Disk Injuries | Headaches | Back Pain | Carpal Tunnel |Muscle Pain | Nerve Entrapments
Tendinitis | Tendinosis | Shin Splints | Stress Fractures

This list is just a sampling to give you an idea of how soft tissue problems work and relate to commonly given diagnoses. This list is not comprehensive.

Disc Injuries
Discs are special structures that lie between most vertebra of the spine. They allow for motion and shock absorption. Discs in the neck and low back are most often injured. Virtually all disc injuries occur due to long standing excessive loads. These loads result in degeneration, or a gradual weakening and thinning of the disc. The degeneration is often punctuated by very painful acute episodes. It is not uncommon for one to wake up in severe pain or experience pain after simply bending over. The acute symptoms are just the “last straw” effect. If it did not happen that day it would have happened the next. Please do not correlate the onset of symptoms with the onset of the problem.

Once the disc is weakened enough it can tear. This results in different types of disc injuries. The least problematic is called an internal disc derangement. This produces severe pain (usually 1st thing in the morning) and antalgia (tilting of the neck or body in an attempt to take pressure off the disc). Painful episodes usually last 2-8 days and resolve with no special care. However, over time, the episodes can become more severe and longer lasting. Therefore, if caught early, the disc injury can be minimized through various treatment options.  If nothing is done internal disc derangements can progress into more severe types of injuries.

Disc bulges and herniations can cause more serious problems. The back of the disc weakens and pushes out. This can be a source of pain but does not often produce symptoms. If the bulge is large enough and in the right place it can compress the nerve root. This will cause referred pain down the leg or arm and possibly weakness, numbness, or tingling.

The third type of disc injury is a sequestration. Some of the inner disc material can pinch off from the disc and “float” in the spinal canal. This is a rare type disc injury.

What does this have to do with soft tissue? Disc injuries do not happen in isolation. Other parts of the body are virtually always involved. It is the role of the soft tissue to support and protect the spine and discs. If the soft tissue system is not working properly the disc will take more load than necessary, often several orders of magnitude more.

Trying to let a disc injury heal without addressing the soft tissue problems is like slamming your thumb in a car door, leaving the door closed, and expecting your thumb to get better. Problems such as scar tissue, weakness, meniscoid entrapment, and neurological inhibition need to be diagnosed and addressed to unload the disc. Only then will the disc have a good opportunity to heal.

Headaches
Headaches are a huge burden. Dealing with recurrent headaches requires tremendous effort, drains energy, and can put you in a perpetual bad mood.

Most headaches are a result of a problem in the neck, called a cervicogenic or tension headache. Stress, poor posture, or previous injury overload the muscles at the base of the skull and neck. This generates tension on the skull and results in headaches. Please note headaches are not due to an Advil deficiency. Although medication can be temporarily be helpful, it is not a solution.

An interesting question: How does stress actually cause headaches? First, stress does not directly trigger pain. Stress causes certain muscles to tighten, restricting blood flow. Restricted blood flow allows chemicals to accumulate. Theses chemicals then cause pain triggering a headache. Usually there is scar tissue, weakness and joint problems that overload the tissues and cause headaches. Note: There are lots of different headache diagnoses; many different kinds, including migraine, can have neck problems as contributing factors.

Back Pain
Back pain is not a diagnosis, it is a symptom. The exact cause of the pain must be identified prior to treatment.
Please link to Dr. Brady’s article Back Pain Literature: What Have We Learned?

Carpal Tunnel
The diagnosis of carpal tunnel syndrome is only accurate when the median nerve is compressed or trapped in the tunnel formed by the wrist bones (carpal tunnel). True carpal tunnel syndrome will only produce symptoms in the first three fingers and the outside half of the ring finger- not ever in the pinky or inside half of the ring finger. If your whole hand goes numb you either don’t have carpal tunnel syndrome or you have more than just carpal tunnel syndrome. There are several places where the median nerve can be trapped; all of these sites must be checked to determine if a median nerve problem exists. The problem is lots of people come to our office who have been told they have carpal tunnel syndrome when, in fact, they have an entirely different peripheral nerve entrapment site. 

Muscle Pulls/Strain/Tears
Muscles injuries fall into a couple different categories. Broadly speaking acute injuries are the result of a tear or crush injury. If excessive stretch (pull) or contraction loads are placed on a muscle it will tear. If a hard blow is delivered to a muscle it can crush. These injuries are graded by the percent of total tissue damaged. One percent being a very mild tear and one hundred percent being a full thickness tear requiring surgery. Healing is determined by several things- percent tear, distance between torn ends, load or use level while healing, and other problems that contribute to overloading the torn muscle. Treatment of muscle strains involves rest, ice, and compression. If the tear does not heal properly, excessive scar tissue can form and cause long standing problems.

Nerve Entrapments
Nerves are the body’s “wires” for receiving and sending information. They exist in all parts of the body. Some, like the sciatic nerve, are the size of your index finger while others, like the median nerve in the arm, are about the size of spaghetti. Nerves travel through and around muscles to get where they go. If excessive loads are placed on these areas scar tissue can develop gluing the nerve to the muscle. This prevents the nerve from sliding properly and results in burning, numbness, tingling, aching etc. There are 85 common locations for nerve entrapment throughout the body.

Tendinitis
Tendinitis is an inflammatory condition involving a tendon, the structure that attaches muscle to bone. Although many overuse injuries are diagnosed as tendinitis, this condition is rare. When a tendon is acutely overloaded or overused, it is damaged and an inflammatory process ensues. True tendinitis usually resolves fully and quickly with little residual problem.

Tendinosis
What is diagnosed as tendinitis is often more accurately termed tendinosis. Tendinosis is degeneration of a tendon that occurs in the absence of inflammation. The degeneration results from an area of increased tension and compromised blood supply.  Picture a tendon as being a brand new, shiny, white rope. Picture a degenerated tendon as being a gray, frayed, weak rope. The degenerated portion of the tendon is weaker and tolerates use poorly. It is important to note that tendinosis is common and tendinitis is rare. Treatment strategies are no longer anti-inflammatory and rather regenerative in nature.  Anti-inflammatory strategies include medication, rest, ice and electric stimulation. Regenerative strategies include restoring blood flow, reducing tension and improving biomechanics.

Shin Splints
“Shin Splints” is a generic term for pain anywhere between the ankle and the knee. The exact tissues involved need to be identified. Usually, there is a problem with scar tissue, tendinosis, proper footwear, and activity level.

Stress Fractures
Stress fractures occur when the load placed upon bone causes it to breakdown faster than it can recover. If high mileage is placed upon a healthy body the bone will weaken and get small areas of fracture. However, if enough load is placed upon the body to damage the bone the soft tissue is likely injured as well. Four to six weeks rest is prescribed for the bone to heal and the pain will often go away. If scar tissue has developed it does not resolve with rest. As activity is resumed similar symptoms may reoccur.

Soft tissue problems will change the way forces are distributed through the body. If everything works well forces are distributed through the bone and soft tissue. If there are soft tissue problems more of the force will be distributed through the bone. This is usually the case if stress fractures are appearing at low or moderate mileage.