If it's accepted that arm and leg pain can originate from the spine, it should be understood that joint pain can as well. I screen the spine with extremity limb and joint complaints. Forearms, thighs, arms, legs, hands, and feet are not entirely different from wrists, hips, elbows, shoulders, knees, and ankles. Limb (between joints) pain is more often coming from the spine than isolated joint pain, but it still happens frequently. Clinicians need to look for this referred and radicular pain. I use repeated movements of the spine to investigate if extremity joint pain is indeed spinal in origin, which could take anywhere from a few minutes to a few visits. -- Laura
Tugging on a hose (nerve) will not be effective if something is compressing it. Several things can compress nerves in our bodies. In contrast, if a nerve is adhered to something, tugging it (typically called flossing, stretching, or gliding) is indicated. I tell patients with nerves that aren’t moving as well as we’d like that we first check to see if someone is “stepping on the hose.” If we investigate and find that to be the case, we work to remove the compression. If we rule that out, then we can start to glide the nerve to increase its length. Performing gliding without investigating potential compression will often get you nowhere - just like pulling on a hose while someone’s foot is on it won’t get you anywhere. -- Laura
Many, many bodily joints and tissues need to function well to be able to fully bend forward. Poor hamstrings, though … they always get blamed!
To regain forward bending ability, I hardly ever loosen patients’ hamstrings. However, say a patient did simply need looser hamstrings - then clinical care is hardly needed. (Stretching is not rocket science!) With consistent home stretching, hamstring length better consistently improve.
In almost all cases, forward bending is limited because lumbar structures are moving improperly. Usually it’s that the joints themselves are misaligned. In other cases, compressed/adhered/trapped nerves create nerve tension that limits this movement (with or without contemporary joint malalignment).
Forward bending (lumbar flexion) is usually restored once we get the patients’ lumbar structures moving properly again. Importantly, using forward bending to achieve this is beneficial in only a small group of patients. More commonly I utilize lumbar extension or sidegliding.
So why do people say they “feel it” in their hamstrings? It’s either that they’re actually feeling the sciatic nerve(s) pull or that, in attempting to bend further, their body eeeks out more motion in the only structures it can – muscles and tendons – so they “feel it” there. Expert mechanical clinicians know better. --Laura
Painful thumbs? Numb fingers or hands? Weak grip? The nerves in the neck and the upper mid-back control the hands. Specifically, nerves C6, C7, C8, and T1. (The "C" stands for cervical, which means neck. The "T" stands for thoracic, which refers to the mid-back.) Most hand issues are a result of the nerves in the neck/upper mid-back being compressed. If someone has problems in BOTH hands, the issue is almost ALWAYS coming from the spine. While it is normal for your hand to fall asleep if you lie on it in a weird position, it is not normal to experience numbness/tingling/pain on a regular basis, even with sleeping. If I determine that your hand symptoms are indeed coming from the nerves in your spine, I treat it with two things: movements to decompress the nerves and postural correction. Posture can refer to your sitting, lounging, and/or sleeping habits. I often suggest modifications to your car seat too. --Laura
Centralization is a very important concept, and is well-documented in many research studies. Problems in the spine often cause pain/numbness/tingling in the extremities (legs, feet, arms, hands) as affected nerves carry symptoms along the distribution of the nerve. Centralization is when symptoms move toward the spine. This is a GOOD thing - even if the spine pain is temporarily more intense (before it goes away for good). By the same token, peripheralization is not a good thing. We don't want pain that is moving farther away from the spine into the periphery (extremities). Keep in mind that centralization also applies when left or right low back pain or left or right neck pain moves to the center of the low back or neck.
Not all patients will experience centralization. Some extremity pain just goes away without moving to the spine first. If you are receiving treatment or are just monitoring or treating yourself, remember to avoid things that peripheralize your symptoms and to perform the activities or movements that centralize your symptoms. When I treat patients with spine or extremity symptoms, I use specific movements to elicit centralization - and prevent peripheralization. If you experience centralization, you know you're on the right track!
I remember learning about dead butt syndrome (DBS) during a presentation at the clinic where I worked several years ago, two years into my career. I believe the sales rep was there to push taping products, but this topic somehow came up. (Please note: while some refer to all the gluteal muscles becoming weak, others specify the gluteus medius muscle in particular.) This gentleman explained that since people sit all day without using their gluteus muscles, they become weak. Made sense to me! And it had a fun name.
However, when I began using the term with patients whose gluteus medius muscles were in fact weak, and fielding patients' questions regarding the topic, I became skeptical. For one, if sitting dormant all day was the root cause, why wouldn't mostmuscles weaken? And, secondly, if it was sitting combined with lack of daily use of the gluteus medius muscles - lack of moving the hips laterally - that was the trigger, wouldn't the lateral movers of other joints suffer then too?
So I did a bit of "research:" I read a few articles intended for the public. The consensus is that DBS not only affects expert sitters, but also people who exercise, but who don't target the glute muscles enough. That sounds strange. Those could be very different cohorts. Or, the exercisers could also be expert sitters when they're not moving. Here are my two chief complaints with what I found to be the commonly proposed etiology of DBS:
Another article states, "It may seem bizarre for a muscle to just stop functioning out of nowhere." Yes! It is indeed very bizarre! Except when you recall that nerves send power to muscles ... and when there is a problem with the flow of electricity through those nerves, muscles will stop functioning seemingly out of nowhere! This inhibition-driven weakness, while not normal, is extremely common. (In fact, if I tested the primary muscles of the upper and lower extremities of 100 people, I bet not one person would demonstrate full strength. That means not one person would have uninterrupted flow of electricity from their spine to their muscles.) The good news is, once you restore the flow of electrical power from the spine - I use specific movements with my patients to accomplish this - muscles should immediately regain normal strength.
So what is going on with DBS? In the large majority of cases, prolonged sitting (the more slouched, the worse) creates a malalignment in the low back which impedes the flow of electricity via the nerves to the glutes, depriving them of their juice to be strong. The same scenario can create pain in the glutes as pinched nerves can carry pain along their path (or any altered sensation such as tingling or degrees of numbness). That'swhy your butt is dead. To fix it, you'll need to address your low back in order to decompress the nerves. And then, once the power is back on, if your gluteus muscle strength doesn't return completely since the muscles had been dead for so long, you can move on to targeted strengthening exercises to rebuild them. -- Laura
Has someone told you you have weak gluteus medius (hip abductor) muscles? The L4, L5, and S1 nerves supply the electricity to this muscle, so there's a GREAT chance the glute med is weak because those nerves are inhibited in your (slouchy) low back. In that case, the solution would simply be to free up those nerves in the low back - and the strength would return immediately! Could save months of strength training, not to mention actually addressing the true cause of the weakness. -- Laura
I consistently hear my patients - and people in general - tell me about their muscle problems. "My upper trap is tight." "My quad is weak." "My piriformis is killing me." "I pulled my calf muscle." "My infraspinatus is in spasm." "My hip doesn't rotate because my muscles are tight." Have you stopped to consider how a muscle would get into such trouble?
While muscle pathology coming from the muscle exists, it is indeed rare. Symptomatic muscle tears and strains are not common. (Often, muscle tears are simply incidental findings on MRI - meaning that while the tear is there, it is not the source of the patient's problem, and may have been there for years.) Muscle tightness and weakness are more common than tears, but are not usually the fault of the muscle itself. Even though we tend to adopt certain unilateral movement patterns (as a result of being right-handed, for example), this should not cause discernible differences in muscles on one side of the body versus the other. And muscles usually don't just spontaneously become painful, tight, or weak all by themselves.
So, if we can't blame muscles, what can we blame? Joints!
Joints commonly move out of their proper position. Haven't you sat on a bent knee and then had to shake it out once you stood up to get it back in place to walk? Or rested on your neck in an awkward position and then had to wait a few seconds for it to straighten out? McKenzie-trained therapists would say the joint has deranged, or, rather, that there is a joint derangement. In these two examples, the derangement is normal and very quickly resolves on its own. However, joints are often deranged more seriously. And when they are, they can refer sensations via nerves of tightness, pain, and weakness away from the joint ... appearing in the muscles.
In extremity joints, the pain is typically referred locally along the nerves. For example, if the shoulder joint is deranged, pain often appears in the lateral upper arm. With an ankle derangement, pain can refer to the bottom of the heel. Joint derangements also frequently create nearby muscle weakness since nerves provide both sensation and electricity to the muscles. Derangements in the joints of the spine behave somewhat differently since these joints can influence the major nerves to the extremities. A joint derangement in the spine can, like extremity joints, refer symptoms locally; a derangement in the low back can create symptoms in the quadratus lumborum or psoas nearby, for instance. But if a major nerve exiting from the spine is impinged, local and/or distant pain/tightness/numbness/tingling/weakness can result. For example, I commonly see tightness in the hand, cramping in the calf, weakness in the hip flexors, tingling in the foot, or pain in the shoulder blade or buttocks as a result of a derangement in the joints of the spine.
The good news is that joint derangements are usually rapidly fixable! McKenzie-trained therapists like myself are trained to differentiate between true muscle pathology and joint derangements creating symptoms that can mimic muscle problems. Over 70% of orthopedic problems are joint derangements. So let's start blaming joints - not muscles! And let's also start fixing them quickly through specific movements. -- Laura
If you have pain on the bottom of your foot, it is common that the source is a pinched nerve in your low back. As this image shows, nerves L4, L5, and S1 send signals to the foot. You can have a compressed nerve that does NOT create back problems, but instead creates pain, numbness, or tingling on the bottom of the foot. The plantar fascia is connective tissue on the bottom of the foot, which, when tight, can also produce pain on the bottom of the foot. A McKenzie clinical evaluation diagnoses the true SOURCE of the problem - which leads to an individualized treatment plan.
One thing the McKenzie method does brilliantly (and better than any other patient approach I've come across) is assess the spine as the source of an extremity problem. A simple analogy uses a fuse box. If an outlet is not functioning properly in your kitchen (ie your knee or elbow), you must take a look at the fuse box (ie the spine) to make sure that the overall system is working properly.
Nerves exit at each level of the spine and carry power and sensation to the extremities. We have maps of where each nerve goes and what muscle(s) each nerve innervates. Therefore, if your wrist hurts, the wrist should be examined locally, but so should the neck and upper back since the nerves that control the wrist come from that area of the spine. If one does not fully assess the spine, one is often missing a lot of information, if not the exact source of the patient's problem, In fact, I tell my students in the clinic that over half of what seem to be "extremity problems" are actually problems of the spine. Even if the patient has no symptoms at the spine, the spine needs to be moved repeatedly to end range to discern if it is playing a role. -- Laura
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