Every once in a while we get a client that comes through the door with both Fibromyalgia and sciatica. Unfortunately, for many people with Fibromyalgia, most new symptoms get put down to simply yet another Fibro symptom. However, if you do have Sciatica, then you will likely already know, that sciatica pain feels very different to normal everyday Fibromyalgia pain.
So, with that being said, I am going to say the same thing to you at home reading this, as we do to our clients in the studio: Do not put symptoms down to Fibromyalgia.
Sciatica is the loose term for one type of lumbar radiculopathy, essentially meaning pain and other symptoms, caused by irritation of a lumbar nerve root or at least a part of it. It’s also good to keep in mind that sciatica is a symptom, rather than a specific diagnosis, and not a particularly specific one either. The term sciatica can be rather confusing, with many medical professionals using it to describe radiculopathy involving the lower extremities and relating to herniated disks. And many patients refer to sciatica as any pain that shoots down the legs.
Now, for anyone with Fibromyalgia, adding sciatica into the mix can make an already painful day, into a seemingly impossible task! However, the good news though, is that most cases of sciatica will resolve on their own within 6 weeks, without the need for any special intervention or treatment.
Most people will never have this problem again, and the rest perhaps a few more times in their lives.
There are myriads of ways for the lumbar roots and sciatic nerve to get irritated, including, but not limited to: a nerve pinch, disk herniations, and genetic abnormalities. However, what’s important to remember, is that generally, nerve impingement doesn’t cause pain, inflammation does. In fact, the majority of the time, Sciatica is referred pain from the lower back and doesn’t even result from nerve-root compression. How one person reacts to load, movement, or even stretch, can be very different across the spectrum of people, and it’s likely that some people have nerve roots that are just a little quicker to react. Those with Fibromyalgia suffer from abnormalities in the way that the brain deals with pain. Supraspinal processes have a top-down enhancing effect on nociceptive processing in the brain and spinal cord. Studies have begun to suggest that such influences occur in conditions such as fibromyalgia. This means that those who do have Fibromyalgia and sciatica, they may be far more sensitive to noxious stimuli compared to the general population. Factoring in changes in tissues, stress, load, and movement, and those with Fibromyalgia may be more prone to reacting to these changes byways of producing pain.
Very rarely is sciatica mechanical in nature. Even issues like nerve impingement are fairly difficult to occur, due to the abundance of room at the nerve root. There are also many cases of actual impingement, where the individual doesn’t even have any pain.
Whilst you very well could have Sciatica, there are a few other things that can often mimic sciatica, things such as;
Piriformis syndrome
Genic abnormalities, wherein the sciatic nerve actually runs through the piriformis muscle, instead of under it.
And less likely, things like cluneal nerve entrapment.
I’m not writing to scare you, as the wide majority of cases of sciatica are completely harmless. However, it is important for you to understand that self-diagnosing sciatica is not a good idea. If it is troublesome, comes with a wide range of completely new symptoms, or you are worried, consult your doctor and get checked out.
Bed rest has been a popular treatment for sciatica for the better part of the last few decades. In terms of published evidence, most meta-analyses and reviews show that there are no significant benefits to bed rest over staying active when it comes to sciatica pain (and vice versa). However, as mentioned in a review posted in Spine, there is no considerable difference between advice to stay active and advice for bed rest, and there are potentially harmful effects of prolonged bed rest, it is reasonable to advise people with acute low back pain and sciatica to stay active.
So, if you do have fibromyalgia and sciatica, you have been checked out and there are no red flags, keeping active can be very helpful. However, being active doesn’t mean you need to be doing crazy exercises, it just means getting up and moving around, as much as the pain will allow.
In terms of movements, gentle dynamic movement that helps to move a joint through its full range can be incredibly beneficial when it comes to sciatica, helping us to utilise our own internal pain killers. Likewise, stretching can be incredibly beneficial, helping to calm the nervous system down, reduce muscle tone and guarding, reduce pain, and to help create a sense of safety. This sense of safety is a particularly interesting topic, as fear will cause you to guard, making you stiffer and most likely in more pain.
Heat can also be used on the surrounding muscles to help them relax. Due to the thickness of the tissue in the buttocks, heat isn’t going to have much of a circulatory effect on the nerves or muscles that can irritate sciatica. However, it will provide enough input to help calm down the nervous system. A good heat pad or warm bath is sufficient.
Likewise, vibration can be used for sciatica with a fairly good outcome. Vibration therapy may help to reduce muscle soreness and interleukin-6, helping to stimulate lymphocyte and neutrophil responses, a useful modality in treating muscle inflammation. Which if we learned anything today, is most likely more important than impingement.
It is not uncommon to see those with hypermobility and EDS covered in an abundance of brightly coloured KT tape. Kinesio tape comes highly recommended for those with hypermobility, however, just like most modalities, there are those that find it helpful and those who do not. There is an abundance of claims when it comes to using KT tape, ranging from injury prevention to increased circulation. However, what does the research say about taping joints with KT tape when you are hypermobile?
This is the topic for today and boy is it a doozy!
Kinesio taping was first brought about by chiropractor Kenzo Kase, back in the mid-1970’s, when he developed the original Kinesio Tape, which he called Kinesio Tex Classic. The term “Kinesio” is a shorthand for the word kinesiology, meaning “the study of movement”.
However, it’s important to note that this is not kinesiology, but rather good marketing. It could have easily been called a number of other things: Injury tape, Rehab tape, or Chiropractic tape. But that just doesn’t have the same ring to it, does it?
In 1980 Kenzo Kase established the “Kase Chiropractic Institute” in Kojimachi, Tokyo, and officially founded The Kinesio Taping Method.
By 1985 a dedicated taping instructor programme had been developed, and by 1989 the national Japanese volleyball team were using Kinesio Taping. Fast forward to 1997 and 7 of the major league baseball teams in America were using it.
At the 2012 Olympics, KT tape exploded! Many professional athletes were spotted on camera with colourful and elaborate designs, with even more elaborate reasons as to why they were wearing them.
At the Olympics there was a huge explosion in competition, with many new brands appearing also using the word ‘Kinesio’ in in the branding. Obviously, there are a few examples of cease and desist letters being sent in this time period, as Kase protected his trademark.
There are numerous claims when it comes to taping joints for those with hypermobility, and the list will probably surprise you;
Lifts the skin, decompressing the layers of fascia, allowing for greater movement of lymphatic fluid which transports white blood cells throughout the body and removes waste products, cellular debris, and bacteria.
However, bold claims require extraordinary evidence. Once you cut through all of the marketing and fancy claims, there are only really three points that may have any substance to them: pain relief, injury prevention, and increased performance.
These extreme claims have resulted in class action lawsuits and caused companies who market Kinesiology Tape to have to remarket and change their claims, as well as pay out considerable sums of money.
Under the terms of the KT Tape settlement, KT Health Holdings Inc paid $1.75 million to resolve the deceptive marketing allegations. In addition to creating the settlement fund to reimburse customers, KT also agreed to change the way that tape is advertised, removing the label claims: “it will keep you pain-free,” “prevents injury” and “provides 24-hour pain relief per application.”
The kinesiology tape packaging also changed to include a large bold disclaimer, to inform consumers that the athletic tape is “not clinically proven for all injuries.”
Likewise, RockTape faced similar class action allegations that its tape doesn’t provide the advertised pain relief. Unfortunately, sports medicine is far from evidence-based, with inventions such as theracanes and scraping tools having a tiny amount of research. However, taping has over 2000! So research isn’t exactly lacking in this area. But what does it say?
With so many claims out there for tape, it can be hard to separate fact from fiction, and placebo from actual mechanisms. As I mentioned before, once we take away the bogus claims, it leaves us with only three main points that may have any truth to them. If you are Hypermobile or have EDS, then I am going to assume that it’s more of the potential benefits to pain that you are most interested in.
The main issue with the current evidence on tape and hypermobility is that many of the research studies conducted conclude that KT tape may be effective, however, the quality of evidence (also known as grade) is insanely low. One example of this is a study in 2013 that concludes KT tape “may be effective in reducing pain during stair climbing activities”. However, the median effect of 0.5 on a pain scale from 0 – 10, was lower than the threshold of clinical importance. Meaning, that the quality of evidence for this study was rated “very low quality” as it was a single trial with a very high risk of bias. Some authors even concluded that Kinesio Taping was effective when their data did not identify significant benefits!
There is an abundance of people with hypermobility that rely on KT tape every day, yet in the same breath, there are people that it simply does nothing for. Likewise, if you take a closer look, there are also people who get negative effects from using tape, usually in the form of blisters, sensitivity, or burning, from the adhesive commonly used in Kinesiology Tape.
Whilst there is an abundance of research into KT tape, the research conducted around taping hypermobile individuals, who are arguably the population that needs it the most, is rather disappointing. Whilst some studies do show that KT tape may have some benefits when it comes to pain and hypermobility, most of the studies are fairly poor, lacking in control groups, consisting of very small sample sizes, and with no to very little follow-up.
A study conducted in 2021, showed that Kinesiology taping may be effective for reducing shoulder pain and improving function in patients with EDS up to 48 hours post application. But, again, this was a sample size of eight females, no control group, and a possible time effect. Hopefully, as research grows, a larger study will be conducted with a control group, more participants, and over a larger time period.
Likewise, a far superior study conducted recently in 2021, showed that 10 sessions of shoulder rehab, over a 6-week time frame, found no difference when KT tape was used. Both groups improved over time, in symptoms, range of motion, and functionality of the shoulder.
An interesting study showed that KT tape, when combined with foot strengthening exercises, compared to just strength exercises, was more effective at increasing navicular height: creating more of an arch. It was a decent sample size and could have been better controlled, but the main issue I have with this study is that it seems a little biased, directly quoting Kenzo Kase’s tape claims. However, it does give us a little food for thought. One of the exclusion criteria for this study though was no neuromuscular disorders, or more pertinent to hypermobility, no lower limb injuries.
The likelihood of someone using KTtape if they are hypermobile is because of recurring injuries and dislocations. So, how does this study compare to those who are injured and prone to dislocations? There is also the issue that one modality coupled with another, is pretty much always more effective than using a single modality alone, like results shown in this Masters thesis using KT tape and Orthotics.
An interesting study performed on recreational dancers found that Kinesio taping was fairly effective in eliminating sacroiliac joint pain, occurring in 13-25% of patients in the dance population. It’s a good idea to keep in mind, that people generally gravitate to activities at which they are naturally good at. This is one of the reasons why we find a higher prevalence of hypermobility amongst dancers, compared to say Rugby or other contact sports.
With research severely lacking in KT tape and hypermobility, I looked more towards the studies that would naturally include those with hypermobility, which is why these studies into dancers give us a little more insight into KT tape and hypermobility. Having analysed numerous publications on the effectiveness of Kinesio taping amongst dancers and athletes, you could conclude that KT tapes proves to be ineffective when it comes to increasing muscle strength or improving proprioception of the joints. However, only if it is used by healthy individuals using moderate physical activity.
Studies of Kinesio taping under strenuous physical exercises, for healthy individuals, have demonstrated numerous positive effects of taping, such as improvement of articular proprioception and postural stability (both static and dynamic), relieving of muscle fatigue and enhancing their recovery, as well as a reduction in the severity of delayed-onset muscle soreness. Kinesio taping turned out to be exceptionally effective for patients with different acute and chronic injuries of the musculoskeletal system. It helped to restore impaired proprioception, stabilise joints, ease pain symptoms, and improve muscle strength. However, there still is one giant issue when it comes to tape and hypermobility; what is the actual mechanism that yields these results? It is incredibly hard to dive deep into this topic with so little specific research into hypermobility and tape.
Not only is this a hard topic to research, but when we factor in the poor quality evidence of the studies and potential bias, it’s easy to get a headache.
Research comes with many levels of evidence, and unfortunately, most of these studies aren’t great. However, I did find a study that sits firmly at the top of the hierarchy when it comes to evidence. In this beautifully done research, it concluded that KT tape, when used for a range of musculoskeletal conditions, has no benefit over sham taping/placebo and active comparison therapies. In essence, the benefit was too small to be clinically worthwhile, or the trials were of very low quality.
Regardless of the comparison used or the outcomes investigated, most research typically showed no significant difference in outcomes between groups, or a trivial effect in favour of Kinesio Taping (ie, small enough to not be considered clinically worthwhile). It seems that the growing use of Kinesio Taping is due to massive marketing campaigns (such as the ones used during the London 2012 Olympic Games) rather than high-quality, scientific evidence with clinically relevant outcomes.
Therefore, current evidence does not support the use of Kinesio Taping for musculoskeletal conditions.
It is also possible that performance could potentially be increased, say through a combination of minor benefits. Alone they are hard to identify, but collectively they may be relevant. So there you have it, the evidence for using KT tape is not very good!
The evidence shows us that KT Tape likey doesn’t do what it says it does, and any effects are likely a placebo or brought about by any number of biological, psychological, or social variables. But, some people with hypermobility like taping. It makes them feel better, experience less pain, and it makes them feel like their joints are more stable. If there was ever a reason to use tape, it’s not because of the crazy marketing, but of how it makes you feel.
So for the people who do seem to get pain relief from taping, why is this?
Well, for those with Hypermobility, and especially those that sublux/dislocate, nociceptive pain can play a large part in their life, and this is where it gets interesting.
Nociception is where high threshold nerves that detect potentially dangerous stimuli, such as extremes in temperature, pressure, chemicals and stretch, inform your brain that something may be wrong. However, keep in mind that this is not a pain signal, because they do not exist. Let’s leave pain receptors in 1664 where they belong. However, for those with hypermobility and EDS, recurrent subluxations/dislocations, are going to cause a lot of nociception. In fact, this may even lead to nociplastic pain, wherein your nervous system changes how nociception works, making it more sensitive to keep you safe.
Let’s say you sublux your hypermobile ankle. Extreme stretching of the ligaments and tendons is likely to cause a nociceptive response. Your brain decided that because of the context of the situation and about 50 million other variables, producing pain to stop you from bearing weight on your ankle and damaging it further, is a very good call.
Your joint isn’t dislocated, however, it did go out and then straight back in…this is known as a subluxation (you probably already knew that if you’re hypermobile). Depending on the degree of subluxation/dislocation that occurs, nerves and blood vessels may be damaged, muscles and ligaments may tear or twinge, the joint may swell, compression of nerves may cause tingling, and inflammatory responses can be activated. Say hello to nociception!
Due to the subluxation, you have a local inflammatory response. Your nervous system is on high alert and it’s sending far more information to your brain than it normally does when it comes to your ankle. Your brain receives around 11 million bits of sensory information every second, so what is a little more if it keeps you safe.
Tape very likely acts as a competing input for those with hypermobility, helping to drown out nociception to some small degree. If you stub your toe on a coffee table, you’re likely going to produce nociceptive pain. The first thing you are going to do is to rub your toes sending competing information to your brain to drown it out. This is why the pain changes from that sudden, acute, and sharp pain, to a more manageable low-level throbbing pain. So, it’s not a far stretch to assume that it is likely the same mechanisms at work.
Likewise, we are human and as such we are incredibly tactile. We love to touch. In fact, it’s one of the very first things we learn as babies, as our mothers cuddle us and provide love. It’s also one of the very first associations we make as small children. We fall over, we scrape our knees, and mum makes it better with a kiss and cuddle. As humans, we often learn that when it comes to pain, sensory information helps. If you don’t believe me, then the next time you stub your toe, just don’t rub it and see how long you can stand. Touch and sensory information for humans is innate.
In the weird world of pain, there are many things that mediate and contribute to why someone experiences it. Likewise, there is also an abundance of factors that help to reduce it, and touch and sensory information is one of those things. Taping a joint does seem to give people have more ownership over it, becoming acutely more aware of joint positioning (well kind of), as well as being more conscious when it comes to moving the joint. After all, it is a lot harder to sublux a joint, if you are paying attention to it. Which coincidentally, is the main mechanism most hypermobility rehab, pilates, and yoga programmes use. The only issue here is that you can be absolutely fine whilst doing the exercise (because you are aware), however, once you finish and go about your day, pop, there goes your joint.
We have said it a million times here at The Chronicillness.co, the way that other professionals go about hypermobility rehab is not right at the moment. Consciously being aware of your joints does not stabilise them outside of sessions, only slightly inside of sessions. If you take a look a some of our clients, you will see that in a very short time frame their joints become stable outside of sessions not just inside, and this is largely because we work neurologically, and don’t stress conscious awareness.
Probably one of the better reasons to choose KT tape if you are hypermobile or have Ehlers Danlos syndrome, over say a rock-hard support splint, is the effect that immobilising can have.
Immobilisation can lead to hypoxic and inflammatory conditions in the joint capsule, which can easily become an initiating factor for issues such as joint contractures, as well as sending constant nociceptive signals.
With a joint that is repeatedly dislocating, there is a fair chance that the person suffering is likely going to avoid using the joint, choosing to immobilise it. This, however, can lead to a vicious cycle of disuse and lack of nourishment to the joint. In immobilisation studies conducted over 32 weeks by binding the hind legs of rats:
Immobilised cartilage had increased collagen content (scar tissue)
The severity of osteoarthritis increased as measured by Mankin scores
The trabecular bone plate area (the spongy bone at the end of long bones, like the thigh and shin bones) at the front and back of the shin showed bone loss, but not in the middle.
Chondral vascular ingrowth was seen in the subchondral bone. This means that blood supply was increased to the bone as the cartilage and outer bone was dying.
The centre of the knee joint was being fortified, as we see in the fact that bone loss was not seen in the centre of the top of the tibia bone.
Replacement of cartilage by bone may have been mediated by chondral vascularisation, suggesting irreversible changes. These findings stress the importance of weight-bearing and joint motion to maintain cartilage structure.
Not surprisingly, it has been shown that the more a specific joint is exercised, the stronger the bone-ligament and bone-tendon complexes become. Exercise specifically helps strengthen the fibro-osseous junction, which is where the ligament/tendon and bone attach to each other, and which, incidentally, is the area where Prolotherapy (often recommended and praised by the hypermobile population) treatments are administered.
With KT tape providing some sensory tickling, as well as helping to support the joint, but not completely immobilise it, it does have the potential to be a lot healthier, given the above.
So, a big reason why a lot of those with hypermobility and EDS use Kinesio taping, is because they feel that it adds to proprioception. Now I will preface this next section by saying here at The Fibro Guy, we do use tape occasionally, however, only ever in session, and we never make KT tape out to be more than it is. Tape can be helpful for some of our clients with issues like Thoracic Outlet Syndrome, to help cue them into positions where they aren’t causing compression. With that being said, it’s only ever added for a tiny boost to positioning and awareness. To be honest, it’s more like an addition to awareness, than actually increasing proprioception.
Research around proprioception and the use of KT tape in the hypermobile population, is again, unsurprisingly sparse!
An interesting study performed on those with hemiplegia due to stroke, found a difference in values before and after the tape was applied in the case of left and right deviation whilst walking. Not a fantastic study, due to a lack of controls, too small of sample size, and the fact that physiological and psychological factors were not considered relating to the subjects.
Many ankle studies show KT tape has no real significance when it comes to proprioception. Likewise, studies around the lower back and proprioception, yield the same results. One study looking at the effects of Kinesio taping of the knee on proprioception, balance, and functional performance in patients with anterior cruciate ligament rupture (ACLr) found some interesting results, in that KT may have beneficial effects on proprioception, balance, and functional performance in people with ACLr, but it cannot completely compensate for the loss of proprioception. The application of KT during rehabilitation may be a good therapeutic option either before ACL reconstruction surgery or as a conservative treatment for ACLr. However, it’s not a great study when it comes to tape, for many of the reasons I’ve already stated in the above paragraphs.
Then we have another study by a team of Italian researchers found that Kinesio Tape may help improve ankle stability for athletes with chronic ankle instability.
So, looking at the research, it looks like sometimes it may help slightly, other times it makes no difference at all, and there are 100,000 other variables that are likely involved, but unaccounted for.
Research always has limitations, and a large one is that a lot of these studies were performed with vision removed from the experiments. Vision is an important part of moving, as it works in conjunction with our cortical maps, to help us over through space and time. People, especially those with hypermobility and EDS, don’t walk through life with their eyes shut using just proprioception, they include visual data. Likewise, small sample sizes, some bias, and a whole host of other things, we end up with more questions than we first started with.
By looking at the research, we can see that something happens when we use KT tape. I mean it’s probably not the KT tape that’s responsible, but a whole host of other factors. But, the fact remains, that KT tape may make people more aware of their joints, but more importantly, it might help contribute to less pain, and that’s what it’s about isn’t it.
Tape isn’t particularly invasive, it’s not damaging (well sometimes, and I will get to that), and it makes some people feel better. Given all of that, if taping does help you, then you don’t really have anything to lose; just don’t go expecting miracles. I think that the use of tape in this context is fine. It’s a little like stretching, a lot of the reasons people do it got debunked years ago. But, if it feels good and it helps, go for it.
So, you have taken a look at the evidence, and you realise that there isn’t anything specifically magical about the tape. However, you do fancy a little bit more awareness of your joints and a little bit of sensory tickling. Well, then, that’s a pretty good reason to use tape. Let’s take a look in the next few sections on how to tape. But first, let’s start with some KT tape tips, that are going to save you a lot of headaches.
For those with EDS and velvet skin, and indeed even those without, perhaps those with mast cell issues, the tape can be an irritant, and in some instances cause blisters and soreness. For KT tape to stick to your skin, it is covered with adhesive. When you apply KT tape, you are recommended to rub the tape to help activate the adhesive. Now, if you do have skin that is irritable (and to be honest, I recommended this for everyone), do a little patch test first. Cut a small square of tape off and apply it to an area for 48hrs, then see how you react. Likewise a really handy tip if you are super irritable to tape, is to use barrier film spray, the same spray used for stoma bags.
It’s all well and good having your tape on, but there will come a time that you need to remove it. Even the smallest of hairs are going to hurt when the tape comes off. So, make sure that you shave the area if it is dense with hair, and you can save yourself some trouble in the future.
Often people end up cutting off more tape than they actually need. Remember, that tape stretches, which means that once you apply some tension to it, it will reach further. This is a handy little tip, especially considering how expensive some tapes can be!
KT tape has a tendency for the ends to curl up, getting caught on clothing. So, if you are going to tape, round off the corners of your tape and it will last far longer.
Trying to pull the backing tape off KT can be frustrating. Instead, if you tear the tape with your hands, you will tear the backing paper, making it easy to remove, whilst leaving the tape unaffected.
By looking at the research, we can see that something happens when we use KT tape. I mean, it’s most likely not the KT tape that’s responsible, but a whole host of other factors. But, the fact remains, that KT tape may give people more awareness of their joints, but more importantly, it might help contribute to less pain, and that’s what it’s about really isn’t it.
So, for those of you who are wanting to tape hypermobile joints, we have compiled a few videos of how to tape some of the most problematic hypermobile joints.
We hope you enjoyed reading, and more importantly, feel more informed about KT tape and hypermobility.
Fibromyalgia and Costochondritis are two conditions that often go hand in hand with each other. Over the years we have lost count of the number of clients who were plagued with the hallmark sharp stabbing pains, that often come with Costochondritis. Within this topic are many questions, most of which become a whole lot harder to answer when we factor In Fibromyalgia.
There are many people in the general population who have Costochondritis, it’s not just another issue that comes along with Fibromyalgia. However, as we will come to find when we take a look at some of the research, Costochondritis does seem to be far more prevalent in those with Fibromyalgia.
Costochondritis is the term given to inflammation of the cartilage that joins your ribs to your breastbone, also known as the costochondral joint. Inflammation is a natural response to illness or injury, it’s essentially the immune system’s response to help initiate the healing process, in other words, it is a defence mechanism that is vital to our survival.
Whilst Inflammation is one of the body’s greatest tools, it doesn’t feel all that great when it does happen. After all, the point of inflammation is healing, and this means that more blood is redirected to the area, tissues become more permeable to allow increased blood flow and nutrients to the areas, and the nerves in the surrounding areas become a whole lot more sensitive. If you have ever had a paper cut you will know exactly what I mean. For such a small cut, it sure does impact your day to day activities.
With Costochondritis, the costochondral cartilage, which connects your ribs to your breastbone, and surrounding tissue can become inflamed, making it tender and unpleasant when pressure is applied, and in most cases, simply from breathing or even moving.
The obvious leading symptom is chest pain, typically it is described as a sharp or stabbing pain, and sometimes it is described as more of a dull ache which often becomes worse when moving or exerting the chest muscles. This can also include breathing, which can cause an increase in pain with large breaths. Many people find that even the slightest touch or pressure around the sternum and ribs can fire off a pain response, as the nerve becomes more and more sensitive due to the inflammatory response.
The most commonly reported pain from Costochondritis can be found in the sternum, around the 4th-6th ribs. However, as the inflammation increases, it’s not uncommon for the pain to begin to spread.
Again, this question takes a little research and some critical thinking to answer. There are some good studies that show us that there is a pretty strong connection between fatigue and Rheumatic conditions in general. In one study of patients with different rheumatic conditions, there was found a 54% prevalence of fatigue for those with a single inflammatory rheumatic disease, such as rheumatoid arthritis, systemic lupus erythematosus, or ankylosing spondylitis. However, this prevalence shot up to 82% for those with Fibromyalgia. In essence, from this and multiple other studies, one out of every two patients with a rheumatic disease seems to be severely fatigued.
On one side of the coin, there are many folk in the general population who do have Costochondritis but report minimal fatigue. And on the other side of the coin, we have those with fibromyalgia and Costochondritis, who report major fatigue associated with it. It’s unlikely that costochondritis directly causes fatigue, as both those with fibromyalgia and without it would be affected. However, that does not mean that it does not indirectly cause fatigue.
If you ask anyone with chronic pain about sleep, they will tell you that it’s incredibly difficult to get a good nights sleep when you are in pain. And one of the hallmark symptoms of sleep disturbances and deprivations is fatigue. Therefore, it’s not such a huge leap to assume that someone with Costochondritis, or Fibromyalgia and Costochondritis, would experience fatigue as an indirect result of being unable to sleep properly due to being in pain.
Likewise, many people with Fibromyalgia, often learn and develop certain coping skills for sleeping when it comes to dealing with the pain of Fibromyalgia. It’s very likely that due to differences in the pain experience, Costochondritis may cause undue stress and anxiety which could disrupt sleep also. Pain from Costochondritis is very hallmarked, it’s sharp, disruptive, and can often make people wonder if there is something wrong with their heart. Therefore, many people with Fibromyalgia and Costochondritis may struggle to sleep due to the new pain that comes from Costochondritis.
When living with Fibromyalgia, it is often hard to distinguish what pain comes from which issue. Many people have gone to their doctors with legitimate concerns, only for those concerns to be passed off as just another Fibro symptom.
One example of this is from a consultation we had here at chronicillness.co, some years back. A young woman had been suffering from severe headaches and every time she went back to the doctors it was promptly put down as caused by Fibromyalgia. However, at her consultation with us, and after going through her history, it was blatant that this young woman had Ehlers-Danlos syndrome. What also stood out was that her headaches were immediately cut in severity when she lay down. Suspecting a Cerebrospinal fluid leak we quickly referred her to her local hospital. And low and behold, it was indeed a spinal fluid leak. After a blood patch, and bed rest to closely monitor for leak recurrence, she recovered after around 6 weeks and has never had another headache since.
We have many stories from over the years just like this one, but the point to take is that you should never put new symptoms down to Fibromyalgia.
While working with our clients in the studio, it’s really not uncommon for us to get the “Is my Costochondritis and Fibromyalgia related?” question. And this is a good question, anecdotally you probably know a whole host of individuals with Fibromyalgia and Costochondritis, but are they related.
When looking at the evidence on this topic, it becomes more clear that they are likely linked, as the prevalence of patients with Fibromyalgia who also have non-cardiac chest pain is far higher than in the general population. In a study conducted in 2016 that looked at symptoms of people with Fibromyalgia, across 4 groups it was found that on average, 29.1% of the 313 participants either currently or previously had Costochondritis. And when compared to the general population, it was found that chest pain in primary care it only accounted for 13%.
In an overview of symptoms of patients hospitalised in the US between 1999-2007, there were over 1.7 million people during this time with Fibromyalgia, of those patients, 10% presented with non-specific chest pain (around 170,000 people). While this is closer to the general population we have to remember that these were only the ones who felt the pain was bad enough to go to the hospital, and its worth remembering that when living with Fibromyalgia, it tends to take a much higher level of pain before seeking medical intervention due to living in pain being accepted as normal.
There may well be a few reasons why are more commonly found together:
Sleep If the last few decades of research into sleep and pain have taught us anything, it’s that with lack of sleep comes a prevalence for more pain. Sleep disruptions lead to hyperalgesia pain changes, which means that your brain becomes far more responsive to noxious stimuli, lowering the pain threshold, and even going as far as to impact our own bodies’ ability to realise pain-killing chemicals. For those with Fibromyalgia, sleep is most often a major issue. Therefore, an activity that would not normally be deemed as strenuous, may become strenuous for someone with Fibromyalgia, and could potential lead to the development of Costochondritis, due to inflammatory responses from strenuous activity or movement.
Guarding response For those in pain, it’s really not uncommon to find them adopting postures to make the pain more bearable. Whilst this may help in the short term, over time staying in any one position can become painful. In the instance of Costochondritis, it’s not a far reach to assume that putting prolonged strain on the costochondral joints and cartilage, could potentially cause an inflammatory response causing Costochondritis for those with Fibromyalgia.
Lack of activity The decrease in activity levels amongst those with Fibromyalgia, as well as being in pain, can lead to sensitisation which lowers tissue tolerance to stress before an inflammatory response is deemed necessary. For tissue to be healthy, we need to move, and for those with Fibromyalgia, this can often be an issue. This gives us another potential reason for a link between Fibromylagia and Costochondritis.
Hypermobility It has been shown in a number of studies that there is a link between hypermobility and Fibromyalgia. One study showed that 46.6% of the Fibromyalgia patients participating, scored at least 4 or more on the Beighton scoring system (A method used to determine hypermobility), compared to 28.8% of the control group. When we look deeper at the connection between Fibromyalgia and Hypermobility, the issues surrounding chest pain and Fibromyalgia can be further explained.The high prevalence of misdiagnosis in the hypermobile population, most likely contributes to the increase of those with Fibromyalgia experiencing inflammation of the chest. A common symptom surrounding hypermobility, is that of joint subluxation/dislocation, due to the genetic make-up of collagen. And a common issue associated with this is rib subluxation. We wrote an article around hypermobility rib subluxation earlier this year, which you can find here. Hypermobility may account for the prevalence of Costochondritis in the Fibromyalgia population, as slipping rib syndrome is pain from inflammation of the cartilage that.
Chest pain can be terrifying when it happens, it can even be severe enough to mimic the symptoms of a heart attack. I remember when I had my first experience of this, I actually thought I was dying and it wasn’t until I was in the hospital, that I found out that I was fine. But, none the less it was a pretty scary experience, as I couldn’t breathe properly because of the pain, and it felt like a tight band around my chest.
The good news though, is that Costochondritis is it is not cardiac related, so it isn’t related to the heart. When there is inflammation in the chest this often leads to shortness of breath, due to us trying to breathe in a more limited fashion to reduce the pressure on the chest. This change in our respiration will often lead to us not taking in as much oxygen as we normally would, and can leave us feeling like we can’t breathe and panicked. But, again, Costochondritis is it is not cardiac related.
Living with Fibromyalgia is bad enough, but when adding Costochondritis to the mix it can seem a whole lot worse. But can Fibromyalgia make Costochondritis worse?
Fibromyalgia often leads to central and peripheral sensitization where nerves are a lot more sensitive to noxious stimuli, so it will take less pressure on the chest before these nerves fire and alert the brain of a potentially dangerous stimulus. This would make it feel a lot more tender to the touch than it should normally be. Think of a turn dial that usually likes to sit at 1-3 unless something is wrong (like inflammation) and is then turned up when there is an issue. With Fibromyalgia though, the dial is already sitting at 7, so when a potential threat is noticed this can turn it up to 10. This can result in more painful sensations than are usually warranted. So, given what we know about the current pain mechanisms, having fibromyalgia is likely to make having Costochondritis worse than it would be for someone without fibro.
Your first port of call when it comes to Fibromyalgia and Costochondritis should be your doctor. Anti-inflammatories will help to deal with a lot of the pain from Costochondritis, but this isn’t a long term solution. As we previously mentioned, having a healthy and happy rib cage means that it needs to be able to move freely, so this should be your second port of call: focusing on relearning to move your ribs.
We would also suggest that you check to make sure that you are indeed not Hypermobile and that the pain doesn’t arise from a rib subluxation.
We often get asked about Fibromyalgia and Osteoarthritis from our clients, because more often than not, they have been told numerous scary stories by consultants. Likewise, many of the people we speak to have read many articles online, that are laden with misinformation. Osteoarthritis as a whole, gest a bit of a bad reputation, despite being completely normal and inevitable.
In fact, even the name Osteoarthritis is somewhat of a misnomer, as “Osteo” means bone,”‘Arth” means joint, and “Itis” means inflammation. And when we realise that Osteoarthritis is a degenerative condition, not an inflammatory one, we can start to see why there is likely so much misinformation around fibromyalgia and osteoarthritis, especially considering it’s not even named correctly!
For those of you reading, we can appreciate that having more labels attached to you can be a scary thing. A lot of the time people have only just gotten used to and accepted the Fibromyalgia label, before being hit with another in the form of osteoarthritis. Unfortunately, for most people, a quick google of Fibromyalgia and Osteoarthritis brings up many horror stories and a tonne of misinformation. This misinformation has the potential to not only make your pain worse, but ultimately make your world smaller and smaller as you inevitably try to protect yourself more and more over time.
So, in the following article let’s take a look at a few things that we should know about when it comes to Fibromyalgia and Osteoarthritis.
Osteoarthritis is defined as “Degeneration of the joint cartilage and underlying bones, usually accompanied by pain and stiffness, and most commonly found in the hips, knees and thumb joints.”
In a healthy joint, a coating of tough but smooth called cartilage covers and protects the surface of the bones, helping them to move freely against each other. However, when a joint develops osteoarthritis, part of the cartilage thins and the surface becomes rougher. This means the joint doesn’t move as smoothly as it should, causing the protective cartilage on the ends of your bones breaks down, potentially causing pain, swelling and problems moving the joint. When cartilage becomes worn or damaged, all the tissues within the joint become more active than normal, as the body tries to repair the damage. This can result in swelling and inflammation of the joint.
As we mentioned earlier, Osteoarthritis isn’t really properly named, because whilst there can be inflammation present, it’s the degeneration that defines it. After all. we already have a name for inflammatory arthritis which we call Rheumatoid arthritis.
There is a good chance you are reading this because you have Fibromyalgia and Osteoarthritis, and you want to know if they will affect one another. Well, having fibromyalgia does change a few things when it comes to osteoarthritis, but it’s mainly not anything to do with the actual tissues, and don’t worry, we will cover these other factors in this article. But, before we get into how Fibromyalgia may affect osteoarthritis, let’s start with a question that’s a little easier to answer for: why do we get Osteoarthritis in the first place?
As we age our bodies incur wear and tear from just being alive. Our hair grows thin and turns grey, our skin thins, and we developed wrinkles. It is essentially just part of the human condition, and just as we degenerate on the outside of our bodies, we also degenerate on the inside.
No, they don’t, well not physically anyway. Anti-wrinkle cream is a multi-million-pound industry, so it’s evident that wrinkles do cause some emotional distress for the majority of us!
So then, if degeneration on the outside of the body doesn’t cause us any pain, then why would degeneration on the inside cause it?
Keep in mind also, that we are way more sensitive to changes on the outside of the body than we are on the inside. There are a great many people right now, with very severe degeneration, who have absolutely no pain. Likewise, there are also people with very little osteoarthritis, who are in a great deal of pain. Before we get into the complexities that is Fibromyalgia and Osteoarthritis, it’s important to remember that this wear and tear is a normal part of ageing. In fact, in the next section, let’s take a look at a few studies that show us that normal wear and tear can actually be painless or not correlate to damage.
As we mentioned before, there is a lot of misinformation around Osteoarthritis, and probably even more around Fibromyalgia. So, let’s take a look at some studies and start to break down those damaging narratives that you have likely been told or have read.
One study focusing on professional football players found that 92% of football players had at least 1 spinal degenerative condition, but in some cases, more than 6 were found. The interesting thing was that none of them reported any pain. This is a nice study that helps us look at the complexities of pain, as when it comes to chronic pain it isn’t always about the tissue.
There is a ridiculous amount of evidence that shows us that pain is not tightly linked to tissue damage. And when it comes to Osteoarthritis, there should also be evidence of people with severe degeneration shown on a scan, but who feel fine, and vice versa. This study of 113 people found exactly that, a huge disconnect between degeneration and pain. In which they found that the people with less degeneration had more pain, and those with more degeneration had less pain!
It kind of changes your opinion on some of the stuff you have been told doesn’t it.
Another study looking at the general population, wherein the focus was on the difference between structural changes in the knees and symptoms, found that there isn’t a great connection between the severity of the condition and pain. However, they did find that the symptomatic group had a slower walking speed, longer stride and standing times and reduced strength. Which, when you think about it, makes complete sense. If you are in pain it’s unlikely that you’re going to be moving quickly, but rather taking your time in an effort to not increase pain levels.
That was the only real difference that this study found between those with Osteoarthritis who had pain and those with it who had no pain. Keep in mind also, that another study found that cartilage defects were found in around 11% of those under the age of 40 who had no pain. This percentage jumped to 43% for those over the age of 40, but still without pain. As you can start to see, that actual amount of degeneration doesn’t really correlate with the amount of pain you would expect someone to have.
In this study, it wasn’t just the cartilage they focused on, but also tissue. There were instances of meniscal tears in up to 19% of the study, bone marrow lesions and even bone spurs were present in 12-24%. I think a good place to end this section is to look at a study from 20 years ago, that will really challenge your beliefs about osteoarthritis and pain.
This study showed that people who received a fake arthroscopic knee surgery for Osteoarthritis had results just as good as people who received the real surgery. And in 2008, the New England Journal of Medicine added more experimental evidence to the pile, reporting that “surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.”
In the years to follow, there has been an exceptional level of evidence showing that arthroscopic debridement has no benefit, showing that it is no better than a placebo.
We have established that the amount of Osteoarthritis doesn’t really correlate with the amount of pain a person experiences. So what is going on then if it’s not about the actual degeneration? Well, this is where Fibromyalgia can start to make things a little bit more complicated.
When we look at the pain and symptom severity of Osteoarthritis, historically, cartilage damage was believed to be the hallmark of Osteoarthritis. However, since cartilage is an avascular, aneural tissue, the mechanisms of pain are likely to be way more complex than first thought, and most likely influenced by non-cartilaginous structures in the joint including the synovium. The current body of evidence points to pain sensitization, and molecular pathways, as the possible main driver of Osteoarthritis pain.
Like we said before, when it comes to chronic pain, it’s not always about the tissue. We know chronic pain changes the brain and nervous system, causing the brain to take note of inputs that it really shouldn’t be. Hence why so many with conditions like Fibromyalgia often developed other conditions such as allodynia.
The Simple answer is yes, it is more common than you think, in fact when you are going through all the tests to get your Fibromyalgia diagnosed, you’ll most likely be told about degeneration somewhere in the body.
Both diagnoses have overlapping symptoms such as pain, stiffness, and limited range of motion. It’s also not just Osteoarthritis and Fibromyalgia, but other rheumatic conditions. One study showed that between 20-30% of those diagnosed with Fibromyalgia, also had co-morbid rheumatic conditions. When we look at the data for just Osteoarthritis, we find that between 10% – 17% of those living with Fibromyalgia also have Osteoarthritis
As we mentioned earlier, Fibromyalgia does indeed have the potential to complicate Osteoarthritis.
Those with Fibromyalgia suffer from abnormalities in the way that the brain deals with pain. Supraspinal processes have a top-down enhancing effect on nociceptive processing in the brain and spinal cord. Studies have begun to suggest that such influences occur in conditions such as fibromyalgia. This means that those who do have Fibromyalgia may be far more sensitive to noxious stimuli compared to the general population. Factoring in changes at the joint, those with Fibromyalgia may be more prone to reacting to these changes byways of producing pain.
There have been a few studies that have looked into how Fibromyalgia may affect Osteoarthritis. One such study published in the European Journal of Neuroscience, measured brainwaves in response to short painful laser pulses on the skin of patients suffering from osteoarthritic and fibromyalgia pain, as well as test subjects who had no underlying pain. Scientists discovered that the insula cortex part of the brain increased its activity when expecting a painful pulse, as it predicts the extent and intensity of the patients’ own chronic pain.
It is important to keep in mind, that increased activity in this brain area has been linked to a number of phenomena, including body perception and emotional processing, which might explain the greater pain perception in some patients.
In essence, there are a lot of factors that come with fibromyalgia that can make osteoarthritis worse, when compared to individuals without it. One such factor is sleep disturbances. It is well documented that with sleep disturbances and lack of sleep, comes an increase in pain. For those with Fibromyalgia, getting a good, restful night’s sleep can be somewhat of a challenge due to pain. Meaning that it has the potential to create a breeding ground for worsening the symptoms of not just fibromyalgia pain, but also the pain of Osteoarthritis.
With chronic pain, also comes the prevalence of mental health issues, which can also make symptoms worse. It is well established that mental health issues can be a large driving force behind chronic pain. And for those with Fibromyalgia, they may be more prone to experiencing pain with Osteoarthritis, whereas those without fibromyalgia may likely not even notice these degenerative changes.
We have taken a look at what Osteoarthritis is, how it’s caused, and how Fibromyalgia may affect it. All that is left now is to look at some of the things that can help you when it comes to Fibromyalgia and Osteoarthritis.
Massage It has been shown that massage can be particularly effective at lowering pain in osteoarthritis and Fibromyalgia. An analysis of 9 studies found that massage helped to improve pain, anxiety, and depression associated with Fibromyalgia.
Stay hydrated It is estimated that around 70% of your cartilage is made up of water, and when we are dehydrated this is going to affect the joints, as the more lubricated a joint is, the less friction there will be. This is important when we remember the studies into those with Fibromyalgia being more sensitive to noxious stimuli. We want to reduce the amount of noxious stimulus coming into the nervous system.
Cold showers The benefits of cold showing with Fibromyalgia can be found in a comprehensive blog post we wrote, which you can find here. The benefits of cold showering with Osteoarthritis can help by reducing pain, decreasing swelling, and constricting blood vessels.
We hope the above has helped to answer the questions you have about Fibromyalgia and Osteoarthritis, and we wish you the best of luck on your journey.
People generally have some issues with the specific hypermobility knee exercises that are currently out there. They either don’t work or they yield very little results. This is largely due to the simple fact that the current treatment around exercises for those with hypermobility, are built on a false premise and simply do not take into account the nuances that come with this population.
The gold standard at the moment for hypermobile knee exercises, and indeed any exercise for those with hypermobility, seems to be the old “build muscle around the joint to help stabilise it” approach.
This old outdated approach that has seen many hypermobile people simply lose interest in, after seeing it return such little results, comes with 2 main issues. Issues that most people don’t really talk about.
Building muscle requires sufficient load and consistency to do so. How is anyone with unstable joints supposed to use such load required to build muscle and not get injured?
Muscle gains are slow. If we use women as an example, and whilst ensuring that training and diet are on point, we could expect to see around a 10lb gain in muscle mass over the course of a year. However, there are no studies that follow muscle gain in those with hypermobility. So how much muscle are we supposed to add to create stable joints: 5lb, 25lb? and how are we supposed to even add muscle tissue when we can’t handle the load required to build muscles in the first place?
There are also other issues, such as why do women with high muscle mass still dislocate, whilst others with less muscle mass dislocate less?
The current treatment seems to fall apart somewhat when we start to question it. No wonder this current treatment has caused so much distress and gaslighting to those with hypermobility when it doesn’t even make any sense. We have seen so many people in the studio who have all reported the same thing, they did their physio, it didn’t work, and they were blamed for not trying hard enough.
Many people have used many different forms of exercise to help stabilises hypermobile knees, and whilst we often see swimming or hydrotherapy as a form of great exercise, please remember there are issues with these.
We live on land and we need to be able to deal with the various forces that enact upon us. Whilst swimming can be a great form of cardiovascular exercise, it is not doing a great deal in the form of stabilising our joints, and it takes away the loading forces that will help up in the long run, which can decondition us further.
There is also an issue with the use of hydrotherapy, those 39-degree waters will vasodilate our blood vessels, forcing our hearts to work harder to pump blood around, as well as causing blood pooling, potentially making us dizzy and faint. Which is not want we want when we are in a large body of water.
Load is a crucial part of stabilising joints, however, it needs to be the right form of load. Open chain exercises such as the leg extension machine you would find at any gym, are a good example of bad load, putting large leverage forces through tissue, which those of us with hypermobility can not properly handle(yet).
A good hypermobile knee exercise needs to be transferable to everyday life, meaning the benefits of it cross over to other movements and other activities.
There seems to be much demand for a simple and effective hypermobility knee exercise. So, below you can find one of our favourite hypermobility knee exercises, which is aimed at helping those with hypermobility and Ehlers-Danlos syndrome, by addressing some of the real issues that need to be addressed.
Keep in mind, that a large problem with hypermobility exercises, in general, is that individuals tend to have trouble contracting the right tissues or even feeling the muscle they are exercising in the first place. This is why a tactile cue, used with a closed chain exercise, is a great way to train the tissue and your brain, in an exercise that is transferable to everyday life.
For this type of exercise, it is far better to use time, rather than sets and repetitions. You can start off performing this exercise for up to 1 minute twice per day, and spend the next 3 weeks trying to get up to a total of 4 minutes.
With so much attention focused on the dangers of opioid painkillers, it’s easy to forget that even “safe” over-the-counter products carry some dangers.
If you don’t think twice about reaching for a pill to relieve aches and pains, especially medicines called nonsteroidal anti-inflammatory drugs, or NSAIDs, you need to know about the wide-ranging cautions surrounding their use, especially if you take them on a regular basis and over a long period of time.
NSAIDs can also increase the chance of a heart attack or stroke, even within just the first few weeks of using one, and the risk can rise over time. Your risk for heart issues is greater if you have high blood pressure or heart disease or recently had a heart attack or bypass surgery. Aspirin is the one NSAID this warning doesn’t apply to. However, NSAIDs, including aspirin, can damage the stomach lining and cause gastrointestinal (GI) tract bleeding and ulcers.
Are also taking blood-thinners, steroids or certain other medications
If you’re considering acetaminophen, commonly known by the brand name Tylenol, as an alternative to NSAIDs, know that acetaminophen can also cause severe liver damage, according to the U.S. Food and Drug Administration. Like NSAIDs, it’s also in hundreds of other products, so as with all drugs, read medication ingredient labels to avoid taking too much of the same active ingredient and potentially overdosing.
In general, always take the lowest effective dose for the shortest amount of time possible, and only after talking to your doctor if you already have high blood pressure or any other chronic condition.
Methadone is often used in the fight against opioid addiction, but long travel times in rural areas may be hampering efforts to get more people treated, a new study finds.
If methadone for opioid addiction was available in primary care clinics, more people would have better access to treatment, researchers suggest.
In the United States, methadone is only available at clinics certified by the federal government as Opioid Treatment Programs, or OTPs. This restriction, along with state and local laws, limits the number of clinics that offer methadone for opioid addiction.
For the study, researchers looked at drive times to OTPs in rural and urban counties in Indiana, Kentucky, Ohio, Virginia and West Virginia. These states are among those hardest hit by the opioid epidemic.
Drive time is important because methadone treatment requires six visits a week to an OTP, the study authors noted.
Except in the largest cities, average drive times to OTPs were longer than to other clinics, the study found.
The average drive time to a methadone clinic was 37 minutes, compared with 16 minutes to other medical clinics and 15 minutes to kidney dialysis centers. In rural areas, the drive time can be close to two hours, the researchers found.
“This study makes clear how poorly accessible methadone is for rural communities harmed by the opioid epidemic,” study author Dr. Paul Joudrey, a post-doctoral fellow at Yale University, said in a university news release.
Joudrey noted that another drug, buprenorphine, is used in primary care settings to treat opioid addiction, but it doesn’t help everyone. Addiction experts recommend that methadone should be available in all communities to improve health and reduce death among people who are addicted to opioids.
The report was published Oct. 1 in the Journal of the American Medical Association.
We’ve all had back pain from time to time. Maybe we lifted luggage that was too heavy, held a baby for too long or carried a backpack overloaded with books.
Some aches and pain here and there are normal—ones that tend to go away after you rest or exercise. But millions of Americans have ongoing back pain. It’s the leading cause of disability in people younger than 45, and many factors can cause it.
You shouldn’t be in severe and significant pain for a long time. So, how do you know if your back pain is serious? Read on to find out more.
Here are a few signs that your back pain shouldn’t be taken lightly.
1. You fell. Consider if you’ve had a serious trauma, such as you fell from a height or had a car accident. Even if you’ve had a minor trauma and are over 50, your health care professional will want to talk to you and examine your back pain. When you’re older, falling down even a few steps can cause a fracture. If there is no fracture, you may be told to manage your pain with medicine and physical therapy.
2. You have an ongoing fever. A fever that isn’t responsive to medicine and is accompanied by back pain could be a sign of a serious infection. If it’s an infection, you may be prescribed antibiotics. You may be told to rest and then resume your daily activities once you feel better.
3. You have tingling or numbness. Here, you have a pins-and-needles feeling in your back that won’t go away. It usually means that you have nerve damage or irritation, making it more significant than your typical back pain. You can experience permanent disabilities if you leave this condition untreated. Your health care professional can evaluate you and may order tests to get images of your spine. Treatment depends on your diagnosis.
Vertebral compression fractures (VCFs) are the most common fractures in people with osteoporosis, a silent condition that weakens your bones and makes them more susceptible to fractures. VCFs affect about 750,000 people annually, says the National Osteoporosis Foundation. And they affect about one-quarter of postmenopausal women in the United States. The risk of this condition increases with age; about 40 percent of women age 80 and older are affected.
VCFs happen when the bony block or vertebral body in the spine collapses. That can lead to severe pain, deformity and height loss. These fractures happen more commonly in the middle portion of the spine.
Most of the time, a VCF happens without an injury or pain. It can be caused by something as insignificant as a sneeze. One of the first signs of VCF is height loss. Think about whether your adult children seem taller. Do you need to hem pants you’ve worn for years? Are you suddenly unable to reach a shelf? These signs may mean you’ve experienced VCF.
VCFs can be very painful. People who’ve had one VCF are at five times greater risk of having a second one. Risk for death goes up to more than 50 percent a year after a vertebral fracture.
Each broken vertebra raises the risk for another since it changes how weight is balanced on the spine. You’ll experience pain in your back and chest as these muscles have to work more to hold you upright. It gets more difficult to walk. You develop stomach troubles and difficulty breathing. If you do nothing, you may experience disability.
When a fracture leads to a vertebral body collapse of more than 50 percent, there is a risk of segmental instability. Because spinal segments work together, when one segment deteriorates or collapses, it can produce pain and impair daily activities. The instability eventually leads to a quicker degeneration of the spine in the affected area.
Here, the front of the vertebrae will collapse and “wedge” because of a lack of normal vertebral space. Kyphosis leads to a more rounded thoracic spine, which may be referred to as hunchback or dowager’s hump.
If the fracture causes part of the vertebral body to place pressure on the spinal cord, the nerves and spinal cord can be affected. The normal space between the spinal cord and beginning of the spinal canal can be decreased if pieces of the broken vertebral body push into the spinal canal.
The narrowing of the spinal canal due to a VCF can injure the spinal nerves or cause problems later from nerve irritation. The lack of space can also lower the blood and oxygen supply to the spinal cord. This can lead to numbness and pain in the affected nerves. The nerves may lose some of their mobility when the space around them decreases, which can lead to nerve irritation and inflammation. Back pain isn’t par for the course as you get older. If you experience any back pain, make sure to speak with a health care professional about your symptoms.
Have you ever slept in an odd position and when you woke up, your arm felt numb and you couldn’t lift it? Well that’s what happened to me a little more than five years ago. I went to bed feeling fine and when I woke up, I couldn’t lift my arm. Except for me, the feeling didn’t go away. My first thought was it must have something to do with the surgery I had years ago on my spine.
Six years before the morning with my arm, I had been lifting boxes and woke up with a stiff neck. For more than a year, I felt pain on and off. I ended up getting an MRI and once I did, I was told I needed immediate surgery to remove herniated discs in my neck. So it made sense to me that maybe my arm numbness was related to my neck issue from years earlier.
I called my spine doctor and after completing a thorough exam, he told me that it was unrelated to my surgery and he thought I may have rheumatoid arthritis. I was in disbelief. I had felt fine the day before and I didn’t even feel bad the day of the appointment, other than the fact that I couldn’t lift my arm! My doctor drew all the bloodwork so he could verify the diagnosis and sent me home.
A few days later, he called and told me my rheumatoid factor, an antibody found in the blood of most patients with rheumatoid arthritis, was off the charts. Normal is considered between 10 and 20 and mine was greater than 600! He suggested I visit a rheumatologist right away to get started on treatment.
At this point, I was starting to feel more and more uncomfortable and experiencing some pain. Feeling fortunate that I live in an area with great access to many specialists, I called around to get an appointment. Every doctor’s office I spoke with said they could see me in August or September. It was March! How was I going to live with this pain? How was I going to work? I am a single mom with a full-time job. I couldn’t wait 5 months! This was the beginning of realizing that I needed to advocate for myself and my care. I called my spine doctor back and he was able to get me in for an appointment. The rheumatologist started me on a disease-modifying anti-rheumatic drug (DMARD) and after a few adjustments, I began managing the medical aspect of my condition.
What may have been even more difficult for me, however, was managing the emotional and mental aspects of being diagnosed with an autoimmune disease at the age of 49. I started out doing exactly what you shouldn’t do—googling my condition. Everything I read made me feel hopeless. On top of that, I found that every thought I had focused on my condition. I would constantly question—should I be eating this? Should I be doing different exercises? Should I try this new vitamin or supplement? Every thought I had was about rheumatoid arthritis. I remember saying to my mom that I can’t wait for the day that I can say this disease is something I have, not something I am.
I looked for a support group with people to connect but found nothing in my area. I found an organization called Arthritis Introspective (who have since merged with the Arthritis Foundation) and went through training to become a facilitator of my own support group. It started with me sitting in Wegman’s (my local grocery store) hoping for one person to show up and now, three years later, we have more than 100 people in our group. The connections within the group help me take power and control back into my own hands, while educating and learning to advocate for myself.
You wouldn’t be able to tell by looking at me that I have rheumatoid arthritis. I work full-time, volunteer with the Arthritis Foundation, and am involved in my church. I spend time with family and friends and stay busy. Because of this, people often forget that I struggle at times. Some days I hurt more than others. Stress is a big factor in how I feel. And my flares tend to be different than other people. Rather than redness and pain in my joints, I feel extremely exhausted, like I’m coming down with the flu. If I’m very busy during the week, I need to take the weekend to recharge my battery. I no longer feel guilty if I stay in my pajamas or cancel plans. I’m constantly learning how to manage my time and my energy reserves.
In the autoimmune world, you often hear about the spoon theory. You start out with a certain amount of spoons each morning and you have to think about how you’ll use your spoons. If you have 15 spoons, it may take one spoon to get out of bed, two spoons to take a shower, another spoon to dry your hair, four spoons to go to work, and so on. My spoons are not endless like maybe someone who is healthy. I’ve learned to manage my spoons. If I work late two nights in one week, I know that I will have no spoons left for the weekend to socialize. It’s a daily struggle to balance what I can and can’t do.
I decided early on that I was not going to let this disease take over. I changed my diet, I found exercise that worked for me, and I found support. I am a platinum ambassador for the Arthritis Foundation, the leader of a top fundraising team for the Walk to Cure Arthritis, and the incoming board chair for our local leadership board. I tell people that the number one thing they need to do is to find their tribe and get connected. Not everyone in your tribe has to have arthritis, but they all have to understand that you are going to have bad days and good days. And your tribe should support you when you are struggling AND when you are celebrating!
After five years, I can finally say that rheumatoid arthritis is something I have, not something I am.
Two-thirds of American women take acetaminophen for pregnancy’s aches and pains. But the medication might not be as harmless as previously thought.
Research published in October online in JAMA Psychiatry shows that women who took acetaminophen (Tylenol) at the end of their pregnancies were much more likely to have a child with attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). After testing blood from the mother and the umbilical cord soon after birth, the odds of these developmental disorders were more than twice as high in children exposed to acetaminophen near the time of birth. The association was strongest between exposure to acetaminophen and ADHD in the child.
Researchers analyzed data from the Boston Birth Cohort, a long-term study of factors influencing pregnancy and child development. They collected umbilical cord blood from 996 births and measured the amount of acetaminophen and two of its byproducts in each sample. Participants‘ average age was 10 and slightly more than half were boys. When the children were an average of 8.9 years, 25.8 percent had been diagnosed with ADHD only, 6.6 percent with ASD only and 4.2 percent with ADHD and ASD. Just over 30 percent had another developmental disability. Almost 33 percent had no developmental concerns.
Researchers classified the amount of acetaminophen and its byproducts in the samples into thirds, from lowest to highest. Compared to the lowest third, the middle third of exposure was associated with about 2.26 times the risk for ADHD. The highest third of exposure was associated with 2.86 times the risk. Similarly, ASD risk was higher for those in the middle third (2.14 times) and highest third (3.62 times).
Authors found that their results support earlier studies linking acetaminophen exposure in the womb with ADHD and ASD. While the study found an association between an expectant mother’s use of acetaminophen and the development of ADHD and possibly autism in her child, it can’t prove a definitive cause-and-effect link.
Don’t panic if you’ve taken acetaminophen during pregnancy. “I wouldn’t worry if you’ve already taken acetaminophen purely based on the results of this study,” says Rashmi Kudesia, MD, M.Sc., a reproductive endocrinologist and infertility specialist who practices at CCRM Fertility Houston in Houston and is Assistant Clinical Professor of Obstetrics & Gynecology at Houston Methodist Hospital. She is on the Women’s Health Advisory Council. “This study only looked at umbilical cord blood, reflective of the time right around delivery. What, if anything, that means for earlier acetaminophen use, is unknown.”
Talk about medication use with your doctor. If you’ve already taken acetaminophen, don’t worry. “As for this study, since the genetics and environmental etiologies of autism and ADHD remain poorly understood, I would advise caution in linking Tylenol to causation or increased fetal risk,” says Dr. DaCarla M. Albright, MD, Associate Professor of Clinical Obstetrics and Gynecology at the University of Pennsylvania School of Medicine and an Assistant Dean for Diversity and Inclusion, with a focus on Wellness, at the Perelman School of Medicine at the Univeristy of Pennsylvania in Philadelphia. She is on the HealthyWomen’s Women’s Health Advisory Council. “We have more to learn.”
Most doctors have a ‘safe-during-pregnancy’ list of medications they’ll provide early in pregnancy, Dr. Kudesia says. “Even with this study, acetaminophen remains among the safest drugs for pain during pregnancy,” she says. NSAIDs like ibuprofen aren’t recommended, and neither are narcotics. If your pain is chronic, develop a long-term pain management plan ahead of time to avoid or reduce repetitive use of acetaminophen. “This latter recommendation is one I’ve always made, and it’s unchanged by the findings of the current study,” she says. For certain conditions, like migraines, there may be specialized prescription medications that work best. “But out of over-the-counter options, acetaminophen remains the best alternative,” she says.
If you get a fever during pregnancy, talk with your obstetrician before medicating; it may be a sign of pregnancy complications and may need further evaluation. Tylenol is your safest medication for fever management, says Dr. Albright. Non-medication alternatives, like ice packs or warm compresses (don’t apply heat directly to your abdomen in pregnancy), or alternative approaches such as massage or acupuncture, depending on the type of pain you’re experiencing. “Discuss the desire to take any medication in pregnancy with your physician,” she says. “It allows your physician the opportunity to appropriately triage the condition and make the best recommendations for you.”
The study was funded by the National Institutes of Health and the Agency for Health Care Research and Quality. The study was conducted by Xiaobing Wang, M.D., of the Johns Hopkins University Bloomberg School of Public Health, Baltimore, and colleagues.
