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How to Tell Apart the Different Kinds of Pain - Part 2

Tendon, Ligament, and Sinew Pain

Sinews are basically the connective tissue that holds and interconnects the muscles, bones, nerves and organs within your body. This broad category includes tendons, ligaments, fasciae, bursae, and joint capsules. Sinew pain is very annoying and can be quite debilitating if severe. Imagine these pains as if they were a sneaky henchman who’s got you in a vice. With a twist and a little pressure, he can make you feel unpleasant and achy. But if you try to move around and do too much activity, the vice will tighten hard and cause very intense pain. This is sinew pain; it’s a creeping, building, intensifying pain — but it’s dependent upon your activity. And, if you leave it alone, and don’t try to pull your hand from the vice, it’s not going to hurt you.

Sinew pain is frustrating because it can last a long time and really impact your fun and active lifestyle. The blood supply to these structures is typically not great, and a normal timeframe for healing here is about 6 to 8 weeks. I’m sure many an orthopedic doctor has told you to wait the infamous “6 to 8” after an injury or surgery. That’s because it takes soft tissue about two months to heal, as long as there is no obvious complication — such you continuing to perform the same activity that provokes the problem.

A classic example of this kind of pain is “tennis elbow,” which is also known as lateral epicondylitis. I had a patient who came in for treatment after doing an excessive amount of weeding in the garden. All that pulling and twisting of his wrist really inflamed his elbow and caused a vicious tendinitis. The rehab process was slow and it took him almost a year to overcome the pain, primarily because it was so hard for him to stop using his hand and wrist for regular everyday activity. So, it just kept on getting irritated.

Sinew pain is one of the most common types of musculoskeletal pains. Think of that henchman with a vice. It’s very frustrating!

Derangement Pain

A derangement sounds screwy and acts just as screwy as well. It’s a broad category of pain, which essentially refers to any structure of your body that is out of place, or “deranged.” A typical derangement that you might have heard of is the torn meniscus in your knee, or the damaged labrum in your shoulder. You actually have a lot of meniscus-type structures in many of the large joints of your body, like your jaw, your wrist, and your hip. But, the absolute most common derangement of all would have to involve the intervertebral discs of your neck and back.

Try to think of a derangement as a wild animal that got out of its cage. These types of pains typically do not go away, unless you put them back where they came from — back in their cage. You can feel perfectly fine and then all of a sudden the derangement can “attack” you, and then go away again. Sometimes it may even be hard for you to provoke the pain. However, there is a general insecurity or fear that it can come back again at any random moment and without warning. As a result, people tend to contort or twist their bodies into abnormal positions to avoid it happening again. This is a derangement pain, and it can be quite unsettling because you don’t trust your body anymore and you can even look crooked.

The blood supply to these meniscal and disc structures is not very good, so just waiting around for spontaneous healing is typically not going to work. Aside from surgery, there’s usually two options here for conservative treatment. The first would be to put the derangement back in its proper place; the second is to temporarily compromise some of your normal movement or function in the hope that it may someday go away — which is not the best option.

I treated a maintenance man in my clinic a while back, who had just herniated a disc in his lumbar spine by trying to open up a jammed window. This young guy hobbled in with a cane and was bent over at the waist, as if he was looking down to inspect the floor. The day before, he was perfectly straight, then suddenly today he can’t stand up. This didn’t develop over years, slowly and gradually. This happened “right out of the cage.” It took a while for him to straighten up and push that derangement back into place by performing repeated cobra backbends while lying on a mountain of pillows. Although he did regain a more normal posture with physical therapy, unfortunately, he could not avoid having surgery. The pain from the derangement was just too severe and would not go away.

Sometimes derangements can’t be put back into place no matter how hard you try, and a surgeon is required to remove the problem completely

Nerve Pain

Any time you feel sudden numbness, weakness, tingling, buzzing or electricity, burning —sometimes even coldness — in an arm or leg, it may very well be because of nerve pain. In my experience, I’ve found that most other types of pains usually occur at the same time with some form of nerve pain. This is because nerves innervate or connect to so many different structures. They are essentially the electrical wiring of the living machine that is your body.

Nerve pain is the worst type of pain because it exists within your nervous system, which is also where your brain and your emotions and mood reside. Trauma to your nerves, whether suddenly or over time, can be overbearing and oppressive to your sympathetic nervous system. This is the “programing” of your body that deals with “fight or flight,” and can therefore create a sense of anxiety, depression, or even nausea along with the localized pain response.

I bet you’re picking up now on some of these computer analogies, with all my talk of wires, electricity, and programing…

Nerves are smart — they live within your nervous system. Nerves are even smarter than you!

It is very difficult to predict and visualize a clear pattern to the healing process of nerves, which is usually a very long time. They take no less than six months to recover from injury, and sometimes take even years to fully heal… or never even heal at all. It is really best not to look at your overall progress from a day to day or week to week basis, but instead to look back at yourself a month ago and compare it to the pain you’re feeling today. This is how therapists approach patients with debilitating chronic pain conditions, where the brain has now “learned” to perpetuate the sensation of pain even after injury has resolved. In the worst case scenarios, nerve damage can change circulation to the area, waste away the muscle, and cause excruciating pain to even the lightest touch of a feather.

It is because of this “wicked, unpredictable intelligence” that I tend to think of nerve pain as some sinister, mastermind super-villain — the kind you see cackling wildly in those old James Bond movies with his big, brainy head and spindly, long fingers. You really can’t push through nerve pain, because it is too debilitating and often worsens very quickly. You have to focus on relaxing, using your breathing and mediation, and staying in control for the long haul.

When I had jaw surgery at age 35 to reconstruct a misaligned bite from a childhood injury, the surgeons had to cut through bones and move nerves out of the way in my face in order to realign the joint properly. After the surgery I had complete numbness all around my chin and cheeks, to the point that my skin literally felt like I was touching a piece of dead drift wood. The muscles in my jaw would be in a perpetual spasm and became so tight that I couldn’t open my mouth enough to stick a spoon in it. Naturally, my emotions and anxiety were in quite the disordered state.

Eventually, over the following six to twelve months the numbness, spasming, and anxieties all subsided and my mouth and bite were better off having opted to do the surgery. What I have described to you just now is one type of nerve pain. There are many types of nerve pains, just as there are many different sensations and functions that a nerve can control.

Continued in Part 3

In the next and final part of our series on "Different Types of Pains," we will examine the behavior of bone pain and also talk about how these different pains can exist together in various combinations and patterns

If you would like to schedule a visit to talk with us at Alté View regarding your specific type of pain, then please reach out to us here.


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