SPINE, MUSCLE, OR NERVE?

With chiropractic we primarily focus on the spine and its subluxations that are causing neck, mid back, and low back pain. Yet, we also deal with spinal misalignment that may be pinching on a nerve, and spinal misalignment that may be pulling on a muscle.  

Many times, my patients ask me questions, such as: “Is this a muscle problem?”, “Is it a nerve problem?”, “Is it a spine problem?”

I think we have done a horrible job in Western Medicine to teach people about their health. Because my answer to all these questions is, “Yes”.  See, you must understand, our body works as a unit: one process. Your spine can be pulling on a muscle which may be pinching on a nerve. A great example of this is the terrible PIRIFORMIS SYNDROME. If the pelvis and sacrum are out of alignment, it can cause tightness along the Piriformis muscle which presses on the Sciatic nerve, therefore cause Sciatica. So, if you only work on “stretching” the piriformis muscle, and you never get relief, it is because you never set the joints back into their proper place. You must place the joints back in the proper biomechanical position to relieve the tension on the muscle, to take the pressure off the nerve. Make sense?

There are several examples of muscle involvement and pains that we miss in everyday diagnosis.  Typically, if you feel like your neck is tight, it is tight! STOP STRETCHING IT! Here is how I explain this to my patients. Think of a rope pull. You have a group of men at one end of the rope and a group of men at the other end of the rope. Both ends are being pulled at the same time. Now can you visualize this rope. Is it taut in the center or is it bunched up? It is taut/tight. Now, if these men are told to stretch this rope even more and both sides pull even harder, what do you think happened to the center of the rope? It begins to fray and becomes week. So, at this point two things will happen, the rope will either break in the center or it will give way at one of the ends. So how does this pertain to muscle?

Muscle is like a rope. It has an origin and an insertion point. I sometimes like to use the neck as an example. There is a muscle that attaches to the base of the skull and to the tops of the shoulders. Now if you tilt your head to the left, that muscle is being stretched on the right and it pulls at its origins and insertion points (skull and shoulders). Yet, if you keeping over stretching, it begins to have these microtears in the center of the muscle belly; giving you a burning, tight, pain sensation. If this stretching continues the body will begin to try to compensate and shorten this tight muscle by either moving the skull closer or the shoulder closer. This is where we get our back of the head headaches (mohawk pattern) or top of the shoulder pain.  The longer we keep stretching the more we will develop microtears/scare tissue and “subluxations” or misalignments. When I find that a patient has this abnormal posture, I will ask them to try this one trick for me: Stop stretching your neck on that side, stretch it on the opposite side and watch how the headaches, neck pain and shoulder pain begins to diminish. They all think I am crazy till they come back and agree that the technique worked. I then explain the tight rope example. 

This is how our body is designed to work. So, I never like to separate muscle from spinal misalignment.  They work as one. In the last example, when we loosen the muscle up and change the posture, we then must “adjust” the spine because it was pulled out of position by this overstretched muscle. If we don’t put the joint back into place, this issue continues again. Everything as to be in alignment: joint, muscle, tendons, ligaments, and even organs.

Here is another muscle that doctors and PT’s and even chiropractors miss all the time. I hear this complaint a lot from women about their neck on both sides hurting. Always tight, always in pain, burning, and sometimes can’t even let anything touch the back of their neck without it being sensitive.  When we mention back of the neck, we tend to focus on the back of the neck, assuming that is where the problem is stemming from. But ladies, we (even me), have horrible posture. Due to our chest development, women are the worst for doing what I call the “chicken neck” posture.  Our shoulders are rolled forward, our head looks slightly down, and our neck juts forward like a chicken. Ok, here is were muscle and spine work together. Our muscles in the front of the neck should be long and the muscles in the back of our neck should be short and have a C like curve. When we have the “chicken neck” posture we do the opposite. We lengthen the back of the neck muscles and we shorten our front neck muscles.  Now the back of our neck feels “tight”. There is that word again! And what do we do? STRETCH. We stretch our neck and massage our neck and put heat on that nice inflamed neck (which is the worst thing to do). 

Ladies, here is the secret that everyone misses. We need to STRETCH our front neck muscles and massage our front neck muscles to loosen up the contracted (shortened) tissue. Massage therapists typically work on the SCM muscle, but the main muscle causing this neck and top shoulder issue is usually the Anterior Scalene muscles, along with a few other small muscles. Typically, I work on these and my patients may cry, but by the second day, they feel like a weight has been lifted off their shoulders and their neck feel lighter. Even sensitivity on the back of the neck goes away.  I know the old Victorian days were horrible, but great grandma had it right when ladies used to walk with books on their head. This is the correct posture.  But with computers and technology today, people barely look up anymore. 

I worked on the front muscle, where does the spine come into play? Well, the muscle was so taut in the back that it began to pull on the joints in the back trying to give it more length. Once we shorten the muscle, we need to put the joints back in their proper position to prevent it from happening again.  Remember, all muscles have to attach to joints: spine, elbows, knees, head, jaw, feet. They both work as a team.

All these examples are of referral pain. Just because your neck hurts in the back, it doesn’t mean it is coming from the back. This is commonly missed for low back as well. Many times I have a patient coming in swearing they have an IT band issue. They may have had PT or seen an orthopedist, or even done their own stretches with some relief but never lasting very long. Here is where my job comes in as a detective. Most patient cannot believe that a subluxation in the sacral area can mimic an IT band issue, as well as, hip issue.  So again, just because you have pain in the area, it doesn’t always mean it is coming from that area, but it could be coming somewhere else. 

My last example is plain old low back pain. This is so common it is a joke to me now. I have had patients with low back pain, and have gone through all the treatments and seen an orthopedist, etc. They may even have an MRI saying they have a bulging disc. These same patients may even had an epidural shot with temporary relief. I like it when my patients come in with all the other treatments done on them.  They did half the detective work for me. So, I see the patient. Sometimes I may recommend acupuncture first. If you listen to my last blogs and podcast, I explain how acupuncture needles will “talk” to me and help me locate the real referral pain area. Yet, most of the time I try a small trick first that I learned from my dad (also a chiropractor) years ago when I first started practicing. There is a point in the spine that gets out quit often due to posture. I tell my patients these are called “posture points”.  What is interesting about this one area is it has the perfect triad. It has a different shape from the spine above it and below it, because it is called a transition vertebrae. It has three large muscles that attach to it (trapezius, quadratus lumborum and psoas muscle) that cause tension in opposite directions at the T12 focal points, and it is a pivot point from where we bend forward. If this vertebrae is slightly rotated it can cause either tight muscle pain in the larger upper back muscle or the large lower back muscles. If this T12 vertebrae is being pulled out by the trapezius or does not set back properly in spinal alignment after bending forward, then it will pull on the large low back muscles, cause severe pain at the L5 region where the quadratus Lumborum inserts. Therefore, is gives an L5 disc like pain. Many times, all I did was adjust this midback vertebrae and “miraculously” the pain is gone. It is not a miracle guys, it is just basic anatomy and physiology and listening to when the symptoms started. Muscle wise, I have worked on the psoas muscle in the groin area, and the low back pain went away as well. It works both ways.

So again, stop focusing on the area, it doesn’t always come from that spot, it can be a referral pain. Also, remember, MUSCLE AND SPINE WORK AS A TEAM, STOP SEPARATING THE TWO. This is why I personally like to work in tandem with PT’s. They have the time to spend on certain muscles that I need corrected and then my job is to set the spine back in alignment, so it runs perfectly.

Now, where does “NERVE” come into play. Well guys, nerves can’t move on their own to get pinched.  Something must pinch it, and what could that something be? Disc? That will be the most common thing that comes out of my patient’s mouth. I am so tired of hearing disc all the time. If the disc is bulging, it causes inflammation around it and the inflammation is what can squeeze on the nerve. Therefore an epidural works well.  It pulls that inflammation out. Yet, why is the disc bulging? Many times, it can be due to lack of nutrition: not enough water, lack of collagen, etc. Yet, the disc does sit between two vertebrae. I like to think of it like an Oreo cookie. The filling is the disc and the cookies are the vertebrae. If you twist the top cookie and the bottom cookie, what happens to the filling?  It pulls and tears.  This kind of happens with the disc as well. So many times we have orthopedists saying a disc issue is not surgery based and recommend chiropractic care. Why? Because if we can align the top and bottom vertebrae’s we can get the disc back to its normal shape and allow it to heal properly. Yet, what if it is not a disc? Guess what guys? Muscle and joints can pinch on nerves as well. We gave you the example of the piriformis muscle pinching on the sciatic nerve. Let me explain how the spine can do the same.  Vertebrae have two prongs above and below that allow it to fit like a puzzle with the vertebrae above and below it. These prongs are called “facets”. Sometimes these facets don’t fit perfectly and get twisted. When they twist, they can cause a narrowing in the hole that the nerve comes out of and “pinch” the nerve. Here is where, we as chiropractors, can move these facets and get the pressure off the nerve. Is that not amazing!!!!! 

This is a very, very, very brief example of how the muscle and spine and nerves work together. What I want you to take from this article is:

• Don’t always think the pain is coming from that spot.  It may be a referral pain.
• Stretching is not always the best thing to do. You may be “stretching the wrong area”.  Sometimes stretching can do more damage than good. If you feel like you have constantly stretched the area to get relief from your pain, then stop! You are stretching the wrong muscle.
• Ice, Ice, Ice!!!!! I tell my patient’s: “Ice is an angel and heat is the devil”. When you feel pain than use ICE. Ice numbs the area and pulls inflammation away. Heat numbs the area but can pull inflammation back. It tricks you. It feels good but if you notice two hours later your stiffer and pain has returned, you’ve been tricked! Switch to ice immediately! We only use heat if a muscle is spasming due to an organ involvement.
• Posture is the number one cause for most of your pain. Watch yourself when you drive.  Your seat should be at a 90° angle (back straight up and knees level with your hips).  Stop rounding your shoulders, looking down, and doing the chicken neck jut forward move. Start walking with a book on your head or sitting on an exercise ball and work on your forward talking posture and not your computer/cellphone posture.
• Repetitive motion is the curse for us all in today’s 21^st century society. In our culture we repeat the same motions for hours and hours on end without stopping. Computers, our jobs, video games, watching movies, driving. We never change or alter these motions and it is the repetitive motions that damage our joints and muscles. Be aware of this and you can prevent many of the bodily injury we cause.
• Nerve pain can be caused by muscle, spinal impingement, and not always a disc issue.
• STOP GOOGLE DIAGNOSING YOUR CONDTION! It is ok to learn why you have something, but stop diagnosing yourself. I always tell my patients, “you may be chasing a ghost”. 

Good luck to you all and as I always say: “TAKE OWNERSHIP OF YOUR HEALTH”! 

Listen to my WEEKLY Podcast, The Common Sense Doctor.