PAIN MANAGEMENT–ADULTS & OLDER PEOPLE
Older people, Hip, Knee & Leg Pain, Arthritis, Muscle Spasms,
HEALTHY LIFE, introduces advanced pain management treatments & therapies, and has called it – DOULEUR THERAPY. It is a system of manual therapy that is recognised as part of the national health system in many western countries. It encourages the body to move as freely and as pain-free as possible by helping to restore normal function to affected structures.
In addition to standardised tests, machine aided and manual therapeutic care, movement & observation to diagnose and treat physiological or mechanical disturbances in the body. This may include spinal and peripheral joint manipulation, soft tissue techniques such as massage & other aids andwith prescribed exercises to help to stretch and stabilise the body.
Some therapies just concentrate on spinal manipulation while others may only focus on massage and exercises. Douleur Therapy is able to cover both of these modalities.
If you’re on the ‘other’ side of 50 , it’s tempting to blame “getting on” for everything. But the truth of the matter is that a lot of your problems are the same that much younger patients come in with. And happily, just like younger people, a lot our more senior patients get better with treatment too.
So perhaps the first lesson is not to give up on
your pain or get too philosophical about it before you’ve tried treatment.
Does this sound like you or someone you know?
You see your doctor because your neck is stiff and painful, and turning to look behind when driving, for example, creates difficulty. You’re sent for an x ray, and it shows obvious signs of wear and tear. The doctor might not even bother with an x ray. And perhaps you’re told: “It’s just your age.” “You’ll just have to learn to live with it.”
Does any of that sound familiar? If so, it might be true in some cases, but ignore it for now.
Never mind the x ray!
X-rays often show degeneration (wear and tear) in a spine over the age of 40. This is a very common & natural development as we age & it’s the cost of using our joints in a world with gravity. But this doesn’t mean that the pain and stiffness is permanent or unchangeable.
Gentle stretching and soft tissue work on the muscles will greatly ease the problem and provide substantial relief. Strengthening will also help because stronger muscles don’t get tired and tight so easily. And quite simple exercise will improve the blood flow to the area, which will also help.
The other good news is that there are many older people with obvious wear and tear on x ray, but who are pain-free! Many, many of our patients come to us in acute pain, but have nothing of note on their x rays. Unless the damage is too far gone, x rays are unreliable indicators of pain.
What will treatments be like?
Everyone wants treatments to be effective. But the main concern that most people in their later decades have is that treatment will be “rough” and painful.
Effective treatments don’t have to hurt to work. At HealthyLife you won’t find yourself being wrenched about or having your joints painfully manipulated. Manipulation (when your neck orback is clicked), can be very useful, but there are many situations in which that tool is best left in the box.
A lot of what we do involves us gently moving your joints around, and slowly coaxing them to move a little more. We also do a lot of work to stretch out tight and irritable muscles, but inside your comfort zone.
Arthritis & Other Degenerative Conditions
As someone once said, ‘movement is life.’ But pain, inflammation & tightening of the muscles around affected joints can lead to further loss of mobility. A downward spiral!
But don’t accept restricted movement as a fact of life. And don’t be told that you’ll just have to live with it. Our treatment CAN help — often with dramatic improvements in comfort and mobility.
Older people may experience this as a result of trauma, inflammation or poor circulation.
Therapeutic work to drain the affected area & promoting the free flow of fluids (blood and lymph containing nutrients & oxygen) will hasten relief.
Simple exercises can also be given to help avoid the problem from returning.
Illness & medical conditions
Our treatments is about much more than bad backs or achy joints!
For example, recurrent chest infections, sinus problems or constipation can often be treated effectively.
Accidents & post-operative recovery
Ill health, a fall or an operation can accelerate the effects of ageing by reducing mobility, muscle strength & circulation. General health & resistance to infection can be weakened. Similarly, weakened leg muscles contribute to balance problems, increasing the chance of falls.
Any or all of these can lead to an erosion of confidence. But with our help and some effort on your part it can be restored!
Gentle HealthyLife treatment restores movement & circulation to all parts of the body. Weakened muscles also need re-conditioning, and we will advise on stretching and strengthening.
How many treatments will I need?
We realize that many older people are on restricted incomes and for that reason we try to give them as much possibility of helping themselves as we can, usually through suggesting a self-help program such as simple things to do at home.
For most of our patients in this category, there is usually a noticeable improvement in comfort and mobility after three or four sessions, though some may need an occasional ‘top-up’ treatment, especially for long standing or severe underlying conditions or bad wear and tear.
For many, a one-off course of treatment will be sufficient.
Arthritis or osteoarthritis, are words which needlessly scare many into believing they’re over the hill, or that there’s little or nothing that can be done to alleviate their discomfort. Thankfully, for many of our clients this is rarely true.
Arthritis is caused by wear and tear through normal ageing. But it can be accelerated & come on much earlier in life through heavy and repetitive overuse of the joints. Accidents (trauma) can also trigger the process.
Having some understanding of the nature of arthritis and what can be done about it will help enormously.
What happens in arthritis?
Wear and tear causes thinning of the discs or cartilage between bony surfaces of joints. The resultant pain & inflammation cause the surrounding soft tissues to shorten & the sufferer to use the joint less. This reduced use deprives the joint of adequate lubrication, drainage & nutrition. Muscle weakness then usually follows from reduced use.
Sometimes the body deposits extra bone in high stress areas. This can limit movement or, if in the spine, press on nerves to give arm or leg symptoms.
You can do a number of things to alleviate arthritic conditions.
Our advice is that you:
- Stay active – gently encourage the affected joints to move into the painful area.
- If possible, select exercise which puts less weight through the joint to move it. Swimming is good in this respect
- Get treatment. Stretching and activity will help, but it can be difficult to focus your efforts on a very specific part of the body in the most appropriate way.
- Stay positive. Remember, many people who have arthritis on their x-rays are symptom free! Why shouldn’t you be one of them?
Healthy Life treatment
We help by gently loosening the shortened tissues around the area, improving mobility and promoting better drainage and nutrition.
Too vigorous a treatment will merely aggravate the pain by traumatising the shortened tissues. Response to any treatment depends on the severity of the degeneration that has taken place.
We can also help you with strengthening muscles that have become weak, often without the need for any expensive or specialised equipment.
Does any of this sound familiar?
Groin, buttock or inner thigh pain, especially with weight bearing movements?
Painful clicking in the groin?
Pain when going up stairs, vacuuming, walking or getting in and out of the car?
Tenderness over the hips on either side of your low back?
Tightness behind your hip joints when stretching?
Pain in any of the areas above during or since pregnancy?
Can’t lie on one side because of a deep pain around the hip against the bed?
Toying with the idea of a hip operation?
Stiff hip that doesn’t seem to move as much as the other?
So what’s going on..?
First off, some anatomy. By hips, many people mean the bony areas where we rest our hands. These are the hip bones (or illium) of the pelvis, far from the actual hip joints. These are where your thigh bones (see picture) join the pelvis.
A. Pain around the hip bones (the ilia)
Pain around the bony areas of the pelvis is very common, just as pain in the shoulders nearly always accompanies a neck problem.
The reason is simple: the nerve supply to the muscles here comes from the low back, and painful lumbar restrictions can sensitise these nerves and the muscles they serve.
Remember, nerves not only register pain and sensation, but they also carry signals telling a muscle to contract and relax. So a stimulated nerve may not only make the muscle feel sorer, but tighter as well. Unfortunately this can also make it frustratingly resistant to stretching no matter how much you try!
If this is the case, then the solution is to normalise nerve function. However, if muscles have been over stimulated for long enough, they can continue grumbling on even after the spine has been freed up. In this case, treating the area with soft tissue work will help a lot.
Sometimes hip pain can be pinned down to a point midway along the bony ridge of the hip bone. This is an area where a group of nerves called the cluneal nerves cross the bone on their way to the upper buttocks from the area where the low back and mid back meet. These nerves can be irritated by restrictions there or from from tight soft tissues lying over them. Patients with this issue often report feeling much improved after only a single treatment.
An over-strained muscle is painful too, but can usually be linked in the patient’s mind to a specific event usually involving an accident or some hard or unusual physical activity. When injured, ankle or knee pain can result in a person having to hitch the hip up on the affected side as part of a limp when walking. This causes tightening of the muscle that does this because the normal use pattern of that muscle has changed dramatically.
Muscle weakness is different. If you overload any muscle with vigorous exercise it becomes sore for a day or two. This is plain old muscle soreness. But if you overload a weak muscle on a daily basis it will feel constantly tight and sore. This is especially true of postural muscles which we can not really avoid using once we’re out of bed!
B. Actual hip joint pain.
May be caused by…
1. Wear and tear in the joint itself, usually visible on x ray, but possibly needing an MRI if the damage has been to one of the soft tissue components of the joint, such as the joint capsule.
Note that the wear and tear isn’t always an “age-thing”. It can happen much earlier on in life due to accidents or intense and repetitive sporting activities. A netballer or dancer, for example, may have it from favouring one leg constantly when landing from a jump.
- Acongenital deformity of the hip. (DDH) In this scenario the baby is born with a malformation of the hip joint. The ball at the top of the thighbone (femoral head) is not stable in the socket (acetabulum). Also, the ligaments of the hip joint may be loose and stretched. This can worsen with age. Usually this will be diagnosed at birth and the baby will be put in a cast for several months to encourage normal hip development.However, if this is missed or left untreated it can lead to pain and osteoarthritis by early adulthood. It may cause legs of different lengths or a “duck-like” walk and decreased agility. DDH has a familial tendency & it usually affects the left hip.3. Irritable Hip Syndrome – This is a diagnosis for someone with apparent symptoms indicating a true hip problem in the making, but with nothing to show on x rays.A lot of times the person might notice tightness around the joint when trying to do a particular stretch in Pilates or yoga. They may also complain of occasional catching in the groin area or pain around the upper part of the inner thigh.C. Not all ‘hip’ pain comes from the hip.
Apart from the low back (mentioned earlier) or serious disease, another major cause is the sacro iliac joint (or s.i.j). This can be injured from a sideways fall onto a hip bone, a sudden jolt from a missed step, or from pregnancy.Pregnancy releases a hormone (relaxin) in the body to soften the pelvic ligaments so that baby can pass through more easily in birth. But relaxin softens all ligaments including those that normally stabilize the s.i.j – not so great when you’re left with pain long after childbirth.Pain may be felt in the groin or inner thigh, and commonly in the area of the joint itself, especially when vacuuming, walking or bending.
Friction bursitis. Tight muscles that rotate the thigh outwards can cause a deep toothache-like pain behind the hip joint and may be uncomfortable to lie on. In more extreme cases this results in a friction bursitis as the shortened muscles contract and rub against a fluid filled sac (called a bursa) that separates the muscle tendons from the bone underneath. The job of this sac is to prevent friction of the muscle against the bone, but unfortunately it can get painfully irritated and inflamed too.
Another bursa lies in the area of the groin itself and directly under the muscle responsible for bringing your thigh forwards and up towards your body. This can suffer in the same way.
Those of us moving through mid-life & beyond are more at risk as our tissues are less springy and elastic than they used to be. The repair rate is also worse…yet another perk of ageing!
Deep soft tissue work is effective, though complete resolution of the discomfort can take a while if the condition has been going on for months or years. Some patience will be needed and anti inflammatory medication is helpful in many cases.
Muscle spasms can be severe, but short lived if treated.
There are two main kinds we see in clinic:
Those that accompany a joint problem in the spine
Those that happen because the person over loaded the muscle, usually because of a sudden and very strong contraction.
In the first instance the patient feels there’s a problem with one of the joints in the neck or back. The usual description is that the back feels “out”. With this even small movements can create a sudden severe spasm. This goes quickly once the joints are freed.
- Physiotherapy for Spine, Knee, Joint Pain = Rs.500 per session
- Physiotherapy for Strengthening Weak Bones & Building
Stronger Muscles = Rs.500 per session.
- Accupunture for Pain & Health + Pain Reduction Light Treatment = Rs.500 per session