Your brain needs rest, but your legs are restless?

Restless Leg Syndrome/Willis-Ekbom disease (RLS/WED) is a rising topic in our office, on television, and in everyday conversation. RLS/WED can begin at any age and generally worsens as you age. Many patients describe abnormal and unpleasant sensations in their legs and feet at night; less commonly the sensations affect the arms. Sometimes the sensations wake them up, and other times they keep them from going to sleep. Descriptions range from itching and crawling to aching and throbbing, but the one thing they seem to have in common is that movement seems to ease the discomfort. So, what gives, right? You’ve worked all day and you’re tired; you take a hot bath, drink your herbal tea, watch one last episode of The Golden Girls and your mind is ready to rest, but your legs are not? Frustrating, right?

Well, first it’s important to understand that there are some conditions that can manifest symptoms of RLS/WED secondary to the primary pathology. These conditions include: Iron deficiency, anemia, peripheral neuropathy (damage to the nerves in your hands and feet), kidney failure, at various stages, and spinal cord conditions such as lesions. It’s important to rule out the serious conditions before settling on an RLS/WED diagnosis. Once it’s determined that you have RLS/WED your next question is, “What do I do now?”

There is quite a bit of debate and quite a few opinions on the topic of treatment. Currently, there are no medications on the market specifically for RLS/WED because no one medication is fully committed to a cause for the syndrome. It’s important to understand that muscles throughout the body work by using electrolytes. Sodium, Potassium, Magnesium, and Calcium allow muscles to relax and contract normally.

Two of these electrolytes, sodium and potassium, also control the gradient threshold in nerves. Sounds big and scary, right? Think about a line on a measuring cup as a threshold; if it’s not filled above the line, or threshold, then the nerve doesn’t fire. So, with so much of the body being controlled and regulated by electrolytes and the rising levels of caffeine in our diets along with the lack of sufficient electrolyte replenishment; is it really surprising that conditions such as RLS/WED and Fibromyalgia are rising in direct correlation with the increased number of people chronically dehydrated?

I discovered this by treating one of my patients who I will call Alan. Alan first came to me for high blood pressure, and then again with symptoms of restless leg syndrome. As a rule of thumb, I always start with proper hydration for patients with high blood pressure. Once I taught Alan how to stay properly hydrated, his blood pressure improved and his RLS symptoms decreased significantly. With the addition of acupuncture treatments, his symptoms of RLS went away entirely. I am not saying that the cause of RLS/WED is always dehydration or that this treatment works the same for every “body”. What I am saying is that electrolytes, and therefore proper hydration, control so much within the body that it is a reasonable place to start. Want to learn more about how we can help you live without the symptoms of RLS/WED? Call us today to schedule your consultation.

Dr. Boyce Callahan Jr, DC, FIAMA

Fibromyalgia and a Dirt Bike?

Last weekend, I was trying to get a few ATV’s running that had been in storage for a couple of years. I have four boys, and they were insistent upon riding the two dirt bikes and four-wheeler. I was able to get two of them running well; but, one of the dirt bikes would crank, run for a few seconds, and then bog out. When I tried to choke it or push the throttle, the engine would immediately shut-off. So, what does this story have to do with the increasing number of people struggling with fibromyalgia and chronic fatigue?

In the case of my son’s dirt bike, the gasoline in the fuel tank sat too long, and it broke down and began to form deposits. The deposits clogged up the filter and fuel lines, preventing the gas from getting to the engine. Research shows that capillary walls thicken in patients diagnosed with Fibromyalgia. This thickening limits or prevents the body’s ability to deliver oxygen or “fuel”, in turn, depleting the energy stored in muscles. As the muscles continue to be depleted of energy, the result is a myriad of escalating symptoms. Many patients experience mild to severe pain, soreness, stiffness, and overwhelming exhaustion and fatigue.

Just as is true with an ATV engine, energy efficiency and production maximize performance. Fuel is used to power the engine, and if the energy generated is limited, or if the fuel can’t get to the engine, due to the “thickening” of the fuel lines, the overall performance suffers. The keyword regarding our bodies and health is “suffers”. Like an engine, we must learn how to maximize energy production. We do this by putting the proper “fuel” into our system. By doing so, we ensure that our bodies have what they need to reach optimum potential. The most exciting news… it’s not difficult or complicated. Through education and supplementation, you can refuel every muscle in your body, and even re-energize those muscles drained by Fibromyalgia.

So, how can we help you? Your health is our priority, and we specialize in helping you reach your optimum health potential. Our providers educate you and help you make gradual, yet significant changes in your diet and lifestyle. We tailor treatment plans based on your needs so that you can live a full, healthy life, without the disruption of Fibromyalgia. Want to learn more? Call us today to schedule your consultation.

Dr. Boyce Callahan Jr, DC, FIAMA

Top 3 Myths about pain

  1. I have to live in pain for the rest of my life

Pain is a complicated, multifactorial experience which is a decision by your brain to a perceived threat (Louw & Puentedura, 2013). Pain is not a result of a specific injury to your knee, foot, back, but a joint effort between your past, present, and future. Here is an example, if you twisted your ankle right now, would it hurt? (nearly everyone would say yes). Many will say ankle injury = pain. Now, same scenario, but you are crossing a busy road. You twist your ankle, but as you twist it, you look up and see a speeding 18 wheeler coming right at you that shows no sign of slowing down. Does your ankle still hurt? I would argue, of course your ankle doesn’t hurt because you need to get out of the way of the speeding 18 wheeler (Louw & Puentedura, 2013). This is a prime example of how your body ranks threats to control your pain experience. I have even met a few people that told me they have been shot in the leg without knowing, had a nail go straight through their foot without knowing, and even broken their toe without knowing.

So you may be saying, “yea, thanks for telling me about pain, but how do I get rid of it?”

Here are a few keys to decreasing your pain:

  • pain education
  • aerobic exercise
  • strengthening
  • meditation
  • humor
  • and sleep to name a few

Honestly, my best advice for anyone in chronic pain is to go and see a practitioner with a background in pain science to help you put all the pieces together for your tailored pain solution. 

  1. Rest is good for my pain

Many therapists and medical professionals now know and preach that rest can be one of the worst things someone can do when they are in pain. From our current understanding, pain is a protective response (an alarm) from your brain in the threat of danger. Meaning, pain is there to protect us from hurting ourselves. Because of this, our body is at a heightened sensitivity level. The simple things we used to do are now harder. For example, you used to be able to stand for 2 hours without any ache in your back, now you can only stand for 10 minutes before your back starts aching or you used to be able to walk from your room to the mailbox without any trouble, now you can barely make it to the door without having to sit down and rest.

Due to this heightened sensitivity, the goal of decreasing pain is by focusing on decreasing your sensitivity (resetting your alarm) and allowing the body to no longer feel a threat.

So, you may be asking, wouldn’t rest help decrease my sensitivity (reset my alarm)?

Unfortunately, in many instances rest is counterproductive to resetting our alarm. Rest actually tells our body something is still wrong.

  1. I have pain because of what is on my MRI (“I have a slipped disk”, “torn rotary cup”, “bone on bone knee”)

Many people believe that the pain in their low back is linked to their slipped disk, or pain in their shoulder is linked to their torn rotator cuff, or even pain in their hip is linked to the dreaded “bone on bone.” From our current understanding of pain, these connections may be far from the truth. In a study completed in 2006, the authors found that 89% of their participants had “abnormal MRIs” (disc degeneration and disk bulges) and even though 89% had “abnormal MRIs” nearly 50% had little to no pain (Kleinstuck, Dvorak, & Mannion, 2006). Boos et. al (2000) reported 73% of their participants showed a disc bulge on their MRIs, but had no pain, while Minagawa et al. (2013) found that 65% of the people with a rotator cuff tears had no pain. Ironically, the American College of Physicians and the American Pain Society have suggested guidelines to discontinue imaging of low back pain unless patients have severe or progressive neurological deficits (“can’t feel your legs”) or to help guide epidural steroid injections (Chou et al. 2007). Now, this is not to say that your images (X-ray, MRIs, CTs) can’t be linked to your pain, but you should know that there is typically a weak link. Think of these changes, disc bulges, rotator cuff tears, etc. as wrinkles on the inside of your body. Do the wrinkles on your face hurt?

So you might be wondering, “if my MRI or X-ray can’t explain my pain, then what can?”

Sorry, but this is a question that doesn’t have a simple answer and varies from person to person. All these quick fixes you see on television, billboards, and infomercials are just like shooting dice, sometimes you will hit, but more often you will crap out. But my advice again, would be and see a practitioner with a background in pain science to create your personalized plan to help you put all the pieces together to get you out of pain.

Work Cited:

Boos, N., Seemer, N., Elfering, A., Schade, V., Gal, I., et. al. (2000). Natural history of individuals with asymptomatic disc abdnormalities in magenetic resonance imaging: predictors of low back pain-related medical consultation and work incapacity. Spine. 25 (15), 1484-1492.

Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, T. et al. (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annuals of Internal Medicine. 147 (7), 478-491.

Kleinstruck, F., Dvorak, J., & Mannion, A. (2006). Are “structural abnormalities” on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain? Spine. 31 (19), 2250-2257.

Louw, A. & Puentedura, E. (2013). Therapeutic neuroscience education teaching patients about pain.

Minagawa, H., Yamamoto, N., Abe, H., Fukuda, M., Seki, N. et. al. (2013). Prevalance of symptomatic and asymptomatic rotator cuff tears in the general population: from mass-screening in one village. Journal of Orthopedics. 10(1), 8-12.

-LD Woods, PT, DPT, CSCS-