Central Cord Syndrome: Arm/Leg Pain Coming From Neck

The following article is from NIH, and it summarizes a serious condition that can go undiagnosed for several months-years. So if you experience any or all of these symptoms, get medical attention immediately! I have seen this many times, and when symptoms are ignored for too long, they can become permanent.

What is Central Cord Syndrome?

Central cord syndrome is the most common form of incomplete spinal cord injury characterized by impairment in the arms and hands and to a lesser extent in the legs. The brain's ability to send and receive signals to and from parts of the body below the site of injury is reduced but not entirely blocked. This syndrome is associated with damage to the large nerve fibers that carry information directly from the cerebral cortex to the spinal cord.  These nerves are particularly important for hand and arm function. Symptoms may include paralysis or loss of fine control of movements in the arms and hands, with relatively less impairment of leg movements. Sensory loss below the site of the injury and loss of bladder control may also occur, as well as painful sensations such as tinging, burning, or dull ache.  The overall amount and type of functional loss is dependent upon the severity of nerve damage.  Central cord syndrome is usually the result of trauma that causes damage to the vertebrae in the neck or herniation of the vertebral discs.  It also may develop in persons over the age of 50 due to gradual weakening of the vertebrae and discs, which narrows the spinal column and may contribute to compression of the spinal cord when the neck is hyper-extended. 

Is there any treatment?

There is no cure for central cord syndrome although some people recover near-normal function. There is no standard course of treatment, although drug therapy, surgery, and rest are often part of the program.  Magnetic resonance imaging (MRI) is used to indicate the degree of spinal cord compression and vertebral instability.  Vertebral instability due to acute traumatic injury or cervical disc herniation is often treated by surgery to prevent further damage to the spinal cord.  Recent reports indicate that earlier surgery may improve chances for recovery.  Numerous recent studies suggest that surgery also can be beneficial in individuals with persistent compression of the spinal cord and ongoing neurological deterioration.

What is the prognosis?

The prognosis for central cord syndrome varies, but most people whose syndrome is caused by trauma have some recovery of neurological function. Evaluation of abnormal signals on MRI images can help predict he likelihood that neurological recovery may occur naturally.  Those who receive medical intervention soon after their injury often have good outcomes.  Many people with the disorder recover substantial function after their initial injury, and the ability to walk is recovered in most cases, although some impairment may remain.  Improvement occurs first in the legs, then the bladder, and may be seen in the arms.  Hand function recovers last, if at all.  Recovery is generally better in younger patients, compared to those over the age of 50.

Reference: NIH: National Institute of Neurological Disorders and Stroke. <http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm>

Which Health Professional Should I See?

If you are experiencing pain or have an injury, there are many options for health professionals to treat your painful condition. So who should you see first? Going to your family doctor is usually the best first step, and he/she will direct you with initial treatments and referrals. However, sometimes you can go straight to another health professional or ask your doctor for a referral to someone on this list. I selected these few to emphasize because many patients have asked me about these options.

1. Physical Therapist: joint pain, new injury, old injury, chronic pain, weakness, balance/walking issues, shoulder pain, elbow pain, neck pain, mid back pain, low back pain, sciatica, pelvic pain, hip pain, knee pain, ankle/foot issues, gross motor delays in babies or children, muscle pain/strain, neurological injury (such as a stroke) 

2. Occupational Therapist: pain/injury of any part of the arm/hand, difficulty with fine motor tasks, hand/arm weakness, difficulty performing usual daily tasks, neurological injury (such as a stroke), developmental delay in babies or children

3. Chiropractor: new episode of spine pain, car accident, whiplash, chronic back pain, some areas of joint pain, alignment issues, low back/pelvis pain, sciatica

4. Massage Therapist: fibromyalgia, chronic pain, tight muscles, stress

MD Specialists for some common painful conditions:

1. Neurologist: nerve problems (numbness, tingling), neuropathies, neurological conditions (stroke, TIA, MS), unexplained weakness

2. Pain Management: chronic pain, need for injections (such as Cortisone), back pain

3. Orthopedist: specific for each joint. For example, find a shoulder specialist/surgeon if you have shoulder pain.

4. Neurosurgeon: new or chronic spine pain that may radiate away from the spine into the arm(s) or leg(s)

Always remember that you can choose your own health professional just like you select your pharmacy. Even if your doctor refers you to a specific therapist or specialist, you can request a referral to someone of your choice.

Inner Knee Pain from Jogging

If you have inner knee pain from jogging, see if you fit this scenario. The inner part of your knee hurts as a result of overdoing your jogging program recently. You have pain only with jogging. Other activities (walking, moving the knee) are not painful.

Treatment for Inner Knee Pain:

1. Rest, ice, over-the-counter medicine if needed.

2. Avoid aggravating activities such as jogging.

3. Knee straightening exercise (the one I showed you on facetime), with the hands-on overpressure.

               

General Knee Strengthening for preventing inner knee pain in the future:

1. Quad squeezes. Sit with your leg(s) extended in front of you or lie down with your legs straight.

          Squeeze your thigh muscles to lock the knee(s) and hold for 5-10 seconds.

          Repeat 30 repetitions, >3x/day.

2. Straight leg raise. I have a single post dedicated to this exercise, so check out the following link:

           http://thinklikeapt.blogspot.com/2012/05/best-single-exercise-for-knee-pain.html

Jogging warmup (for once you are healed from this episode):

1. Walk fast for at least 5 minutes.

2. Stretch your legs for at least 5 minutes, including calf, hamstrings and hip adductor stretching (google it). Hold stretches for 20-30 seconds and repeat 2-3 for each muscle group.

3. Try short bouts of jogging only if pain-free. 

4. Slowly and steadily (likely over several weeks), you should be able to increase the jogging and decrease the walking.

Jogging cool down:

1. Stretch for 5-10 minutes, including calf, hamstrings adn hip adductor stretching. Hold stretches for 20-30 seconds each, and repeat several stretches for each muscle group.

7 Easy Exercises At Your Desk

1. Do a runner’s stretch for your calf muscles. Stand facing a wall, put one foot in front of the other foot, and place your arms out in front of you on the wall. Push into the wall with your hands. Keep both feet facing forward and keep both heels on the floor. The leg behind you will get a stretch to the calf. Calf flexibility can help to prevent Achilles tendonitis and plantar fasciitis.

2.Stretch your arms up to the sky and reach up as far as you can. Hold this stretch for a few seconds. This stretches your shoulders and can help to prevent frozen shoulder.

3.Roll your shoulders backwards. Roll them upward, backward and downward. Do big circles and small circles. This will remind you about proper upper body posture, which helps to prevent neck and shoulder pain, especially related to sitting excessively at work.

4.Move your neck up and down as far as is comfortable by looking up and down. Hold for a few seconds each way. Feel the motion of your upper spine and your neck muscles. Good motion of your neck is needed for almost all your daily tasks. If you do not have full motion of your neck in all directions, you likely have a neck problem that needs treatment (such as Physical Therapy).

Photo: ergomomma.com

5.Bring your hands behind your back and join your fingers from both hands together. Then reach both arms upward until you feel a stretch in your chest. Hold for at least ten seconds. Most people have poor posture, so their chest muscles remain tight. This stretch can help to prevent such tightness.

6.Move your ankles around in circles. Circle both directions at least ten times. Ankle motion is important to maintain good circulation of blood through the legs, which can help to prevent blood clots.

7.Squeeze your shoulder blades together. Feel the muscles between the shoulder blades pinch together. Hold for 5-10 seconds. Repeat several times. Shoulder blade motion is important to assist with shoulder motion, and shoulder blade muscle strength assists with good posture.

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Twisting and Back Pain, Joint Pain

Photo: joystiq.com

Twisting one of your joints in an awkward way is an easy recipe for injury, especially in the low back, shoulder, knee and ankle.

How To Avoid Twisting Your Back:

Turn your entire body by turning your legs.

Change positions in order to reach the object with ease.

Turn toward the object, then squat down.

Don't be afraid to get down onto your hands and knees to reach for something.

How To Avoid Twisting Your Shoulder:

Don't reach for objects in the backseat of the car.

Don't reach for an object behind you when you are sitting; simply turn around.

Don't close heavy doors carelessly.

Turn your body toward the object you are reaching for.

Keep your arms as close to your body as possible when reaching.

How To Avoid Twisting Your Knee:

Be cautious when playing sports.

Use a knee brace when playing sports if you have had a past knee injury.
Take time when turning around.
Don't turn your body if your knees are locked.

How To Avoid Twisting Your Ankle:

Use an ankle brace for your sport if you have twisted or sprained your ankle in the past.

Be extra cautious when walking, hiking or jogging on uneven terrain.
Try to avoid walking on ice. If it is icy, stay indoors (especially if you live in the South).
Watch where you are walking. Prevent falls by not doing 5 things at once.

A Healthier New Year

Photo: Ruben A.Navarrete

Looking back on this past year, are you happy with your health? Are you as healthy as you should be or want to be? Are you physically doing all you hoped and expected at your age? You cannot change everything about your health. You cannot control if you get cancer or are in a bad car accident or if everyone in your family has high blood pressure. But what can you control to make you as healthy as possible in order to live every day to its fullest?

1. Attitude. I recently met a man who had been paralyzed from a car accident when he was 21. He had an unusually positive attitude, so I asked him how long it took him to accept the fact that he was paralyzed. His surprising answer was "about 3 months." He told me how God used the accident to change his life and show him that he was not living how he should. So now he is--from his wheelchair. He just got married and is working and volunteering. He is not bitter, angry or depressed but sees his wheelchair as his legs, and it takes him everywhere. 

Having the right attitude will help you this new year because you can see your life as an opportunity instead of a struggle. Even if your circumstances are hard, such as being overweight or struggling with a health condition, you can still make the most of what God has given you. If you can walk, don't just sit. And if you can run, don't just walk. Use your body to its utmost potential this year!

2. Exercise. This is one area that only you can control. You can choose to be lazy or active. It takes work and discipline to exercise effectively, but everyone can do it in some form. Picture yourself 10 or 20 years from now. What physical condition do you expect to be in? If you don't take practical steps in that direction, you will likely fall short of that goal.

3. Time. How have you spent your free time this year? Do you have any regrets? Did you spend more time on Facebook and Instagram than playing with your kids? Did you waste time on TV or video games? There is a time for restful leisure, but at the end of next year, wouldn't you rather say you trained for a marathon or went skiing or hiking instead of just talking about the latest celebrity news? Remember that you are not guaranteed another day or another year. Think about what really matters in your life, and invest your time wisely. 

4. Excuses. Making excuses for an unhealthy lifestyle will only put you in the same or worse condition this time next year. Everyone is tired of your excuses, and you should be too. Don't blame anyone or anything else. Simply choose to take charge of your body right now and all year long. If you have lost a good amount of weight this year, I can guarantee it was because you worked your tail off. And it has paid off! 

One of the most important things in life is to leave a legacy. You cannot take anything with you to the grave, but you can take souls to heaven with you. You may not be the next Billy Graham, but maybe your son will. Or maybe the person you influence will become the next Mother Teresa. Maybe you will start a company that gives millions to cancer research. Or maybe those two pints of blood you donate will save a child's life.