Pain in the Neck (or Back, or Knee)? Focus on the Muscles

Don't neglect the muscles when you're trying to find the cause of common aches and pains.

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When faced with a sore knee or a back pain, the first inclination is to look to the bones and joints. And that's appropriate in some cases. But many times, the answer lies in how all of the elements of the musculoskeletal system work together, especially those often overlooked muscles, says sports chiropractor Rob DeStefano. By taking this more global perspective, you're more accurately able to treat (and prevent) nagging injuries and aches, according to Muscle Medicine (Fireside), a new book DeStefano wrote with orthopedic surgeon Bryan Kelly and health writer Joseph Hooper. It takes you on a tour of your body's trouble spots—including the lower back and the knee—and helps you tease out the roots of common problems and possibly even how to fix them yourself. I asked DeStefano about muscle medicine in a chat; here are some edited excerpts:

If you have pain in your back, knee, ankle, or other body part, whom should you turn to for help?


We're often taught to go to the top of the diagnostic chain, the orthopedist. But the truth is that most orthopedic surgeons, unless they [have some particular interest or specialty], don't want to see patients unless it's a surgical case. Otherwise, it's just evaluating and referring out. A good manual therapist who will refer out when it's necessary-whether a chiropractor, a physical therapist, or an internist who works with manual therapy—is a good port of entry. But some of the indications to see an orthopedist [first] include tingling and numbness, an extremity with swelling or redness, edema, or pain in the area that really limits your range of motion. And anything that's a result of an acute injury should be checked out. [The book also recommends that you should immediately seek medical help if you have any injury or trauma in the vicinity of the spinal cord, progressive muscle weakness in any part of your body, or a change in your bowel or bladder function. Heat and fever are also symptoms that should make you head to a doctor.]

[Read more about hands-on fixes for sports injuries.]

So many people have pain in the back. Why?


We're dynamic creatures, and we aren't supposed to sit for eight or 10 hours at a time. If you look at our muscularity, we're meant to be lower down, in a hunched position. By sitting all day, you're shortening the iliopsoas [a powerful muscle group that flexes the hip and the trunk], and when you try to stand up, it can cause a lot of discomfort [in the back muscles, which are forced to constantly pull back to keep the spine straight]. If we looked at the musculature, we might say, hey, listen, it's really short and tight, so let's reduce that tightness [with manual therapies designed to loosen up muscles and break up scar tissue] to improve pain. If we took that conservative [step] first, along with stretching and strengthening, we wouldn't have to look at the structural problems. Now I'm talking about the vague back pain so many people have, not something potentially serious.

Are there easy ways to deal with back pain on your own?


You can definitely loosen up the quadriceps, the hamstrings, and the glutes [by self-massage and stretching]. Unfortunately, the most important thing—the psoas—you cannot self-treat. That's in the front of the lumbar spine and should be left to the experts. [The book also recommends preventive steps such as avoiding heavy shoulder bags, which stress one side of the back, sitting up straight and tall when you drive, picking an office chair with armrests and an adjustable lumbar support, and taking frequent breaks from computer work to keep circulation and the muscles moving.] [Check out how to get rid of bothersome neck pain.]

Do you recommend stretching to prevent pain or muscle problems?


Instead of generally asking "to stretch, or not to stretch," the question should be: Should you stretch for a particular condition,and if so, what kind? For example, static stretching [traditional stretching, bringing the muscle right to the end of its range of motion and holding it for 20 or 30 seconds] really seems to have its place in post-surgical rehab for injuries to the capsule [a sleeve of collagen surrounding a joint], for example, in the hip joint or shoulder joint. It can really break up post-surgical scars. It can also really increase the flexibility of the joint capsule for people who need it, like ballet dancers or gymnasts. [The book notes that static stretching for most athletes has not been shown to be particularly helpful in reducing injury or boosting performance.] Dynamic stretches [which incorporate movement to bring blood to the area; an example is simply moving your outstretched arms from the front to the side and back, crisscrossing in front of the chest] are great for people who want a little more flexibility before a run, for example. They're also a great progression to a more active role after surgery.

[See how to prevent and help heal hamstring injuries.]

I'd rather see athletes do no stretching at all rather than the wrong stretch. I'd rather see them warm up really well, doing their activity for 10 to 15 minutes at a very low level.

[Try some tricks to get the most out of your workout.]

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