FAQ Category: General

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.

That statistic has been quoted many times by many people. There is a general truth behind the statement. It does take some time for information to filter down from the scientist to the clinician.

When a study first comes out, it has to be repeated by other researchers with the same results to confirm the findings. Usually, more than one study must repeat the process and validate the findings. When there’s enough evidence, then guidelines may be presented to help identify what is the best approach to each problem.

This process has been speeded up now in today’s electronic age. Information is passed back and forth and accessed much faster than ever before. The media is also very good about letting the public know the latest findings. This gives patients a chance to research information for themselves and ask their doctors more specific questions about their condition.

Physicians who are board certified show that they are keeping up by taking this test in their specialty area. They must be re-certified periodically, which means reviewing studies and information and staying current in their field.

You have pointed out something that is happening around the world. Studies do indeed confirm the rising rates of joint diseases as a leading cause of early retirement, disability, and rising health care costs. These trends have caught the attention of the World Health Organization (WHO).

As a result, they set up a special program in 2000. The program was called the Bone and Joint Decade. The goal was to improve quality of life for people with musculoskeletal problems throughout the world. This program was especially geared toward adults over the age of 65. Half of all chronic health problems in this age group are caused by joint diseases.

Traffic accidents and war are two other factors linked with the rising numbers of bone and joint disorders in younger adults, too. Not only that, but neck pain affecting the upper back and arms disables many more people of all ages than we ever thought possible.

What can be done? Studies are looking for ways to identify risk factors that can be modified or changed. Change in behavior or lifestyle are often the first suggestions. Education and prevention are the areas targeted for current studies. Understanding the causes of neck and back pain and joint disorders will go a long way to helping us prevent these problems.

Right now, we have far more questions than answers. We know that exercise and proper nutrition can make a difference. Experts are looking for a specific prescription of exercise (how much? what kind? how long?). The results of many studies show that almost any kind of exercise is beneficial.

So if you aren’t in a program of regular exercise, get started. If you are, stick with it. Thirty minutes of daily activity and exercise is advised. New findings suggest 60 minutes is even better. Watch here for future news reports to help guide you in planning a program that best suits your specific needs and concerns.

Tai Chi has certainly been hailed as the perfect exercise for older adults. It is said to improve general physical condition, increase strength, and improve balance.

As a form of exercise, it provides different benefits from walking. The movements are slower. You are in a crouched position for much of the time. This sustained posture and movement requires a longer duration of muscle contraction than walking.

Tai Chi requires a different degree of muscle and postural control compared with other forms of exercise. Keeping an upright posture while holding the center of gravity down low is required while moving from one posture to another. These are all challenges to older adults who tend to walk slowly with a short stride length and wide base of support.

No one would suggest you trade one form of exercise for another. If possible, do both. Or alternate between the two. In this way, you’ll gain the benefit of both kinds of exercise. Exercise of all types is important since falls and fractures are the number one cause of death and disability among older adults.

You may not be doing anything wrong. The slow forward and sideways movements of Tai chi may be triggering an abnormal response in your inner ear or in the vestibular system. This can be checked by a doctor.

The vestibular or balance system sends information to the brain about movement and position in space. The inner ear is part of the vestibular system. Anything that changes the inner ear mechanisms can lead to dizziness.

In fact, there are many possible causes for dizziness. You should have this checked by a medical doctor. It could be something basic like an ear infection. Or you may have a problem with the vestibular system itself.

Many times vestibular problems can be treated quickly and easily by using specific positions of the head and body. Physical therapists and doctors trained in vestibular function can examine and treat you for this problem.

Your observations are very correct. A recent study released by the CDC says that one in five adults in the United States has some form of arthritis. This means more than 46 million people are affected by this disease.

And two-thirds of those adults are younger than 65. But this may be because better diagnostic tests make it possible now to identify the condition earlier than ever. Whether or not there are social or cultural factors is being studied. No conclusions have been reached yet.

Although we think about arthritis as being osteoarthritis (OA) or rheumatoid arthritis (RA), there are actually many other forms of this disease. These include gout, fibromyalgia, lupus, ankylosing spondylitis, Sjögren’s disease, and Giant cell arteritis (to name a few).

The general trend for all of these conditions is upwards. The only exception is RA, which has declined by 50 per cent in the last 15 years. The reasons for this are unknown.

Scientists are predicting an epidemic of age-related rheumatologic disorders in the near future. With the first of our baby boomers turning 65 in 2008, more efforts are needed to find ways to prevent these diseases.

A new study has been released by the Centers for Disease Control and Prevention (CDC) on this subject. The work was done by the National Arthritis Data Workgroup (NADW).

The NADW is a combined group of experts in gathering statistics from a national database. They used research published by others to estimate the number of people affected by arthritis in the year 2005.

They did indeed find that rheumatoid arthritis (RA) is on the decline. This is a general trend and may not reflect future numbers. It is based on the fact that there were 1.3 cases of RA reported in 2005. This was compared with the 2.1 million adults with RA reported in 1990.

Reasons for this change are only speculative. First, fewer people are diagnosed with RA because of changes made in the diagnostic classification of the disease. In layman’s terms, this means that the diagnosis is made differently now. Patients diagnosed today with something other than RA might have been placed in an RA category according to guidelines used 10 years ago.

There may be other reasons for the apparent decline in RA. These remain unknown at this time. Further study and research to identify trends and causes will continue through the National Center for Chronic Disease Prevention and Health Promotion.

Compensation injury refers to an injury that occurred on-the-job and is covered under Worker’s Compensation. Disability and personal injury litigation are common results of compensation injuries.

In fact, studies show that the results of treatment may depend on whether or not the person has a compensation injury. Return-to-work rates are lower in this group. At the same time, use of health services of all kinds is increased when it’s a compensation injury.

Experts point to financial secondary gain as a possible reason for the behavior of patients covered under Worker’s Comp. When compensation (money) is given for illness or injury, there may be less motivation to get better. This is especially true if the person’s job is stressful or they feel undervalued by the employer.

Many patients have legitimate claims and have made every effort to comply with rehab. They have given 100 per cent effort to getting back to the job site but fail to do so. In such cases, disability is awarded and the person stays home or finds a different line of work.

As far as types of exercise go, there’s a relatively short history behind the concept we call core training or stabilization exercises.

In the 1980s, mechanical engineers studying the low back started looking at forces and load placed on the spine by different muscles. Certain core (local or deep) muscles were found to transfer load between the spine and the pelvis.

Other (more global) muscles provided balance between the rest of the body and the spine. Together, both groups of muscles provide control within the spine and postural alignment of the whole body.

In the 1990s, a well-known scientist (M. M. Panjabi) proposed a new three-prong model to help us understand spinal stability. This information helped bring to light what happens when injury or dysfunction occurs. These three subsystems (passive, active, neural) work together to stabilize the spine.

As a result of these and other studies, we now understand that there are a group of core or central muscles. These particular muscles are largely responsible for stabilization of the spine. When injury occurs, recovery requires restoring spinal stabilization.

Experts have devised a program of exercises aimed at core stabilization. As a natural result, many groups have suggested using these exercises to develop core strength. The hope is to prevent back injuries by doing this type of core training. Whether or not these exercises can maintain a healthy spine remains to be seen.

There may not be a clear cut answer to this question. Most of the studies of lumbar stabilization (core) exercises do not report any harm from doing this program. But these studies also exclude (keep out) patients who have any potential risk factors.

For the most part, anyone with a fracture, severe osteoporosis, malignancy, or spondylolisthesis should get medical approval before participating in a class of this type.

Others who should be precautioned to seek medical counsel include anyone who has had prior back surgery, pregnant women, and anyone with a serious medical condition that could prevent any kind of exercise from being done. Anyone with numbness and tingling, muscular weakness, or other neurologic sign should also have a medical exam before exercising.

The majority of the people who participate in core stabilization exercises have a history of chronic low back pain. Usually this pain is of unknown cause but it could be from disc lesions, osteoporosis, or arthritis.

Another group of people who take these kinds of classes are interested in keeping from developing back pain. A subset of this group would be the worried well. These people engage in all kinds of activities and exercise designed to stay well and keep from any illness or injury. There is nothing wrong with this and unless they have any of the conditions listed, they should be included.

You might benefit from a program called functional restoration (FR). It is a multidisciplinary team approach. This means the whole patient is taken into consideration.

A nutritionist will advise you about healthy food choices to help foster healing. A behavioral psychologist will guide you through the thought processes that affect function and help reduce disability. The focus is on enablement, not disablement. The psychologist helps the client identify and overcome barriers to recovery.

A physical therapist addresses issues of body mechanics, deconditioning, and pacing activities and exercise. An occupational therapist helps the patient work through rehab with an eye to physical and vocational needs.

The goal is to returning to work. This may be on a part-time basis at first with some restrictions. Over time, the worker is advanced in skill and physical capacity. If pain remains a problem, a pain specialist (nurse or doctor) can guide you in finding the best pain management program. This may include injections, nerve blocks, or devices such as a spinal pain pump.

FR is a medical rehabilitation approach to chronic low back pain. Ask your doctor if you qualify for such a program. Find out if there is anything like this already available in your area.

If not, you may have to seek the services of each individual with your doctor acting as the medical director to coordinate services. In a true FR program, all services are housed under one roof. Services are provided by each specialist as needed.

Stem cell research is well underway in the U.S. Despite controversy over embryonic stem cells, scientists are finding ways to harvest and use adult stem cells. In this way, they can bypass the problems with stem cells from embryos.

Stem cells refer to the basic cell before it differentiates or turns into a specific type of cell. The value in using stem cells is that when injected into a damaged or diseased area, they can produce healthy cells of whatever type is needed. For example, when placed in a hole in the articular cartilage, they reproduce to form many new cartilage cells. In this way, they enhance and speed up the healing process.

Some stem cells are multipotent. This means they have the ability to turn into more than one type of cell. Adult stem cells don’t do this as well, or as easily, as embryonic cells. But with careful treatment in the laboratory setting, enough adult stem cells can be made to use for healing or regenerating tissues.

Arthritis is one condition that has come up whenever stem cell research is mentioned. The ability to repair and restore cartilage and bone tissue would be miraculous for many older adults suffering from this disabling condition.

Right now this research is still in the early phases. It is not available yet for the everyday patient. Scientists haven’t been able to always get stem cells to make true articular cartilage. Sometimes a weaker, fibrocartilage is formed instead. Finding the optimal conditions to grow cartilage tissue is the focus of some studies in the area of tissue engineering.

All very good questions! First, stem cell research is alive and well in the U.S. Although federal law prohibits the use of embryonic stem cells harvested after 2001, there is nothing stopping research on adult stem cells. Embryonic stem cells have the advantage of being able to produce any kind of cell or tissue. But they do cause an immune response that can set up growth of tumors.

Adult stem cells are not as versatile as embryonic-derived cells. But scientists have found ways to harvest multipotent stem cells from the bone marrow, adipose (fat), and skeletal muscle. Multipotent refers to the fact that these stem cells can become several different kinds of tissues in the adult.

Adult-derived stem cells can be harvested from any adult of any age. Once removed from the body, they are treated in a lab with growth factors and given the right conditions to reproduce and expand greatly. They can be genetically altered to grow fast and speed up healing. This makes their use with many orthopedic conditions such as you mentioned very attractive.

Muscle-derived stem cells (MDSCs) are a key source of study material right now. These cells are multipotent, easily harvested, and quickly grown (expanded) for use. Animal studies with mice, rats, and rabbits show positive results for potential use in humans.

There are some clinical trials in progress for some conditions in humans. In the near future, tissue engineering for the repair of musculoskeletal damage and disease may revolutionize orthopedic care of many patients.

A person’s body weight can put a stress on the joints and back; the heavier the weight, the more the stress. People who are not heavy can hurt their back just by bending the wrong way, picking a piece of paper off the floor, for example. It’s not the paper that was heavy, it was the upper body.

It is possible that your back injury is new and is being aggravated by your body weight. Perhaps your doctor feels that if your weight decreases, the strain on your back will decrease as well.

When you have questions like this, it’s always best to speak to your doctor so you can get a better understanding of the reasoning.

It’s always a good idea to take a list of questions or concerns with you when seeing your physician. This helps make the best use of your time. And it allows your doctor a chance to review everything carefully.

The National Osteoporosis Foundation has suggested the following guidelines to determine who should have bone density testing:

Crohn’s disease is an inflammatory bowel disease (IBD) that can, in fact, be linked with arthritis. This type of arthritis is referred to as enteric arthritis. Enteric is a general term that refers to the intestines.

IBD-induced arthritis occurs in about 25 to 30 per cent of patients with IBD. Back pain and arthritis of the extremities are the main symptoms reported. Fortunately, this type of arthritis is not destructive to the joints. Medical treatment of the gut inflammation usually brings the arthritis symptoms under control.

This type of arthritis is sometimes accompanied by a red or purple skin rash of the lower extremities. Like the joint pain, the skin rash usually goes away when the underlying inflammatory condition is brought under control.

Doctors do not usually recommend prophylactic (preventive) treatment for osteoporosis unless there are sufficient risk factors and evidence of a possible problem. Anyone who has osteopenia (mild loss of bone density) is at risk for full-blown osteoporosis. Preventive care is often recommended in such cases.

Post-menopausal women with a low T-score who smoke or drink more than two alcoholic drinks each day are at increased risk. Previous health history is also important. A history of rheumatoid arthritis or previous history of hip fracture are key risk factors. Past or current use of steroids is another risk factor.

The risk of hip fractures from osteoporosis in older women is very real and can cause serious loss of function and disability. Over two million fractures related to osteoporosis occurred last year alone. Don’t become a statistic. Find out more about your done mineral density and risk factors. There is strong support for preventive measures in anyone with low bone density and/or significant risk factors.

Studies of injuries in high school and college wrestlers confirm your observations. Wrestling causes more injuries than any other sport except football. The nature of this combat-like sport may account for this.

Injuries occur most often during the takedown. During the takedown, there is a high-energy struggle between the two players. It ends when one wrestler is able to throw the other wrestler to the mat.

Each match begins with a takedown. Points are awarded to the wrestler with the most takedowns. So there is great motivation to be the first to take down the other player.

In high school wrestlers, injuries of the shoulder, trunk, and knee are most common. Studies report head, face, and knee injuries among college wrestlers. Bone fractures, joint dislocations, and cartilage injuries are are also reported. Concussions can occur but are more likely the result of illegal activity. For example foul play resulting in blows to the head are possible.

Skin infections are fairly common in both high school and college wrestlers. In fact, outside of body injuries, skin infections are the most common adverse event associated with wrestling.

Herpes gladiatorum is the name given to herpes simplex infections of the skin in wrestlers. The virus is passed or transmitted through regular and close skin contact. Close contact causes infected blisters to pop. The virus is contained in the fluid that is then rubbed against the player in contact with the infected wrestler.

There is no cure for herpes gladiatorum. There are several effective treatments for outbreaks. Medical care should be sought as soon as symptoms develop. Skin rash with a cluster of blisters, often around the head and neck area may be observed. Swollen glands in the neck, fever, sore throat, and headache often accompany the blisters.

Prevention is the key. Mat cleanliness is important, as is wrestler hygiene. But the most important way to reduce the risk of transmission is identifying infected athletes and keeping them from playing.

Routine skin checks of all participating wrestlers should be conducted by trained personnel prior to practices or matches. The most effective practice screenings should take place mid-week between match screenings.

Proprioception is the term used to describe an important sensory system of the body. It allows humans to detect position and position change in the limbs and joints. The body uses this information to direct how far joints move. It also directs how much force is used to accomplish each movement.

There are special receptors in the connective tissue to gather proprioceptive information. These receptors are located in the joints, ligaments, capsule, tendons, and muscles.

The information is used by the brain to tell the joint how to move with precise and coordinated motion. The data collected is also used to maintain knee joint stability when standing or when holding the joint in one position for a long time.

Proprioception can be improved. It requires a special program of small movements repeated many times. Usually a physical therapist instructs patients with osteoarthritis (or other conditions) how to do these exercises.

Proprioceptive activities can include side stepping, cross over stepping, and challenging the balance in all directions. A special platform or roller board is often used for the balance training.

For patients who can’t stand up to exercise, proprioception is still important and can be improved. Foot-stepping exercises in the seated position have been shown effective for patients with knee osteoarthritis.

In a study from Taiwan, a series of four pedals on a foot board were used to move a computer mouse cursor up, down, and to both sides on the screen. A computer program controlled by the foot pedals was used to improve proprioception. It was very successful. Patients with knee OA were able to walk faster with less pain after six weeks of training.