What Can Be Done for Kneecap Pain?

19 Apr

Patellofemoral (PF) pain (or pain in the area of the knee cap) is a very common problem, especially in women because they naturally have a wider pelvis. A wider pelvis can cause a “knock-knee” effect, which can be exacerbated by flat feet and ankle pronation (rolling in at the ankles). The net result is that outward pressure increases on the patella, which can be quite disabling and interfere with weight bearing activities. So, what can be done for individuals with patellofemoral pain?

Because we cannot change the width of the pelvis, the focus must shift to the foot/ankle and hip/knee muscle balance. A 2014 study set out to prove (or disprove) that exercises that target BOTH the hip and knee vs. the knee only would yield better long-term outcomes.

Here, researchers randomly assigned 31 women with PF pain to one of two treatment groups: Group A participated in BOTH hip & knee exercises for eight weeks and Group B engaged in ONLY knee exercises for eight weeks. Following the completion of each eight-week exercise program, the researchers examined each participant, followed by a re-examination three months later. The investigators found that patients in Group A experienced greater improvements with regards to pain and function.

The authors of the study concluded, “An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was more beneficial in improving pain, physical function, kinematics, and muscle strength compared to a program of quadriceps-strengthening exercises alone.”

The “take-home” message here is that patients obtain the best results when treatment—in this case, exercise—is applied to more than just the area of complaint. Chiropractic care includes assessment of the whole person, not just a localized area where the patient feels pain. Perhaps this is why chiropractic almost always scores highest in “patient satisfaction” surveys when compared with other healthcare delivery systems.

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.

Are Egg Yolks and Grass Fed Beef Really What I Should Eat?

16 Apr

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.

To borrow from a chapter we are authoring for a book to be published about a year from now: “There are plenty of health concepts that are easy to visualize even if you can’t see them such as a broken bone, a clogged artery, or a torn muscle. At the chemical level, it gets a little trickier to see your anatomical world working. Because of that, perhaps, it can be harder to grasp the scale and importance of certain health events. That’s really the case when it comes to inflammation.”

Yet inflammation—in its chronic form—ranks as one of the most important concepts you should familiarize yourself with. That’s because, in the beginning, inflammation serves as a positive process in your body. Inflammation is a signal that your body is fighting off something that shouldn’t be there. But if your body thinks you’re constantly under attack, such is the case when you have too much blood sugar circulating through your veins, then inflammation can persist with negative consequences.

For example, when you eat egg yolks or red meat, it raises your inflammation, which damages your blood vessels, which makes it more likely to increase your lousy (LDL) cholesterol as your body attempts to heal itself. That cycle happens all over your body with all kinds of organs, cells, and systems. This places you at higher risk for developing heart disease, stroke, cancer, arthritis, memory issues, pain, hormonal issues, organ damage, and more.

However, you can do a lot to help quiet inflammation by eating foods that will help shush the immune response. Your anti-inflammatory all-stars:

Fruits and vegetables: Mix produce of all colors into your diet to get a wide range of vitamins and nutrients.

Fish, nuts, oils: Healthy fats are some of the strongest foods to bring down inflammation. This is one of the reasons why a salad with salmon and a little olive oil and a few walnuts may be the most powerful meal that your body can have.

What Not To Eat: Added sugars, syrups, simple or stripped carbs, foods with saturated or trans fats all stimulate inflammation. And anyone who says eating egg yolks with their choline content doesn’t cause inflammation should have their books, columns, and blogs banned from your reading materials.  The science of harm from carnitine, lechithin, and choline that Drs. Hazen, Tang, and colleagues first found at the Cleveland Clinic is strong and repeated in animals and four other human studies.  Anyone who says red meat (whether grass fed or not) or egg yolks are great or even okay for you to eat should justify to you why the Hazen-Tang science is wrong—it isn’t the saturated fat, although that is a little bad. The major bad is the inflammation caused by the amino acids and proteins that accompany that saturated fat in the red meat and egg yolks (egg whites are fine).

And it may take nearly 20 years for such bozos who are ignoring the science or don’t understand this science (even if some of them are from a noted institution like mine and ignore the data from their own noted scientists) to admit they caused more deaths and disabilities. Okay, let’s give ‘em a break and say they are just trying to stimulate more studies that confirm they are wrong…

I want you to thrive: The science was strong in 1998 (there were more than 4 studies that linked egg yolk and red meat consumption to shortening of life spans and an increase in disabilities) and there have been over 10 randomized studies since then confirming that data of harm from these on one or more aspects of heath.  Hopefully Hazen and Tang will find an antidote for this harmful effect of red meat and egg yolks.

 

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.

CTS and Other Causes of Hand Numbness

12 Apr

Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed at the wrist. However, there are other anatomical locations in which the median nerve can experience interference, and the median nerve is not the only nerve that ventures into the hand. So if you experience a symptom like hand numbness, CTS may not be the culprit…

After CTS, the next most common nerve pinch is the ulnar nerve at the inner elbow, which is technically called “cubital tunnel syndrome” (CuTS). This is often caused from over-use of the arm such as lifting and/or gripping with the palm up. The unique difference between CuTS and CTS is that the pinky and ring finger are affected but NOT the index, middle, and thumb-side ring finger, which are the median nerve-innervated fingers affected by CTS. Because over-use is also a common cause of CTS, these two conditions can co-exist, in which case all five fingers may be affected but not necessary all at the same time.

The shoulder is yet another fairly common location for a pinched nerve and is referred to as “thoracic outlet syndrome” (TOS). The most common nerve pinched here affects the fourth and fifth fingers, similar to CuTS; however, with TOS the upper arm is also affected, not just the elbow to the inner hand.

Another relatively common location for a pinched nerve affecting the arm is at the neck, often from a herniated disk and/or an arthritic spur where the nerve exits the spine. Depending on which nerve is compressed and the amount of compression, the numbness/tingling can affect different parts of the arm and/or hand.

Doctors of chiropractic are trained to differentiate between these various “syndromes” and to safely deliver treatment to the affected joints, muscles, and other soft tissues to reduce pain and restore proper motion so patients can return to their normal activities of daily living.

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.

What Causes Low Back Pain?

9 Apr

Low back pain (LBP) is VERY common condition, and research shows that up to 50% of the adult population in the United States will experience LBP in any three-month time frame over the course of a year. Worse, low back pain can persist for months, years, and even longer, significantly reducing one’s ability to work, play, and enjoy life. So, let’s take a look at where LBP can come from…

ANATOMY: There are five lumbar vertebrae located just below the last rib and extending down to the sacrum. The FRONT of the vertebral column is made up of large box-shaped “vertebral bodies” that are strong and made to bear heavy weight. Between the vertebral bodies are shock-absorbing “intervertebral disks” that have a tough outer layer that surrounds a liquid-like center, giving it the ability to absorb vertical loaded pressure.

The spinal cord runs through the MIDDLE of the vertebra through the spinal canal. Nerves also exit the spine at each spinal level.

The BACK of the vertebra is made to protect the spinal cord. There are two gliding joints on the either side (called facet joints) of the vertebrae, which allow us to bend sideways, backwards, forward, or a combination of movements.

Below the lumbar spine sits the sacrum. The sacrum is wedged between the left and right wings of the pelvis, the ilia, forming the sacroiliac joint (SIJ). For many years, anatomists didn’t believe the SIJ could move and thus, could not be a pain generator. More recent research has concluded that not only is there movement in the SIJ but it may be the primary pain generator in up to 30% of lower back pain cases.

CASE STUDIES: Each of the above anatomical structures can be potential causes of LBP, and the presenting patient’s symptoms and clinical signs can help a doctor of chiropractic figure out what’s going on. For example, when a patient states, “My back kills me and the pain shoots down my leg when I bend over and feels better when I bend backwards and leg pain disappears,” this is most often caused by a herniated disk pinching a nerve in the low back.

In the above case, it’s important to examine the nerves that run down the leg, as the nerve can become damaged if too much pressure is exerted on the nerve for too long. Here, your doctor will ask you to walk on your toes and heels, check your reflexes at your knee and heel, and test your ability to feel sensations on the skin. If any of these tests reveal loss of function, the first goal of care will be to remove the pinch on the nerve to restore leg feeling and strength.

On the other hand, when a patient feels better bending over and worse bending backwards, the facet joints and/or the SIJ may be the culprit.

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.

Which is Better: HIGH or LOW Cholesterol?

29 Mar

While many of us have been told we need to take steps to lower our cholesterol levels, it turns out that having high cholesterol may actually be a good thing.

As far back as 1994, Dr. Harlan Krumholz of the Department of Cardiovascular Medicine at Yale University reported that older people with low cholesterol died TWICE AS OFTEN from a heart attack as those with high cholesterol. While this finding sparked debate due to being inconsistent with the belief that high cholesterol levels lead to atherosclerosis, there are now several studies that challenge the lipid hypothesis of heart disease. In fact, a Medline database search revealed 11 studies that concluded high cholesterol did not predict all-cause mortality in older adults (about 90% of all cardiovascular disease occurs in people over the age of 60).

Even better, in 6 of the 11 studies, researchers observed an inverse relationship between all-cause mortality and high total cholesterol or LDL (bad) cholesterol OR BOTH. Other studies have noted that having low triglycerides and low HDL (good) cholesterol levels are also tied to an increased mortality rate.

So how does high cholesterol improve longevity? It appears that high cholesterol helps improve the immune system, protecting us from infections. In 19 large-scale studies including 63,000 deaths, a research group from the University of Minnesota, Division of Epidemiology reported that low cholesterol predicted an increased risk of dying from gastrointestinal and respiratory diseases.

Were the patients’ low cholesterol levels caused by an infection or did having low cholesterol predispose the patients to infection? To find out, researchers followed more than 100,000 healthy subjects for 15 years. At the conclusion of the study, those who had lower cholesterol had more hospital admissions due to an infectious disease vs. those with high cholesterol.

In two very large-scale studies of men infected with the HIV virus, the mortality rate in those with low cholesterol (<140) was four times higher than it was in those with high cholesterol (>240). A range of 200-240 and even higher in older women appears to be a good target for improving longevity.

Other studies have found that chronic low-grade inflammation may be the real culprit when it comes to atherosclerosis. In other words, worrying about cholesterol levels may not be more important than engaging in a lifestyle aimed at reducing inflammation: get regular exercise, don’t smoke, get plenty of sleep, and eat an anti-inflammation diet, among other things.

 

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 – What Will X-Ray Tell Me?

26 Mar

Although whiplash injuries arising from motor vehicle collisions (MVC) are very common, there doesn’t seem to be consistency in the evaluation one receives at an emergency room (ER) or later in an outpatient setting when it comes to the utilization of x-ray and other imaging. So, what are the pros and cons of imaging a whiplash patient?

A review of published guidelines suggests that if a person involved in a MVC presents to the ER awake, alert, with no neurological deficit or other distracting injury, with no neck pain or midline tenderness, and has a full range of neck motion, then x-ray is not considered necessary. If a fracture is suspected, an x-ray and/or CT (Computerized Tomography) scan is appropriate. Magnetic resonance imaging (MRI) has a role when a soft tissue injury such as a ligament tear, spinal cord injury, and/or arterial injury is suspected by clinical impression and/or prior imaging.

The major concern involving trauma to the neck is fracture, but this is actually quite uncommon as a result of an MVC. Some ERs routinely x-ray all trauma cases to rule on the presence or absence of fracture, though CT scan is much more sensitive than x-ray, especially in subtle or the not-so-obvious types of fracture.

Doctors and hospitals utilize treatment guidelines in an effort to provide the best possible care while limiting potentially unnecessary testing. For example, the Canadian C-Spine Rule (CCR) is an assessment to help determine who does vs. does not need x-rays in trauma cases.

According to the CCR, those over 65 years of age or those who have significant trauma and/or numbness in the extremities should receive x-rays. Situations in which x-rays are not needed include a simple rear-end MVC; if the patient can walk around; delayed (not immediate) onset of neck pain; or the absence of midline neck tenderness.

Another study reported that more than 800,000 patients in the United States (US) receive a cervical x-ray each year. Minimizing x-ray use is important, not just because of patient exposure to radiation, but because more than 97% of x-rays are interpreted as negative, and costs associated with x-ray exceeds $175,000,000 per year! Hence, there is a definite need for better guidelines in the US like the CCR!

Doctors of chiropractic see many whiplash patients either soon after an injury or later, though sometimes it may be years before a patient with whiplash presents for care. For patients under age 65 who have a full range of cervical motion, no neurological deficits or complaints, no other distracting injuries, and no midline tenderness, in most cases, x-rays can wait.

 

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.
← Older Entries
Newer Entries →