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Medical Blog
1) Shoulder pain
2) Could I Be Suffering from a Herniated Disc?
3) What is the Sciatic Nerve? What is Sciatica?
4) 3 Things you can do now to prevent future back pain


Shoulder pain

Shoulder pain is all too common. A few of you have shoulder pain following a fall. Many more suffer from shoulder pain due to repetitive stress, and the majority of simply woke up with shoulder pain and have no idea how you injured yourself.

Many of you can't sleep at night, yet others only have pain when they exercise. A few of you might be worried that your shoulder will dislocate at night.

There are many structures in the shoulder which can become injured and lead to shoulder pain. The 5 most common causes of shoulder pain we see include:

• Labral Tears
• Rotator Cuff Tendinosis
• Rotator Cuff Tears
• Calcific Tendonitis
• AC Joint (Separations and Arthritis)
• Stress Fractures

The cause of your shoulder pain has a lot to do with what age group you are in. Different problems arise in the shoulder and cause pain as we age. In each grouping I provide links which go into more detail on the specific diagnosis which is mentioned.

Causes of Shoulder Pain

Age 14-20:

In the pediatric population most of you have shoulder pain due to a traumatic event, a fall, a tackle or a tumble off your new hoverboard. Shoulder dislocations are one of the leading causes of shoulder pain in this age group.

Labral tears are a very common source of shoulder pain in the pediatric athlete. The labrum is a cartilage disk that helps maintain stability of the shoulder. Pitchers and overhead athletes can develop a labral tear from repetitive stress. Football, soccer and other contact sports can produce a dislocation which leads to a different type of labral tear.

Stress fractures arise in this age group because their bones might still be growing. The "growth plate" will start to fail with the chronic repetitive stress of pitching in excess.

Age 20-35:

Labral tears are still very high on the list of possible causes of shoulder pain, particularly if you are under 30.

The AC Joint: Especially in the heavy weight lifter and football players the AC Joint — or that little bump above your shoulder can start to wear out from the constant weight training. Following a severe fall you might also suffer an AC Separation where the bump on top of the shoulder becomes much more prominent.

Rotator Cuff Tendonitis: This is the first group where the rotator cuff can start to become a cause of shoulder pain. In these instances, you were likely working out heavily and now the front or side of your shoulder is very sore with minimal activity. It is very easy to exceed what the rotator cuff is capable of handling. If you exercise the larger muscles around the shoulder and do not pay attention to exercising the rotator cuff the the cuff might simply remind you by causing a deep dull ache on the side of the shoulder for a few weeks.

Age 35-50:

The rotator cuff starts to become the number one source of shoulder pain. The most common cause of rotator cuff related pain is a process we call rotator cuff tendinosis. That is a process where your rotator cuff is starting to show its age and it is starting to wear out. Early in the process of wearing out, the rotator cuff doesn't actually start tearing … it simply starts hurting.

If the rotator cuff wears out enough then it may develop into something we call a partial thickness rotator cuff tear. Partial tears are very common… even in people without shoulder pain. Again, this is part of the aging process. Some of your tendons will start to degenerate at a younger age than others … and some of you will have more pain than someone else with a partial rotator cuff tear.

Full thickness rotator cuff tears can occur following a significant injury. Unfortunately the majority of you have a full tear simply because your tendon wore out. This post goes into detail on the causes of rotator cuff tears. Many rotator cuff tears are small. You can have very severe shoulder pain and have no tear or just a small tear. This is one of those moments when size doesn't matter. The amount of pain that you have will not correlate with the size of your rotator cuff tear. The treatments of rotator cuff tears vary depending on many factors.

Calcific tendonitis causes very severe shoulder pain. In calcific tendonitis you develop a calcium deposit in the middle of your rotator cuff tendon. When your body is trying to reabsorb or take back the calcium it sets off a series of events which leads to severe pain. The treatment is usually straight forward and doesn't involves surgery. This post goes into more detail about calcific tendonitis.

Age 50+:

The rotator cuff remains the most common cause of pain.

Cause of rotator cuff tears

Treatment of rotator cuff tears

Can small rotator cuff tears become larger?

Labral tears are rarely a cause of shoulder pain after 50. We all have them… but they are not the reason why our shoulder hurts. The labrum frays and wears out like your favorite pair of blue jeans. Labral tears are a very uncommon cause of shoulder pain after the age of 50.

Osteoarthritis: After 50 and beyond the cartilage which covers the bones can start to wear thin and degenerate. This is the definition of osteoarthritis. Your symptoms start with a dull ache after activities and sometimes the shoulder starts to click and catch when the osteoarthritis is more severe.


Could I Be Suffering from a Herniated Disc?



Lower back pain has been found to be the number one cause of disability around the world. Though many conditions can cause back pain, a herniated disc is a common cause. Discs are the soft, rubber-like pads that fit between the bones (vertebrae) of the spinal column and cushion it. The discs allow the back to flex and bend and absorb shock. Herniated discs, which can also be called slipped or ruptured discs, are caused when all or part of the disc is forced through a weakened part of it, which places pressure on the nearby nerve and/or spinal cord, causing numbness, and most commonly, pain. Herniated discs can occur both in the lumbar spine (lumbar herniated disc) and the cervical spine (cervical herniated disc).

This can happen when the disc moves out of place (herniates) or breaks open (ruptures) due to injury or strain. It is most commonly found to happen in the lower back, but can also affect the neck's discs, or, even more rarely, the discs in the upper-to-middle back.

Herniated Disc Risk Factors

If you're not sure if a herniated disc is causing your pain, Orthopedic Surgeons point out a few factors that can put you more at risk:

Usually, herniated discs are caused by the natural aging of your spine. When we're young, our discs have a high water content, making them spongy. When we age, they begin to dry out, becoming weaker and narrowing the spaces between our vertebrae. This is called disc degeneration.

Men between 30-50 are more likely to have a herniated disc

Jobs or tasks that require you to repeatedly lift heavy objects can put you at risk, especially if you are lifting with your back and not your legs, or if you are twisting while you lift.

Being overweight can add stress on the discs of your lower back

If you are frequently in the car, staying seated for long periods of time along with the vibrations of the car, can put pressure on your spine and discs Staying sedentary can cause herniated discs

Smoking can reduce the amount of oxygen reaching your discs to cause more rapid degeneration

Herniated Disc Symptoms

For most people suffering from a herniated disc, lower back pain is the first symptom. The pain may come and go, but can eventually lead to leg pain, numbness or weakness. These sensations can reach all the way below the knee, to the ankle and foot.

Additionally, the symptoms can be all or one of the following:

• Back pain
• Leg and/or foot pain (sciatica)
• Numbness or tingling in the leg and/or foot
• Weakness in the leg and/or foot

If you feel like you may be suffering from a herniated disc, see your orthopedist for a physical examination or MRI scan, so they can make sure that it's the cause of your back pain. Due to a wide range of non-surgical and surgical treatments available, most patients are free from their symptoms in 3-4 months!


What is the Sciatic Nerve? What is Sciatica?



Over 85 million Indians suffer from back pain. In fact, according to the National Institute of Neurological Disorders, back pain is a leading cause of missed work and the most common cause of job – related disability. Many times, pain in the lower back could be caused by a condition called sciatica. Sciatica is a condition often caused by a ruptured or herniated disk that irritates the sciatic nerve. The sciatic nerve is formed from the nerve roots coming out of the spinal cord into the lower back. When the nerve is irritated it can cause debilitating pain, numbness or a tingling sensation down the leg and occasionally all the way to the foot. At times, the pain is so severe that the pain sufferer may lose control over the leg.

Causes of sciatica

• Piriformis syndrome
• Spinal Stenosis
• Pregnancy

Treatments for sciatica

Depending on the cause of the sciatica, it can take weeks to years to relieve the pain from the condition. Research has not shown that low activity versus high activity and physical therapy will help the symptoms. Although medications do not always relieve the pain in the sciatic nerve, medications are typically the first line treatment option. If medications don't work, the physician will work with the patient to determine the next steps which could include surgery, epidural injection or alternative medicines.


3 Things you can do now to prevent future back pain



At some point in our lives, most of us struggle with lower back pain. The good news is it's never too late to make positive changes in your lifestyle. Preventive steps now can help keep your back healthier down the road. These three things may make the difference between future suffering and living pain free:


1) Get active

Staying active may be the single most important thing you can do to maintain a healthy back. When you don't get enough exercise, the muscle tone in your lower back can weaken, which may cause the pelvis to tilt too far forward, causing back pain. Regular exercise helps prevent back pain by strengthening your back and abdominal muscles. Just 30 minutes a day of a low-impact exercise like swimming, walking, or stationary cycling can increase muscle strength and flexibility. Yoga is also great for stretching and strengthening muscles and improving posture. If you're already experiencing back pain, you may want to meet with an physical therapist, who can customize an exercise plan for you.

2) Lose weight

If you're overweight or obese, chances are you already experience back pain. One of the best things you can do now to ease pain and prevent future back pain is to lose weight. Being overweight or obese affects not only the cardiovascular and endocrine systems but the skeletal system. The skeletal system is made to support a healthy weight. Obesity puts an extra strain on all your weight-bearing joints, such as the hips and knees, but also on the spinal column. The resulting poor posture can cause chronic back pain.

3) Stop smoking

If you're a smoker, you already know it's not healthy. But you may not have realized it can contribute to back problems, not just later in life, but now. Many of the chemicals in cigarettes, including nicotine, have been shown to be toxic to spinal disc cells in laboratory experiments. Also, the carbon monoxide in cigarettes decreases the amount of oxygen in the blood. Because spinal discs have no capillaries, they rely on osmosis for oxygen delivery. Without oxygen-rich blood, the discs don't get the nutrients they need, making them brittle and at risk for rupture.

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