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Do You Feel Knotted-Up? Is Muscle Pain Holding You Back?

If you suffer from headaches or chronic pain in your neck, shoulders, muscles, or joints,  then you probably have KNOTS in your muscles that are either the cause of the pain or contributing to it.

Why Do Knots Form? Factors that may increase your risk!

  • Chronic Muscle Overuse (repetitive muscle stress, strain and injury)
  • Poor Posture
  • Lack of Exercise
  • Injury to Vertebral Discs
  • Chronic Medical Conditions
  • Fibromyalgia
  • Stress and Anxiety

Where Do These Knots Come From?  

Chronic stress, strain and injury to the myofascial tissue (the muscle fibers and the fibrous connective tissue – that cover the muscle) can form taut, bulb-like pockets. These appear as contracted myofascial knots, which cause the muscle to shorten and tighten. As a physician, I can often find the areas where there are knots just by pressing on them.  

But…NOT all Knots are the SAME!

What Kind of Knot Do You Have?

  • An acutely inflamed knot feels sore when pressed.  
  • A  chronically inflamed knot will begin to calcify, and is often described as a “rock” or “pebble.”
  • A trigger point knot leads to localized shooting pain when pressed. In other words, a knot in one muscle can create pain in another area. This is an important distinction, as trigger points can result in severe muscle spasm, limit your movement, and decrease strength.

What are the Symptoms?

Trigger point pain is often misleading and misdiagnosed as something more serious.
The trigger point can cause severe unpleasant and even debilitating pain with a referral pain pattern described as a shooting pain, tingling sensation, or numbness to adjacent areas.  The referral pain mimics the symptoms of other common conditions such as a pinched spinal nerve; “sciatica” or peripheral neuropathy (peripheral nerve problem).

Here is a good example.

Acute strain or stress to trigger point(s) of the muscles of the shoulder, neck and face are a well known source of headaches and migraine symptoms. One common trigger point in this area is located at the top of your shoulder, in the trapezius and rhomboid muscles, which can refer pain to the neck and head. Trigger points can also occur in the low back and in extremities.

To complicate matters, the trigger point might develop secondary to an underlying joint, spinal disc or peripheral nerve problem. Even if the primary problem is treated, you may continue to suffer with pain, if the trigger point was not identified as an contributing problem.

This may lead to unintended consequences like prolong pain and chronic use of pain medications, with an increased risk of medication related side effects. The best-case scenario is to determine whether the trigger point is the primary or secondary cause of your pain problem with a trigger point injection.  

If you have struggled with chronic, unexplained aches and pains that seemingly have no cause, read on because there’s good news…

There is something you can do to help relieve your pain.  

Doctors like me who specialize in Pain Management and Physiatry, can “release” these knots by injecting different kinds of fluids into them, and can immediately relieve the pain and muscle tightness created by the trigger point. This simple procedure is called a “trigger point injection”.

What Exactly are Trigger Point Injections?

A trigger point injection is a routine office procedure involving an injection (usually a local anesthetic or normal saline) at the the trigger point (myofascial knot) site. The local anesthetic will numb the area, provided symptomatic pain relief, and decrease the muscle spasm.

As part of our Integrative Medicine approach, we also use Homeopathic injectables like Traumeel and Zeel for additional anti-inflammatory and healing benefits.  

Top 5 Benefits of Trigger Point Injection Therapy

1. Improved Headaches
2. Immediate Pain Relief
3. Improved Range of Motion
4. Improved Flexibility
5. Improved Posture

Are Trigger Point Injections Right for You?

  • If you have pain, reduced range of motion, or any physical issue that’s preventing you from  sleeping at night, exercising, or reaching your optimal performance, a trigger point injection might be for you.
  • It is used to both diagnose and treat the source of the issue.
  • As a diagnostic tool, it helps us know if muscle spasm, muscle cramp or muscle aches are in fact the root of your problem.
  • As a therapeutic tool, trigger point injections provide pain relief, help you move more easily with increased range of motion, and improves your tolerance of physical activity and exercise.

Other Treatment Options

In addition Trigger Point Injections, physical therapy, massage, manipulative therapy (osteopathy and chiropractic), and acupuncture are also good ways to treat trigger points, especially in the early stages of trigger point formation. However, for chronic trigger points, trigger point injection is the most effective treatment.

Advanced Trigger Point Intervention

Depending on the location of the trigger point, the injection can often be done by palpating it directly during a physical exam. At Blum Center, we also perform Musculoskeletal Ultrasound-Guided trigger point injection for hard to treat areas, especially calcified trigger points. Trigger point injections have been shown to provide significant pain relief and improvement of functional mobility.

Live in our neighborhood? Want to know if you are a good candidate for trigger point injections?   Make a Trigger Point Evaluation appointment with me! Call Blum Center for Health at 914-652-7800 to get on my schedule and relieve your pain.

 

Meet Dr. Aligene:  Dr. Kathy Aligene is Double-Board Certified in Physical Medicine & Rehabilitation (Physiatry) and Interventional Anesthesiology Pain Management. She completed her medical residency and ACGME-accredited Fellowship training at the Icahn School of Medicine at Mount Sinai, where she served as Chief Resident. Her expertise in these complementing areas of medicine has led her to successfully treat patients with musculoskeletal, joint, spine, pelvic and nerve related problems without depending on chronic use of pain medication.  

She is recognized as a local and national leader in her field, an innovative physician in the field of Integrative Pain and Regenerative Medicine. She recently recognized as New York 2018 and 2019 SuperDoctors.

 

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When Does a Shoulder Ache Become A Shoulder Problem?

Did you know that shoulder injuries typically occur prior to the progressive aches and pains that follow the injury? The shoulder joint is the most complex joint of the upper body, designed for mobility and physical interaction.

For example, think about opening a jar: although the hand and wrist provides the twisting motion, the shoulder joint provides the greatest amount of strength and stability. In fact, the shoulder’s multidirectional flexibility relies on the ‘rotator cuff muscles’ – four muscles (supraspinatus, infraspinatus, subscapularis, teres minor) inserting around the shoulder joint that help move it, as well as providing stability. However, this architectural complexity creates an inherent risk for shoulder instability and injury, and is a common source of pain

Shoulder Aches and Pains

Most people are unaware of their shoulder problem for a long time. This is why: There are several muscles connected to the shoulder joint. When there is a deficit in one of the muscles, the other muscles have the ability to compensate. Therefore, shoulder injuries do not become apparent as problems until there are multiple deficits causing significant aches and pains.

Another important point to mention is that acute pain felt in the shoulder region may not indicate that there is a primary shoulder problem at all. There are several adjacent musculoskeletal regions (e.g. the neck) that can be painful but appear to be originating from the shoulder. In addition, there some body organs that, when inflamed, can “refer pain” to the shoulder- such as the heart, gallbladder, liver, and lungs. Therefore, a thorough clinical assessment must be made to differentiate whether it is a true shoulder problem, a problem with a nearby musculoskeletal region, or a problem with other internal organs.

The Common Presentation of Shoulder Problems:

  • Non-specific aches and pains in the shoulder area that occurs spontaneously, oftentimes unaware of source or trigger of pain.
  • Loss of range of motion usually in one or two directions (often goes unnoticed)- difficulty with regular activities (reaching for an object, pulling, lifting, holding, etc).
  • Noticeable weakness with activities, inability to lay on the shoulder, swelling, stiffness and difficulty with dressing (e.g. clasping brassiere).
  • If untreated, progresses to multi-directional loss of range of motion and muscle atrophy.
  • Shoulder discomfort with daily activities:
    • Reaching overhead – i.e. opening kitchen cabinet, grabbing an item on a shelf above your head
    • Repetitive motion- i.e.driving, combing hair, brushing teeth,
    • Sustained activities- i.e. pulling, lifting or carrying an item
    • Opening door
    • reaching for seatbelt or an item from the back seat of your car
  • Grinding or cracking sound with shoulder movement
  • Pain or discomfort when laying on the shoulder
  • Difficulty with upper body dressing (ie. clasping brazire)
  • Shoulder discomfort with daily activities, ie driving, carrying grocery, shopping

6 Common Musculoskeletal Shoulder Problems:

  1. Shoulder Arthritis (Glenohumeral Joint Disorder)
  2. Rotator Cuff Syndrome
  3. Frozen Shoulder (Adhesive Capsulitis)
  4. Shoulder Instability
  5. Shoulder Acromioclavicular (AC) Joint Pain

Treatment Options:

Conventional Treatment includes:

  • Ice
  • Anti-inflammatories (oral, topicals, steroid injections)
  • Physical Therapy
  • Surgical Interventions

How Shoulder Problems are Evaluated and Alternative Therapeutic Treatments offered at the Blum Center:

  • Comprehensive Physical Diagnostic Evaluatio
  • Musculoskeletal Ultrasound Diagnostic and Therapeutic Treatment
  • Comprehensive Physical Therapy Program based on diagnostic evaluation
  • Platelet Rich Plasma (PRP)– used to repair the damaged degenerative cartilage, tendons and ligaments
  • Bone Marrow Derived Stem Cells– recommended for more progressive and severe joint issues
  • Prolotherapy– for loose and unstable shoulder ligaments and tendons
    Prolotherapy is routinely the preferred treatment option for chronic shoulder pain/injury. Prolotherapy can be used successfully for treating most chronic injuries of the shoulder including rotator cuff injuries and tears, arthritis, sprains, and AC separation. Prolotherapy is 85-90% successful in stimulating healing of the injured shoulder. Prolotherapy, the injection of a growth promoting solution in injured ligaments and tendons of the shoulder is an effective treatment that decreases pain, increases functional capacity and promotes healing better and in less time than standard treatment with physiotherapy.Remember, shoulder injuries typically occur prior to the progressive aches and pains that follow the injury. The shoulder joint is comprised of a complex system of muscles, tendons, bones, and ligaments that act in a dynamic and flexible way to provide structural support and mobility. Therefore, if you suspect that you’re having progressive shoulder aches or pains, it is highly recommended to seek medical evaluation and treatment if necessary. If so, please call us to make an appointment!

Meet Dr. Aligene: Dr. Kathy Aligene is a Double Boarded Physiatrist and Interventional Pain Management Specialist, and an innovative physician in the field of Integrative Pain and Regenerative Medicine.  Her expertise in these complementing areas of medicine has led her to successfully treat patients with musculoskeletal, joint, spine, pelvic and nerve related problems without depending on chronic use of pain medication. Dr. Aligene treats men and women of all ages and activity levels to support their functional goals and promote an active and healthy lifestyle. Book an appointment with Dr.Aligene by calling 914-652-7800.

  • References
    1. https://www.myvmc.com/symptoms/pain-2/
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Is There a Way to Prevent and Delay Knee Arthritis?

Chronic Inflammation in the bones and the joints (osteoarthritis, OA, or commonly referred to as arthritis) is one of those hushed terms that we tend to associate with aging or obesity. Yet, as the U.S. population ages, surviving well past “old age,” and remaining physically active, more and more people will suffer from OA. Due to chronic pain and limited range of motion, OA places a significant functional limitation on the individual and can negatively impact mental health and well-being.

How do people develop OA?

Knee osteoarthritis, the most prevalent type of OA, is a main cause of disability, and affects men and women equally. Over a person’s lifetime, bones and joints are subjected to normal wear and tear. Our bodies will naturally repair itself through an inflammatory and healing process. As we age, inflammation in bones and joints can become unchecked, made worse by poor diet and other system-wide triggers of inflammation like digestive issues (imbalanced gut microbiome) and chronic stress. (You can learn more about that in Dr. Blum’s book, Healing Arthritis).   In weight-bearing joints, such as the knee, in addition to systemic inflammation, the direct and repetitive physical impact with abnormal loading forces and stress to the joint, further contributes to increased inflammation and slowing of the healing process.

How you can prevent or delay knee arthritis 

Luckily, knee OA  is more preventable than is commonly assumed. The early stages of joint degeneration often does not cause pain, and early detection is key to making sure your arthritis doesn’t progress to irreversible damage. So, what are some of the warning signs to look out for?

Signs that might indicate you have knee OA:

  • Decreased range of motion or pain on initiating movement (sitting to standing, getting up out of bed, squatting)
  • Difficulty walking up/down stairs
  • Knee swelling (with exercise or activity)

How can we solve the Knee OA problem?

Here are ways you can help make sure you don’t get OA, and how you can prevent it from getting worse:

  • Have a Physiatrist (Physical Medicine & Rehabilitation Specialist) evaluate the physical factors that might be adding wear and tear to your joints:
    • Biomechanics — addressing underlying or potential biomechanical problems leading to abnormal forces or stress on your knee joint.
    • Ergonomics — activities or position that lead to knee ache, pain or stiffness.
    • Footwear — wearing well-fitted and appropriate footwear that supports the entire foot
    • Physical and Joint Health — maintaining joint stability with muscle strengthening, range of motion and balance exercises. The key to maintaining active exercise routine is to use proper positioning techniques that are personalized to you. Using proper techniques during any activity, decrease your risk of abnormal joint stress.  
  • Work with a Functional Medicine Practitioner, such as ours at Blum Center for Health, to treat underlying medical conditions that may cause chronic inflammation, like improving your gut microbiome.
  • Work with a Nutritionist to learn how to eat an anti-inflammatory diet.

How is Blum Center of Health helping to change the course of Knee OA?

We are thrilled, that in addition to our functional medicine and nutrition team, we are now able to offer Regenerative Medicine — a state-of-the-art treatment focused on directly impacting the damage in, and around, the joint.

Treatment Options:

  • Platelet Rich Plasma (PRP)– used to repair the damaged degenerative cartilage, tendons and ligaments.
  • Bone Marrow Derived Stem Cells– recommended for more progressive and severe knee OA
  • Prolotherapy– for loose and unstable knee ligament and tendon

Remember, knee osteoarthritis (OA) is a medical condition that is increasing in prevalence in the US, as the population ages and survives longer. OA is a chronic condition in the soft tissue of joints that causes significant disability due to pain and limited range of motion. OA can be delayed, or even prevented with proper medical management and innovative/integrative medical interventions. If you or someone you love shows signs of OA, please call us to make an appointment!

Meet Dr. Aligene: Dr. Kathy Aligene is Board Certified Physiatrist, Interventional Pain Management Specialist and an innovative physician in the field of Integrative Pain and Regenerative Medicine.  Her expertise in these complementing areas of medicine has led her to successfully treat patients with musculoskeletal, joint, spine, pelvic and nerve related problems without depending on chronic use of pain medication. Dr. Aligene treats men and women of all ages and activity levels to support their functional goals and promote an active and healthy lifestyle. Book an appointment with Dr.Aligene by calling 914-652-7800.