Stressipedia

The Source for Health and Stress News You Can Use

About The Joy Of Stress

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About “The Joy of Stress”:

The Joy of Stress was written originally over three decades ago, and has proven to have lasting and universal appeal.  The concept was started as an information piece for specific questions asked by my patients.  In the course of a busy practice of family medicine and emergency care, I was asked by my patients to simplify the complicated steps to deal with their particular problems.   I heard myself repeating  verbal lists  for management of obesity, high blood pressure, low back pain etc.  However, verbal “core dumps” are very poorly retained (or, worse yet, misremembered), and I would inevitably have to repeat them at intervals.  Initially, I thought I should write these down, and started handing out printed action-items for some of the more common conditions.  Strress was the most common basis for most medical visits, so that was the starting point.  To this was quickly added obesity, high  blood pressure, elevated levels of blood sugar or cholesterol, and pain management.  As I catalogued each new subject brought up by the next patient, the pamphlet idea soon grew to a book. 

The manuscript for the book was turned down by all publishers, as I was an unknown young doctor in the countryside north of Toronto.    I had never written professionally, and knew nothing of editing, illustrating, marketing, and printing.  However, I did know that stress is not always bad, and indeed is a needed ingredient to success.   Mortgaging everything to self-publish, it was indeed a great joy to see the book enter the Canadian Best-Sellers list, rising to number one for over three months. 

The American edition

 

 

 

 

 

 

 

was then picked up by a real publisher, and translations were done in dozens of countries.  Some of these are shown below.

Since then, I have travelled the world as a professional speaker, yet always remained in active practice.  My millennial patients suggested blogs, which now form the basis of www.stressipedia.com.  Along the way, I also rewrote the entire book;  “The Joy of Stress”, now available on Amazon in print or as an e-book. 

 

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Trigger Point Injections (w/ Micro-Dissection)

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Dr. Hanson now has several locations in the Vancouver, BC area where he routinely provides trigger point injections.

 

Physical pain can often be caused by a mechanical source, which is why pills don’t always work.  Trigger points are painful sites inside our muscles or connective tissues. They behave like a burr caught in the moving parts of our body. Trigger points are defined as having the following characteristics:

  • Pain related to a specific point inside a muscle (like a knot in a wooden plank) or in the tight fascial layer covering the muscle. These are not caused by an obvious local injury or infection.
  • Palpable nature: these can feel firm, like a small walnut embedded in muscle, or they can be palpated as a thin sheet of tenderness in the overlying fascial layer. 
  • Reproduction of symptoms: Direct pressure over the correct trigger point will reproduce the symptoms, often not in the same place.
  • Invisible on images such as x-ray, ultrasound or MRI.  As such, they are often missed. 

 

Commonly, pains present in one or more parts of the body, while the root cause comes from a distinct trigger point. For example, pains in the arm could be coming from a trigger point in the neck. Or a tender trigger point in the sacro–iliac joint (low back) can cause a person to “walk funny”.  This can shift the burden of weight- bearing, thus setting up myriad muscle pains in the back or limbs. We usually do not need to treat each of these extra sore spots, just the one or two that are the root cause.

For decades, doctors have used cortisone shots into trigger points, with some good effects. However, the cortisone itself carried considerable risk of side effects in the local tissues, such that it could be only used three times a year in the same site. Happily, it turns out that the shape of the needle was more important than its contents.  Researchers found the same results injecting plain saline, or using a dry needle, as long as it passed through the trigger point.

 

The trigger point needle is hollow and has a beveled edge, which makes it possible to mechanically break down these painful spots.  We only treat one or two spots at a time, to maximize benefits.   The needle tip is used to gently explore around the area of pain through a single point of entry, using a drop of local freezing if needed.  Through touch, the needle will detect areas of inflammation, scar tissue, or calcification. Once discovered, these targets are then microdissected with the tip of the needle.  This allows restoration of normal blood supply and function.

  

The procedure takes only a few minutes and, with a few drops of local anesthetic, is basically painless.  Results are usually quick, although a few patients may experience a temporary soreness for several hours before improving.  It is helpful to drink lots of water following the treatment, and to be moving rather than resting or sitting for the next while. One can go straight to the gym or yoga class or back to regular activities.

Examples of acute and chronic cases we treat: back pains, from upper to lower, rotator cuff and frozen shoulders, tennis elbows, and tendon pains in wrist and hand.  In the lower limbs we treat hip pains and stiffness, sciatica, sacro-iliac strain, knee, calf and iliotibial (lateral thigh) pains, ankle and foot issues including plantar fasciitis.

 

Permanency:

This depends on the root cause. If the injury is recent and unique, a few visits may be all we need.  If the root cause is a recurring one, such as bad posture or poor ergonomics, then the complaint is likely going to come back.


Side Effects:

The technique is done with the usual sterile protocols. Because there is no cortisone, there are no drug interactions, nor any problems interfering with current medications. If you are on blood thinners – please consult your doctor first. We do use a few drops of local anesthetic, Xylocaine 1% (Lidocaine). This is only injected if the patient feels discomfort. In case of allergy to local anesthetics, treatment can be done with nothing in the needle.

Other treatments: Trigger Point Injections work well in conjunction with other disciplines such as physio, acupuncture, IMS, therapeutic massage, yoga and chiropractic treatments.  Indeed, by restoring blood supply to trigger points, simple medications like Advil will work better, and stretching and exercises will be easier to do. 

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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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GERD: There's a Fire Down Below!

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Is stress getting you right in the breadbasket? Here are some tips to put out that “fire in your belly”!

A generation ago, people would associate stress with stomach ulcers.  In cartoons and family sitcoms, the children would cause some stress of the week, the father would rise to the bait, and the mother would caution: “Henry, watch your ulcer”.  Often, this would be followed by the automatic response of a glass of milk.  Ulcers didn’t seem to be happening to women, and the male victims were always being told to “calm down”, or advised to sidetrack their careers to something less stressful.  If the ulcers persevered, most patients would end up with major surgery to cut the vagus nerve, leaving behind a huge scar on the abdomen.  My, how things have changed!

Now ulcers are diagnosed much more easily, and treated much more simply.  To diagnose one of the common causes, a blood test for helibacter pylori is a good start.  If this bacteria is present in the stomach (its antibodies show up on a regular blood test), then the doctor simply reaches for a prescription of antibiotics to kill the offending organisms for good.

If the ulcer needs images for diagnosis, these can be easily arranged, but often yield to the more definitive scoping down through the esophagus and into the stomach itself.  Here the ulcer can be spotted, photographed, and biopsied to rule out malignancy and check for infections. Once diagnosed, the treatment is done effectively with drugs, such as Nexium and others.  Surgeons have basically been written out of the equation, and, thankfully ulcers are not much of a real threat any more.

But with the routine of scopes inserted down into the stomach, doctors have become very familiar with a previously unheralded inflammation in the lower part of the esophagus.  This is popularly known as GERD, or Gastro-Esophageal-Reflux-Disorder, and it has replaced ulcers as the number one stomach complaint today.

In part, it is made worse by eating too much, eating too quickly, eating the wrong inflammatory foods (spices, sugars, junk foods), and by drinking too much (pop or alcohol). Just to make your sleep miserable, it is also made worse by eating too late.  Then the sufferer will be rolling in agony as dinner tries to repeat itself, with an acid backwash  into the throat, accompanied by nausea and sweats, and a racing heart.  This is even worse for the 60% of the population over age 60  who already have a hiatal hernia.   (http://www.emedicinehealth.com/hiatal_hernia/article_em.htm)

 A billion dollar industry has rushed into the breach.   And what a breach this is.  Currently one third of adult Americans suffer symptoms of GERD at least once a month.  That doesn’t get much better in many other western countries, including the UK and Europe.  It basically marches in step with obesity and fast food popularity. 

But note that not one case is caused by the lack of a brand name drug.  Almost all cases can be controlled by addressing the root causes:

1.       SLOW DOWN: Stop wolfing your food, and your GERD will thank you.  Swallowing fast will cause ingestion of air (aerophagia), in the same way that fizzy drinks, or drinks slurped through a straw will do.  For more on eating slower, visit our article here.

2.       SIT UP: This includes slouching at work, and certainly includes post prandial posture.  Obviously we would all expect GERD if we did a head-stand right after a thanksgiving dinner, but even lying flat right after a meal is tempting the stomach to spill its contents easily into the esophagus.  If you are having trouble sleeping, sit up on a “chair” of pillows at the head of your bed, or elevate the feet at the head of the bed on blocks or books to keep the stomach contents from washing back into the gullet.

3.       DON’T SMOKE: well, that is obvious for a dozen other reasons, but here is another good one to add to the litany! For more, read our stop smoking article here.

4.       DON’T OVERFILL:  Even gas stations admonish users to not overfill their tanks, as spillage will predictable follow.  How about trying that for your own stomach, or else it will also become a “gas” tank!

5.       DON’T EAT NAPALM: White sugars, as in that gooey dessert that topped off the meal, are hugely inflammatory.  Also spicy foods, or alcohol, and even good foods that contain gluten, if one is sensitive. If you can’t resist, make sure the portion is very small!

6.       SEE YOUR DOCTOR if the above doesn’t help.  You may indeed need investigations, and, ultimately, appropriate treatment.  But don’t go back to ignoring steps 1 through 5 above, or you will be right back to step 6!

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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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Herbal Remedies for Aches and Pains

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Lets face it, many people are over-medicated, either from over the counter products or from prescription drugs, and many of their complaints could have been better handled with grandmother's old fashioned herbal remedies. An image of useful herbs But that does not mean that drugs from factories are bad, while drugs from plants are safe.

Plants can produce very potent drugs, some of which are the raw materials for medicines such as digitalis, morphine, aspirin, and quinine. When taken in their raw form, it can be a tricky thing to get the dosages right.

 

Much has been written and claimed about herbs, but here are a few guidelines. The following herbs can be very helpful:

 
  • Aloe gel from the inner leaves of the aloe plant whose derivatives are natural herbal remedies for the pain of burns, including sunburns.
  • Chamomile tea can relieve indigestion, and act as a mild sedative.
  • Feverfew tea is said to help colds, flu, and migraine-headaches.
  • Gingerroot tea can counter motion sickness.
  • Peppermint and spearmint tea can help heartburn, indigestion, and cold symptoms.
  • Raspberry leaf tea can help alleviate diarrhea and menstrual cramps.

With all of these, as with most medicines, there can be individual allergic reactions. However, others are not herbal remedies at all, and are downright hostile. Calamus and coltsfoot and Sassafras contain suspected carcinogens. Ginseng and licorice, when taken in large amounts, can raise blood pressure, and in the case of licorice, cause fluid retention. Goldenseal and senna can both cause miscarriage and severe stomach pains, and can be fatal in large doses.

Here's an action tip:
Just because a herbal remedy is marketed as natural, organic, or herbal doesn't mean it is free from side effects. Check with your doctor to see if your herbal remedies are appropriate for you, especially if you are on prescription medications or are pregnant or breastfeeding, and don't give them to children.

Because herbal medicines can be so powerful, they deserve all the respect you would give prescription drugs.

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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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How to take the knee stress out of running

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Here are some good tips for reducing the stress on your knees. 
an image of a woman jogging

 

One of the more common stress relievers is exercise, and simple running leads the pack. In large part, running has become so popular because of several features:

  1. It takes no time to coordinate. Just go when you are ready, with or without friends. No teammates are needed, you don’t need to book time on the court or field, and, with minor modifications in equipment, you can run day or night, summer or winter.
  2. It doesn’t require lessons. Although there are certainly very good lessons to be had, most people can just take off. Not true of skiing, tennis, and, least of all, golf.
  3. It is cheap. An old t-shirt and shorts, and a good pair of running shoes gets you started. No need for pads, helmets, uniforms, or equipment.
  4. It is a great way to burn off calories, and counteract the lack of movement incumbent in the modern work station.

The down-side of running is really just two-fold:

  1. Running can be boring, if you are not into the zen of it. Remedy: try running on a treadmill, and tune in to a video screen, or read a magazine while you trot. If you are an outdoor person, consider the ipod or other portable sources of sound. However, it is best to only plug into one ear, so the other one is left free to alert you to impending traffic warnings, or the sounds of an upcoming biker or dog.
  2. Running can hurt. Not every body is built for running. Some people have knock-knees or arthritis in feet, ankles, knees, or hips. Others have scoliosis or just poor posture, and find they get back pains if they run on hard surfaces. Others have unrealistic goals, and try to run too far before they get fit. (One tip from running coaches for beginners is to walk for a minute, then run for a minute. Repeat. Then gradually build up the minutes of running, still with a minute of walking between each set)

 

However, in medicine it is never that hard to figure out what kind of an injury a person has. The real question is what kind of a person does the injury have. I see runners every week in my office, often with the same pains, for example in the knees. Some are looking for an excuse to get off the compulsory running team at school, and want a note to join the swim team. Others are devoted to running, and nothing else will do as an option. It is in the latter group that we focus on in this article.

While running can cause pains in many body parts, let’s focus on the knee for now. One of the most common complaints is “runner’s knee”, otherwise called the “patella-femoral” syndrome. If you suffer from this, please read this article:  “patella-femoral” syndrome

In severe cases, we may need to have the patient lay off all running for a while, and switch to other “cross-training” exercises that don’t cause pain. The list of these could include such things as blading or skating, biking, or using the elliptical machine, or yoga. As a home treatment, it is good to follow the RICE principle after activity (Rest, ice, compression, elevation above the heart). Also remember that you may be making your knees hurt while you are NOT moving during desk duties all day. Set your computer to alert you every fifteen minutes, so you can flex/extend your knee regularly. See your doctor for specific guidance, and for customized strategies that might include orthotics, physiotherapy, massage, acupuncture, a trainer in the gym, or even a running coach.

 

For more info on coaching for beginners, read this link: http://hyannisroadrunners.com/

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