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Hip Pain? Hip Tips...

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One of the common complaints I see in my office is that of hip pains, which come in two varieties:  

ACUTE hip pains:   We see these cases a lot as injuries to the groin muscles on the inside aspect of the hip.  These are usually pretty obvious in their origin, for example when a hockey player collides with legs straddling the ice, or when a football player is tackled with one leg extended out to the side.  (Hip fractures are the subject for a separate blog).  These cases often respond quickly, as long as there is no serious tear in the muscle/tendon structure as it inserts from the inner thigh.  Other cases involve the outside of the hip joint, seen with cases of bursitis or capsulitis from extended exercises like rowing, biking, or running.  Treatments include rest, physical therapies like ultrasonic vibrations, electro-stimulation, and medical acupuncture are often all that is required. An anti-inflammatory medication can also help settle things down.  If this is not working, then further investigation with images can prove helpful, and more aggressive treatments like cortisone shots could be considered.  Gentle movements are encouraged, along with a graduated program of stretching and toning of the inner thigh muscles to rehab the area. Assuming the root cause was a one-time injury, recovery is usually excellent.  If continued trauma occurs, then the problems become more chronic.    

CHRONIC hip pains: These occur if the root cause is repetitive, such as the constant pounding felt by rodeo riders, snowmobilers, or moto-cross cylclists. This can lead to the destruction of the cartilage and the build-up of extra bony growth causing osteo-arthritis.   l More commonly, the root cause is just the repetitive effects of gravity as seen in the daily movements of an obese patient.  Especially with the morbidly obese ( 100 pounds or 45 kilograms over their ideal weight) this means the simple acts of standing up, walking, and stair climbing all cause daily damage to the hip joint.  Other conditions such as systemic forms of arthritis can certainly also affect the hip joint itself, leading to “bone-on-bone” instead of smooth surfaces where the hip joint is supposed to move.  Again, we look for any correctable root causes.  This would entail routine blood-work and images, to assess underlying diseases.  It would also involve corrective action for the obese patient, with proper diet and exercise regimens.  In severe cases, that are beyond any such help, replacement of the hip joint may be needed. 

In the meantime, here are some hip tips:

  • Watch your posture: Sitting is hip-hostile.  Try to stand up a few times per hour if you can.  We have already written about the benefits of sitting on a pilates ball for back pains, 
  • it also helps hip pains by introducing some movements into an otherwise frozen posture.  If you can, try to rig your work station for standing up all the time. 
  • Select non-impact exercises, like the bike or elliptical machines in the gym.  Also try yoga and pilates to help with toning and flexibility.
  • Watch your weight.  One of the rules of medicine is that pain is fattening.  If you are in pain, you can’t move much to burn off your daily calories.  This becomes a viscous circle, where any excess calories are simply added to one’s fat stores, adding to the pains of simple movements.  To compound this, junk foods such as white sugar, white flour, etc are all known to cause more inflammation, further adding to the damage to the hips and other joints.
  • See your doctor to seek out underlying diagnoses, from systemic diseases to simple things like one leg being significantly longer than the other.  Depending on the underlying causes, you may also benefit from massage, physical therapy, or chiropractic treatments. Follow their exercise tips to stretch and tone the surrounding hip structures.

For more info,  

http://www.mayoclinic.org/symptoms/hip-pain/basics/when-to-see-doctor/sym-20050684

http://orthoinfo.aaos.org/PDFs/Rehab_Hip_3.pdf

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Knee pains: How to prevent and recover

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Knee pains are becoming very common.  Most of the orthopedic surgeons in professional football and hockey are specialists in the knee, leaving others to look after the rest of the bones in question.  In looking after sports injuries in my clinic, I can attest to the high rate of knee injuries among part-time athletes as well. 

Some logical questions follow:

1. Why is the knee so vulnerable to sports injuries?  The main reason is its range of movement is only in one plane.  Other joints can swivel, but the knee is just like a single hinge that straightens or flexes the leg, and is integral in our ability to walk, run, and jump.  However the knee has virtually no protection to a side impact.  Nor does the knee do well with twisting or rotational forces.  With the popularity of contact sports, especially ones with  helmets and hard pads, we are seeing more collisions resulting in serious knee injuries.  

2. Even in non-contact sports, such as running, we are seeing more gradual erosion of the knee structures.  While running is one thing the human body was well designed to do, the knee is not a great shock-absorber when one runs on pavement.  

3. Paradoxically, the inactivity of the modern work place also contributes to the rise of knee injuries.  With movement, the synovial membrane around the knee produces fluid, which not only lubricates the joint, but provides trace quantities of oxygen and food to the cartilege cells.  But today, we don't move our knees at work, we fold them under us like a deck chair.  At the end of day, it gets ugly, watching people trying to force their stiff legs into the standing position.

 

If you have injured your knee, here are some important action items:

1. Apply ice to ease swelling and pain, for about 10 minutes every half hour.  Make sure you have a layer of cloth between your skin and the ice, to protect from freezer-burn

2. See your doctor if you are not improving.  Images of Xray, Ultrasound, and MRI can help identify pathology.

3. When bending the knee, there is never any need to go beyond 90 degrees, unless you are just stretching. 

 For example, when you are doing a squat in the gym, just bend as far as if you were about to sit in a chair, then back up.  

Never bend the knees so far you can sit on your haunches if you are loading the joint with weights, or even your body weight.  If bending to pick something off the ground, bend just one knee to touch the ground, so both knees are at 90 degrees.  Its much easier to stand up, and much less likely to hurt the knee.

 

4. Watch your leg posture at the desk.  If your knees are hyper-flexed all day under your chair, they you will have a host of issues from dry knees, including stiffness of the surrounding muscles.  Try to set a timer to remind you to bend and flex the knee every fifteen minutes, even if you have to cradle it in your hands to get it started.  

5. Consider a soft knee brace when standing or doing activities.  

Not great for sitting with bended knee, as they tend to cut off the return blood flow if they crinkle behind the knee.  But when the knee is more straight, it can provide support, and may help reduce some of the swelling.  At the very least it will remind you which one is the sore knee, so you won't accidentally land on the wrong foot when running down the stairs for a train!

6. For rehabilitation, seek exercises that don't hurt, and that don't create impact.  Eliptical machines, bikes, swimming, skating etc are all good suggestions, along with controlled weight lifting and stretching exercises.  Make sure you seek professional guidance to make sure your ergonomics are good.  

 

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Workplace Ergonomics: A Pain in the Neck!

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Work injuries used to be from highly mobile tasks of hunting and gathering, for which the body was actually well designed. So the injuries tended to be from pure accident, rather than from enforced ergonomics. This changed with the industrial age, when we started to see work injuries to the hands from machines, or to the low back from lifting. But now that we have entered the digital age, our workplace has once again radically changed. Robots and machines do the assembly and lifting, while we sit.

We don't get injuries from "hunting and gathering" in the field, we get them from "hunting and pecking" at a keyboard. 

To see what hours of unremitting bad posture does to the neck, take a look at this image:

In order to see the flickering images on the screen, the head is projected drastically forward, leaving the neck almost parallel to the horizon. While this is fine for a few moments, it becomes an unremitting strain for the neck muscles after a few hours. Much the same as trying to hold two buckets of water at arms length for hours. Human muscles are built for movement, and need to be supplied with fuel and oxygen between beats. Permanent contraction becomes painful, as the muscles are literally starved of oxygen and fuel, much like we can visualize in our hands if we are having a "white knuckle" anxiety attack. We have small mucles that span the gap between each vertebra, and larger muscles along the entire spine and in layers protecting the neck. If these muscles do not relax between movements, then bad things happen.

First the muscles start to scream with pain, developing knots, and restricting simple movements. 

Secondly, over time, the disc spaces between the vertebrae become compressed, and the joint surfaces between the vertebra start to dry out. This explains most of the disc disease and osteoarthritis that we see causing neck pains as we age.
However, neck pains are rare among people who move during their work. We see inspiring examples of octagenarians with perfect posture who spend their lives as ski instructors, yogis, or dancers, or in people who seek out athletic endeavours when they are able to get away from their desk jobs.

But the age of the keyboard does not need to bring new pains to our neck, or to our lives. It simply means we need to develop a strategy to the new workplace. Take a look at the two images below:


In this one, we can see trouble already starting. The laptop is either at the right level for your hands (ie on your lap), or it is at the right level for your neck (ie on a tall table). In the former case, it is terrible for your neck, and in the latter case it is terrible for your hands (see our post on carpal tunnel). The same could be said of even smaller devices like the tablet or the phone. Never a problem for a short task, but this is a prescription for trouble when it extends for hours, days, and years without remission.  

By contrast, take a look at this person's posture. In particular, the neck is now in its normal position, as part of the spine, not a right-angle side road. The weight of the head can now be carried by the structure of the vertebrae, instead of relying on the constant pull of the mucles. Oxygen and food supplies can now be restored to the neck muscles, and knots and pains go a way (or, better yet, never get started!). 

 

 

 

If your work posture is giving you a literal pain in the neck, try these tips:

  1. Use a head-set or speaker feature on your phone.
  2. Have someone take a picture of you at your desk, near the end of day. How's your posture? If it is like the bad example above, then its time to do an ergonomic assessment. Many employers will have professionals who can do this, sometimes requiring a doctor's note. Or, you could follow some of the above advice to help prevent your own neck pains. In my own case, I have found a stand-up screen/keyboard works well when I am in front of my patients.
  3. Set a timer. Every fifteen minutes MOVE YOUR NECK! You can still keep your eyes on the screen if you must, but pull back your shoulder blades, roll your shoulder tips, and swivel your neck in all directions. Use something to pop up on your screen, or try a kitchen timer. Frankly, even a cuckoo clock would work (the original ones all chimed at the quarter hour, not just on the hour). The movement will restore circulation to tense muscles, and it will bring fluid back into the joint spaces. Pain and stiffness don't last long, as long as you move!
  4. When you walk, look ahead of you. Swing your arms normally, and hold your head as if you were balancing books on it. Don't hunch your neck over your cell phone or tablet while you are walking or on public transit. As a reminder, back into a wall and have a friend measure the distance between the back of your skull and the wall; your head should almost touch the wall behind you, and not be leaning towards the wall in front of you! For a video about this, see: http://www.youtube.com/watch?v=FV3ZflQjmxk
  5. If you have a stiff neck, see your doctor for assessment. Sometimes images are needed, like ultrasounds or X-rays. If the problem is musclular, massage can work wonders. If the problem is caused by a rigid alignment of the vertebrae, then chiropractic or physical therapy can be of great value. I have also found great results from doing medical acupuncture, with needles placed into strategic trigger points with almost instant relief. Also, consider a change of pillow, depending on whether you sleep on your back or side; some do well with the "reverse curve" pillow, others prefer a horse-shoe shaped pillow filled with air or bean husks. Be prepared to try a few variations to see what works best for you.
  6. Consider yoga or pilates, or other athletic endeavours that break away from the desk posture. Also consider the foam roll, (as seen in our blog on back posture); my patients find this an excellent daily antidote to desk posture. Lying flat on the floor with a rolled towel across the line of your neck can also restore the normal curve of your neck, and ease the muscles that create the stiff and rigid conditions of modern neck pain

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Static Tension: The Non-Sports injury

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Sports injuries are usually not subtle.  Tension in the underlying tissues results from acute acceleration or deceleration movements.  For example, we see this with a check into the boards,

 a tackle from the side,

 or a crash over the handlebars.

 

 

  Some sports injuries are a lot less dramatic, yet still involve movement.  We see this in stress fractures, plantar fasciitis and shin splints in runners,

 

 

 or in the gradual disc degeneration in spines of  motorcycle racers.

 

But one of the much more frequent injuries I see in my office today is the NON-sports injury, caused by the complete LACK of movement.  Otherwise known as STATIC TENSION, the condition can best be illustrated by trying to freeze like a statue, with  two hand-weights held out to the horizon.

Even if the weights are small, this position can cause acute pains if the muscles don't move for extended times.  

Yet today, we freeze our muscles for long hours at our desks.  Even with no weights in our hands, we tense our muscles, ready to pounce on the next stroke on a keyboard. 

 This static tension produces similar results to sports injuries, such as sore shoulder tips, necks, upper and lower back muscles, stiff knees, and leg cramps.

At a cellular level, here’s how it works.   Each cell in our body needs circulation, to provide incoming food and oxygen, and to carry off the waste products of metabolism.  Our muscles get this circulation only BETWEEN beats of contraction/relaxation.  Normally, this works fine, as the human body was designed for hunting and gathering, moving all our waking hours. 

However, the modern work place has replaced movement with stasis.  With legs folded tight under our chairs, our necks craned forward, our shoulder-tips raised, and our knuckles white, we freeze our muscles in the name of progress.  Trouble is, when the work day is over and we try to stand up, it gets pretty ugly. 

Our legs betray us, our heads can hardly swivel to look for oncoming traffic, and we continue to wear our shoulders as ear-rings.  The muscles have been effectively starved of circulation for hours, and respond with expected results.  

So when you are at a work station, remember to be kind to your muscle cells.  Ease up that static tension, and move at least a few times an hour, to allow precious food and oxygen to fuel your cells again.  It could be a simple shoulder-roll, a pulling together of the shoulder blades, or standing up to twist your torso to the left and right a couple of times.  It could be as easy as straightening one leg at a time under the table during a meeting, or as subtle as rising up on your heels when you are standing in conversation or at a work station.  When you do get away from work itself, make a point of climbing stairs, walking quickly, or pursuing any active movement, from dance to tennis, or from yoga to gym work.

In any event, stop letting your work station give you the non-sports injuries of static tension.  Your muscles will definitely serve you a lot better.

 

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Sitting is the New Smoking

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Times have certainly changed.  Smokers were “cool” in the early days of movies, and they were even hailed by doctors in media ads. 

Smoking became so popular that anyone who didn’t light up at work was considered “anti-social”. 

 Today, the few remaining smokers are kicked out of the building.  

So smoking is in decline.  It seems the old generation of smokers have killed themselves off faster than new recruits can be found

But just as we have turned back one self-inflicted threat to public health, we see another take its place.  SITTING is now the new smoking.

 In my practice of urban millenials, almost all earn their living by sitting all day long.  Those that commute will sit even more in their cars or trains.  Then, by the time they have eaten, they are too mentally exhausted to do much other than sit in front of their screens.  (That explains part of our fascination with professional sports: it is a lot easier to sit and watch somebody else exercise than it is to do it ourselves!).

Our bodies were carefully evolved for movement, but the new workplace denies all but a few finger strokes on a keyboard or screen.  As a consequence, we are seeing a host of self-inflicted medical complications, from obesity to neck and back pains, and from insomnia to attention deficit disorders. 

Our ancestors never had to think about exercise; they got plenty working the land, rowing the fishing boats, chopping the firewood, walking miles every day.  But today, we need a strategy for movement.  This needs some time management, and some creativity to pull it off. 

One can join a fitness club, buy a bike, or take up a sport like tennis, soccer or ultimate frisbee. For those who find these options impractical, be creative.   Remember that exercise doesn’t need to be formalized as a solid hour, it could also come in random short bursts.  Any kind of movement is better than finding a new place to sit as your day goes along.  Here are a few examples my patients have found useful:

  • Add a few extra minutes to your commuting schedule to allow for some movement.  Get off at the wrong stop on your bus, train, or subway, and walk the rest of the way.  Park your car a long walk from where you work, and walk or jog the rest of the way in. If you are in a huge parking lot, try to find a spot in the most remote corner. 
  • If you work or live in a tall building, get off at the wrong floor, and take a few flights of stairs up and down.  If you see an escalator, make a point of not taking it, but try the adjacent stairs instead. 
  • When you get a break for lunch, take it in a different building, so you need to incorporate some walking.  If you want to catch up on lunch conversation with friends, invite them to walk and talk once the food is eaten. 

If you absolutely have to sit, consider sitting on a Pilates ball, instead of a chair. 

 

With a chair, you can stay at your place without moving a single muscle.  Indeed, you could even fall asleep at your desk.  Can’t do that on a Pilates ball, or you’ll roll right out of the cubicle.  Like riding a horse, sitting on a ball requires great core strength, good posture, and the constant adjustment of muscles from your toes to your neck.  If the actual ball looks too silly to use at your work, consider rigging your work station for standing.


If all else fails, use the front few inches of your chair seat as a “pseudo-ball”, keeping well away from the back rest and arm supports. 

So if you have joined the ranks of the sedentary, don’t despair.  Sitters don’t need to be Quitters!

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Dry Eyes - How to make them less stressful

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Dry eyes are more than a modest problem.  They can be the cause of great stress.

Sufferers wake up with scratchy eyes, and have to take drops frequently just to avoid discomfort.  

 

When untreated, dry eyes are more likely to get infections or redness, and their owners are more likely to be irritable. 

Let's take a look at the problem, and consider solutions.

1. What are tears?

Tears are really a mixture of three layers over the surface of the eye; water, oil, and mucous.  The water layer is closest to the cornea, while the oil or lipid layer is secreted by the mebomian glands of the lids.  The lipid layer keeps the water from evaporating.  The mucous layer on the top is there to protect the other two layers from blasts of air and particles that might prove irritating.  The final protective layer of the eyeball is the lids, which blink to renew the spread of the three layers, and to refresh the eyeball surface.  Tears are produced inside and along the edges of the lids, and drain out through the punctum or hole in the inner margin of each of our upper and lower lids, close to the nose.  The tear ducts then carry them away into the nose.  This is why crying is also associated with blowing your nose!

2. What makes eyes go dry?

There are many factors that lead towards dry eyes.  These include staring too long at computers, tablets or cell phones, where the eyes are trying to stay open for focus and concentration.  The same can happen with prolonged study of books, or staring at the road while driving on a long trip.   LASIK surgery (to restore normal vision to people who need glasses) can also be drying in later years.  People with certain skin diseases like acne rosacea and Sjogren's syndrome may suffer from dry eyes.  Even birthdays can cause dry eyes, starting at about the age of 50.  In younger people, makeup and facial soaps can add to the problem, as can wearing contact lenses for excessive periods of time (even if the manufaturer promises you can leave contacts in overnight).  Ambient dust or other small particles can also bedevil the dryness problem.  Certain medications can also cause dryness as a side effect; be wary of drops that "remove redness" as these too can make the problem worse.

3.  What can I do about it?

Try to establish root causes.  If your room air is dusty, try to control it with air filtration or other measures.  If you wake up with dry eyes, make sure your pillow is not a bag of dust by washing or dry-cleaning it.   If makeup is a problem, use hypoallergenic products, and learn how to apply them properly.   If you stare for hours at computers, then try to take your breaks outside, and focus on distant objects to give your eyes a break from the short distance stare.  If non-prescription drops are not sufficient, please see your doctor.  While your family doctor can initiate investigations, including for general health issues, you will need to see a specialist to further examine the eye, including to measure the production of tears with a strip of litmus paper and stained eye drops.  As you will see on our post on the subject, it is important to have the full array of modern tools to examine the eye, not just a hand-held light with an eye chart at the end of the room.  Once the doctor assesses the problem, then a menu of options apply. 

 Punctal plugs can be inserted into the drain holes of each lid, commonly the lower ones.   If you have tried non-prescription drops, make sure you use them often and correctly. (see our article on Eye Drops Made Easy)   

 If the problem is with dry wax in the meibomian glands of the edges of each lid, then try to use warm compresses such as a face-cloth.

Press firmly over each eye for a minute or so, and the dry balls of wax in each gland opening will melt away.  Shampoo in the eyes, (almost!) can also be effective in dissolving the waxy gland material; use a gentle shampoo like Baby Shampoo, and rub it into each eye, almost opening the lids.  After leaving it for a minute, then rinse under the shower. 

Use regular drops like Refresh or Systane, just for lubrication and moistening. 

 

Above all, make sure you have your eyes examined regularly, and protect them with sunglasses, or appropriate goggles for handywork or sports. 

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Osteoarthritis and the Cherry: The latest Joint Venture

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Joint inflammation,  or “arthritis”, is very common with today’s active public.  As opposed to a disease that travels through various joints in the body, osteo-arthritis is one condition that is physical in nature.  In other words, “osteo” form of arthritis is a “wear and tear” or “rusty hinge” phenomenon, usually caused by repetitive trauma in any joint, which can vary depending on the activity in question. 

For example, runners often get this in their great toe joint, where the toe meets its metacarpal.  This form of repetitive motion is certainly aggravated by poorly fitted shoes, or by running on concrete (instead of grass or soft ground).   When this joint is inflamed by gout (a systemic condition where millions of crystals of uric acid deposit in joints and kidneys), we call it “podagara”.  Coincidentally, Sports Medicine researchers are now finding that an old-fashioned natural remedy for gout can also work wonders for any “osteo” joints in the body. 

Tart cherries have long been suggested as an anti-inflammatory aid to gout patients, as part of their treatment protocol.  But recently researchers at the Oregon Health and Science University studied twenty women between the ages of 40-70, all of whom had osteoarthritis.  Each was asked to drink tart cherry juice twice a day for three weeks.  They were tested for markers of inflammation in the blood stream.  It turns out that excellent results were seen, especially with those who had the worst inflammation to begin the study. 

Principal investigator Kerry Kuehl  M.D. of the Oregon Health and Science Universtiy, was delighted to confirm that a natural food could offer such anti-inflammatory help without any of the side effects associated with drugs.  Since most people who exercise are also health conscious, this is particularly good news for athletes, including the weekend “warriors”. 

Leslie Bonci, Director of Sports Nutrition athe University of Pennsylvania Medical Center for Sports Medicine, has incorporated tart cherries into the training menu for all of her athletes. 

The active ingredient in the cherry is the antocyanins; antioxidant compounds that reduce pain and inflammation at levels comparable to many well-known pain pills.   Available in dried, frozen and juice forms, tart cherries are versatile, and easy to find.

So if you are aching in any joint, don’t be intimidated by all the pills at the drug store.   Sometimes the best treatment can be “cherry-picked” right from your local grocery store. 

For more reading: Reduce Chronic Inflammation in People with Osteoarthritis 

And for another good way to treat pain without drugs: Acupuncture: An old treatment gets to the point!

 

 

 

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Ankle pain or injury: how to recover faster

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 Talk about your pain-in-the-ankle! One of the more common complaints I see in my sports medicine practice is the ankle sprain

sprained ankle

Just what is a sprained ankle? It is when one or more of the ankle ligaments is partially or fully torn. It usually is accompanied by a great deal of ankle pain and swelling.

Most of the time an ankle sprain is caused by inversion: the ankle rolls inward, so the sole of the foot faces the mid-line.  This injury is common during simple walking, more so when hiking over uneven ground, and also to a varying degree with sports. 

Once sprained, the outer side of the ankle becomes tender, often puffy, and sometimes bruised. 

 

 

Especially in cases where weight-bearing is difficult, prompt medical attention is helpful:

1.       Clinical exam: I always compress both the shin bones towards each other starting midway between knee and ankle.  As one moves the heels of the hands down the leg, one can determine if the bones are intact all the way to the ankle.  Then palpation, including with the foot partially inverted, will often highlight which tendons and ligaments are involved.

 

 

2.       Images: An X-ray will show bone damage (fractures, spurs), an ultra-sound will show soft tissue damage

Where indicated, bone scans or MRI’s may also be needed to identify finer detail.

Once the images are reviewed, the plan for recovery can be firmed up.  In cases of frankly broken bones, or completely torn ligaments, operation or immobilization in cast or walking boot may be needed.  In most cases of simple strain, immobilization is NOT helpful, except for a few short walks.   Rather than get a full Velcro walking boot, many will opt for a couple of days of crutches, or simply hop the few paces needed at a time.  As soon as weight bearing is pain-free, we encourage it.

 In almost all cases, the best recovery comes from movement, as long as one can do this without pain.  A good review is listed here.

If you don’t have access to resistance bands, you can resist each movement of the foot with the opposite muscles.  Instead of flopping the foot like a dead fish, try to resist raising it, or pointing it, and in the movements of describing circles.  Visualize putting a pen between your toes, and writing the alphabet in slow motion, trying to resist every movement to add tension to the opposing muscles.

To best protect yourself from ankle sprains, consider:

  1. Activity selection: Some activities are ankle friendly, such as an elliptical or bike in the gym.  Others have ankle-friendly boots, like skating and downhill skiing. 
  2. Equipment selection: Sports that involve lateral movements, like tennis, need a shoe with a heel shaped like a pyramid when viewed from behind.  Normal running shoes tend to have heels that are straight on each side, like a man’s dress shoe, as they are anticipating no sudden side-twists.  Do NOT play tennis in regular running shoes.  For much the same reason, hiking boots are designed with high-tops and firm laces, to support the ankle.  Wear these when you hike, not regular running shoes or flip-flops.
  3. Watch out for static ergonomics.  As we discussed in our How To Keep Your Spine Straight post, there is much damage done sitting at the desk, especially with the legs flexed and feet folded up for hours.  Remember to set a timer for every fifteen minute interval, and straighten your leg to do a few more resistance exercises with the ankle.
  4. Ice after activity, along with elevation above the heart will help reduce swelling.  Remember that sitting with your foot on a stool is not elevation, as the heart needs to be six inches below the foot to let the fluid run downhill.
  5. Walk like a duck.  A little known anatomical trick will help prevent the ankle from rolling inwards, especially on uneven or slippery ground.  If you evert your feet (like a duck) it is very difficult to roll your foot inwards, due to the support of the ankle bones.  If the feet point straight ahead, or, worse yet, if they are pointed slightly towards each other, then an inward roll/sprain is much easier to occur.  Try your duck walk the next time you are walking over uncertain ground on your way to the car, or over a patch of ice or wet leaves.  It may feel a little silly, but it will help keep the sprains away!

 

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Yoga: Good for many, but not without caveats

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Many people have been attracted to Yoga for its many benefits. 

 Doctors have often recommended Yoga for their patients, to help with back pains, injuries to the limbs, or for routine post-operative care.

However, that does not mean Yoga is automatically safe for all.  It has come to light that many amateur enthusiasts force themselves into text-book (or video) positions even if the pose hurts.  The dangers are not just with the unsupervised beginners.  In class situations, there are instructors who will try to force all the people to get into all the poses, even if it means exhorting them past the point of pain or comfort.  Other instructors are too swift with their pacing, forcing participants to change positions too quickly for comfort. 

An interesting new look at Yoga has been written by William J. Broad, pointing out that many people should not be doing certain Yoga poses, and some should not be doing Yoga at all.  A compelling look at the good and bad sides of Yoga is to be seen in the following link, which is highly recommended: NYTimes-Yoga

However, this is an example of the universal rule of sports; not every body is suited for every activity.  That’s why such diverse body types excel in the Olympics, where the marathoners and sprinters have completely different strengths and aptitudes, not to mention body builds.  And, within running, there are many of us who are simply not built for it, such as people with issues of bony alignment, arthritis, or pains when running on concrete.  Others are not suited to the mental discipline required in long distance running, and simply cannot appreciate the zen of it.  Swimming is another sport thought to be universal, but many just sink like a stone, or otherwise seize up with fear when they get near the water.

 So the point is to consider the whole menu of options for sports, activities, and therapies.  Following the latest fads is fine if you turn out to be well suited to it.  But be prepared to bail on even the gentlest of exercises if they don’t work for you.   

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Avoid That "Postural Challenge" In Your Later Years!

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The human body was built for “hunting and gathering”, not “hunt-and-peck” typing. Our DNA and our evolution is built on movement. However, we now have invented a work form that is virtually movement-free: the modern office. Instead of walking, foraging and farming, we now sit all day, with tense fingers poised over keyboards, and our eyes straining to read back-lit images. an image of poor posture in the workplace By the end of the day, our shoulders are up around our ears, our necks are craned forward, and our noses are almost touching our screens. Our legs are folded like a card table, and our arms and wrists are stiff from their tense day of hovering over the mouse or keyboard.

To make matters worse, we have none of the usual animal signals of the passage of time. We don’t get winded, so we don’t take time out to catch our breath. We don’t need the sun (and many of us do not have outside windows at work) so don’t get the signals of increasing amounts of daylight to help wake us up. And we are not hiking over great distances, nor carrying loads on our frame, so we don’t have to think about good posture. In fact after years of hunching over our computers at work, our spines become curved like a “question mark” when viewed from the side.

A shipwreck’s anchor chain crusted in coral quickly fuses into its last position. The same thing can happen to the human spine. If movement is denied, and if the spine is left to compress itself into the distortions of modern desk work, then old age will surely be a postural challenge. We often note that our elderly tend to have a curved spine, or “postural kyphosis”. However, it should be noted that this is very rare among dancers, or devotees of Pilates, Yoga, or the Martial arts.

The reason is simple. If we only exercise the muscles on the front of our chest and neck, then we draw our body closer to the screen in the classic “hunchback” mode.

To recap, consider the following points to help you fight the office hunch, and keep your posture forever young:

1.Set a timer. Every fifteen minutes or so, set a timer, or have your computer screen alert you to take a quick few moments to stretch, roll the neck and shoulders, and to squeeze the shoulder blades together. Try a few phantom rowing movements as well, then plunge back to your work.

2.Set your ergonomics. Make sure you have a screen height that approximates your eye-level when you are sitting up straight. Don’t use a laptop down on your knees (at least not for long), and make sure you have a separate keyboard down at a comfortable level so the forearms are parallel to the ground. Lastly, have a decent chair, which can be adjusted in several dimensions to fit your comfort level.

3.Use the reverse muscles in the gym. Back exercises like the lat pull-downs, upright rowing, as well as certain yoga poses will help reverse the forward drift of the pectoral and neck muscles as they draw your face into the screen all day. A professional trainer can assist with proper programs here, as well as with the use of such aids as the foam roller. The latter is basically a Styrofoam version of a three-foot long cigarette, with about a 4-6 inch diameter. Lie on the floor with this tube along the length of your spine, from the back of your head to your tailbone. Balance with your legs. Then use your arms to hoist light weights in a “bench press” or “butterfly” move, for three sets of ten or more repetitions. Take deep breaths with each movement, and you may notice some “cracking” noises coming from your upper spine. This is a great technique to “open” up the disc spaces, and fight against the forward compression that we associate with age.

4.When you walk, look ahead, not at your feet. Remember to stand tall, and frequently pull your shoulder blades together to tone up these muscles. Also swing your arms normally as you walk, don't have your shoulders seized and arms stiff. The military has always taught posture from the beginning of any soldier’s training; not for simple appearances, but for function (if soldiers had to carry heavy packs and march miles into battle, they would all arrive with stiff backaches if they slouched the whole way). When your body posture becomes part of your muscle memory, you are on the way to a youthful aging process.

For further reading: http://en.wikipedia.org/wiki/Kyphosis

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