CONTENTS: Section I.......From the Editor's Keyboard Making Bones About It Section II.......Special Feature Fibromyositis Section III......From The Lifestyle Center of America Section IV.......Parting Words Subscription Information Back Issues
Even if you've never broken a bone, it seems like all of us experience periodic problems with our muscles, bones and/or joints. The frequency of these problems has given rise to a variety of medical specialists like orthopedists and rheumatologists. Here at the Lifestyle Center of America although people come for all kinds of reasons, it is rare to find a person who doesn't also have at least one minor orthopedic problem. An individual may be here to help reverse blockages in his heart arteries, but he may also have foot problems. Another person in our diabetes reversal program may also be struggling with the results of a shoulder injury. Someone else who is here primarily to lose weight and stop smoking may be troubled with low back pain.
The frequency of these musculoskeletal problems makes it mandatory for us to have a strong physical therapy department here, yet it also should impress the average person with a need to have a knowledge of what to do at home for common orthopedic problems.
This virtually universal need has made me very excited about a new Website. Honestly, however, when I first checked out the site, I was not terribly impressed. There were no slick graphics or vivid illustrations. However, after just a few minutes I recognized the beginnings of an excellent orthopedic resource for lay people.
The site already has the makings of an impressive library of short articles on common musculoskeletal problems. Each of the articles is written by Dr. Ray Foster, an internationally known orthopedic specialist. Dr. Foster combines his expertise in bone, muscle and joint disorders with a strong commitment to preventive medicine and patient education. He has managed to summarize current medical therapies for common conditions and put them side by side with simple treatments that people can use in their own homes.
When I recognized the practical value of this site, I contacted Dr. Foster with a request to repost some of his material in a special issue of our newsletter. That request was generously granted. I have chosen Dr. Foster's article on the subject of fibromyalgia (also known as fibromyositis) for this edition of WEJ.
If you want to check out his other articles, visit the West Seattle Adventist Community Clinic Website at: http://www.tx3.com/~rf/
Here's a listing of the other subjects that Dr. Foster has posted as of our current publication date: Heel Spurs (Heel Pain), Tennis Elbow, Osteoarthritis, On Being Overweight, Ingrown Toenails, Corns & Callosities, Plantar Warts, Trigger Finger, Dupuytren's, and Carpal Tunnel Syndrome.
by Dr. Ray Foster
**Definition**
The following definition is taken from Harrison's Principles of Internal Medicine 13th edition (on CD ROM 1994) 23rd Chapter, Heading: muscle pains, Section: Diffuse myalgias
Muscle pain in the absence of muscle weakness can occur in acute infections caused by influenza virus and coxsackievirus. Fibrositis, fibromyalgia, and fibromyositis are synonyms for a disorder associated with pain and tenderness of muscle and adjacent connective tissue. Focal "trigger points" of tenderness can be identified, and systemic symptoms such as fatigue, insomnia, and depression are frequently present (see Chap. 384). Although patients often identify painful swellings, histologic evaluation discloses no abnormality of muscle or connective tissue. Symptoms may respond partially to amitriptyline or nonsteroidal anti-inflammatory agents, but the disorder tends to be chronic and unrelenting. A supportive program of physical reconditioning is sometimes helpful. Patients whose symptoms persist for months or years are often considered to have a psychiatric disorder, but its nature has not been defined.
**What Is Going On**
The pain and sore spots characteristic of FIBROMYOSITIS can be due to several causes. First of all there may be a local inflammation due to a virus. This is like having a "cold" in your back or neck. Generalized muscle pains may be due to systemic toxins in the blood that results from a viral infection, usually somewhere else other than in the aching muscles or joint capsules. One common cause of localized tender spots is what is called "referred pain". A common site of inflammation due to trauma such as a strain or a sprain is from the many joints in connection with the spine. Because these joints are close to the coverings of the nerves being distributed from the spinal cord the covering of these nerves called the "dura" may become irritated or inflamed. When this happens, the trouble is not where it hurts, but deeper inside around the inflamed joint linings and nerve coverings. Should the pain and tenderness last for more than a few months chronic pain and joint stiffness may result. The brain has memory banks. If these memory banks store a lot of pain pattern memories they can be self-perpetuating in some degree. As the body sympathizes by splinting the body part that hurts, stiffness may result. When a part is protected by splinting or guarding it for many months the muscles can become weaker and the joints stiffer because of lack of full range of motion. Thus the pain, splinting, lack of movement, stiffness, pain cycle may develop which may make the condition chronic.
Many Faces - common mechanism: The same mechanism occurs in many different body sites. "Tennis elbow", "heel spurs", back, neck, shoulder pain with tender spots are common locations.
**What To Do**
Most of the time we pay no attention to aches and pains associated with the flu or head colds or just "feeling under the weather". This is the very best thing to do because in the vast majority of times the pain and stiffness goes away without any specific treatment on our part. The body has a wonderful built-in healing mechanism which keeps us in good condition.
1. So the first thing to do is to ignore it and most of the time it will go away.
For those sore spots that do not go away, the first common sense question is whether this is what has been described here as FIBROMYOSITIS or not?
2. If in doubt of the diagnosis seek professional medical advice.
For the conditions we have described here, most of the time the following suggestions will lead to a large degree of relief, if not a total cure in time (about one and a half to two times the length of time that it took to develop).
3. Local heat will have the effect of making it unhealthy for any virus. Alternate hot and cold applied locally will increase the blood flow to the part and have the effect of "washing out" the collection of pain chemicals. Heat will ease the pain and relax the muscles allowing for more normal local blood flow. There are a number of easy ways to apply hot and cold to the part (e.g. 3 min hot and 1/2 min cold): - shower or water baths or heating compress or electric pad and ice locally. Use a thermometer to measure the heat of the hot water. Start the hot water about 100F (37.7C) and increase the temperature by adding more hot water (without burning yourself) to a maximum temperature of 110F (43C). Add ice to the cold water to keep it cold and end the treatment with cold (at least three hots and three colds). If you have diabetes, peripheral neuritis, or other disease that makes your body part insensitive to temperature consult your professional medical providers before attempting to use hot and cold on yourself.
4. Local stretching of the joints and muscles will regain or maintain the normal range of motion.
5. Exercise will increase the local muscle blood flow and keep the muscles from becoming atrophied by disuse. Walking is without doubt the best exercise. We recommend walking little by little to increase your tolerance. Exercise appropriate to your age and station (e.g. walk 2 -3 miles a day 3 - 5 days a week).
6. Eat an unrefined, whole plant diet. Complex carbohydrates are the best source of fuel for your body.
7. Other remedies include: 1) local massage of the tender "trigger points"; 2) special physiotherapy methods which have been developed to "stretch and hold" a tender, tight, sore muscle; 3) putting the joint through a full range of motion may stretch and relax the muscles and regain lost range of motion. Consult your professional medical personnel regarding other physiotherapy modalities of treatment, if necessary.
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