Do You Have a Chronic Injury That Isn’t Healing?




In my last post I mentioned the concept of Neuromuscular efficiency.

Neuromuscular efficiency is the ability of the neuromuscular system to allow agonists (the primary muscles involved in a movement), antagonists (the muscles opposing the agonists), synergist (muscles that assist movements) and stabilizers (muscles stabilizing the core), to work together to produce, reduce and dynamically stabilize the Kinetic Chain (Human Movement System), in all planes of motion.

Optimum Neuromuscular efficiency depends on:

  1. Optimum length-tension relationships in the muscular system
  2. Optimum force-couple relationships (movement coordination) in the nervous system
  3. Optimum Joint function

Because of the integrated nature of the Kinetic Chain, impairment or injury to one system rarely involves one structure and will often result in compensations and adaptations in other systems.  These compensations and adaptations result in movement impairment syndromes, which are characterized by predictable patterns of tissue overload and dysfunction.

Altered length-tension relationships in the muscles, altered force-couple relationships in the nervous system and altered joint function affects neuromuscular efficiency and can initiate the Cumulative injury Cycle.

The Cumulative Injury Cycle is a cycle whereby an injury will induce inflammation, muscles spasm, adhesions, altered neuromuscular control and muscle imbalance.

The best time to address an injury is as soon as possible after the trauma. Acute pain responds well to numerous natural therapies, including:

  1. Ice for the first 24-72 hours
  2. Contrast therapy (alternating hot and cold applications)
  3. Anti-oxidants (Vitamins A, C, E and minerals Zinc and Selenium)
  4. Botanical anti-inflammatories, e.g. Bromelain, Curcumin
  5. Omega 3 fatty acids
  6. Acupuncture

Injuries that are left untreated, often lead to adhesions, altered neuromuscular control. Muscle imbalances and chronic pain.

Chronic pain is more difficult to treat because the nervous system is often involved. i.e muscle imbalances and joint dysfunction created postural distortion patterns that result in the compensations by other muscles and joints. This can be confusing for doctors and therapists, because the source of pain is often masked by compensatory neuromuscular adaptations.

An example is an ankle injury that is left untreated:

  1.  Lack of motion at the ankle joint or a pronated foot, results in internal rotation of the tibia and femur.
  2. Increased knee valgus (knock-kneed) results in increased movement at the lumbar spine and hip complex in order to compensate.
  3. The lumbar spine tilts anteriorly (forward), resulting in tension on the muscles that attach to the pelvis, e.g. the latissimus dorsi.
  4. The latissumus dorsi also attaches to the shoulder complex and if tight, will affect shoulder, neck and upper extremity alignment.
  5. These malalignments result in altered length-tension relationships in muscles (a combination of over and under active muscles), altered reciprocal inhibition (Tight muscles causing reduced nerve flow to their opposing muscles), synergistic dominance (altered recruitment of assisting muscles in order to compensate for weakened prime movers) and joint dysfunction (decreased joint mobility).
  6. The end result is Possibly:  ankle, knee, hip, low back, shoulder, neck and/or upper extremity pain


So what if you have chronic ankle, knee, hip, low back, shoulder, neck and/or upper extremity pain?

There is a simple test called an Overhead Squat Assessment which can provide information about dysfunction at the 5 major Kinetic Chain Check points:

  1. Foot and Ankle
  2. Knee
  3. Lumbo-Pelvic –Hip complex
  4. Shoulders
  5. Head and Cervical Spine

This assessment can help to determine which muscles may be weak or tight and which joints may be affected, thereby helping to streamline where to focus therapy and which therapeutic exercises to prescribe.

Addressing chronic pain that has progressed in the cumulative cycle should include:

  1. Therapy and corrective exercises to break up adhesions
  2. Therapy and corrective exercises to lengthen  tight muscles
  3. Therapy and corrective exercises  to activate or strengthen weak muscles
  4. Integrative exercises to coordinate full body movement patterns
  5. Diet and nutrition to reduce inflammation and enhance healing

Medical Foods and Pain

Medical Foods work as precursors to neurotransmitters- neuronal messengers that can control pain and inflammation.   Neurotransmitters inhibit neural firing and reduce inflammation. They activate opiod receptors and maintain balance between the sympathetic and parasympathetic nervous system.

Theramine is classified as a “medical food” that has been approved by the FDA for pain management.

Medical foods are not supplements and cannot be purchased over the counter or without a prescription.

For more information about using medical foods for pain, appetite suppression, hypertension, insomnia, depression and viral infections contact call Evergreen Integrative Medicine at (425) 646-4747 or e-mail Dr. Lecovin at

Geoff Lecovin, MS, DC, ND, L.Ac., CSCS, CISSN

Dr. Lecovin is a chiropractor, naturopathic physician and acupuncturist. He graduated from Los Angeles College of Chiropractic in 1990, earned a Masters in Nutrition from the University of Bridgeport in 1992, and then went on to complete the naturopathic and acupuncture programs at Bastyr University in 1994. He holds additional certifications in exercise from the National Strength and Conditioning Association, National Academy of Sports Medicine and International Society of Sports Nutrition.

Dr. Lecovin specializes in treating musculoskeletal pain and sports injuries by integrating trigger point acupuncture, soft tissue release, joint manipulation, corrective exercise and nutrition. In addition, he combines exercise and nutrition for weight loss, weight gain and performance enhancement.

His clinic, located in Bellevue, WA, offers naturopathic medicine, chiropractic, acupuncture, massage and infrared sauna therapy.

He can be reached at Evergreen Integrative Medicine at (425) 646-4747 and his website address is:

About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin