Dr. Jeffrey I. Kennis,  D.C.
205 Commercial St.
Boston, MA 02109
NORTH END

( 617)720-2329


 

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Posts for: September, 2019

If you suffer from chronic pain, it's important that your friends and family know what you're going through. With this in mind, here are 5 things to know about chronic pain that you can share with your loved ones:

See Chronic Pain As a Disease: Why Does It Still Hurt?

physical therapist examining patient's lower back

Your chronic pain may not be directly tied to an injury or underlying condition.
Read:
 Modern Theories of Chronic Pain

1. Chronic pain is real

People with chronic pain are often treated as if they are making up (or at least exaggerating) their pain. But the truth is that all pain is real, even if there is no known cause. Additionally, almost all people with chronic pain want nothing more than to be pain-free.

See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

So what your friend or family member needs from you is your support and kindness, not condemnation. Statements like "Get over it" or "It can't be that bad" don't accomplish anything other than to discourage those with chronic pain.

Thankfully, there is an increasing consensus in the medical community that all chronic pain is real, and that it needs to be treated even if there is no known cause.

See Modern Theories of Chronic Pain

 

2. Chronic pain commonly leads to disuse syndrome

Chronic pain often leads to long-term lack of physical activity and a condition recognized as disuse syndrome. This syndrome can negatively impact your musculoskeletal, cardiovascular, neurological, psychological, and emotional processes. At its worst, disuse syndrome leads to a pervasive lack of wellness that in and of itself can be debilitating.

Of note, disuse syndrome can both perpetuate and increase the likelihood of chronic pain worsening over time.

See Pain Management for Chronic Back Pain

3. Chronic pain commonly leads to sleep-related problems

Chronic pain can create a troubling cycle when it comes to sleep. That is, chronic pain can make it harder to sleep, and in turn a lack of sleep can make chronic pain worse.

See Addressing Pain and Medical Problems Disrupting Sleep

Common sleep-related problems caused by chronic pain include an inability to fall asleep, constantly waking up at night, and not feeling refreshed upon waking up in the morning. Because of the close connection between sleep problems and chronic pain, the two need to be treated together.

See Chronic Pain and Insomnia: Breaking the Cycle

4. Pain is deeply personal

Everyone persons experience of pain is different. For example, two people may have the same condition, and one may display no ill-effects, while the other may be incapacitated. When it comes to back pain, this is especially true. Two people can have the same type of herniated disc, but one feels only slight discomfort and the other feels burning, debilitating sciatic pain.

See Diagnosing Disc Problems

There are a number of possible reasons for this, including individual physiology, a person's upbringing, etc.

See Pain Signals to the Brain from the Spine

5. Happiness does not equal health

Often times, when a person with chronic pain is smiling or having a "good day," people assume that the person is not experiencing pain. However, this is not necessarily the case.

11 Chronic Pain Control Techniques

It is important to recognize that a person can be happy and at the same time be experiencing pain. So be careful to not assume that a friend or loved one is "healed" simply because they seem to be enjoying themselves.

The bottom line

There are so many secondary and related issues that accompany chronic pain that it would be a real challenge to address them all. This list is intended to at least get the conversation started—and for anyone living with any type of chronic pain, please pass this along to your loved ones to help them better understand and support you.

All About Neuropathy And Chronic Back Pain

If you have chronic pain, your may also find it does you a world of good to have increased emotional support, more effective and sustainable pain management, and even possibly harnessing the power of your mind to assist in coping with the pain.

Pain Management for Chronic Back Pain

Learn more:

Chronic Pain Coping Techniques - Pain Management

When Acute Pain Becomes Chronic Pain


When upper back or shoulder pain is accompanied by numbness in the arm, it can stem from a problem in the neck or shoulder that inflames a nerve going down the arm. Some people may have worsening upper back pain and arm numbness as the day goes on, whereas others may experience worse symptoms when waking up in the morning. Here are 6 potential causes.

Cervical herniated disc

A cervical herniated disc may cause numbness and weakness in the arm. Watch: Cervical Herniated Disc Video

Cervical herniated disc

When a cervical disc herniates, inflammatory proteins can leak out of the disc and inflame nearby muscles, joints, and/or nerve roots. If a cervical nerve root becomes inflamed, radicular pain, tingling, numbness, and/or weakness may go down into the shoulder, arm, and/or hand. Especially if a disc herniates in the lower cervical spine, pain may be felt in the shoulder blade area with some numbness that could go into the arm or hand.

See Cervical Radiculopathy from a Herniated Cervical Disc

 

Foraminal stenosis

When the intervertebral foramen narrows between adjacent vertebrae, called foraminal stenosis, a nerve root can become impinged while exiting from the spinal canal. Foraminal stenosis can be caused by bone spurs (osteophytes) or other spinal degenerative processes. If the nerve root in the lower cervical spine becomes pinched or inflamed, it can potentially cause pain, tingling, numbness, and/or weakness in the shoulder, arm, hand, and/or fingers.

See Cervical Foraminal Stenosis

Stinger

A stinger typically results from trauma to the neck or shoulder, such as during a sports collision or fall. When the brachial plexus (a group of nerves that run through the shoulder and down the arm) becomes overstretched during a collision, a stinger injury can cause burning pain that starts in the neck or shoulder and goes down the arm. It may also be accompanied by some numbness or weakness in the arm or hand. While stingers usually only last a few seconds or minutes, they sometimes last days or longer.

Read more about Stinger Injuries on Sports-health.com

Thoracic outlet syndrome

Thoracic outlet syndrome (TOS) occurs when the nerves or blood vessels become compressed in the thoracic outlet, which is the area between the top rib and collarbone. This rare condition can cause pain, tingling, numbness, and/or weakness anywhere from the neck and shoulder down into the arm and hand. So it’s possible for someone with TOS to feel pain in the shoulder and numbness in the arm. Performing overhead work may exacerbate shoulder pain and arm numbness/weakness. The arm and hand may also become more easily fatigued during routine activities.

See Neck Pain from Thoracic Outlet Syndrome

Brachial neuritis

Brachial neuritis, also called Parsonage-Turner syndrome, develops when at least a part of the brachial plexus (a group of nerves that run through the shoulder and down the arm) becomes inflamed. This condition typically has sudden onset unrelated to an injury, and it can cause pain, tingling, numbness, and/or weakness anywhere along the nerve pathways from the neck, upper back, shoulder, and down into the arm and hand. Brachial neuritis typically lasts anywhere from a few hours to a few days. In rare cases, it can last much longer or become permanent.

See Brachial Neuritis (Parsonage-Turner Syndrome)

 

Stress

It is well established that stress, anxiety, post-traumatic stress disorder (PTSD), and other psychological conditions can create physical symptoms that can mimic the above conditions. It is always important to consider stress as a possible source for symptoms including upper back pain and associated arm numbness.

See Stress-Related Back Pain

Any type of pain that is accompanied by numbness or weakness requires a visit to the doctor. Getting an accurate diagnosis from a medical professional can help determine the most effective treatment for relief and recovery.

See The Diagnosis of Stress-Related Back Pain

Learn more

What Causes Hand Pain and Numbness?

Could That Shoulder Pain Really Stem From the Neck?


When you have back pain, riding in the car for an hour or more can be a real challenge. Consider the following advice and see if it helps on your next road trip.

Stretching for Back Pain Relief

Get out of the car and stretch often to keep you back happier during road trips.
See:
 Stretching for Back Pain Relief

1. Get comfortable immediately

Take the time to make sure you're comfortable from the moment you set off on your trip. The smallest irritant in the beginning of your trip can turn into raging pain later.

  • Keep your back pockets empty. Sitting on your wallet, phone, or anything else may throw your spine out of alignment.
  • Sit up straight with your knees slightly higher than your hips, and keep your chin pulled in so that your head sits straight on top of your spine.

    See Posture to Straighten Your Back

  • Sit a comfortable distance from the steering wheel. For airbag safety, the National Highway Traffic Safety Administration advises sitting with your breastbone at least 10 inches from the steering wheel,1 and keeping your hands on the wheel at 9 and 3 (the sides rather than the top of the wheel).2 But don’t sit too far away either, which can cause you to reach too far for wheel and places more stress on the lumbar spine, neck, shoulder, and wrists.

    See Office Chair, Posture, and Driving Ergonomics

  • Keep your back aligned against the back of your seat. To better support the contour of the inward curve in your lower back, use a small pillow or roll up a scarf and place it between your lower back and the seat. Also, there are many specialized cushions and pillows that can help with sciatica pain and lower back pain.

    See Types of Lumbar Support and Ergonomic Office Chairs

There is no single best option, and it may take some effort and trial and error on your part to find what works best for you.

 

2. Make your ride as smooth as possible

Bumps in the road can jar your spine and increase pain. For a smoother ride, consider:

  • Riding in a passenger car, rather than an SUV or pickup
  • Replacing worn shocks to limit the bounce in the car
  • Replacing worn tires to reduce vibration or shaking
  • Sitting on a car seat pillow or coccyx cushion to provide more padding between you and the road

See Pain-Free Travel Tips

3. Get out and move around

Sitting in one position in a car will stiffen up your back muscles and can lead to achiness and possibly muscle spasm. Everyone should ideally take at least a 15-minute break for every 2 hours of driving. If you’re prone to back pain, you may want to take breaks more frequently, such as every 30 to 60 minutes.

Watch Video: What Is Your Back Muscle Spasm Telling You?

Try to plan ahead to schedule stops. Get out of the car so you can move around and stretch. Movement stimulates blood circulation, which brings nutrients and oxygen to your lower back.

Watch 4 Easy Stretches for Lower Back Pain Video

4. Shift your position periodically

When possible, try to move a little in your seat. Even 10 seconds of movement and stretching is better than sitting still. At a minimum adjust your seat and change your position slightly every 15 to 20 minutes. Pump your ankles to keep the blood flowing and provide a slight stretch in your hamstring muscles. Any movement that is safe to do in the car will help you out.

See Specific Hamstring Stretches for Back Pain Relief

5. Try cold or heat therapy

Many people find that applying cold or heat therapy is a good way to alleviate pain on a long road trip.

  • Cold therapy can help reduce inflammation and swelling. Consider bringing a cooler to store reusable ice packs or other cold therapy packs. You can buy cold therapy packs at the store or make your own.

    See Ice Packs for Back Pain Relief

  • Heat therapy can help increase blood flow and relax the muscles. Various types of heat therapy are available to buy, such as heat wraps or heat pads. You can also make your own moist heat pack. Some people prefer to place a moist heat pack in the microwave so it’s warm when they go on the trip.

    See How to Apply Heat Therapy

It is recommended to apply ice or heat for only 15 or 20 minutes at a time, then give your skin a rest to recover for at least a couple hours before the next application.

For drivers, it may be best to apply cold or heat therapy while taking a break from driving. Since you are unable to check the skin while driving, it is harder to ensure that the skin is not being damaged during an application of cold or heat therapy. Some cars have heated seats that provide continuous low-level heat, which can be a good option while driving if it is comfortable and provides relief.

6. Support your back with your feet

Supporting your spine starts with bottom-up leverage from your feet. Your feet need to be placed on a firm surface and at the right height to avoid transferring stress to your lower back. It is ideal to have your knees at a right angle. This means, if your seat is too high it is best to put your feet on a footrest. If you are the driver and have the ability to use cruise control for a longer drive, you may want to do this to allow you to have both feet on the floor for periods of time.

See Good Posture Helps Reduce Back Pain

7. Employ diversions from pain

Having something planned to take your mind off the pain could make a big difference. Even if you're the driver, there are still a few options to safely help occupy your mind. Try a new music channel, download a podcast, or listen to an audio book.

Passengers have many additional choices, such as meditating, reading, watching a show, solving a sudoku or crossword puzzle, or playing an electronic game.

Bonus tip

If you know that long car rides give your back trouble, you may want to consider taking an over-the-counter NSAID (nonsteroidal anti-inflammatory drug) right before the trip to reduce the risk of back pain developing or worsening. Some examples of NSAIDs include aspirin, ibuprofen, and naproxen. Just remember to check with your doctor first and read warning labels carefully to reduce the risk of serious side effects or complications.

See Common NSAIDs for Back and Neck Pain

Try out these tips and see what works for you. Hopefully at least some of these tips help reduce your back pain while on the road.

Learn more:

29 Best Travel Tips for Your Aching Back

9 Quick Back Pain Tips for Airplane Rides


Yoga is a low-impact, effective way to relax tight muscles and build strength—which can help relieve lower back pain. Try these 3 beginner-level poses and see if you find relief. Remember to take it slow and stop if the pain gets worse.

Image of a yoga class doing the seated prayer pose

Yoga can help to strengthen and strech the lower back muscles, alleviating tension and pain.
Read
 How Yoga Helps the Back

Sphinx pose

The sphinx pose puts your lower back muscles in a more relaxed position and is sometimes recommended for people who have sciatica pain from a herniated disc. You need to lie on the ground, so use a yoga mat or thick towel.

  1. Lie flat on your stomach with your legs straight. Keep your forearms on the ground next to you, tucked in close to your sides.
  2. On an inhale, tighten your legs and raise your chest off the ground by pushing with your arms. Your forearms and palms should stay on the ground.
  3. Your hips, legs, and feet should maintain contact with the ground, and your elbows should be aligned directly under your shoulders.
  4. Hold this pose for 5 seconds, then gently lower your torso back to the ground.

See Exercise for Sciatica from a Herniated Disc

Repeat this pose as you are comfortable. Gradually work your way up to 30 seconds per repetition.

 

Cat/cow pose

Illustration of the cat and cow yoga pose for lower back pain

Cat and cow are 2 different yoga poses, but they are typically practiced together. Here’s how to do them:

  1. Start on your hands and knees. Align your arms straight under your shoulders and your knees under your hips.
  2. Look at the floor, keeping your head straight in line with your torso and spine.

Move into the cat pose:

  1. Round your back, lifting your spine toward the ceiling.
  2. Your eyes will face your belly.

After a breath, move into the cow pose:

  1. Slowly lift your chest and tailbone toward the ceiling, letting your stomach sink toward the ground.
  2. Your eyes will look up toward the ceiling.
  3. After another breath, gently return to the cat pose.
  4. Repeat these motions a few times or until you feel adequately stretched.

Together, these poses form a gentle yet effective stretch for your lower back.

See Healing Benefits of Yoga

Modified down dog pose

Downward-facing dog is a popular yoga pose, but it can be difficult to perform, especially for people with painful hand or wrist conditions. Here’s a modified version that may be gentler on the body:

  1. Stand and face a wall. Place your hands on the wall between waist and chest level. Set your feet hips-width apart.
  2. Bend your knees slightly and slowly walk away from the wall, keeping your hips over your feet and your hands pressed against the wall.
  3. Stop in place once your arms form a straight line with your spine, keeping your back as flat as possible.
  4. You should feel a stretch through your back.
  5. Hold this pose for 30 seconds, then slowly walk forward to come out of the pose.

This pose helps lengthen your back muscles.

See Pulled Back Muscle and Lower Back Strain

Not all of these yoga poses may ease your lower back pain, so experiment and see which ones work best for you. If any of these poses worsen your pain, talk to your doctor immediately.

Learn more:

Stretching for Back Pain Relief

Pilates Exercise and Back Pain


Cold and heat therapy may both provide effective relief from your lower back pain—but how do you know which one to use?

See Heat Therapy Cold Therapy

heat or ice for lower back pain

Many lower back problems can lead to painful muscle spasms. See Lower Back Pain Symptoms, Diagnosis, and Treatment

Read on for helpful advice on deciding whether you should use ice or heat to treat your lower back pain.

See Early Treatments for Lower Back Pain

 

As a general rule, it is best to apply cold therapy to your lower back in the first 24 to 72 hours following your lower back injury. The application of cold therapy can minimize your inflammation and swelling—which in turn may reduce your pain. In addition, ice can decrease your tissue damage and numb your sore tissues.

See Ice Packs for Back Pain Relief

There are numerous options for cold therapy, including a frozen bag of vegetables, frozen gel packs, and a frozen towel. Regardless of which option you choose, make sure to note the following precautions:

  • To avoid ice burn, place a cloth between your skin and whichever source of cold you select.
  • Apply cold therapy for no more than 20 minutes at a time. You can apply cold therapy 8 to 10 times per 24 hour period.

Watch: Video: How to Make 5 Quick and Easy Ice Packs

Use heat to encourage healing

After your initial swelling and inflammation has subsided, heat therapy can be utilized to encourage healing in your lower back. The application of heat therapy stimulates blood flow to the area, which brings restorative oxygen and nutrients. Additionally, heat can inhibit the transmission of pain signals to your brain and decrease your stiffness.

See How to Apply Heat Therapy

There are two basic categories for heat therapy: dry and moist. Dry heat may leave your skin feeling dehydrated, but many people feel it is easier to apply. Heat therapy may be more difficult to apply, but it can aid in the penetration of heat into your muscles.

Watch: Video: How to Make a Moist Heat Pack

If you have diabetes, an open wound, or dermatitis it is best to avoid heat therapy altogether.

 

What about chronic lower back pain?

All of the above advice addresses when to use heat and ice following the first occurrence of lower back pain after an injury. But what about chronic lower back pain?

See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

The simple answer is that there is no right answer. Finding the balance between cold and heat therapy for chronic lower back pain is a process of trial and error—and what might work for one patient may not for another. But when it comes to exercise, many people with chronic back pain find heat therapy helps to warm up their muscles beforehand, while cold therapy helps with pain and inflammation afterwards.

See Heat Wrap Therapy Can Reduce Post-Exercise Low Back Pain

Additionally, if you do suffer from extended or chronic lower back pain make sure to receive care from a qualified medical professional. Relying on self-care for too long may make your back pain worse.

See Pain Management for Chronic Back Pain

I hope all of the above advice will help you determine if cold or heat therapy is right for you, which in turn may help you find meaningful relief from your lower back pain.

Learn more:

How to Use Ice Massage Therapy for Back Pain

Benefits of Heat Therapy for Lower Back Pain