What causes headaches in the back of the head or neck?

What causes the back of the head or neck to hurt?

If headache, neckache, and back of head pain plague your daily life, you are not alone. In fact, one in every six Americans experiences chronic headaches. 

Pain in the back of the head or neck is a common occurrence with many possible causes and treatments. Head and neck pain may seem like it defines your days, but the good news is it can be treated and our pain professionals are here to help identify the cause.

The following are some of the most common causes of pain in the back of the head and neck.

Poor Posture

Poor posture is a common cause of pain in the body, but it especially takes a toll on the neck. “Poor posture” refers to the postural positioning of the head being different than a neutral state. 

A neutral postural state, or “good posture,” refers to when a person’s ears are positioned directly over their shoulders which are rolled back. This posture minimizes stress on the neck and balances the weight of the head on the spine.

Poor posture causes increased pressure on the spine, especially when the head is leaning too far forward. Tension created by poor posture can lead to headaches which are felt as throbbing pain in the base of the skull. 

Correcting unbalanced posture and avoiding sitting or standing in one position for too long can help alleviate these pains.

Arthritis Headache

Headaches are one of the unfortunate side effects of osteoarthritis. Arthritis headaches are felt at the top of the neck where the spine meets the skull. Though the pain is felt in the head, it is caused by inflammation in the neck.

When this occurs, tension from compression of the upper spine is interpreted by the brain as neck pain. The body then limits the blood supply sent to the brain which creates head pain and arthritis headaches.

Tension Headache

Tension headaches are one of the most common types of headaches. This head pain is caused by muscle tension and stress. Pain from tension headaches is usually felt as a constant ache on both sides of the head. They may be chronic and often come on gradually.

Low-Pressure Headache

Low-pressure headaches occur after the removal of cerebrospinal fluid (CSF) during a lumbar puncture (also called a spinal tap). CSF may also be removed from the body if there is a cyst or tear in the spinal cord tissue that results in a leak. 

Headaches occur from the loss of CSF because this fluid cushions the brain by flowing around it, reducing pressure. When CSF is lost, pressure increases resulting in a headache.

Diagnosing low-pressure headaches sometimes requires imaging tests such as an MRI or CT scan. If the headache follows a spinal tap, patients will be given pain relievers, fluids, and caffeine which will aid in producing more cerebrospinal fluid. 

Occipital Neuralgia

Occipital neuralgia is a type of headache that is unique in the way pain is experienced. These headaches are characterized by chronic pain that is described as electric-shock-like in the upper neck, back of the head, and behind the ears. 

The headache is typically felt on just one side of the head and often begins in the neck and moves upwards. People with occipital neuralgia may have a scalp that is tender to the touch and their eyes may be more sensitive to light.

Occipital neuralgia headaches are caused by nerve injury or irritation. This nerve damage is often the result of pinched nerves from tight neck muscles, osteoarthritis, tumors in the neck, or trauma to the back of the head. 

 

Treatments for Headaches in the Back of the Head or Neck

Treatment for pain in the back of the head and neck varies depending on the cause of the pain. 

The following are treatments that often alleviate this pain:

Massage

Massage can provide relief for several different types of head and neck pain, specifically tension headaches and migraines. Massage is an effective form of pain relief and can help prevent headaches from recurring.

Physical Therapy

Physical therapy is one of the most common and effective treatments for head and neck pain. When used correctly, physical therapy can contribute to a reduction in neck stiffness and improved head and neck range of motion, and can teach strategies that prevent pain from coming back. 

The types and frequency of exercises are unique to each individual and their pain symptoms. Physical therapy is usually recommended in cases where the cause of pain is unknown, when the patient is recovering from injury or surgery, or alongside other treatments for headaches. 

Anti-Inflammatory Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often what people experiencing head and neck pain reach for first. These medications include ibuprofen, naproxen, and aspirin and work by reducing inflammation. Acetaminophen may also be used, but it does not have anti-inflammatory properties and is less effective.

Some cases of neck pain caused by inflammation in the spine and surrounding nerves may also be addressed with anti-inflammatory medications. For both types of pain, anti-inflammatory medications should be used only as short-term treatments.

Warm Compresses

Warm or hot compresses are used in temperature therapies to relax tight muscles. The alternative is cold compresses, which have a numbing effect on areas experiencing pain. Warm showers, hot baths, and ice baths are other forms of temperature therapy that will help alleviate some neck pain and headaches.

Injections

Botox is known for its ability to hide signs of aging, but did you know that it can also effectively help manage pain? Botox injections work to address pain by target and treat a specific area. Our physicians start by identifying the area causing head tension and then use injections to relax the affected muscle or muscle groups. 

 

Frequently Asked Questions

When should I be concerned about back of head pain?

You should seek medical advice for any chronic or extreme pain in the back of the head. A doctor will assess your symptoms and develop a treatment plan specific to you.

How serious is pain in the back of the neck?

Pain in the back of the neck can be caused by some serious medical conditions but is usually from postural issues. Seek advice from a pain doctor to assess the severity of your neck pain.

How do you relieve pain at the base of your skull?

Ice or heat therapy, the use of NSAIDs, and neck massage can all help to relieve pain at the base of the skull. This type of pain is often from a condition called occipital neuralgia.

What causes occipital neuralgia to flare up?

Occipital neuralgia can flare up after a traumatic injury to the back of the head or neck. It can also occur spontaneously for no obvious reason.

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Knee Pain When Squatting Down or Kneeling: Causes and Treatments

What causes knee pain when squatting?

Does the idea of dropping something and having to bend over to pick it up make you groan? Maybe you experience outer or inner knee pain when you squat down to look in the oven or tie your shoe. 

Sharp pain in the knees from squatting down or kneeling is a common annoyance that may be a sign of an underlying condition. This pain may just be a nuisance or it can prevent you from enjoying your day, but the good news is that it can be corrected. 

 

Here are some of the most common causes of knee pain when squatting or kneeling:

Knee arthritis

Arthritis is caused by inflammation in the joints. Inflammation from arthritis can lead to pain, swelling, and stiffness. Any joint in the body can experience arthritis, but knee arthritis is one of the most common forms.

Knee arthritis can cause inner knee pain during everyday activities such as climbing stairs or walking. This disability may cause you to miss out on experiences with your friends and family or be unable to work.

The “wear-and-tear” arthritis causes in the knee occurs most often in people 50 years of age and older, though it may also occur in younger people. This form of knee inflammation is caused by the gradual degeneration of cartilage in the knee. As the cartilage wears away, it decreases the protective space between bones in the knee which leads to them rubbing together. 

The most common symptoms of knee arthritis are stiffness and swelling causing pain when bending or straightening the leg, pain that is made worse by vigorous activity or after a period of rest, and weakness in the knees that may lead to “locks,” creaks or clicking sounds, or buckling.

 

Runner’s knee

Runner’s knee is the informal term for Patellofemoral Pain Syndrome. This form of knee pain is felt around the front of the knee (the patella) where it connects to the lower part of the thigh (the femur).

Though it is most often associated with running, runner’s knee may also be caused by a structural defect or certain ways of walking. Examples of situations that can contribute to the development of runner’s knee include:

  • Weak thigh muscles
  • Tight hamstrings
  • Tight Achilles tendons
  • Poor arch support
  • Excessive training or overuse
  • Existing injuries

Pain from runner’s knee is felt when a person is active or after sitting for an extended period with legs bent. A feeling of rubbing or grinding, or a clicking sound at the kneecap, may also be experienced with runner’s knee and the kneecap may be tender to the touch.

 

Tissue trauma

Knee tissue trauma is caused by a sudden movement or direct force that strains the knee beyond its normal range of movement. This trauma results in the soft tissue of the knee being torn or strained. Soft tissue includes ligaments, muscles, tendons, and menisci.

Trauma that causes a knee injury is most often experienced by athletes, but it may also occur on intensive job sites, while chasing children or pets, or with other forms of activity.

The most common symptom of tissue trauma is an immediate sharp pain that may be followed by swelling. After the trauma has occurred, you may feel like your knee is close to “giving out” when you walk. You might have difficulty straightening your leg, have bruising, and/or experience stiffness around the trauma site.

 

Iliotibial band syndrome (ITBS)

Iliotibial band syndrome (ITBS) occurs when a tendon called the iliotibial band gets irritated or swollen from friction in the knee joint. The ITB stretches from the top of the knee to the top of the pelvic joint and creates friction when it tightens.

ITBS may occur in one or both legs. If it is experienced in both legs, it is called bilateral iliotibial band syndrome. This knee condition is most commonly experienced by basketball players, cyclists, hockey players, runners, skiers, and soccer players. 

Certain people may have an increased risk of developing ITBS including people with bowed legs or one leg that is longer than the other, people who have knee arthritis, and people who rotate their ankle, leg, or foot inward when they move. 

Symptoms of Iliotibial band syndrome include hip pain, knee pain when flexing or extending the knee, sensations such as a pop or click on the outside of the knee, and discoloration and warmth on the outside of the knee. At first, this pain will be felt at the onset of exercise and as it worsens, it will also be felt while resting.

 

What are the best treatment options for knee pain when kneeling or squatting?

Knee pain caused by activities such as kneeling or squatting may have you feeling discouraged, but there are treatment options available that can help alleviate your symptoms. Our expert pain doctors will work with you to identify the cause of your knee pain and then will develop an individualized treatment plan to address the issue.

The following are some of the best treatment options for knee pain experienced when kneeling:

Improvement of ankle flexibility

Lack of ankle mobility may be the source of some knee pains, and improving the ankle’s flexibility could be the only treatment some people need. When your ankles are restricted in their mobility, the next nearest joint will take over some of the load, causing inflammation of the knee.

It’s important to improve ankle flexibility not just to avoid or treat knee pain, but also to prevent pain in other joints of the body. As one of the lower weight-bearing joints, the ankles have a lot of work to do to help keep the body in motion effectively. 

People who have experienced an ankle sprain at any point in their lives may have limited ankle flexibility, poor mobility, and resulting knee pain.

 

Strength training exercises

Many different forms of strength training can help alleviate knee pain. With all of these exercises, it’s important to remember to warm up and cool down to prevent additional pain in the body.

Here are some of the best exercises for increasing strength, reducing friction, and helping address knee pain:

  • Straight leg raises
  • Wall squats
  • Calf raises
  • Step-ups
  • Side leg raises

 

Periods of rest

Taking a break from rigorous workouts or normal day-to-day activities may be required to treat certain forms of knee pain. Resting allows the body to recover and heal the strain that is caused by repetitive movements. 

For minor injuries, a day or two of rest may be all that is needed to alleviate symptoms. More severe pain may require a longer recovery time. Taking rest days between especially difficult workouts can benefit your recovery in the long term.

If knee pain during exercise or daily activities plagues your life, our pain management doctors across Texas, Florida, and Orange County, California can work with you to develop an individualized recovery plan. 

 

Frequently Asked Questions

What does knee bursitis feel like?

Knee bursitis may cause a warm, tender, and swollen feeling when pressure is applied to the knee. Pain can also be felt while moving or even when resting. Knee bursitis is most commonly caused by jobs that require a lot of time spent kneeling on hard symptoms.

What are a few common symptoms of knee tendonitis?

Knee tendonitis or Patellar tendonitis is felt as pain between the kneecap and shinbone. This pain may only be felt during physical activity, but over time it will worsen and appear at all times of the day.

What happens if knee bursitis is left untreated?

If knee bursitis is left untreated, symptoms will gradually worsen over time. The bursa that lies over the knee cap may also become infected leading to additional pain, swelling, and fever.

Does knee bursitis require surgery?

Treatment for knee bursitis usually involves a combination of lifestyle changes, self-care practices, and treatments administered by a doctor that help alleviate pain and inflammation.

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Tips for Sleeping with Sciatica Pain

Sciatica is pain that involves the sciatic nerve. This nerve in the lower back runs through the hips and travels down the legs. Sciatica pain is prevalent in society today, with nearly 40% of people experiencing it at some point in life, especially as they age.

The level of discomfort can range from mild twinging to significant, chronic pain that interferes with activities of daily living. Understanding what causes the problem, and specifically how to improve comfort when sleeping, can help you better manage your sciatica pain.

 

What Causes Sciatica?

Sciatica occurs when surrounding structures pinch the sciatic nerve. This nerve becomes pinched when a disc in the spine herniates or bulges. However, bone spurs (which is an overgrowth of bone) or a tumor may also cause sciatica. This is typically a rare occurrence. Diabetes and other diseases may also be causes of sciatica since they damage the nerves by reducing the blood flow those nerves need to function properly. 

Finding the cause of sciatica pain is an important part of determining how to treat it. Since sciatica pain is often most uncomfortable when lying down to sleep, it’s important to find ways to manage the pain before bed.

 

What to Do Before Bedtime to Alleviate Sciatica Pain 

Perform Stretches Before Bed 

Stretching before bed is one of the ways you can reduce sciatica pain. Because sleeping with sciatica isn’t always easy, you want to make sure you’re doing all you can to feel as well as possible. There’s certain equipment you can use to help with these stretches, as well. Many people use a spine roller, or they roll their lower back over a tennis ball to help get more sciatica relief.

Take a Bath Before Bed

A warm or hot bath is another great way to reduce the pain you’re experiencing from sciatica. The warmth will help relax your back and its nerves, and that can make you more comfortable faster. Alternatively, you can use a hot water bottle for the same effect, either before bed or while you sleep. 

Develop a Consistent Bedtime Routine

Developing a consistent bedtime routine can help with sciatica pain, by decreasing discomfort and nerve problems and increasing relaxation. When you take the time to create a peaceful setting before bed, you make it easier for your body to heal. This may not completely alleviate sciatica, but it can help move the problem in the right direction. This may not completely alleviate sciatica, but it can help move the problem in the right direction.

Buy a Mattress That Provides Sciatic Relief 

When you have the right mattress, it can help reduce sciatica pain. There are several types of mattresses you can choose, depending on the position in which you normally sleep. But the most important consideration is to select a mattress that’s firm enough. A softer mattress doesn’t provide the support you need if you struggle with sciatica.

 

Best Sleeping Positions to Alleviate Sciatica Pain

The right sleeping position is an important part of getting relief from sciatica. Some people are simply more comfortable in certain positions than others. So, you may need to experiment a little bit to find which position is going to feel best to you. However, there are a few specific positions that can make sleeping with sciatica easier:

Sleeping on Your Side

Side sleeping can be a great choice if you have sciatica. However, you’ll notice that one side feels much better than the other. That has to do with the way your spine aligns when laying on your side and which side puts the least amount of pressure on your sciatic nerve. Pick the best side for your comfort, and you should get a better night’s sleep.

Positioning a Pillow Between Your Knees

When you put a pillow between your knees, you can help align your spine. That takes the pressure off your sciatic nerve and reduces sciatica pain while sleeping. It may not eliminate sciatica completely. However, it can help you sleep better and give the area that’s damaged or pinched a chance to start healing.

Assuming the Fetal Position

If you curl into a fetal position you open the space between the vertebrae and take pressure off of the sciatic nerve. You can sleep in the fetal position, but even just lying that way can improve your comfort.

Sleeping on Your Back With a Pillow Under Your Knees

If you prefer to sleep on your back, putting a pillow under your knees helps with spinal alignment. Make sure to use a firm pillow that’s going to provide support, because a pillow that’s too soft won’t provide the solid support you need to take the pressure off your sciatic nerve.

 

You Have Options to Reduce Sciatica Pain

Sleeping with sciatica isn’t always easy. However, the right position and treatment can help you sleep more comfortably and reduce pain. You don’t need to suffer from sciatic nerve pain when there are options to make your life (and your sleep) better. If you need assistance to make sciatica less painful while you wait for the nerve to heal, schedule an appointment with our pain specialists now. 

 

Frequently Asked Questions

What makes sciatica worse at night?

Sciatica gets worse at night because lying down puts pressure on the sciatic nerve that’s not there when you’re sitting or standing.

Does elevating legs help sciatica?

Elevating your legs, or putting a pillow under your knees, is a good way to reduce the pain that can come from sciatica.

How do you massage a sciatic nerve?

You can massage the area along your spine with your thumbs, use tennis balls to put pressure on your back while lying on the floor, or use a tennis ball against your back when sitting in a chair. A professional massage can also help.

Does bending over make sciatica worse?

Bending over can cause sciatica pain to flair up because it causes the muscles in the buttock to rub up against the nerve.

When is sciatica a medical emergency? 

If pain is severe and common treatments don’t provide relief, or if you have numbness or weakness in one or both legs, you need to see a doctor promptly. Loss of bladder or bowel control also means you should go to the ER for treatment.

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Facet Arthropathy: Primary Causes, Symptoms, and Treatments

What is facet arthropathy?

Facet joints are located on the back of the spine at each vertebral level, with one on each side. The joints provide flexibility and stability by allowing the spine to bend or turn with movement and preventing excessive motion. Facets provide counterbalance support within the spine that keeps vertebrae in healthy positions.

Facet arthropathy, or facet joint disease, is a form of arthritis in the back that causes back pain, swelling, and pain with movement. Facet joint degeneration can be exacerbated by age, obesity, lifestyle choices, as well as a genetic predisposition to having frail joints.

 

Causes of facet arthropathy

Causes of facet arthritis vary from patient to patient and their origins are not fully understood by medical professionals. One common cause is wear on bones and joints from aging. 

Certain conditions can contribute to the degradation of facet joints and the development of facet arthropathy. Those conditions include: 

  • Osteoarthritis, the most common type of arthritis, affects millions of people around the world. Osteoarthritis is caused by the protective cartilage on the end of bones wearing down over time. Most often this disorder affects joints in the spine, knees, hips, and hands.
  • Synovial cysts can lead to facet arthropathy in aging adults. Most often these cysts are found in the lower back, also known as the lumbar region. The term ‘synovial’ refers to joints lubricated by synovial fluid, a thick liquid located between joints. Synovial cysts are non-cancerous and the symptoms they cause vary depending on their size and location.
  • Back trauma can contribute to the development of arthropathy. Back trauma includes any type of accident that contributed to an injury of the spine.

 

Symptoms of facet arthropathy

General symptoms include pain and stiffness in the back. This condition causes a dull aching on one or both sides of the lower back, centered on a specific area of the spine. It may be worse after an extended period of rest or sleep as well as when twisting, bending backward, and standing. 

The location of the pain varies depending on the type of facet arthropathy being experienced. Neck facet arthritis is often felt behind the ears and in the shoulder region whereas lumbar facet arthritis pain is felt in the lower back and radiates toward the hip, thigh, or buttocks.

Facet arthropathy may cause the development of other conditions of the spine including spinal stenosis and bone spurs.

In cases of facet arthropathy caused by synovial cysts, some people experience pain in the back and legs that is made worse by standing or walking. Similarly, bone spurs caused by facet arthropathy can lead to pain, numbness, and weakness in the legs and buttocks.

 

Diagnosing facet arthropathy

If you are experiencing any of these symptoms, reach out to our spine specialists immediately for a complimentary consultation. At your appointment, the doctor will review your symptoms and medical history and perform a physical exam. 

The doctor may then order one of the following tests to diagnose facet arthropathy:

  • Bone scan
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • X-ray

 

Treatments for facet arthropathy

There are several ways facet arthropathy can be treated. If your pain is mild, your doctor may recommend avoiding motions that increase your pain. For example, extending the lower back, lifting heavy objects, or excessively twisting your torso, all of which can exacerbate lower back pain. 

Anti-inflammatory medications may be prescribed to relieve some pain in the spine. An epidural steroid injection is the delivery of strong anti-inflammatory medicine directly into the space around the spinal cord (the epidural space). This is an outpatient procedure that is recommended to patients who did not experience relief from changes in activity or medications.

Laser-assisted spine procedures can help with symptoms of facet disease. These minimally-invasive spinal decompression procedures include:

  • Foraminotomy: the enlargement of the area around one of the bones in the spinal column to relieve pressure on compressed nerves.
  • Laminotomy: the removal of a portion of the lamina, the back part of a spinal bone which will create a hole that is just large enough to relieve pressure.
  • Laminectomy: the removal of all or most of the lamina.
  • Radiofrequency ablation (RFA): shrinking the size of nodules, growths, and tumors, or cysts along the spine.
  • Discectomies: the removal of the damaged part of a disk in the spine

If physical therapy or other noninvasive treatments are unsuccessful and in cases of more advanced facet arthropathy, your doctor may recommend back surgery. Back surgery is needed when there is a nerve-root compression which requires the removal of facet joints that are fused together. 

Facet joint ablation is an additional type of treatment that involves the destruction of the facet nerves using electrical shocks.

Treatment for facet arthropathy varies depending on the extent of your lower back pain. If you are experiencing symptoms similar to those we’ve described, let us show how you can live pain-free.

 

Frequently Asked Questions

 

Can facet arthropathy lead to other conditions?

Facet arthropathy can contribute to the development of bone spurs and spinal stenosis.

What is the outlook for facet arthropathy?

Those experiencing pain from facet arthropathy usually respond well to forms of physical therapy. More progressed stages of this condition may require minimally invasive procedures or surgery, but pain relief is still possible. 

Does facet arthropathy require surgery?

Facet arthropathy may require surgery if other forms of treatment or physical therapy are not successful at alleviating lower back pain. Noninvasive or minimally-invasive techniques can be attempted before surgery.

Can a pain doctor help alleviate facet arthropathy?

Pain management doctors may help alleviate pain from facet arthropathy by recommending stretches and exercises of the lower back. In certain cases, medication and surgery may be required.

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TMJ Headaches: Symptoms, Treatments and Causes

If you’re experiencing frequent headaches, it’s essential to find the cause. In many cases, the pain in your head may be coming from your temporomandibular joint (also known as TMJ) instead. So, how can you find out? Plus, what kinds of symptoms should you be looking for? 

Here’s what you need to know about how TMJ causes headaches, and what kinds of treatments may help you reduce or eliminate headache pain.

 

What is TMJ?

The temporomandibular joint is the jaw joint, which allows you to open and close your mouth. You need it to talk, eat, drink, laugh, and sing. But sometimes, it doesn’t align quite right, or there’s too much pressure on it. That can lead to TMJ, which is an interchangeable term for TMD (temporomandibular disorders). Often, pain is one of the problems you encounter that indicates issues with this joint.

 

How Does TMJ Differ From Headaches?

TMJ causes pain in the jaw, but it can also lead to pain in the neck and head. Many people with TMJ experience headaches, but they might not realize the connection between the two issues. A headache typically involves pain in the sides or front of the head but can also include pain in the back of the head and neck. Since TMJ causes headaches, someone with this condition can experience pain in these areas that come from their temporomandibular joint, as opposed to coming from other headache sources.

 

What are Common TMJ Disorder Symptoms?

Some of the most common symptoms of TMJ include clicking or popping noises in the jaw when chewing or yawning, facial pain, and changes in your bite. You may also experience dizziness, earaches, numbness in your fingers, or pain in your eyes, face, shoulder, or back. If you notice any of these issues, especially if you experience them frequently, you may have TMJ.

 

Risk Factors of TMJ

Clenching or grinding your teeth (bruxism) is a common behavior that can lead to TMJ. Most people who clench their jaw or grind their teeth don’t notice that they’re doing it, especially if it happens while they’re asleep. Other risk factors for TMJ include having an overbite, arthritis, nutritional deficiencies, structural changes such as missing teeth, and emotional issues such as stress or anxiety.

 

Popular TMJ Relief and Treatments

There are several available treatments for TMJ. These involve prescription, surgical, and at-home treatments that require lifestyle changes. Needing more than one type of treatment is also possible. Generally, your dentist considers the severity of your TMJ and its causes when making treatment suggestions.

 

Prescribed Treatments

Some of the most commonly prescribed treatments for TMJ relief include dental appliances such as clear aligners or a mouth guard. These protect your teeth when you have TMJ and gently realign your jaw to reduce pain and discomfort. Often, they’re used in conjunction with lifestyle changes.

 

Surgical Treatments

In severe cases of TMJ, surgical realignment of the jaw may be necessary. This is generally only suggested when the issue is significant enough to make talking, eating, and other daily activities difficult. People with a severe overbite or underbite sometimes need surgical correction to their temporomandibular joint.

 

At-Home Treatments

Conversely, there are at-home treatments that relax your jaw and also reduce TMJ headaches. These treatments include massage and stretching, which help reduce jaw clenching and keep the muscles around the temporomandibular joint looser and less tense. You can also work to identify the behaviors or movements that contribute when TMJ causes headaches. Avoiding those movements and behaviors reduces pain and discomfort.

 

Help is Available for TMJ Headache Pain

If you’re not experiencing any symptoms besides headaches then there may be another cause for your discomfort. However, if your headaches are caused by TMJ, it is something you and your dentist can manage together. Getting to the root of the problem will help you manage it and reduce your pain.

If you experience headaches and want to know if TMJ is the cause, schedule an appointment with us today at Physician Partners of America. We are here to help.

 

Frequently Asked Questions

 

What is the most common treatment for TMJ?

The most common treatment for TMJ is lifestyle changes that can reduce discomfort. These are usually the first line of defense unless there is a very severe case. If lifestyle changes don’t work for TMJ, then mouthguards, clear aligners, and other treatments may be necessary.

 

Is TMJ a medical or dental problem?

TMJ is both a medical and a dental problem. Clenching and grinding your teeth, for example, can lead to many dental health issues that require treatment. But these kinds of behaviors also contribute to TMJ and the problems it causes with headaches and other pain. Because this is a two-fold issue, getting to the bottom of it can prevent various issues. For example, tooth damage, headaches, shoulder, back, and neck pain, dizziness, and other symptoms.

 

What will a pain specialist do for TMJ?

A pain specialist will first do a thorough evaluation of your bite and may take x-rays to see how your temporomandibular joint moves. If there are issues found, then the severity of your condition will be what the specialist uses to decide on a treatment plan. Common treatment options to alleviate pain include the use of Botox and trigger point injections. Each cause of TMJ is very individual, but most are not severe and very treatable with lifestyle changes and oral appliances.

 

How do you know if you have TMJ headaches?

Even though TMJ causes headaches, that doesn’t necessarily mean the cause of your headaches is your jaw joint. The best way to determine whether your headaches are coming from TMJ is to consider any other symptoms you’re experiencing. If you have a clicking or popping in your jaw, earaches, dizziness, neck pain, and eye pain, that’s a pretty good indication that TMJ could be the issue.

 

What is the connection between TMJ and head or neck pain?

According to one study1, experts determined that as much as 70% of head and neck pain issues may be related to TMJ. Seeking help for this misalignment of the jaw joint can reduce discomfort and alleviate pain for many patients. Physician Partners of America provides trigger point injections and other services to reduce pain and address TMJ, which treats the problem at its source.

 

 

Sources:

  1. A. Silveira, I. C. Gadotti, S. Armijo-Olivo, D. A. Biasotto-Gonzalez, D. Magee, “Jaw Dysfunction Is Associated with Neck Disability and Muscle Tenderness in Subjects with and without Chronic Temporomandibular Disorders”, BioMed Research International, vol. 2015, Article ID 512792, 7 pages, 2015. https://doi.org/10.1155/2015/512792 
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Lateral Knee Pain: Primary Causes and Treatments

Lateral knee pain refers to pain you feel outside or around your knee joint. Depending on the cause of the injury, the pain may be a general ache or a specific sharp pain associated with a certain type of movement. You may experience outer knee pain that worsens with time or feel acute pain immediately after an injury. If the injury is associated with neural damage or impaction, you may also feel pins and needles, tingling, and/or numbness.

What are the Causes of Lateral Knee Pain?

Localized lateral knee pain is usually caused by injury to one of the tissues (nerve, tendon, muscle, or bone) on the outside of your knee. This could be the result of a sporting injury, overuse, or age-related degeneration.

Osteoarthritis

Osteoarthritis, (wear and tear arthritis) is the degeneration of the protective layer of cartilage within a joint. With the cartilage wearing away, the ends of the bones begin rubbing together. This causes severe discomfort and leads to bone damage and inflammation within the joint.

Osteoarthritis (OA) is more common in people over the age of 50.1 Knee OA occurs more frequently in people who play intense sports and have had previous knee injuries. There is a genetic correlation with the prevalence of OA. The risk of developing OA is higher if there is a family history of OA.

Iliotibial Band Syndrome

Iliotibial band syndrome (ITBS) is the most common cause of lateral knee pain. The iliotibial band is a thick tendon that runs along the outside of your thigh from the iliac crest down to the knee. ITBS, inflammation of the iliotibial band, is usually a non-traumatic injury caused by overuse. The outer knee pain associated with ITBS usually worsens with exercise such as running, hiking, cycling, climbing stairs, or squatting.

Differences Between Inner and Outer Knee Pain

Depending on where in the knee the injury occurs, there are slight differences between inner and outer knee pain.

Meniscus Tears

The meniscus is a C-shaped piece of cartilage that acts as a shock absorber between the femur (thigh bone) and tibia (shin bone). There are two menisci in each knee joint. One on the outside of the knee (lateral) and one on the inside (medial). A medial meniscus or lateral meniscus tear can occur because of a single acute injury such as a quick turn during sports. It can also be a result of degeneration due to overuse or age.

MCL vs. LCL tears

There are two collateral ligaments on the sides of your knee. On the inside of your knee, the medial collateral ligament (MCL) connects the femur to the tibia while the lateral collateral ligament (outside) attaches the outer side of the femur to the fibula. These ligaments control the side-to-side movements of your knees and brace them against unnatural motion. Collateral ligaments may tear during sporting activities when you change direction quickly, stop suddenly, or are tackled.

Injury to the MCL will cause pain on the inside of your knee, while an LCL tear will result in pain on the outside of your knee. The pain often worsens with bending your knee, walking, or climbing stairs. Swelling may occur around the injury site, and you could feel as if your knee is giving away when you stand up or try to walk.

How Do You Relieve Lateral Knee Pain?

The best treatment for lateral knee pain depends on the underlying cause of the pain. A treatment plan will usually combine physical therapy, specific exercises to strengthen adjacent muscles, and rest from strenuous or aggravating exercises. Depending on the origin and severity of the lateral knee pain, your treatment protocol may even include injections and/or surgery.

At-Home Treatment for Knee Pain

For pain resulting from soft tissue injuries such as a sprain, the following treatment may help:

  • Ice wrapped in a cloth can lessen pain and inflammation.
  • The application of a hot water bottle or heating pad can relax muscles and improve lubrication within the joint.
  • Resting with your leg raised just above heart height will encourage circulation and decrease swelling.
  • Support of the knee joint with compression or bandages can improve your comfort levels.

Professional Treatment for Knee Pain

There are several treatment options for knee pain. The protocol you and your doctor choose will depend on the extent of your pain and what is causing it. You may consider some of the following options:

  • Lateral knee pain caused by osteoarthritis is usually treated with medication and physical therapy.
  • Orthopedic surgeons can repair tendon and ligament tears with minimally invasive surgery.
  • Injecting corticosteroids, lubricants (hyaluronic acid), or platelet-rich plasma (PRP) directly into the knee can help reduce inflammation and improve mobility.
  • Severe damage to bones in the knee joint may require knee replacement surgery.
  • Acupuncture may help with lateral knee pain.

What are the Top Risk Factors that Lead to Lateral Knee Pain?

Systemic Inflammatory Disease

An overactive immune system can cause joint inflammation or inflammatory arthritis (IA). IA conditions such as gout and rheumatoid arthritis can be painful and incapacitating.

Previous Injury

People who have previously had a knee injury are more likely to re-injure their knee.

Lack of Muscle Flexibility

Strong, flexible muscles help to prevent injury by providing good joint support and range of motion.

Bursitis

Bursae are small synovial-secreting sacs that cushion joints and reduce friction during movement. There are 11 bursae in each knee. Bursitis, inflammation of one or more of these sacs, may cause knee pain and limited mobility.

Tendinitis

Biceps femoris tendinitis is the degeneration or inflammation of the hamstring tendon (biceps femoris) that connects at the back of the knee. Tendinitis may cause stiffness in the knee joint first thing in the morning or after sitting for a time. It could also result in pain and swelling at the back of the knee.

How to Prevent Lateral Knee Pain

Individuals who are overweight or obese are at higher risk of lateral knee pain. Maintaining healthy body weight is vital for reducing inflammation and limiting stress on joints like the hips and knees. Regular low-impact exercise can boost the health of cartilage tissues in the joints and strengthen muscles that support the joints.

Regular sessions with a physical therapist can help to strengthen muscles and other tissues adjacent to the knee joint. This will result in better support of the joint, quicker rehabilitation, and a decreased likelihood of injury.

Find the Right Treatment Protocol for Your Lateral Knee Pain

Knee pain affects almost one in four Americans.2 Whether your lateral knee pain stems from chronic inflammation or degeneration, there are several treatment options available.  Our pain specialists can help to address your knee pain. If you need assistance finding the right treatment protocol, schedule an appointment today to discuss your knee pain and the treatment options available.

 

Frequently Asked Questions

Is it better to keep a sore knee straight or bent?

It is advisable to keep your leg straight as much as possible. If you have to sit with crossed legs, try to minimize it to 20 minutes at a time. The best sleep position for knee pain is to lie on your back with your knee slightly elevated.

What exercises should be avoided with lateral knee pain?

Avoid any exercise and movement that places excessive strain on the knee joint such as deep lunges and deep squats. Also, steer clear of activities that jar your joints such as running, jumping, and kicking.

How do you stretch the lateral part of the knee?

The knee joint attaches to several muscles, so it is essential to stretch all these muscles. Stretches such as knee straighteners, straight leg raises, side leg raises, calf stretch, and seated hamstring stretch.

 

Sources

  1. Lawrence et al, 2008.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266664/
  2. Nguyen et al, 2011. https://acl.gov/news-and-events/news/one-four-adults-suffers-chronic-knee-pain / https://www.acpjournals.org/doi/10.7326/0003-4819-155-11-201112060-00004?doi=10.7326%2F0003-4819-155-11-201112060-00004
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Phantom Limb Pain: Causes, Symptoms, and Treatment

Amputations are one of the most difficult medical experiences a person can go through. Not only is one’s mobility and lifestyle affected but the grief of losing an appendage can turn someone’s life around. In many cases, both the body and mind have trouble adjusting to the loss of a limb which can result in some unexpected symptoms, including phantom limb pain.

Phantom limb pain is a common occurrence among amputees but is often difficult to talk about because of the physical and emotional experiences that go along with it. Don’t be afraid to talk to your doctor and ask for support. The sooner you seek help, the easier it is to recover from these symptoms.

What is phantom limb pain?

Phantom limb pain is a side effect of amputations in which the patient feels pain in a limb that was amputated. This is similar to phantom limb sensations, where the amputee still feels as if the limb is there. However phantom limb pain is typically more debilitating, as the pain is just as intense as if the limb were still attached to the body.

While phantom limb pain is most common in patients who have lost arms or legs, it can be felt by patients who have lost eyes, tongues, breasts, or other body parts.

What causes phantom limb pain?

It can be both frustrating and confusing for patients to experience phantom limb pain. We think of pain as a physical response to external stimuli; so, if the stimuli aren’t there, why is the pain? For decades, doctors believed that this condition was solely a psychological phenomenon. However current research suggests that patients are actually experiencing the brain’s way of “rewiring” the nerves after amputation. Your nervous system is highly complex and the brain needs time to understand your body’s new “layout” before it can begin to process external stimuli correctly.

It is believed that part of phantom limb pain is the brain’s way of warning the body that something is wrong. When the nerves are damaged or missing at the site of the amputation your brain received new signals that aren’t in alignment with what it understood before. Therefore, it sends pain signals as a sort of “memory” of where the limb used to be. Your brain is simply trying to catch up with your body.

Approximately 8 out of 10 patients experience some form of phantom limb pain after amputation. Some of the factors that can increase the likelihood of phantom limb experiences include:

  • Angina (chest pain due to low oxygen to the heart)
  • Changes in temperature or barometric pressure (similar to how the weather affects arthritis patients)
  • Constipation
  • Shingles
  • Physical touch
  • Smoking
  • Emotional stress

Symptoms of Phantom Limb Pain

Phantom limb pain is your brain’s way of adjusting to amputation and typically gets better with time. However, it is very common for amputees to experience one or more of the following symptoms while they are physically and emotionally healing from their amputation:

  • Stabbing or aching pain in the area of a lost limb
  • Pain near the amputation site after the body has healed
  • Pain in the area of the amputated limb farthest from the body (for example, pain in the hand of an amputated arm)

This condition can be exacerbated by emotional stress and real pain at the site of the amputation, either from the healing process or from an uncomfortable prosthetic. However, with the help of a specialist, you can seek lasting relief from your pain.

How to treat phantom limb pain

Phantom limb pain is difficult to treat because it originates in the brain rather than the body. A variety of treatment options exist and are typically tailored to the patient’s history and severity of their symptoms. In addition to medications and interventional medicine, several unconventional therapies have proven effective, such as:

  • Mirror box: A mirror box is a device that helps patients to visualize the missing limb as if it were there, helping the brain process and reduce the pain. For example, a patient with an amputated leg sits with the mirror facing their intact leg. They can then do exercises or move their leg to visualize the other leg as if it were still there. This has shown to help some patients reduce phantom limb flare-ups.
  • Acupuncture – Acupuncture is used for a variety of chronic conditions and is showing promising results with phantom limb patients. Acupuncture works to trigger self-healing mechanisms in the body, and is widely accepted in the medical community as a treatment for chronic pain.

If traditional therapies have not worked for you in the past, talk to PPOA about other treatment options. We take a holistic approach to pain management that utilizes a variety of techniques and medical interventions to provide you with long-lasting relief. To learn more about your options, contact your local PPOA office today.

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What Is Interventional Pain Management?

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Chronic pain is one of the most common complaints of patients in the U.S., with approximately 50 million Americans (over 20% of the population) experiencing some type of pain regularly. Causes range from work-related injuries to repetitive stress, but these patients share one thing in common: they want relief, and in many cases, interventional pain management is able to provide it. Long-term pain has significant economic, social, and emotional impacts on individuals, and deserves to be treated with the utmost concern.

Not all chronic pain sufferers seek out treatment, and those that do often do not experience the results they hoped for. If traditional therapies are not working to reduce your everyday pain, you may want to talk to your doctor about interventional pain management.

What is Interventional Pain Management, and how is it different from traditional treatments?

Interventional pain management is a type of pain management plan that uses pain-blocking procedures and medicines to stop the pain patients regularly experience. These therapies “intervene” with the nerve signals, rather than trying to treat the source of the pain. These techniques are used for patients who have not responded to less invasive options such as prescriptions or physical therapy, and for conditions where a root cause cannot be found.

Interventional pain management is particularly helpful with chronic pain conditions, where the source of the pain can be unclear, or in cases where the injury has healed but the pain remains. Interventional therapies do not have to be “invasive” but are considered any type of treatment that targets the nerves causing pain.

Types of Interventional Pain Management

Interventional pain management consists of all types of therapies used to block pain sensations, ranging from nerve-blocking implants to infusions and other drug therapy. Below are some of the most common types of interventional pain procedures your doctor may use to treat you:

  • Nerve blocks: As the name suggests, nerve blockers simply block the pain receptors in the nerves to inhibit the sensation of pain in a particular area of the body. Nerve-blocking treatments range from minimally invasive procedures that last for a few hours, to permanent and semi-permanent surgical implants.
  • Infusions: Infusions are a type of drug therapy that infuses pain medications directly into the body. Most are delivered through catheters or an epidural and are typically used for long-term pain relief.
  • Injections: Similar to infusions, injections target pain at the source by delivering steroids and numbing drugs to the area affected by pain. These can be used for short- or long-term pain relief and can target joints, muscles, or other areas of pain.
  • Radiofrequency ablation: Radiofrequency ablation uses radio waves to target areas of the back and neck affected by nerve damage. The radio waves create heat which in turn reduces pain and is particularly effective to treat arthritis.

Surgeries are also sometimes used to treat or block nerve pain, but only if the damage is severe and does not respond to traditional methods. These interventions, along with other less invasive options such as physical therapy, can be used in tandem to create long-lasting relief for patients.

At PPOA, we work with patients to create long-lasting solutions to pain that help them get their lives back. We manage short- and long-term treatment plans and ensure that patients are informed of all of their options before making a decision. If you are interested in solutions for your chronic pain, talk to a PPOA specialist today.

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What Is Pain Management?

Chronic pain is unfortunately one of the most common causes of doctor’s visits in America. All over the country, people are searching for answers to their back, joint, muscle, and all-over body pain with very few answers from their general practitioner. However, the answers they are searching for can be found, with the help of a pain management specialist.

Pain management is the field of medicine that focuses specifically on pain – chronic pain, acute pain, and pain caused by other conditions such as cancer. A pain management center can give you a more tailored approach to your treatment than a primary care doctor can, with the help of a variety of specialties working together.

What is a Pain Management Specialist?

A pain management specialist is a physician that specializes in the diagnosis and treatment of acute and chronic pain. While a variety of specialists fit within the pain management category – such as surgeons, chiropractors, physical therapists, and even psychiatrists – many of them work together to create comprehensive approaches to pain that can work in the short- and long-term.

Pain management specialists can help identify the underlying causes of your pain, whether it’s repetitive stress or a previous injury, and will tailor a pain management plan to suit your needs.

They will create a step-by-step plan, beginning with the least invasive options, and work through potential solutions until you find what’s right for you. Some of the common methods used by pain management specialists include acupuncture, physical therapy, chiropractic medicine, at-home remedies, and interventional medicine.

Chronic vs. acute pain management

Pain management specialists treat both acute and chronic pain, but the treatment plans are very different. Acute pain is a type of pain that is caused by a specific injury or ailment and typically goes away after that injury is healed. Most people who experience acute pain come in because they know something else is wrong, and the treatment of the injury itself typically resolves the other symptoms. While it may take up to six months for acute pain to go away completely, it will be treated by treating the underlying issue, and with supplementary methods until the body is fully healed.

Chronic pain, on the other hand, is considered a condition all its own. Chronic pain can start from an underlying injury, but if it does not go away as the injury heals, it means that something else is wrong with the body that needs to be addressed. Chronic pain can be caused by repetitive stress, injuries that did not heal properly, or abnormalities in the nerves that cause secondary issues.

Chronic pain is more difficult to treat and therefore requires a multi-disciplinary approach to achieve long-lasting results. Chronic pain is also frustrating to the patient, as it can impact mobility and lifestyle for months or even years if left untreated. Many chronic pain patients seek both medical help and mental health support, as chronic pain is a common cause of depression and anxiety as it limits a person’s ability to enjoy a normal life.

What treatment options are available to me?

When you visit a chronic pain specialist for the first time, you will likely sit down for a consultation to go over your medical history and previous diagnoses. If you don’t have a diagnosis for your pain, this will be the first step followed by a long-term pain management plan. Depending on the type and severity of your pain, your physician may recommend one or more of the following treatments:

  • Over-the-counter and prescription pain relievers
  • Physical therapy
  • Medical and surgical interventions
  • Meditation and mindfulness practices
  • Heat therapy
  • Exercise and lifestyle changes
  • Mental health treatment to assist with psychological symptoms of chronic pain

PPOA works with our patients one-on-one to ensure they get the long-lasting relief needed to get their lives back. If you have been experiencing pain with little to no relief, contact our local offices today to find a pain management specialist who can help you thrive.

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What is Causalgia?

Are you suffering from long-lasting, intense pain after a nerve injury? If so, you’ve likely been through the wringer when trying to find pain solutions that work. Many nerve injuries, and the chronic pain that often comes with them, go undiagnosed and thus untreated for many years. If you’re struggling to find solutions, you may be suffering from a rare but treatable condition called Complex Regional Pain Syndrome Type II (CRPS II), or causalgia.

CRPS II is a neurological disorder that causes intense pain radiating from the extremities. Typically caused by a trauma or injury to the peripheral nerves, this type of pain is rare and can be difficult to diagnose. However, with the help of a pain specialist, you may be able to find long-lasting solutions to reduce or even eliminate your pain.

What is Causalgia?

Causalgia, or CRPS II, is a very rare chronic pain condition, affecting less than one in 100,000 Americans on average. This condition occurs when one of the peripheral nerves (nerves in your arms, legs, and other extremities) is injured in a fracture, sprain, surgical procedure, or other trauma. This condition is unfortunately common in elective foot and ankle surgeries, affecting approximately 1.8 percent of post-surgical patients. Other causes of CRPS II include:

  • Burn incidents and other soft-tissue trauma
  • Crushing injuries and fractures
  • Injuries to the brachial plexus
  • Amputation

It is not fully known why some patients develop CRPS II after injuries and others do not. It is believed that some patients may have abnormalities in the structure and lining of their nerves, or that some patients experience more inflammation in the nerves, which in turn causes hypersensitivity to the pain.

Symptoms of CRPS II

CRPS II has similar symptoms regardless of whether it occurs in the arms, legs, neck, or other extremities. Most patients report one or more of the following symptoms:

  • Burning or aching in a particular muscle or joint in the body
  • “Pins and needles” feeling in the affected area
  • Pain lasting longer than six months that seems disproportionate to the injury the patient experienced
  • Hypersensitivity to touch surrounding the injury
  • Swelling or stiffness in one or more areas of the body
  • Changes in skin color or temperature in the affected area

Unfortunately, because these symptoms seem disproportionate to the original injury, CRPS II patients are often not heard by their doctors and peers, as it is assumed they simply have a low pain tolerance. But this is not true, and those experiencing intense pain after an injury should seek help for their chronic pain to ensure it gets treated promptly.

How CRPS II is Diagnosed and Treated

Most CRPS II patients are diagnosed through patient history, a physical examination, and a series of tests including MRIs and X-ray scans to understand the point of origin of the pain. Physical examinations may be difficult to perform due to the level of pain experienced by the patient. However, the physician must first eliminate more common causes of pain such as fibromyalgia to effectively treat CRPS II.

Treatment for CRPS II is multi-faceted and will include a variety of methods tailored to your needs and pain experience. Common treatments for CRPS II include:

  • OTC and prescription pain medications
  • Traditional physical therapy
  • Transcutaneous electrical nerve stimulation (TENS), a type of physical therapy that sends electrical impulses through the body to block pain signals.
  • Heat therapy

PPOA offers a variety of approaches to treating CRPS II, ranging from at-home remedies to interventional therapy that can create lasting pain relief. If you are interested in consulting with a pain specialist about your CRPS II or chronic pain after an injury, contact us today.

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