Tuesday, December 1, 2020

Why Do My Joints Hurt More When It Rains?

One of the most common problems I hear about with patients with chronic pain is that rainy weather seems to make things worse. Is there a real biological reason for this or is this just an old wives tale that has been passed on through time?

Don’t Stop Believing: The Uncontrollable Factor

People have been talking about how they can sense weather patterns in their joints for thousands of years. You’ve probably heard of this phenomenon from your grandmother or another relative whose arthritis pain flared up when it rains. They might say that they feel the rain in their bones.
Hippocrates, the Father of Medicine, was the first to note changes in a person’s illness status due to weather way back in 400 BC. Yet, as long as this idea has been around, studies about this phenomenon have been inconclusive. Some studies show that pain patients can feel a difference, while others say that the weather makes no difference.
It’s hard to study this effect because of the impact that belief systems have on pain. When human beings have a strong enough belief in something, it can drastically affect their perception of the world. This is seen in pain science all the time, and it makes studying pain very challenging and difficult.
Short of locking people in a box and hiding them from weather reports, it’s hard to know how this affects humans with any degree of certainty.

Animal Studies Leaving Clues

While belief systems can impact humans, some of our furry friends have helped leave some clues.
Scientists believe that the pressure in the air (barometric pressure) is what allows people to feel pain when the weather changes. When storms come, the pressure in the atmosphere begins to drop. The theory is that as air pressure drops, it decreases the amount of pressure on your joints leading to the joints and soft tissues to expand and irritate nerve endings causing pain.
In Michigan, we get experience weather changes quickly so pain patients have the unfortunate opportunity to experience this regularly.
Scientists tested this idea on guinea pigs and rats. They placed animals bred with with a pain predisposition into two environments. One group had normal air pressure while the other group had the air pressure lowered artificially.
They found that the low pressure animals showed increased pain behavior compared to the controls.
This is important because you can’t sway or convince an animal that lower pressure is going to make them hurt more. It’s a much closer relationship to cause and effect than can be currently studied in human beings.

 So What? Is This Treatable?

So we know that feeling weather changes when you have pain syndromes is at least plausible based on animal models, but why does it happen and is it treatable? The truth is, we still don’t really know what mechanisms cause this type of pain so we have no idea if it’s treatable or preventable.
Based on my experience, I believe that when pain tends to be triggered or aggravated by weather, there’s likely a pain processing problem in the body.

Tissue Damage vs Pain Perception

The most common conditions associated with weather-related pain are osteoarthritis (wear and tear arthritis, not joints on fire arthritis), headaches, and fibromyalgia. The important thing to note about these 3 conditions is that the pain related to these conditions is NOT dependent on tissue damage. What does that mean?
It means that the level of pain associated with these conditions is not tied to the amount of damage that’s in the body. When you have a sprained ankle, broken bone, torn muscle, or a cut, there is damage done to the tissues that sets off a series of chemical signals meant to trigger a pain response. It’s a very linear relationship.
With joint degeneration, you might feel pain, you might not. With headaches and fibromyalgia, there’s not necessarily any physical damage that’s related to the the pain being felt.
It’s not to say that the pain isn’t real, it just means that there’s no obvious source of damage that’s causing the pain. The problem is related to the way your brain processes pain. Your brain has a built in volume control for pain perception. It can turn these signals up in certain situations, and it can turn it down in others. Chronic pain patients have their volume dial on high all the time.
It’s not just a matter of belief. Although that’s an important piece of the puzzle, there are other factors like:
  • Brain oxygenation
  • Hormones in the blood
  • Global inflammation
  • Joint movement, especially in the spine
That’s why pain isn’t just a physical phenomenon. I’m sure you’ve been in a situation where you you suffered an injury, but you didn’t feel it until much later. This happens frequently after the shock of car accident, the thril of playing in a championship game, or the necessity of escaping a dangerous situation.
You get stunned, your heart races, adrenaline is surging through the veins, and you don’t notice any pain until hours later when those hormones leave the blood stream.

Pain Perception is Malleable

This brings some good news and bad news.
Bad News: It means that for lots of cases, there might not be a treatable lesion that is generating some of the chronic pain problems you’re feeling.
Good News: This also means that your pain levels are malleable and there are different things you can do to turn down the volume of the pain you experience. Things like meditation, exercise, and cognitive therapy can all allow us to change our experience with pain, and get a little bit more control over how we feel. It gives us control over the volume dial.
This is actually one of the primary mechanisms that Structural Corrections can help people with headaches, fibromyalgia, and arthritis related pain syndromes. We are not fixing or repairing damaged tissue, we are creating an environment for healthy neurological function.
When the structure of the spine are disrupted, it decreases 2 things:
  1. Blood supply in and out of the brain
  2. Mechanical input into the brain
Both of these factors cause the brain to be more sensitive to pain signals. When the spine moves better and normal blood supply is restored, you can see not only an improvement to someone’s weather related pain, but also an improved resiliency and control over chronic pain syndromes.

Sunday, November 1, 2020

Whiplash Associated Disorders – What are the Facts?

In my experience, I’ve found that whiplash is a commonly misunderstood diagnosis among the patient population. Many people self-diagnose the pain in the neck following a bad roller coaster ride or car accident as a whiplash injury. While they may or may not be correct, the truth is that whiplash is a type of injury with serious implications, and is frequently mismanaged by unscrupulous folks with a big stake in the business of personal injury.

Whiplash is a common name for a group of neck disorders known as cervical acceleration-deceleration injury or cervical sprain/strain injury. It occurs when the head and neck are placed in motion and suddenly forced to a stop causing a hyperflexion or hyperextension motion. 

This irregular movement of the neck causes the ligaments of the spine to sprain and the muscles to splint the unstable structure. This type of injury is also known to cause the discs of the spine to bulge and herniate, thus complicating matters even further.

It’s easy to see how whiplash can be a real pain in the neck (pun intended), but most people treat it like a sprained ankle and hope that the pain goes away in a few weeks. However, there can be long term consequences; even for people who don’t have pain symptoms immediately. Research has shown that whiplash associated disorders are related to inflammatory and endocrine problems like those seen in chronic fatigue syndrome or fibromyalgia1. Whiplash is also associated with chronic pain by making your brain more sensitive to pain signals, which explains why so many people can suffer without any evidence of physical damage2. Additionally, people who report whiplash injuries after a rear-end accident are likely to show complaints of headaches, TMJ, back pain, fatigue, and sleep problems even 7 years later3! Whiplash has even been associated with chronic inflammation by making the body’s own immune system overly responsive to normal stimuli4,5.

Though the focus of my practice has never been on auto-accidents cases, the truth is that most drivers will be involved in a collision no matter how good a driver they may be. Most will probably not experience pain immediately after a collision, especially if you’re in your teens or early 20’s. However, the impact of a vehicle traveling at speeds as low as 15 mph can show visible signs of structural damage to the neck. These include s-shaped curves in the neck, anterior ligament instability, atlas displacement, and Anterior Head Syndrome. A recent study has found that this type of trauma to the spine can cause parts of the brain and brain stem to slip further into the neck creating a condition called Chiari Malformation6. While they may not be painful in their early stages, these structural changes can pre-dispose the spine to early degeneration and arthritis if left uncorrected over the course of several years.

 Normal Neck X-Ray

S-shape X-ray Characteristic of Whiplash

As a chiropractor focused on Structural Correction, I see patients everyday with Secondary Conditions like headaches and TMJ related to accidents that took place many years earlier. While some of these patients suffered painful injuries and received treatment following an accident, most people will walk in and say they didn’t have any symptoms until years later. When someone asks why their pain seemed to come out of nowhere, I can usually look at their x-ray and see that the structure of the neck fits the familiar S-shape of a previous rear end collision.

Here are your take home messages:

  • First, problems can grow in the body in the absence of symptoms. Much like cancer and heart disease don’t happen overnight, people with chronic pain usually under go slow physiologic changes in their brain and hormonal systems for years before they have a condition that won’t go away.

  • Second, if you have a physical/structural problem, then you must go beyond treating the pain symptoms to help get full resolution of the problem. Whiplash injuries cause distinct structural problems in the spine. While pain relief is important, making the pain go away while leaving the structure in bad shape is like taking the battery out of a smoke detector when a fire is burning in the house.

Whiplash associated disorders can be a complicated problem that requires a comprehensive solution. When selecting a team of doctors, make sure that you have someone in your corner that can look at you from a functional standpoint rather than sheer pathology, that addresses the structure of your spine in 3-dimensions, and understands the nature of traumatic injuries.

1. Banic B, Peterson-Felix S, Anderson OK et al. Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain. January 2004. 7-15. 

2. Berglund A, Afredsson L, Jensen I, Cassidy JD, Nygren Ake. The association between exposure to a rear-end collision and future health complaints. J of Clinical Epidemiology. Aug 2001 (54): 851-856. 

3. Kivioja J, Rinaldi L, Ozenci V et al. Chemokines and their receptors in whiplash injury: elevated RANTES and CCR-5. J Clin Immunol. Jul 2001; 21(4): 272-7 

4. Kivioja J, Ozenci V, Rinaldi L. Systemic response 

5. Gaab J, Baumann S, Budnoik A et al. Reduced reactivity and enhanced negative feedback sensitivity of the hypothalamus-pituitary-adrenal axis in chronic whiplash associated disorder. Pain. December 2005. 119(1). 219-224. 

6. Freeman MD, Rosa S, Harshfield D et al. A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash). Brain Inj. 2010; 24(7-8): 988-94.
If you have experienced this kind of injury, call our office today and book your consultation. 248-287-8700