Tag: tingling

Don’t Forget Your Back

Most of us spend a large portion of the day hunched forward.  Think about when you are working on the computer, cooking, driving or even relaxing.  Your typical posture during these activities is head and neck forward, shoulders rounded forward, back curved and hips flexed.    When you remain in this position for an extended period of time, the muscles in the front of the body tend to shorten or contract, while the muscles in the back of the body tend to weaken.    This can be a set up for back, neck and shoulder problems and in addition, tends to make you look shorter, heavier and less confident.

Stretching before and after exercise as well as during the day is often overlooked in the rush to “get your workout in”.   Stretching however, has numerous benefits.   According to a study published in the Annals of Physical Medicine and Rehabilitation Medicine in September 2016, by I Fekhfekh, et al, dynamic muscle stretching of the knee musculature actually resulted in an increase strength gain in those muscles.  Interestingly, this study also found a decrease in the postural stability of the knee after stretching.    In English, it appears that stretching helps your to build strength, but may decrease the stability of the muscles you stretch at least temporarily.

In general, stretching helps to improve flexibility, joint range of motion, and usually is helpful for injury prevention.    Stretching helps by increasing blood flow to the muscles stretched.  This increased blood flow carries important nutrients to your muscles to allow for muscle growth and repair.  In addition, the increased blood flow helps to wash away muscle “waste” which leads to decreased soreness and inflammation of the muscle.

If allowed to remain in a contracted position for a prolonged period of time, our muscles will shorten.  For example if you spend a large portion of your day sitting in a chair or driving, the muscles in the front of the hips, your hip flexors will shorten.  These muscles have a direct effect on both your posture and your back health.

 

So what should you do?

It is important to stretch the muscles in the front of the body at least daily.

Exercises that focus on the hip flexors:

-Kneeling hip flexor stretch  – in the position of a lunge, allow your back knee to touch the floor and drive the hip of your front leg forward.  This will stretch the hip flexor of the knee on the floor

–Pigeon stretch – extend your right leg straight back and bring the heel of your left leg underneath your right hip.  Then drive your hips forward towards the ground.  Stretch and repeat on the other side.

– Yoga poses such as: low lunge, crescent lunge, upward facing dog, and revolving side angle pose

 

Stretches that focus on the chest muscles and prevent rounded shoulders:

– Door Frame stretch- stand in a doorway or at the corner of a room with your arms up like you were going to stop traffic.  Line your arms up from the elbow to the hand with the doorframe or in the corners of the wall.   Step towards the door and you should feel a stretch in your chest (pectoralis “pec” muscles) and hold for 20-30 seconds.

– Wall slides – stand with your back to the wall and keep your shoulders against the wall.  Walk forward 1-2 steps and slide your arms up and down the wall and squeeze your shoulder blades together.  You should feel a stretch in your upper chest muscles.

–Shoulder squeeze stretch –  clasp your hands together behind your back and slowly try to lift your hands.  Squeeze your shoulder blades together to stretch out the chest wall.

– Yoga poses include : bridge pose, camel pose, cobra pose and cow face pose

 

Stretches for your neck:

– Chin Tucks (Neck Retraction) – keep your shoulders back and your head in a neutral position (eyes facing forwards, chin level) slowly move your head backwards until you feel a slight stretch in the back of your neck.  Hold for 10-20 seconds and repeat.  If needed you can apply a gentle pressure on your chin with your fingertips to press your chin backwards and deepen the stretch.

Incorporating these exercises into your daily routine will help to prevent shortening of the muscles in the front of the body which leads to poor posture and often pain of the neck and back.  As always, if you are having pain which persists you should be evaluated by a certified health care professional to ensure that these exercises are safe for you.

This week we primarily discussed stretching exercises to prevent muscle contraction, and next week we will discuss the importance of strengthening the back muscles to further combat the issues of a hunched posture.

Exercise Through The Pain Versus Get It Checked?

As an individual either new or returning to exercise it is very common to sustain injuries.  Most often injuries occur in the joints such as knees, hips, feet, low back, neck and shoulders.   Although there are numerous reasons for injuries, the most frequent injuries are a result of poor body alignment, overuse injuries, increasing exercise duration or intensity too quickly, unequal strength that develops in opposing muscle groups, and improper shoe wear.

The warm up before exercising is very important because it allow for an increase in blood flow to the muscles.  Red blood cells carry oxygen, a requirement for muscle function.  As you become more “fit” your muscles get better at extracting oxygen from the blood.   In addition to carrying oxygen, the increased blood flow to the muscles helps to “wash away” hormones and neurotransmitters that can build up in the muscles and cause irritation and pain.

Pain is an adaptive mechanism that the body uses to prevent injury.  For example, if you put your hand near a fire you will sense instant pain and reflexively pull your hand away to prevent a burn and limit further damage.   In this case the sensation of pain in beneficial.

The pain pathways are very complex and the body has a remarkable way of increasing and decreasing pain sensation.  When you bang your leg and develop a bruise, the bruise and the surrounding areas become exquisitely sensitive.   Due to the release of certain substances, the body is able to up-regulate the sensation of pain.  Over time, as the bruise heals and the swelling decreases, the sensitivity in that area returns to baseline. However, sometimes the pain system can go awry.

In some cases, there is an acute injury that causes increased pain sensitivity, but instead of the pain receptor sensitivity returning to normal over time, they remain ultra-sensitive.  Even though there is no longer a reason for the sensation of pain to be generated, the body gets “confused” and can interpret sensations of light touch, heat, cold, or pressure as pain.   In this instance, the pain is no longer adaptive nor beneficial.   This malfunction is often seen in individual with chronic pain.

In my mind, there are two types of pain, “safe pain” and “dangerous pain”.   Safe pain to me, is pain that does not indicate worsening damage, cancer pain, or harmful injuries.  Safe pain is pain that often gets better during exercise and mobility.   In contrast, dangerous pain is pain that indicates a significant issue that needs prompt attention.   Some examples of dangerous pain include but are not limited to:

A fall or high-speed injury resulting in immediate severe pain and the inability to bear weight.  This pain can indicate conditions such as fractures, ligament injuries, or instability.

Chest pain or heaviness which occurs during exercise should never be ignored.  Typically, cardiac pain is described as chest tightening or pressure which often radiates down the right arm or into the jaw.  However, in individuals with diabetes, chest pain can be atypical and present like indigestion.  Chest pain is a medical emergency and should be evaluated immediately.

Neck or low back pain with associated numbness, tingling, or weakness should also be evaluated promptly.  In addition, any neck or back pain associated with bowel and bladder symptoms such as difficulty controlling urine, loss of sensation or funny sensation around the buttocks, and/or constipation and loss of bowel control needs to be addressed by a doctor.

The general rule of thumb is that pain which worsens incrementally with activity, persists despite rest, or is associated with numbness, tingling, radiating pain down arms or legs should be evaluated by a trained medical professional.   Pain that improves after a few minutes of exercise and is not associated with the above mention symptoms will often improve in its own.  Again, it is most important to listen to your body.  If you feel that “something isn’t right” or your symptoms are not improving you should  go with your gut and have your symptoms evaluated.

Carpal Tunnel Syndrome

 

One of the most common causes of hand and wrist pain is a condition called Carpal Tunnel Syndrome. This condition is usually the result of the median nerve getting trapped and compressed in the carpal tunnel as it courses towards the hand.

The carpal tunnel is a tunnel in which the bottom and sides of the tunnel are formed by the carpal or wrist bones and the top is formed by the transverse carpal ligament. This ligament or fibrous band connects the top two carpal bones. Inside the carpal tunnel is the median nerve as well as 9 of the flexor tendons for the fingers and thumb. The purpose of the carpal ligament is to stabilize the carpal bones and anchor some of the tendons for the hand muscles (finger flexors) to enable them to work correctly.

Carpal tunnel syndrome occurs due to compression of the median nerve running through this tunnel. The compression can be due to swelling of the tendons, inflammation of the tendons, overall fluid retention in the body (due to pregnancy, allergies, or other inflammatory conditions) and over-use injuries (such as typing).

Carpal tunnel syndrome can be classified as mild, moderate or severe.

Mild carpal tunnel presents as primarily sensory symptoms with numbness and tingling of the fingers and hand. As the median nerve gets more compressed the symptoms of carpal tunnel syndrome becomes more severe and the motor component of the nerve gets involved. When this happens, weakness and atrophy (muscle wasting) can be seen.

Common Symptoms of Carpal Tunnel Syndrome:

Mild:

  • Numbness, tingling or aching of the thumb, 2nd, 3rd, and part of the 4th fingers
  • Nighttime hand/wrist pain and numbness
  • Difficulty typing, or with fine finger movement involving the first 3-4 fingers
  • Numbness and tingling which worsens when the wrist/hand is bend at a right angle (either flexed forward or extended backwards)
  • Electric shock sensations radiating into the hand
  • Pain that radiates from the wrist upward towards the elbow

Moderate to Severe: (in addition to above symptoms)

  • Weakness in hand grip
  • Dropping objects from the hand
  • Muscle wasting in the palm of the hand, especially at the base of the thumb

For mild symptoms the use of a wrist splint at night will be helpful. These splints can be purchased over-the-counter at a pharmacy or medical supply store. The splint should have Velcro or adjustable type straps and should have some sort of support or rigid material on the underside of your wrist and palm, that will prevent your wrist from bending forward too much. The splint should be worn at night to prevent inadvertent wrist bending, and can be worn during the day if symptoms are continuously present.

Certain exercises may exacerbate carpal tunnel syndrome such as push-ups, planks, and low jacks. Any exercise which puts pressure through the wrist while it is at a 90 degree angle from the arm can further compress the median nerve in the carpal tunnel. Helpful exercise modifications include doing push-ups on your fists and keeping your wrists straight, or doing the push-up on an incline (with your head higher than your feet) so you are putting less weight through your wrists.

In addition, activity modification may be indicated if the above interventions are not helpful. If cleared by your doctor, adding a small amount of Vitamin B6 (<200mg/day) is beneficial for improvement of nerve function. Vitamin B6 acts a a diuretic (decreases swelling), helps the body to make neurotransmitters and helps with the function of the immune system.

Foods which contain B6 include:

  • Wild caught tuna
  • Bananas
  • Salmon
  • Grass-fed beef
  • Chicken breast
  • Spinach

If dietary, activity, and exercise modification are not successful in treating your carpal tunnel syndrome in conjunction with the use of a wrist splint and occasional anti-inflammatory medications, it is important to be evaluated by a health care professional. In addition, if your symptoms progress, are not localized to your first three fingers, or are associated with any other symptoms, make sure to get checked to rule out other causes of hand/finger numbness.

If conservative treatments fail, other interventions such as physical therapy, corticosteroid injections, prolotherapy, platelet rich plasma injections, or surgical release may be indicated.

Numbness in The Feet When Exercising

 

Numbness and tingling in the feet during exercise is a fairly common complaint I have come across during my years of treating patients. There are multiple etiologies for numbness, some of which are benign, and others that may indicate a more serious underlying issue. In this article we will focus on some of the causes of numbness and tingling and several factors that can be modified to alleviate these complaints.

Some common words used to describe pain related to nerve injuries include:

  • Numbness
  • Tingling
  • Burning
  • Electric Shock
  • Freezing
  • Pins and Needles

In addition, sometimes nerve pain can cause a sensation that is out of proportion to the amount of pressure or stimulation applied to an area. For example, when you lightly touch your skin, you know you are being touched, but it should not feel painful. When the nerves in the area you are touching are damaged, the light touch can actually stimulate a painful sensation.

One of the most common causes of foot pain and numbness during exercise is due to poorly fitting shoes or socks that are to bulky. The easiest fix is to have your shoe wear evaluated by a medical professional or even a specialty shoe store. If you are wearing shoes with a toe box that is too small or have stiff shoes with an exceptionally high arch support these might be the causes for your pain. By getting proper fitting shoe-wear for your body type, you maybe able to completely eradicate your pain.

The nervous system has two parts, the central nervous system, and the peripheral nervous system. The central nervous system is composed of the brain and the spinal cord, and the peripheral nervous system is made up of all the peripheral nerves in the body found outside of the spinal cord. The nerves themselves are composed of two basic parts the axon and the myelin. The axon is like a wire that carries the information from one part of the body to another. The myelin is the covering outside the nerve, like the insulation of a wire. In a nerve injury, the axon, the myelin, or both can be damaged. The type of damage sustained by the nerve determines the symptoms that are present and the duration of the injury.

Pain in the foot can be due to compression, inflammation, or infection anywhere along the path of the nerve. Pain during exercise is most likely due to intermittent nerve compression. There are certain places in the body which are prone to nerve compression because of our anatomy and the tight spaces the nerves need to pass through. It is important to assess the areas of the foot that are numb because this can help to localize where the compression is occurring.

Morton’s Neuroma
One example of nerve compression is a Morton’s Neuroma. This is the result of compression, stretching, or repeated irritation of the interdigital nerve usually between the 2nd and 3rd or 3rd and 4th toes. It is more common in females than males, and is sometimes described as walking on marbles. Typically the pain radiates into the toes closest to the neuroma and the forefoot. The pain is usually intermittent in nature and can be alleviated by removing shoes. Often sneakers with small toe boxes “tight shoes” and high-heeled shoes aggravate the neuroma. It is also more common in people with tight calf muscles and very flat feet due to their body mechanics. It can be treated temporarily with a nerve injection into the foot. In addition, changing your shoe wear and possible use of shoe insert or pad may be helpful. Physical therapy may also be indicated. If physical therapy and conservative interventions fail, then surgical removal may be necessary.

Tarsal Tunnel Syndrome
Another reason for nerve compression is a condition called Tarsal Tunnel Syndrome.  The tarsal tunnel is the canal formed between the inside of the ankle bone and a band of ligaments that stretch across the foot. The tibial nerve runs inside the tunnel and can get compressed. Pain and sensory disturbances due to tarsal tunnel syndrome is usually located in the bottom of the foot. Some causes for tarsal tunnel syndrome include, bony anatomy, ankle swelling (due to cardiac issues, inflammation, or injury), flat feet, arthritis or bone spurs. Non-surgical treatment options include, steroid injections, orthotics (braces, shoe inserts, and splints), anti-inflammatory medications and dietary modification (removal of inflammatory foods). If conservative treatments fail, a tarsal tunnel release may be indicated.

Common Peroneal Neuropathy
The common peroneal nerve can get compressed at the fibular head, which is the bony prominence just below the outside of the knee. If this happens, pain and numbness is present along the outside of the leg from the knee down into the top of the foot. The common peroneal nerve then further divides into two branches. If one of these branches gets compressed, the numbness and tingling will occur in a more specific distribution.

It is also possible for the nerves of the leg to become entrapped or compressed in the muscles of the back of the thigh, (i.e. Sciatica)or at the level of the spine (Disc Herniation, or Radiculopathy) . However with Sciatica and Radiculopathies the pain, numbness and tingling tend to include the leg as well as the foot.

Other mores systemic but common causes of foot numbness include, but are not limited to:

  • Diabetes peripheral neuropathy
  • B12 deficiency
  • Disk Herniation
  • Radiculopathy
  • Vasculitis (inflammation of the blood vessels)
  • Stroke (more likely if numbness is only on one side of the body)
  • Raynauds phenomenon

As always, if you suffer from foot pain during exercise, it is a good idea to have it looked at by a health care professional.