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Traveling Stress and Economy Class Syndrome (Deep Vein Thrombosis)

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We always knew that economy class wasn't the most comfortable way to travel and can be quite stressful. But now it turns out that, if you're not careful, it can even be harmful to your health on long journeys.

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Three distinguished scientists, Drs. Cruikshank, Gorlin, and Jennet have called the condition the Economy Class Syndrome, otherwise known as E.C.S. I call it leg lag. The underlying medical condition is deep vein thrombosis. The symptoms can appear several weeks after flights as short as three hours, and can-in extremis-lead to death. We do not yet know what causes deep vein thrombosis, but it obviously has something to do with the cramped leg-room in the economy class seats. Economy or charter class seats, also known euphemistically as hospitality class seats, have only half the leg room of first class seats. Yet economy class passengers, on average, have just as many legs as their first-class co-travelers. The longer the journey, the greater the risk is of a blood clot forming in the leg, which could then end up in the lung, with potentially fatal complications.

What is Deep Vein Thrombosis?

A deep vein thrombosis is a blood clot in a deep vein. A clot inside a blood vessel is called a thrombosis. Deep vein thrombosis predominantly occur in the legs and may have no symptoms. The non-specific signs of  deep vein thrombosis include pain, swelling, redness, warmness, and engorged superficial veins in the leg. A  deep vein thrombosis may go away naturally, but the most serious complication is when a blood clot dislodges (embolizes) and travels to the lungs to become a life-threatening pulmonary embolism.

In 2011,  The sudden death of rapper Heavy D was due to a pulmonary embolism caused by deep vein thrombosis, a Los Angeles coroner has decided.  His weight, heart disease and a recent transcontinental jet flight were cited as contributing factors to deep vein thrombosis.

In another example, tennis star Serena Williams appeared on the Today Show March 9, 2011 and gave host Matt Lauer additional details about her recent health scare. Williams was  being treated for a pulmonary embolism which resulted from a deep vein thrombosis. The Grand Slam tennis champ had two surgeries on her foot and she apparently was in a cast for 10 weeks, followed by 10 with an orthopedic boot on her leg. She also was doing a lot of flying during that time as well.

Why is this a potential problem when traveling?

The only way blood can circulate freely from the legs back to the heart is through the pumping action of the leg muscles in motion. The blood in these veins returns most easily when it is not thickened: unfortunately three factors on a plane conspire to turn our blood into sludge. At altitude, the humidity on a passenger jet is drier than the Sahara desert, causing the body to dehydrate. Alcohol also dehydrates the body, as does salty food. To make matters worse, most planes on this continent carry no bottled water for the passengers. The soda water and tonic water both have considerable quantities of salt and sugar, respectively, and thus neither solves the dehydration problem.

What is at stake here is a lot more serious than the minor nuisance of not being able to get back into your shoes after you have taken them off during the flight. In 1986 a three-year study carried out at Heathrow Airport found that 18% of 61 sudden deaths among long-distance passengers were due to blood clots in the lungs, which had originated as deep vein thrombosis in the legs. But this doesn't mean that we all have to win the lottery to be able to fly long distances safely in first class. Now that you know the dangers, you can take some simple steps to avoid the pitfalls of having a  deep vein thrombosis develop in your legs while flying.

Here's an action tip:
Fight leg-lag, otherwise known as Economy Class Syndrome (deep vein thrombosis), by taking the following precautions:

  • Make sure you wear loose clothing. Girdles, tight belts, garters, and executive socks are out. Support hosiery, on the other hand, provides some protection against deep vein thrombosis.
  • Drink lots of water, even if you have to bring your own bottles on board.
  • Avoid alcohol in flight; also avoid sugared drinks and excessively sweet foods.
  • Get some exercise. If you have a bit of time on your hands in the airport building, do a few laps of the concourse instead of sitting in the cafeteria or lounge. If you are held at the gate, choose to stand rather than sit. Once on the plane, Stretch your legs by walking the aisles, or standing out of the way at the back of the plane for at least a few minutes every hour. If you are stuck sitting in your seat try compressing and releasing your calf muscles
  • Don't smoke, as this further impairs the circulation of blood in the body.

Deep vein thrombosis while traveling in cramped quarters (think economy class on a 14 hour flight from San Francisco to Hong Kong) should be a concern to all travelers. If you take control, you can enjoy any flight, and arrive in complete safety.

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Colonoscopy for Cancer of the Colon: Hind-sight is 20-20

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Colon Cancer Prevention

 Aging is supposed to be a reward, not a punishment.  However, there are days when that may not seem to be much consolation.  Just like with a car, we can ignore maintenance at first, but after it becomes an old classic, it needs a lot more maintenance.

One human example is our search for preventable diseases.  Colon cancer is certainly one of the classic examples. 

Our society is at a high risk of the disease, for a number of reasons.  Our aging population, or changing diet with less fiber and more sugars and additives, and our increased levels of stress all mitigate increased risks of this (and other) diseases.  Because cancer of the colon is so easy to prevent, and yet so deadly if allowed to grow undiagosed, prevention trumps heroic surgery as our first option.  While prevention incorporates the usual good lifestyle choices of diet, exercise, and stress management, here are some critical elements of detection:

1.       Fecal Occult Blood test: this is a simple test kit, available from your doctor or lab, which will show trace amounts of blood in the stool.  This might be from bleeding from the gums or swallowed blood from a nosebleed, or it could come from the stomach or any part of the intestines down to the rectum.  While blood is visible as red or black discoloration in the stools, this test is sensitive enough to detect blood hidden from the human eye.  Because it is inexpensive and non-invasive, this can be done to any age group.  We often order it for patients with low iron levels, or with known bowel diseases like chron’s or ulcerative colitis.

 

2.       Colonoscopy:  This is the definitive test, routinely suggested for all adults after the age of 50.  Earlier screening is suggested for those who have any of the risk factors mentioned above, including those who have positive Fecal Occult Blood tests.

Treatment:

                1. Minor surgery:  Nip it in the bud: the point of a direct (as opposed to a “virtual” one) colonoscopy is that it will not only show any polyps, but allows the doctor to snip, zap, or otherwise eradicate them before they turn into cancers.  A classic “two-fer”, this means the diagnosis is made, and the treatment is given all during the same procedure.  For patches of suspicious cells, a biopsy can be taken which will detect diseases within a few days of lab processing. 

2.    Major surgery: If the above is too late, and the cancer has progressed into and through the wall of the colon, then full abdominal surgery is usually indicated.  Often this ends with a segment of bowel removed, and a colectomy or removal of bowel being done.  The patient is left with a colostomy bag, which is often permanent.  In some cases, the cancer may have already spread beyond the colon and into the lymph nodes, meaning that systemic chemotherapy or radiation may then be needed.

Please consider option 1, no matter how you might rather postpone or ignore it.  Those who are in denial are likely going to end up with Option 2, and for some of those, even surgery may be too late to save their lives.  Once cancer has been established,  a third of all patients will die from it.  If detected early, the survival rate should be 100%.

There are plenty of “bad luck” reasons for us to die; please don’t let “bad management” add to your risks!  Ask your doctor for a referral, and make sure you check out your colon when you are due. 

For more info on colonoscopy:

 http://en.wikipedia.org/wiki/Colonoscopy

For more articles on colon issues, check these articles on www.stressipedia.com:

A-new-wrinkle-on-fatigue-Flat-Iron

Stress-and-Constipation-How-to-Move-Things-Along

Probiotics-new-use-for-an-old-bacteria

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Achilles Tendon Injuries: how to fix

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One of the more common complaints among patients is a pain above the heel, in the Achilles tendon.

This debilitating injury is seen commonly in athletes, where explosive forces are

channeled into the pencil-thin tendon that joins the calf muscles to the heel bond.  For example, when running backward in soccer, then suddenly changing direction and sprinting forward.  The acceleration/deceleration physics contrives to put hundreds of pounds per square inch into the Achilles tendon, causing it to stretch, strain, partially tear, or completely rupture.  The history is defining: it feels like someone "struck my heel with a board", followed by a sudden crippling pain, and inability to even bear weight on the limb.

For the weekend athlete, the injury is even more common.  In large part this is because we tend to sit all week at a desk, with our legs folded under us, and our feet pointing behind.  This shortens the Achilles and calf muscle, in much the same way that we see happening with wearers of  high heeled shoes (including cowboy boots).  When these contracted muscles are taken for a run, they are stretched with every push-off into the next step.  Especially in cases where pre-run stretches or warm-ups are skipped, the results are quite predictable: strains, partial tears, or, ultimately the complete rupture.

For minor strains, conservative measures such as ice and rest can suffice. Some will benefit from a temporary heel-lift in their shoe, to prevent stretching the tendon back out to its full length until it is ready. For more significant tears, often one needs physiotherapy, and possibly rest in a "boot" or cast.

When the Achilles tendon is completely severed, surgery is really the only solution.  Often this is done a few days after the injury, in order to wait until the bleeding has stopped.  Once sutured, the tendon heals slowly, due to its inherent poor blood supply.  (Think of a chicken leg, where the tendons are like clear plastic rope).  For virtually all such ruptures, the standard recovery time is over a year, often 18 months.  For a professional athlete, this can mean a career ending injury.

 One such patient that I treated was Wes Hart, of the Colorado Rapids in the MLS.  He had a classic injury on the field during the opening game of the 2001 season.   His surgery was done by team doctor Wayne Gersoff, who also followed with MRI images at intervals.  He was monitored and treated daily by Theron Enns, the team trainer, and encouraged to progress to more weight bearing and movement each week.  As an additional therapy, I treated him twice weekly with acupuncture needles placed deep into the tissues above and below the tear.  His speed of recovery was beyond expectations: he advanced so quickly that he was able to play for the final game of the same season, a mere sixteen weeks after his surgery. 

To recap, here are some tips to prevent Achilles tendon injuries:

1. At work: Try to keep your feet flat on the floor when you are at your desk, don't fold your legs and point your toes behind you.  This will train the calf muscles to shorten, meaning more pressure will come to the Achilles tendon when you stress it in athletics

2. Under your desk: Periodically straighten your leg, pull your foot up at the ankle until you feel your calf muscles engage.  Hold this for several seconds. 

3. Before sleep, stretch your calf muscles and your Achilles tendon. 

4. In the shoe store: make sure you have proper shoes, professionally fitted.  Step into the sizer, and make sure the shoe is comfortable all over, including over the Achilles tendon.  Don't keep your shoes too long, as they will lose their supportive function with regular use.  Most runners will need fresh shoes every six months, which is long before the shoes are looking worn.

5. Before exercise: Stretch after your initial warm up, as we discussed in another blog.  No bouncing, just smooth regular stretching.

Calf stretch/ exercise : 

Your Achilles tendon connects the muscles in the back of your leg to your heel bone. The calf stretch exercise can help prevent an Achilles tendon rupture. To do the stretch, follow these steps:

1. Stand at arm's length from a wall or a sturdy piece of exercise equipment. Put your palms flat against the wall or hold on to the piece of equipment.

2. Keep one leg back with your knee straight and your heel flat on the floor.

3. Slowly bend your elbows and front knee and move your hips forward until you feel a stretch in your calf.

4. Hold this position for 30 to 60 seconds. 5. Switch leg positions and repeat with your other leg.  

6. After exercise: More stretching, and an ice pack if you feel any pains over the calf or achilles mechanism. Also consider this stretch:

7. In the doctor's office: once you do present with an injury to your Achilles tendon, your doctor can take images to get a better sense of your severity.  At that point, one can prescribe from a list of options, from orthotics to physiotherapies, and from anti-inflamatory medicines  to medical acupuncture.

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Realistically Beginning A New Weight Loss Exercise Regimen

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Are you embarking on a new weight loss exercise program to redress the flab put on over years of sedentary living? Well, there are a few things you should be aware of right at the start.

An image that depicting people running on a treadmillThe human body was built for motion, and until the computer age changed the workplace during the last generation, we had plenty of motion just staying alive. To find food, ancient hunters had to walk or run for miles. To kill it, they had to exert great muscular strength and reflexes in battle.  To carry it home, they had to be weight lifters. Even in the Industrial age, men at work needed brute strength on the assembly line, and women, lacking refrigerators and cars, put in thousands of calories of exercise walking to stores, tending the vegetable gardens, and, for the minority, joining the men on the assembly lines.

Well, now we all have the easy life, at least as far as weight loss exercise goes. With no more exercise than pushing a few buttons or keys at work, and with an average of 5 hours of television to watch each evening after work, it is no wonder that we have collectively turned to flab.

To correct this, many have embraced the quick fix exercise remedy. Jogging along with Jane, or bouncing along with Biff on the TV fitness shows, the average person can be setting him or herself up for injuries big-time. First of all, there is no way that these people get their terrific bodies doing just twenty minutes a day. These professionals work out almost as many hours a day as you work at your desk. So the first step to reintroducing motion to your body is to have a realistic goal, such as to have fun and to gradually improve your exercise tolerance. The sports medicine clinics are filled with weekend athletes wearing slings and tensor bandages to treat injuries caused when their mental enthusiasm exceeded their physical shape.

If you have been under-exercised for years, don't try to make up for it in minutes. Make sure you invest in the right equipment, seek professional instruction, and check your pulse regularly during the exercise. And remember, one of the best exercises of all is to turn off the TV for a while, and go out for a walk.

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Tips For Health: Begin Jogging By Starting Slow

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Are you in a hurry to get fit? Well, before you start jogging, there are a few things under the category of 'tips for health' you should know.

Without question, jogging is the most popular form of exercise on the planet, because virtually everyone in reasonable health can do it, even if finances dictate that they must run barefoot.

An image depicting a jogger stretching

Of course, in the western world, barefoot is not preferable, except perhaps along a sandy beach. One of the nice features of jogging is that even professional grade equipment is still inexpensive, when compared to equipment for almost any other sport. To make it an even better bargain, there are no clubs to join, and no lessons to hire, you can do it whenever and wherever you wish.

However, there are some caveats that are very important before you transform yourself from couch potato into running star. First of all, take a look at yourself. If you are out of shape from at least three months of inactivity, if you have or are recovering from an illness, or if you are over forty years of age, you should start with a full physical examination from your doctor. In addition to ruling out such problems as metabolic disorders or blood pressure problems, your doctor can examine your joints and muscles to see if they are strong enough to sustain the forces of running. She can also give you valuable diet and nutrition information that can help improve your fitness while you exercise.

In some cases, a treadmill test is helpful, not only to check your ECG but to see how you run. If you are knock-kneed, bow-legged, flat footed, or have one leg longer than the other, then special shoe inserts may be needed to prevent injury. If you are obese, remember that each step you run carries a force of three to eight times your body weight, depending on terrain. So in other words, if you are over 25 pounds overweight, try another sport first, such as walking, cycling, or swimming until you get into better shape.

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What To Do About Being Stressed-Out and Overweight

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Obesity. Plumpness. Full figure. There are more euphemisms for this condition than any other medical problem. This is probably because it is not a medical problem at all. With the exception of a very few cases of true glandular dysfunction, such as with certain conditions of thyroid, liver, or adrenal disorder, being fat is an arithmetic problem.

An image of glass of red wine

When the numbers of calories in exceed the number of calories burned off, the body stores the difference. In other words, obesity is caused by eating too much, and/or exercising too little. On the very rare chance that your case may be caused by more than bad dietary arithmetic, a proper medical work-up can pick up most endocrine disorders, and, of course, the appropriate treatments can then be started.

In some cases, such as with thyroid replacement, or surgery on an overactive adrenal gland, the results can be dramatic. But for the vast majority of heavyweights, the problem is not related to luck, genetics, or metabolism. It usually all comes down to choice. That's right, choice. Most fat people choose to be fat, in spite of their protestations to the contrary. When their eyes are closed, they see themselves as fat people, when they talk about themselves, they refer to themselves as heavyweights, and when they buy clothes, they look in the "full figure" section. They may try a diet, out of guilt at being faced with an increasingly lean lifestyle portrayal in the media. But without choosing to see themselves as thin, the dieter feels ill at ease with their new weight, and soon bounces back up to even greater heights.

Often the obese kid themselves into believing that they really don't eat much, just because they see others eating more in public. But the food one sneaks without witnesses can do all the damage, even if one denies having eaten it. My old professor used to point out to her obese patients that "nobody ever came out of a prisoner of war camp fat". Indeed, in circumstances where the freedom of choice in one's diet is removed, such as with the post WWII rationing in England, obesity virtually disappeared from view (at least it made everyone suspicious of ration stamp forgeries if one showed up overweight). Indeed, during these periods, the incidence of heart disease, diabetes, back pains, sore knees and ankles, and a host of other obesity-related diseases all plummeted with the national weight. In the case of post-war British, the choice was made for them. But, for the rest of us, we still have that precious freedom. So, whether you consider yourself pleasingly plump, rotund, or "big boned", remember that you are ultimately the only one to blame, and the only one who can make the choice to correct the problem. It has always been thus. Ever since the days of Shakespeare, the choice facing every dieter as he or she sits down before another meal has always been the same: "tubby, or not tubby, that is the question".

Here's an action tip:
If you are overweight, by which I mean ten pounds over the weight at which you look your best in a bathing suit, remember to exercise your freedom of choice, as well as to exercise your muscles.

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Boxing for Fitness

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Sometimes rehearsal is a lot safer than the real thing. 

boxing for fun and exercise

Ski and snowboard acrobats rehearse over a trampoline with bungee cords tied above them to prevent injuries as they learn new flips.  Even sword-fighters in the days of the French musketeers had to come up with a rehearsal format.  Thus was born the art of ballet, which basically incorporates all the jumps, thrusts, lunges and spins needed to keep the swordsmen sharp between wars.

Boxing is another such sport.  In actual combat, or a pro fight, boxing is indeed very dangerous.  Every blow to the head counts as a potential brain injury, from which the brain has very limited powers of recovery. In addition, head injury is also possible including injuries to both the the scalp and skull.

For the few who do this as a profession, there are now a great number of safety measures installed, such as pre-fight physical examinations, MRI’s of the brain, neuropsychological testing, and on-site physicians.  But for the general public, one can gain a lot from boxing as a rehearsal - especially in terms of eliminating the risk of brain injury or head injury.  In other words, be the boxer, not the box-ee. 

 As the popularity of arena fighting surges, ordinary people are learning to get their fitness from fighting against inanimate objects such as the heavy punching/kicking bags, or the hand-pads held in place by the trainer.  In a way, this gives the best of options; no head contact, yet full benefits of the sport.

 

having fun punching a bag!

For most people working at a computer all day, the back hunches, the neck is craned forward, and the abdomen sags.  Over time, this becomes a habitual then permanent “posture creep”.  In order to reverse this trend of the modern office work, boxing (as training) is extremely efficient.

As with any sport, there are issues of technique.  Boxing is more than just beating away on a bag, as any coach will tell you.  Proper technique involves good posture, balance, footwork, and rotation around your core.  As one arm advances to land a jab, the other shoulder rotates backward, in order to add strength to the punch.  This involves great use of the back and shoulder-blade muscles, as well as the abdominal ones, all of which are ignored in our desk posture.

Boxing is a higher-impact alternative cardio exercise routine. If you are looking for something new to add to your regular exercise routine then perhaps you look for boxing gloves and bags. Boxing is a good way to build both strength and endurance and can be a great way to add to your abdominal exercises. Speed bags and heavy bags offer different ways to develop a core work out, letting you choose what’s most comfortable for you. Workout balls offer another option, allowing you to stretch, strengthen muscles and augment your abdominal workout exercises.

Even without equipment, shadow boxing in front of a mirror, (or, in the picture below, on a beach) can be very useful, especially for your core mid-section or abdominal exercises.

shadow boxing on the beach

In much the same way as Tai Chi can rehearse martial arts, one can even slow down the motions, and practice good boxing form between lessons.

While the subject of professional risks is best left to another forum, be sure to consider boxing lessons as one way to strengthen your core, improve your cardio fitness, and burn off a lot of calories in just a few minutes.  You will quickly appreciate how long a two or three minute round can be!

Professional trainers demonstrate great results in teaching the “sweet science” to all age groups, from school children to octogenarians. 

 

For more info, see www.ringfitboxing.com

Toronto gym, boxing for fun and exercise

That's where I train with Stephan Boyd, Canada's middleweight champion in 2012.  He and his professional coaches make a great training team.  If you are interested, check out similar facilities in your area.  As a break from the mental and physical stresses of office work, this could be one of the more fun fitness options for you to explore.

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Exercise: Another Weapon in the Fight Against Cancer

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We all know that exercise keeps us fit, and prevents heart disease, but it turns out to also be a cancer fighter.

image of man exercising

Regular exercise, for which our body has been designed, and which our modern lifestyle sees far too little of, has a number of benefits beyond toning up the muscles. 

It can help prevent heart disease, burn off some cholesterol from our blood stream, release endorphines to reduce pains, and improve our mood. 

Researchers  at the University of Alberta, headed by Dr. Vickie Baracos, have shown a new value to the humble exertions.  Rats were placed on varying levels of exercise regimens, such as swimming, and then injected with cancer cells.  While all developed tumors, the sedentary ones had far more significant disease.  Those that exercised even modestly had tumor sizes fifteen to forty five percent smaller in the same time frame. 

Exercise dramatically slowed cancer growth regardless of the rats sex, when the tumor was introduced, or the amount of exercise over the moderate level.  The results are extremely promising, especially as exercise has no adverse side-effects and does not need to wait for government approval.



The tendency most of us show towards those being treated for cancer is to coddle them, to save them steps where possible.  Now it seems the exact opposite should obtain.  The exercise need not be herculean, but should be tailored to suit the physical limitations imposed by the disease itself.  Even patients who are admitted for chemotherapy, who may well prefer to stay in bed due to side effects, should be encouraged to get up for at least brief forays around the room, or down the hall. 

If you have cancer, make sure you augment your medical treatments with everything you can, including good humor, and a positive attitude. It also means summoning the resolve to do at least some form of exercise each day.  Come to think of it, there's no need to have cancer to benefit from the same advice. 

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Tai Chi, a Sure Way to Balance your Health Defense

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Our bodies were designed, built, and programmed for movement.  Our joints need movement to self-lubricate through the bag of synovial membrane. 

This movement even feeds food and oxygen to the bloodless cartilage inside the joints, and carries away the products of metabolism.  Movement also benefits our muscles, by contracting, toning, and stretching them.  Even our stress defenses were wired to energetic  responses.

But now we have redesigned our ancestors' active workplace to remove most movements as we sit all day at a desk.   So the modern response to stress has gone from the “fight and flight” option to  a not-so-energetic “sit and stare” response.  

But new research is indicating that even more is at stake with our modern inactivity.  Mental functions are all sharper if we move, and duller when we sit.  Even our immune mechanisms are enhanced with movement.  Scientists have emphasized h that sitting still for 4 hours at a time is basically an “inflammatory”event, sort of like eating a donut.  (Worse, obviously, if you are sitting and eating for the same four hours!).  Not only do bones lose their density and muscles lose their mass, but our mental alertness suffers from this inactivity too.

 So our basic instincts of movement are correct, and we indeed need room to roam.  In other articles, I have reviewed posture at the office, as relates to carpal tunnel and low back pains

 But another solution comes from the world of Tai Chi.

 An interesting discipline, Tai Chi basically is a slow motion version of martial arts.  Speed up the film of people doing Tai Chi in the town square, and you get a Jackie Chan fight scene.  While it may look simple, it involves weight shifting, swaying, stretching and toning.  And, above all, balance.  Now doctors are appreciating how well it works with patients suffering from Parkinson’s as well as many other medical conditions.  See this link to learn more

Requiring no equipment, Tai Chi is easy to start.  While learning can be an infinite process, even a  beginner can benefit right away.

So if you are getting stressed by your desk job, try to interject a few moments of Tai Chi into your breaks.  Remember to set a timer for every fifteen minutes, to remind yourself to move something.  For example, at least pull back your shoulders, neck and head away from the computer, and try to touch your shoulder-blades together in a “rowing” motion .  At the very least, make this a simple part of your routine for a few seconds.  If space and time permit, use one of your 15-minute breaks to stand up and try a few Tai Chi moves, and notice the difference.    Who knows, the whole office might join in!

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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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