Chronic spine and joint pain is a very common problem that afflicts a large portion of the population. In its simplest form, pain is a signal to the body that a tissue has been injured and needs to heal. In most cases, the tissue damage heals and the pain resolved. Other times, the pain lingers for weeks, months or even years, affecting job performance, recreational activities, relationships, or worse, basic activities of daily living, including sleep. In many cases it is easy to find the underlying problem causing the pain. Imaging, labs or other specialized tests can identify many causes of pain. Unfortunately, there a portion of the population where the tests do not pin-point the problem and herein lies the problem. This post is geared to these people who need to understand what other factors may be contributing to the persistent pain.
The ligaments in your spine and joints are important for maintaining proper pain-free joint alignment at rest and in motion. They are also critical for preventing disc herniations and arthritis. Ligaments and tendons are made of braids of collagen fibers. The only difference is that ligaments connect bones to bones and tendons connect bones to muscles. Both ligaments and tendons intertwine into the connective stabilizing tissues of joints and stabilize the joint in all activities.
The most common ligament that people are familiar with is the anterior cruciate ligament (ACL) within the knee. Surgery is recommended when the ACL ruptures, and if not done, arthritis develops earlier in the joint. The same thing happens in the spine and other joints within the body, but we have no to images the integrity of ligaments.
Since MRIs do not image ligaments, and for the most part, most tendons, we instead watch for secondary signs of ligament and/or tendon damage in the form of spine straightening, joint arthritis, or spinal disc degeneration.
Biomechanical Support
External Ligament/Tendon Support
To stabilize the spine and pelvic region, I recommend speaking to your treating physician about trialing a sacroiliac joint belt. Please wear it as you need to when standing and walking. Please see this link or this link for an examples of good quality supports for the spine and pelvis. For the other large joints, you can use this link for high quality supports.
Recent or past long-term sitting causes stiffening of the muscles surrounding the neck, shoulders, lower back, and hips which increases your risk of pain. Periodic standing allows you to off load these structures if you spend long hours sitting or standing. Changing positions or frequent breaks allows you to be more mobile during the day which is excellent for maintaining your muscles. See more information on the dangers of sitting here.
Please do not forget about good posture when standing and sitting. This free webinar may be helpful to understand the importance of good posture.
Joint Flexibility
We lose flexibility as we age, not because of the aging process, but because of the general inactivity of our daily lives. The larger joints (shoulders and hips) stiffen up first followed by the smaller joints (elbows, knees, hands and feet). In chronic pain, the larger joints are first focused upon.
Shoulders
For the shoulders, please do the “hands up” stretch daily to help stretch the front of your shoulder joints. To review, it is most effective if lying on the floor but you can do in on a bed as well. First, raise your hands over your head and position your shoulders and elbows each at ninety degrees. Then hold this position passively for up to 10-15 minutes. Relaxed without forcing your shoulders into an uncomfortable position. You may have your hands raised in the air, or flat against the surface. The only thing you should feel is a gentle stretch in the front of your shoulder. If painful then do it for as long as possible working up to 15 minutes. Further excellent shoulder stretches can be found here. It may take at least two weeks before you will feel any changes.
Hips
Please also work on your hip joint flexibility. Start by lying on your back in bed or on the floor and bending your knees comfortably with your feet on the floor. Then let your knees fall to the side making a diamond shape with your legs. You should feel a gentle stretch in your groin. Please hold this for up to 10-15 minutes with breaks as needed You can repeat this 1-2 times per day. It may take at least two weeks before you will feel any changes. Further excellent hip stretches can be found here. More information about the problems with the hip spine interface can be found in this free webinar.
Biochemical Support
Anti-Inflammatory Diet
An anti-inflammatory diet discontinues or greatly limits the intake of not only sugar, but also flour/starch and dairy products for at least several weeks. Unfortunately, these are the things we love the most, so this can be extraordinarily difficult. These three items are the most significant pro-inflammatory mediators in our diet. They have been found to contribute to lingering pain, weight gain, liver disease, increased cholesterol, diabetes, and many other chronic diseases. My patients have found this reference (link) to be particularly helpful. Also, I highly recommend the following book, “How Not to Die” by Michael Greger, M.D.
Hydration
Females need on average 12 8-oz cups (96 oz) of water per day which is 3 quarts or nearly 3 liters , whereas males need on average 15 8-oz cups (120 oz) of water per day which is almost one gallon or nearly 4 liters. Water is absorbed not only by drinking water, but also through foods we eat. An easy way to maintain hydration is to drink about 4-5 cups of water at least 30 minutes before meals and try to decrease caffeine intake (if applicable). This can make your muscles more resilient, improve your digestion, increase your bladder function, and decrease overall inflammation which can be very helpful for pain. It is important not to drink a great deal of fluid during meals as it dilutes the hydrochloric acid in your stomach which slows or prevents digestion of certain foods. Please see the following link for further details.
Magnesium
Up to half the U.S. population is magnesium deficient which results in a myriad of symptoms including high blood pressure, constipation, fatigue, weakness, nerve irritation, and muscle spasms. There are many different forms of magnesium available. Magnesium citrate is the most easily tolerated. A starting does of 150mg at each meal is a good place to start. If you are healthy, the only side effect is loose stool. If this occurs, just lower the dose until your stomach symptoms resolve. Please see this link for more information.
Emotional Health
Medicine has woken up to the importance of meditation to improve the body’s capacity to heal. An example of this is an article about wound healing improved with Mindfulness-Based Stress Reduction (MBSR). The MBSR program probably has the most research behind its over thirty years of existence. It is an online program based out of the University of Massachusetts. The best meditation smart phone apps that I know of are called Headspace and Calm.
MicroHabits for Health
The small things that we do day to day can either promote health or promote disease. More information about the importance of developing small daily habits that promote health can be found in this free webinar.
This information is for educational and informational purposes only and solely as a self-help tool for your own use. I am not providing medical advice. You should not use this information to diagnose or treat any health problems or illnesses without consulting your own medical practitioner. Always seek the advice of your own medical practitioner and/or mental health provider about your specific health situation. For my full Disclaimer, please go to https://healthcareextreme.com/disclaimer/.
