Sarah
It Figures: Taking Care of Your Back by Numbers
In all the outpatient facilities I have worked at, the #1 condition that remains prevalent is… you guessed it, back problems. We cannot emphasize enough how important it is to take care of your back. It is one area of your body that remains in constant contraction whether you are sitting, standing or lying. It needs to be strong, it needs to be mobile and most of all, protected at all times. Here are a few figures that will give you more insight in taking care of your back.
- When sitting choose a chair that has a backrest. It should be at an angle of 105-110 degrees to the seat.
- When standing, the work surface should be waist high or slightly below so that the elbows are bent no more than 10-15 degrees below the right angle.
- A worktop that is used for writing or reading should slope upwards 10-15 degrees.
- The distance of eye to a computer screen should be between 50-90 cm.
- If you have to be in stooped position to do something ( e.g. gardening), restore the upright position every 10 minutes.
- For do it yourself home improvement activities (such as woodworking), rest one foot up on a low footstool 10-16 cm. high.
Taking Care of Your Heart
February has always been known as the love month. For most of us who have been in love and have our hearts broken we know how much it hurts. But do you know that heart disease does more than just hurt… it kills! The statistics are staggering: Every 34 seconds a person in the US dies from heart disease. That is more than 2600 Americans each day. Heart disease can be silent, meaning a person may not be aware that he/she has heart disease until a heart attack actually ensues. It is because of this that knowing the risk factors for heart disease is important for all of us to know. A risk factor is something that makes you more likely to have a disease. Some factors cannot be changed such as age (Hey… its tough getting old), but most of the factors can be modified or changed. (Hint to all of the smokers & couch potatoes out there).
So are you at risk? Answer the following questions.
Do you have a family history of heart disease? YES NO
Are you a male? YES NO
Are you >50 yrs old? YES NO
Do you smoke? YES NO
Are you obese? YES NO
Are you diabetic? YES NO
Do you have high cholesterol? YES NO
Do you have high blood pressure? YES NO
Are you highly stressed? YES NO
Do you have a sedentary lifestyle or do not engage much in physical activity? YES NO
If you answered yes to 3 or more questions, then you are at risk. The 1st 3 questions pertain to factors that you cannot change but the rest of the questions are modifiable.
To Take Care of Your Heart, here are a few tips:
- Stop Smoking— A single puff is enough to increase heart muscle oxygen demand.
- Get to your ideal weight—A Body Mass Index between 18-25 is ideal.BMI is calculated as: BMI= Weight in lbs. x 703 divided by(Height in inches) x 2
- Control or prevent diabetes— manage it with medications & a healthy lifestyle.
- Lower your cholesterol— 200mg/DL is unhealthy, ask your doctor also the ratio between your LDL (Low Density Lipoproteins) and HDL (High- Density Lipoproteins) or good cholesterol. The higher the ratio, the greater the risk.
- Lower your blood pressure—A systolic (high number) of > 160 and a diastolic (low number) of >95 is considered high.
- Reduce stress — Easier said than done, right? But when you find yourself sweating the small stuff just think about what your heart is doing.
- Get up and move around!!! — Do you know that all of the modifiable risk factors above can be helped by exercise? In physical therapy, we cannot emphasize enough how important it is to continue exercising at home during and after therapy.
There is no miracle pill out there that will wholly address these factors. Diet and exercise, lifestyle changes, we hear it over and over again, but it’s so true. Achieving a healthy heart and a healthy life is totally up to you.
Shouldering Your Pain
Ever have a doctor tell you, you have an impingement in your shoulder? And another says you that it’s bursitis and tendonitis…maybe some arthritis, while another say you have a rotator cuff tear? What exactly is going on? What does it mean by “impingement”?
A crash course on the anatomy of the shoulder would help you fully understand this term. The shoulder is actually made up of 3 bones: the clavicle (collar bone), scapula (shoulder blade), and the humerus (upper arm bone). These bones actually form not just one or 2 joints but 4 all in all. Don’t want to get too technical here, but throwing in some pretty long words is inevitable; the joints are:
- Acromioclavicular (between the collarbone and the upper portion of the shoulder blade)
- Sternoclavicular (between the breastbone and collarbone)
- Glenohumeral (this is the actual shoulder joint, between the socket formed by the shoulder blade and the ball in the upper portion of the arm)
- Scapulothoracic (between the shoulder blade and the ribcage).
Another noteworthy area in the shoulder is the subacromial space (the area between the uppermost portion of the shoulder blade and the tip of the clavicle). Structures in this area include: a bursa and 2 tendons— that of the supraspinatus and long head of the biceps. Bridging this space at the top is an arch (coracoacromial ligament).
The shoulder is the most mobile joint in the body. The ball formed by the upper arm bone is usually larger than the socket formed by the shoulder blade (the socket only covers ¾ of it). The upper arm bone is basically just suspended, but not too worry, the famous (or rather infamous), rotator cuff stabilizes it.
The rotator cuff is a group of muscles (four in all) that pushes the ball formed by the upper arm bone into the socket and clears the subacromial space. Without these muscles, moving your arm overhead will result in constant abutment against the “bridge” (coracoacromial ligament) causing what we call “impingement”. Impingement causes inflammation of structures in this area— thus you can also have bursitis and tendinitis. If you already have an impingement and continue to use your arm, it further weakens your tendon like the fraying of a rope, going from a partial tear to a complete tear. So what would cause impingement?
Factors:
- Irregularities in the bones that you maybe born with.
- Weakness in the rotator cuff due to degeneration and arthritis in the joint — yea, we’ll blame age again.
- Overuse, repetitive activities (playing tennis, painting, etc), and forceful movements (throwing a baseball).
You can’t take impingement lightly, if ever you raise your arm overhead and your shoulder hurts, don’t ignore it. Medical and Physical Therapy management is your first line of defense.
Choosing the Right Bed
It is no mystery that a well-rested sleep can mean the difference between a good day or a bad day. That is why choosing the best bed for you is of utmost importance.
In this day and age, we are met with so many options. Which mattress is the best? Spring or Foam? If it’s spring, should you choose open, continuous or pocketed? Is it better soft, hard or firm?
Here are a few tips:
- A soft bed causes the whole body to round and the spine to lose good alignment. A hard bed on the other hand does not support your low back at all as gravity tends to pull it down. A bed with a firm base and a soft surface undulates with the normal curves of your spine and would be the best choice.
- Choose a mattress that combines open coil and pocketed spring (mixed mattress).
- Never buy a bed solely for its name or a recommendation by another. Ignore all publicity regarding mattresses that claim to be “medical” or “orthopedic”. The most expensive bed does not necessarily mean the best bed for you.
- Take time over your choice, lie on the bed to test its comfort.
- Turning over in the mattress should be easy.
- If two people of different sizes are sharing a bed, consider a zip-up mattress with different mattress in each side.
Your posture in lying is just as important as your posture when upright. Who knows, your 10-year-old mattress could be one of the culprits for your back trouble.
Laser Therapy | The Healing Effects of Light
Call it nature’s wonders but almost everything around us has healing effects. Heat and cold therapy has been around for centuries; sound is used in ultrasonic therapy, a great tool for inflammation; light is used in anodyne therapy which started in the late 1990’s for the treatment of peripheral neuropathy and now low-level lasers show a lot of promise in the treatment of musculoskeletal conditions.
Cold laser, or specifically the ML 830 nm low-energy laser gained FDA clearance in February 2002. It is called, cold laser because it’s healing effects is non-thermal or not because of heat. Light energy promotes the process of “PHOTOBIOSTIMULATION.” This photochemical reaction increases metabolism rate and removal of debris at the site of injury thus expediting cell repair. This in turn reduces pain, inflammation, and increases healing time.
The strongest evidence supports the use of cold laser for mild to moderate carpal tunnel syndrome. Other conditions where it may be helpful is arthritis, overuse injuries, tendonitis, sprains and strains, post-operative pain, tennis elbow and other soft tissue injuries.
The tools to get better is all around us. You don’t have to go very far.
FACTS AND FIGURES
- The ML830 has also been called “The world’s most expensive flashlight.”
- It has a penetration of approximately 5 cm with a 3 cm lateral spread.
- Laser therapy has been around in Canada, Europe, Asia, Australia and New Zealand for 40 years.
- Laser is actually an acronym for Light Amplification by Stimulated Emission of Radiation.
- Laser delivers light that is monochromatic (single color & wave length); coherent (in phase); and directional (collimated).
- Various types of light have been used in
Changes When We Age
Whether we like it or not, it is no myth that aging causes physical changes in our body. Gone are the days when we can eat anything and everything without gaining a single ounce of fat or play hopscotch without losing our balance. With the elderly, a minor incident such as tripping can turn into a full blown broken ankle. So, let’s study the aging changes in bones, muscles and joints.
Bones – Bone mass or density decreases while calcium and other minerals are lost. Bones then become brittle and may break more easily. This loss of bone mass also causes loss of height because the trunk and spine shorten.
Joints – Joints are areas where bones come together and allow for movement. Bones do not directly contact each other. Instead, cartilage, membranes and fluid cushion them. The fluid is lost with aging and joints become stiffer and less flexible. This, in turn, makes the cartilage rub together and erode. This loss of the normal joint structure is a process called “degeneration”. Inflammation and pain usually accompany these changes.
Muscle – Loss of muscle tissue decreases lean body mass. Muscle fibers shrink and may be replaced by tough fibrous tissue. This leads to reduced muscle tone and contractility.
So, let us look at this picture:
An elderly person has stooped posture because of height loss from bone changes. His movement is slow and limited due to decreased joint flexibility accompanied by pain and inflammation. He would rather sit in his recliner because of the fatigue brought on by muscle weakness. He tries to get up but readily learns that the changes in posture, flexibility and strength make it quite difficult. As he starts to walk, his gait may be slow, unsteady and abnormal. He did not notice a pen on the floor and accidentally trips on it. With all of his limitations, he could not prevent his fall and landed on his left hip sustaining a broken hip.
The picture may seem grim for most of us, but in physical therapy, this scenario is so commonplace. It should not be if you keep your bones, muscles and joints in check. Do you think you are limber enough? Have good strength? Or have a high risk for falling?
Exercising in The Golden Years
A lot of our elderly patients claim that the golden years are not golden after all and that it is tough getting old. For the young generation, maybe so; but there is a way to not let the golden years go rusty.
Aging can result in actual muscle cell loss and muscle atrophy (loss of muscle mass), a condition called “Sarcopenia”. Muscle loss occurs at a rate of about 1% per year after the age of 30, then speeds up to 3-5% per year after the age of 50 depending on how physically active the person is. Even a few days of bed rest resulting from an injury, surgery or just a minor respiratory infection can be devastating to the elderly and may take up to a month to over come the loss of strength. Muscle weakness in turn leads to loss of ability to move around effectively, a surefire entry way into frailty.
The answer? The only effective intervention for muscle loss is resistance exercise. Physical therapists (P.T.) can literally change lives by designing and supervising appropriate exercise programs. Assessing the whole patient is very important. We also take into consideration other medical conditions that the patient may present with. Aside from strengthening regimens, the elderly exercise routines are done best in conjunction with dynamic balance exercise programs and an aerobic component. Proper form is critical as well as balancing aggressiveness and the patient’s limitations.
For our elderly population, P.T. may be otherwise known as Pain-and-Torture; the truth is we are just ensuring that your golden years stay golden.
All About Muscles
Whether you’re a fitness buff or an avid couch potato, all of us have muscles. Some have bigger ones than others of course and others have healthier ones while other are in pretty bad shape. We use our muscles every day; it’s what helps us to move our limbs and our whole body. Here are a few things you need to know to take care of your muscles, keep them healthy and avoid or prevent any injury to them.
- Muscles are contractile elements meaning they are supposed to contract and relax. The old adage “if you don’t use them you look them” is true as well as if you use them too much (like staying in one position for long periods), it can strain them, tear them or produce muscle spasms.
- Just like any parts of your body, good nutrition is vital to muscle health. Foods rich in Vitamin D, Calcium and Iron are very important.
- A warm muscle is less prone to injury than a cold muscle. That’s why a warm-up is needed when you know you are going to perform any vigorous activity. A warm up increases blood flow to the muscles and makes them ready for the task at hand.
- Muscle flexibility is as important, if not more important than strength. It’s impossible to gain maximum strength in a muscle that is tight, in fact strengthening a tight muscle can lead to muscle imbalances that can produce further dysfunction.
- Remember the words trigger point, knots or nodules? You probably have heard these from your doctor or therapist. These are hypersensitive spots in a muscle made up of that band of muscle fibers. They are areas of pain and tenderness that when pressed on can elicit a referred pain at times (a pain distant from the trigger point itself). Although this is nothing to be concerned about, trigger points are symptoms of an underlying dysfunction or condition.
One technique used by Physical Therapists is myofascial release:
What is myofascial release (MFR)? It is a form of soft-tissue therapy to treat pain and restriction of motion by relaxing contracted muscles, increasing circulation and establishing the normal reflex of muscles and overlying fascia.
Our therapists are all equipped with this knowledge and tool to rid you of your pain caused by muscle dysfunction and trigger points. Come experience the difference at any of our clinics.
Coping with an Acute Attack of Back Pain
Have you ever experienced a sudden “twinge” in your back after picking up a pencil from the floor? You thought you were ok until you realize you can’t hardly get up out of bed the next morning and find yourself limping to your car. Odds are, you are having an acute attack of back pain.
Icing — Should be administered as soon as possible (for the case above, as soon as the “twinge” was felt). Leave it on for 5-10 minutes and repeat every hour during the first 24-48 hours.
Rest — We’re not talking about complete bed rest. Rest means avoiding positions or activities that provoke or aggravates the pain. Gentle movement within the limits of pain actually enhances the healing process.
Medicines — Acute pain is mediated by a lot of inflammation so it makes sense to take anti-inflammatories. It should be taken regularly as prescribed or as indicated in the bottle (if it is over-the-counter).