Chronic Pain Syndrome (CPS) is a common problem that presents a major challenge to health-care providers because of its complex natural history, unclear etiology, and poor response to therapy. CPS is a poorly defined condition. Most Academics consider ongoing pain lasting longer than 6 months as diagnostic, and others have used 3 months as the minimum criterion. In chronic pain, the duration parameter is used arbitrarily. Some Academics suggest that any pain that persists longer than the reasonably expected healing time for the involved tissues should be considered chronic pain.
CPS can affect patients in various ways. Major effects in the patient’s life are depressed mood, fatigue, reduced activity and libido, excessive use of drugs and alcohol, dependent behavior, and disability out of proportion with impairment.Chronic pain may lead to prolonged physical suffering and various adverse medical reactions from long-term therapy.
If you suspect yourself suffer from chronic pain syndromes, please seek early appropriate treatment / therapy. We can help you.
Neck pain can come from a number of disorders and diseases of any tissues in the neck. Examples of common conditions producing neck pain are degenerative disc disease, neck strain, neck injury such as in whiplash, a herniated disc, or a pinched nerve. Neck pain can come from common infections, such as virus infection of the throat, leading to lymph gland swelling and neck pain. Neck pain can also come from rare infections, such as tuberculosis of the neck and bone infection of the spine in the neck (osteomyelitis and septic discitis), and meningitis (often accompanied by neck stiffness). Neck pain can also come from conditions directly affecting the muscles of the neck, such as fibromyalgia and polymyalgia rheumatica. Neck pain is also referred to as cervical pain.
Risk factors for neck pain include injury from involvement in contact sports, motor vehicle accidents, bull or bronco horse riding, etc. Prevention of neck pain in the context of these activities should include neck strengthening exercises and often neck bracing.
Neck pain is commonly associated with dull aching. Sometimes pain in the neck is worsened with movement of the neck. Other symptoms associated with some forms of neck pain include numbness, tingling, tenderness, sharp shooting pain, fullness, difficulty swallowing, pulsations, swishing sounds in the head, dizziness or lightheadedness, and lymph node (gland) swelling.
Neck pain can also be associated with headache, facial pain, shoulder pain, and arm numbness or tingling (upper extremity paresthesias). These associated symptoms are often a result of nerves becoming pinched in the neck. For example, compressing the nerve of sensation to the back of the head, which comes out of the neck, causes headaches in the back of the head. Depending on the condition, sometimes neck pain is accompanied by upper back and/or lower back pain, as is common in inflammation of the spine from ankylosing spondylitis.
Ankle sprains are one of the most commonly occurring injuries in athletics. They can side-line any athlete from competing and are difficult to prevent from coming back.
Mechanism of Injury
Lateral Ankle Sprain: usually from inversion with plantarflexion (turning the toes in while pointing them down) leading to injury of the ligaments on the outside of the ankle.
Medial Ankle Sprain: usually from eversion with dorsiflexion (turning the toes out while pointing them up) leading to injury of the ligaments on the medial side of the ankle. Because the ligament here (deltoid ligament) is very strong, this injury is rarer and can take up to twice as long to heal than lateral sprains. It is also often
associated with fractures of the fibula or other bones in the ankle (medial malleolus, talar dome, articular surfaces).
Syndesmotic Sprain: Injury to the front and/or back lower ligaments of the ankle. This often occurs from hyperdorsiflexion (pointing the toes up too far) and version (pointing the toes out).
Signs and SymptomsLateral Ankle Sprain
Potential significant swelling within 2 hours because of the rich blood supply.
Tender to the touch over the outside ankle ligaments, bruising that drains into the foot.
Different levels of instability (depending on grade of the sprain).
Positive tests for ligament laxity of your outside ankle ligaments.
X-ray shows no signs of fracture.
Medial Ankle Sprain.
Tender to the touch over the inside ankle ligament.
Bruising and swelling along the medial side of the ankle
Positive test for ligament laxity of the inside ankle ligament.
X-ray needed to rule out avulsion fracture (bone fragment pulled away from the bone) or fracture of the inside ankle bone, or top of the ankle.
Positive tests for front/back ligament laxity and severe swelling (possibly fracture) in the lower leg
Pain and swelling over the front/back ligaments and the lower leg space.
Specific X-ray may show abnormal joint space in the lower leg.
Recovery time is longer compared to other sprains.
Need to rule out fracture and avulsion.
There are 3 degrees of ankle sprains which indicate the severity of the sprain :
1st degree : involves minimal swelling, point tenderness, no ligament laxity, no limp or difficulty hopping. An athlete typically recovers in 2-10 days.
2nd degree : has more swelling specific to the ankle, increased ligament laxity, a limp and athlete is unable to heel raise, hop, or run. Typical recovery time is 10-30 days.
3rd degree : includes a lot of swelling, tenderness on both the inside and outside of the ankle, even more ligament laxity, and the athlete cannot put any weight on the ankle. Recovery can be anywhere from 30-90 days or more.
Medical Referral and Rehabilitation :
When there is a 2nd or 3rd degree ankle sprain or a syndesmotic sprain it is important that you seek medical attention to rule out a fracture. Once a sprain has been confirmed it is important to see a practitioner /therapist in order to properly treat and rehabilitate the injury before returning to play. Changes to footwear, posture and biomechanics, orthotics, bracing options and return to play protocol will be determined by the practitioner/ therapist, depending on the specific injury.
Prevention from becoming a chronic injury :
Immediate effects are not generally seen after seriously injured. In order to prevent an ankle sprain from becoming a chronic injury several preventative measures should be taken. After an ankle sprain the risk of reinjuring the ankle post-injury is increased for at least 6 to 12 months. Both prophylactic and neuromuscular techniques can be utilized to decrease the incidence of inversion sprain re-injury. It is important to see a practitioner / therapist in order to properly treat and rehabilitate the injury for strengthening the joint and helping prevent future ankle sprains.
Return to Activity :
This is a gradual process and time is dependent of a variety of factors including: degree of injury severity, duration of symptoms prior to treatment, history of injury to the area, compliance to treatment and rehabilitation protocol.