Knee Pain and Jumping Injuries

15 Jan

The term “jumper’s knee” was first coined in 1973 to describe an injury to the tendon that attaches the lower (most common) to the prominence (tibial tuberosity) on the proximal shin bone (tibia) or the upper pole of the knee cap or “patella” to the quadriceps femoris muscle.

Jumper’s knee is one of the more common tendinopathies that affect up to 20% of all adult athletes in sports with frequent jumping, typically among adolescent basketball and volleyball players. Individuals who are obese or who are bow-legged or knock-kneed or whose lower limbs are unequal in length have a higher risk for jumper’s knee. Poor jumping technique can also increase the risk for this condition as can cause overtraining, especially on hard surfaces.

The disease process for jumper’s knee can be divided into four stages: 1) pain only after activity without disability; 2) pain during and after without disability; 3) prolonged pain during and after which affects function; 4) complete tendon tear that requires surgical repair.

Treatment for jumper’s knee can include: 1) reducing jumping activity;  2) icing the knee for 15-30 minutes, four to six times a day, especially after the activity; 3) a thorough exam of the hip, knee, ankle, and foot to assess joint function; 4) stretching the hamstrings, calf, quadriceps, hip flexors, gluteal (buttocks), iliotibial band, and tissues around the knee cap; 5) strengthening exercises focused on specific parts of the quadriceps (vastus medialis oblique especially) and other leg muscles; 6) ultrasound and other therapies that may help speed recovery; and 7) taping to help patellar tracking.

Doctors of chiropractic are trained to evaluate and treat the whole person and frequently treat athletic injuries. A successful treatment outcome for jumper’s knee requires both local knee care and the management of the entire lower “kinetic chain” which includes the foot, ankle, knee, hip, and pelvis.

The Most Important Principles for Staying Young: Exercise Increases Brain Game Benefits

11 Jan

Our basic premise is that your body is amazing.  You get a do over. It doesn’t take that long, and it isn’t that hard if you know what to do.  In these notes, we give you a short course in what to do so it becomes easy for you and for you to teach others. We want you to know how much control you have over both the quality and length of your life.

We’ve previously discussed how physical activity can increase the one organ in your body where size matters: your hippocampus.  Yes, when it comes to your hippocampus—the memory relay station in your brain—size matters.  The larger your hippocampus, the better your memory, and the lower your risk for developing dementia later in life.

Not long ago, a study found that doing 18 hours of Speed of Processing Brain Games (see AARP for a very low-cost version) over the course of a decade decreased the dementia risk for 73 to 83 year olds by nearly 50 percent.

A study from scientists at McMaster University in Hamilton, Ontario, tested what these two activities—brain training and exercise training—did when combined. To find out, the research team studied a group of healthy, young college students—people expected to have good memories. The researchers hypothesized that if a program resulted in better cognitive function in people with good memories, it should also benefit those whose memories might be worrisome.

The investigators randomly assigned each of the 95 participants to one of three groups. The first group participated in 20 minutes of supervised, high-intensity interval training on stationary bicycles.  The second group did the same cycling program but with the addition of 20 minutes of computerized brain training before or after their workouts. Finally, the last group continued their normal lives and served as a control group.

In general, those who exercised—as would be expected based on prior data—performed better on memory tests than individuals in the control group. The researchers also observed that the benefits were greater among the volunteers whose fitness levels had improved the most, especially if they also practiced brain training.  And to address the purpose of the experiment, the participants in the combined exercise and brain training group experienced the greatest memory enhancements and the results appeared to be more than just additive.

So the take home message for all of us who want to keep our brain in tip top shape is to do both: move your body on a regular basis and work your brain with Speed of Processing games.

Thanks for reading. Feel free to send questions to: AgeProoflife@gmail.com

Dr. Mike Roizen

 

PS: Please continue to order the new book by Jean Chatzky and myself, AgeProof: Living Longer Without Running Out of Money or Breaking a Hip.

 

NOTE: You should NOT take this as medical advice.

This article is of the opinion of its author.

Before you do anything, please consult with your doctor.

You can follow Dr Roizen on twitter @YoungDrMike (and get updates on the latest and most important medical stories of the week).  The YOU docs have two newly revised books: The patron saint “book” of this column YOU Staying Young—revised and YOU: The Owner’s Manual…revised —yes a revision of the book that started Dr Oz to being Dr Oz.  These makes great gifts—so do YOU: ON a Diet and YOU: The Owner’s Manual for teens.  

Michael F. Roizen, M.D., is chief wellness officer and chair of the Wellness Institute at the Cleveland Clinic. His radio show streams live on http://www.radioMD.com Saturdays from 5-7 p.m. He is the co-author of 4 #1 NY Times Best Sellers including: YOU Staying Young.

Carpal Tunnel Syndrome – More Than Just a Wrist Problem

8 Jan

Carpal tunnel syndrome (CTS) is a common condition that affects around 6-12% of the population and can result in significant pain and disability. The financial costs associated with CTS can be staggering – ranging from $45,000 to $89,000 per patient over a six-year period when productivity loses are taken into account.

Historically, doctors and researchers have described CTS as the result of compression of the median nerve as it travels through the bony carpal tunnel at the wrist. However, there is recent evidence that CTS is a more complex pain syndrome with multiple studies showing women with CTS exhibit widespread pressure pain hypersensitivity, thermal pain increases, and what’s called “enhanced wind-up in extra-median nerve territories.” In other words, the central nervous system seems to be involved, affecting the whole body, not just the wrist and hand.

Traditionally, the management of CTS has included conservative interventions primarily focused on relieving wrist and hand symptoms using splints, manual therapies, modalities (ultrasound, laser), and exercise—with surgery recommended if the patient fails to respond treatment. In looking at CTS as a product of the central nervous system (CNS), therapies that target desensitizing the nervous system may be more effective.

A 2017 randomized clinical trial compared manual therapy with surgery for improving BOTH pain and central sensitization (“nociceptive gain”) in CTS patients. Here, researchers randomly assigned 100 women to either a manual therapy group who received one session per week for three weeks including “desensitizing manoeuvres of the CNS” or a surgical intervention group (50 in each group). The research team evaluated pressure pain thresholds (PPT), thermal pain thresholds (hot or cold – HPT or CPT), and pain intensity at baseline, three, six, nine, and twelve month intervals following the intervention.

After one year, those in the manual therapy group experienced higher increases in PPT over the carpal tunnel at three, six, and nine months and greater decreases in pain intensity at three-months than those who underwent a surgical procedure. Otherwise, the outcome measurements were similar for both groups.

The significance of this study supports that a non-surgical, manual therapy approach (in which chiropractic specializes) is more effective in the short term and equally effective in the long term as surgery for BOTH pain and central sensitization (PPT only – not HPT/CPT for either group).

A Simple Remedy for Chronic Low Back Pain?

4 Jan

Low back pain (LBP) affects about 80% of adults at some point in their life, and its impact on work, recreation, and overall quality of life can be devastating if it transitions into chronic LBP (low back pain that persists for more than three months).

So, is there really a simple remedy for chronic LBP (cLBP)? Since back pain is often multifactorial in its causation, the simple answer is “probably not”. BUT, a 2017 study reports that simply taking vitamin D can offer significant benefits for the cLBP patient.

In the study, researchers provided participants (68 patients with a history of cLBP and low vitamin D levels) with an oral dose of 60,000 IU of vitamin D3 every week for eight weeks. The research team measured pain intensity and disability using common outcome assessments at baseline and at two, three, and six months post treatment. They also collected blood samples to measure vitamin D serum levels.

The data show that not only did the patients’ vitamin D levels improve from 12.8 ng/mL (+/- 5.73) at baseline to 36.07 (+/- 12.51) at eight months with 45 (66%) of the patients attaining a normal level of >29 ng/mL, but the participants also report significant improvements in pain and disability throughout the course of the study.

The authors conclude that vitamin D supplements can improve pain and function in cLBP patients with vitamin D deficiency. Hence, this is a VERY SIMPLE remedy!

It is well known that vitamin D deficiency is a very common problem, with up to 75% of teens and adults having suboptimal levels. Past research has demonstrated vitamin D deficiency may be a risk factor for many disorders including cancer, heart disease, diabetes, and depression. It appears that we can now add cLBP to the long list of conditions that vitamin D supplementation may benefit.

Chiropractic services frequently include nutritional counseling, diet management, and other wellness-related services in the quest of optimizing patient health, well-being, and quality of life.

Charlie Horses and Management Strategies

28 Dec

At some point in time, most of us have had a “Charlie horse” or muscle cramp. In fact, 50% of adults over the age of 50 suffer from night cramps. Doctors of chiropractic are often asked by their patients, “Where do these come from? Why am I having these? What can I do to get rid of them?”

 

The most common type of muscle cramp is caused by exercise, hence the label “exercise-associated muscle cramps” (EAMC). Though EAMCs are common in both recreational and professional athletes, the actual cause remains unclear. Therefore, treatment is often based on anecdotal studies rather than sound scientific evidence.

With that said, a thorough analysis of previous studies published between 1955 and 2008 concluded that the two most widely discussed theories for the cause of EAMC are 1) dehydration and the resulting electrolyte imbalance/depletion and 2) neuromuscular causes. The authors of the analysis concluded that the actual cause is “…likely due to several factors coalescing to cause EAMC.” In other words, it’s sort of like “a perfect storm”, as several causes interact to result in the cramp, which is why treatment and prevention strategies for EAMC can vary considerably.

The recommended care for acute EAMC is to apply a steady, moderate static stretch to the muscle followed by gathering a proper history to determine if any predisposing conditions exist that can trigger EAMC. Prevention should focus on fluid and electrolyte balance (replacement) and/or neuromuscular training.

Specific physical problems that can increase the rate and/or intensity of muscle cramps include conditions affecting the endocrine system (hormonal imbalance), the metabolic system (loss of fluids and electrolytes), and/or the neurological system (such as nerve injury or damage). Common areas for muscle cramping include the calf, front of the thigh (quadriceps), and back of the thigh (hamstrings).

A thorough history and physical examination may include a nutritional assessment, which can lead to treatment strategies tailored for each unique, individual patient. Additionally, it’s a good idea to review what medications a patient is taking as they may play a role in the development of cramps. For example, diuretics commonly prescribed for high blood pressure and other heart-related conditions may lead to potassium depletion.

Some helpful natural remedies for those with persistent muscle cramping may include a mineral/electrolyte replacement such as calcium, potassium, and/or magnesium. Anti-inflammatory nutritional care such as ginger and turmeric and/or muscle relaxing approaches such as valerian root can also be helpful. Other anti-cramping natural substances include Cassia oil and capsaicin. Riboflavin has been used preventatively with success as well.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Whiplash Injury Prevention – Part II

21 Dec

Last month, we discussed whiplash injury prevention by focusing on the physical characteristics of crashes. This included information about head restraints, collision speed, seat back position, body size differences, air bags, and more. This month, we’ll focus on the MOST important aspect of whiplash prevention: driver distraction!

According to a survey of 6,000 drivers conducted by the National Highway Traffic Safety Administration (NHTSA), 20% of those surveyed in the 18-20 years old age group and 30% of those 21-34 years of age claimed texting does not affect their driving.

Of the 6,000 drivers surveyed, 6% reported having been in a crash in the prior year and 7% had been in a near-crash, with men being at a slightly higher risk than women. Young drivers, those 18-20 years old, had the highest incidence of crash or near-crash experiences (23%) compared with all other age groups while interestingly, drivers aged 65 years and older had the lowest (8%). The younger drivers reported almost double the number of crashes (17%) as drivers in their early 20s (9%) and up to four-times more than the other age groups (4-6%).

Of the 718 drivers who were involved in a crash or near-crash in the previous year, 6% reported phone usage at the time (4% talking, 1% sending a text or email, and 1% reading a text or email). The young driver (18-20 years old) group, reported the highest cell phone use (13%) at the time of the crash or near-crash (2% talking, 8% sending a text or email, 3% were reading a text or email). The highest incidence of talking on the phone at the time of crash/near-crash was in the age 25-34 years old group (10%). Not too long ago, we reported statistics comparing texting to drunk driving, and the data was sobering. Researchers from the Monash University Accident Research Centre in Australia found that texting severely impaired driving skills, as participants spent 400% more time with their eyes off the road!

Hands-free devices are NOT without risks either. Put simply, the brain is distracted when talking, as attention is displaced from the road to the conversation—especially if the conversation is heated! Interestingly, the Texas A&M Transportation Institute reported that voice-to-text offers no safety advantage over manual texting while the AAA Foundation for Traffic Safety reported voice-activated in-car technologies “dangerously undermine driver attention.”

To summarize, avoid all distractions while driving and keep your eyes on the road!

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.
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