There are many different reasons for pain, limitation and loss of function throughout the body. We have briefly discussed a couple of the possible sources of pain at each joint. Our physical therapist will conduct a thorough evaluation and examination along with your input, which is vital! We address the source of our patients’ symptoms, which is why our patients feel a reduction in pain in the first couple of sessions. Your increase in function and decrease in pain lets us know that we are treating the source of your problem. If you do not feel a dramatic reduction in pain or increase in function within the first couple of sessions, then we reevaluate you to get to the bottom of your symptoms. Regular “mini-evaluations” will ensure the appropriate plan of care has been implemented.
Pain can referred to the head from many different muscles from the T.M.J (Temporomandibular joint) and neck or cervical spine. Muscles in the neck may refer pain anywhere throughout the head. Patients may experience severe tension headaches or pain behind the eye as a result of muscles strains in the neck. TMJ pain may be caused by the muscles involved with movement of the jaw for chewing, speaking etc. These small but powerful muscles may cause severe headaches, which can radiate pain all over the head and behind the eyes as well.
Many muscles and all of the nerves that feed the muscles of the upper extremities originate in the cervical spine. Muscle fibers run vertically along the spinal vertebrae and, if inflamed, will cause the joints in the neck to “lock up”, restricting movement and causing pain. Unfortunately, muscles and nerves do not have their own private pathways to their attachments or destinations. Therefore, muscles and nerves are very close to each other and pathology of one will most likely affect the other. A muscle in the neck can become inflamed and become swollen thus causing increased pressure on the surrounding nerves. The affected or “impinged” nerve will then shoot pain down the arm, as far as the fingertips. Like other muscles, cervical muscles may cause referred pain down the arm to the fingers. Various positions or activities will either increase or decrease pain in the neck based on the soft tissues or structures involved. Contrary to popular belief, a herniated disc is much less likely to be the cause of pain and functional limitation compared to muscle strains. A herniated disc is when the disc in between the vertebrae protrudes out, impinging the surrounding spinal nerves causing numbness.
The ribs attach to the Thoracic spine and may impinge or press on the nerves that wrap around to the front of the chest or abdomen. This follows a “ring” pattern from the mid back to the chest or stomach. Ribs may sometimes become rotated excessively in one position causing pain in the mid back and with breathing. Deep breaths may also be limited due to a tight muscle in the thoracic spine. There are muscles that attach from the spine to the scapulae (shoulder blades) and others that attach up and down the spine. Spasms of these muscles may cause the vertebrae to “lock up” limiting thoracic range of motion as well as referred pain anywhere in the thoracic spine and will limit function and posture. Various positions or activities will either increase or decrease pain in the mid back based on the soft tissues or structures involved.
Like the Cervical and Thoracic Spines, the Lumbar spine has many muscles and nerves that are on top of each other. Therefore, inflammation of muscles may impinge or press on nerves thus causing shooting pain down the thigh to the toes. Many muscles attach along the vertebrae and, if inflamed, can cause the vertebrae to “lock up” limiting Lumbar range of motion. Inflammation of the lower back musculature may cause severe pain to the back and buttocks, poor posture and limitation in function. At times, there may be severe lower back pain with weight bearing on either lower extremity. Various positions or activities will either increase or decrease pain in the lower back based on the soft tissues or structures involved.
The Sacrum is the base of the entire spinal column and houses some of the nerves that control the lower extremity in terms of sensation and motor (muscular) function. This region is famous for housing the biggest nerve in the body, the Sciatic nerve. The Sciatic nerve is not the Sciatic nerve until it’s in the buttock and is lies directly next to the Piriformis muscle in the buttock. Inflammation of this muscle will impinge or press on the Sciatic nerve causing severe neurological symptoms down the back of the thigh down to the outside of the ankle. Sitting usually increases symptoms of Sciatica, which vary from burning, electric, numbness to sharp or a dull throbbing. Along with Sciatica, there are a number of causes of pain from the Sacral spine. Muscles, ligaments, bone or nerves may all attribute to pain in the buttock or groin regions. A physical therapy examination will determine the different causes of pain.
Pain at the shoulder may come from many different sources. Since the shoulder is the connection from the upper extremity to the torso, many muscles, ligaments and nerves cross this joint. The famous Rotator Cuff muscle group is in the shoulder complex and controls much of the motions at this joint. Without these four tiny muscles (ranging from the size of 2-4 finger widths), you would not be able to raise your arm beyond chest height, even with compensating with upper back muscles. Inflammation of these muscles may cause shoulder or arm pain or numbness all the way down to the hand. Lack of strength and mobility at the shoulder joint will cause “impingement” at the shoulder. This means that the tendons that cross the shoulder joint are being pinched in that joint, causing severe pain and limitation. Inflammation of all of the larger muscles that cross the shoulder joint may affect mobility and function at the shoulder.
The elbow, like the knee is a hinge joint, meaning that it allows only bending and straightening of the joint. The Triceps & Biceps Brachia cross this joint from the shoulder along with muscles that attach from the elbow to the fingertips. There are also muscles that allow you to turn your palm up or down. If any of these muscles are inflamed or injured, one will most likely have limitation and pain at the elbow. Many nerves cross the elbow on their way to the hand. Numbness in the forearm or hand may be attributed from an impinged nerve at the elbow. A detailed evaluation will determine whether the elbow, the shoulder or the neck is the cause of the numbness. Many times, limitation at the elbow joint will cause swelling, pain and limitation in the hands as well. The ligaments that stop the elbow from bending sideways commonly become injured with throwing activities seen in young teens involved with sports. Strengthening of the joint along with hands on treatment will most likely quickly return the athlete to sports.
The wrist and hand account for all of the fine maneuvering that we take for granted. There are several tiny bones and a soft tissue disc that join the two forearm bones (Ulna / Radius) to the first row (4 bones) of the 8 Carpal bones. The second row of the Carpal bones (4 bones) attach to all of the bones of the fingers. The famous Carpal Tunnel is at the wrist, which houses nine tendons and one nerve, with a ligament as the roof of the tunnel. Inflammation of any one of the tendons will cause swelling in the tunnel and compression of the Median nerve. This will cause numbness in the hand, mostly the thumb, index and middle fingers. Inflammation of the muscles that attach from the elbow to the fingers may cause pain at the wrist, finger joints or in the forearm itself. The Median, Ulner and Radial nerves are all in the forearm and could be compressed by any of the forearm musculature leading to numbness in the wrist or hand. The thumb is key for grabbing and maneuvering objects in the hand and has its own group of tiny muscles that control it. Additional injuries may include fractures of the wrist or hand due to a fall on an outstretched hand or other traumatic injuries that would cause fractures, muscle or nerve damage. A full examination by a physical therapist will determine the cause behind your pain and limitation.
The hip, like the shoulder joint, is a much more stable ball and socket joint. This means that there are many degrees of motion at the hip. It can bend, straighten, go out and in along with rotate internally or externally. This mobility can sometimes make you more prone to injury. All the nerves that enter the lower extremity must pass through the hip, which make them vulnerable to compression of any of the hip or pelvic musculature. Numbness, tingling or sometimes shooting stabbing pain will be the result of a nerve irritation from the hip. The major muscle groups of the thigh attach to the hip, which if inflamed will cause severe pain, sometimes shooting to the groin. Patients sometimes immediately opt to have a total hip replacement due to the immense amount of pain at their hip. Many times however, this pain is due to inflammation of hip musculature, which is resolved with physical therapy thus avoiding surgery! Inflammation of hip muscles will irritate the joint causing “temporary arthritis” (inflammation of the joint) and feel like you need a hip replacement. However, once the muscle irritation is resolved then the irritation of the joint and pain will be resolved as well. Pain in the hip may cause pain with getting in and out your bed or car, lying on your affected side, weight bearing on the affected side, standing, walking and stair climbing. It is important to determine the cause of hip pain to effectively treat the source of the problem.
The knee, like the elbow, is a hinge joint, which means that it flexes (bends) or extends (straightens out). The knee has two joints, the Patellofemoral and the Tibiofemoral. Major muscle groups such as the Quadriceps and the Hamstrings attach to the Tibia (leg bone) to control all weight bearing activities. Pain in the knee could be from numerous sources. Inflammation of any of the many muscles that cross the knee can cause severe debilitating pain at the knee and limit much function. Many patients over the age of 65 will immediately opt to have a total knee replacement due to the severe pain at their knee. Many times however, their pain is due to muscle imbalances and weaknesses at the knee causing “temporary arthritis” of the joint resulting in severe pain. For example, inflammation of the Quadriceps muscle group will cause the Patella (knee cap) to grind down against the Femur (thigh bone) with weight bearing. This causes severe pain and lack of weight bearing due to pain. This lack of weight bearing will cause further muscle weakness and more inflammation. This vicious cycle, which usually occurs with hip, knee and ankle injuries, will continue until the source of the inflammation is treated. Once treated, the joint irritation and pain is resolved and the patient usually cancels their scheduled total knee replacement! 85% of the time, pain at the knee is due to muscle inflammation and weakness. Our therapists’ thorough examination of your knees’ ligaments, meniscus and muscles will determine the cause of your pain and help effectively treat the source of your symptoms.
There are numerous causes of pain in the back of the thigh and calf. First, you may be suffering from a strain of the Hamstring muscles, which attach from the base of you hip to the back of your Tibia (shin bone). Of the three Hamstring muscles, one attaches to the central back of the Tibia while the other two attach to the inner and outer aspects of the Tibia and Fibula (outer leg bone). A Hamstring strain will be evident with difficulty straightening out your knee or walking. Inflammation of the Sciatic nerve in the buttock area may cause severe tightening and shooting pain into the back of the thigh and calf. Patients sometimes complaining of pain and swelling in the back of the knee suffer from a Baker’s cyst. This may require a visit to your doctor for further treatment. A calf strain will usually cause pain in the back of the leg but may also refer pain to the inner or outer part of the knee. Hamstring and calf strains are usually diagnosed by feeling muscles knots in the muscles
It is our experience that has led us to believe that ankle and foot pain is mainly brought on by problems at the hip or knee. The foot is merely placed where the hip and knee place it. An inappropriately place foot due to problems at the hip or knee may cause increased pressure or tension on certain aspects of the ankle resulting in pain, abnormality of gait (walking) and possible fractures of the lower leg bones or tearing of ligaments at the ankle. The ankle allows for up/down, side-to-side and circular motions of the foot for various functional activities. With this great amount of movement comes a greater risk of injury if there is muscle weakness of the hip, knee or ankle. Many times, inflammation of the calf will cause severe pain in the back of the ankle and heel. Inflammation of the muscles on the inner and outer lower leg will cause pain at the inner or outer part of the ankle, respectively. Many times, weakness of a certain hip muscle group will cause the feet to be placed too close to one another, which highly increases the risk of “rolling over” or “twisting” your ankle. This causes severe pain due to the sprain of the ligaments on the outer ankle joint. The knee could indirectly cause pain at the ankle. For example, lack of full extension (straightening out) of the knee will cause a gait (walking) abnormality, which in turn, increases the stress of the calf muscle causing severe pain in the calf and ankle. These mechanical abnormalities will be examined and evaluated during your evaluation to determine the primary source of your pain.
It is our experience that has led us to believe that heel and foot pain is mainly brought on by problems at the hip or knee. The foot is merely placed where the hip and knee place it. An inappropriately place foot due to problems at the hip or knee may cause increased pressure or tension on certain aspects of the foot, causing pain, abnormality of gait (walking pattern) and other functional limitations. Pain in the heel may be brought on by inflammation of the calf, since its tendon, the Achilles tendon, attaches to the heel. The Plantar fascia, which attaches from the bottom front surface of the heel to the underside of the big toe, will cause severe pain in the bottom of the foot and limit walking if inflamed. This, Plantar Fascitis, is usually more painful in the morning when first getting out of bed. There are many small bones that are in the foot, which could suffer stress fractures causing severe pain and inability to walk. Muscles in the front and back of the lower leg attach to the toes and foot and may cause functional limitations if inflamed.
