Expert: Dr. Victor Dolan, DC, DACBSP - 1/24/2010

Question
Hi
I live in western Canada where we can get pretty severe winters. At least once a year I will take a fall. I usually land on my bum/lower back.
Inevitably I get up and brush myself off, being still fully mobile, with the knowledge that tomorrow I will be stiff as a board.
What exactly is happening here and why the delayed reaction?
I took a fall today at 1 pm. Its now 5 pm and I am very stiff, although I only get a spasm when I move.
Also, what is the proper medication, if any? I take those 'back and muscle pain' pills but they don't seem to be too effective.
I do exercise and try to keep my back supple, as I am a bus driver and back and neck on the job injuries are common-luckily I haven't had any yet even though I am 53.
When this happens should I keep moving around, or hit the couch?
If I have to call in sick tomorrow and chances are I will, should I go soak in my neighbours hot tub or something?
Thanks!

Answer
Back Pain, Staten Island Back Pain, Staten Island Chiropractic, delayed onset muscle soreness




Hello Bud,

I am sorry that you have fallen and will be sore.

Why sore 24 or 48 hours later?????
We have theories, but I do not know that we have ironclad answers.  Many, Many people have similar experiences as you report; a trauma of some sort- that does not leave them initially, immediately sore,,,, but they know that tomorrow or the next day, they are gonna be really sore!!
I have experienced this many times in my own  life.

The jolt, the sudden tightening of the muscles, the instantaneous 'exercise' of the fall could be analagous to exercise, to working out.  In that regard then the soreness tomorrow or the next day is called D.O.M.S. = Delayed Onset Muscle Soreness.

See also:

http://en.wikipedia.org/wiki/Delayed_onset_muscle_soreness - - - - -
- - - - - "Although the precise cause is still unknown, the type of muscle contraction seems to be a key factor in the development of DOMS. A recently developed theory states that DOMS is caused by the breakdown of muscular fibres. This is particularly apparent in strength/resistance programs. The breakdown occurs due to stress, and allows the muscles to grow stronger and larger, as shown through hypertrophy. Exercises that involve many eccentric contractions, such as downhill running or slow "negatives" during weight training, will result in the most severe DOMS. This has been shown to be the result of more muscle cell damage than is seen with typical concentric contractions, in which a muscle successfully shortens during contraction against a load."


".....Delayed Onset Muscle Soreness - Causes
Delayed onset muscle soreness is thought to be a result of microscopic tearing of the muscle fibers. The amount of tearing (and soreness) depends on how hard and how long you exercise and what type of exercise you do. Any movement you aren't used to can lead to DOMS, but eccentric muscle contractions (movements that cause muscle to forcefully contract while it lengthens) seem to cause the most soreness. ....." - - - - http://sportsmedicine.about.com/cs/injuries/a/doms.htm

You state: "...I live in western Canada where we can get pretty severe winters. At least once a year I will take a fall. I usually land on my bum/lower back....", congratualtions on living in Canada, looks like the USA is going to follow your footsteps and have national healthcare (socialized medicine)- #1) go see your local Doctor of Chiropractic!, he(she) could give you a quick adjustment and head off that soreness-- and it is Free in Canada!  #2)  I know you have historically taken a fall or two with little more than muscle soreness to show for it; BUT as we age, we do become more 'brittle'---- try not to fall !!!


"....Inevitably I get up and brush myself off, being still fully mobile, with the knowledge that tomorrow I will be stiff as a board.
What exactly is happening here and why the delayed reaction?....", I think the best explanation? = D.O.M.S.  , see above.

"....Also, what is the proper medication, if any? I take those 'back and muscle pain' pills but they don't seem to be too effective....",  I would be VERY careful with medications, here is an information handout sheet I give in my Staten Island Chiropractic office:



PAIN           

Pain  is a  ‘red light on the dashboard’.

Pain  is  your  body  telling  you  that  something  is  wrong.

  Think  you  should  listen??

That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?  

Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?   

Pain,  
do you cover up the pain by taking a painkiller?  
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?

Pain  Killing  medication???  =    16,000  deaths   ( probably  under-reported )
                         DEATH ! ? ! ?    better   watch  out  on  those  medications!!!  

                             NOTICE  ON  PAIN  RELIEVERS:
 
Label changes ORDERED by FDA;  the FDA announced proposed label changes for OTC over-the-counter pain relievers to  include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;
SIXTEEN THOUSAND DEATHS: "Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective medications for the treatment of many chronically painful medical conditions. However, it is estimated that 25% of all serious adverse drug reactions involve NSAIDs, with more than 100,000 hospitalizations and 16,000 deaths occurring annually due to NSAID-induced gastrointestinal (GI) events."----- http://hhc.sagepub.com/cgi/content/abstract/13/6/468   Home Health Care Management & Practice, Vol. 13, No. 6, 468-475 (2001)  Motrin, Advil = NSAIDS

The  American Heart Association issued a scientific statement   recommending medical doctors change the way they prescribe OTC pain relievers from a first choice    to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07).

NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage  destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ).   Many times people take NSAIDS  for  the pain of Arthritis,  not realizing these drugs may make the underlying condition worse.   These medications  cover  up  the  pain,  and  cause  the  problem  to   worsen.

Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.

Vertebral  Subluxation           (  ‘VSC’ ,    ‘subluxation’   )
Vertebral Subluxation  is  actually  a  quite  common  condition.   Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).  VSC- ‘Subluxation’ – can be the cause of many symptoms and conditions.

Only  a  Doctor of Chiropractic  will  evaluate  and  treat  for  VSC,   as  well  as  other  pathology.

The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.
              A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine , Invited to Colorado Springs (Olympic Training Center) to  Care for USA Olympic Athletes 2010

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".....I do exercise and try to keep my back supple, as I am a bus driver and back and neck on the job injuries are common-luckily I haven't had any yet even though I am 53....", exercise, yoga, stretching, swimming, glucosamine supplements, omega 3 essential fatty acids, chiropractic = these would all be helpful in PREVENTING injury, and if you did this prior to injury,,,,, your recovery would be faster and more complete.  After injury- all of these: exercise, yoga, stretching, swimming, glucosamine supplements, omega 3 essential fatty acids, chiropractic , would speed your recovery and return to function.
              Uou are in Western Canada ????? - Go to the Vancouver Olympics!- look up my Chiropractic friend- Dr. Blaise Toto, he is one of the Doctors (chiropractor) for our USA Olympic team !!!  http://www.totodc.com/

"....When this happens should I keep moving around, or hit the couch?..."- my recomendation? = 'active rest',  keep moving, as much as you can tolerate.
  http://www.answers.com/topic/active-rest

"....If I have to call in sick tomorrow and chances are I will, should I go soak in my neighbours hot tub or something?...", I am not a big fan of heat when someone initially injures themselves, I prefer ice over the 'sore spots'.  That being said,,,,, some people do not have a bad reaction to heat.  You can use heat if you have found heat to be helpful in the past FOR YOU; however-- I usually prefer ice over the sore spots.

Another handout I utilize in my Staten Island Chiropractic practice:


P.R.I.C.E. =    P  protection.   R rest.   I  ice.   C  compression.   E  elevation.

Hurt  yourself ??  injury/ trauma/  bruise/ not even sure - - a broken bone ??

You should certainly get to the Doctor or trained health professional to be examined  if you think it  is  bad  enough.    

BUT  in  the  meantime,  some  simple  steps  may  help.   

PRICE.

The  PRICE  protocol will usually help just about any musculoskeletal injury.

P = Protection;  protect the area from further injury- stop what you are doing, can you
     pad  or bandage the area ? Tape the area? Do something to protect the area !

R = Rest;  rest the area as much as possible, if a part is damaged, give the body time to
       repair the area

I = Ice;  ice is a potent anti-inflammatory; it will slow swelling, help with pain control
     (ice is analgesic), place ice over cloth over the injured area for 5, 10 minutes, off the
     injured area for 30 minutes; then back on again

C = Compression;  to help prevent swelling compression may be helpful- for example
      if it is an ankle, wrap the ankle with an ace bandage and ice the area.  Many body
      parts may not be applicable to compression.

E = Elevation; again to fight swelling and pain, raising the injured body part above the
      heart may be helpful- ie raise an ankle or knee, you lay down, raise the injured part

PRICE  may  help :    Sprains,  Strains,  musculo-skeletal injury,  bruise,  contusion
Sometimes  a slip, trip, fall, heavy lift, athletic injury, or a motor vehicle accident can cause a bump or bruise, sprain or strain.  Sometimes also involved with the injury is a vertebral subluxation (or other joint subluxation) (subluxation is a mechanical problem- of any joint- and requires a mechanical correction).  In the spine, a sprain/strain  is a misalignment,  a ‘kink’ in the joint, a stretch of the muscles, tendons and/ or ligaments:- more properly termed a Vertebral Subluxation.   Sometimes symptoms can come immediately, sometimes days, weeks or even months later!- Well after the actual trauma !!!

         Spinal = Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)  ;   ( subluxation COULD be any joint )
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A  subluxation  interferes with the proper functioning of the nervous system  (the master system  which controls and coordinates all function within the body)  and may cause various other conditions, symptoms and problems.


This is a serious condition identified by its five parts:
    Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
    Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
    Myopathology:
          Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
    Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
    Pathophysiology:
         Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
         Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
          Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.  For good health- Treat the   Cause,  not just the Symptoms.  Sprain/ strain/ bump/ bruise?= may result in subluxation of the nearby joint.  CORRECT the subluxation !!!!

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine

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"...If I have to call in sick tomorrow and chances are I will, should I go soak in my neighbours hot tub or something?.....", IF you use the Hot Tub,,, I would say use the Jacuzzi or Whirlpool portion, keep moving;  I think gentle movements will help keep you 'looser', BUT do not use heat if it has aggravated you in the past!, I Like ICE.

I hope this all helps!!!!!

I wish you good luck and good health naturally, If you need further- do not
hesitate to REcontact me here at AllExperts.com :
http://www.allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm


Thank You for the question,

Dr. Victor Dolan, DC, DACBSP
Email newsletter:.........http://drvictordolan.chiroweb.com