FAQ Category: General

Tendons are very tough, fibrous tissue that connect muscle to bone. As the muscles move to make your limbs move, they pull on the tendons, which in turn, pull on the bones to make the actual movement.

Ligaments, on the other hand, connect bone to bone. For example, your knee has ligaments that go across it to stabilize the joint and to keep it from bending in ways that it shouldn’t.

Tendons are very tough, fibrous tissues that connect muscle to bone, but they can become injured due to overuse or from a sudden trauma to the area.

Tendonitis, or tendinitis, is an overuse injury of the tendon. If a tendon is forced to do the same motions over and over again, it can develop irritation and inflammation that can cause enough pain to become disabling.

The most serious injury that can occur with a tendon is if it ruptures or tears. This can happen through sudden force (as with an Achilles tendon rupture) or from injury while lifting something heavy (triceps tendon injury).

Iontophoresis uses an electric current to push a chemical compound through the skin. Most often a steroid such as dexamethasone (DEX) is used. DEX is a synthetic compound (not naturally occurring but manmade).

It has been used to treat many types of soft tissue problems. Achilles tendonitis, knee arthritis, and plantar fasciitis top the list. But it has also been used for carpal tunnel syndrome, myofascial syndrome, tennis elbow, and problems with the temporomandibular joint (TMJ).

It’s thought that the steroid passes through the skin through the pores in the skin. Once it gets past the skin, blood and diffusion carry it the rest of the way to the soft tissues such as tendons, fascia, or the bursa.

It works by reducing the effects of immune cells capable of setting up an inflammatory response. By suppressing the immune system at the cellular level, DEX decreases pain and increases function.

You are facing a problem that many clinics, doctor’s offices, and hospitals are trying to get a handle on. Time, cost, and the use of paper are all matters of economics and efficiency. Third party payers want to know that treatment offered and paid for is benefitting the patient.

One tool to help with this is the electronic medical record (EMR). The EMR is quickly becoming a reality in many practices. Inputting data is fast and easy. Patients can use a tablet personal computer with a touch screen to complete the surveys required. High-speed Internet access relays the information collected to the right person or people for analysis.

The software is designed to use the answers to questions in order to determine the next question to ask. This avoids asking patients questions that aren’t needed or have already been answered another time.

The same survey can be taken before, during, and after a treatment procedure or protocol. The computer can compare the results each time the survey is taken. Other data can be included to help look for predictive factors of success or risk factors leading to failure.

Although converting to an EMR is expensive, economic analysts predict it will save millions of dollars in the long-run.

In general, exercise to change muscle strength requires a consistent approach. Three times a week for 30 minutes is the base rate usually recommended. When an aerobic component is included, then sessions are longer to include a warm-up and cool-down time.

Most programs offer somewhere between 30 and 90 minutes of exercise and activity. The exercises include elements of muscle strengthening, joint range of motion, and cardiovascular fitness. Physical therapy supervised programs often add functional activities as well.

In a small number of patients, painful symptoms were increased with aquatic exercise. Because of the buoyancy of the water, it may be easy to overdo in the first few sessions. Pace yourself and see how you feel after the first session before going full-speed ahead.

Whereas patients with multiple sclerosis need cool water, those with fibromyalgia may do better with warm water. Depth of the water can make a difference, too. Water level between waist and chest height seems to work the best.

Monochromatic infrared photo energy is known as MIRE. It is a physical therapy treatment that uses flexible pads that contain 60 near-infrared diodes placed on the skin over the painful joint. The treatment time is usually 30 minutes. There are units available for use at home also. It is proposed that MIRE increases circulation which then affects nitric oxide production. Nitric oxide is usually thought to be harmful, and cause pain. However, MIRE is thought to increase the production of nitric oxide that is helpful to our bodies.

Osteoarthritis (OA) is often called the wear-and-tear arthritis. OA most often affects the hips, knees and spine, although it can affect other joints as well.

With time, the joints wear down and can cause bone-on-bone rubbing. This causes pain and, unless the joint is replaced, will continue to deteriorate.

Rheumatoid arthritis (RA) is an inflammatory disease. The joints become red and inflamed, causing pain and deformity. RA affects more women than men and is treated with anti-inflammatories and pain relievers.

The word septic means infected; septic arthritis is an infection in the joint. Somehow, the joint becomes infected and can cause severe pain. Although it can happen in any joint, the knee is the one that is most often affected.

It is vital that this type of arthritis be treated as soon as possible to avoid permanent damage to the joint.

Many experts are investigating the cause and effects of fibromyalgia syndrome. It is called a syndrome because it isn’t a disease, but a group of symptoms that occur together.

The most common symptom is widespread muscle and/or joint pain. The list of other symptoms is quite long. Not everyone has the same symptoms, but the most common are sleep disturbance, fatigue, headaches, irritable bowel, numbness and burning, restless legs or arms, and difficulty concentrating. Less often, patients also report irritable bladder, problems with hearing, lack of sex drive, and a sensation of swelling.

No one is sure just yet what the exact mechanism is behind fibromyalgia syndrome. Some experts have shown evidence that thyroid problems is the key feature. Others suspect the immune system is the underlying system at fault. It’s even possible that the enteric system (digestive nervous system) is where it all begins for some patients.

Many scientists and researchers agree there is a connection between thyroid function and fibromyalgia. But it’s not present in everyone and just exactly what the connection is remains to be completely unraveled.

Early diagnosis and a comprehensive management plan for fibromyalgia syndrome (FMS) are advised. With the right program of care, many patients with this condition are free of symptoms or have their symptoms under good control within two years of their diagnosis.

A thorough exam and understanding of the symptoms, triggers, and stressors in the patient’s life is the first step. Since FMS is believed to be a problem with processing sensory input as pain, medications are used at first. The medications can help ease the pain-spasm cycle and reduce hyperexcitability of the nervous system.

Exercise to raise the natural levels of endorphins (pain killers) in the body is the next step. A physical therapist will prescribe the right program and advise you accordingly. Modalities such as ultrasound, electrotherapy, and manual therapy may be used at first to help get your pain under control.

Your physician may suggest other ways to manage this problem. Some patients benefit from behavioral counseling, biofeedback, or psychiatric care to address any anxiety or depressive mood disorders. Post-traumatic stress disorder (PTSD) may require a combination of ongoing counseling and long-term medication.

Each patient will be treated differently depending on the individual circumstances of their life and physical condition. There is no standard one-program-fits-all type of approach. Many patients try one method or a combination of treatments before finding the one that helps the most. What works today may not be as helpful three months from now. This means that the management plan can change as your symptoms improve.

Scientists are finding that because of genetic differences, usually in the ability of the body to breakdown or bind certain molecules, some people can respond to a drug when others do not. Those who are able to benefit from a drug are called responders. Those that do not are called non-responders.

In 1980, a screening tool was developed by Waddell et al to assess nonorganic behaviors and signs. Nonorganic behaviors are thought to be driven by emotional or psychological distress, not necessarily underlying pathology. It also does not necessarily mean someone is purposefully faking an illness, but the behaviors are an expression of the underlying emotional or psychological distress. Some clinicians do not feel this screening tool is reliable however.

Up to 80 percent of people who have an amputation feel either phantom pain or stump pain (or both). Stump pain is easily understood for the most part as it is caused by the nerves where the limb was amputated.

Stump pain can include pain from rubbing against a prosthesis, swelling, wounds, infection, or many other problems. Phantom pain, on the other hand, is not well understood and does not seem to have a particular issue that can be pinpointed.

Phantom pain is felt as aching, cutting, throbbing, or even itching for some people. This pain is not in the person’s head – it is true pain that can be severe enough to affect their lives.

For some people, medications that ease nerve pain may be able to help relieve phantom pain. There are other therapies that are being researched as well.

I’d love to tell you that it’s not true, but some parasites can get into the human body and set up residence. This happens in certain parts of the world where hygiene may make it easier for the parasites to affect humans.

One example is the tapeworm. As the tapeworm works its way through the body, it usually settles in the liver or lungs, although more rarely, it can settle just about anywhere else.

There are two ways of treating the cyst the tapeworm makes: medication and surgery. Some medications can kill the parasite and shrink the cyst. Surgery can remove it completely, however there is a risk of the cyst breaking open and causing an allergic reaction to the patient.

Once the cyst has been removed, usually antiparasitic medication is given for a while afterwards to prevent a reinfestation.

The technology around MRIs continues to improve and advance every year. The quality is better now with a greater field of view. Detailed pictures of the soft tissues around the joints and the condition of the joints themselves are possible. Best of all, the patient isn’t exposed to harmful radiation.

Newer MRIs have several field strengths beyond conventional MRIs. The high-field MRIs show the anatomy clearly in detailed images. Fluid, fat, and even bone edema are seen. Areas of inflammation show up well when a special dye is injected intravenously. Any erosion in the synovium (lining) of the joint is visible. In fact, MRIs can pick up fluid collection in the joint up to a year before any changes would show up on conventional X-rays.

The disadvantage of MRIs is their availability and cost. Some hospitals and clinics have an extremity MRI. The cost is less and because it’s much smaller, it doesn’t require an entire room of its own. This makes it more likely that more physicians will be able to offer this service to their patients in the future.

Early diagnosis and treatment for rheumatoid arthritis (RA) can make all the difference these days. Preventing joint erosion preserves function and limits disability. X-rays do not show the early changes that can occur in the soft tissues around the joint and synovial cartilage inside the joint.

MRIs and ultrasound studies may be more advantageous. Although these imaging tests are more expensive than X-rays, they don’t expose you to any ionizing radiation, and they show early signs of structural changes.

There are some blood tests that can be helpful. Rheumatoid factor (RF) has been relied upon for many years. The presence of RF early on does predict joint damage later in the disease. Most patients have some clinical signs and symptoms of rheumatoid arthritis before there’s a positive RF.

Antibodies against cyclic citrullinated peptide (CCP) occur in the blood before any clinical signs of the disease. This may be the earliest predictive sign available. Some genetic markers such as HLA-DR4/DR1 associated with rheumatoid arthritis may also show a predisposition to this condition.

Many diagnostic tests are available now. Check with your physician to find out which one(s) (if any) are needed. A baseline study may help put your fears to rest. And the results of early tests can be used as a baseline later should any changes come about.

Gout is a metabolic problem of too much uric acid in the blood. Urate crystals form in the joints causing painful swelling. Tophi (crystal stones) can also form in the cartilage, bones, and other places throughout the body. Tophi can break through the skin. The crystals look like a white or yellowish-white, chalky substance.

Serum urate levels are increased with there is an excess amount of purine in the body. Purines are found in high concentration in meat and meat products, especially internal organs such as liver and kidney.

Other dietary risk factors for excess purine in the body include fructose from high-fructose corn syrup and alcohol. Alcohol and fructose speed up the breakdown and release of purine in the body. Beer has both ethanol and high levels of purine. It increases the amount of uric acid production. Wine and hard liquor (in moderation) do not appear to increase the risk of gout.

Zyloprim is the brand name of a group of drugs used to treat gout called Allopurinol. Other allopurinol drugs on the market include Allohexal, Allosig, Progout, and Zyloric.

Allopurinol is a drug used to treat conditions arising from excess uric acid. The most common of these is chronic gout. Zyloprim does not take away the acute attacks of gout. But it is useful in preventing recurrence.

Experts think these flare-ups occur when people take the drug because old deposits of crystals from the tissues are released. Since getting rid of the crystal burden is the goal, this response is a good sign the drug is working.

One way to combat this effect is to take daily doses of colchicine. Colchicine has an anti-inflammatory effect. It also inhibits urate crystal from forming deposits.

Understanding when, how, and why to take your prescribed medications is essential for the management of gout and prevention of flare-ups. If you do not fully understand your current drug regimen, talk with your doctor. A well-educated patient with gout has a better chance of minimizing painful episodes by using medications appropriately.

Repetitive stress injuries are new to the medical community, meaning that – for the most part – they didn’t exist decades ago. Now, with our technology, we can do things with certain motions but as those motions are repeated again hundreds or thousands of times each day, every day, the body is ripe for injury.

First, you need to see that your work area is ergonomically correct and safe for you. That means that your work station should be accommodating your body, your body shouldn’t be accommodating the work station.

Second, you need to listen to your body. You need to take frequent breaks from the repetitive motions. The breaks can be just 30 seconds long, but they break the constant string of motion and redirect the movement in your body. If you are typing nonstop, take your hands off your keyboard and flex them. Rotate your wrists around, move your fingers around, and so on.

Finally, if you feel pain, pressure, or stress in your body, you need to listen to it. Get checked by a doctor to ensure that you aren’t damaging your body. He or she may be able to help you make acfcommodations at work to lessen the chances of UEDs.

When muscles are used during physical activities, oxygen is transported to the area. In the chemical process that occurs, glucose (sugar) is broken down into carbon dioxide and water to supply the muscle with energy to keep going.

If the muscles are working fast and furiously and there’s not enough oxygen, metabolism occurs by an anaerobic (without oxygen) process. Instead of releasing carbon dioxide and water, lactate is produced in the form of lactic acid. This is typical of high-power activities such as sprinting.

The rate of demand for energy is high and lactate forms faster than the tissues can get rid of it. If enough lactic acid builds up, it was believed that a condition called acidosis developed. This is a sign of hypoxia or shortage of oxygen. Muscle soreness would occur a day or two later.

Today we know that an increased concentration of lactate does not directly cause acidosis. And it is not responsible for delayed onset muscle soreness. Acidosis from increases in lactate during heavy exercise does occur but it is from a separate reaction.

It’s still true that when there isn’t enough energy to supply the needs of the muscle, energy released in the form of ATP is produced quickly anaerobically. New research shows that the buffering systems of the tissues are overcome by the large amounts of ATP produced in a short amount of time.

This is what causes pH (a measure of acididity) to fall and creates a state of acidosis. This may not be the only reason acute muscular discomfort occurs after intense exercise. There may be other factors as well. Exercise physiologists are very busy studying this new understanding of muscle function. You can expect to see more news about it in the near future.