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Pain involving the ligaments and muscles is often seen in athletic injuries. When the ligament is torn, the injury is called a sprain. This often occurs in the ankle, the knee, the low back, or shoulder. Muscles that are bruised often
become painful and when the injury is considerable, that is called a strain. These small ligaments and muscle fibers may actually be torn, but heal without any residual weakness, after a short period of rest.

Inflammation of the bursa (bursitis) may occur as the result of trauma, arthritis, infection or other disorders. Common locations include the shoulder, hip, knee, elbow and heel. Severe local pain and tenderness is often present. Sometimes calcium deposits are seen on x-ray. Immediate application of cold in the form of snow or an ice bag is one of the most helpful remedies, followed by mild exercise and gentle hot and cold compresses, after the acute inflammation subsides.
The tendon sheath of the hand or wrist may become inflamed, Some of these are due to constriction of tendons or nerves, and may require surgery. In the wrist this is called carpal tunnel syndrome. Others are seen in
conjunction with rheumatoid arthritis, discussed in chapter five.

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Pain in the lower back, as well as the neck is very common in America. Many related, but distinct conditions can produce discomfort here. Disease of the spine, although less common than other problems, is often related to injury. An auto accident or sudden fall, causing acute flexion of the back, may compress and fracture one of the vertebral bodies. It may be an early sign of osteoporosis, thinning of the bones due to calcium deficiency. X-ray is often necessary to diagnose this condition accurately. Immobilization on a straight board, with the avoidance of any flexion, standing, or walking is extremely important First Aid in dealing with these acute injuries. Braces, which keep the back in extension, are often worn for several months in the treatment of a fractured spine.

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The correct interpretation of acute abdominal pain is one the most challenging demands made of any physician. Sometimes proper therapy requires urgent action. A great deal of experience and judgment is needed to
elucidate the cause.

A number of mechanisms can produce abdominal pain. Inflammation of the lining of the abdomen (peritoneum) can produce pain of steady, aching character. This pain is usually located directly over the inflamed area and the
area will also be quite tender. Release of a small amount of stomach acid will cause much more pain than even contaminated intestinal contents will when the appendix ruptures.

Another type of pain occurs in the distention or obstruction of hollow organs. This is usually intermittent or cramping in nature. Colic in the abdomen can be produced from obstruction of bile duct, the gallbladder, the ureters, or the intestines. Since all of these may cause vomiting, the location of the pain and other related symptoms must be considered in arriving at a rapid diagnosis. Finally, it is important to consider the blood vessels in the abdomen as causes of potential pain. An out pouching of the aorta (aneurysm) may produce pain, developing slowly, increasing gradually, or in a sudden rupture, may become quite catastrophic. Abdominal angina occurs when the vascular supply to the intestines becomes clogged with cholesterol deposits and this pain, similar to the angina pectoris of the heart, occurs
following a heavy meal.

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There is very little parallel between the severity of chest pain and the seriousness of its cause. A frequent problem exists in distinguishing trivial disorders from coronary artery disease or other serious health hazards. It is important to avoid the long tradition now shown to be myth, that pain beneath the left breast or radiating into the left arm is always of cardiac origin. Such pain is often observed in patients who are tense, easily fatigued, or anxious.

Oxygen deficiency of the heart muscle can produce pain. This is the syndrome medically termed angina pectoris. When the oxygen supply is deficient in relation to the need, pain will develop in the heart muscle. This may be aggravated by exercise, or occur during a stressful situation, or after a heavy meal. Atherosclerosis (narrowing) of the coronary arteries is the most common cause. Spasms of the small cardiac vessels may also trigger this pain (angina), which usually subsides with a short rest.

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This type of headache usually occurs over both sides of the head and often settles at the base of the neck. A fullness, tightness, or pressure is often described. Sometimes these headaches show the peculiarity of being continuous day and night for long periods of time. Sustained muscle tension, as well as vascular changes may be involved. Sometimes a similar headache may follow injury (auto accidents, head trauma) and gradually resolves over many months.

Simple remedies may be used with success in the treatment of headache. A person should lie down in a quiet area, apply a cold compress to the head, and seek to put the mind at rest. Often a drink of water or mild nerve-calming tea such as catnip or chamomile tea can relax the person until the headache passes. More severe types of headaches can be treated with the hot foot bath. This is described in the section on hydrotherapy. Adding mustard to the foot bath may also bring relief through acting as a counterirritant as well as pulling blood to the lower extremities (called derivation) to relieve congestion in the head. Extra hours for sleep, daily nature walks, or a change of pace may be needed. General hygienic recommendations for a more healthful diet, systematic exercise, and improved stress control are valuable preventives.

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