Shoulder Pain - Heart Attack or Rotator Cuff Injury?

Rotator Cuff Rehabilitation

Basic rotator cuff rehabilitation addresses the loss of mobility. The two main activities are finger walking and pendulum swings. In finger walking, stand about 18 inches away from a wall, positioned, so your torso is perpendicular to the wall. Reach your arm out to the side and touch the wall with the tips of your fingers. Your elbow should be bent slightly. Slowly walk your fingers up the wall as high as you can go. Walk your fingers slowly all the way down the wall and repeat ten times. As you continue the exercise over days and weeks, your range of motion will improve. In pendulum swings, sit at the edge of a hard chair and bend your torso forward, supporting your weight by activating your stomach muscles and resting your non-working arm on the inner thigh. Let your working arm dangle to the side and, slowly and gently, begin to swing the arm in a small circle. The movement begins by a gentle swaying of your torso. Slowly increase the diameter of the circle to a maximum of about 18 inches. The whole routine should take about a minute.

The great TV classic ER helps teach armchair physicians to become amateur diagnosticians. He's in shock! She's got kidney stones! Rule-out pheochromocytoma!

But sometimes a little knowledge can be a dangerous thing.

You've learned somewhere - on the network news, in the Science section of The New York Times, or in a CPR class at your job - that shoulder pain can mean you have a heart attack. Now, seemingly out of the blue, your shoulder begins to ache and throb. Very concerned, you rush to the local emergency room.

The resident's first question, of course, is "where does it hurt"? You point to your right shoulder and blurt out, "Am I having a heart attack?" The resident smiles, gently reassuring. "A heart attack might give you pain in your left shoulder," she says. "Have you been to the gym lately? This might indicate a rotator cuff strain."

The resident knows that heart attack symptoms usually involve chest pain (in two-thirds of cases), and may include faintness, shortness of breath, sweating, and a feeling of impending doom.¹   Chest pain may spread to the back, jaw, and arms. Left arm pain may radiate to the inside of the forearm and the ring and little fingers. So, shoulder pain by itself probably doesn't suggest a heart attack.

She orders an MRI which shows mild damage to the right rotator cuff. What's going on? What exactly is the rotator cuff?

The rotator cuff is a muscular sheath that surrounds the head of the arm bone (the humerus) and the entire shoulder joint (really, two joints - the acromioclavicular and glenohumeral joints). The four muscles that comprise the rotator cuff help raise the arm to the front and the side and help turn the shoulder inward and outward.

If you're a sports fan, you know that rotator cuff injuries affect baseball pitchers, tennis players, swimmers, and football players. Such injuries are due to repetitive motion, and may also result from falling on the shoulder or arm or lifting heavy weights.

Rotator cuff injuries may also be slowly developing and chronic, related to arthritic and degenerative changes in the rotator cuff tendon and the two shoulder joints. Low-grade pain may develop, and the pain may become aching, throbbing, and chronic. Raising the arm may cause pain, and there may be a loss of mobility.²

In the above-40 population, lack of exercise and chronically poor posture may contribute to rotator cuff problems. Sitting at a desk all day, with the neck jutting forward and slumped shoulders, places long-term mechanical stress on the rotator cuff.

Chiropractic treatment may be very useful in helping to rehabilitate chronic rotator cuff injuries. The chiropractic physician is an expert in evaluating postural problems and associated spinal conditions. By providing effective treatment, postural corrections, and rehabilitative exercise, chiropractors offer a comprehensive therapeutic program to reduce pain, improve shoulder mobility, and regain function. 
Dr.’s Steven Warfield and Dr. Dave Edenfield offer the most advanced treatments for back pain, sciatica, neck pain, whiplash and headaches. They also treat auto accident, Veterans and Workers Compensation injuries with state-of-the-art technologies.

http://www.lakewoodchiropracticjax.com/

¹Source: Cedars-Sinai www.cedars-sinai.edu
²Baring T, et al.: Management of rotator cuff disease. Best Pract Res Clin Rheumatol 21(2):279-294, 2007.

When Are Simple Headaches Not So Simple?

High Blood Pressure

High blood pressure (HBP) is a common unrecognized cause of headaches. And, HBP itself is very common - according to the American Heart Association, approximately one-third of American adults have HBP. And nearly one-third of these people don't know they have HBP. This is a big problem. The National Heart, Lung, and Blood Institute of the National Institutes of Health has recommended the DASH diet (Dietary Approaches to Stop Hypertension). This diet has been shown to reduce high blood pressure within two weeks. Daily recommendations include •  7 to 8 servings of grains •  4 to 5 servings of vegetables •  4 to 5 servings of fruit •  2 to 3 servings of low-fat or non-fat dairy •  2 to 3 servings of fats and oils •  4 to 5 servings per week of nuts, seeds, and dry beans

Headaches are big business. For the drug companies, that is.

Approximately 10 million Americans suffer daily headaches, and 50 million have headaches often enough to seek medical care.  Approximately 23 million Americans suffer from migraines.  Billions of dollars are spent each year on Aleve and Motrin for tension headaches and Imitrex for migraines.

But all that money might just as well be poured down a hole in the ground, because the statistics haven't changed in almost 20 years.  Approximately one out of every six Americans suffers from headaches.

Tension headaches are most common, caused by muscle spasm in the neck and shoulders, stress, and even eye strain. The dull, pounding pain may be severe, and there may be nausea. Migraines are even more debilitating, and may be preceded by an "aura" - visual symptoms such as flashing lights or loss of portions of a visual field.

Headaches, although common, should never be taken for granted. People suffering headaches should, at some point, have a physical examination to rule out underlying problems such as high blood pressure.

Importantly, an unusual headache, accompanied by brand-new symptoms, should be evaluated by a physician immediately. A sudden, severe headache, "like nothing I ever had before", needs immediate attention. If you've never thrown up as a result of a headache, and suddenly you are, you need to see a physician. An unusual, unexpected level in the increase of headache pain needs immediate attention. Any of these situations could be caused by a serious underlying problem, and an MRI is usually necessary.

Chiropractic treatment may be of benefit for many people suffering with tension headaches and even migraines. A chiropractic physician will perform a complete physical examination, which may include x-rays. Underlying causes of headaches are ruled out. If a medical condition is suspected, the patient may be referred to the appropriate specialist.

Chiropractic spinal manipulation is a gentle procedure that reduces muscle tension and increases spinal mobility. Neck and shoulder muscles are freed from being held in fixed positions, resulting in increased circulation, improved nutrition, and more efficient muscle activity. The frequency and intensity of tension headaches may improve noticeably. Migraine headaches may improve as well.

Regular exercise and a balanced diet are very important in the treatment of headaches. Exercise improves all aspects of muscle function and improves circulation. Improved cardiovascular function means more blood is flowing to neck and shoulder muscles, bringing oxygen and nutrients and removing irritants such as lactic acid.

A balanced diet ensures that neck and shoulder muscles are getting the energy sources, vitamins, and minerals they need to work properly. A balanced diet in combination with regular exercise also results in weight loss, removing unnecessary mechanical stress in the form of excess pounds.

Headaches are usually a symptom of being out-of-balance. Exercise, balanced nutrition, and chiropractic care can help restore balance to our highly stressed lives.
http://www.lakewoodchiropracticjax.com/

¹"Hospital Treats Headache Suffers". The New York Times, 12/25/88.
²Source: National Headache Foundation - www.headaches.org
³Source: Yale Medical Group - www.ymghealthinfo.org

Dealing with Arthritis

Arthritis Prehabilitation

The best way to deal with arthritis is not to get it in the first place. Osteoarthritis (OA) is not really a disease, it's much more of a condition. And in many cases, OA is a lifestyle-related condition. It is associated both with a long-term lack of activity and with being overweight. In the sense of "use it or lose it", people who spend most of their day sitting at a desk and/or working on a computer are at risk for developing OA of the neck, lower back, hips, and knees. These same people are at even increased risk if they're overweight. Supple joints that go through an entire range of motion are doing what they're designed to do. Given the structure of modern life, we need to intentionally work our bodies to keep them healthy and well. This means regular exercise and it means eating smart to maintain our weight at a healthy level. What kind of exercise? Do what you like, do what you're interested in doing. Just be consistent and exercise three, four, or five days every week. And, every so often, vary what you're doing. Your body will let you know when it's getting bored.

We've all seen the TV ads ─ nice-looking woman in her fifties, sitting on a nice sofa in a nice living room, rubbing her hands, in obvious pain. Of course, she's not Lady Macbeth, trying to rub off the imagined blood of her murdered husband. She's a woman with arthritis.

According to the Center for Disease Control, arthritis is the leading cause of disability in the United States.¹  Approximately 47 million people have doctor-diagnosed arthritis and 17 million have arthritis-attributable activity limitations.

Osteoarthritis, the most common form, is a degenerative condition affecting the joints and the soft tissues around the joints ─ the associated cartilage, ligaments, and tendons. The most commonly affected areas are the spine, the hands, and the shoulders, hips, and knees. The pain of arthritis, the reduced mobility, and the lifestyle accommodations needed for pain avoidance are discouraging and may even lead to depression.

Many anti-inflammatory drugs are available for the treatment of arthritis, and in recent years many of these have been found to cause severe side effects. Vioxx is the most notorious of these ─ cardiovascular complications caused a worldwide recall of the drug. Celebrex, another well-known arthritis medication, was also found to increase the risk of heart attack and stroke at high doses.

The very good news is there are several wellness-based treatment alternatives to long-term medication. These include exercise, diet, and in many cases, chiropractic treatment.

Exercise is critical in restoring mobility and, over time, in reducing pain.^2,3  Persons with osteoarthritis often experience a vicious cycle of deteriorating symptoms. Pain causes reduced mobility (pain avoidance), which (paradoxically) actually causes more pain, which causes further reductions of mobility . . . . Activities of daily living ─ getting out of a chair, opening a jar, bending and lifting ─ become a real challenge as the person struggles to avoid further pain.

So, restoring mobility is key. Exercise ─ very gently at first ─ is the answer. Range-of-motion activities to get the joints moving again are very beneficial, including
•    Arm circles
•    Wrist circles
•    Shoulder shrugs
•    Side-to-side bending for the lower back
•    Gentle knee bends
•    Ankle circles
•    Flexing and pointing the feet

Walking is a perfect exercise for treatment of arthritis. Begin by walking one block, then two, then around the block. Walk five minutes daily for a week, then increase by a minute or two each day. Get up to 15 minutes of gentle walking, then begin to gradually increase your pace. The increased mobility will not only reduce pain, but also provide a cardiovascular benefit and improve one's ability to perform activities of daily living.

Chiropractic treatment, in combination with an exercise program, may assist in restoring joint mobility and reducing pain. Gentle chiropractic manipulative therapy is designed to improve mobility of spinal joints. As spinal joint motion improves, pain lessens, and a positive cycle of return-to-function begins.
http://www.lakewoodchiropracticjax.com/

¹"Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation." CDC Morbidity and Mortality Weekly Report  55(40);1089-1092, 2006.
²Huang MH, et al: A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Semin Arthritis Rheum 32(6):398-406, 2003.
³Suomi R, Collier, D: Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis. Arch Phys Med Rehabil 84(11):1589-94, 2003.