Back and neck pain is crazy common in the general American population. A lot of studies have tried to categorize just how prevalent it is and the general number seems to fall around 60%.
That’s crazy! For every 10 people that you come across in your day, 6 of them are struggling with chronic back and neck pain.
That’s a whole lotta people.
When it comes to musculoskeletal pain, I’m a firm believer in approaching it from a comprehensive and fundamental level (common theme? Megan and I are into this!).
That means I believe that you have to address how you sit, how you walk, how you stand, how you sit, and the ranges of motion that you actually utilize.
No article of mine about functional movement would be complete without a mention of Katy Bowman’s work. If the topic of functional movement is a new concept for you, start by checking out this book. And her blog has a wealth of information to get you started.
All this being said, I think it’s important for physicians to help people with pain bridge the gap between providing pain relief and having them make lifestyle/mechanical changes. After all, I could tell you to do proper squats until I’m blue in the face…but if you have so much pain that you have a hard time getting up from a chair, it really isn’t all that helpful as advise.
There are many musculoskeletal reasons for back/neck pain. The ones I have lifted are the common ones but this list is in no way all-inclusive.
The pain can present because of the way the bones connect to one another, causing compressions of the large nerves coming out of the spine. Arthritis is a common reason but trauma is up there pretty high as well.
Between the vertebral bones of our spines, there are gelatinous discs…they are meant to be our natural shock absorbers. Unfortunately, the discs also undergo changes over our lifetimes. The discs can lose hydration which makes them ineffective at keeping the bones from crushing into one another (ouch!) or slip backwards into the nerve exiting the same area.
Very commonly though (which is the point of this post) is that the muscles around the spine are the actual causes of the pain.
Because we tend to be a sitting and furniture/comfort driven society, we spend a huge majority of time locked into several familiar positions. (Think about it: how often do you move your arms in a way that’s not in front of you? Most of us type, cool, drive, sleep in one basic configuration…but there are so many ways the body can move!)
This means that we get tight and weak muscles. And that combination is not a great one when it comes to pain. You end up getting stuck in a downward spiral of more tightness leads to more weakness which leads to more tightness, ad nauseum.
So what’s a person supposed to do if pain doesn’t allow you to do most of the helpful exercises?
For one, there are LOTS of different procedures that pain physicians can provide. But the one I wanted to touch on today is the one that many people start with and then go up to the heavy hitters at a later point if necessary.
Trigger point injections sort of go like this:
Find a tight muscle by pressing around the painful area. Tight muscles tend to hurt.
Mark the area.
Clean the area.
Using a very small, short needle, do dry needling. While that sounds like something no one would ever sign up for, it’s actually not that bad. (I’ve gone back for multiple rounds!)
At this point, some pain physicians will actually stop. You can think of it as focused acupuncture for tight muscles. That’s not actually true, but it’s a nice way to understand what’s happening.
Other pain physicians will inject a type of solution (often a local anesthetic and a low dose steroid, but there are lots of options) to break up the connective tissue and muscles in the area.
How does this help?
For one, the steroid is in there to help locally calm the uncontrolled inflammatory process that’s occurring. The local anesthetic provides quite rapid pain relief and the solution itself helps break up the spasming muscle fibers. Ironically, an inflammatory response follows the disruption of the muscle tissue.
But wait, didn’t we just use steroids to calm the inflammation? We did.
The body’s response to the tissue disruption promotes a more controlled and effective regeneration response. It’s like putting out a house fire versus starting a bonfire to make s’mores. In one, there end result is destruction; the other, you’re eating delicious goo-ey-ness and loving life.
On average, most doctors will do about 5-8 sites over the area that hurts. But it definitely depends on the part of the body that you’re caring for.
The End Result
Trigger points can be very helpful at getting muscular pain under control enough for you to begin to rebuild through physical therapy and changes in lifestyle.
They’re by no means a magic bullet. Everyone still has to put in the hard work of changing how you move your body on a regular basis.
But that’s also the fun part 🙂 So having a boost to get you there is pretty handy to have in your toolbox.
Pain physicians are the doctors who do these procedures most commonly. But there are certified family medicine doctors that get special training for these kinds of procedures that you can sometimes find in your area.