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Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
October, 2008, Vol. 08, Issue 10
Complex Regional Pain Syndrome
By Whitney Lowe, LMT
Pain resulting from nerve entrapment syndromes is a common reason for clients to seek the care of a massage practitioner. However, there are numerous neurological disorders that, at first glance, might appear to be nerve entrapment but are an entirely different pathological condition. Complex regional pain syndrome (CRPS) falls into that category.
A brief review of fundamental neuroanatomy is helpful to properly understand what occurs in CRPS. The autonomic nervous system has efferent fibers that control activity in various smooth muscles, glands and cardiac muscle. Within the autonomic system there are two divisions, the sympathetic and parasympathetic. The primary function of the sympathetic branch is to stimulate activity, while signals from the parasympathetic branch serve to inhibit activity. Of these two, the sympathetic branch is more involved in CRPS.
The sympathetic nervous system has a vital role in protective reflexes as the body responds to stress. It is in high gear during the "fight or flight" response. However, excess sympathetic system activity can generate and maintain pain states in different regions of the body. It is this excess sympathetic activity that causes the symptoms of CRPS. While there still is not a complete understanding of how excess sympathetic branch activity causes these pain conditions, it appears there is some spillover of noxious input from the sympathetic efferents into various nociceptors, especially in the extremities.
The term complex regional pain syndrome has only recently been added to the medical lexicon. It includes two separate conditions that have similar symptoms, but are different in cause. The two conditions were formerly called reflex sympathetic dystrophy (now called CRPS 1) and causalgia (now called CRPS 2).5 The primary difference between them is how they occur. In CRPS 1, symptoms commonly occur as a result of some traumatic incident, but there is no evidence of specific nerve damage. In CRPS 2, there also is some event that initiated excess sympathetic activity, but this condition also involves identifiable damage to the nerve. Most of the symptoms of CRPS 1 and 2 are similar and are listed below:
Symptoms of CRPS
Distinguishing CRPS from other neurological disorders is aided by detailed evaluation of several clinical features in addition to those listed above. The condition can affect either the upper or lower extremity, but is more common in the upper extremity, and the pain usually is aggravated with moving the affected limb. Various myofascial dysfunctions also might accompany the extremity pain.1 Women are affected more often than men by approximately a three-to-one ratio.2 Some degree of depression or psychological dysfunction is common with CRPS. However, it is unclear if this psychological dysfunction is a causative factor or a result of the condition, because depression and similar psychological manifestations are common in severe and chronic pain conditions.4
Treatment for CRPS varies widely, but physical therapy is a primary component of most treatment protocols. The goal of most physical therapy treatments is to desensitize the area and restore normal function of the affected extremity. Massage might play a fundamental role in this process. Because myofascial dysfunction often is a part of the array of symptoms, addressing the myofascial component might interrupt the cycle of pain and dysfunction. In many cases, if the myofascial pain condition was properly addressed, the whole syndrome may resolve.3 Massage is also likely to be helpful because it is effective at decreasing overall sympathetic system activity.
If you have a client demonstrating signs and symptoms that indicate the possibility of CRPS, it is important to have them properly evaluated by a physician. There are a number of other treatment strategies such as nerve blocks and medications that are effective in addressing the problem, and it might be important to start these treatments as early in the rehabilitation process as possible.
CRPS can be a debilitating condition. Because it occurs more often in the upper extremity, it might be easy to dismiss many of the symptoms as arising from a peripheral compression neuropathy such as carpal tunnel syndrome. However, awareness of the variety of symptoms associated with CRPS allows the practitioner to look at a bigger picture and catch this condition early on, if present, so it can be most effectively treated.
Click here for more information about Whitney Lowe, LMT.
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