More than 11 million seniors in the U.S. experience falls each year-that’s one in every three people over age 65. These falls have many causes, including osteoporosis and neurological issues. The Archives of Internal Medicine recently reported new findings on another leading cause of falls: poor sleep. For older women, sleep deprivation can be even more hazardous. According to the Archives of Internal Medicine article, actigraphy measured sleep studies done to determine fall risk in older women demonstrated that sleep deprivation can lead to an actual slowing in motor reaction time, even when accounting for other factors, such as age or the use of benzodiazepines or other medications.

 

A large new study shows that obesity and pain often go hand in hand. That appears to be true even if an obese person is otherwise healthy. Researchers say that begs some questions: Can extra pounds cause pain? If so, how does fat make us hurt?  A slew of chronic conditions that cause pain are also more common in people who are overweight and obese. Those conditions include arthritis, depression, fibromyalgia, type 2 diabetes, and back pain.  So the assumption has been that being obese makes a person more likely to have multiple medical problems, and many of these conditions may cause pain.

The new survey, however, which included responses from more than 1 million Americans, found that the relationship between obesity and pain persisted even after researchers tried to account for the influences of other pain-causing health problems.  “Being sick can cause pain, but that doesn’t necessarily take care of the relationship between obesity and pain,” says researcher Arthur A. Stone, PhD, distinguished professor and vice chairman of the department of psychiatry at the Stony Brook University Medical Center in Stony Brook, N.Y.

The study is published in the journal Obesity.

Obesity and Pain in America
For the study, researchers relied on data collected by telephone surveys conducted by the Gallup organization from 2008 to 2010. The majority of survey participants were white (85.1%) and had at least a high school education (94.2%).  Every survey participant was asked to report their height and weight. Based on that information, 36.8% of people in the study fell into the low or normal body mass index (BMI) category, 38.3% were considered overweight, and 24.9% were considered obese. People were asked if they had experienced physical pain the previous day. They were also asked if they had neck, back, leg, or knee conditions that had caused pain during the last 12 months, or if they’d experienced any other condition that caused recurring pain.

They were also asked about the presence of a variety of other medical conditions, including high blood pressure, high cholesterol, asthma, diabetes, heart attack, and depression. Researchers found that as weight increased, so did the likelihood that a person would be experiencing pain. Compared to normal-weight people in the survey, people in the overweight group — those with BMIs between 25 and 29 — had about 20% more pain. People with BMIs between 30 and 34 had about 68% more pain. Those with BMIs between 35 and 39 had 136% more pain, and those with BMIs over 40 reported having 254% more pain. As expected, chronic pain conditions accounted for a good portion of those results. And researchers recognize that the relationships between chronic health problems and pain and obesity are complex. In some cases, it could be that having arthritis makes a person less likely to move around, which makes them more likely to gain weight. In others, it may be that being overweight puts strain on the joints, which leads to joint problems that cause pain.

When researchers accounted for the influences of other health problems and pain causing conditions, being overweight was no longer associated with being in pain.
But people who were obese still reported more pain than those with normal BMIs. Researchers caution that their findings are just an association. They don’t prove that fat alone causes pain.  But they mirror a handful of other, smaller studies that have also found links between pain and obesity, even when there were no other chronic conditions to explain the findings. So they say it makes sense that there might be another mechanism connected to having a lot of fatty tissue or to problems with the body's metabolism that might explain the pain.

The study wasn’t able to explain how fat might cause pain.  But Stone says that fat cells are known to make chemicals that increase inflammation. “And we know that inflammation is very closely linked to pain perception, so there’s the possibility that there’s some connection through that kind of process."  He says those questions will ultimately need to be addressed by other researchers.

 

By Brenda Goodman MA

 

What is Carpal Tunnel Syndrome (CTS)?

Carpal Tunnel Syndrome is the pain of the hand at the palmer area with the involvement of thumb, index finger, middle finger and half of ring finger. It is due to the median nerve repetitive compression injury at the carpal tunnel of the wrist.

Median nerve gives you the sensation of the hand and control the movement of thumb and wrist.  This is the most common nerve entrapment disease. About 3 to 6% of general adult population suffers from carpal tunnel syndrome.

Who gets it?

·  Laborers and freight, stock, and material, movers

·  Customer service representatives

·  First-line supervisors/managers of office and administrative support workers

·  Janitors, maids, and housekeeping cleaners

·  Food service managers

·  First-line supervisors/managers of retail sales workers

·  Automotive service technicians and mechanics

·  Executive secretaries and administrative assistants

·  Financial managers

·  Sewing machine operators

·  Truck drivers

·  Office clerks

·  Accounting and auditing clerks

·  Welders, cutters, solderers, and brazers

·  Sheet metal workers

·  Packers and packagers

·  Computer software engineers

·  Inspectors, testers, sorters, samplers, and weighers

·  Stock clerks and order fillers

·  Packaging and filling machine operators and tenders

 Also people with smoking habit, increased alcohol intake or diabetic tend to have high chance of developing CTS as well. Women with pregnancy tend to temporarily develop CTS due to water retention around the wrist. This water build up will compress the median nerve at the carpal tunnel.

How do I know if I have CTS?

If you feel tingling and pain of the hand, wake up at night, drop the glass or object from your hand, small muscle bulk on the side of the thumb as compare to the non symptomatic hand and constant shaking your hand trying to get some relief, then you will have high chance of having CTS.

The accurate diagnose is established by electrodiagnostic testing. It is usually known as NCV/EMG testing. This can be done by physicians or physical therapists with electrodiagnostic testing training.

What are the treatment options?

Besides resting and avoiding repetitive wrist bending activity, mild type of CTS usually responds well with conservative treatment such as wrist splint, ultrasound, massage, stretching exercise and median nerve glide therapy.  Once a woman with pregnancy-associated CTS gives birth, for instance, the swelling in her wrists and other symptoms almost always subside. Some people also respond well with acupuncture and corticosteroid injection. If no significant change after 6 to 8 weeks conservative treatment, carpal tunnel release surgery will probably be the next option.

Prevention of Carpal Tunnel Syndrome

There are some preventive measures to mitigate the CTS development.

1. Maintain a healthy weight
2. Avoid smoking and alcohol intake
3. Get regular exercises
4. Keep your arm, hand, and finger muscles strong and flexible
5. Wear a wrist splint to keep your wrist in a neutral position
6. Switch hands and change positions
7. Avoid repetitive wrist activity
8. Maintain correct posture
9. Arrange your workstation with sound ergonomic
10. Restrict salt intake if you tend to retain fluid

Over the years, I have consulted and treated hundreds of runners, from average joggers to marathoners, professional athletes and high school athletes. Foot and ankle injuries, including plantar fasciitis, Achilles tendonitis, fibularis tendonitis and posterior tibialis strain are the most common we see among this population. Treatment for these types of injuries presents additional challenges when dealing with runners given the nature of their injuries, typically chronic/overuse type injuries, and the typical runner's propensity for training "through the pain."

A speedy recovery for runners, like all athletes, is paramount. This fact underscores the need as a clinician to appropriately identify the nature of the problem from a biomechanical standpoint and everything contributing to it, and then implement a treatment approach addressing what's been identified through our evaluation as comprehensively as possible.

With treating foot and ankle injuries, it is easy to develop tunnel vision, focusing too narrowly on the affected tissues and not adequately considering the big picture. Beyond the specific injury, adjacent structures need to be assessed and treated for their potential role in the cardinal complaints. In addition, patient education about factors such as training routines, early injury recognition, footwear and overall conditioning needs to be a substantial part of any treatment plan. This will minimize recovery time and maximize efforts for prevention of future occurrences

Localized Treatment

As with any injury, managing symptoms and promoting tissue healing is initially the primary focus. There is a wide variety of therapeutic exercises, manual techniques and modalities that can be employed to assist the body's ability to heal. Balancing all of these options has proven a key factor for success in my experience. The most common modalities we utilize include various forms of heat or ice, and educating patients about when to use either is important. It is also significant to avoid the habit of "icing after every treatment" or using heat before every treatment. Consider exactly what the desired treatment and tissue response is and apply the modality (or not) that best aids in that effort.

Manual techniques: Manual techniques including joint mobilization and stretching, traditional soft-tissue manipulation and IASTM (instrument-assisted soft-tissue mobilization) can improve circulation, tissue remodeling and joint mobility, as well as modulate pain. Plantar fasciitis and tendonitis injuries tend to respond particularly well to the appropriately implemented manual techniques.

Therapeutic exercise:This involves prescribing exercises that promote ROM, healthy blood flow and oxygenation of tissues, along with joint lubrication, below a threshold that exacerbates the inflammatory response when dealing in the more acute phases of injury. Using very light resistance with high repetitions (i.e., three sets of 30 for each exercise) helps promote healing but it is imperative that patients adhere to the prescribed number of exercises and not exceed the threshold that will exacerbate their condition. Once out of the acute phase, more traditional PREs become the focus to promote localized strengthening and neuromuscular control.

Therapeutic taping: A growing trend over the recent past is the use of elastic therapeutic tape, which has been made popular by professional athletes from all the major sports and Olympians. Therapeutic taping is used to augment traditional physical therapy in an effort to help relieve pain and sore muscles, enhance function and facilitate the healing process.

Therapeutic tape is a lightweight, "breathable" elastic tape with a long-lasting adhesive that is extremely durable. One theory is that the tape helps support muscles and improve the stability of joints that are in a particularly weakened state from overuse/strain or injury. It is also said that the elastic composition of the tape enables "lifting" of the skin at the injured site, resulting in increased blood flow and a reduction in the perception of pain. In these ways, elastic therapeutic tape may help to speed healing and rehabilitation.

The application and positioning of the tape is key. Depending on the type of strain or injury involved, the tape may be used to limit or promote movement. This modality, when used and applied correctly, has been reported to help runners reach their therapeutic goals in a timelier manner.

Kinetic chain and muscle imbalance: The fundamental problem we see with the majority of our runners and their associated foot and ankle injuries involves muscle imbalance/weakness beyond the lower leg itself. It is important to establish a strengthening program that addresses potential weakness in the trunk, hip and upper-thigh muscles, using functional movement patterns promoting synergy for neuromuscular control. Reinforce the basic concept: Control and stability of a distal extremity requires strength and stability proximally.

Training habits: Overtraining is one of the more common contributing factors involved in the onset of ankle tendonitis injuries and plantar fasciitis in more serious runners. In an effort to improve stamina and endurance, early warning signs of injury are often ignored as the intensity and frequency of training increase. As tissues break down in response to these increased challenges, the body's ability to respond and repair may not always be able to keep pace, eventually leading to injury.

Every injury and individual has a different threshold, which is why educating patients about the overall concept and how they can control it through training modification is so important. As a simple part of this training management, teaching runners the importance of avoiding abrupt changes in their regimen like excessively increasing miles, speed or intensity goes a long way in avoiding injury.

By Brendan Carman, PT, MPT, ATC

A cancer diagnosis is terrifying. The questions, the fear and the concept of facing their own mortality are enough to paralyze even the strongest individual.

In the not-so-distant past, the standard treatment protocol was surgery, chemotherapy, radiation or some combination of the three, and that was it. Then the patient played the waiting game to see what, if anything, worked.

What people didn’t realize was that the end of a course of a course of chemotherapy was not the end of the healing process. They would be dealing with the lasting effects of chemotherapy long after their hair returned and the nausea ended.

One of the those lasting effects is post-chemo-therapy peripheral neuropathy.

Fortunately for the PT community, cancer patients are quickly learning that the right physical therapy, nutrition and often the correct forms of nerve stimulation, when combined in the hands of a skilled therapists, can help alleviate the symptoms of their post-chemotherapy peripheral neuropathy.

Physical therapy can help the post-chemotherapy neuropathy patient deal with the symptoms and pain associated both with their cancer and their course of treatment. Often, by carefully addressing pain in the correct way and related tissues, we may actually stimulate a healthier nervous system. This is a basic building block for regaining pre-cancer health and alleviating nerve pain.

Chemotherapy and other cancer medications can wreck a patient’s digestive system. In the process of killing cancer cells, it can also damage healthy cells, and that’s what brings on the side effects of chemotherapy. This can not only affect the ability to eat but also prevent the body from getting the nutrients it needs. They can be dealing with any number of symptoms, ranging from nausea and loss of appetite to dry mouth and changes in their sense of taste and smell.

Patient with post-chemotherapy neuropathy need to make sure they’re getting nutrients to prevent or reverse nutritional deficiencies, lessen the side effects of treatment, and improve their quality of life.

Physical therapy practice can offer them hope for a more normal life without debilitating pain. Yes, they survived cancer, but they can also beat their post-chemotherapy peripheral neuropathy.

By alma Deguzman, PT, CPed, and John Hayes JR.,DC

Moderate exercise such as brisk walking is linked to an increase in the number of T-Cells-which form part of the body’s immune system-circulating in the blood. Exercise raises body temperature, which may also help kill some types of viruses or bacteria. Fitness is also associated with habits that promote overall god health, including good nutrition and a tendency to get adequate sleep, which may aid in the body’s fight against infection. However, overtraining by doing high-intensity exercise of long duration may actually lower T-cell count, suppressing the immune system and leading to an increased risk of infection.

 

               (AVN), also known as osteonecrosis, aseptic necrosis and ischemic bone necrosis, is when bone tissue does not get adequate blood circulation and begins to die at a faster rate than can be repaired. Approximately 10,000 to 20,000 people develop AVN each year in the United States. Early diagnosis and intervention is the key to maintaining an active lifestyle in the shadow of dying bones.

The gastrointestinal system (GI) runs your life, especially when aged. Colon health is part of physical health and fitness. It is a major factor in energy, endurance, strength, balance, mental alertness and pain-free movement. It is a major factor in life viability. The GI system impacts heart function. It can change the heart rhythms and speed according to the vagus nerve. It could stop the heart if it is under severe stress. Taking care of the GI and its nervous system can improve physical, mental and emotional aspects of life as age. It can lengthen life and make it more enjoyable.