Blog - Page 2 of 15 - Michigan Spine & Pain

5 Types of Headaches and the Best Ways to Get Rid of Them

Is there anyone in the world who has never had a headache? In some cases, we can solve this pesky problem by ourselves, yet sometimes we should see a doctor immediately.

With this in mind, the experts at Michigan Spine and Pain have put together a quick reference guide to help you identify the type of headache you have and the best strategy for pain relief.

TENSION HEADACHE

This is the most frequent type of headache in the world: everyone has experienced it at least once in their life.

Symptoms: Usually, this is a mild non-throbbing pain. Tension headaches often cause a pressure sensation that feels like you’re wearing a tight band around your forehead. Most often, the intensity of the pain increases from morning to evening.

CAUSES: Factors that seem to contribute to tension headaches are severe stress, fatigue, poor posture, and holding the head in an improper position for a long time. Chronic tension headaches are rare and are often associated with head or neck injuries.

TREATMENT: There are many over the counter medications that effectively mitigate a tension headache. However, this should only be used occasionally. If headaches occur frequently and last for a long time, consult your doctor. Also, try to be physically active, stretch your shoulders and neck regularly, and spend more time outdoors.

SINUS HEADACHE

This type of headache is caused by sinusitis. It is often accompanied by fever, facial swelling, and tension in the forehead and cheekbones.

SYMPTOMS: Typically, you’ll feel a deep pressure, and pain in your forehead in the area of the eyebrows and under the eyes. The pain usually gets stronger when you move your head sharply. You may also have a running or blocked nose and feel tired.

CAUSES: Sinus headaches are caused by sinusitis. They are also a common complication after having a cold or are the result of a seasonal allergy.

TREATMENT: Sinus headaches rarely go away on their own. If you have an allergy, antihistamines may help. In other cases it’s best to see a doctor who will most probably prescribe antibiotics, if you have a sinus infection.

MIGRAINE

All symptoms of this severe headache occur during a migraine attack that progresses through four main stages. Different people report various symptoms of these headaches. Not all migraines are experienced identically.

CAUSES: A migraine is often associated with a violation of the metabolic processes and dilation of blood vessels in the brain. A person also may inherit a genetic predisposition for developing migraines.

TREATMENT: There’s currently no cure for migraines, although a number of treatments are available to help ease the symptoms. You need to see your doctor to choose the right medication. Moreover, regular exercise will help you improve your health significantly.

CLUSTER HEADACHE

Cluster headaches are rare, affecting less than 1 percent of the population. They are five times more common in males than females.

SYMPTOMS: A cluster headache may cause a stabbing pain behind or around your eyes, usually on one side of your head. It frequently develops during sleep. Symptoms may also include redness of the eyes, sensitivity to light and eye tearing. The pain usually lasts from 15 minutes to 1 hour.

CAUSES: Scientists don’t know exactly what causes cluster headaches. They are most often linked to disruptions in the body’s biological clock.

TREATMENT: Treating a cluster headache can be tricky because the pain appears and disappears spontaneously and at a moment’s notice. Only a doctor can help you solve this problem.

HANGOVER

CAUSES: We hear many different versions about why people often have a headache after drinking alcohol. One of them suggests that alcohol causes blood vessel dilation and affects serotonin levels in the body. Moreover, alcohol promotes water loss and dehydration — major migraine triggers.

TREATMENT: The best remedy is to take an over the counter headache medication, drink plenty of water and get some good sleep. You should take a hangover seriously. If you have a headache after consuming even a small amount of alcohol it may indicate that you’re suffering from a mild form of migraine.

Can Acupuncture Offer Pain Relief and Reduce Opioid Use?

A new study will seek to determine whether access to acupuncture as a pain management tool for chronic pain could help prevent patients from becoming addicted to opioids.

The state of Vermont is seeking to answer that question by funding a study to see if making acupuncture accessibly to Medicaid patients could be useful in treating chronic pain, as a way to avoid or reduce reliance on opioid medicines and is both feasible — and useful.

Since acupuncture is increasingly considered a viable option for pain relief, Vermont legislators have made clear that they want to explore how it could impact the lives of others — particularly those living below the poverty line.

Robert Davis, a neuroscience professor at the University of Vermont Larner School of Medicine, is running the study. During the three-month study, different acupuncturists in three different Vermont cities will offer free sessions to qualifying Medicaid patients with chronic pain.

Davis acknowledged in an interview with Vermont’s National Public Radio that people who often seek out acupuncture are those who can afford it, but he says it often doesn’t mesh with the larger trend toward including non-pharmaceutical options for treating pain and other illnesses.

“For example, the Joint Commission, which is a nonprofit organization that credentials hospitals and health organizations, they made it clear that you can’t just rely on pharmacologic treatments for pain,” Davis said in the radio interview. “You should also consider non-pharmacologic treatments, and they specifically mentioned things like acupuncture, massage, mindfulness.”

While not without controversy, there is growing evidence that acupuncture can be effective for some types of pain relief. In 2010, 93 percent of deaths from opioids in Vermont involved overdosing on prescription medicine, according to the state’s Department of Health. That percent has since decreased as use of heroine has risen. But misuse of prescription opioids continues to be a problem. Addiction issues stemming from prescription medicines are still a significant part of the opioid epidemic.

The Legislature-funded study is looking to see if acupuncture could provide an alternative, or a complement, to prescription opioids. It isn’t evaluating the science of acupuncture; there won’t be any comparing its effectiveness to a placebo — and there’s already evidence it can provide pain relief.

Instead, the research project is set up to see just how feasible it would be for Medicaid patients to use acupuncture. And what impact it might make on their lives.

“One of the things that we’ll learn from this study is: Will these people utilize acupuncture if offered?” Davis asked in the interview.

The study will also measure if people’s pain was reduced, and will look at a whole range of health measures, from the ability to do daily activities to the patient’s psychological status to whether his or her use of painkillers decreases.

The study is even measuring how acupuncture might impact the patient’s use of other health services.

“In other words, we’re interested to see: Did it affect the amount of times that people went to the emergency room? Did it affect how often they went to doctor, or filled prescriptions, or things like that?” Davis asked.

If early indications hold any weight, there’s certainly interest in acupuncture among people suffering chronic pain. The trial just began soliciting volunteers a few weeks ago, and already 75 people have been processed and enrolled, according to Vermont NPR.

The study will continue through April 2017 and the results will be submitted to the Vermont legislature later this spring.

5 Common Causes of Hip Pain in Women

As with other types of chronic pain, women tend to experience hip pain more often than men. Yet, hip pain can have a number of different causes and determining the correct one is the key to getting the best treatment.

Getting a Hip Pain Diagnosis

When you tell your doctor your hip hurts, the first thing he should do is confirm that your hip is actually the problem. Women might say they have hip pain, but what they may mean is they’re having pain in the side of the upper thigh or upper buttock, or they may be experiencing lower back pain. Hip pain is often felt in the groin or on the outside of the hip, directly over where the hip joint (a ball-and-socket joint) is located.

Hip Pain Causes in Women

When a female patient comes to Michigan Spine and Pain complaining of hip pain, our clinicians and physiatrists consider the patient’s age, build and activity level. Depending on the patient’s weight, general physical fitness and health as well as age and other factors, the possibilities will be different.

Some of the most common causes of hip pain in women include:

Arthritis.

The most common cause of chronic hip pain in women is arthritis, particularly osteoarthritis — the wear-and-tear kind that affects many people as they age. The ball-and-socket joint starts to wear out. Arthritis pain is often felt in the front of your thigh or in the groin, due to stiffness or swelling in the joint.

Hip fractures.

Hip fractures are common in older women, especially those with osteoporosis (decreased bone density). Symptoms of a hip fracture include pain when you straighten, lift or stand on your leg. Also, the toes on your injured side will appear to turn out, a sign that can aid our preliminary diagnosis.

Tendinitis and Bursitis.

Many tendons around the hip connect the muscles to the joint. These tendons can easily become inflamed if you overuse them or participate in strenuous activities. One of the most common causes of tendinitis at the hip joint, especially in runners, is iliotibial band syndrome — the iliotibial band is the thick span of tissue that runs from the outer rim of your pelvis to the outside of your knee.

Hernia.

In the groin area, femoral and inguinal hernias — sometimes referred to as sports hernias — can cause anterior (frontal) hip pain in women. Pregnant women can be susceptible to inguinal hernias because of the added pressure on the wall of their abdomen.

Gynecological and Back Issues.

Hip pain in women can have gynecological causes and it’s important not to just assume the pain is caused by arthritis, bursitis or tendinitis. Depending on one’s age and other health issues, the pain in your hip could be coming from some other system.”

Treatment for hip pain depends on the diagnosis, but pain caused by overuse or sports injury is often treated with heat, rest and over-the-counter anti-inflammatory medication. To prevent injuries, it’s important to stretch before exercising and wear appropriate clothing, especially good shoes when running. Some causes of hip pain, such as fractures or hernias, may need surgical repairs. If your hip pain persists, come in and let’s discuss the possible causes and treatment options.

6 Healing Herbs for Your Medicinal Garden

Medicinal plants (either grown in your garden or purchased) can reduce your dependence on drugs and while some plants are used for treating specific ailments, others have a generalized positive effect on our health. Many herbs belonging to the latter group have since found their way into our culinary scene as flavoring agents.

Here’s our practical guide to a few of the accessible herbs that have stood the test of time:

Aloe Vera

Aloe Vera is well known as a skin-friendly plant and is one medicinal plant people really make use of, since it is generally safe and requires no processing before use. It is a must-have in every garden whether you grow it in pots or in the ground.

Aloe Vera plants grow well in a sunny location in warmer areas where there is not much danger of killer frosts. Being a succulent, this drought resistant plant requires very little care and thrives in poor soil. It suckers freely, so you can start with just one or two plants sourced from a reliable supplier. Note: there are several aloes around and not all of them are edible, or have the medicinal properties attributed to Aloe Vera.

The jelly-like, colorless pulp of mature leaves can be applied to minor cuts and burns and to dry, inflamed, or damaged skin due to eczema or other skin conditions. It’s an excellent moisturizer with anti-inflammatory and mild antimicrobial effect. The leaf pulp can be eaten too. Regular use can prevent constipation and relieve other digestive problems, including ulcerative colitis and irritable bowel syndrome.

Peppermint (Mentha × piperita)

This natural hybrid of spearmint and watermint is widely used in dental hygiene products, mouth fresheners, soothing balms and candies. Quite possibly the oldest medicinal herb to be used by man, there’s evidence that peppermint has been used for thousands of years. Grow it in a part of the garden where the plants are assured of water and give it plenty of room to spread.

Sip a tea made of a handful of peppermint leaves to calm stomach upsets and relieve pain and discomfort due to gas. Carry a few sprigs of peppermint when you travel. Sniffing on it every now and then will prevent nausea and vomiting associated with motion sickness.

The active ingredient found in abundance in peppermint is menthol (as well as in many other aromatic members of the mint family) and has a cooling effect on the skin. Make a poultice of the leaves and apply it on the skin to relieve itching and burning resulting from skin allergies and inflammatory conditions. (A poultice is a soft, moist mass of plant material applied to the body to relieve soreness and inflammation and kept in place with a cloth.)

Thyme (Thymus vulgaris)

This perennial herb with tiny, aromatic leaves is easy to grow in a sunny location and thrives between rocks and boulders, braving summer heat and winter freezes. The characteristic scent of thyme comes from the volatile oil containing thymol, which gets released at the slightest touch. Many herbs contain this powerful antiseptic phenolic compound, but thyme oil has more than 50% thymol content.

Use an infusion of thyme as a gargle to get rid of bad breath and mouth sores. It can help with tonsillitis and laryngitis. Crushed fresh thyme applied on the neck is said to reduce throat infections. Inhaling the vapors reduces nervous exhaustion.

The most important use of thyme is to treat respiratory tract infections. Thyme extract is taken orally to relieve symptoms of bronchitis, chest congestion and mild asthma.

Rosemary

Rosemary is more of a woody shrub and although it doesn’t look anything like other mint plants, it belongs to the same plant family. In your medicinal garden, rosemary is stocked for general health and wellbeing rather than for specific problems.

Chamomile (Chamaemelum nobile)

Chamomile flower heads can be made into a soothing tea that can calm a troubled mind as well as a colicky baby. Its widespread use across many cultures and for myriad ailments is time-tested, safe and effective.

There’s more than one type of chamomile, but we’re going to focus on the Roman chamomile, Chamaemelum nobile. This hairy plant has finely divided leaves and white daisy-like flowers with bright yellow centers, and looks similar to German chamomile, which is why scientific names are important for identifying medicinal plants.

You can make a tea from fresh flower heads or dry them for later use. Take a handful of flowers in a bowl and pour boiling hot water over them. Allow steeping for 15-20 minutes and drain. Have a cup of this soothing brew when you feel anxious or unsettled, or before bedtime in case you have difficulty falling asleep.

Use it as gargle to relieve mouth ulcers. Bathe the skin affected with eczema several times a day with cooled chamomile tea.

Pot Marigold (Calendula officinalis)

Pot marigold with its yellow and orange flowers is a delightful addition to any garden. Not very finicky about soil fertility or pH, it can be grown easily from seeds and can be treated as an annual or perennial depending on your growing zone.

The edible flowers can be used to treat almost any problem related to skin. Use a poultice of the petals to relieve sunburn and to clear up acne and blemishes on the skin. Use it as an antiseptic on cuts and bruises. It stops bleeding and reduces inflammation when applied on nicks and cuts. Many skin ointments contain pot marigold extract as the active ingredient.

A tea made of the flowers can be ingested to ease digestive problems.

While none of these herbs should supplant your medicinal regimen prescribed by your physician, it’s always nice to know Mother Nature can be a source for some home remedies.

NOTE: Speak with to your physiatrist to make sure none of the above herbs inadvertently have an antagonistic effect on current medications you may be taking.

Common Myths About Pain Management

As our population ages, many people need short-term rehabilitation as they transition from the hospital to home. This post-hospital period can be challenging. However, the transition can be much easier if the patient is cared for in a sub-acute rehabilitation setting with close supervision from physicians, nurses, therapists, social workers and other specialists.

Whether a patient has had an elective surgery or an unplanned hospitalization, pain management is often the determining factor in the success or failure of these outcomes.

In general, the first two weeks after injury are the most intense from a pain standpoint and are crucial for optimal pain management. Patients may need pain medications, often narcotics, in order to maximize their therapy.

Improving therapy progress and minimizing comorbidities such as pneumonia and/or skin breakdown are focal points of sub-acute rehab. Comorbidities happen when patients are too sedentary because pain limits mobility.

Luckily, most patients are able to significantly cut back on their pain medications and many no longer need pain management after six-to-12 weeks. Most people return to their previous activity level by about six weeks. In most cases, a narcotic given at the beginning of rehab allows the patient to actually do more and go home more quickly.

There are several myths regarding narcotics, which make patients hesitant to take these pain medications. One of the biggest worries is the concern for addiction. While narcotic addiction is a very serious issue, narcotic use can be safe in an environment supervised by a physician trained in pain management.

In sub-acute rehabilitation, narcotics are used as a short-term medication to get over a specific injury with the goal of weaning off the drugs as soon as appropriate. Careful screening is considered when prescribing narcotics.

Patient history, physical exam, side effects of medications, history of any personal or direct family addictions are all evaluated. Where addiction has been present, patients will need more education and other pain management techniques to avoid further addiction potential.

As board-certified Physical Medicine and Rehabilitation (PM&R) physicians, Drs. Bleiberg and Ruiz monitor patients constantly to ensure minimal side effects. Our team also discusses cases with the patient and, if desired, family members to ensure they are getting the maximum benefit from medication and therapy.

Left to their own choices, many elderly patients will fall behind in their pain medication cycle, limiting their progress in therapy. Combined with a change from their normal environment and uncontrolled pain, worsened dementia is also seen frequently in this population. Often, the patient cannot distinguish between pain and other aging issues (loneliness, depression or failure to complete basic tasks in a timely fashion). When patients are in pain, everything comes to a grinding halt; movement becomes extremely limited. Pain medications are sometimes necessary to allow for a maximum effect on patients when they are moving, allowing progress in therapy.

When we talk about pain, we must always distinguish between neuropathic pain (pain coming from nerve damage) and nociceptive pain (pain from the injury or surgery). Nerve pain does not always require a narcotic, so a history from the patient is critical in determining the correct medication.

A thorough physical exam is also key, as important findings often arise. For example, a thorough exam of a patient complaining of rib pain may lead to finding a rash, resulting in a diagnosis of shingles rather than suspected rib fractures. In a case like this, shingles pain responds better to a nerve pain medication rather than a narcotic.

Another important factor to remember is that just taking pain medications doesn’t mean a patient will be completely pain free.

Pain management is based on the condition and is best managed by a pain specialist, often times a rehab doctor or a physiatrist. Physical Medicine and Rehabilitation (PM&R) physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. Physiatrists maximize what a patient can do and in coordination with therapy, assist the patient in adapting to what they cannot.

When to Choose a Physiatrist?

The practices of physiatrists and other practitioners, such as chiropractors, may be similar in scope but their differences should factor into a patient’s decision on which professional to visit. The severity of the condition for which a patient is seeking treatment, being of paramount importance.

Physiatry is a branch of medicine that deals with the prevention, diagnosis and treatment of disease or injury ¾ and the rehabilitation of resultant impairments and disabilities ¾ using physical and sometimes pharmaceutical agents.

One patient describes how he made the decision to seek out a physiatrist at the suggestion of his chiropractor: “I was seeing a chiropractor and he urged me to consider physiatry,” the patient, whose name is being withheld because of privacy laws, said. “Chiropractics was born out of the practice of osteopathic medicine, with a focus on body health by manipulating the spine.”

At Michigan Spine and Pain, we believe strongly in the usefulness of chiropractic medicine, which is why chiropractors have a significant role in our practice. However, we do not believe in chiropractic medicine in a vacuum.

Physiatry, by its nature, involves more medical investigation and lab work to find the cause of pain. Physiatrists can achieve a lot of physical progress without the need to go under the knife. One of the most significant differences is that a physiatrist can prescribe pain medication and typically has better access to lab and advanced imaging testing.

At its most basic level, chiropractic medicine is designed to adjust the spine and to reduce or remove subluxations (misalignment) of the spine. Working on stress management and diet, in addition to pain management can be big factors in addressing back pain health. A physiatrist’s practice will work on those issues, because that is part and parcel of the subspecialty, which all affects the impact of treatment on the patient. In our practice, the physiatrist works with the chiropractor, so that the patient receives the best of all available treatments.

Physiatry is a whole body approach and the overall outcome will be better in the long run. Of course, if the issues are severe enough that non-surgical techniques are ineffective, a physiatrist, being a medical doctor, has the network of colleagues in other subspecialties to make specific referrals. In the end, it is about achieving the best outcome for the patient.

“Back” to School

In Greek mythology, Atlas was the Titan god of endurance and astronomy, condemned to hold up the sky for eternity. While our school-aged children may be using atlases in geography class, there is only so much of a load they should be allowed to carry safely in order to protect their growing spines.

Backpacks that are too heavy or are worn incorrectly can cause problems for children and teenagers. Improperly used backpacks may injure muscles and joints. This can lead to severe back, neck, and shoulder pain, as well as posture problems.

In order to distribute the weight of the packed bag effectively and safely, there are a few guidelines that all parents should be aware of when shopping for a new backpack.

Shop at a sporting supplies store where the sales staff is trained in how to properly fit backpacks. A small or shorter child needs a different type of backpack than a larger or taller sibling.
The waist strap that comes with most backpacks is not an accessory, and should be used. The waist strap allows for a more even distribution of the weight of the backpack’s contents. By using the strap, the bulk of the weight can be carried on the hip bones, rather than on the shoulders.
You might notice your child “slinging” their backpack over one shoulder or another, and this is absolutely the improper way to use a backpack. Backpacks should be worn over both shoulders so that they place an even amount of stress on both sides of the spine. Look for wide, padded shoulder straps.
Choose a backpack with different compartments so that when loading in school supplies and books, the weight of the contents can be distributed. Pack heavier items lower down and closer to the body.
In order to further reduce the stress on the spine, consider a rolling backpack as an alternative.

Once you have purchased the backpack, you will still have to be alert to clues about the impact the daily load is having on your child. Here are a few tips to help you (and your child) through the school year:

Encourage your child or teenager to tell you about numbness, tingling, or discomfort in the arms or legs which may indicate poor backpack fit or too much weight being carried.
Watch your child put on or take off the backpack to see if it is a struggle. If the backpack seems too heavy for the child, have them remove some of the books and carry them in their arms to ease load on the back.
Do not ignore any back pain in a child or teenager.
Talk to the school about lightening the load. Team up with other parents to encourage changes.
Encourage your child to stop at his or her locker when time permits throughout the day to drop off or exchange heavier books.
If your child has back pain that does not improve, consider buying a second set of textbooks to keep at home.

Why Do Your Ankles Hurt?

Known as chronic lateral ankle pain, the recurring or chronic pain you feel on the outer side of the ankle often develops after an injury such as a sprain. However, several other conditions may also cause chronic ankle pain.

What are the symptoms of chronic lateral ankle pain?

Pain, usually on the outer side of the ankle, may be so intense that you have difficulty walking or participating in sports. In some cases, the pain is a constant, dull ache.
Difficulty walking on uneven ground or in high heels
A feeling of giving way (instability)
Swelling
Stiffness
Tenderness
Repeated ankle sprains

What causes chronic lateral ankle pain?

According to The American Orthopaedic Foot & Ankle Society, the most common cause for a persistently painful ankle is incomplete healing after an ankle sprain. When you sprain your ankle, the connecting tissue between the bones is stretched or torn. Without thorough and complete rehabilitation, the ligament or surrounding muscles may remain weak, resulting in recurrent instability. As a result, you may experience additional ankle injuries.

Other causes of chronic ankle pain include:

An injury to the nerves that pass through the ankle. (The nerves may be stretched, torn, injured by a direct blow or pinched under pressure, known as “entrapment.”
A torn or inflamed tendon
Arthritis of the ankle joint
A fracture in one of the bones that make up the ankle joint
An inflammation of the joint lining, called “synovium.”
The development of scar tissue in the ankle after a sprain. The scar tissue takes up space in the joint, thus putting pressure on the ligaments.

How is chronic lateral ankle pain diagnosed?

The first step in identifying the cause of chronic ankle pain is taking a history of the condition. Your health care provider may ask you several questions, including:

Have you previously injured the ankle? If so, when?
What kind of treatment did you receive for the injury?
How long have you had the pain?
Are there times when the pain worsens or disappears?

Because there are so many potential causes for chronic ankle pain, your health care prodider may need to conduct several tests to pinpoint the diagnosis, beginning with a physical examination. S/he may feel for tender areas and look for signs of swelling, and may have you move your foot and ankle to assess range of motion and flexibility. Your provider may also test the sensation of the nerves, and may administer a shot of local anesthetic to help pinpoint the source of the symptoms.

Your health care provider may also order X-ray views of your ankle joint. If needed, you may also need to get X-rays of the other ankle so the doctor can compare the injured and non-injured ankles. In rare cases, additional tests such as a bone scan, computed tomography (CT) scan or magnetic resonance image (MRI) may be needed.

What are treatment options?

Treatment will depend on the final diagnosis and will be personalized to your individual needs. Both non-operative and surgical treatment methods may be used.

Some conservative treatments include:

Anti-inflammatory medications such as aspirin or ibuprofen to reduce swelling
Physical therapy, including tilt-board exercises, directed at strengthening the muscles, restoring range of motion and increasing your perception of joint position
An ankle brace or other support
An injection of a steroid medication
In the case of a fracture, immobilization to allow the bone to heal

If your condition requires it, or if conservative treatment doesn’t bring relief, your doctor may recommend surgery. Many surgical procedures can be done on an outpatient basis. Some procedures use arthroscopic techniques; other require open surgery. Rehabilitation may take six to 10 weeks to ensure proper healing. Surgical treatment options include:

Removing (excising) loose fragments
Cleaning (debriding) the joint or joint surface
Repairing or reconstructing the ligaments or transferring tendons

Prevention

Almost half of all people who sprain their ankle once will experience additional ankle sprains and chronic pain. You can help prevent chronic pain from developing by following these simple steps:

Follow your doctor’s instructions carefully and complete the prescribed physical rehabilitation program.
Do not return to activity until cleared by your physician.
When you do return to sports, use an ankle brace rather than taping the ankle. Bracing is more effective than taping in preventing ankle sprains.
If you wear high-top shoes, be sure to lace them properly and completely.

Panacea Alert: Glucosamine, Chondroitin and Fish Oil

The scientific research, however, isn’t as effusive as the marketing copy on the back of the bottles. Here, we look at the evidence for when these supplements might help — and other pain management strategies to consider.

Omega-3 Supplements

Research suggests that high doses of fish oil, or other sources of omega-3 fatty acids, may help for one particular type of joint pain: rheumatoid arthritis. But its effect on most other types of joint pain, including osteoarthritis, is unclear.

For example, Consumer Reports cited analysis in The Journal of Pain that looked at 17 randomized controlled clinical trials which concluded that people with rheumatoid arthritis who took 1.7 to 9.6 grams of fish oil a day reported less joint pain, tenderness and stiffness. The investigation also found that people who took more than 2.7 g per day reported a greater improvement in morning stiffness and painful or tender joints than those who took lower doses.

But taking fish oil isn’t risk-free. “Even at doses below three grams per day, fish oil can cause side effects, including upset stomach, diarrhea, and a tendency to burp,” writes Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser, adding that with every incremental increase in dosage taken “…the more likely [one is] to experience gastrointestinal problems.”

Another sticking point that is often acknowledged but also given short shrift: dietary supplements aren’t regulated by the Food and Drug Administration the same way prescription or over-the-counter medications are — so there’s no guarantee the fish oil listed on the label is what’s actually in the bottle, or that it’s high quality, or even that it’s safe to take. According to the American College of Rheumatology: “Some fish oil supplements may contain high levels of mercury or vitamin A, which could be toxic.”

Glucosamine and Chondroitin Supplements

A 2010 trial of 662 people with knee osteoarthritis published in the Annals of the Rheumatic Diseases did find that these supplements relieved pain for some people — but over time were no more effective than a placebo. More recently, a study of 1,625 people published in the journal Arthritis & Rheumatology in 2015 found that using glucosamine and chondroitin over a four year period did not relieve knee pain or prevent cartilage loss in people with osteoarthritis any better than a placebo. In addition, The American Academy of Orthopaedic Surgeons does not recommend either of these supplements for osteoarthritis of the knee.

Got Knee Pain? What to Do Instead…

One step is to lose weight. Research suggests that for every pound of excess weight you shed, it can take approximately 4 lbs. of pressure off the knees when walking. Additionally, strength training can help build up the muscles that support the affected joint. As well, gentle, low-impact exercise such as swimming and walking can relieve dull knee pain by keeping the joints flexible and lubricated. And, for flare-ups, try over-the-counter anti-inflammatory medications like ibuprofen or naproxen, if your medical provider agrees that this is safe and recommended for you.

If you are experiencing joint pain, we suggest a thorough for proper diagnosis. To schedule an appointment, contact Michigan Spine and Pain online or by calling (800) 586-7992.

Top 11 Knee Pain Issues

Receiving an accurate diagnosis is vital in overcoming your knee pain, receiving the correct course of treatment and stopping it from returning. For example, if the knee is swollen you can treat the swelling with ice, but if you don’t treat the underlying cause, it will just keep coming back. The best way to receive an accurate knee pain diagnosis is to see your healthcare professional, but here is a guide to help you find out what your problem might be and some questions to think about:

Specific symptoms: What are the main symptoms associated with your pain (e.g. popping noises, locking, etc.)?
Location of the pain: where exactly is your knee pain (e.g. inner our outer knee)?
How did the pain start: the mechanism of injury (e.g. sudden twisting or gradual onset)?

Specific Symptoms

One of the most important parts of diagnosing knee pain is thinking about the specific symptoms that accompany the pain. These tend to be the most defining features in knee pain diagnosis, as the presence or absence of them quickly rule conditions/injuries in or out.

1) Knee Makes Unusual Noises

A sudden popping noise at the time of injury usually indicates a ligament injury or sometimes indicates a cartilage tear. Persistent clicking/grinding when the knee moves may indicate an ongoing knee problem affecting the joint surfaces or how the bones are moving such as chondromalacia patella.

2) Pain When Kneeling

Kneeling puts pressure through the front of the knee and primarily aggravates three conditions:

Housemaids Knee: inflammation of the prepatellar bursa (fluid filled sac) at the front of the knee. It is a common problem for people who spend long periods kneeling (e.g. carpet layers)
Osgood Schlatters: common in adolescents, particularly after a growth spurt. Tension on the tendon just below the kneecap damages the bone, often resulting in a hard lump on the front of the shin
Arthritis: changes in the bone caused by wear and tear or sometimes inflammation. Most common over the age of 50

3) Locking (knee gets stuck)

This happens when something gets wedged in the joint, stopping you from moving the knee. You generally have to wiggle the knee around before it will then move. The most common cause of locking is a Meniscus Tear (a tear in the cartilage that lines the joint.) It can be caused by sudden twisting or a force through the knee, or can come on gradually due to wear and tear.

A less common cause of locking is Osteochondritis Dissecans, a condition where poor blood supply causes small bits of bone and cartilage to break off at the joint.

4) Running Knee Pain

Knee pain from running is hardly surprising when forces up to 550% of one’s body weight go through the joint when running. Running knee pain is usually due to either training errors or poor biomechanics.

5) Knee Gives Way

This is when the knee buckles underneath you without you being able to control it. The most common cause of this is a ligament injury, usually an ACL tear or sometimes a PCL injury. They are usually caused by sudden twisting, a force through the knee or the knee bending backwards the wrong way. Only 20% of ACL tears are caused by direct contact. It may be accompanied by a popping sound, swelling and extreme pain.

Meniscus tears often make the knee feel unstable and can occasionally cause the knee to give way, but this is much less common.

6) Pain When Bending The Knee

A great deal of force goes through the knee when we do any activities with a bent knee. For example, squatting down places a force seven times body weight through the knee. It may be caused by a problem inside the knee, such as a cartilage tear or arthritis, or one of the surrounding structures, such as a ligament tear or inflammation of the bursa.

7) Pain When Sitting for Long Periods

It is not just activity that aggravates knee pain. Some conditions tend to get worse with prolonged inactivity (e.g. office workers sitting for long periods.) The pain may start while you’re sitting or when you first get up. The most common causes are:

Runners Knee: a problem in how the kneecap moves that causes pain and stiffness at the front of the knee
Arthritis: changes in the bone caused by wear and tear or sometimes inflammation
Osgood Schlatters: common in adolescents, particularly after a growth spurt. Tight muscles irritate the bone causing pain just below the knee

8) Pain Going Down Stairs

This usually indicates a problem with the kneecap, as the force going through the kneecap when you come down stairs is 3.5 times bodyweight.

9) Swelling

If the swelling begins immediately or within the first 48 hours, it usually indicates a ligament or cartilage injury. If it comes on gradually with no specific cause, it usually indicates an underlying knee problem such as bursitis. If there is moderate to severe swelling, you should see your doctor immediately.

10) Stiffness

Knee stiffness may develop as a result of an injury or a medical condition. It may develop suddenly or gradually, and often fluctuates. Stiffness when you first wake up that settles once you’re moving about is a classic feature of Osteoarthritis, which is most common in people over age 50.

11) Bony Lump at Front of Knee

This is a classic sign of Osgood Schlatters, which is common in teenagers and young adults, particularly after a growth spurt. Tension on the tendon just below the kneecap damages the bone, often resulting in a hard lump on the front of the shin.

Remember, the best way to get an accurate knee pain diagnosis is to see your doctor. Contact Michigan Spine and Pain for an appointment to receive a proper diagnosis.