type and tends to follow prolonged use of the eyes in close work. Muscle imbalance is often involved. A careful examination of the eyes by your doctor is recommended.
Headaches accompanying diseases of the ligaments, muscles, and joints in the upper spine are usually referred to the back of the head and nap of the neck. Later in life, these pains are seen frequently in arthritis and also tend to occur after whiplash injuries. Massage very deeply in the area and you may disclose the presence of tender nodules near the insertion of the neck muscles.
Moist heat, as well as skillfully performed massage is particularly helpful in relieving this type of pain.
The headache of irritation in the meninges or coverings of the brain, is usually of an acute onset and becomes severe, deep seated, and constant. Usually this occurs in conjunction with fever. Whenever the neck becomes stiff, immediate consultation with a physician is recommended. Both meningeal infections or brain hemorrhages can cause this type of pain. Lumbar puncture in about 20% of normal patients may produce a transient headache. Usually this is relieved in the lying position and subsides after a few days.