Having an understanding of what may be causing your pain is actually the start of your treatment. When you begin to understand the structures at fault, what is causing that feeling of pain, and where that pain may be coming from, you have started to gain knowledge, and knowledge, as the saying goes, is power.
Whiplash is mainly associated with car accidents, but can be caused by any sudden acceleration or deceleration of the body, such as in a fall. Often the patient will initially feel very little straight away. Then, as the inflammation from the strained structures starts to take hold, neck pain and stiffness are felt. Soft tissue is most often strained, but discs and joints can also be affected.
Wry neck is sometimes called “couch neck” as it’s associated with having fallen asleep on the couch. Prolonged awkward postures can set this condition off, as can quick movements of the neck. Often the patient has one sided neck pain, and difficulty turning the head with a feeling that a joint near the top of the neck is pinched. While commonly a joint is the cause of this painful condition, it can also be caused by a disc.
A bursa is a pocket of fluid that’s meant to be there. If the bursa is pinched, which can happen when you reach up, or if it suddenly increases in size, perhaps due to extra fluid in the area flowing into it from a strained structure nearby, it too can be painful. Often the patient has difficulty lying on that side, and arm movements cause a strong ache in the front of the shoulder.
Inflammation of the shoulder joint capsule and the shoulder joint itself causes this painful and limiting condition. Arm movements are restricted, particularly reaching up, reaching out, and reaching behind your back. While pain is mainly felt in the shoulder, pain can run down the arm, and the neck can also become tight and painful as a result of guarding the painful shoulder.
The Supraspinatus is a shoulder muscle that works to lift the arm out to the side. The tendon attaches it to the arm. When this tendon has been pinched, is overused or has degenerated, it typically causes pain running down the upper arm, or an ache over the front of the shoulder. One of the most painful movements is lifting the arm out to the side to shoulder level which will often cause sharp pain.
Commonly known as “tennis elbow”, Extensor Tendinopathy is due to the overuse and subsequent changes in the tendons that extend the wrist and fingers, and are used in gripping. So while linked to tennis, other causes include hammering, painting, typing or excessive gripping. Typically, pain will develop gradually, often felt the next day, and is felt on the outside of the elbow and in to the forearm.
Commonly known as “golfers elbow”, this Flexor Tendinopathy is similar to tennis elbow except that it affects the flexor group of muscles in the forearm. Pain is located on the inside of the elbow as this is where the forearm flexors attach. The tendon is aggravated by activities involving excessive use of the forearm flexors such as golf, using a screwdriver or water skiing.
Disc bulges are a very common injury in the low back, or spine. The spine is made up of bones called vertebrae and between them are discs. The discs are cushions of a jelly like substance wrapped in a strong outer layer of connective tissue. This design is very good for allowing a variety of movements and dealing with shock absorption. The problem often occurs when people lift too much, sit too long or over twist. These actions can stress the disc causing the jelly like substance to push out through its connective tissue wrapper. Strangely, pain may or may not be felt in the low back. This can depend on whether nerve endings in the back pick up on the problem. It is possible to feel pain in the buttock or down the leg, and not feel low back pain.
Facet joint strain
Vertebrae are the bones that make up the spine. They connect to each other in two ways, one is the disc and the other is via the facet joint. Each vertebra has two facet joints with the vertebrae above, and two facet joints with the vertebrae below. Each of these small facet joints receives a compressive or stretching force depending on the movement. Often excessive repetition of the same movement or one excessive movement, such as overreaching, can strain these joints. Pain is usually fairly well pinpointed in the back. Pain may or may not be felt in the leg.
Sciatica describes pain running from the low back down the back of the leg. It could be caused by a disc bulge, facet joint strain, or other problem in the back, which then puts pressure on one of the nerves that go down into the leg. Often the patient will have one sided low back pain, pain in the buttock region and down the back of the leg. There may be pins and needles, numbness, or weakness in the leg.
Pain is felt locally over the outside of the upper leg which is where the trochanteric bursa sits. A bursa is a pocket of fluid that’s meant to be there. The Trochanteric bursa is commonly inflamed by excessive activity involving the buttock muscles including climbing stairs, running, and lunging. Walking abnormally, such as limping due to back pain, can also be a cause. Trocanteric bursitis often occurs together with Gluteus Medius Tendinopathy.
Pain from a labral tear is typically felt deep in the front of the hip or groin. Often there is pain in the buttock. The labrum of the hip is a strong tissue which helps to increase the depth of the socket of the hip joint. As the source of the pain is deep it is difficult for the patient to pinpoint exactly where the pain is coming from. A labral tear can occur from direct trauma from a fall or car accident, or sports with quick changes of direction such as soccer, tennis or netball. Degenerative tears can also occur in the older patient. Labral tears increase the risk of other degenerative changes, including osteoarthritis.
Pain is often felt over the front, side or back of the hip, as well as down the leg. Walking any distance becomes a problem. In a normal joint, the surfaces that touch each other are lined with cartilage and are very smooth and glide nicely on each other. Ageing, excess weight, previous injuries to the joint and previous surgeries predispose patients to hip degeneration, and the condition of osteoarthritis. As a general rule this starts affecting people in their 50’s and 60’s.
Patellofemoral Joint Syndrome
Pain is often felt over or around the knee cap. It is a common condition in runners, and can also be felt getting in or out of a chair, or climbing stairs. The patella, known as the knee cap, should track nicely in the groove of the femur. When it tracks to the side, or high, it causes excessive rubbing and the joint becomes irritated. This condition can affect the teenage athlete, or the sedentary office worker. The underlying causes can often be found in the balance of muscles around the knee and hip.
Medial Collateral Ligament Tear
The medial ligament of the knee is a strong piece of connective tissue that connects the inner aspect of the Femur or thigh bone to the inner part of the Tibia or shin bone. A tear is usually due to a traumatic incident such as a fall, a quick change of direction while running, or a big dog running into your leg from the side! Repeated bending of the knee with poor mechanics can also strain this tendon.
Medial Meniscus Tear
The knee joint has a lateral and a medial meniscus. They sit in the joint and help with shock absorption, and shaping the joint. The medial meniscus is the most commonly injured of the two and usually occurs traumatically with excessive twisting and weight bearing such as with a sudden change of direction during sport. It can also be caused through wear and tear over time in the older patient. With a small tear, pain and stiffness may not come on until the next day. Often the pain will be on the side or back of the knee and is painful on weight bearing, twisting and getting in or out of a chair. In some cases the knee will give way or lock.
Ankle and Foot
“Rolled Ankle” or “Sprained Ankle” are terms typically used to describe a tear of the ligaments on the outside of the ankle, the main one being the Anterior Talofibular Ligament. This injury often occurs playing sport. Pain is usually instant, and the area quickly swells.
Pain is felt over the Achilles Tendon at the back of the heel. Injury can be caused by a sudden increase in the amount of exercise or type of exercise placing excessive strain on the tendon. This could be from walking, running, jumping, hopping or any activity that uses the calf muscle and therefore the Achilles tendon. When the Achilles tendon is not familiar or prepared for this activity, tendinopathy can develop.
Pain tends to be under the heel and can run along the arch of the foot. This is because the plantar fascia attaches to the bottom of the heel at one end and fans out to attach to the bottom of the toes at the other end. Plantar fasciitis is the inflammation of the plantar fascia which can occur with overuse by activities that load it, such as running, jumping, and dancing. Calf tightness can increase the risk of this injury.