Occasional Pain: Insights from Rehabilitation Medicine

Intermittent pain?

Hello, I have accumulated many injuries due to my love for sports, and I have several questions that have been bothering me for a while.
Please help me answer them:
1.
My left wrist has been experiencing sharp pain when I push against the floor, especially when getting out of bed or crawling.
There was a period last month when it hurt, but after not seeking medical attention, it stopped hurting.
However, it has started again in the last couple of days.
What could be the cause?
2.
My right wrist has an old sprain injury, and I used to feel some soreness on the outer side of the wrist.
However, after doing some exercises, the pain has decreased.
Still, about once a week, I feel a slight misalignment.
I can't describe it well, but it doesn't hurt; I just feel like it's out of place.
When I press on it, it feels like I can pop the bone back into place, which is more comfortable.
Does this require treatment?
3.
I sprained my right ankle at the end of November, and it has been slowly improving.
However, I still feel pain when pressing down on the top of my foot, and my heel feels tight when squatting.
Should I continue to apply heat on my own, or do I need to go for rehabilitation?
4.
I often feel pain around my right acromioclavicular joint, particularly in a slightly recessed area at the front.
For example, it hurts when I carry a backpack or do weight training at the gym.
The pain is not sharp, but I notice that when it hurts, I can hear popping sounds when I rotate my shoulder or the joints near my scapula.
This feels similar to the instability in my right wrist.
When my right shoulder doesn't hurt, I don't experience any popping in either shoulder.
Could this be related to the pain near the acromioclavicular joint? What might be the cause?
5.
In early September, I seemed to have twisted my left knee in a car accident.
I feel pain in the back of my knee when squatting.
During rehabilitation, I received electrical therapy and manual therapy to relax the front of my thigh.
By the end of the year, it was almost pain-free, but it has hurt twice in the last month.
Once was when squatting, and the other was when lifting my knee.
The pain doesn't last long, usually resolving after a day.
Could it be due to the cold weather or from riding a stationary bike? My right knee is fine, but my left knee hurts.
Is it not fully healed? Do I need to seek medical attention?
6.
I have only experienced this about twice.
When exercising, such as cycling or running, I feel slight pain on the inner side of my left knee and the front of my right knee.
However, it's not severe enough to stop me from continuing.
If this happens again, what should I pay attention to?
7.
I usually have no issues while exercising, but symptoms like those in questions 1, 2, and 4 occur intermittently in daily life.
I have previously consulted rehabilitation and orthopedic specialists, but I don't feel pain during the appointments.
The doctors don't find anything wrong when they manipulate or ask me to exert force.
Despite undergoing the prescribed rehabilitation treatments, the problems persist.
However, I do experience pain frequently.
What could this intermittent pain indicate? Can doctors identify the cause when I'm not in pain?
8.
I'm not sure which specialty to consult, but I feel a slight protrusion in my lower abdomen that I hadn't noticed before.
Could this be caused by pelvic tilt? If so, where should I seek treatment? When I touch my abdomen, the area above my navel feels soft and flatter, but below the navel, it feels soft with a harder area inside.
When standing relaxed, my lower abdomen protrudes.
Is this normal? Is the hard area my bladder? I read online that it could be a sign of organ prolapse, which sounds alarming.
Thank you for helping me answer all these questions.

Christy, 20~29 year old female. Ask Date: 2019/01/15

Dr. Wang Zhaomin reply Rehabilitation

1.
There are many causes of wrist pain, such as sprains, contusions, tendonitis, chronic inflammation due to prolonged activity, or even degenerative joint reactions.

2.
There may be subluxation or joint laxity; while aggressive treatment may not be necessary, it is still recommended to seek medical evaluation for an accurate diagnosis.

3.
If the injury has persisted for over a month, although heat therapy may aid recovery, further rehabilitation treatment may be required if there is no significant improvement.

4.
Muscle strains or tendonitis near the shoulder joint and upper back may be related to the pain, and joint laxity may indirectly contribute to insufficient stability and damage to related soft tissues.

5.
If an injury has not fully healed, it can lead to chronic inflammation or further damage; it is advisable to continue medical treatment to achieve complete recovery.

6.
If there is pain, do not continue exercising; ensure adequate warm-up before activity, and use protective gear if there is a relevant medical history.
Engage in moderate strength training only when pain-free to avoid injury.

7.
Clinical symptoms need to be assessed on-site, and sometimes the cause may not be quickly identified.
It is recommended to continue medical follow-up, and if there is no improvement, referral to a medical center for further evaluation may be necessary.

8.
Anterior pelvic tilt can indeed cause lower abdominal protrusion, but other potential issues should also be considered.
Consultation with specialists in gastroenterology, general surgery, urology, or obstetrics and gynecology may be warranted.

Reply Date: 2019/01/15

More Info

Understanding occasional pain, especially in the context of sports injuries, is crucial for maintaining an active lifestyle. Your concerns cover a range of symptoms that can be indicative of underlying issues, and it's important to approach them systematically.

1. Left Wrist Pain: The sharp pain you experience in your left wrist when pushing off the ground could be due to several factors, including tendinitis, ligament strain, or even carpal tunnel syndrome. If the pain is intermittent and resolves on its own, it may not be severe, but if it recurs frequently, it would be wise to consult a healthcare professional. They may recommend imaging studies like an X-ray or MRI to rule out any structural damage.

2. Right Wrist Old Injury: The sensation of your wrist feeling "out of place" could suggest instability or a previous injury that hasn't fully healed. While exercise has helped reduce the pain, the recurring sensation of misalignment indicates that there may still be underlying issues, such as ligament laxity or joint instability. A physical therapist can provide targeted exercises to strengthen the wrist and improve stability.

3. Right Ankle Injury: Since you mentioned that your ankle is slowly improving but still experiences pain during certain movements, it may be beneficial to engage in rehabilitation. Physical therapy can help restore strength and flexibility, and modalities like ultrasound or electrical stimulation may aid in pain relief. Continuing to apply heat can also help, but if pain persists, a professional evaluation is warranted.

4. Shoulder Pain: The discomfort near your shoulder and the popping sounds could indicate issues with the rotator cuff or shoulder impingement. These symptoms often arise from muscle imbalances or overuse, particularly if you're engaging in weight training. A thorough assessment by a physical therapist can help identify specific weaknesses and guide you through rehabilitation exercises to improve shoulder mechanics.

5. Left Knee Pain: The recurrence of pain in your left knee after a prior injury suggests that it may not have fully healed. The fact that the pain is intermittent and resolves quickly is a positive sign, but it still warrants attention. Engaging in a structured rehabilitation program focusing on strengthening the muscles around the knee can help prevent future injuries.

6. Knee Pain During Exercise: Experiencing pain during activities like cycling or running can be a sign of overuse or improper form. It's essential to listen to your body and adjust your activities accordingly. Consider cross-training or modifying your routine to reduce stress on your knees, and consult a physical therapist for guidance on proper techniques.

7. Intermittent Pain: The nature of your pain being sporadic can be frustrating, especially when medical evaluations yield no definitive answers. This could be due to a variety of factors, including muscle tightness, joint instability, or even referred pain from other areas. Keeping a pain diary to track when and how the pain occurs can provide valuable information for your healthcare provider.

8. Abdominal Concerns: The protrusion you describe in your lower abdomen could be related to several factors, including muscle weakness, fat distribution, or even pelvic floor issues. If you're concerned about the possibility of organ prolapse or other serious conditions, it would be best to consult a specialist, such as a gastroenterologist or a pelvic floor therapist, who can provide a thorough evaluation and appropriate treatment options.

In summary, while occasional pain can be a normal part of an active lifestyle, persistent or recurrent symptoms should not be ignored. Engaging in a comprehensive rehabilitation program tailored to your specific needs can significantly improve your quality of life and athletic performance. Always consult with healthcare professionals who can provide personalized advice and treatment based on a thorough assessment of your condition.

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