Tag: trauma

Don’t Forget Your Back

Most of us spend a large portion of the day hunched forward.  Think about when you are working on the computer, cooking, driving or even relaxing.  Your typical posture during these activities is head and neck forward, shoulders rounded forward, back curved and hips flexed.    When you remain in this position for an extended period of time, the muscles in the front of the body tend to shorten or contract, while the muscles in the back of the body tend to weaken.    This can be a set up for back, neck and shoulder problems and in addition, tends to make you look shorter, heavier and less confident.

Stretching before and after exercise as well as during the day is often overlooked in the rush to “get your workout in”.   Stretching however, has numerous benefits.   According to a study published in the Annals of Physical Medicine and Rehabilitation Medicine in September 2016, by I Fekhfekh, et al, dynamic muscle stretching of the knee musculature actually resulted in an increase strength gain in those muscles.  Interestingly, this study also found a decrease in the postural stability of the knee after stretching.    In English, it appears that stretching helps your to build strength, but may decrease the stability of the muscles you stretch at least temporarily.

In general, stretching helps to improve flexibility, joint range of motion, and usually is helpful for injury prevention.    Stretching helps by increasing blood flow to the muscles stretched.  This increased blood flow carries important nutrients to your muscles to allow for muscle growth and repair.  In addition, the increased blood flow helps to wash away muscle “waste” which leads to decreased soreness and inflammation of the muscle.

If allowed to remain in a contracted position for a prolonged period of time, our muscles will shorten.  For example if you spend a large portion of your day sitting in a chair or driving, the muscles in the front of the hips, your hip flexors will shorten.  These muscles have a direct effect on both your posture and your back health.

 

So what should you do?

It is important to stretch the muscles in the front of the body at least daily.

Exercises that focus on the hip flexors:

-Kneeling hip flexor stretch  – in the position of a lunge, allow your back knee to touch the floor and drive the hip of your front leg forward.  This will stretch the hip flexor of the knee on the floor

–Pigeon stretch – extend your right leg straight back and bring the heel of your left leg underneath your right hip.  Then drive your hips forward towards the ground.  Stretch and repeat on the other side.

– Yoga poses such as: low lunge, crescent lunge, upward facing dog, and revolving side angle pose

 

Stretches that focus on the chest muscles and prevent rounded shoulders:

– Door Frame stretch- stand in a doorway or at the corner of a room with your arms up like you were going to stop traffic.  Line your arms up from the elbow to the hand with the doorframe or in the corners of the wall.   Step towards the door and you should feel a stretch in your chest (pectoralis “pec” muscles) and hold for 20-30 seconds.

– Wall slides – stand with your back to the wall and keep your shoulders against the wall.  Walk forward 1-2 steps and slide your arms up and down the wall and squeeze your shoulder blades together.  You should feel a stretch in your upper chest muscles.

–Shoulder squeeze stretch –  clasp your hands together behind your back and slowly try to lift your hands.  Squeeze your shoulder blades together to stretch out the chest wall.

– Yoga poses include : bridge pose, camel pose, cobra pose and cow face pose

 

Stretches for your neck:

– Chin Tucks (Neck Retraction) – keep your shoulders back and your head in a neutral position (eyes facing forwards, chin level) slowly move your head backwards until you feel a slight stretch in the back of your neck.  Hold for 10-20 seconds and repeat.  If needed you can apply a gentle pressure on your chin with your fingertips to press your chin backwards and deepen the stretch.

Incorporating these exercises into your daily routine will help to prevent shortening of the muscles in the front of the body which leads to poor posture and often pain of the neck and back.  As always, if you are having pain which persists you should be evaluated by a certified health care professional to ensure that these exercises are safe for you.

This week we primarily discussed stretching exercises to prevent muscle contraction, and next week we will discuss the importance of strengthening the back muscles to further combat the issues of a hunched posture.

Common Causes of Knee Pain

The primary function of the knee is to bend and straighten the leg, to allow for a smooth gait during walking and running and to allow for jumping.    It is very common to develop knee pain in both new and seasoned exercisers.  Often the type of pain which develops is related to the type of exercise being done.

To understand knee pain, it is helpful to have a basic understanding of knee anatomy.

The knee joint can be divided into intra-articular and extra-articular compartments.

Intra-articular – structure inside the knee  joint

Extra-articular – everything else

The knee joint is where the surfaces of the leg bones meet and interact.  In order for the bones to move smoothly against each other and to provide additional stability, there is articular cartilage or cushioning shock absorber called the meniscus on both sides of the knee joint.  There are also many important ligaments which connect one bone to another and provide stability.  In addition, there are fluid filled sacs called bursae which allow for separation between solid tissues so that smooth movement can occur.

To help visualize the components of the knee, let’s break it down into 3 parts.

  • The anterior (front) of the knee
    •  Knee cap or patella
    •  Quadriceps tendon
  •  The medial aspect (side) of the knee  closest to the other knee
    • Medial meniscus (cushion)
    • Medial part of the joint capsule (the whole joint capsule encloses the entire knee)
    • Medial Ligaments  (provide stability for the knee and connect bone to bone)
  •  The Lateral aspect (outer) part of the knee
    • Lateral part of joint capsule
    • Lateral meniscus
    • Lateral ligaments

The knee is actually more complex then described above and does have the ability for rotation in addition to bending and straightening and other components not described above.  For the purpose of this article, we will focus on basic knee motions and components.

Now that we have a basic understand of the knee, let’s focus on what can go wrong with the knee.

In general, knee pain can be caused by:

  • Injuries due to trauma
  • Overuse injuries due to
    • Body misalignment
    • Muscle imbalances
  • Degenerative conditions
  • Injuries in the hips or feet

Patellofemoral syndrome (Anterior knee pain – front of the knee)

Common in new exerciser, especially runners and jumpers.  This is usually due to irritation between the patella (knee cap) and femur (thigh bone).  This pain can occur with increased jumping, squatting, running and climbing stairs.  Usually pain occurs if there is repeated stress on the knee or if there is a sudden significant increase in physical activity.   It is often treated with rest, ice, elevation and compression (RICE) and specific exercises to strengthen muscles surrounding the knee, and core.

Structural Injuries 

Knee injury can also result from structural changes or damage such as a dislocation, slippage or tears of the menisci or ligaments surrounding the knee.

Meniscal Injuries – The meniscus serves as a shock absorber for the joint.  Injuries of the meniscus can be the result of a twisting injury and can cause considerable pain, joint swelling, difficulty with stairs and the sensation of locking of the knee.  Occasionally the pain in the joint due to meniscal injuries will cause the brain to “shut off” the quadriceps at the knee causing the knee to “give way”.

Ligament Injuries – Ligament tears, such as a tear of the ACL (anterior cruciate ligament) can occur with a twisting injury and results in knee instability and may require surgical intervention depending on the degree of the tear.  It is common to sense a “pop” and immediate leg instability with this injury.    If surgery is used to repair the ACL, recovery is long and only low impact exercises are recommended initially to strengthen the muscles around the joint.  In contrast, PCL (posterior cruciate ligament) tears often can be treated non surgically with physical therapy and if indicated bracing.   When ligaments are torn or lax (loosened) it is common to have the sensation of poor balance or joint instability.

Tendon Injuries – Tendons are tissues that connect muscle to bone.  Typically, complete tendon ruptures are abrupt and result in the inability to move the joint.  The quadriceps tendon is quite large and a significant amount of degeneration must be present for it to rupture.  More often this injury is the result of a high force injury.   A completely torn tendon requires surgical intervention, but a partially torn one, will likely heal with immobilization followed by physical therapy.

Overuse injuries

Overuse injuries such as bursitis (inflammation of bursae), tendonitis (inflammation of the tendons), muscle strains, and Iliotibial band syndrome are usually the result of repetitive stress on a muscle, tendon or bursa.  Usually there is a component of body malalignment, muscle strength imbalance, improper shoe wear, or poor form which leads to the development of these conditions.  Treatment may include RICE (rest, ice, elevation, and compression) along with a detailed musculoskeletal exam to determine the etiology of the injury.  This will allow for a proper treatment plan to prevent recurrence.

Arthritis

Arthritis can be divided into Osteoarthritis (wear and tear), Rheumatoid (immune mediated), Gout (due to gout crystal build up) and Septic (due to infections).   Arthritis may be the result of poor diet or gluten sensitivity in some individuals.   While some forms of arthritis are genetic, diet modifications, weight loss, proper shoe wear and exercise may help to offset the severity of these conditions.

Some Common Causes of Headaches

Last week we discussed the importance of avoiding aspartame and artificial sweeteners due to the numerous deleterious effects on our bodies. One of the issues we addressed was the potential for headaches due to the use of aspartame. However, this is only one of the myriad of triggers for headaches.

When addressing headaches, it is important to determine the characteristics of your headaches. It is crucial to understand dangerous vs. safe headaches. I use safe as a relative term, because all headaches are painful and significantly impact our quality of life, but not all headaches are indications that a serious issue is going on. Headaches have been classified by the most common constellation of symptoms that occur with each type.

To begin, we will discuss the headaches that require emergent attention.

HEADACHES DUE TO BLEEDING IN THE BRAIN
A sudden onset of a severe headache, often described as the worst headache of my life is concerning for possible bleeding in the brain. These headaches can be associated with nausea, vomiting, visual changes, neurological changes and/or changes in consciousness. Especially if these headaches occur after a trauma or head injury, it is imperative to go directly to the emergency room for imaging studies to evaluate for any bleeding in the head. In addition, if you have a family history of individuals having bleeding strokes, you should be evaluated promptly.

Another headache that, if chronic, requires attention is a headache that presents upon waking up. Infrequent morning headaches are not generally worrisome especially if you have a cause, like a sinus headache, significant tension/stress, or an illness. However, if you have chronic morning headaches, which actually get better throughout the day it is a good idea to have these headaches evaluated by a health care professional. Especially if the headaches are associated with progressive neurological symptoms such as, but not limited too, numbness, tingling, weakness, word finding difficulties, visual changes, balance issues, and decreased coordination.

Finally, any headaches associated with fever, chills, light sensitivity, and neck pain should be evaluated promptly as these can be indications of infections in the brain and/or spinal cord.

TENSION HEADACHES
The most common type of benign headaches are TENSION HEADACHES. These headaches can be described as band-like in nature. Typically, there is dull aching pain around the temples. Often there is tightness or pressure in the forehead, sides or back of the head. In addition, you may have tenderness in the shoulder and neck muscles and even the scalp. Generally these headaches are brought on by stress and alleviated with stress reduction and relaxation. Exercise can be helpful to relieve tension headaches.

CLUSTER HEADACHES
These headaches are much less common and not very well understood. It is hypothesized that they are related to blood flow in the brain. These headaches by definition occur in groups or clusters. These headaches are always located only on 1 side of the face. Usually, they present around the eye but can radiate to the jaw, temporal region or forehead. They can be associated with symptoms on the side of the headache, such as eye tearing, nasal congestion, sweating, eyelid drooping, and pupil changes. These headaches can be worsened by alcohol consumption during the time when they are occurring. In addition, cluster headaches are associated with heavy smoking. These headaches tend to occur in groups (ranging from 1 time every other day, up to 8 times per day, by definition) and there can be periods of remission. Cluster headaches are more difficult to treat and require physician supervision for treatment and prevention.

MIGRAINE HEADACHES
Migraine headaches can also be described as the worst headache of ones life and therefore can be confused with headaches due to bleeding in the brain. Typically, migraine suffers have had a series of migraines and are able to tell the difference. In general, migraines can occur with or without an aura. An aura is a constellation of symptoms which presents before the actually headache ensues. For example, an aura can be visual changes, sensory changes (such as smells, strange lights,) or hallucinations (confusing thoughts). Migraines can be associated with nausea, vomiting, visual changes and even neurological symptoms. In addition, migraines can be associated with hormonal changes. Like Cluster headaches, Migraine headaches should be managed by your health care professional.

SINUS HEADACHES
These headaches are associated with sinusitis, or an infection/inflammation of your sinuses. Typically these headaches are associated with facial pressure, pressure above your teeth, congestion, and post-nasal drip. Treatment of these headaches should be focused on treating the sinusitis.

So what can you do to help alleviate your headache intensity and frequency?

Monitor your diet, because often headache triggers include foods. The most common offender is dairy. This can be because dairy leads to sinus congestion. However, other foods, such as alcohol, gluten, chocolate, bananas, sugar and artificial sweeteners can be implicated causes for headaches.

If you suffer from chronic daily headaches, keep a food diary and rotate your foods. Sometimes, headaches can occur even 1-2 days after eating the offending food. Try to eliminate foods and then re-introduce one food at a time every 2-3 days to determine if your headaches return.

Daily exercise also helps to alleviate most headaches, though you can get an exercised induced headache if you do heavy lifting, heavy exertion, or especially if you are dehydrated.

A few tips for preventing headaches:

  • Stay hydrated – drink lots of water and eat foods with a high water content such as cucumbers and watermelon
  • Coffee can help with headaches, however, caffeine withdrawal headaches are often a common cause of headaches
  • Foods rich in B vitamins, or the addition of a B complex vitamin to your diet can help prevent headaches. Both vitamin B2 and B3 deficiencies have been implicated in contributing to headaches
  • Foods rich in omega-3 fatty acids help prevent headaches (salmon, flax seed)
  • Bananas and foods rich in potassium are helpful for headache treatment and prevention
  • Magnesium containing foods or supplements are helpful in treatment and prevention of headaches (quinoa, spinach)
  • Co-Enzyme Q10 and Selenium have also been useful for treating headaches (speak to your doctor first before beginning these supplements).

As always, if you suffer from chronic daily headaches, address these with your healthcare provider for optimal treatment and prevention.