Shoulder Pain – What Exercises Are Best?

13 Nov

The shoulder is a unique joint because it has a great range of motion. Unfortunately, that benefit is negatively balanced with poor stability. This is likely why between 20-25% of the population is afflicted with shoulder pain at some point in life.

One of the greatest challenges in managing shoulder pain of musculoskeletal origin (it can also be a referred pain from a visceral organ like the gall bladder or from the heart) is its slow recovery rate. Some studies show that only about 50% of all new episodes of shoulder complaints have a complete recovery within six months. Add in the aging process, conditions that can slow recovery (like diabetes), and hobbies and jobs that increase the risk of re-injury and it’s understandable why it may not be possible for some patients to make a full recovery.

So, what can doctors of chiropractic do to help those with shoulder pain? The use of manipulation, mobilization, and modalities such as class IIIb and class IV laser (and others) can help a lot. But most importantly, exercise training is the KEY to a successful outcome.

Because of the slow recovery time for shoulder injuries, it is IMPORTANT to gradually introduce exercises at the correct time. In the initial acute stage, the following are appropriate:

Pendulum exercises: Like the pendulum of a clock, let the arm hang freely and gently swing while grasping a light weight (2.5-5 pounds, or 1.13-2.27 kg) – DO NOT try to lift the weight!

Finger walks up a wall: Face a wall and slowly walk your fingers up the wall but STOP at the point of pain. Remember, the first goal is to restore pain-free motion.

Once pain levels have improved and range of motion has been restored, resistance exercises are necessary to regain full function. TheraTube or TheraBand exercises are very practical, as you can travel with these and perform them anywhere. Here is a sample protocol: https://youtu.be/HKdm-2WYxDQ

Start with only three repetitions for each of these movements and SLOWLY release the tubing to help build coordination. If the protocol is too difficult, move toward the anchor point/door to reduce the tension on the tube. Be patient with your progress. It’s a slow but a consistent routine that will get you to your desired goals.

 

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.

Protect Yourself from Damaging Personal Care Products!

9 Nov

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 on 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.

In the 1998 comedy, Something About Mary, Chris Elliot’s character (Woogie) breaks out in “love blisters” (hives) every time he encounters Cameron Diaz’s character (the titular Mary). Unfortunately for most folks, it’s much harder to predict what will trigger an unpleasant skin reaction—especially when it comes to encounters with personal hygiene products and makeup.

According to a new report in Jama Internal Medicine online, adverse reactions to personal care products are underreported and the industry is under-regulated. Dr. Steve Xu, the study’s lead author, notes in Europe they’ve banned 1,000 chemicals from personal care products while in the United States, only 10 are forbidden. An accompanying editorial points out that reigning in the industry is a daunting task: “The Office of Cosmetics and Colors within the FDA [Food and Drug Administration ]…is tiny…even considering its limited responsibilities and scope of authority.” At present time, the FDA cannot order a mandatory recall of a harmful cosmetic. In one case, the manufacturer of a hair care product had more than 20,000 complaints about “permanent” hair loss while the FDA only knew about 127 of them—and the product is still being sold!

The most common troublemakers (that we know about) are hair and skin care products that trigger rashes, hair loss, and other dermatological problems. However, there are reports of potentially more serious adverse events, such as cancer or severe allergic reactions.

A recent study by researchers at Northwestern University suggests that many moisturizers promoted as remedies for skin problems like eczema and labeled as `fragrance-free’ or `hypoallergenic’ may still contain chemicals that can cause irritation.  Researchers asked Amazon, Target, and Walmart to name their top 100 best-selling whole-body moisturizers sold online and then they assessed how well these popular products moisturized the skin and whether or not the ingredients within the products might trigger allergic reactions.

The study found that only 21 of the 174 individual products tested were free of allergens.  Roughly 83% of moisturizers labeled “hypoallergenic” contained at least one ingredient believed to potentially cause allergic reactions. Furthermore, 45% of products claiming to be “fragrance-free” actually contained a fragrance or a botanical ingredient.  Thus, for people with sensitive skin or problems like eczema or psoriasis, simply reading labels may not necessarily guarantee a safe or effective product. Many of the moisturizers contained fragrances and chemicals known as parabens, which can cause rashes and worsen skin conditions like eczema and psoriasis. This means you can’t assume that moisturizers marketed as hypoallergenic, fragrance-free or even dermatologist-recommended will actually help skin conditions.

For moisturizers, white petroleum or pure shea butter are lower risk, but trusting the labels is not enough. Moisturizers are a great solution for patients with skin disorders because they retain moisture in the skin, reduce inflammation, help prevent infection, are widely available, and can be more affordable than prescription skin remedies.

So how can you know if a shampoo, face cream, moisturizer, or anti-aging potion is safe for you? Try an at-home patch test before using the product. The researchers suggest putting a small amount on the inside of your forearm and monitoring it for 24 hours. It’s not an overly sensitive area, so if the product triggers a reaction there, chances are you’re at risk for a true allergic reaction.

 

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.

What Causes Carpal Tunnel Syndrome?

6 Nov

Carpal tunnel syndrome (CTS) is a condition that arises when the median nerve becomes compressed as it travels through the bony tunnel made up of the eight small carpal bones of the wrist. Its symptoms include pain, numbness, and tingling in the thumb, index, middle, and thumb-side half of the ring finger. If the pressure is great enough, weakness in grip and pinch strength can occur as well.

There are many conditions or factors that contribute to and/or cause CTS, which can complicate its diagnosis and treatment. Some of these include: diabetes, obesity, pregnancy, birth control pills, hypothyroid (low thyroid function), arthritis, smoking, alcohol abuse, poor nutrition, being female (due to wrist size and/or hormonal shifts), bony abnormalities (such as spurs, misalignment of the carpal bones, and tunnel shape), aging, and certain occupations (heavy manual labor, vibrating tools, high repetitive tasks, firm gripping requirements, food servers, dental hygienists).

Additionally, impingement of the median nerve as it passes through other structures in the body can contribute to a patient’s symptoms, so it’s important for a doctor of chiropractic to examine the entire course of the nerve—from the neck to the shoulder to the elbow and then to the wrist. In some cases, the median nerve may not be impeded as it passes through the carpal tunnel but rather, there is pressure on the nerve elsewhere that causes symptoms similar to CTS. In these instances, if treatment only focused on the wrist, the patient may not have a successful outcome.

Outside of an urgent condition, like a broken wrist that may require surgery to take the pressure off the median nerve, treatment guidelines recommend using conservative (non-surgical) approaches first. This can include addressing any activities that place pressure on the nerve (making changes to a workstation, for example) or conditions that may contribute to inflammation or swelling in the wrist.

Inflammation within the carpal tunnel can be reduced using both ice therapy, as well as by consuming turmeric, ginger, and other spices with anti-inflammatory properties.

To restore normal motion to the joints in which the median nerve may be compressed, doctors of chiropractic may utilize manual therapies such as manipulation and mobilization. Patients may also wear a wrist splint at night in order to avoid increased pressure caused by bending the wrist in an effort to find a comfortable sleeping position.

 

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.

The Mysterious Sacroiliac Joint

2 Nov

Low back pain (LBP) can arise from a number of structures that comprise the lower back like the intervertebral disk, the facet joints, the muscles and/or tendon attachments, the ligaments that hold bone to bone, the hip, and the sacroiliac joint (SIJ). Though several of these can generate pain simultaneously, the focus of this month will center on the SIJ.

The role of the SIJ is quite unique, as it has a big job: it is the transition point between the flexible axial skeleton (our spine) and the pelvis, below which are the lower extremities or legs. The pelvis supports the weight of the torso, which usually accounts for about two-thirds of our body weight. The SIJ is shaped at an oblique angle that diverges or opens at the front and converges inwards at the back of the joint in order to support the weight on top of it. Because the sacrum/tailbone is “V” shaped, it fits like a wedge and is held together by very strong ligaments, making it an inflexible but sturdy joint.

Making a diagnosis of SIJ syndrome or identifying it as a pain generator can be a challenge. Your chiropractor may depend on several types of examinations in order to arrive at an SIJ syndrome diagnosis, such as palpation looking for pain directly over the SIJ; compression tests of the pelvis; front-to-back hip movements to stretch the joint; and imaging, such as x-ray, CT scans, and MRI.

Since the SIJ is NOT a flat and smooth oblique joint, an x-ray has many limitations. However, the pubic bone called the “symphysis pubis” (SP), which is located in the front of the pelvis, can be easily seen on x-ray. Because the pelvis is a ring-like structure, an SP that is out of alignment may indicate SIJ dysfunction.

In a recent study, two independent orthopedic surgeons analyzed the x-rays of 20 consecutive patients (17 women and 3 men) with proven SIJ dysfunction and LBP (confirmed by SIJ injection testing), which resulted in the findings of osteoarthritic degeneration and subluxation (misalignment) in 18 of the 20 subjects.

When they assessed the SP in 20 non-SIJ LBP control subjects (16 women and 4 men), 7 had abnormal SP findings (35%) versus 18 of 20 with SIJ-LBP mentioned above (90%). A review of the patients’ past radiology reports found that only three reports mentioned this in the SIJ-LBP group and none reported this in the control group. The authors concluded that SP findings are underreported by radiologists, and because SP is much easier to “read” or assess than the SIJ itself, it NEEDS to be looked at!

 

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.

Is There a “CURE” for Diabetes and Aging?

30 Oct

This certainly is a provoking question! Interestingly, there appears to be some fairly convincing evidence that intermittent fasting can have a dramatic effect on both diabetes management (and possibly play a role in preventing the condition) in addition to increasing longevity. In 2013, researchers looked at this approach in a British Journal of Diabetes & Vascular Disease article entitled, “Intermittent fasting: a dietary intervention for prevention of diabetes and cardiovascular disease?”

The study’s authors reported that intermittent fasting helps reduce the risk of heart disease as well as type 2 diabetes AND obesity, as it provides a method to help people manage their weight. They reported generally good compliance and described intermittent fasting as a “clinically relevant therapeutic approach.”

There are several options for intermittent fasting such as fasting on alternate days or not eating for 16 hours (last meal at 8PM and first meal the next day at 1PM, for example). Another option is to simply cut out one meal on days when you observe that your weight has increased.

Not only can intermittent fasting reduce one’s risk for developing diabetes but it may also help diabetics better manage their condition, as this form of fasting improves blood sugar and insulin levels in addition to insulin sensitivity. The research also shows that intermittent fasting can reduce inflammation and improve blood pressure and blood lipid levels. ALL of this, unlike most medications, comes with a low risk of adverse effects and is highly cost effective!

There is also evidence to support the addition of chromium to the diet in order to help prevent and/or control diabetes. According to the National Institutes of Health, chromium is known to enhance the action of insulin—the hormone that keeps our blood sugar levels from soaring out of control. Your doctor of chiropractic can help you establish a program of both chromium intake and fasting.

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 Injuries and Missed Diagnoses of Traumatic Brain Injury

22 Oct

Traumatic brain injury (TBI) is also becoming a “hot topic” as it relates to motor vehicle collisions (MVC). The question is: how often is TBI missed?

The simple answer is: FREQUENTLY! This is due to the fact that attention is often drawn toward other injuries such as a neck injury or a limb injury. One study found that doctors were more likely to miss an mTBI diagnosis in patients who had sustained an arm or leg fracture. Among a total of 251 trauma patients, only 8.8% were diagnosed with mTBI at the time of injury vs. 23.5% who were eventually diagnosed at a later date. The authors of the study note the importance for healthcare providers to not be overly focused on the most obvious injury, as it may result in missing an mTBI diagnosis and the opportunity for early management of the condition—potentially leading to greater pain, suffering, and long-term disability.

But how “good” is our ability to assess mTBI? In a recent study on the ability of sideline assessments to predict subsequent problems after a sport-related concussion, researchers concluded that although sideline measures are useful for diagnosing concussion, they are not suitable for determining the extent of injury one to two weeks post-injury.

Part of the problem associated with concussion, regardless of cause, is an overall lack of knowledge about the condition on the part of athletes, parents, coaches, and medical professionals. In a Canadian survey of members of these groups, “predictors” of better concussion knowledge included prior personal experience or history of concussion. Factors affecting knowledge included language, age, educational level, annual household income, and TBI history.

Yet another issue is the “under reporting” of concussion. Looking at gender differences in a total of 288 athletes across 7 sports (198 males, 90 females), in spite of having similar knowledge about concussion, female athletes were more likely to report their concussive symptoms than males.

Sobering facts: 1) About 1.7 million cases of TBI occur in the US annually, and approximately 5.3 million live with a disability caused by TBI; 2) Annual direct and indirect TBI costs are estimated at $48-56 billion; 3) Among children under fourteen years of age, TBI results in 2,685 deaths and 37,000 hospitalizations; 4) Between 50-70% of TBI accidents are the result of a motor vehicle crash.

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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