What is Fibromyalgia? - Physiotherapy Halifax - Physio-Fitness - One to One Wellness

What is Fibromyalgia?

What is Fibromyalgia?

Fibromyalgia is a systemic issue characterized by widespread pain, fatigue, fogginess, and tenderness in tendons and muscles. 

How do I Treat Fibromyalgia?

The best way to treat fibromyalgia is through lifestyle changes that include diet, mobility and resistance training, sleep, pacing and energy management, and returning to things you enjoy. These changes have been proven to be difficult for people for many reasons, therefore it is best to have a multi-disciplinary team that works with you to help make these changes.

senior woman sitting on the beach

Why Does Fibromyalgia Hurt?

There are processes in the body associated with Fibromyalgia that researchers are still trying to figure out. One process is called central sensitization. This is a fancy term for when our nervous system freaks out easily. With this process there are changes to how our nervous systems react to stimulus that generally are not perceived as dangerous. This can range from touch, heat, cold, scents, etc..In some cases, simply poking an area lightly can cause pain, a process called allodynia. Despite this increase in pain being experienced, it is essential to know that damage to the tissues is not occurring. 

How Can Physiotherapy Help Fibromyalgia?

At One to One Wellness we focus on health empowerment, meaning we take the time to better understand what is important to you and strive to give you the tools to improve your quality of life. An assessment of your current mobility, strength, and nervous system sensitivity provides us with an idea of what additional movements, activities, resistance training or manual techniques may be beneficial to help you achieve your goals.

It is essential that time be taken to better understand Fibromyalgia and how it is affecting your life. Sessions should include education on helping you understand the symptoms of Fibromyalgia and how they relate to your experience. These education sessions are important as they can help reduce fear of the symptoms and increase confidence in your ability to return to things that you enjoy.

Want to Learn More About Fibromyalgia?

Book a Free 30 minute screening with one of our Physiotherapists to determine what would be an appropriate course of action in helping you manage Fibromyalgia.

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What can we do about pain?

What can we do about pain?

  1. Learn about pain: read (David Butler, Patrick Wall, Ronald Melzack, Lorimer Moseley), search the web (aptei.ca, bettermovement.org), talk to professionals!
  1. Become aware of your body:
Mind and body lifestyle balance concept

– sometimes tissues repair but associated protective patterns may not, and that may be creating the persisting pain. Have you developed protective, but harmful, movement patterns? Are there areas of tension, tightness, weakness, compensation, that are not allowing your body to function normally as it once did?

– some tissues don’t repair as well as we would want, so have you learned how to stabilize, support, mobilize, or strengthen the area to make it as healthy as possible?

  1. Understand that disc bulges, diagnosis of arthritis, DDD, tendon tears, are a normal part of ageing processes and that 90% of people with no pain will have at least one of these findings. It takes away a lot of fear of those nasty reports.
  1. Learn to breathe and be mindful.
  1. Sleep well, eat well, and drink lots of water.
  1. Become more active, especially in the outdoors, and have fun/hobby in your life to take focus off of your pain.
  1. Become aware of emotional and physical stressors and change those that you can.
  1. Be hopeful. The brain, spinal cord, nerves, and tissues are constantly changing. The brain is always looking for more information. Adding new movements and exercises that are painfree helps with new patterns of movement and decreases painful avoidance patterns, and increase blood flow to help heal tissues.  It is never too late for change.
  1. Set goals, have something to strive for!
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What is Pain?

What is PAIN?

A leading world pain researcher Lorimer Moseley describes it like this:

“Pain is a CONSCIOUS experience that motivates us to do something to PROTECT the tissues that the BRAIN PERCEIVES to be under threat.  Pain does not provide a MEASURE of the state of the tissues that are perceived to be under threat.”

You see, there are 3 main types of pain:

Injury (Acute):  Sprains, strains, contusions, lacerations, fractures, herniation, tendonitis, etc.

Back, Pain, Physical Injury.
  1. Pathology Pain: Infections, autoimmune disease (lupus, RA, Crohns disease, IBS), cancer, cardiovascular disease.
  2. Persistent pain (chronic): Neurogenic, central sensitization.

So in trying to understand a complex topic like pain, let’s focus on the facts we do know:

Pain is an alarm meant to protect you

  1. All pain is real.
  2. Injury or harm does not always equal pain and pain does not always mean harm or injury.
  3. Pain is normal but can seem weird, and sometimes it hurts where the brain thinks the problem is, not necessarily where the problem is.
  4. Pain can lead to more pain, we can get “good” at it because of “practice”.
  5. Pain is multifactorial. It can be triggered by factors unrelated to physical harm.
  6. Many factors can influence the sensitivity of tissues, even at the brain and spinal cord levels.
  7. If the brain thinks it is in danger, it will do anything to protect itself.  The resulting protection can be overamplified and persist past tissue healing.

For much detail about pain and explanation of the facts presented above, please watch the following video.  https://www.youtube.com/watch?v=kQRqDoNvVYQ

For more information about how you can start to treat your pain, see “What  Can We Do About It” on our website in the Blog section.

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The Role of Pain Neuroscience Education in Cancer Recovery

According to a European study, cancer patients felt their pain was viewed as secondary to the cancer treatment itself, and they wish more time was spent consulting on the pain they were experiencing .1 These results are important because it demonstrates the need for Pain Neuroscience Education (PNE) in treating these patients from the beginning stages of treatment and beyond. When treating cancer, it can be lost that this biological process is connected to a human being. The resulting pain can slowly strip away the interdependent, complex components that make us human.

PNE is a foundational pain management tool that helps form a greater understanding of how the biological, psychological, and sociological components of our being are important and play a role in managing and changing the pain experience.2 PNE helps accomplish this by eliminating some fear, worry, and stress through increasing knowledge, and awareness. This can lead to greater empowerment and sense of control for the patient.

human fugure with particles

PNE can be thought of as a knowledge translation process that helps patients better understand their pain experience in hopes of changing their interpretation of it.  One of the main metaphors that we use for mechanical persistent pain conditions (Pain lasting more than 3 months) is this idea of hurt vs harm. This teaches that instead of pain representing damage to the tissues, that there is something wrong with the area, and that you are broken or debilitated, it can be thought of as an area that has heightened awareness or sensitivity due to multiple biopsychosocial factors.2 A common emerging theme viewing pain as a protector (Tame the Beast Video). Our brain does not want us to do a certain task because it perceived it as dangerous before and does not want us to experience that again.

PNE has been proven to be effective in reducing pain for many chronic musculoskeletal disorders,3 but what role does it have in helping active cancer patients and survivors where these biological processes are life-threatening, or in other words where hurt can equal harm?

A possible role of PNE during active cancer treatments is to help the individual learn to distinguish between active cancer pain and pain as a result of active cancer treatments.Helping them understand that pain is a primitive protective mechanism that can be exacerbated by context and fear can provide relief.3  The context here is cancer in our society, and the fear can be loss of life, the unknown, and the billion other worries and stress that can coincide with it. So, when going through active cancer treatments it is beneficial to know that tissue injuries are going to result, and this is going to take the natural healing process that involves pain. The difference here can be knowing that this pain is a result of a life saving treatments, not the cancer itself. A mindset that changes the perspective of the experience and can change the interpretation from life-threatening to life-saving.

Survivorship can come with its own challenges as there are often side-effects that result from these life-saving procedures. This can include increased risk of future cancers, joint and muscle pain, peripheral neuropathies,5 and central sensitization. 6 This is where the hurt vs harm analogy becomes very relevant as pain remains despite the elimination of the biological threat, and beyond the normal tissue healing time. This brings up past experiences, fears, and emotions, which all without proper knowledge and interpretation behind it, can lead to behaviours such as remaining sedentary (See Flow Model7).

Some education points through this stage:

  • knowing common medications are linked to peripheral neuropathy,
  • joint pain is common in breast cancer survivors7,
  • how thoughts and emotions can alter pain response,2
  • and how there is help available to work on active management strategies such as graded motor imagery,8 neurodynamic techniques,9 and exercise.7
diagram of cencer rehab

In my opinion, PNE’s role in cancer rehabilitation should be immediate and ongoing as the European study demonstrated its importance to patients. Pain, a biopsychosocial phenomenon can take less priority to cancer, a biological entity. Although pain is a symptom of this baffling physiological process, it is the aspect that can lead us to seek help, it takes away our ability to move, it can increase fear/worry/stress and can hurt our relationships. We need to let individuals with cancer know that we are listening, that we can help them understand the what and why surrounding their pain, and that we can help them gain some control over something that is trying to take that control from them.

  1. Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, Cohen R, Dow L. Cancer-related pain: a pan-European survery of prevalence, treatment, and patient attitudes. Ann Onc. 2009; 20 (8): 1420-33
  2. Moseley GL, Butler DS. Fifteen years of explaining pain: the past,present and future. Jour Pain. 2015;16(9): 807-13.
  3. Louw A, Zimney K, Puentedura EL, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature. Physio Theor Prac. 2016. DOI: 10.1080/09593985.2016.1194646
  4. Bennett MI, Rayment C, Hjermstad M, Aass N, Caraceni A, Kaasa S. Prevalence and aetiology of neuropathic pain in cancer patients: a systematic review. Pain.2012; 153:359-65.
  5. Segal R, Zwaal C, Green E, Tomasone J, Loblaw A, Ptrella T, et al. Exercise for people with cancer. Toronto (ON): Cancer Care Ontario; 2015 Jun 30. Program in Evidence-based Care Guideline No.: 19-5
  6. Nijs J, Leysen L, Adriaenssens N, Ferrandiz MEA, Devoogdt N, Tassenoy A…Meeus M. . Pain following cancer treatment: guidelines for the clinical classification of predominant neuropathic, nociceptive and central sensitization pain. Acta Onco. 2016;55:659-63.
  7. Sangster M. Cancer rehabilitation for the physiotherapist (powerpoint). Delivered October 21st Think Healthcare.
  8. Bowering JK, O’Connell N, Tabor, A, Catley MJ, Leake HB, Moselet LG, Stanton TR. The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. Jour Pain. 2013; 14: 3-13.
  9. Kumar SP, Saha S. Mechanism-based classification of pain for physical therapy management in palliative care: a clinical commentary. Ind Jour Pall Care. 2011; 17: 80-86.
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What is Osteoarthritis?

What is Osteoarthritis?

woman with knee paun

In general, osteoarthritis (aka arthritis) is the gradual breakdown of the cushion on the end of our bones called cartilage. It is typically diagnosed using imaging techniques such as X-Rays and MRIs and is mostly seen in knees, hands, hips and spine joints. Among other things, cartilage acts as a cushion to absorb forces that are put on the joints of the body.

With the degeneration of the cartilage, in combination with other factors such as age, diet, stress, sleep, and activity levels, the body may respond in a way to protect the area via pain and inflammation. This can lead to regular activities such as walking and stairs to become painful and you may notice swelling around the joint. 

So what can you do? 

Educate yourself

There are many people living with osteoarthritis who are pain free (>43% of people over 40 years of age in this study https://bjsm.bmj.com/content/53/20/1268). So although there is some degeneration of the cartilage, it does not mean pain is inevitable. When trying to understand where your experience fits in with facts like these, it is really valuable to have a better understanding of how pain works and how many areas of our lives can influence it. To learn more about pain click here: What is pain

What we know for certain is that each individual experiences osteoarthritis in different ways, and unfortunately it isn’t as black and white as saying osteoarthritis is causing your pain. Following some of the tips below can be a great place to start.

Move More Throughout the Day

Keeping our bodies moving helps reduce inflammation, helps maintain lubrication of our joints and can reduce pain and stiffness. It doesn’t have to be anything elaborate, as additional movement throughout the day is beneficial. Starting 5-10 minute walks or general body movements every hour is helpful.

Add Resistance Exercises

Strength training is a scientifically proven management strategy for osteoarthritis. Among many other roles, stronger muscles help provide additional support by absorbing more load and building confidence in our bodies. 

Reduce Stress and Improve Sleep: 

When we are feeling stressed and tired we have less motivation and less ability to cope and manage our current pain. Having a stress management plan and a consistent bedtime routine can be a good start.

Set Goals and Keep Doing the Things You Enjoy

Becoming fearful and avoiding activities are two major factors in any persistent pain issues such as osteoarthritis. Coming up with goals to help maintain or return to activities we enjoy keeps us motivated and moving toward a better quality of life with osteoarthritis.

woman hiking

What can we do?

Knowing where to start can be the biggest challenge, especially when everything seems to be painful. Your health care team is here to educate you on the processes of osteoarthritis and the best starting points for you to best manage it. We help you come up with a plan to attain your goals in a way that best fits into your current lifestyle.

It is important to understand that despite an osteoarthritis diagnosis, there are many aspects within your control to keep doing things you enjoy. Starting with the few steps mentioned above can help you start moving forward as you live with osteoarthritis.

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The Predicting Brain

With regards to the brain: “All it has at its disposal is your past experience, the past experience it has wired into itself” A great quote from Lisa Feldman Barrett on how the brain works to make decisions throughout our day to day life (Interview here!)

But what does this mean for people where pain persists past normal healing time and is becoming chronic? How do your past experiences shape your current pain experience?

What Happened Before?

human with image of brain

The brain is a phenomenal structure that drives everything we do. It receives an outstanding amount of information from your entire body in a fraction of a second, analyzes it at a ridiculous speed, tells us what action to do or not to do, and then briefly stores everything that just happened for possible future use. Beyond the fact that this happens without us even knowing, the fascinating thing is that if it keeps receiving the same information over and over, it becomes so fast and so great at analyzing the sequence, it typically has pinpoint accuracy in predicting what to do next. This is great when we are taking our next step while walking, or go to fall and are able to catch ourselves, but not so much when we are talking about pain sensitivity.  So if you have been experiencing pain for a significant period of time, a major component can be that your brain is predicting things to be painful based on what’s happened previously (The Predictive Brain article here!).

Predicting Danger

The prediction of danger is a genius protective mechanism during the initial stages of healing when things need to be protected, but not so much when things are healed and life needs to return to normal. So once the danger is no longer present (i.e.,muscle/ligament is healed, cast is off etc…), thank your brain for trying to protect you, but start letting it know that it’s no longer necessary. The major question is how do you go about that? Here are a few tips: 1) Know that movement is safe and needed for healing. 2 )Pain is not a direct measure of tissue damage. 3) Keep moving within your limits. Somatic exercises can be a great place to start (Youtube One to One Wellness). Finding your limits can be difficult so seeking professional help is strongly encouraged. 4) Start loading. Our brain needs to understand that this area is capable of going under stress, and that it is safe to do so. Star with low intensity and go slowly to build up tolerance and confidence. 5)Have recovery time and sleep. Your brain and body need time to adapt to these increases in demand and it can only do so if you are getting adequate breaks and a good night’s sleep. 6) Take a look at what you are eating. There is truth to the old saying “you are what you eat”.

The changes will not happen overnight  but when you provide new, SAFE experiences to help re-wire the predictive nature from danger to safety, we can change for the better.

Lisa Feldman Barrett is a neuroscientist, psychologist and author who researches how the brain constructs emotion.

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Oxygen, we heart you!

We all know the urban legend that bad luck or death comes in threes. But have you heard the axiom that death comes by threes? Three weeks without food, three days without water, and three minutes without air. While this satisfies my theatrical brain, and the rule of three in drama and story telling, it might not actually be precisely accurate.

True, the body can survive, on average, 3 weeks without food (Ghandi lasted exactly 21 days on his famous hunger strike). But, we can survive a little longer than 3 days without water. Perhaps even up to a week.

As for how long we can survive without oxygen, to be honest, there isn’t an exact number, but there is a pretty basic timeline of what happens to your body and brain without oxygen:

  • At one-minute, brain cells begin dying.
  • At three minutes, lasting brain damage becomes likely.
  • At 10 minutes, even if the brain remains alive, severe brain damage is almost inevitable.
  • At 15 minutes, survival becomes nearly impossible.
oxygen symbol

Given that the brain governs our entire body, it goes without saying that keeping it oxygenated is integral to our overall health and wellness. There is a ton of research devoted to oxygen’s role in exercise and post-exercise, everything from VO2max, to anaerobic threshold, to EPOC. High performance athletes benefit a great deal from understanding and enhancing their body’s ability to deliver oxygen throughout their body. But what about the rest of us? Athlete or not, we would all be wise to better understand oxygen’s role in wound healing and recovery.

The body’s ability to thrive, or heal from illness or trauma, is greatly influenced by factors such as nutritional state, immune function, blood flow and volume, hormonal mediators, sleep, etc… but some research suggests that oxygen may, in fact, be a critical rate limiting factor in early stages of repair.

Injury poses two conflicting complications, as the tissue has an increased need for oxygen and metabolic energy, but injury disrupts the normal capillary network, which is responsible for oxygen delivery to the tissue. So, it stands to reason that if you are further depriving your body of oxygen, your body may never meet the demands required for adequate repair and recovery. Let’s look, with very simplified explanations, at some of oxygen’s main roles in wound healing:

  • Energy Metabolism: oxygen is the key catalyst to energy production.
  • Protein and Collagen Synthesis: collagen creates an essential matrix of tissue in wound healing. Oxygen synthesizes the two necessary amino acids that help form that collagen.
  • Neovascularization: the body’s ability to make new capillaries for oxygen delivery is, as luck would have it, also dependent on oxygen availability and the aforementioned collagen production.
  • Polymorphonuclear Cell Function: PMN cells locate, identify, phagocytize (the ingestion of bacteria), kill, and digest invading microorganisms.

There are several metabolic and chemical variables we can manipulate to improve ones oxygen intake, transport, and delivery through the system. There are exercises we can do to improve our respiratory activity, our lung capacity, and even the oxygen transport. In fact, any exercise that challenges your body’s need for oxygen can, over time, improve your body’s uptake and delivery of oxygen. And there are even various oxygen supplementation products on the market. But one free and incredibly easy thing to do is to BREATHE better. I’ve written about this in a previous blog (Just Breathe), and we’ve posted a video  on Alternate Nostril Breathing (https://youtu.be/-P6cnNZpdGU), which is a very easy breathing exercise that will help increase the amount of oxygen you are taking in and improve your exhalation, helping you to release carbon dioxide.

In so much as we can improve our oxygen levels, we can also severely hinder it. While there are some conditions that might prevent a person from maximizing their oxygen potential, the single most damaging choice you can make for your overall health is… you guessed it: smoking. Chronic inhalation of tobacco smoke causes irritation, inflammation, and scarring of the lungs tissue. With compromised lung tissue, you can’t get maximal oxygen intake or carbon dioxide output. Further, smoking increases blood levels of carbon monoxide. Yup! The stuff from car exhaust is also found in cigarette smoke. Carbon monoxide has the ability to attach itself to hemoglobin where oxygen otherwise would attach. This further decreases the oxygen delivered to the muscles (and the rest of the body, including the brain). The body tries to compensate for the lack of oxygen by creating more red blood cells. This sounds like a good idea, but more is not always better. In this case, the extra red blood cells can thicken the blood and actually further slow down circulation. It’s a veritable vicious cycle!

Bottom line, if you improve your body’s oxygen levels, you’ll improve its healing potential!

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Dem Bones

By Andrea McCulloch, RMT

You may be familiar with the song which describes how the “toe bone is connected to the foot bone, the foot bone is connected to the ankle bone, the ankle bone is connected to the shin bone”.  A beautifully simple and clear lesson in skeletal anatomy, but there is so much more going on!

image of human skeleton

We are born into gravity and for the rest of our lives we are in a constant relationship with it.  It is sometimes a battle, and gravity very often wins!  But our bodies are very specifically designed to engage in this relationship – we have bones that are shaped and placed to bear weight and/or transmit the forces associated with gravity.  In theory, if we used our bodies as they are designed, we shouldn’t have a problem with gravity.  And I’m not just talking about losing your balance and falling down, I’m talking about the slow deterioration of joints, the “falling” of the arch of your foot, the downward sloping of the shoulders.  Of course, there is the natural ageing process, but most of us spend a lifetime developing postures and movement patterns that will potentially speed up that process.  How do these dysfunctional patterns develop?  Through compensations.  These are the acquired patterns that we adopt to keep us moving upright through gravity when we’ve been injured – and it’s not always a traumatic injury.  Sometimes the injury is the slow onset of dysfunction related to how we spend our lives – sitting 8hrs a day, for example!

How does this relate to the song?  Well, as I said, there’s much more to it than one bone connected to the next – the position and function of one joint can affect joints all the way along the chain.  Let’s consider a common area of injury which may result in compensations down the line.  “The hip bone is connected to the back bone” – in proper anatomical terms this is the iliac bone connecting to the sacrum.  Perhaps you’ve experienced some low back or hip/buttock pain and been told it is your “SI joint (sacroiliac joint)”?  This is the joint between the “hip bone” and the “back bone”, and as such it is very important in translating forces between your lower body and your upper body.  The sacrum is a wedge shaped bone at the base of your spine and is specifically designed to translate forces (not weight bear) from above, across the wide base at the top of the bone through to the hips.  If, through trauma (a fall on the ice), or habitual positioning (seated with legs crossed), your sacrum is knocked (trauma) or pulled (muscles from habit) out of position, it will no longer transmit those gravitational forces evenly through the pelvis.  Now, with a sacrum in a dysfunctional position, there is more weight being born on one side.  Sacral dysfunction often does illicit local discomfort, and may prompt you to seek treatment. 

But in some cases, it isn’t treated and a compensatory gait has already developed, altering the positioning of the hip, the knee, the ankle, and the bones of the foot, allowing them to bear that extra little bit of weight that is coming down the line, keeping you upright in gravity.  And thank goodness those joints did compensate, otherwise a lifetime of sitting with your legs crossed would mean you would fall over every time you tried to stand up!  But it also means that now these joints are doing more than their share, and here we have the accelerated ageing mentioned earlier. (And don’t even get me started on how altered movement of the sacrum can affect the contents of your pelvis (bladder, uterus, prostate, colon), and even the spine and head!)

And to be clear, it can work in both directions – maybe that old ankle injury has altered weight bearing at the foot, and years later your knee and hip are giving out. So don’t be surprised if after a thorough assessment your manual therapist tells you that even though your pain is always in your left hip, the problem is originating at your right ankle!

Now that you see how your body is a functional unit (not a bunch of pieces operating independently), what advice do I have?  Treat it that way! Move!  In every possible direction – let your muscles do all of the things they were designed for (how often do you use the full range of your shoulder?)  When you move, move the whole thing! When you seek treatment for a specific pain, don’t forget to mention that you repeatedly sprained your ankle when you were younger.  Don’t leave out that you have frequent headaches, or digestive issues.  Your manual therapist may ask you a lot of questions that don’t seem to be related to your complaint, now you know why!

Maybe the song should be “the foot bone is connected to… everything”!

Bones and joints: bone broth provides the raw materials for building and reparation of lean tissues. There is even some evidence to support regular consumption reducing joint pain.

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Learning Opportunities

Many thanks to those who came to our seminar series “Understanding and Overcoming Persistent Pain” at the Halifax Library. It was great to help people gain more knowledge about treating and, more importantly, preventing pain. Based on our experience, we know there is a gap in people’s understanding of pain. We wanted to let people know that (1) that they are not alone, (2) that help is available and (3) that it’s possible to regain control over that aspect of life.

learning blackboard

Our passion stems from helping people who are suffering with persistent pain live more fulfilled lives. Education, movement, and exercise are key to achieving this. We are firm believers that knowledge is power and it is the first step in gaining freedom from persistent pain.

We were very pleased with the turnout for the last series of workshops and recognize that people want help managing their pain or a loved one’s pain. Here are some upcoming opportunities to learn more:

April 27th at One to One Wellness:
“Health Empowerment: 4 Steps for Shifting From Pain to Performance”

June Seminar Series at the Halifax Library: “Strengthen Your Health”

  • Monday, June 5, 7:00pm:  Expressing Authentic Movement
  • Monday, June 12, 7:00pm:  Strength Training for Managing Chronic Conditions
  • Monday, June 19, 7:00pm:  What the Foot: A Game-Changing Philosophy of Human Movement
  • Monday, June 26, 7:00pm: From Pain to Performance 

We will explore different wellness principles and how putting all the pieces together helps to not only overcome pain, but to optimize performance as well. Please come along and bring a friend. If you have any questions in the meantime, feel free to ask!

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Mysterious knee pain and/or swelling?

Without any thorough examination, you may have been given the diagnosis of osteoarthritis and be expected to just live with it. However, you may be experiencing Saphenous Nerve Entrapment.

Saphenous nerve entrapment is a frequently overlooked cause of persistent medial (inner) knee pain. I chose to write about it because I saw 2 cases of random knee pain and swelling recently.

person with knee pain

Nerve entrapment is often the cause of pain when you cannot recall a mechanism of injury. This condition can result from low grade irritation over a long period of time from sustained postures or repetitive activities, or perhaps resulting from guarding mechanisms that never fully resolved from a previous injury. Symptoms can be episodic (come and go), may come on randomly, and may resolve randomly as well.

The saphenous nerve is the longest branch of the femoral nerve. It travels from the groin, down the front of the inner thigh, past the inner knee, and into the inner lower leg. Because of its long course, it can become entrapped in multiple locations from the thigh to the lower leg. The saphenous nerve is often entrapped by connective tissues where it pierces the muscles of the inner thigh, or where it takes a sharp turn at the inner knee. The nerve can also be injured as a result of an improperly protected knee during surgeries or activity that puts pressure on the nerve (kneeling).

It is a pure sensory nerve, meaning it is responsible for sensation and not muscle contraction. As this is a purely sensory nerve, weakness should not be noted with an isolated injury or entrapment of this nerve. Some mild weakness may be present because of guarding from pain, but no significant direct weakness will result from the nerve impingement.

Symptoms of entrapment: may include swelling of the knee, a deep aching sensation in the thigh, knee pain, tenderness along the nerve pathway, and altered sensation in the knee and lower leg such as numbness, tingling, pins and needles, reduced sensitivity to heat or cold, reduced vibration sense, and dullness to touch. The main diagnostic features of this condition are altered sensation (vibration sense is usually the first to be affected), and reproduction of symptoms during a femoral/saphenous nerve neurodynamic test.

Other diagnoses given for this condition may be arthritis, bursitis, patella femoral pain syndrome, or chondromalacia patella.

Treatment to resolve this issue may be as simple as learning to do some gentle nerve gliding exercises. Effective treatment may also involve soft tissue release (via massage or physio); and gentle manual mobilization techniques that reduce mechanical forces on the nerve, improve nerve mobility, reduce muscle guarding, and restore blood flow to the affected nerve.

It may not be arthritis, and you may not have to just live with it.

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