Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (5 page)

FIVE REASONS MUSCLES ARE WEAK

1.
Underuse:
This may cause pain and dysfunction, possibly affecting other muscles and joints along the “kinetic chain.” A good example would be the gluteal muscles in the butt, which aren’t used much by distance runners. Their weakness causes the hips to move laterally during running and may add to muscular imbalances, an inefficient stride, and the possibility of lower-leg injuries.

2.
Fatigue from overwork:
Muscles may tire out trying to stabilize an unstable structure. When you sit for long periods, the muscles of the lumbar spine can become weak or tired and painfully tight, fighting a losing battle against gravity and poor posture.

3.
Nerve damage:
If a nerve going to a muscle is damaged, the muscle can’t properly fire. Despite the tissue’s potential, the body can’t communicate with it, so the muscle will test as weak. And if the nerve problem isn’t corrected, over time the muscle will atrophy from lack of use.

4.
Infection:
The muscle is using its resources to fight the infection. In this condition, it will test as a weak muscle.

5.
Muscle disease:
A disease such as muscular dystrophy will cause progressive muscle weakness and atrophy.

repetitive stress injuries have become the bane of the workplace, and are increasingly considered the most common form of occupational injury, costing the nation, by some estimates, more than $100 billion a year in medical costs, decreased productivity, and other related expenses. The two biggies that we’ll discuss in the “Hot Spots” section are carpal tunnel syndrome and lower-back pain. Interestingly, in the latter case, the problem isn’t too much movement but too little. The postural muscles have to work so hard to keep the spine aligned when the body is sitting in a fixed position that they tire out and become irritated.

The line between traumatic and chronic injury is anything but hard and fast. Sometimes a muscle trauma can destabilize a joint area, setting it up for chronic problems. Sometimes chronic inflammation can weaken the muscles or connective tissue to such a degree that an otherwise ordinary pivot or twist can cause structures to rip—the straw that broke the camel’s back. But let’s go beyond standard
textbook terms and take a closer look at the different ways muscle can cause pain and limit movement before we consider the ways to treat it.

When muscle is asked to do too much, to fire too long or too hard, it can simply tighten up and shut down in self-defense so forcefully as to cause pain. But the tricky thing about diagnosing muscle pain is that the site of the original tissue damage is sometimes not where it hurts the most. This is one reason muscle problems can be mistaken for joint injury. Muscle can refer pain to other areas of the body in several ways. Sometimes a contracted muscle will press down on a nerve sending pain (or numbness or tingling) to some other part of the body along that nerve track; for instance, a compressed sciatic nerve in the back can cause pain down the leg. Sometimes an overwhelmed muscle just shuts down, forcing neighboring muscles to pick up the slack, and then
they
become fatigued and painful. Restriction in one part of the muscle can pull on the tendon where it attaches the muscle to the bone, causing pain there. Diagnosis in these cases of “referred pain” can be tricky, and the bigger musculoskeletal picture needs to be considered. Just because you have pain in the lower back doesn’t mean that is the source of the problem and the location that needs to be treated first. This is why it is so important to see a doctor and not try to self-diagnose!

The tendon is a popular area for pain. Everyone has heard of tendinitis, the inflammation that sets in when tendons and the surrounding muscle are overstressed and overstretched. “Tennis elbow” (lateral epicondylitis) and Achilles tendinitis are all-too-common examples. But in fact, the latest research is telling us that the tendons have only a limited capacity to become inflamed. Chronic pain is usually produced by the deterioration of the tendon’s collagen fibers, a downward spiral of microscopic tearing and scarring better described by the term
tendonosis.
Conventional medicine has had only limited success treating tendonosis with anti-inflammatory drugs. And it doesn’t pay much attention to the potential root cause of the problem: overly contracted muscle fibers that pull on the tendon ends.

Finally, in the case of a serious joint injury, muscle problems are not the cause, but the effect. Pain receptors inside the joint detect something disturbing about the way the joint is moving, and they send signals to the muscles telling the joint to slow or shut down, minimizing the chance of further damage. You see this “guarding reflex” in nature all the time such as when an animal limps with a leg drawn up so as not to further stress an injured joint. Humans, of course, are good at over-

REFERRAL PATTERNS

Very often, the muscles refer pain to other parts of the body. In other words, the symptoms of an injured or irritated muscle can be felt in areas other than the actual damage site. This makes diagnosis and treatment difficult at times and can be very confusing for the patient. The following charts illustrate the most common muscle referral patterns. The shaded areas represent spots where you may feel all or just some of each muscle’s referred pain.

1. Psoas [A]

2. Gluteus Maximus [C]

3. Piriformis [E]

4. Upper Trapezius [G]

5. Biceps [I]

6. Scalenes [K]

riding their body with their brain, choosing to finish their run or their basketball game even though their knee or hip is aching and the muscles around it have tightened up.

As we’ve seen, when damaged muscle is the primary problem, the immediate source of pain may be the nerves, the tendons, the muscle fibers themselves, or a combination of the three. Fortunately, hands-on muscle therapies have shown themselves to be effective at getting to the source of the problem: tight muscles.

When treating muscle, the manual therapist has to contend with the secondary damage brought about by inflammation. In the case of a traumatic injury, inflammation is a good thing, at first. It’s the body’s attempt to protect itself against further injury, and start the healing process, by flooding the area with plasma, fluid, and immune cells. But if the injured area remains irritated, or the problem is chronic, inflammation settles in for a longer stay and becomes part of the problem, not the solution. The muscle fibers remain locked in contraction, clamping down on the capillaries and reducing blood flow through the area. This has a doubly bad effect, reducing the supply of oxygen into the tissues and the flow of metabolic waste products out.

In this distressed environment, the body lays down collagen-based scar tissue to stabilize the area. In the case of an acute injury, this makes sense. It’s the only patch material muscles have. But in a chronic situation, it just gums up the works. These microscopic adhesions impede the way the fibers inside the muscle move against each other, and the way the muscle slides over neighboring muscles and nerves, and how it moves within the broad layer of fascia that gives shape to the entire soft-tissue system. The friction creates more inflammation and swelling, triggering the formation of yet more adhesions, and so on.

HANDS-ON MUSCLE THERAPY

Manual therapy has more than one way to pull muscle tissue out of this downward spiral. Massage therapies have been around for centuries as all-purpose body tonics. Massage stimulates the circulatory system to bring blood back to oxygen-starved muscles and helps the lymphatic system flush out waste. Modern therapeutic schools such as Active Release Techniques (ART) and Trigger Point Therapy have brought manual therapy into the twenty-first century, drawing on scientific
anatomy and physiology to target damaged muscles. They can trace their roots back to ancient China and the development of acupressure and then acupuncture therapies. (The creator of Trigger Point Therapy, a pioneering M.D. named Janet Travell, served as personal physician to both President John Kennedy and President Lyndon Johnson.)

It’s beyond the scope of this book to offer a who’s who of manual therapies. Dr. DeStefano, though well versed in a number of different muscle techniques, predominately uses ART. While that certainly influences the way we discuss the treatment of the various hot-spot issues, our emphasis is not on the specific treatment techniques, but on understanding and diagnosing problems that can be treated manually in a variety of ways. No scientific rationale for one form of manual therapy being “better” than another exists; some therapists have had excellent success combining therapies that have very different theoretical underpinnings, for instance, ART and acupuncture. Many ART practitioners, including Dr. DeStefano, believe in the value of combining muscle work with chiropractic treatments to address a range of musculoskeletal problems.

Over the past decade or so, researchers in academic physical therapy have filled in our understanding of the physiology of distressed muscles. But we still don’t know how exactly the different schools of manual therapy get the good results that they do. Every manual therapy has its dogma, but unlike many medical and surgical treatments, there is not a lot of supporting hard science.

Exciting research
is
being published that looks at the key role fascia plays, binding together muscles, joints, and bones in a single interconnected system. Researchers are doing groundbreaking work on a class of molecular receptors called integrins. These molecules seem to permit the different cells of the musculoskeletal system to communicate, so that when, for example, the arm moves, everything from skin to bone moves as a coordinated whole.

In the coming years, this research may give us a better theoretical handle on what we’re doing when we manually work on muscle or, for that matter, when we cut through muscle to surgically repair joints. But the focus of this book is mostly practical, helping to ensure that your muscles and joints work as well, and last as long, as the rest of you.

PART 2
RESILIENCE

The next three chapters map out a program to build up the resilience of your musculoskeletal system, protecting it against injury and plain old everyday life. In
chapter 4
, “Mind-Body,” you’ll learn how psychological stress can wreak havoc on the system and how to contain the damage by developing a measure of control over your stress. In
chapter 5
, “Nutrition,” you’ll learn how smart food choices can build up the durability of the system by supporting bone growth and reducing inflammation in your joints. And by maintaining a healthy weight, you reduce the physical stress that wears the body down. In
chapter 6
, “Fitness,” you get moving. Using our exercise principles and our favorite exercises, you’ll build your own all-around “functional” fitness program that develops balance, cardio endurance, and muscle and bone strength, enhancing your health and cutting down the chance of injury.