Muscle Physiology and Pain
Muscle tissue is a unique type of tissue in the human body. It is responsible for several different duties including movement, posture, containment, and circulation. I want to spotlight circulation because it receives important support from the muscles of the body. As a muscle contracts, it shortens. This shortening creates a pressure within the muscle, helping to circulate blood. When the muscle relaxes, blood can flow into the muscle and the cycle continues. Both contraction and relaxation help to force blood through the muscle. This helps the flow of nutrients into the muscle and waste products out of the muscle. As long as muscles are routinely contracted and relaxed, there will be adequate physiological support for the muscle. Herein lies the potential problem.
When a muscle is static--that is, when a muscle is not regularly relaxed and contracted over the course of a day, there begins to be a deficit in the blood flow. In the course of time, the muscle will begin to react to the changing amount of nutrients and waste products. Since it is absolutely necessary for there to be adequate blood flow to remove waste products that are produced when a muscle works and to supply oxygen and food, the lack creates a toxic environment within the muscle.
Most everyone has experienced the results of this. Think back to a time when you had to sit at a desk for a long time, typing, working on a project, or whatever. Remember the ache you had in your neck and shoulders or lower back? That ache is caused by a muscle slowly going into spasm. It is the nature of muscles to contract when irritated or disturbed in some way. For instance, when a muscle is struck hard, it contracts as a protective reflex. When you have your reflexes tested, you know, the old hammer on the knee, the first reaction the muscle has is to contract in a protective response. This same response occurs when an internal irritation is present. As the muscle slowly begins to contract, it becomes tighter and tighter. This, of course, makes it even more difficult for the circulation to reach into the muscle. Try squeezing a sponge in your hand and then sticking it underwater and pulling it back out. Kind of hard for the water to enter the sponge with all that "contracting" going on, isn't it? You get the idea.
The pain associated with a muscle spasm can be excruciating. The slow buildup of the spasm presents varying degrees of discomfort. Anyone who has experienced the tight neck, shoulders and back know how good it feels to get up and move around a little. Often, just the simple act of moving can remove the pain. This movement is just enough action to remove enough of the toxins within the muscle and allow the blood to circulate. You know how much relief there can be from a quick massage of the affected part.
The latest studies in workplace "ergonomics," that is, studies looking into how a person works, their posture and the equipment suitability, etc., shows that people in jobs which limit their movement should stand and stretch a little at least every 10 minutes. That's what the studies show. Let's be realistic, though. You know and I know that most people don't come remotely close to that kind of standard. I know for a fact that most people will work at a desk for hours before getting up to move. I know, because I've been sitting at my desk typing this material for over two hours already. That's why the muscles in my right shoulder blade area are killing me. And that's why anyone in any static job needs to make a point to activate their muscles regularly.
Multiply this typical example by the months and years people spend doing it and you can see how the body begins to break down prematurely. It is my professional opinion that the long term effects of prolonged muscular stress and "starvation" for blood promotes premature muscle cell death. This, in turn, is replaced by scar tissue, although on a cellular level. When this occurs for a period of 20, 30, 40 years, you can begin to see how this can add up to the total effects we call aging, and specifically, arthritic changes in joints. Aging isn't just a mysterious event that takes place within a given time span. It is a result of specific events that take place over that time span. The cumulative damage that occurs over time is what we call "aging."
It won't be long before every employer will realize that enhancing workplace ergonomics will benefit them. If the employees are hurting or uncomfortable, they aren't going to work as well, right? Compound that by years of the same and you have permanent injuries resulting in accumulated trauma. That translates into lost money. Billions of dollars to be exact.
Key to muscle "rehabilitation" - STRETCHING
The subject of "Stretching" may bring on the same mindset as the word "exercise," but rest assured, you will feel different about it once you do it the right way.
I feel it is important to discuss the subject of warming up prior to any activity which places high loads on your muscular system, especially sports activities. Any muscle that is "cold," that is, is in a partially contracted condition and with minimal blood flow through it, is a muscle just waiting to be injured when any stress is placed on it. "Warming up" increases the amount of blood flowing into the muscle by reason of muscle activity. This prepares the muscle for greater activity. The muscle and tendons which attach the muscle to the bones are more ready for stress. Most of us have experienced the proverbial muscle "pull," right? A muscle pull is a muscle tear. We described muscle damage and healing earlier. If this muscle tear isn't properly addressed, it quite often leaves to permanent residual pain which occurs during activity placed on the muscle.
Remember the discussion of how the blood from an injury forms a pool for cell growth? If this growth happens to be between adjacent tissues, or even within the muscle belly itself, the scar tissue growth acts like a "glue" and prevents normal relaxation and contraction. That's because the area was allowed to heal in a contracted state, without motion to allow healing of the tissues during a full range of motion. When an activity is required within the restricted area, the scar tissue pulls on normal tissue it is adhered to around it creating pain, irritation, inflammation, and further tissue damage if another tear occurs.
The important thing is to work with the already damaged tissue to minimize the damage, whether the injury is only a few days old or 10 years old. I will point out that in any type of accident or injury, there is some kind of internal tissue damage done. From sports activities, falls and fractures, scar tissue becomes involved. This is one of the most commonly overlooked aspects of what we know as "sprains and strains". The medical profession quite often ignores the internal soft tissue injury and hasn't fully appreciated the residual effects of this kind of damage. I will describe some treatment procedures important for minimizing muscle damage in the chapter on self-help.
THE STRETCH TECHNIQUE
In doing these stretches, please keep in mind that you should get some advice from your doctor if you have certain complications that could become involved as you stretch. If you've had a recent muscle injury, have some degenerative conditions in the area, or have had chronic pain that doesn't seem to respond to the stretches within a week, check it out. If these stretches DO NOT HELP WITH YOUR CHRONIC PAIN, then I highly recommend you have the condition examined by your Chiropractor. If the pain is NOT caused by muscle spasms, then you have a more serious condition, such as scar tissue adhesions, nerve entrapment or joint fixations going on.
In most cases, stretching will not be a problem. When doing these stretches, it is much better to do them on a firm surface such as on the living room or bedroom floor. Doing them on a bed reduces the effectiveness because the bed "gives" too much, and doesn't allow for full motion. There are several preparatory stages involved in stretching any particular muscle. It is important to be in loose clothing. If you've ever tried to stretch in a pair of jeans, you know what I mean. It is important to have as much freedom of movement as possible. You can't hurry a stretch unless you want to make the muscle tighter or damage it. The key to these stretches is to hold the stretch for a minimum of 30 seconds, and even up to 1-2 minutes. This gives the muscle time to relax and lengthen. As this occurs, the circulation is allowed to flow easier through the muscle.
As you stretch a muscle, you will reach a point where you either feel firm resistance or definite discomfort. Usually, the pain is a sign that the muscle is tight and needs the stretch. When you reach either tightness or pain, hold the stretch at that point. (Remember, to stretch a muscle it has to relax. That means you shouldn't be using ANY muscles in the area of the stretch. For instance, it is best to concentrate on using only your arms when you are stretching the leg, thigh and neck muscles, or allowing gravity to assist in the stretch of the lower back and pelvic area. The more you can relax any muscle not being used to support the stretch, the better it will be.)
As you hold this stretch, you will notice the tightness, or discomfort begins to subside. At this point, stretch a little more. Keep this progress up until there is no change. If the muscle is very involved, you may not notice ANY let-up in pain or tightness from the beginning. That's OK. At this point, simply hold the stretch for 30-60 SECONDS.
Remember, it is VITAL to HOLD EACH STRETCH FOR AT LEAST 30 SECONDS FOR IT TO BE OF ANY VALUE. The traditional 5-10 second stretch that most of us grew up with CAN ACTUALLY SHORTEN AND WEAKEN THE MUSCLES and can INCREASE MUSCLE SPASMS WITHIN A MUSCLE. You have to overcome the muscle's natural response of contraction when tugged on. If you simply place a stretch on the muscle for a short time, you trigger the contraction response and don't allow the muscle to continue through to the relaxation response.
IMPORTANT KEY TO IMPROVING MUSCLE STRETCH:
This is another little trick you can employ to further encourage the muscle to relax. When you are through stretching, but before you relax the stretch, contract the muscle you are stretching with about 70% of your strength. For instance, if you are stretching your thigh or buttock muscles, try to draw your leg down and out in the opposite direction of the stretch. If you are doing this correctly, you will feel some discomfort. Hold this contraction for a count of 5-6 seconds and then relax the contraction but don't let the leg, (or whatever) out of its stretch. Oftentimes, you will actually be able to FURTHER stretch the muscle after this technique.
This process actually "forces" the tight muscle fibers to elongate because you have the muscle tissue that isn't involved with the actual spasm stretched further than the muscle tissue IN the spasm. When you contract the muscle in its "stretched-out position, the muscle spasm HAS to elongate WITH the rest of the tissue, at least to some degree. Using this technique regularly with your stretches facilitates the circulation and relaxation of the muscle.
One other trick you can do once you have completed the stretch, but before you let it go, is to relax the stretch to just short of tightness or pain for another 30+ seconds. This allows more time for the lengthened muscle to receive more blood and discourage the muscle from tightening back up as you relax the stretch.
If you have trouble with these, ask a friend to help you with them. If you are older, with arthritic problems, a friend can make the difference between success and failure. The key to all of this is motion, as I've stated before. I am convinced that a complicating factor in arthritis is the lack of motion over a period of time. By incorporating these stretches and movements on a regular basis, you can minimize degenerative changes. Of course, as I've already mentioned, diet is a vitally important factor as well, especially complete mineral intake.
This technique can be used for any muscle you have and any area you may suspect of harboring a spasm, or for warm-up prior to any sporting activity, and cool-down stretching to minimize muscle discomfort from toxin buildup due to the activity. This includes all the areas listed and described below. You will be very surprised at how much range of motion you have lost, even if you are young, and how tight your muscles have become.
One last thing. These stretches can be done several times a day without any harm. In fact, it is BEST to do them 3-4 times a day in the case of spasms and pain. This helps to re-establish circulation within the muscle before it has time to tighten up again, and you lose the benefit of the stretch. The key is to continue with the stretching until you overcome the natural physiology of the muscle problem. After this, you do the stretches at the end of each day, just before you go to bed. You will find that these stretches make for a great sleep in a relaxed condition. Oftentimes, problems with sleep are caused by chronic tension within the muscles of the body. This tension can stay there all night and prevent the proper rest from taking place. Ever woke up tired and sore? Now you know why.
In the workplace, you can do the neck and shoulder stretches right at your desk, and I highly recommend you do them routinely if you want to minimize the pains you normally get from being at the desk for long periods of time.
At home, you can have a friend or mate help. There will always be some local spots within the muscle itself that will be "especially" sensitive to touch. This is called a TRIGGER POINT. This spot is a focal point of toxin buildup and inflammation. These spots can be massaged, always massaging toward the heart, NOT away from it. You can apply pressure to these spots for 5-10 seconds and then release. This, combined with heat, can rapidly improve things. In MOST cases, except for acute (just occurred) injury, HEAT is the best choice between ice and heat. This has ALWAYS been an area of controversy in the medical/health profession. My experience is that most people prefer heat over cold.
The heat increases circulation in the area, which is what you want, and it simply feels good. Cold causes contraction, something you want to avoid, UNLESS IT IS AN INITIAL INJURY. You ALWAYS want to put COLD on an injury that just occurs. You WANT to cause contraction of the tissues and vessels to minimize swelling. The swelling actually can cause more damage than the initial injury, so COLD is important in these cases.
Otherwise, a hot pad or hot water bottle for approximately 20 minutes is good, BEFORE the stretch, at MEDIUM. This increases circulation and can ease the discomfort while stretching or being massaged. NEVER SLEEP ON A HEATING PAD, OR USE IT FOR MORE THAN 20 MINUTES. This can cause TOO much local circulation for too long a time and actually SLOW the process down by creating a "fluid jam." Remember, when you sleep, your circulation is greatly reduced. Keep in mind too, that because you have toxins within the muscle itself that have been trapped, when you stretch, you will begin to RELEASE these toxins. They have to travel SOMEWHERE, and this can cause some temporary general soreness throughout the muscle as they irritate the surrounding tissues. This is very temporary, however, and will pass.
It is good to drink plenty of good water, during this time especially. Also, the use of digestive enzymes can make a tremendous difference in eliminating the actual inflammation and supporting other health functions. You can also temporarily use some over-the-counter anti-inflammatory medication, like Ibuprofen, if the pain is severe. This can help to provide immediate relief in the first day or two while the enzymes go to work and you do the stretching technique. However, I always recommend providing the body with the elements it needs to prevent inflammation in the first place. (Enzymes are one of the greatest deficiencies that exist in the human body and are directly related to premature degenerative changes in health.)
OCCASIONALLY, the heat might cause your symptoms to actually increase IF you have a highly inflamed situation going on. In MOST cases, this won't occur. If it does, don't panic, just stop using the heat and focus on stretching and easy, short periods of massage of the area. The enzymes will really help here, too. Between stretching, heat, and massage, you will have a remarkably efficient means for dealing with muscle spasm pain.
Simply follow the instructions below for each stretch.
Laying on your back holding your upper head in your cupped hands;
- Forward stretch - chin to chest
- Right stretch---angle head to the right while stretching the muscle. You should feel the stretch on the LEFT side of your neck and even in the left mid-shoulder area.
- Left stretch---angle head to the left while stretching. You should feel the stretch on the RIGHT side of your neck and even in the right mid-shoulder area.
MIDBACK: *Flat on back.
- Pull your knees up to your chest, and continue arching back, drawing knees closer to your head. The full stretch will occur when you have your knees right next to your head, on the floor. This, of course, will take some time and effort for most people since most haven't done this kind of stretch for decades. It can be quite helpful to have someone support your back in this stretch until your range of motion increases.
- * A word of caution with this stretch. You will find that the older you are, the less you will be able to perform this stretch. You won't be able to overcome 20, 30, 40 years of tightness in a day or two. If you are elderly, or in poor health now, you may want to check with your doctor regarding some of these stretches.
- A variation of this stretch is to do the above stretch to whatever degree you are able, and ant the same time, pull your head forward, tucking your chin to your chest. This will often cause your mid-back spine to move" and you will hear the "cracking."
LOW BACK: Laying on the floor.
- Pull both knees to chest.
- Pull right knee to chest, using only your arms and relaxing your leg and hip muscles, and keeping your left leg as straight as possible, and resting on the floor.
- Pull left knee to chest, using only your arms and relaxing your leg and hip muscles, and keeping your right leg as straight as possible, and resting on the floor.
- Lying on your back, rotate your hips to the left, with your right side up, and your right leg is drawn toward your chest somewhat but keeping your upper back as flat on the floor as you can. You may have the right shoulder riding up off the floor to allow for your right knee to touch the floor. Relax as much as possible and hold for 30-60+ seconds.
- Lying flat on your back, rotate your hips to the right, left side up, with left leg drawn toward your chest somewhat, but keeping your upper back as flat on the floor as you can. You may have the left shoulder riding up off the floor to allow for your left knee to touch the floor. Relax as much as possible and hold for 30-60+ seconds.
PELVIS/BUTTOCKS: Laying on the floor.
This particular stretch affects THE most overlooked set of muscles in the body. This is similar to the knee to chest stretch above and can be done at the same time as the above stretches.
- Pull your left knee to your chest, keeping your other leg straight as possible. As you pull the knee toward your body as far as possible, angle it to the right across your midline. Keep your left hand on your knee, maintaining the stretch, and place your right hand on your lower leg or ankle. As you angle your knee across your midline to the right, begin pulling on your lower leg toward your head. You will begin to feel the tightness right in the butt area, a DEEP tightness or pain. These are the muscles that quite often cause low back, hip and thigh pain due to spasms.
- Pull your right knee to your chest, keeping your other leg straight as possible. As you pull the knee toward your body, angle it to the left across your midline. Keep your right hand on your knee, maintaining the stretch, and place your left hand on your lower leg or ankle. As you angle your knee across your midline to the left, begin pulling on your lower leg toward your head. You will begin to feel the tightness in the left butt area. A DEEP tightness or pain. These are the muscles that quite often cause low back, hip and thigh pain due to spasms.
SHOULDER/UPPER BACK: Sitting.
- Reach across your chest with your right arm and grab your left arm just above the elbow. Keep your left arm straight and pull your left arm across to your right as far as you can. At the same time, turn your head halfway to the right and drop your chin to your chest. Let your neck relax and maintain the pull on your left arm. You should feel the tightness in your left shoulder blade area, the area between your spine and your shoulder blade, and your left neck area. These are muscles that can cause headache, neck pain, arm pain, and upper back pain.
- Reach across your chest with your left arm and grab your right arm just above the elbow. Keep your right arm straight and pull your right arm across to your left as far as you can. At the same time, turn your head halfway to the left and drop your chin to your chest. Let your neck relax and maintain the pull on your right arm. You should feel the tightness in your right shoulder blade area, as well as the area between your spine and your shoulder blade, and your right neck area. These are muscles that can cause headache, neck pain, arm pain, and upper back pain.
THIGH: Sitting on the floor.
- Bend your left leg so as to almost sit on your left foot. Keep your right leg straight or slightly bent at the knee. Supporting yourself with your arms behind you on the floor, slowly lower your upper body toward the floor in the same way as you did with the other leg.
- Bend your right leg so as to almost sit on your right foot. Keep your left leg straight or slightly bent at the knee. Supporting yourself with your hands behind you on the floor, slowly lower your upper body toward the floor. It probably won't take long before you feel the discomfort right in the middle of your front thigh area. Few people will be able to lower themselves to the floor at first. Just go to the point where the tightness or discomfort begins, but don't back off from this pain. You NEED to go INTO the pain a little in order to make any changes to the tight muscle. RELAX the muscle. you will find yourself tightening the muscle as you feel the discomfort to prevent the stretch. This won't work. Just go as far as you can without feeling the need to tighten the muscle, but FAR enough to feel the stretch. Having some support at your back as you do this can help. Hold the position and try to relax the muscle as much as possible. Remember, this isn't a torture session. It IS meant to loosen and relax the muscles. If you are stretching this or any muscle too much, you won't be able to relax it.
CALF: Standing facing the wall, counter or tabletop.
- Plant your right foot flat on the floor, several feet from the wall or countertop you are facing. Step toward the wall or countertop with your left leg, but keep your right leg straight with your toes pointed directly forward. Support yourself with your arms against the wall as needed, and bend the left leg to allow forward motion. If you are doing the stretch the right way, you will feel the tightness or discomfort in your right upper calf area. Maintain this stretch and be sure you don't bend your knee on the side being stretched or you will lose the stretch.
- Plant your left foot flat on the floor, several feet from the wall or countertop you are facing. Step toward the wall or countertop with your right leg, but keep your left leg straight with your toes pointed directly forward. Support yourself with your arms against the wall as needed, and bend the right leg to allow forward motion. If you are doing the stretch the right way, you will feel the tightness or discomfort in your left upper calf area.
RANGE OF MOTION:
Range of motion (ROM) is included here as part of the stretch technique. Range of motion is useful AFTER the initial stretch to facilitate blood flow and help to lessen time in ridding the tissues of toxins released by the stretch. Basically, ROM is applying motion to various body areas through the entire range which that particular area can go through. Obviously, if an injury is involved you wouldn't apply ROM without your doctor's approval, but for general maintenance, it is very good.
ROM consists of slow, deliberate motion in every direction you can but doing it in a circular motion. For instance, ROM of the neck would involve a slow circular motion, perhaps 5 to the left and then 5 to the right. This can be done with any extremity or joint in the body. Arthritic joints such as shoulders can respond to a slow ROM and what is called the "Wall Crawl." This involves facing a wall and placing your hand flat against the wall at shoulder level, with the arm bent at the elbow. Slowly, using your fingers, crawl your arm up the wall, keeping the heel of your hand resting against the wall after each "crawl." Do this to the point of pain and or tightness, and then hold AND RELAX. The wall supports the arm and allows slow, but steady movement. This is, of course, done over time and can increase joint ROM, even in arthritic joints.
I want to be a little more specific in this area of stretching due to the nature of the area. As mentioned above, the general stretching will help a lot to relax the muscles in the area. A method you can use to help this process is to have someone do the following procedure:
Hold the person's head in your weaker hand so you have your strength for the process. Turning the head away from the side you will be working on. You will be able to feel where the muscles of the neck attach to the back of the base of the head. If you start at the very base of the head, up above the hairline, using your thumb for greater action, press into the area anywhere between the two bony bumps (mastoid process) behind each of the ears. The line of attachment of the muscles will begin right at the bottom of these bumps and move toward the midline of the skull, rising in an arc as you go toward the middle. With a little practice, you will readily feel where the muscles attach.
It is much better to use a lotion or gel for this procedure because you will be pulling the hair and adding to the discomfort if you don't. Just enough to make your thumb or finger slide easily along with the skull where the muscles attach. Beginning at the top of the attachment area, even if you start on the actual skull above the muscle attachments. Press in on the tissue and slide DOWN the head and neck, toward the heart. Be sure to have the "patient" let you know where the "hot" spots are, and how much they can tolerate. If you press too much, they will tighten up, defeating the process.
IT WILL DEFINITELY BE TENDER!!! Chronic muscle spasms cause an increased pull on the bone where the muscles attach to the skull. This area can become quite sensitive and is most often the cause of general headaches. Always massage TOWARD THE HEART for the following reason; Remember that toxins are involved with muscle spasms. Inflammation and toxins can be FORCED higher into the already inflamed tissues, WITH NOWHERE TO GO INTO GENERAL CIRCULATION, if you rub or massage UPWARD toward the skull. This can worsen and prolong the problem.
Before and after the massage action, you can apply MEDIUM heat to the area for about 5-10 minutes, but no longer. Simply take a towel and hold it at the short end at the corners, allowing it to the dropdown. Fold it in half, top to bottom, then in half the other way, and then roll it up. A couple of big rubber bands are very handy to place on this roll to hold it in place. Take a heating pad and place it over the curve of the towel, and lay your neck down on the towel, holding up any long hair that might be there. The hair will insulate the heat from the area if it remains between the pad and neck. The towel's curve will support your neck in a good neutral position, and the heat will increase the circulation. BE SURE TO DO "SOME" MASSAGE AFTER YOU DO THIS, ESPECIALLY IF THERE IS TENDERNESS AT THE SKULL/NECK JUNCTION.
You don't want to heat up the area and then NOT drive some of the toxins out.
Bruce Brightman – founder
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