Pain Management

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Neck and shoulder muscle tension and stiffness is an extremely common complaint.

Neck pain can be very frustrating and irritating; so much so that the phrase "a pain in the neck" has become a metaphor for all kinds of other irritants. Because of its position and range of motion, and because it plays a vital role in the support of the head, the neck is more subject to injury than any other portion of the spine.

The neck is a crucial part of the body which very readily reflects the state of tension and stress typical of the rushed life-style of industrialized countries which causes tensing of the neck muscles and pulling of the head backwards.

Tightness at the top of the neck can influence autonomic nervous functioning and prolonged period of tension can cause a various symptoms such as headache, lack of concentration, poor memory, insomnia or irritability.

Most neck and shoulder stiffness results from a variety of factors including continuous mechanical strain and emotional stress.

Wrong position for a prolonged time often causes neck and shoulder stiffness. For example, sitting in front of a computer and typing for extensive periods of time causes a lack of circulation in the tissue and fatigue of the muscles involved.

Also sudden force such as a car accident (whiplash) can cause neck pain.

Constant emotional stress is also a huge factor to neck and shoulder stiffness, especially in today's stressful society. Prolonged emotional stress creates a sympathetic dominant state in the autonomic nervous system and leads to decreased blood flow to most of the organs, muscles and peripheral tissues. When blood flow to the neck and shoulder muscles is decreased, the muscles become tight, lose flexibility, and are easily fatigued. In this case, patients also suffer from other internal problems such as digestive problems, constipation, insomnia, irritability, cold hands and feet etc.

In terms of Chinese Medicine, "pain" is due to stagnation of vital energy, called Qi. Neck and shoulder pain simply means bad circulation of Qi in the affected area. Constant stress can aggravate the circulation of the whole body, resulting in making the neck and shoulder pain worse.

Therefore, Chinese medical treatment to neck and shoulder stiffness and pain deals with both mechanical and emotional aspects. The best result can be obtained by acupuncture, massage, cupping, TDP lamp, herbal medicine, consultation for proper diet, exercise, and stress management.

Pain between shoulder blades

The area of the spine between the shoulder blades is one of the most tired and strained areas of our back. This area is called the thoracic spinal column and has a natural curve forward or convexity. It is located between the cervical spine and the lumbar spine, both curving in the opposite direction, forming a concavity. This puts extra strain on the thoracic part of the spine.

The pain is located between the shoulder blades, close to the spine – maybe one to two inches away from it – and either on the right or left side. The area is usually described being as big as a loonie or a toonie.

The pain can vary from mild to excruciating, but has a tendency to be severe, especially when people are tired or stressed. I have known several patients who had morphine injections on a regular basis right into the pain point, because that was the only way to –temporary- suppress the pain. Normal physiotherapy and chiropractic treatments only gave a short relief and the pain would always come back. In severe cases the pain would radiate from the back along the ribs to the front.

Almost all of our daily activities are directed forward; think about driving, typing, writing, painting eating etc. These activities make the convexity even stronger. Along the spine are muscles that connect the different vertebrae to each other. When the natural curve is constantly over strained, these little muscles become over worked and their blood supply decreases. As a result too much debris is built up in the muscle and this creates tension and pain. Eventually only a little bit overuse is enough to trigger the pain and this becomes worse over the years. This is an example of a repetitive strain injury.

Another possibility for this pain is irritation of the intercostal nerves. These nerves run from the vertebrae to the front of the body, between the ribs. These nerves are very sensitive and a wrong posture for a prolonged time or too much muscle tension can irritate them and cause a very intense pain.

As we can see the main reason for the development of this pain is bad posture and repetitive strain.

The reason that this pain is so severe and long term is that people only seldom take the trouble to really improve their (working) posture and try to break through the repetitiveness. Most patients who develop this pain have a sitting (computer) job.

It is obvious that the first thing to do is teach the patient the mechanics of the area and the injury. Without that no treatment will work and the pain can become so strong that it becomes disabling.

When the proper instructions are given, the spine needs some mobilization techniques in extension direction (from convex to concave) and some good home exercises. A very good exercise is the towel exercise: role up a small towel into a foot long towel roll. Put the roll on the floor and lie down on top of it, so that the roll is positioned lengthwise between the shoulder blades. The neck is free, head on the floor, arms next to the body, palms up and knees bent. Stay in that position for 15 minutes, three times per day. This will help restore the natural curve of the spine.

Acupuncture is ideal to relieve muscle spasm and tension in this area, because of the localized character and the relatively small size of the lesion. The needles can find the right ‘hot spot’ better then any other approach. Acupuncture will at the same time improve the blood flow, increase the flow of energy and relax the muscles. Distal points can be used on meridian points that are related to the situation. The needles will help the brain send a flow of endorphins to the area to suppress the pain.

Acupuncture, mobilization and postural correction are the ideal combination to fight this very severe and stubborn pain. Even then it will still take some time before this pain can be brought under control.

Rotator Cuff Injury

The rotator cuff is made up of the various muscles and tendons in the shoulder that connect the upper arm bone to the shoulder blade. They also help hold the ball of the upper arm bone firmly in the shoulder socket. The shoulder has the greatest range of motion of any joint in our body.

A rotator cuff injury is fairly common and can involve any type of irritation or damage to the rotator cuff muscles or tendons. The most common problems are tendinitis, when one of the rotator cuff tendons becomes inflamed due to overuse or overload (especially common in athletes), bursitis, when the fluid-filled sac (bursa) between the shoulder joint and rotator cuff tendons become irritated and inflamed, and muscle or tendon strain or tear, which can happen with tendonitis that is left untreated, or with stress from overuse.

Injuries are most commonly caused by normal wear and tear of daily life, poor posture or slouching, a sudden fall (and using our arms to break the fall), lifting a too-heavy object or lifting improperly, pulling something heavy, or repetitive arm activities, especially those done overhead, that cause stress to the shoulder.

Symptoms may include shoulder pain, tenderness and weakness, loss of shoulder range of motion, and a tendency to keep the shoulder inactive. Pain is the most common symptom of rotator cuff injuries, and may be experienced when reaching overhead, behind the back, lifting, pulling, or sleeping on the affected shoulder. A severe injury, such as a large tear may cause continuous pain and muscle weakness.

Treatment for rotator cuff injuries typically involves rest, over-the-counter pain relievers, and gentle stretching. Physiotherapy may be recommended to help heal the injury, improve flexibility of the rotator cuff, and develop shoulder muscle strength. Depending on the severity of the injury, full recovery may take from several weeks to several months. In more severe or chronic cases, treatment may involve corticosteroid injections or surgery. About half of the time, a rotator cuff injury can heal with self-care measures or exercise therapy.

Acupuncture can be very helpful in dealing with rotator cuff injuries. Treatments can help to relieve the inflammation, pain and muscle weakness and stiffness caused by the injury, which can speed recovery and bolster the body’s self-healing mechanisms. This makes acupuncture an excellent option in treatment of rotator cuff injuries, as it can complement other treatment therapies and can reduce the length of recovery time. Acupuncture can also be of particular benefit to lagging injuries that seem to just not want to get better. In addition, acupuncture helps the body to function better, and so can help to strengthen the shoulder and promote its proper functioning. In Chinese medicine, rotator cuff injuries are often due to an obstruction of the flow of qi-energy and blood to the shoulder, causing pain and weakness. Acupuncture can remove these blockages to allow full circulation of qi-energy and blood to the shoulder, allowing it to receive the nourishment it needs for proper functioning. In addition, a person may also have internal balances or weaknesses that make him or her particularly prone to a shoulder injury of some sort. By determining the cause of the pain and looking at each person’s individual health, we can not only resolve the pain and weakness that is being experienced, but we can also strengthen the body so that it is functioning in better health and less prone to a repeat injury or pain problem in the future.

Upper back pain can be a common problem for a few reasons, a lot of which have to do with our lifestyle. Because we spend a lot of time sitting, we can put extra strain on the upper back as well as create postural problems. This, combined with lack of exercise which weakens the muscles in the upper back, can lead to upper back pain. Also, many of us carry tension in the shoulders, neck, and upper back, leading to further pain. The spine is a connected unit, so problems in the neck or lower back can lead to pain in the upper back as well.

The two most common causes of upper back pain are muscular pain and joint disorders. Muscular pain can develop easily in the large upper back muscles, either due to lack of strength, or injury from overuse through sports, work, or repetitive use. Joint dysfunctions can also lead to upper back pain. Because the vertebrae in the upper back are connected both to each other and to the ribs, there is more possibility for problems. Problems can arise where the ribs connect to the vertebrae, such as with a rib fracture or a rib that shifts out of place.

In the treatment of upper back pain, exercise and postural correction are very important. Acupuncture can also help in the healing process, by helping to relieve pain, inflammation, and stiffness and strengthen the area. By looking at what is causing the pain, we can determine how to correct the problem. Is it due to trauma, whether through an injury or over time through poor posture or repetitive stress? Is it due to our external environment such as too much exposure to cold, heat, damp, or wind? Or is it due to an underlying internal imbalance that is weakening the musculo-skeletal tissues?

While working very well for dealing with the pain and inflammation of upper back pain, acupuncture can also help to strengthen the upper back and to correct internal imbalances that may be contributing to weakness or pain or hampering proper healing. 

The sciatic nerve is the longest nerve in your body, running from the spinal cord to the buttock and hip area and down the back of each leg, and about the size of your little finger. Sciatica is a condition where the sciatic nerve is irritated. The most telltale symptom of sciatica is pain that radiates along the path of the sciatic nerve- from the lumbar area to the buttock and down the back of the leg. The pain can be anywhere from a mild ache to a severe sharp or burning pain, numbness or weak muscles along the nerve pathway, and tingling or pins and needles feeling in the toes or foot.

The irritation of the sciatic nerve can be the result of pressure from muscles that are too tense or too short, a bulging disc in the lumbar vertebral column that pushes on the nerve, an inflammation of the nerve, or bad posture or heavy work that involves a lot of lifting and bending over. The pain can be severe and often gets worse while sitting too long, driving, bending over and lifting heavy objects. Sciatica is a widespread injury and about 40% of us will eventually be affected by it in some form. Sciatic pain will sometimes be the sign of a herniated disc and it is certainly wise to pay attention to it in an early stage and get expert advice.

In Western medicine sciatica can be treated by many different health care professionals. The massage therapist will loosen the tension in the muscles of the back and leg, in order to relieve the sciatic nerve, the physiotherapist will give exercises to improve posture and stretch muscles and can apply ultrasound or interferential current. The chiropractor will align the spine in order to relieve pressure on the nerve. The doctor can prescribe painkillers or anti-inflammatories and the surgeon can do surgery to remove the bulging of the disc or contributing problem.

In Traditional Chinese Medicine (TCM), sciatica is considered to be a lower back problem, an area that is strongly influenced by the bladder and kidney channels. Sciatica can be differentiated into different types, depending on the exact cause. Damp-cold invading the back channels can occur in both acute and chronic cases, causing a dull, heavy, radiating pain that may be worse with cold or dampness. Sciatica due to stagnation of qi-energy and blood in the back area can cause either an acute or chronic condition that is aggravated with the absence of movement. Sciatica due to kidney deficiency will result in a chronic condition because of the fact that weak kidneys are unable to properly nourish the lower back area, making it susceptible to injury and dysfunction. This type of sciatica has a slow, gradual onset and typically will get worse in the evening and with fatigue.

Acupuncture can be extremely effective in the treatment of both acute and chronic back pain, including sciatica, regardless of how long the condition has been present. Sciatica often takes longer to treat than other types of back pain, but acupuncture can produce great results, both in treating the pain and in addressing the underlying weakness that is contributing to a sciatic problem.

Often in cases where there is a stubborn problem that doesn’t seem to respond to treatment, acupuncture can remove the blockages and open the doors for healing. Combined with exercises and postural advice, is a very valuable tool in treating sciatica.

The ankle joint is an intricate network of bones, ligaments, tendons and muscles. It is built for both strength and flexibility, as it needs to bear the weight of our body while also having the flexibility for the various surfaces we walk on. The ankle joint can be prone to various types of injury and pain and ankle pain may be experienced on the inside or outside of the ankle or along the back where the Achilles tendon connects the muscles in the lower leg to the heel bone.

Most ankle pain results from a sprain, which occurs when the ankle rolls over the foot, causing a ligament to stretch or tear.  Sprains are often sports-related but they can also occur when walking on an uneven surface of from taking a misstep.  Ankle pain can also be caused by injury to any of the bones, ligaments or tendons in the ankle. Any kind of ankle injury will also affect our gait or walking pattern and in a chain reaction, the knee joint, hip joint, SI joint and spine become involved and so ankle pain can have far-reaching consequences.

As with other pain or injuries in the body, Chinese medicine (TCM) usually diagnoses ankle pain and injury as a blockage or lack of proper circulation of blood and qi-energy in the affected area. These blockages lead to pain, weakness, and an inability for the ankle to heal properly because it cannot receive the proper nourishment to do so. Acupuncture helps to remove blockages, increase circulation of the blood and energy, and also resolve any imbalances in the meridians that may be causing a weakness in the ankle and leaving it prone to injury or strain.

In the early stages of an injury, acupuncture can help to remove blockages and promote blood flow to the ankle, as well as relieve swelling and pain. With injuries in the middle stage of healing, acupuncture can help alleviate swelling and pain in the ankle, and promote healing of the tissues and bones. In later stages of injury, where the ankle has become rigid and weak, acupuncture can help to relax the tendons and remove blockages to regain movement and strength in the ankle. 

In all cases, acupuncture helps to strengthen the body and promote better functioning so that the body is better able to heal and to resolve the problem fully. Whether we are dealing with acute or chronic ankle problems, acupuncture can help to boost the body’s healing so that we can regain our health and return to our regular day to day functioning.

The elbow is a complex joint formed by three long bones. Four sets of muscles help move the joint and are attached to the bones by thick tendons. Damage to any of these structures or to the joint's network of nerves, blood vessels and ligaments can lead to elbow pain. 

Most elbow pain results from overuse injuries, often sports-related but also as a result of activities or work that require repetitive arm, wrist, or hand movements. Elbow pain may also be due to arthritis, but the elbow joint is much less prone to wear-and-tear damage than other joints are. Common causes of elbow pain include ligament sprain and tears, golfer’s elbow, dislocation, elbow fracture, tendinitis, tennis elbow, osteoarthritis, or irritation or damage to one of the nerves in the elbow.

Acupuncture can be very effective for the many possible problems of the elbow, both acute and chronic. Acupuncture treatment can relieve pain, aid healing and help prevent future problems with elbow disorders.

Although muskulo-skeletal problems like elbow disorders are typically due to external causes such as a blow to the joint or an overuse injury, internal weaknesses of the body can complicate or aggravate a problem once it is there. So we also look at the overall health of the internal functions to find any areas of imbalance, particularly those that affect the meridians of the elbow. Imbalances will contribute to weakness in the elbow and make it more prone to injury, as well as more slow to heal.

Our bodies are amazing organisms that have the ability to self-regulate and repair themselves. In any disorder the body attempts to minimize, repair and overcome the damage to its normal functions and in many cases, given adequate rest and support, our bodies are able to recover successfully. However, in cases where the body isn’t able to correct a problem on its own, acupuncture is a promising treatment that helps bolster the body’s healing abilities so that we can return to our normal, healthy selves.

The temporalmandibular joint is the joint connecting the upper and lower jaw. TMJ disorders, commonly just called "TMJ", are used to describe pain or dysfunction in this joint. TMJ typically involves pain and stiffness of the joint.  There may also be clicking or popping noted when chewing or opening the mouth fully, like when one yawns.  Or there may be associated symptoms like headaches, neck stiffness, or even difficulty sleeping. TMJ is linked to stress, teeth grinding, dental problems, and excessive gum chewing. 

Of all the joints in the body the jaw joints are the only ones that move simultaneously. This creates problems that are unique to the jaw area. TMJ disorders can occur when the joint’s disc erodes or moves out of its proper alignment, the joint’s cartilage is damaged by arthritis, the joint is damaged by a blow, or the joint muscles become fatigued from overwork. The muscles that move these joints are small and have to work hard- they are involved in speaking, eating, laughing, yawning and singing- and it is relatively easy to overwork them.

Stress can also take a toll on the TMJ joint- a lot of people grind their teeth when they are stressed, nervous, or angry, or during their sleep, which puts enormous strain on the small joints and muscles. We can also cause strain to the area through our eating habits, like biting off hard food like chocolate or carrots. TMJ disorders can cause pain or tenderness in the jaw, aching pain in and around the ear or in the facial muscles, difficulty chewing, headaches, and difficulty opening the jaw.

In Western Medicine, TMJ disorder can be treated with physiotherapy and massage and with exercises, which teach us proper jaw alignment. Usually the results of this treatment are positive. Medications such as anti-inflammatories, muscle relaxants, and cortisone may be prescribed.

Acupuncture can help with TMJ disorder in a number of ways. When it comes to pain, acupuncture can give fast and positive results. Acupuncture can also help reduce inflammation to the area, as well as bring blood and energy circulation to the area, all of which help to promote healing. The muscles will begin to relax and automatically correct the opening movement.

The meridians that have connections to the jaw belong to the Gallbladder, Triple Burner, Small Intestine, Stomach and Large Intestine (partly). A deficiency of Blood and Energy (Qi) in these meridians is usually the cause of the pain. Blood and Qi will stagnate and can cause severe pain and stiffness.

The combination of acupuncture with other therapies and removing stress to the area can help to resolve this disorder. Things that can be done to reduce stress on the TMJ joints include maintaining a relaxed jaw posture, avoiding clenching or grinding teeth, avoiding overusing the jaw muscles such as avoiding sticky or chewy foods and cutting food into small pieces, and working to reduce stress and anxiety.

Rheumatoid arthritis is a chronic inflammatory disorder that affects the lining of the joints, causing a painful swelling that can eventually lead to bone erosion and joint deformity. This condition is an autoimmune disorder where the immune system mistakenly attacks the body's own tissues.

Rheumatoid arthritis can cause symptoms of joint pain, swelling and tenderness, as well as red and puffy hands, firm bumps of tissue under the skin on the arms (rheumatoid nodules), and morning stiffness that may last throughout the day. It can also affect the whole body with fevers, fatigue, and weight loss.

Rheumatoid arthritis tends to affect the smaller joints first, such as the wrists, hands, ankles and feet, but as the disease progresses, the shoulders, elbows, knees, hips, jaw and neck can also become involved. Symptoms may vary in severity and may come and go. Flare-ups of disease activity alternate with periods of relative remission, during which the swelling, pain, difficulty sleeping and weakness lessen or disappear.

Doctors don’t know what causes rheumatoid arthritis, though it may have a genetic factor that is triggered by environmental factors such as a bacterial or viral infection. There is no cure for rheumatoid arthritis, and treatment involves managing symptoms to prevent flare-ups and further progression of the disease. Western medical treatment may involve medications to reduce joint inflammation, relieve pain and prevent or slow joint damage; physiotherapy to teach better movements to protect the joints; and in severe cases, surgery.

In Chinese medicine, rheumatoid arthritis is considered a “bi syndrome”. “Bi” means obstruction or blockage, and bi syndromes are characterized by an obstruction of qi-energy and blood by wind, cold, dampness, or heat. This causes symptoms of aching, pain, heaviness, numbness, stiffness, redness, and swelling. Bi syndromes usually arise because of an underlying weakness or imbalance in the body that makes us vulnerable to injury or disease.

Bi syndromes that lead to rheumatoid arthritis typically arises from an imbalance of the kidneys, because of their role in the functioning of the bones and marrow, and the spleen, because problems with the spleen can lead to internal dampness in the body, as with joint swelling during a flare-up. The liver is also often involved with rheumatoid arthritis, because liver dysfunction can lead to blockages of qi-energy and shortage of blood, and the liver is also closely tied into the health of the tendons and ligaments.

However, rheumatic arthritis may have different causes depending on the person, and determining the organs involved is done by looking at the specific symptoms for each person. In this way, treatment is tailored to the individual’s symptoms and constitution, to better target the causes and relieve the symptoms.

Acupuncture has a lot to offer those suffering from rheumatoid arthritis. It offers a healthy way to manage the symptoms of the condition, helping to reduce pain and inflammation and prevent flare-ups from occurring. Acupuncture improves the body’s healthy functioning, including the immune system. It is also very effective for the relief of pain and inflammation- in the case of rheumatoid arthritis, relieving joint pain and stiffness and helping the joints to function more healthily.

For those who suffer from rheumatoid arthritis, acupuncture offers a safe and healthy option to help manage the condition, prevent further progression, and enjoy life symptom-free.

Fibromyalgia is a chronic condition characterized by a constant dull pain throughout the body accompanied by fatigue and sleep disturbances. Symptoms can vary depending on the weather, stress, physical activity, and even time of day. Generally the pain is widespread and occurs in the muscles, tendons, and ligaments, along with especially sore spots called “tender points” on various areas of the body.

Fibromyalgia can be accompanied by many other conditions including chronic fatigue syndrome, depression, headaches, IBS, arthritis, and restless legs syndrome, among others. There is still no clear cause for this condition, though it is believed to be a combination of genetics, stressful events such as car accidents, emotional stress or trauma, repetitive strain on the body, infections and other illnesses- basically everything that drains our immune system.

Fibromyalgia is a complicated condition and Western medicine often finds it difficult to treat. Fortunately, acupuncture has a lot to offer for sufferers of fibromyalgia. 

With fibromyalgia, there are a number of patterns in Chinese medicine (TCM) that can contribute. The first is spleen deficiency, which can be responsible for many of the symptoms of fibromyalgia, including fatigue, digestive problems, muscle weakness, and poor thinking. Liver qi/energy stagnation or blockage can also be a factor, causing emotional symptoms and muscle-joint stiffness. Blood deficiency prevents the body from being properly nourished, causing the constant pain typical of fibromyalgia. Kidney deficiency also plays a role, as all chronic muscle-joint pain tends to include the kidneys, and the kidneys are at the foundation of good health.

Acupuncture can help to reduce tender points, relieve body aching and pain, and improve mood, sleep and digestion, as well as many of the other symptoms associated with fibromyalgia. The key to remember with acupuncture is that it is a healing process, rather than an instant fix, so recovery takes time and each treatment builds on the progress of the last, producing a steady and gradual improvement. We must also factor in the complexity of the condition and consider that conditions that are more complex or that have been developing over a longer period of time take more time to reverse and undo.