What to Do If You Wake Up in Pain

What to Do If You Wake Up in Pain

Feeling achy and stiff in the morning? Try these seven techniques to ease into the day.

Nothing is more restorative than a good night’s sleep. You wake up refreshed and ready to take on a new day. Yet, for some people, the early morning hours bring unwelcome neck and back pain.

Movement during the day promotes fluid secretion from your tissues, which in turn keeps your joints mobile. When you’re asleep, however, you’re not moving for an extended period of time, which can cause your joints and muscles to stiffen up.

For some people, morning pain and stiffness go away as the day goes on. For others, the pain lasts all day. If you find yourself waking up constantly in pain, try these seven tips for a pain-free morning:

1. Stretch

When you wake up, do some simple stretches to unlock your joints and muscles. Here are two to try:

  • Knee to Chest Stretch: Remain on your back in your bed, and pull both knees toward you until your feet are flat on the bed. Grab your right knee with both hands and pull toward your chest. Do the same with the left knee. Hold for about 30 seconds. Repeat two to three times.
  • Shoulder/Upper Back Stretch: Stand up and hold your right elbow with your left hand. Stretch your right arm across the front of your body, keeping your arm straight. Do the same with your opposite arm. Hold for 30 seconds, and do two to three repetitions.

2. Change Your Mattress and Pillow

Your morning pain and stiffness could be caused by your bed or pillow. Be sure to choose a pillow that aligns your neck parallel to the mattress so it isn’t bent up or down. As for your mattress, it should be firm, but not too firm.

3. Change Your Sleep Position

Sleeping on your stomach may be the root of your pain. If so, switch to your back and prop up your knees with a pillow to keep your spine in a neutral position. Side-sleepers can try inserting a pillow between their knees.

4. Exercise Regularly

An intense workout just before you slip under the covers is not advisable. However, a brisk walk or relaxing yoga during the day can loosen up your muscles and joints, setting you up for a pain-free morning. Typically, thirty minutes of exercise a day will tire you out so you can fall asleep faster.

5. Stay Hydrated

During the night, you lose water when you sweat, which can lead to dehydration. Dehydration stiffens your muscles and joints as your tissues are deprived of fluids. So instead of going for that cup of morning coffee, drink two glasses of water first to rehydrate your body.

6. Take Vitamin D

Most people don’t get enough vitamin D in their diet. But the vitamin is essential for bone and muscle health. Have your doctor test your vitamin D levels, and if you are deficient, take a vitamin D supplement regularly.

7. Visit a Physical Therapist

Lingering morning pain should be checked out by a physical therapist. Keep a log of where the pain is strongest and which actions seem to aggravate it. Your physical therapist can show you how to adjust your sleeping position to prevent pain and improve your posture. He or she can also recommend the right pillow and mattress for a restful night’s slumber.

Don’t Live With Pain

If you’re experiencing pain and stiffness in the morning, the orthopedic specialists at Comprehensive Orthopaedics can review your symptoms to determine the source of your discomfort.

Tennis Elbow (Lateral Epicondylitis)

Tennis Elbow (Lateral Epicondylitis)

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities besides sports can also put you at risk.  Tennis elbow is inflammation or, in some cases, microtearing of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists and, in some cases, surgeons work together to provide the most effective care.

Anatomy

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles, where several muscles of the forearm begin their course. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.

ECRB muscle and tendon

The ECRB muscle and tendon is usually involved in tennis elbow.
Reproduced and modified from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.

Muscles, ligaments, and tendons hold the elbow joint together.

Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm that are responsible for the extension of your wrist and fingers. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone.  The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).

Cause

Overuse

Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.

Activities

Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle or repetitive extension of the wrist and hand.

Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, cooks, and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.

Tennis player

Playing tennis is a possible cause of tennis elbow, but other activities can also put you at risk.

Thinkstock © 2015.

Age

Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. In racquet sports like tennis, improper stroke technique and improper equipment may be risk factors.

Unknown

Lateral epicondylitis can occur without any recognized repetitive injury. This occurrence is called “idiopathic” or of an unknown cause.

Symptoms

The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.

Common signs and symptoms of tennis elbow include:

  • Pain or burning on the outer part of your elbow
  • Weak grip strength
  • Sometimes, pain at night

The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however, both arms can be affected.

Location of pain in lateral epicondylitis.

Location of pain in lateral epicondylitis.

Doctor Examination

Your doctor will consider many factors in making a diagnosis. These include how your symptoms developed, any occupational risk factors, and recreational sports participation.

Your doctor will talk to you about what activities cause symptoms and where on your arm the symptoms occur. Be sure to tell your doctor if you have ever injured your elbow. If you have a history of rheumatoid arthritis or nerve disease, tell your doctor.

During the examination, your doctor will use a variety of tests to pinpoint the diagnosis. For example, your doctor may ask you to try to straighten your wrist and fingers against resistance with your arm fully straight to see if this causes pain. If the tests are positive, it tells your doctor that those muscles may not be healthy.

doctor pressing lateral epicondyle

During the exam, your doctor will apply gentle pressure to the lateral epicondyle, checking for pain and tenderness.

Tests

Your doctor may recommend additional tests to rule out other causes of your problem.

  • X-rays. These tests provide clear images of dense structures, such as bone. They may be taken to rule out arthritis of the elbow.
  • Magnetic resonance imaging (MRI) scan.  MRI provides images of the body’s soft tissues, including muscles and tendons. An MRI scan may be ordered to determine the extent of damage in the tendon or to rule out other injuries. If your doctor thinks your symptoms might be related to a neck problem, he or she may order an MRI scan of the neck to see if you have a herniated disk or arthritic changes in your neck. Both of these conditions can produce arm pain.
  • Electromyography (EMG). Your doctor may order an EMG to rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.

Treatment

Nonsurgical Treatment

Approximately 80% to 95% of patients have success with nonsurgical treatment.

Rest. The first step toward recovery is to give your arm proper rest. This means that you will have to stop or decrease participation in sports, heavy work activities, and other activities that cause painful symptoms for several weeks.

Medications. Acetaminophen or anti-inflammatory medications (such as ibuprofen) may be taken to help reduce pain and swelling

Physical therapy. Specific exercises are helpful for strengthening the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulation techniques to improve muscle healing.

Wrist stretching exercise

Wrist stretching exercise with elbow extended.

Brace. Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons.

Counterforce brace

Counterforce brace.

Steroid injections. Steroids, such as cortisone, are very effective anti-inflammatory medicines. Your doctor may decide to inject the painful area around your lateral epicondyle with a steroid to relieve your symptoms.

Platelet-rich plasma. Platelet-rich plasma (PRP) is a biological treatment designed to improve the biologic environment of the tissue. This involves obtaining a small sample of blood from the arm and centrifuging it (spinning it) to obtain platelets from the solution.  Platelets are known for their high concentration of growth factors, which can be injected into the affected area. While some studies about the effectiveness of PRP have been inconclusive, others have shown promising results.

PRP injection

An injection of PRP is used to treat tennis elbow.
Courtesy of Allan K. Mishra, MD, Menlo Park, CA.

Extracorporeal shock wave therapy. Shock wave therapy sends sound waves to the elbow. These sound waves create “microtrauma” that promotes the body’s natural healing processes. Shock wave therapy is considered experimental by many doctors, but some sources show it can be effective.

Equipment check. If you participate in a racquet sport, your doctor may encourage you to have your equipment checked for proper fit. Stiffer racquets and looser-strung racquets often can reduce the stress on the forearm, which means that the forearm muscles do not have to work as hard. If you use an oversized racquet, changing to a smaller head may help prevent symptoms from recurring.

Surgical Treatment

If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your doctor may recommend surgery.

Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to bone.

The right surgical approach for you will depend on a range of factors. These include the scope of your injury, your general health, and your personal needs. Talk with your doctor about the options. Discuss the results your doctor has had, and any risks associated with each procedure.

Open surgery. The most common approach to tennis elbow repair is open surgery. This involves making an incision over the elbow.

Open surgery is usually performed as an outpatient surgery. It rarely requires an overnight stay at the hospital.

Arthroscopic surgery. Tennis elbow can also be repaired using miniature instruments and small incisions. Like open surgery, this is a same-day or outpatient procedure.

Surgical risks. As with any surgery, there are risks with tennis elbow surgery. The most common things to consider include:

  • Infection
  • Nerve and blood vessel damage
  • Possible prolonged rehabilitation
  • Loss of strength
  • Loss of flexibility
  • The need for further surgery

Rehabilitation. Following surgery, your arm may be immobilized temporarily with a splint. About 1 week later, the sutures and splint are removed.

After the splint is removed, exercises are started to stretch the elbow and restore flexibility. Light, gradual strengthening exercises are started about 2 months after surgery.

Your doctor will tell you when you can return to athletic activity. This is usually 4 to 6 months after surgery. Tennis elbow surgery is considered successful in 80% to 90% of patients. However, it is not uncommon to see a loss of strength.

Get Relief for Hip Pain at Any Age

Get Relief for Hip Pain at Any Age

Arthritis isn’t the only cause of hip pain. Find out which condition may be causing your discomfort — and how to treat it.

Hip pain doesn’t only affect older adults — stiffness and pain in this joint can strike younger people, too. Although osteoarthritis ranks high on the list of causes of hip pain, the discomfort can result from overuse or injuries at any age.

In most cases, the pain radiates from the side of the hip or groin. It can also be felt in the buttocks. The pain may worsen when you stand, walk, sit for long periods, or twist the hips. If your pain persists, see an orthopedist for a correct diagnosis and treatment.

What Causes Hip Pain?

To determine the exact cause of your hip pain, your doctor will analyze your movements, review your symptoms, and order imaging tests, such as an X-ray or MRI. Those details should provide a picture of what’s happening in your hip.

Common causes of hip pain include:

OsteoarthritisWhen the cartilage cushioning the hip joint wears down, it can lead to pain and stiffness. Mostly the result of advanced age, osteoarthritis may also be due to a fracture or infection of the hip joint.

Bursitis. The bursae, or the fluid-sacs between the bones and soft tissue of the hip joint, sometimes become inflamed when the hip is stressed from overuse. That’s why bursitis is especially common among runners.

Labral Hip Tear. The hip joint is formed by the femur (the ball) and the pelvic acetabulum (the socket). A ring of cartilage — the acetabular labrum — surrounds the joint. An injury or a malformed hip (known as hip dysplasia) may cause the femoral head to grind against the acetabulum, eventually rupturing the labrum.

Hip Impingement. A hip impingement develops when the bones of the hip joint rub against each other, causing significant pain. The most likely cause is an ill-fit between the ball and socket of the hip joint, which can also lead to cartilage damage.

Fracture. As we age, our bones weaken and become more susceptible to fracture. If you fall and feel sharp, sudden pain, seek immediate medical attention. A blood clot in the leg can form following a hip fracture, which makes it especially important to act fast.

Osteonecrosis. Osteonecrosis, or avascular necrosis, is a breakdown of the hip bone because blood fails to penetrate the bones. Over time, the cartilage and bones wear away, leading to severe bone loss. In most cases, a definitive cause is not determined, although joint trauma, excessive steroid use, and certain cancer treatments may put a person at greater risk.

Snapping Hip Syndrome. Another rare condition, snapping hip syndrome, is characterized by a snapping sound or feeling in the hip, particularly when you walk or rise from a chair. Dancers and athletes are prone to this condition, which is usually painless.

Treatment for Hip Pain

Once you’ve been diagnosed, your doctor will recommend a treatment plan, which can range from conservative therapy to surgery. If the pain is due to overuse, a few days of rest can heal the strained joint or tendon. For arthritis, pain medication and physical therapy can help heal the pain and encourage freedom of movement.

Some conditions, however, may require surgery. If a labrum tear or impingement doesn’t respond to conservative treatments like physical therapy, arthroscopic surgery can repair the damaged cartilage. Therapies for bursitis typically involve physical therapy and anti-inflammatory medications. In severe cases of bursitis, surgery may be an option to drain the bursa or remove it altogether.

If the damage to the hip is substantial, either due to advanced arthritis or a fracture, hip replacement surgery is available. After surgery, intensive physical therapy will be needed to get you acclimated to your new joint.

If your hip pain doesn’t fade in a couple of days, it’s time to see a specialist at CompOrtho. Using the latest technology, we’ll diagnose your condition and recommend a customized treatment plan. Contact us today for a consultation.

No Evidence Muscle Relaxants Can Ease Low Back Pain

No Evidence Muscle Relaxants Can Ease Low Back Pain

Although tens of millions of Americans turn to muscle relaxants for lower back pain relief, a new Australian review finds little evidence that such drugs actually work.

That’s the conclusion of a deep-dive into 31 prior investigations, which collectively enlisted more than 6,500 lower back pain patients. Enrolled patients had been treating lower back pain with a wide range of 18 different prescription muscle relaxants.

But while the studies suggested that muscle relaxants might ease pain in the short term, “on average, the effect is probably too small to be important,” said study author James McAuley. “And most patients wouldn’t be able to feel any difference in their pain compared to taking a placebo, or sugar pill.”

Another concern: Beyond their ineffectiveness, “there is also an increased risk of side effects,” cautioned McAuley, director of the Centre for Pain IMPACT with the University of New South Wales’ School of Health Sciences in Sydney.

Such side effects can include dizziness, drowsiness, headache and/or nausea, in addition to the risk that patients will develop a lingering addiction.

McAuley said his team was surprised by the findings, “as earlier research suggested that muscle relaxants did reduce pain intensity. But when we included all of the most up-to-date research the results became much less certain.”

One problem is that much of the research “wasn’t done very well, which means that we can’t be very certain in the results,” McAuley said.

For example, none of the studies explored long-term muscle relaxant use. That means the Australian team could only assess muscle relaxant effectiveness during two time frames: throughout an initial two-week regimen and between 3 to 13 weeks. In the first instance, they found low evidence of an insignificant pain relief benefit; in the second instance, they found no pain intensity or disability relief benefit whatsoever.

McAuley’s take-away: “There is a clear need to improve how research is done for low back pain, so that we better understand whether medicines can help people or not.

“Low back pain is extremely common. It is experienced by 7% of the global population at any one time. Most people, around 80%, will have at least one episode of low back pain during their life,” McAuley noted.

But because it’s often very difficult to isolate a precise cause, many treatments — including NSAIDs, opioids, exercise therapy and/or counseling — aim to control pain rather than provide a cure. Muscle relaxants — prescribed to 30 million Americans in 2020 — fall into that category, McAuley said.

Given that muscle relaxants provide neither a cure nor pain relief, there’s “a clear need to develop and test new effective and cost-effective treatments for people with low back pain,” he said.

In the meantime, McAuley says a move is underway to “de-medicalize” lower back pain treatment by embracing techniques that focus on alternatives to medicine or surgery.

For example, “we know that people with low back pain should avoid staying in bed,” he noted, “and they should try to be active, and continue with usual activities, including work, as much as they can.

“People with recent onset low back pain should be provided with advice and education about the low back pain,” McAuley added. “[And] they should be reassured that they do not have a serious condition, and that their low back pain is very likely to improve over time, whether or not they take medicines or other treatments.”

He and his colleagues reported their findings in the July 7 issue of BMJ.

“The problem is, back pain has so many causes,” said Dr. Daniel Park, an associate professor in the department of orthopedics with Oakland University’s William Beaumont School of Medicine in Rochester, Mich.

So when it comes to treatment, “there is no one-size-fits-all,” stressed Park, who is also a spine surgeon at Beaumont Hospital-Royal Oak.

Still, Park thinks that when it comes to muscle relaxants, “there probably is a place for short-term benefit to help patients manage severe pain.”

For example, he suggests patients with “muscle strain from overdoing it,” or those with a herniated disc may actually benefit from short-term muscle relaxant use.

But patients with garden-variety back pain from a degenerative disc? Not so much.

Regardless, long-term pain relief is unlikely, regardless of the source of the problem, Park noted.

“Long-term, therapy and core strengthening will be much more beneficial,” Park said, while every effort should be made to identify the specific cause, and to minimize the risk for a chronic condition, permanent damage and enduring discomfort.

More information

There’s more on back pain at the U.S. National Institute of Neurological Disorders and Strokes.

SOURCES: James McAuley, PhD., director, Centre for Pain IMPACT, School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia, and senior research scientist, Neuroscience Research, Randwick, Australia; Daniel Park, MD, associate professor, department of orthopedics, Oakland University William Beaumont School of Medicine, and spine surgeon, Beaumont Hospital-Royal Oak, UnaSource Surgery Center, Oakland Regional Hospital, Rochester, Mich.; BMJ, July 7, 2021

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4 COMMON ACL TEAR SYMPTOMS & WHEN TO SEEK TREATMENT

4 COMMON ACL TEAR SYMPTOMS & WHEN TO SEEK TREATMENT

ACL tears are common in physical activities that involve quick stops, changes in direction, or direct contact with the knee. Knowing the symptoms of ACL tears can help you recognize an injury and prevent it from getting worse. Explore our guide to learn how to tell if an ACL is torn and the procedures a knee specialist can perform to help you get back on your feet faster.

 

Signs & Symptoms of ACL Injuries
Individuals who suffer an ACL tear often note an audible “pop” or snapping sound as the injury happens. The onset of symptoms is immediate and usually accompanied by:

  • Decreased range of motion in the knee
  • Rapid swelling
  • Severe pain, soreness, and tenderness along the joint
  • Instability and discomfort while walking

ACL injuries usually occur during sports and fitness activities that can put stress on the knee. This includes movements like:

  • Pivoting with your foot firmly planted
  • Suddenly slowing down and changing direction
  • Stopping suddenly
  • Landing awkwardly from a jump
  • Receiving a direct blow to the knee

There are three levels of ACL injuries, which are classified by the amount of damage to the ligament (partial or complete tear). A grade 1 sprain, for example, is when the ACL is stretched but not ruptured. While a grade 3 sprain means the ACL is torn into two pieces, rendering the joint completely unstable.

 

When To Seek Treatment
If you are experiencing symptoms of an ACL tear, you should schedule an appointment with a knee specialist. They will conduct a physical exam in order to determine the extent of the injury. An X-ray may also be performed to assess if there is damage to the surrounding bone, but MRI will ultimately be the deciding factor in treatment.

Rehabilitation can be the first step in the recovery process with the goal of regaining full range of motion. You may spend several weeks working with a physical therapist who will develop a custom exercise program centered around your unique needs and symptoms.

However, ACL reconstruction surgery is often recommended if the ligament is injured or the injury is causing your knee to buckle during everyday activities. During the procedure, a surgeon will remove the damaged ligament and replace it with a new segment of tendon which recreates the ACL. This replacement tissue — called a graft — can be taken from your own patellar, hamstring, quadricep, or cadaver tendons.

The surgery is typically done using a minimally invasive, arthroscopic approach. Special surgical tools and a video camera are inserted through small incisions in the knee joint. The graft is then secured to the tibia (shin bone) and femur (thighbone) using sutures (special surgical thread) or screws depending on the type of graft. This acts as a bridge for the new ligament to grow on and reconnect the bones.

Recovery time varies based on the severity of the injury. Your doctor will recommend physical therapy in order to regain full range of motion, strength, and stability in the affected knee in the weeks and months that follow. Regular follow-up visits with your knee specialist and physical therapists are necessary to assess progress and readiness to return to your favorite activities.

Understanding the common symptoms of ACL tears can help reduce the risk of injury while playing your favorite sports. If you find yourself with pain or injury, CompOrtho offers top-level care to help you get on the road to recovery quicker. To learn more about injury prevention or make an appointment, contact us today!

Biggest Reason Teens Injure Their Spines: Not Wearing Seat Belts

Biggest Reason Teens Injure Their Spines: Not Wearing Seat Belts

(HealthDay News) — Two-thirds of spinal fractures suffered by American children and teens occur in car crashes when they aren’t wearing seat belts, a new study finds.

Researchers analyzed data on more than 34,500 U.S. patients younger than 18 who suffered spinal fractures between 2009 and 2014. Teens aged 15 to 17 accounted for about 63% of the spinal fractures, two-thirds of which occurred in motor vehicle accidents.

These findings show that around the time teens get their drivers’ licenses, young drivers and passengers are at highest risk for spinal fractures in car crashes, according to the authors of the study published online recently in the journal Spine.

The investigators also found a strong link between not buckling up while in the car and increased risk of spinal fractures.

“Nearly two-thirds of pediatric spinal fractures sustained in [motor vehicle accidents] occurred in children who did not use belts,” Dr. Vishal Sarwahi, from Cohen Children’s Medical Center, in New Hyde Park, N.Y., and colleagues wrote in a journal news release.

Spinal fractures in children and teens were associated with a 3% death rate, with many deaths occurring in unrestrained drivers and passengers, the researchers noted.

Another study finding was that the risk of severe or multiple injuries and death was more than twice as high (nearly 71%) when children and teens didn’t wear seat belts than when they did (29%).

Wearing seat belts was associated with lower rates of multiple vertebral fractures, other types of fractures in addition to spinal fracture, head and brain injuries, and a more than 20% lower risk of death in car crashes.

The researchers also found that 58% of the young spinal fracture patients were male, and that spinal fractures were most common in the South (38%), likely because a lack of public transportation results in more vehicles on the road.

The percentage of U.S. drivers wearing seat belts has risen steadily over the years, but teens and young adults remain less likely to use them, the study authors noted.

The findings highlight the need to take steps to increase seat belt use by younger drivers and passengers, such as targeted approaches using technology and media awareness campaigns, the researchers suggested.

“Ensuring our new, young drivers wear protective devices can greatly reduce morbidity/mortality associated with [motor vehicle accidents] and can help save lives, and spines,” the research team concluded.

More information

The American Academy of Pediatrics has more on seat belt use by older children and teens.

SOURCE: Spine, news release, May 14, 2021

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