Over the years when I worked in hospitals, I occasionally saw patients who were admitted with chest pain. A heart attack wasn’t the culprit (but of course had to be ruled out), but after many tests and doctor examinations, it was determined that the source of pain was due to inflammation at the joint where the ribs meet the sternum, or breastbone. This condition is known as costochondritis.

The joints where the ribs attach to the sternum do not allow a great amount of motion, but they do glide and can become inflamed or irritated. In many cases, the problem stems from poor posture. When the shoulders and upper back round forward, the chest caves in and the joints at the breastbone get compressed. The pain associated with this often increases with coughing, sneezing, sudden movements, slouching, or stretching the chest.

If you experience any chest pain, it’s essential to seek care from a physician immediately in case it is of cardiac origin (early access to care is the best indicator for positive outcome with coronary events). If they determine that you have costochondritis, you may be prescribed anti-inflammatories and rest or referred to an orthopedist, physical therapist, or chiropractor.

I recommend being very aware and careful with your posture and avoid slouching at all. Use a lumbar support cushion to help maintain upright sitting posture with ease. Deep breathing, gentle chest stretching (as long as it doesn’t increase your pain) and icing the area are also helpful to facilitate healing.

Growing up I loved the Wizard of Oz. The combination of the music, costumes, and the absurdness of it was really so entertaining. In my work, I often think of the poor Tin Man, who was so stiff and constantly needed to oil his joints to keep mobile. That’s really not too far off from our bodies in a way. We have special lubricating fluid in our joints that helps the joints move smoothly.

The joints in the body bend and straighten, but they also glide in multiple directions. For example, the knee bends and straightens, but as it bends, the tibia (shin bone) glides backwards on the femur (thigh bone). And at the same time, the knee cap glides down. There’s a lot of complexity to that really, and if any part of the bending or gliding is limited, pain can occur.

I’m going to stay with the knee as an example because it’s an easier joint to explain. If you sit with your legs straight out in front of you and relax your thigh muscles, you can use your hands to gently wiggle your kneecap up and down and side to side. If the joint capsule (which is essentially like saran wrap around the joint) here becomes tight due to a new or old injury, a disease process, or disuse, knee dysfunction could occur. In addition, tight muscles can restrict the kneecap’s ability to glide. For example, a tight IT Band will tend to pull the knee cap out to the side, decreasing it’s ability to glide inward and altering the resting and functional alignment of the kneecap. This can cause wearing on the underside of the kneecap which would inflame the joint. Injuries to the knee such as chondromalacia patella, IT Band syndrome, patella dislocation, and patella tenndinitis can all be related to a disruption in the gliding mechanism of the kneecap.

So sometimes when you stretch on your own and don’t see an improvement in flexibility, it may be because the joint isn’t gliding correctly and that is what is limiting your motion and progress. The only way to restore normal flexibility in that case is by mobilizing the joint and stretching the joint capsule. This could be done by a chiropractor or physical therapist. There are also self mobilization straps and wedges you can be instructed to use for mobilizing the neck and back. It’s important to maintain the flexibility of both muscles and joints in order to keep from getting stiff and creaky like my friend the Tin Man.

Over the years, I’ve learned to very easily distinguish between the pain I feel when I injure a joint versus a muscle. And I’ve had my share of injuries… plantar fasciitis, Achilles tendinitis, chondromalacia patella, ITB syndrome, SI sprain, thoracic/rib sprain, rotator cuff strain, cervical sprain, and I’m probably leaving out a few.

Though I’m not into extreme sports and I exercise regularly, I have some structural skeltal abnormalities that have predisposed me to these many injuries just with somewhat normal activity (especially running…which I love but my body doesn’t share the sentiment.)

The pain from the joint injuries or sprains is quite distinct from muscular injuries. Joint pain is often felt or described as being:

1. Sharp

2. Localized

3. Worse with specific movement patterns

For example, when I sprained my wrist, I could pinpoint the exact joints/ligaments that were affected, and it only hurt in the one spot when I extended my wrist back. When I sprained my SI joint, the pain was again, very specific to the SI joint, and it hurt when I brought my leg out to the side and extended my spine as if into a backbend.

A muscle injury, or strain is usually experienced differently. The pain tends to be:

1. Along the length of the muscle or tendons

2. Worse when the muscle contracts and stretches

3. More difficult to pinpoint to just one spot

4. Tenderness to the touch with or without muscle spasm

When I strained my rotator cuff, it hurt to both reach my arm up (as it contracted) and reach my arm around my back (as it stretched). When I pressed on the tendon it was very sore to touch, and the pain seemed to travel all around my shoulder.

The treatment for both types of acute injuries is the same: rest, ice, compression, and elevation. In terms of rehabilitation, it’s important to consult with a doctor regarding the best form of treatment for your specific injury. You may find that for joint injuries, a chiropractor or physical therapist may offer the most relief. Muscular injuries may respond well to massage and/or physical therapy. Again, I can’t stress the importance of early access to evaluation and treatment to prevent a chronic condition from developing.

So we decided for the first time this year to forgo the flu shot. I’ve done it in years past when I worked in hospitals and then with young children we always opted for it. My kids are 4 and 5 this year and out of the high risk age range, so we skipped it since we’re generally healthy and I was feeling optimistic.

Well, live and learn. We got the flu (and I say this diagnosis with confidence because the pediatrician did a nasal swab on my daughter to confirm that it was in fact the flu) not once, but twice. Yes, we got two different strains of the virus this year, and it hit hard. High fevers, stomach upset, and a cough that was unlike any I’ve ever experienced. And this is how my injury came to be.

From my frequent, violent, coughing fits, I managed to send my entire neck into painful spasm, to the point where I couldn’t even turn my head. It was so excruciating and every time I coughed I had to brace myself and support my neck in anticipation of the pain.

Now, I’m an advocate of early access to treatment, so after unsuccessfully trying to treat myself (and actually making myself worse by trying to stretch the joints and muscles of my neck and upper back), I went to see a chiropractor and then a massage therapist. My pain gradually decreased as my motion also improved. I have regained almost full motion, and only have pain when I cough (which has lasted over 2 weeks now) and at the extremes of motion. Had I not sought immediate treatment, I don’t believe I would be feeling as well as I am today.

I can’t stress enough the importance of early access to treatment for any type of musculoskeletal pain. It helps to restore function and prevent secondary effects from stiffness and immobilization. Although waiting it out to see what happens is sometimes OK, in many cases, you will speed your recovery time and healing process by seeking out professional care from a doctor, chiropractor, physical therapist, and/or massage therapist within the first three days.

This is a question I hear often from patients, friends, and family. It’s so interesting the way the body responds to an injury, and how a specific injury or problem can cascade into other areas of the body.

Here’s a great example…many patients with lower back pain present with restricted movement in their neck or upper back. Although these areas may not be painful or uncomfortable (and many would not think they are related) I would bet that in most cases they are a huge part of the problem at the lower back. You see, the body is an amazing structure, and it compensates in many ways so it can still function fully. So if the upper back is stiff, the lower back may overstretch in efforts to reach or twist, creating an imbalance there. This over stretching can create a condition of excess mobility in the lower back, which may become a source of pain before the root of the problem (the neck or upper back) ever speaks up. And for some, the neck or upper back area may start to become bothersome after the lower back is inflamed, painful, and weak. Here comes the feeling of falling apart…

So what can you do to prevent this? Stay as healthy as possible. This includes eating a well balanced diet, and getting enough exercise, sleep, and relaxation time. Regular physical exams are important as are some regular pampering sessions. You may choose quarterly massages, chiropractic treatments, working with a physical therapist or trainer, acupuncture, Reiki, Reflexology, or any number of other alternative forms of body work or healing practices. Getting prompt treatment and care when you feel pain or discomfort is also of huge importance so any imbalances get addressed immediately and secondary problems can be avoided.

My Dad called me from Florida the other day to boast about the warm weather and also to ask me what I thought about spinal decompression therapy. His chiropractor recommended it for him to help with chronic lower back pain from an injury he sustained years ago that was recently aggravated.

Basically, spinal decompression is exactly that…a way to decompress the spine. The spinal joints, ligaments, discs, and muscles can be compressed due to arthritis, spinal stenosis, disc disease, trauma, and as a result of chronic pain and muscle spasm. Decompression aims to stretch, open, and relieve pressure in that area, thereby giving more movement, space for the discs, and reducing pressure on surrounding nerves. Although it is an option for cervical and lumbar pathologies, I will focus here on the benefits for the lumbar spine.

Spinal decompression therapy can be administered by a chiropractor, physical therapist, or independently by the patient depending on the means of decompression. Many chiropractors and physical therapists have mechanical traction machines that they use as part of their treatment programs. The patient lays on the table with corset belts strapped around the pelvis and rib cage. The rib corset acts to stabilize the body so the whole patient doesn’t slide along the table (as the lower part of the body is distracted). The pelvic corset is connected to a cable that is programmed to pull or provide traction with a certain amount of force, usually somewhere around 30% of the patient’s body weight. The traction can be administered in a sustained manner, or intermittently with periods of traction and release. Intermittent traction is more commonly used in my experience and may be more comfortable for the patient to tolerate.

Self traction via home mechanical traction units is an option, though these units can be expensive. Prior to investing in one of these, success with clinical mechanical traction should first be demonstrated. A less expensive option gaining popularity is the use of inversion tables. These can sometimes take a little getting used to as most people aren’t accustomed to being upside down, but they use body position and gravity to create a traction force for the lumbar spine. The user starts in a standing position with the back supported on a backrest and the feet secured under foot bars. Then the table can be reclined as far back as possible until a comfortable stretch or distraction force is achieved.

So I did suggest my dad try spinal decompression therapy. It’s a safe, non-invasive means of achieving pain relief and improved function. I wouldn’t, however, recommend it for individuals with infections, tumors, osteoporosis, or conditions of instability (such as spondylolisthesis).

I have worked with physical therapists who are anti-chiropractic, even to the point of being unwilling to treat patients who are simulatneously under the care of a chiropractor. I also know some chiropractors who do not recommend exercise or physical therapy to their patients. I often find patients who turn to physical therapy because chirporactic didn’t cure their back pain, and others who leave physical therapy to find relief from a chiropractor.

Although I’ve been open to chiropractors and referred patients to them, there does indeed seem to be some rivalry between the 2 professions. In some states there is overlap in the procedures that each can perform: ultrasound, electric stimulation, joint manipulations, soft tissue work, and exercise prescription. So, I suppose it would make sense that in the spirit of competition and livelihood, there may be some strong opinions within and between the professions.

Personally, I appreciate what chiropractors have to offer and I have been treated myself for a rib and back injury. I’ve learned recently that chiropractic care can have benefits beyond relief of pain. We decided to bring my son to see a chiropractor due to a problem he was having with chronic nasal congestion and enlarged adenoids. Our pediatrician was out of ideas and wanted to put him on long term antibiotics as a last option, but we wanted to avoid that. After researching online, I found several articles that suggested chiropractic might help. It did take some time, but we saw an improvement in my son’s breathing and overall comfort level.

I would strongly recommend that in conjunction with chiropractic care (or spinal manipulations performed by a physical therapist), people with any sort of joint or musculoskeletal pain also perform stretching and strengthening exercises to maintain their alignment. I’ll try to explain why…but it’s a little bit like the chicken and the egg.

Which came first? Did an alignment problem in the spine cause the hamstrings to be tight, or did tight hamstrings cause the alignment problem? Or was it weak abdominals? Or perhaps a traumatic injury caused the alignment problem and resultant muscle spasm and tightness. If there is an alignment problem that gets fixed by a manipulation, the muscles that are tight will pull the joint back out of position until they regain their normal length. Along that same line, if the muscles surrounding the spine, such as the abdominals, are weak, they will not be able to provide sufficient dynamic stability to maintain the alignment. In certain situations where pain is less chronic and muscle length/strength changes have not occurred, simply correcting the alignment problem may provide relief, but I have not found many people (I actually can’t think of any, but I’d love to hear your stories) who only needed 1 adjustment to feel 100%.

I believe the goal is to create an environment in the body that is in equilibrium in terms of alignment and muscle balance. So my general recipe for success would be:

Success= Alignment correction + Stretching + Strengthening