Archive for June, 2010

Have you ever been doing an activity and felt a pain somewhere and decided that you were just going to work through it? 

How long does it take you to seek assistance after that first notion that something hurts?  A week?  A month?  Several months?

How do you know when you should keep going or should stop? 

I have some basic tips/rules for clients to follow with regards to this question.

 Pain is a signal from our body that we are doing damage to it – most of the time anyway. 

When you touch something that’s hot, you get a pain signal telling you not to touch something hot.

When you step on something sharp, you get a pain signal. 

 Do you keep touching the hot object and stepping on the sharp object? 

So why when you feel a pain in your body when you’re exercising or doing an activity, would you keep going –

especially if it was getting worse?

The pain is telling you to stop! 

 

 

 

 

What about if you have pain and when you continue to do the activity it actually starts to get better? 

 

 

Well maybe this time this is what it needs.  I had this experience when I had developed a tendonitis in my shoulder.

Doing a particular stretch in an exercise class I noticed and increase in pain. The more I stretched, the better the

 shoulder felt. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What’s going on? 

I suspect scar tissue was forming that needed to be mobilized.  After an injury where there is

inflammation, scar tissue forms. It forms in an unorganized manner and we often need to move the

injured area in a gentle manner in order for it to heal in a more organized fashion. 

Another example of this is of a friend who had a sore back and was thinking of not running that evening. My suggestion

was to do the run but if the pain got worse, then to bail. The back pain improved.  Or there was also the time after

picking up an extra bucket of strawberries, I couldn’t straighten back up. It wasn’t a pretty sight watching me getting

 in and out of the car. Instead of not going to do my swim later on, I decided to try it. By the time I finished the

kilometre swim, I was pain free. 

Picking strawberries is a bending forwards (flexion) activity that can aggravate a disc or muscles. 

Swimming is more of backwards bending activity (extension) and doesn’t have the

compressive forces from gravity.  The change in  activity direction was helpful in

counteracting the pain-causing activity. 

 

 

 

 

 

 

 

 

 

Pushing through an activity when you have experienced an injury can take it from a grade 1 injury to

a grade 2 injury (more damage) or worse. 

 

What this means is that you will have a longer time to heal and get back to your normal activities.

 

 

So why would someone not stop when it hurts? 

You want to finish the race. 

You want to finish the game. 

You don’t want to look weak in front of everyone else in the group. 

You don’t think it’s really that bad. 

Let me tell you a couple of stories about pushing through the pain.  A runner who was trying to finish a marathon after

experiencing pain in the pubic area ended up having to take a year off running due to the stress fracture in the pelvis. 

 

 

Another athlete

 

had to have surgery for pain in the front of the shins after continuing to play a running sport.  Okay, then there’s me

 who persevered through a game of hockey because I was the goalie (a whole other story…) after pulling my

hamstring.  It’s still a bit sore eights months after. 

 

 

I read an article awhile back about shoulder injuries and recovery. The longer someone waited to seek treatment, the

 longer the treatment took (more sessions equals more money).

There’s a natural healing process that does occur and the pain in most cases will gradually improve if you are not

doing any aggravating activities. But if the injured area is not improving on a daily basis, I would recommend getting

it assessed and treated—this is within the first week of the injury.  The inflammation stage should only last 24 to 48

hours—this is when you have pain even at rest.  But remember that even though your body will heal itself, there may

be muscles that have gone into a protective pattern that need to be released or joints that may be stiff and tight, or

scar tissue that is forming.   Knowing what to do to help  your body heal the best is important.  What activities should

you do and which ones do you avoid? Getting the area assessed early can save you a lot of aggravation and money.

 

To summarize, don’t keep doing the activity after the injury if the pain is getting worse.  But if the activity is helping

improve your movement and reduces your pain then it’s okay to continue provided it is not more sore after the

activity.  We are not talking about post-exercise muscle soreness, but pain from the injury.  Remember too that the

delayed muscle onset soreness (DMOS) that arrives the day after vigorous exercise is an indication of inflammation of

the tissue and recovery time is needed. 

Get an assessment done early by a therapist who can give you advice on what you can do to manage your symptoms

and help with your recovery. 

 

 

 

 

 

 

 

 

Don’t wait until you are desperate!

This was one of the questions from someone reading one of my earlier blogs. 

It’s a great question, but unfortunately there is not a simple answer. 

Some victims claim it lasts as long as there is litigation. I know this will ruffle a few feathers and by no means am I

attempting to discredit those experiencing the pain of a neck injury following an accident. 

But there are a couple of facts that we have to talk about.

The first is that of my ten years of practicing locally, I only have two clients

who have continued to seek treatment for ongoing pain following receiving

their settlements from their insurance company. 

The second is that 99 per cent (my estimate) of the time treatment is only

sought by the person who wasn’t at fault. 

There is a ton of literature available on whiplash associated disorders and predictors surrounding recovery.  

 

 

 

 

 

WHIPLASH IS CATEGORIZED INTO FOUR GRADES

Grade I: there is soreness when touched but no loss of neck motion, range of movement (ROM)

Grade II:  there is tenderness and loss of ROM

Grade III:  there is tenderness, loss of ROM and evidence of neurological involvement

Grade IV:  there is evidence of fracture 

What is the scoop on pre-existing conditions?  

As you may already be aware (if you have read earlier blogs of mine on spinal degeneration), that our spines do wear out as we age,

some faster than others depending on how we have treated our bodies. But you can argue that you did not have this pain before the accident. 

I am not sure what research article I read this in (sorry folks but I do not have a photographic memory for research, I

only seem to remember pertainent facts, which won’t do me any good in a court of law), but people with pre-existing

problems in their necks prior to the accident tend to have a worse prognosis when it comes to recovery. What this

means in English is that if your neck is worn out (degenerated)–weak or tight prior to the whiplash injury–you’re

likely to have a longer recovery time and may not recover completely. 

I did find, however, something in one of the reviews that proves I am not just making this stuff up as I go along.

 

 

“… neck pain and severe headaches are more prevalent in subjects with a history of neck injury due to a car collision.”3

 

  

 

 

 

 

WHY IS THIS SO?

If there’s spinal degeneration, you may experience more trauma to the joints as your neck is thrown backwards

(jamming the joints). 

If your neck is weak, you are less likely able to protect the neck during the whiplash injury. 

If the muscles are tight, the muscle is not able to stretch and is more likely to experience trauma (strain). 

WHAT IS THE BEST TREATMENT

The answer from my clinical experience is that first and foremost you must be an active participant in your own

recovery. 

People who keep moving and get involved in exercises seem to recover much better. 

Manipulation (by a qualified physiotherapist or chiropractor) if you are comfortable with this technique has been shown to be effective (both clinically and in the literature) for stiff joints.  

There is a great deal of controversy around the use of neck manipulations.  There’s some research that indicates adjustments to the upper back without adjusting the neck can be just as effective in helping restore mobility.

I personally use IMS (www.istop.org) very effectively for relaxing the tight, tense and ropy muscles. 

I am very pleased to say that I have been using IMS on a number of clients who, for several years after

their car accidents, were still experiencing muscle soreness and tightness often resulting in tension headaches. 

Just like the Buckley’s saying, “it is painful but it works”. 

“A recent Cochrane review concluded that dry-needling, added to other conventional therapies such as exercise, is

more effective at relieving pain than conventional therapies alone in non-specific low back pain.

This combined approach to management has never been investigated in whiplash.” 1

“Adequate information and successive mobilization without a collar as early as 

possible supported by a physiotherapist are the best treatments for reducing

pain and increasing ROM at six months follow-up according to one study.”3

 Once muscles are relaxed and joints are moving, you must re-strengthen the muscles (see my Neck Stabilization Blog). 

 

SO HOW LONG WILL IT LAST?

“The evidence suggests that approximately 50 per cent of those with WAD will report neck pain symptoms one year after their

injuries.

Greater initial pain, more symptoms, and greater initial disability predicted slower recovery.

Few factors related to the collision itself (for example, direction of the collision, headrest type) were prognostic;

however, post injury psychological factors such as passive coping style, depressed mood, and fear of movement were prognostic for slower or less complete recovery.

There is also preliminary evidence that the prevailing compensation system is prognostic for recovery in WAD.”2

It is estimated that five to eight per cent of people who sustain a whiplash injury will continue to experience problems beyond six

months post accident (depending on what study you look at). 3

References

1. Michele Sterling, Stephanie Valentin, Bill Vicenzino, Tina Souvlis, and Luke B Connelly. Dry needling and exercise for chronic whiplash – a randomised controlled trial. BMC Musculoskelet Disord. 2009; 10: 160

 2. Linda J, Can-oil, PhD  et al. COURSE AND PROGNOSTIC FACTORS FOR NECK PAIN IN

WHIPLASH-ASSOCIATED DISORDERS (WAD) Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders 

3. Ylva Sterner and Bjorn Gerdle. ACUTE AND CHRONIC WHIPLASH DISORDERS – A REVIEW. J Rehabil Med 2004; 36: 193-210