Dr. Matta has been providing treatment for acute and chronic pain, as well as migraine and myofascial pain treatments, for over 20 years. We are pleased to add the Storz acoustic wave therapy to treat different causes of pain throughout the body.
Migraines are a terrible form of severe headache, often associated with nausea, vomiting, sound and light sensitivity and many other symptoms. They can be debilitating and it is estimated they cost the Canadian economy over half a billion dollars annually in direct and indirect costs.
There are definite triggers (chocolate, red wine, cheese, etc.) and it is very important to avoid them if you can. Many women suffer premenstrually or as a result of the birth control pill. Some patients respond well to natural supplementation with magnesium or vitamin B, but many women do not.
New treatment options have become available over the last two decades. Studies have shown that the majority of migraine patients respond to a multi-faceted approach. I have been treating migraines for over 20 years and the quality of life of many of my patients has improved greatly with treatment. Men and women alike who have suffered for years and missed out on special times with their family and friends can now return to a normal life. Insurance companies often pay for the treatment.
Neck spasm and tightness is a common cause of neck pain in both men and women of all ages. Whiplash disorder also happens frequently after a car accident and results in long term pain. Treatment options include physical therapy, ultrasound, electrical stimulation, chiropractic and acupuncture. Spasm can also occur in the lower back resulting in severe pain and limitation of movement and function. Many patients who have endured this chronic pain and have tried multiple therapies without success may benefit from current treatment options.
Treatment that reduces muscle spasm helps relax the muscles and significantly improve pain and is sometimes covered by private insurance companies.
Rotator cuff and calcific tendonitis:
This shoulder pain can occur in people who use their arms a lot, especially in an “above shoulder” position, such as baseball players and electricians. Pain usually occurs when the arm is raised to the side and is especially bad at nighttime when you roll onto it. I have had some patients describe it as worse than childbirth. Standard treatment includes anti inflammatory medication, physiotherapy, acupuncture, and possible cortisone injection or even surgery for severe cases. Treatment with the acoustic wave usually requires 3-8 sessions and improves pain in over 80% of patients.
While it is rare for me to see this in professional tennis players, it is common in “weekend warriors”, those individuals who aren’t usually active, but decide to go out on one Saturday and pretend they’re 17 again. It is also very common in tradespeople. It can make it very difficult to do simple tasks, such as opening a jar or lifting a purse. Treatment with acoustic wave provides an immediate improvement that continues to get better with each subsequent session.
Achilles tendonitis and Plantar Fasciitis:
Achilles tendonitis is most painful when one lifts up onto the tiptoes of their feet such as in stepping up, while plantar fasciitis is usually worse first thing in the morning when you step down out of bed. It can be so painful that simple walking becomes a major undertaking; it usually eases up after 10-15 minutes but can persist throughout the day. This is probably one of the most tender areas to treat with acoustic wave but results are very dramatic.
There are many different forms of pain that can mimic true “sciatica”. Classical sciatica occurs when one of the nerves in your back is “pinched” and causes pain, tingling, numbness and/or weakness down into your leg. This can occur from either a bulging or herniated disk, or severe arthritis with bony spurs pressing on the nerves. Typically, either L4, L5 or S1 nerve roots are involved. The L4 nerve refers pain and numbness to the knee and can cause weakness of straightening out the knee as well as a drop in your knee reflex. L5 impingement usually refers to pain and numbness to the big toe and weakens the muscle that flexes your ankle upwards, making it difficult to walk on your heels. S1 dysfunction refers to tingling and pain to the baby toe and weakens the muscle that flexes your ankle downward, making it difficult to stand on your tiptoes. The only true way to see if there is an actual nerve impingement is by a CT or MRI. The problem is that MRI results and clinical presentation do not always correlate. This means that you can have a terrible looking MRI, but feel very little, if any, pain. Conversely, you can have no MRI findings but have severe pain. It obviously works well for the former case, but in patients with no objective MRI findings but with severe pain, it may be difficult to convince them that their pain is valid. It is in these cases that a lot of the pain is not coming from a pinched nerve, but instead from myofascial sources. Myofascial pain (discussed in more detail in the next section) is commonly associated with referred pain and trigger points. In fact, over 20 years ago I used to see patients all the time whose pain appeared to be coming from a pinched nerve, but instead was coming from knots in the muscle. These knots (or trigger points) may or may not be obvious to patients but can exactly mimic sciatica radiating down from the buttocks to the legs. I have had patients that endorsed classic symptoms of sciatica but their pain and tingling improved by treating their ankle or lateral calf. More on trigger points in the next section.
As discussed in the previous section, much of our pain is due to what is referred to as myofascial trigger points. We still don’t understand everything about them but we are certainly more knowledgeable than the days before Drs. Travell and Simons wrote their groundbreaking book decades ago. We tend to think of myofascial trigger points as sensitized areas of muscle that can either cause local pain directly in the area of the point, or can refer pain and even numbness into classical patterns far away from the actual point. The most common one that I see is in the neck and is the bread-and-butter of massage therapists. This trigger point, or collection of points, as can be the case, causes pain in the neck (no it’s not just your boss that can do that) and refers either pain, numbness or both into the head, behind the ears, behind the eyes and down the arm with tingling into the two small fingers of the hand. I have had a patient in which this classic trapezius trigger point reaches the size of a golfball and is so hard that we have actually done an MRI on it to make sure it wasn’t anything more serious. This patient had 40 years of pain and had tried multiple treatment methods such as acupuncture, massage, chiropractic, Botox, physiotherapy, and ultrasound. With acoustic wave therapy, we were able to completely break down the knot so that it was barely palpable anymore. She still requires ongoing therapy for maintenance, but was able to finally conquer 40 years of pain!
These myofascial trigger points can be so remote that you may not even think of them as the source of your pain. They also correlate with traditional acupuncture points. My experience is that they are not consistent in patients. Some patients may notice a sensitivity on the lateral calf that can refer pain to their back or neck, while others have severe pain on the outer back part of their rib cage. There’s no way to know exactly where one’s trigger is until diagnosing it with the acoustic wave. A full diagnostic assessment for severe chronic myofascial pain can easily take an hour of testing just to find the relevant triggers, then treatment is directed to the most obvious or painful points. Most patients will describe that the pain “moves” after treating one area, they may notice it more in another area. This usually occurs along the myofascial plane in reverse order of severity and usually requires less therapy to treat it, but can occasionally be more resistant to treatment. As you now get to appreciate, chronic myofascial pain can be an incredible challenge for both the patient and doctor alike. With repeated acoustic wave treatment it is common to reach an 80% improvement in pain.