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Why is my pain not going away?

Why is my pain not going away?

If you have an area of pain like your knee, shoulder, Achilles tendon, or heel that continues to have flare-ups of pain you likely have tendinopathy or an underlying degenerative disease like osteoarthritis. Historically tendonitis has been used to describe pain in tendons without tears. Still, over the past few years, the sports medicine community has pushed for changing the term to tendinopathy or tendinosis, because it is not truly an acute inflammatory condition. This is a repetitive microtrauma to a tendon that can lead to chronic pain.

Your body is always breaking down and rebuilding. If the breaking down outweighs the rebuilding your body can no longer correctly heal the microtrauma to that tendon due to chronic low levels of inflammation. Therefore, if you take short periods of rest from the bothersome activity the pain will get better, but returns quickly after you resume. Tendinopathies can develop from overuse, improper form or alignment, core weakness, or inability to rebuild (poor cell health). Taking an anti-inflammatory may help in the short term, but the long-term risks are problematic and it does not target the underlying cause of the problem. They are not helping to heal the tissues and can actually inhibit our body’s natural ability to heal leading to further breakdown. Tendinopathies in the past have been difficult problems to treat. The good news is with regenerative treatments we can target these areas and help the body to heal to help keep you moving.

What is Nerve Pain? Many people suffer from neuropathic, or nerve-related, pain in the upper and lower extremities. It’s a deep burning, aching, and at times knifelike pain that just won’t go away. Most physicians prescribe pain medications for neuropathic pain with limited success and few providers have knowledge of newer treatment strategies.

Nerves are sensitive to stretching and compression. When there is too much of either of these it can lead to the release of inflammatory signals to the surrounding area where injury has occurred. These injured nerves tend to be swollen, tender, and leak substances that can cause further abnormal nerve function, breakdown of surrounding joints and soft tissue, and even insomnia, depression, and anxiety.

​With a repetitive injury to a nerve, a vicious cycle develops. Unhealthy nerves can lead to “sick” fascia and vice versa. Poor movement of nerves through fascia forms adhesions or scar tissue, leading to nerve entrapments, and more pain. There are many different types of nerve entrapments in the body. Carpal tunnel is probably the most familiar nerve entrapment, but essentially any nerve can get entrapped due to poorly moving or injured fascia or muscles, crossing over bony edges, going through tunnels, and/or being compressed or stretched beyond its tolerance level. At PICSM we specialize in the identification and treatment of nerve injury/entrapment using a comprehensive history and exam along with high-resolution ultrasound (HRUS) imaging.

Back Pain:

If you have lower back pain, you are not alone. About 80 percent of adults experience low back pain at some point in their lifetimes. It is the most common cause of job-related disability and a leading contributor to missed work days. In a large survey, more than a quarter of adults reported experiencing low back pain during the past 3 months.

Most low back pain is acute, or short-term, and lasts a few days to a few weeks. It tends to resolve on its own with self-care and there is no residual loss of function. The majority of acute low back pain is mechanical in nature, meaning there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move. Traditional treatments are focused on one specific area of the back, but it should be looked at as a functional unit as all of these components are interconnected and affect each other.

At PICSM we focus on a whole body approach to not only figure out the source of your back pain but why it did not resolve on its own and why did it happen in the first place. Many times recurrent episodes of acute back pain, even if they are

resolved on their own, are a sign there is a bigger problem with your back that is developing over time and needs to be addressed.


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