FAQ Category: General

Studies show that low back pain will affect up to 85 percent of the United States adult population at some time in their lives. Other work-related musculoskeletal problems such as neck, arm, or leg pain are a large part of manual laborer use of sick leave and health care services.

A recent study of risk factors for recurrence of symptoms linked the following with increased health care and sick leave use:

Peoples’ opinions aren’t always cut and dry or black and white. Sometimes researchers ask the same question in a variety of ways to find out how firmly someone thinks or believes something. At other times an issue has several ways to look at it. Different questions about the same thing may help get at true opinions about each one.

And surprisingly, sometimes a question asked two different ways is really getting information about two different things. This is called nonredundant information. There can be more than one way to look at a subject. Questions that seem repetitive may be good at collecting nonredundant information.

Fibromyalgia (FMS) is described as a painful body condition affecting the muscles but with many other symptoms. It’s most likely a systemic problem. Researchers think it’s caused by altered function of the nervous system in connection with hormones. The exact cause remains unknown.

Myofascial pain syndrome (MPS) is a local problem affecting the muscles. Overuse and repetitive motion are the main causes of MPS. Trigger points are described as overly irritable spots within a muscle. There’s usually a taut band of tissue around the trigger point. The painful spots and painful muscles of these two conditions may be similar but the two overall conditions are very different.

It can be difficult to tell the difference between the tender points of FMS and the trigger points of MPS. Sometimes patients have both. Well-trained experts are often
unable to identify which is which just by feeling or palpating the muscles.

A pedometer senses your body motion and counts your footsteps. By knowing the length of your usual stride you can convert this count into distance. An accelerometer is a more advanced pedometer. It also shows your speed and distance.

In an accelerometer, a strain gauge allows the device to know how hard or soft each step is. Accelerometers are also known as piezoelectric pedometers. According to the latest research these have the most accurate and reliable step counting mechanism
available.

Accelerometer-type step counters are more accurate for older adults and for overweight adults. The disadvantage of an accelerometer is a shorter battery life. The constant sampling of the strain gauge uses up the battery. Accelerometers also cost more than a
regular pedometer.

That’s a great idea since implant wear is based on amount of use, not how long you’ve had it. It makes sense that the more you use it, the more accurate it will be. For patients who don’t want to be bothered to wear it everyday or who forget to put it on, here’s some help.

A recent study at the Joint Replacement Institute in Los Angeles, California suggests a four-day sample. Put the pedometer on when you get up in the morning and don’t take it off until you go to bed. The four-day activity sample is at least as accurate as a seven-day sample would be.

What this doesn’t show is any changes that may occur as the seasons change or should you go on a trip or change your daily routine. It also doesn’t really measure how strenuous your activity is either. For example walking 50 steps to the bathroom and back isn’t the same as climbing 50 stairs or walking uphill.

Studies show that at least four days are needed to record enough activity level to be equal to a week’s worth of data. Since you’re just starting out after surgery you should find that activities and movement get easier with every new day.

Your pedometer will show you how many steps you are taking each day. During rehab that information can help in two ways. First it will encourage you to walk more tomorrow than you did today. And second it will help you see over time how much more you’re doing that you couldn’t do the first week.

Most people find it’s a lot of fun to keep track of their steps. Some folks even put up a map of their city, state, or country and chart an imaginary course based on how much they’ve walked each week. Imagine knowing you walked the equivalent of a hike from coast to coast over a five-year period of time!

There is no set standard for clinical practice in this area. Many therapists learn this skill as part of the standard physical therapy training. They practice it under the supervision of a more experienced clinical instructor. Others take courses later after graduating.

There are specialty programs that lead to certification in manual therapy. These are not required or mandatory before a therapist can use manipulation.

Clinical coordinators from university PT programs were surveyed about this issue. They said one or more of the following was needed to qualify as a manual therapy training instructor:

Experts share your concerns. The recent reports about inactive youths and rising rates of obesity and diabetes may bring this question to the forefront.

In the last 10 years the number of high school students taking PE has gone from 42 percent down to 29 percent. Illinois is the only state to require daily PE through high school. Others like your own state have a two-year PE program.

Studies show that physical inactivity in the teen years leads to the same sedentary lifestyle later in life. And later is when rates of heart disease start to rise.

Activity and exercise during the younger years is linked with similar behavior in the middle years. Middle-aged adults who are active suffer less heart disease. Daily PE throughout the high school years may be the next heart disease prevention program.

No one knows for sure just how much is “enough” or the “right” amount. Is there a certain frequency, intensity, and duration of exercise that works best to prevent diabetes? A different amount for heart disease? Something else for cancer?

Researchers are actively exploring these kinds of questions. In the meantime, walking can be broken down into four activity groups:

Our ability to stay upright and in the center is called postural control. Postural sway such as you’ve seen in your grandfather is a natural part of keeping our upright balance. In a normal, healthy adult this movement is so small it’s not even noticeable.

Many factors can result in increased postural sway. Change in vision is the most common with older adults. Loss of peripheral vision occurs along with decreased visual acuity. Add any other condition such as glaucoma, cataracts, or macular degeneration and the problem can get worse.

The inner ear plays a role in keeping upright balance. This is called the vestibular system. Humans use visual cues along with vestibular input to help us keep our balance.

One other important factor is ankle strength and sense of position. Any ankle injury or lower extremity weakness can also reduce a person’s ability to maintain postural control.

A physical exam is a good place to start for your grandfather. His problem could be something as simple as an ear infection. Or he may need glasses or a change in his current corrective lenses if he already wears glasses. Perhaps a strengthening program for his ankles would help.

For a long time, exercise was “dispensed” or given out by coaches, athletic trainers, and physical therapists, in one simple formula. Everyone started with one set of 10 repetitions and then built up to three sets of 10 reps. At that point, weight could be added for a better workout or more repetitions were done.

Today, thanks to many new studies, this formula is being replaced. Exercises are becoming more specific as scientists learn how muscles work normally. Not all muscles work in the same way and not all conditions or diseases affect the body the same way.

Prescriptive exercise is an idea that is gaining in many circles. Exercises are given to patients based on what we know about muscles in general and what we know about diseases.

For example, low back pain is a common problem. Scientists have shown that low back muscles fatigue easily and bring on this condition. Electromyograhic (EMG) studies of the low back muscles show that only 55 per cent of the muscle fibers are firing during maximal exercise.

After that, the body “derecruits” low back muscle fibers. Other muscles are called upon instead. These “recruits” include the hip and leg muscles. Researchers suggest that repetitions beyond 55 per cent of maximal fatigue won’t result in increased muscle activity in the low back. More information is needed before we know exactly what to prescribe instead.

You’re seeing one form of the visual analogue scale (VAS). This is a helpful tool that measures pain. Patients choose the face that best shows how they feel.

The same kind of measure can be done using numbers. The doctor, nurse, or physical therapist may ask the patient to rate the pain from zero (none) to 10 (worst).

Researchers with the Swedish Lumbar Spine Study say that this simple test is still very accurate. Even small changes in the patient’s symptoms or function show up.

When a drug is out for the first time, it’s called a first generation drug. As time goes by, more research is done. The drug is improved or a new, similar drug is made. This is the second generation of that medication.

The process may continue to a third or even, fourth generation. With each new generation, the drug is more effective, more potent, or has fewer side effects. For example, a new group of drugs came out for osteoporosis called bisphosphonates. At first, these had to be given intravenously. The second-generation was made as a pill to be taken by mouth.

There were also major intestinal side effects with this drug. The third-generation is now taken only once a week. It was made especially for patients who couldn’t take other oral bisphosphonates.

Most drugs have one intended use. They were researched and tested with that one use in mind. Studies on animals and then trials with humans are done before a drug is released to the public.

Sometimes, just by chance, a drug will have an effect on something else. For example, mustard gas was used in previous wars to kill people. This led to its later use as an agent to kill cancer cells.

Likewise, pregnant women used Thalidomide for nausea in the early 1960s. It resulted in birth defects and was taken off the market. Today, it has been found effective in treating some forms of cancer. This is an off-label use until studies are done just on its use with cancer.

One final example that has been in the news lately is Provigil. This is a stimulant like caffeine and amphetamines. It’s FDA-approved for only one condition: narcolepsy. Narcolepsy is a condition of daytime sleepiness. The person falls asleep suddenly at any time of the day. Use of Provigil for people who want to stay awake all night is considered off-label and isn’t approved by the FDA. After careful study of safety issues, some drugs are approved for off-label uses.

Fosamax is the trade name for a group of drugs called bisphosphonates. These drugs keep bone cells from being absorbed by the body or destroyed. They are used to prevent and treat bone diseases such as Paget’s disease, bone cancer, and osteoporosis.

Bisphosphonates taken in pill form have a low absorption rate. This means that much of the drug passes through the body without being used. Absorption of Fosamax is even less when there is food or liquid in the stomach. Taking the drug without food and water helps ensure its proper use.

Bisphosphonates can also cause intestinal upset and ulcers. To avoid inflammation and ulcer, patients are advised to sit or stand after taking oral bisphosphonates. This helps the drug pass through the stomach more quickly.

See your doctor if you follow all of these instructions and still have problems. Nausea, vomiting, taste disorders, diarrhea, and constipation can be helped with a change in drug or dosage.

Muscle weakness can cause this to happen. The person uses his or her hands to “climb up the legs” when going from a sitting-to-standing position.

Doctors suspect muscular dystrophy when this happens in young children. In such cases this activity is called Gower’s sign.
It’s seen most often when the child is getting up off the floor.

When Gower’s sign occurs in adults doctors look for other telltale signs. Are you having any trouble walking on a straight line? Any recent skin rashes?

The most common condition that can cause Gower’s sign in adults is simply deconditioning. Guillain Barré syndrome or dermatomyositis are more serious possibilities. If you think this is happening because you’ve become too inactive, try an exercise program of walking or biking and see if it makes a difference.

If there are other symptoms you haven’t mentioned, see a physician for an examination to rule out other problems. Take steps to find out now what the problem is and restore full strength. This will help avoid future problems or complications.

There are many age-related changes that can be prevented with a little time and attention. This is one of them.

If you are in good health without major aches and pains, you should be able to keep your full motion and coordination for sit-to-stand and stand-to-sit activities. Anyone with pain and stiffness from arthritis is at a disadvantage in this area.

The first step is just being aware of the problem. Whenever you sit down, use your legs to slowly lower yourself. Bend the knees first, then the hips. Avoid reaching for the chair with your bottom first. Women can especially carry out this exercise daily when getting on and off a toilet.

Whether sitting down or standing up, you’ll use your legs more if you don’t use your arms. Don’t use the armrest on chairs or other furniture to push up to standing. Likewise once you feel the backs of your legs against a chair or couch, sit down without reaching for the armrest.

On a more intense level you can certainly start a program of leg exercises to help maintain your strength. This can be done at home or at a health club.

Yoga is an ancient Indian practice for the body, mind, and spirit. It’s been around since 2000 B.C. but is now gaining in popularity in the West.

Yoga is said to be a way to relieve stress, improve balance and strength, and even improve your sex life. In actual fact, the breathing and postures do help improve blood flow, balance, strength, and much more.

Several studies in older adults have shown yoga can improve metabolism. Reducing medication use can occur as a result. Overall health benefits for diabetes have been shown as well. Improved cardiovascular function is an important benefit since diabetes affects the blood vessels.

A few studies have shown reduced use of medication is possible for patients with diabetes who practice yoga on a regular basis. You have nothing to lose and many possible benefits to gain, so give it a try!

People of all ages, but especially seniors at risk for age-related changes, are encouraged to keep active. A walking program is one excellent way to do this.

Yoga is another form of exercise with a slightly different approach and results. A combination of walking and gentle yoga may be the best option for many people.

Studies have shown yoga can improve strength, flexibility, and balance. These three factors can reduce the risk of falls for older adults. Yoga has also been shown to improve grip strength, reduce pain, and increase motion for folks with arthritis of any kind.

A gentle program of yoga can be done by anyone with chronic pain, illness, or disability. Yoga has been shown to improve mood and sleep patterns.

With all these proven benefits everyone should try it at least for a short time. Continued improvement in walking patterns has been linked with doing yoga over a longer period of time.

The benefits of yoga have been touted by many people. Studies to show its effects have been very encouraging. Many studies have shown yoga’s positive effects on older adults.

People with strokes, arthritis, and carpal tunnel have been studied. They’ve shown good results in strength, motion, and pain reduction.

A recent study of adults ages 62 to 83 included healthy adults with no prior yoga experience. They followed an eight-week program of Iyengar yoga. Hip motion and walking were both improved.

There are different kinds of yoga. Power yoga or Bikrum yoga is not advised for a beginner, older adult. Try to find a class that’s advertised as “gentle.”

One form of yoga that might work best is Iyengar yoga. Modified poses are often shown. Breathing exercises are an important part of this type of yoga. Props and blankets are used to support the body. This helps prevent overstretching or injury.