Fibromyalgia, joint pain and sleep. Finding a common ground through sleep.

Anyone who has been diagnosed with Fibromyalgia, or has joint pain and achiness has also likely been challenged by problems with the quality of their sleep.  Without getting too technical, sleep disturbance is one of the symptoms of Fibromyalgia.

Earlier this week, while dining with Dr. F (A well-known local Rheumatologist who helped craft the current criteria for Fibromyalgia) and Stu Carlitz, (the president of Eclipse who manufactures Therapedic as well as other brands of mattress), we had a lively discussion about chronic pain, Fibromyalgia and how to improve the quality of sleep in these individuals through better mattress design. 

During the conversation, it was clear that Dr. F who is currently involved in a drug trial and has pioneered the use of drugs such as Lyrica had a belief that Fibromyalgia according to the latest research is a neuro-chemical problem with a likely genetic basis (pain threshold is believed to be genetic based on current research).  Apparently, Lyrica is one of the drugs of choice for chronic Fibromyalgia and according to Dr. F, in Europe it is also approved as a sleep aid.  Dr. F believes based on what he has seen clinically that if you improve sleep, reported levels of pain are markedly reduced. 

The book Cheating Mother Nature, what you need to know to beat chronic pain talks about fibromyalgia in a more functional way.  One of the criteria is the 18 tender points which are not described other than to look for them as diagnostic criteria. In the medical world, if the person has a certain number of these tender points, and sleep problems, where they do not reach the deepest levels of sleep, they can be classified as having Fibromyalgia. In the book, it shows what the tender points are, which are areas of strain from Bio implosion, a concept pioneered by Brian Rothbart DPM, who is sort of a podiatric heretic who I believe based on years of observation and practice, figured out years ago the basis for chronic pain.  If bio implosion occurs only on one side, the asymmetry distorts the pelvis  in a similar way to how a towel is twisted which strains all the joints throughout the body.  This is as described in the book the reason chronic pain exists and the problem begins at the feet and is compensated by the myofascial that surrounds the core muscles.

The reality is that long term, as chronic pain develops, more pain results in a less restful sleep from the point of view of Cheating Mother Nature.  From Dr. F’s point of view, lack of sleep causes chronic pain, and Lyrica improves sleep quality and therefore helps these people function better. Dr. F also believes that Lyrica works on the neurology behind the abnormal pain these people experience.  Current research shows the body will adapt to its situations neurologically so chronic pain accommodation can go terribly wrong.

When trying to help those who meet the Fibromyalgia criteria, are we treating a disease classification with a drug that works while they take it, or do we fix the mechanical problems that create bio implosion to fix the problem.

A third idea comes to mind.  What if the mattress design addressed the sleep issue? This is why Mr. Carlitz decided we should work with one another and this is why the conversation was so fruitful.  We all agreed on the fact that better sleep improved pain levels.  The challenge now is to design a sleep system to address it head on, with the help of Dr. F’s guidance would decrease the reliance on drugs and allow people with mechanical basis problems to feel better and more refreshed in the morning.  The result will be less pain, less reliance on medication and while many of these people can benefit from the correct biomechanical interventions such as foot orthotics, fascial release treatment and manipulation, often their mattress offers a consistency not offered on today’s healthcare system since your mileage may vary between different healthcare providers and belief systems.

At the end of dinner, I gave Dr. F a copy of my book and suggested we get together for lunch or dinner more often.  We go back quite a few years as being friends and colleagues.  I think the open exchange of ideas is important, to avoid any of us from retreating back too far into our own ideologies.  While I believe that almost all chronic pain begins from asymmetry of the musculoskeletal system, I also believe there is a time and place for medical co management as well.  Conversely, they need to see things in a similar light.  At least we can agree on the importance of sleep and how a bed may be able to affect the growing problem of chronic pain.

Cheating Mother Nature is available through Amazon.com and other booksellers.  You can check out Dr. Charschan's authors page at whypeoplehurt.com and visit his blog at http://www.backfixer1.com/blog/.

Dr. F is a well known Rhumatologist in NJ who helped craft the current Fibromyalgia criteria. He is current involved in a 20 center drug trial to help those in chronic pain.

Tiger Woods Achilles problem last week is a symptom of a bigger problem; Here's how to fix Tiger Woods before it is too late

Why did Tiger Woods have an achillies problem last week, or was there more to the story?

On, March 12th, CBS news reported that Tiger Woods had to withdraw from the Cadillac Championship because of what he described as a sore achillies tendon (http://www.cbsnews.com/8301-505245_162-57395267/tigers-woods-withdraws-with-sore-achilles-tendon/)
.  While many athletes have problems with their back and legs especially as they age, Tiger has had a history of left knee,  right ankle, and neck problems as well as a previously ruptured right achillies tendon (http://www.utsandiego.com/news/2011/jun/07/timeline-of-tiger-woods-injuries/) and stress tibial fractures in his left leg.

Of course, a professional athlete with his resources and reputation should have the best care anyone could ask for, and because of the high stakes of the game, he will not bow out of a tournament easily.

What if there is an obvious reason for the injuries that was never diagnosed because most health care practitioners have never learned about its importance.  The book, Cheating Mother Nature, what you need to know to beat chronic pain offers some vital clues to the reasons Tiger has had repeated problems in his legs and back.

Conventional wisdom in healthcare and sports would dictate that he is an elite athlete who has injured his Achilles tendon on the right and ripped up his left knee.  From a golfers perspective, the golf swing requires great pelvis stability during the swing which places stresses on these areas.  Most people from the conventional perspective fail to see what is obvious in these photos.

Those who are built asymmetrically are that way because of genetics.  As described by Brian Rothbart DPM in his bio implosion model, when the foot turns out, the leg rolls in and so does the shoulder as the lower back hyper extends in compensation.  As described in Charschan's basic pronation accommodation pattern, the muscles and the fascia will adapt to this holding it in place.  If you look at the photo's, notice that his right foot turns out.  This is foot overpronation which also drops his right hip lower.  The compensation for this on the other side is his lateral leg, hip flexors in the front will tighten, placing huge forces in the kneecap and the ligaments by creating shear.  On the right side where the foot turns out and the hip drops, the leg will have a shortened stride, which will create adhesion formation in the back of the knee and the gluteal muscles on that side, which will place tension into the calf and Achilles.

When we look at the complaints he has, this matches perfectly with his left sided knee injuries and right sided achillies problems.  Because his mid section will also distort, the unequal distribution of forces from the pelvis will cause his legs to tighten.  While the author of this article has never met Tiger Woods, it would be safe to say that he has a heavy heel strike and likely slams his foot in the ground which over time would lock up both that ankle and the hip on the same side making this problem worse.  It is also quite likely that he has to constantly work an unstable core which he has been able to stabilize despite his body style issues.

While scanning the internet, I have noticed some enterprising podiatrists seem to believe he may need a boot and foot orthotics.  The author definitely agrees with foot orthotics to level his pelvis  and help with stability while walking and then swinging the club,  boot idea works on the symptom only, rather than why he continues to re injure himself.

To make this simple, Tiger has a gait issue and everyone is looking at the injuries which are the micro vs. the gait issue which is the macro. The symptom he experienced was sciatica, not an Achilles issue although I have no doubt his Achilles was quite tight as well as his calf on the right side.

How to fix Tiger Woods.

1. Foot orthotics - improves his body style while allowing the transference of force through his core muscle during the swing for a better transference of force.
2. Fascial Release - Whether ART, Graston or another style, fascial release to improve his core and release the fascial distortion will take the load off his legs and allow for more power off the ball.
3. Core training after his stability improves.  He can use a personal trainer quite effectively after step 2. The Wii fit actually works quite well.
4. Chiropractic manipulation would be quite helpful.  I would be surprised if this is not part of his regimen.
5. Proprioceptive exercises to improve side to side balance, strength and coordination.

Tiger, I hope you read this.  It has been a tough few years for you and I would like to see you stage a great comeback.  Hopefully, someone will pass these tips along to you.

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