FAQ Category: General

Fibromyalgia isn’t really a disease. It’s a group of symptoms that tend to occur together either at the same time or in close proximity to one another. You may experience tension headaches that seem to come and go even when you aren’t stressed. Sometimes there’s joint pain that travels from one joint to the next. Or you feel like a truck ran over you every morning when you wake up.

Scientists haven’t been able to unlock all of the secrets behind fibromyalgia syndrome (FMS). Right now, the main theory is that FMS occurs when something goes hay wire in the nervous system. That something may be what’s called central sensitization syndrome. It means your nervous system is ramped up to react too soon, too often, and for too long. Pain signals are sent when ordinary sensations of light (or other pleasurable) touch occurs.

According to a recent article in The Journal of Musculoskeletal Medicine there are five key areas of importance in understanding and treating fibromyalgia syndrome (FMS). These are:

There’s new understanding of the underlying pathophysiologic mechanisms for fibromyalgia. And that new knowledge is slowly bringing forth new medications and ideas for managing the painful symptoms of this condition.

Today’s modern approach to is multimodal, meaning many different treatment options are pursued at the same time. Combining medications with exercise, behavioral counseling, and alternative medicine have made it possible to live a more normal life for those who suffer with this condition.

At one time, there was a strong suspicion that the symptoms of fibromyalgia were psychosomatic — the result of stress and “all in the head” of affected individuals. But scientists have come a long way since then in unraveling the mystery behind this complex condition.

Right now, the main theory is that FMS occurs when something goes hay wire in the nervous system. That something may be what’s called central sensitization syndrome. It means the nervous system is ramped up to react too soon, too often, and for too long.

With a dysregulation of the central nervous system, there appears to be some kind of mistake within the nervous system in how it recognizes and transmits pain messages. Somehow, the nervous system seems to think even the simplest touch is a noxious (painful) stimulus. It’s like a ten-alarm fire signal is sent to the brain when a breeze blows by the barn.

Nervous system dysregulation of this type is likely caused by biochemical abnormalities, altered brain blood flow, and problems with the pain processing mechanisms. Sufferers have lower pain thresholds and lower levels of serotonin, a brain chemical involved in pain, sleep, and mood.

Many people with fibromyalgia also have anxiety disorders, depression, panic disorders, and phobias that are chemically induced and/or the result of abnormal central (nervous system) processing. It’s these chemical changes that have prompted drug companies to look for a way to treat the problem with pharmaceuticals (medications).

Two of the drugs now approved in the U.S. for fibromyalgia are antidepressants (duloxetine and milnacipran). Studies have shown that these medications don’t work because they improve the person’s mood (reduce depression). The chemical pathway of the drug seems to impact pain signals directly.

Neither one of these drugs works to improve sleep. They do improve energy levels, physical functioning, and cognitive function — probably because they reduce pain, a symptom that can level a person in all these areas.

Medications are only used in conjunction with other treatment such as exercise, meditation, hypnosis, acupuncture, nutritional counseling, biofeedback, massage, and behavioral counseling. A new treatment approach involving electromagnetic wave therapy is being tested for pain control by modifying brain activity in a noninvasive way without drugs or surgery.

Should you have a flare-up of symptoms that don’t go away using your management plan, seek your primary care physician’s counsel on what else is available that would best suit your situation. Having some information like this about what’s new will help you explore together options best for you.

Fibromyalgia, a common painful disorder among women in their middle years (40 to 60 years old) is no longer considered a “disease” but rather a syndrome. The term “syndrome” is used to represent a group of symptoms that tend to occur together either at the same time or in close proximity to one another.

Sometimes fibromyalgia is referred to as fibromyalgia syndrome (FMS). The most common symptom is widespread pain throughout the body, with especially tender spots near certain joints.

Pain and stiffness concentrate in spots such as the neck, chest, shoulders, elbows, knees, buttocks, and lower back. The tender spots don’t seem to be inflamed. The pain stops people with fibromyalgia from functioning normally, partly because they feel exhausted most of the time. Most tests show nothing out of the ordinary in the anatomy of people with fibromyalgia.

At one time, there was a strong suspicion that the symptoms of fibromyalgia were psychosomatic — the result of stress and “all in the head” of affected individuals. But scientists have come a long way since then in unraveling the mystery behind this complex condition.

Right now, the main theory is that FMS occurs when something goes hay wire in the nervous system. That something may be what’s called central sensitization syndrome. It means the nervous system is ramped up to react too soon, too often, and for too long.

Fibromyalgia is a chronic (meaning long-lasting) condition that usually requires many years of treatment. It can occur along with other forms of arthritis or all by itself. It can occur after an injury or out of the blue. When fibromyalgia occurs alone, it is referred to as primary fibromyalgia. If it’s not the main problem, but rather caused by something else (e.g., thyroid problems, cancer, arthritis, Lyme disease), then it’s called reactive fibromyalgia.

Folks who have fibromyalgia syndrome (FMS) often have certain triggers that seem to bring on (or increase) symptoms. The triggers vary from person to person but may include degenerative (spinal) disc disease, headaches (all kinds), irritable bowel syndrome, reflux (heart burn), trigger points of the muscles, and poor posture. Anxiety, depression, and post-traumatic stress disorder also seem to be linked with FMS. Having a bipolar illness increases the risk of developing fibromyalgia syndrome (FMS) dramatically.

About 80 percent of all fibromyalgia patients report serious problems sleeping. Because fibromyalgia is so strongly connected to sleep disturbance, in some cases it is possible that the sleep disturbance may be a major contributing factor. In fact, studies have produced fibromyalgia-like symptoms in healthy adults by disrupting their sleep patterns.

That all sounds a lot of bad news. The good news is that with early diagnosis and appropriate treatment, you can get your symptoms under control quickly and protect your ability to perform daily functions and activities.

There are many treatment choices. Your doctor will help you navigate those waters and find the right combination of options that work the best for you. Many people find it extremely helpful to join a support group. Those who have gone down this path ahead of you can offer some useful tips to save you time, money, and the aggravation of making the mistakes they made in finding the kind of care they needed.

Many people support the use of stem cell research but government regulation (both in the U.S. and in Europe) has slowed the process of study in this area. Change in hard fought legislation such as the restriction of government funds to support embryonic stem cell research won’t change over night.

In the meantime, scientists have started looking elsewhere for solutions to the problem (e.g., whole blood, platelet-rich plasma). But for those who have stuck with stem cell therapy, here’s a little idea of the status of this area of study:

When the body fails to heal tennis elbow (also known as epicondylitis or tendinitis), a condition referred to as tendinosis can develop. Tendinosis follows the body’s attempt (and failure) to organize a healing response.

Instead of making new, healthy tendon cells to replace the damaged cells, the tendon tissue becomes thick with disorganized fibers. The already damaged tendon, now further weakened, fails to heal and may even go on to tear even more.

An injection of stem cells might help with tendinosis. But this treatment has not been studied enough to allow for everyday use — yet. Scientists have figured out a way to harvest stem cells from fat, skin, tendon, and muscle then take it to the lab where they can multiply the sample and grow more cells.

When there are enough cells to do the repair job needed, they are injected into the damaged area (e.g., tendon). That sounds simple enough but in fact, there are major barriers to the process. For example, it takes time to generate more tissue in a lab setting. The lab has to have expensive, specialized equipment to do this type of work.

Meanwhile, the injured athlete or other patient is waiting and the window of opportunity for healing is getting smaller and smaller. Transporting the cells comes with a lot of potential problems. No one is quite sure how well the cells travel from lab to patient.

Questions have been asked about the need to freeze the cells in order to keep them preserved for use. If they could be frozen ahead of time and ready at a moment’s notice, the donor cells could be used right away at the time of injury.

Pharmaceutical research and development is focused on finding a way to provide off-the-shelf (ready-to-use) sources of stem cells to avoid the time and expense of harvesting and expanding cells retrieved from the injured athlete (or patient). The market is still a few years away from seeing this as a reality.

A nerve conduit is a fairly new surgical technique under investigation for nerve injuries. The conduit (also referred to as an artificial nerve graft) uses synthetic materials to create a guided pathway for nerve tissue growth. The nerve ends and gap between the ends are enclosed within a tube composed of biological or synthetic materials like silicone.

The nerve conduit is being tried for patients with large distances between the two ends of the torn nerve. The distance is too great to use direct suturing of the two stumps of a severed nerve. While the two severed ends of nerves could be stretched to meet each other, it can’t be done without tension.

Sometimes autologous nerve grafting is possible. The surgeon uses some of the patient’s own nerve tissue to fill in the gap. But there is limited availability of donor tissue. And functional recovery in autologous nerve grafting isn’t always so great. That’s why surgeons started looking at ways to engineer artificial nerve tissue.

The development of bioartificial nerve guidance conduits as an alternative treatment for large defects may be a major breakthrough discovery. This approach has worked for small sensory nerves that have been injured but its use with mixed (sensory and motor) function is still being studied.

Loeys-Dietz is a genetic disorder that can affect many different parts of the body. Once it is confirmed with genetic testing, then the specifics of what went wrong must be determined. For example, there can be aneurysms anywhere in the body. An aneurysm is a weakness or thinning of the blood vessel wall. With enough blood pressure, the defect in the blood vessel wall can burst, causing serious hemorrhaging.

Head through pelvis imaging is done to look for places where aneurysms are present. The physician uses this information to determine treatment. In some cases, blood pressure medication may be all that’s needed. With more severe aneurysms, it may be necessary to do surgery to repair this problem.

Echocardiography and CT scans are also used to show details of the blood vessels. Besides aneurysms, some of the blood vessels can be twisted and malformed.

X-rays are another way to identify skeletal problems such as scoliosis, cervical (neck) instability, hip socket malformation (dysplasia), or other orthopedic deformities. The same reason applies: early identification can lead to early treatment and prevention of long-term problems and complications.

Platelet-rich plasma (PRP) (also known as blood injection therapy)) is a medical treatment being used for a wide range of musculoskeletal problems. Platelet-rich plasma refers to a sample of serum (blood) plasma that has as much as four times more than the normal amount of platelets. This treatment enhances the body’s natural ability to heal itself and is used to improve healing and shorten recovery time from acute and chronic soft tissue injuries.

Blood injection therapy of this type has been used for knee osteoarthritis, degenerative cartilage, spinal fusion, bone fractures that don’t heal, and poor wound healing. This treatment technique is fairly new in the sports medicine treatment of musculoskeletal problems, but gaining popularity quickly.

Patients with chronic tendinitis (e.g., tennis elbow, patellar tendinitis or jumper’s knee, Achilles tendinitis) have also benefited from this treatment. It’s even being tried on hernias, labral (shoulder cartilage) tears, meniscal tears of the knee, and ankle sprains. Some surgeons are using it more and more with any orthopedic surgery involving the soft tissues to augment (reinforce) bone or ligamentous graft materials already being used.

In the case of chronic tennis elbow (also known as chronic tendinopathy), the PRP contains inflammatory cells called cytokines that do, indeed, kick start the process of healing. These cytokines act as stimulants to get a healing response in tissues that have scarred over without adequate repair. The stalled effort to repair the tissues naturally gets back on track with a little help from PRP.

Platelet-rich plasma (PRP, also known as blood injection therapy) refers to the use of a sample of serum (blood) plasma to enhance healing of soft tissues and bone. The product has as much as four times more than the normal amount of platelets, along with growth factors and inflammatory cells.

This treatment enhances the body’s natural ability to heal itself and is used to improve healing and shorten recovery time from acute and chronic soft tissue injuries. It has been used for chronic osteoarthritis, tennis elbow, plantar fasciitis, rotator cuff tears, and the early stages of wound healing.

As with any new treatment, over time it is possible to see more clearly the pros and cons of treatment. Data can be collected on long-term results and more information published to guide surgeons in using this treatment tool.

Taking a look back over the past few years, we now see there are some inconsistencies in results with this treatment. Some studies have shown no benefit from the use of platelet-rich plasma (PRP) for tissue healing. Why is that?

First, not all PRP is the same. The product may vary based on how much whole blood was taken and how quickly platelets recover during the injection. The presence of other blood parts such as red or white blood cells can make a difference. And any other substances that might have been added (e.g., thrombin, calcium chloride) can affect how the PRP functions.

Second, the potency (strength) of each PRP preparation varies — again, this depends on what’s in the product. Too little or too much of any component part can change how quickly and how effectively the body responds to the product. Then there is what’s called biologic variation — everyone responds a little differently to the same PRP. Individual body chemistry, metabolism, and reactivity can vary significantly.

Along these same lines, getting the right mix of product for each person is a challenge. Clearly, one formulation does not fit all. The amount of PRP to achieve the best result for each person is called the dose-response. This goes back to how the body responds to each substance within the PRP (e.g., growth factors, cytokines, proteins, clotting factors).

And finally, even with the right mix of elements within the PRP, using it at the exact right time for best results may make a difference. The best timing for the use of PRP has not yet been determined. Likewise, the way in which the PRP is delivered (e.g., injected, brushed on) might make a difference in results.

Future research done using PRP will have to pay attention to which PRP product was used and how it was used. The early enthusiasm about PRP may be still warranted but since not all results have been positive, scientists will be taking a closer look at this new treatment before continuing as if this product is fail-proof.

The cause and cure of muscle cramping remains a mystery. Sometimes there’s a simple explanation such as dehydration from exercising in hot, humid weather without replenishing fluids and electrolytes.

In some cases, there’s an imbalance in the sodium-calcium-chloride mechanism that controls how and when muscles contract. This can develop in part due to dehydration and electrolyte imbalances.

But it’s possible that some people have some internal metabolic imbalance that gets fired up when exercising that isn’t present in others doing the same type of exercise under the same conditions.

Pickle juice (along with other remedies such as eating mustard) may help replace the sodium needed for normal muscle contraction/relaxation. Without the proper mix of calcium, potassium, sodium, magnesium, chloride, and others, the nerve endings attached to the muscles can’t work properly.

When the nerve terminals are too sensitive, they set off a series of events that leave the muscles in a chronic state of contraction, unable to relax. That’s when the muscle cramps become unbearable.

So far, there hasn’t been a one-cure-fits-all approach to muscle cramping — either for prevention or for the treatment once they develop. It’s always advised that affected individuals check with their physicians to rule out a medical problem such as diabetes or thyroid problems.

Until evidence-based experiments can sort out who should do what to prevent the problem, a multi-strategy approach is advised. Stretching, replacing fluids and electrolytes, and conditioning muscles affected most often are all advised. Strength-training, endurance, and plyometrics may help prevent neuromuscular imbalances and fatigue that set off inappropriate signals.

You may be experiencing something called exercise-associated muscle cramps and you may be someone who is cramp prone. There are lots of theories around the reason why some people develop muscle cramps and others don’t.

Athletes of all kinds experience them — including recreational and high-level competitive players. It doesn’t seem to matter what type of sport the player is involved in. Climate (hot and humid) may be a factor. Dehydration and electrolyte imbalances are more likely during hot, humid outdoor activities.

The dehydration theory is the most commonly used explanation. But why does dehydration trigger exercise-associated muscle cramps? Sweat loss without replacing fluids adequately alters the balance of fluids and electrolytes (chemicals) in the body. Without the proper mix of calcium, potassium, sodium, magnesium, chloride, and others, the nerve endings attached to the muscles can’t work properly.

When the nerve terminals are too sensitive, they set off a series of events that leave the muscles in a chronic state of contraction, unable to relax. That’s when the muscle cramps become unbearable.

But this is just a theory based on observations of athletes suffering from muscle cramps in hot environments. The fact is, the same problem has been seen in athletes exercising in cool or temperature controlled arenas and gyms. So maybe it’s something else — like some athletes are just more susceptible because of the way their bodies function. Maybe there are crampers and noncrampers and that’s just the way it is!

The next theory proposed is the neuromuscular theory. In this model, muscle overload during exercise results in an imbalance within the motor firing mechanism of the muscle. The feedback loop that tells a muscle when to contract and when to relax gets off-balance. An imbalance of impulses results in messages to the muscle to contract getting stuck. Stretching the muscle overrides the system and is like hitting the reset button.

Scientists have found it difficult to study this problem. Animal models (cats, rabbits) can’t be used because they have different neuromuscular signaling mechanisms that don’t match humans. It’s likely that exercise-associated muscle cramping is the result of a combination of factors.

Working backwards (find a solution, then figure out why it’s working) hasn’t panned out either. People have used a wide variety of sports drinks, massage, electrical stimulation, changing exercise/workout intensity, and even drinking pickle juice! None of these seems to work equally for all people prone to muscle cramps or in the midst of an attack.

All that to say that the cause of your muscle cramping (while your twin has none) remains a mystery. Even identical twins have their own body chemistry function, balances, and imbalances. There is a reason — we just don’t know what it is yet.

As you probably already know quite well, physicians keep up with the rapidly changing discoveries in medicine by reading journals. Sometimes it’s just a matter of browsing various journals to see what’s happening. In other cases, a specific journal title may catch the physician’s eye as being worth the time to sit-down and read it page-by-page.

One of the services the American Academy of Orthopaedic Surgeons (AAOS) provides is a specialty update on various topics in orthopedics. In the June 2010 issue of The Journal of Bone and Joint Surgery, updates are provided on a wide variety of pediatric orthopedic conditions that might help you with this project.

If you are located anywhere near a hospital (especially a pediatric specialty hospital), the hospital librarian will have subscriptions to journals on line that you can browse. There is a journal devoted to pediatric orthopedics by that very name.

Our own website www.eorthopod.com has a series of Patient Guides that provide up-to-date information about various orthopedic conditions and injuries. Scroll down on the home page to Topics and click on Children’s Orthopedics. You’ll find everything from Blount’s disease and scoliosis to Osgood-Schlatters and Perthes disease and much, much more. That should give you a head start!

It’s possible your daughter has a condition known as generalized joint hypermobility (GJH). Generalized joint hypermobility (GJH) is defined as a condition in which most, if not all, of a person’s joints are super flexible. They move past the range of motion that the normal, average person has. This type of connective tissue flexibility is sometimes referred to as being “double jointed”.

The person really only has one joint at each location. It’s just that those joints move too far, too easily. Sprains, strains, subluxations (partial dislocations), and complete dislocations are common.

The lack of restraint on the joints in someone with GJH contributes to joint injuries (especially of the knee). Without stiff ligaments, there’s no tension keeping the joint from sliding too far.

This condition has been seen in a wide range of athletes from ballet dancers to football players. In fact, some experts suggest that the extra flexibility helps these folks excell at their sport. Certainly in the ballet world, joint extensibility is an added bonus.

There aren’t any real studies comparing ways to “stiffen up” joints. The most common sense approach seems to be to strengthen the muscles around the joint. The muscles then function more as a restraint system. The muscles offer active restraint when and where the abnormally loose ligaments don’t provide the passive restraint needed to prevent injury.

You may want to check with your primary care physician to see if there is any kind of medical diagnosis for this condition. If it’s just a matter of being on the loose end of normal, then muscle strengthening may be the way to go. A physical therapist or athletic trainer will be able to set up a program specifically geared toward muscle strengthening for prevention of joint injuries caused by joint hypermobility.

Generalized joint hypermobility (GJH) is defined as a condition in which most, if not all, of a person’s joints are super flexible. They move past the range of motion that the normal, average person has. This type of connective tissue flexibility is sometimes referred to as being “double jointed”.

The person really only has one joint at each location. It’s just that those joints move too far, too easily. Sprains, strains, subluxations (partial dislocations), and complete dislocations are common. It seems like athletes with generalized joint hypermobility (GJH) actively involved in sports injure the joints of the legs more often than those players who don’t have GJH. But does it just seem that way or is it a true observation?

The results of a recent systematic review with meta-analysis suggest there is a direct link between GJH and leg injuries. In fact, an Australian physical therapist (they are called physiotherapists down under) won The American Journal of Sports Medicine’s annual competition in 2009 for the best systematic review with meta-analysis on the subject of leg injuries in athletes who are hypermobile.

Let’s back up a bit and explain a few things. First, what’s the big deal about the competition? Well, a systematic review involves sifting through 1000s (4841 to be exact in this study) of studies on a particular topic. Meta-analysis means the researchers had to find studies that were similar enough in data collection and analysis that the results could be pooled together.

There was a wide range of athletes included from ballet dancers and divers to military recruits and football players, the last group was from the college and professional level. Some of the injuries were from contact activity with high-impact collisions (with another body or with the ground). Others were from overuse (e.g., diving, dancing). Overall, there were significantly more injuries among the contact or collision sports participants.

As for the joints injured most often — that distinction goes to the knees. Individuals with generalized joint hypermobility (GJH) were much more likely to injure the knee (much moreso than the ankle) compared with athletes who had normal joint motion.
These findings are consistent with what other studies show about ankle injuries — namely, that loss of ankle motion is the key risk factor in ankle injuries (not hypermobility).

Likewise, when it comes to knee injuries, when the foot is planted on the ground and the body twists or rotates above, the lack of restraint on the knee joint in someone with GJH contributes to knee injuries. Without stiff ligaments, there’s no tension keeping the joint from sliding too far.

So to answer your question, there is finally some clear and conclusive evidence that people with generalized joint hypermobility are at an increased risk of leg (especially knee) injuries.

Fractures are classified as either open or closed, depending on if there is an open wound (cut or tear) in the skin over the site of the fracture.

If you have an open fracture, the bone is broken and there is a wound, from where the broken part of the bone may protrude (come out) through the skin. With a closed fracture, there is no such wound. The bone still may be visibly broken, but it cannot be seen.

People who can put their legs behind their head or fold up the arms and legs and then fit into a tiny box have something called joint hyperlaxity. The condition is considered congenital because it is something they are born with and remains present throughout life.

Joint hyperlaxity means the soft tissues around the joint that usually hold it in place are extra long and very elastic. Without those restraints, the joint can slide and glide all over the place. The end result is the ability to move and rotate joints in all directions without dislocation.

The condition can be acquired, too. Athletes who perform the same motion over and over (e.g., serving a tennis ball over the net, pitching a ball forward) can also develop joint hyperlaxity.

One portion of the joint capsule gets so stretched, the joint becomes hyperlax. This can happen to window washers who have their arms and hands overhead hours each day or rowers who are repeatedly pulling the arms back. Gymnasts, tennis players, weight-lifters, pitchers, and house painters

Can those joints be dislocated? Yes they can. Fortunately it doesn’t happen very often. But you don’t want to develop shoulder instability by repeatedly stretching out the soft tissues that are meant to support the shoulder. By showing others what you can do over and over, you actually develop muscle patterns that can be difficult to change.

Platelet-rich plasma (PRP) is also known as blood injection therapy).It is a medical treatment being used for a wide range of musculoskeletal problems. Platelet-rich plasma refers to a sample of serum (blood) plasma that has as much as four times more than the normal amount of platelets.

This treatment enhances the body’s natural ability to heal itself and is used to improve healing and shorten recovery time from acute and chronic soft tissue injuries. It is used in patients with early signs of osteoarthritis. The hope is that it can help the joint cartilage repair itself before serious signs of arthritis develop. This is important because cartilage doesn’t have the ability to heal itself.

Growth factors in the platelets seem to help stem cells turn into chondrocytes (cartilage cells), which is just what’s needed. Platelet-rich plasma injection into cartilage lesions or defects has been shown to decrease pain and improve function in humans.

The side effects seem limited to wound infection (where the injection enters the body) and possible pain, redness, and swelling at the injection site. The response doesn’t last long or affect the final results.

Platelet-rich plasma (PRP) (also known as blood injection therapy)) is a medical treatment being used for a wide range of musculoskeletal problems. For those who don’t know, platelet-rich plasma refers to a sample of serum (blood) plasma that has as much as four times more than the normal amount of platelets.

Platelets are like the emergency medical technicians (EMTs) of the body. When there’s an injury, they are the first one on the scene of the accident, so-to-speak. Platelets have a large number of available growth factors and other bioactive molecules that signal the body to start the tissue-healing process.

The platelet treatment enhances the body’s natural ability to heal itself and is used to improve healing and shorten recovery time from acute and chronic soft tissue injuries.

It has been used for years after plastic surgery and surgery on the mouth, jaw, and neck. It seems to promote bone graft healing. Researchers have found a way to combine this substance with other chemicals to make it into a putty or gel that can be painted on a surgical site to speed up healing.

Now its uses have been expanded to include knee osteoarthritis, degenerative cartilage, spinal fusion, bone fractures that don’t heal, and poor wound healing. This treatment technique is fairly new in the sports medicine treatment of musculoskeletal problems, but gaining popularity quickly.

Patients with chronic tendinitis (e.g., tennis elbow, patellar tendinitis or jumper’s knee, Achilles tendinitis) have also benefited from this treatment. It’s even being tried on hernias, labral (shoulder cartilage) tears, meniscal tears of the knee, and ankle sprains. Some surgeons are using it more and more with any orthopedic surgery involving the soft tissues to augment (reinforce) bone or ligamentous graft materials already being used.

As for how effective is it? Well, most of the studies have been done on animals. Human studies either have not been high enough quality or too different in design to make comparisons possible.

There are also different growth factors released and different concentrations of platelets in samples used from study to study. It’s not really clear yet just how much platelet-rich plasma is needed for each type of injury or even how many platelets are needed for the best response.

The lack of high-quality, randomized controlled trials points to the need for attention in this area. Before expanding its use to an even wider array of musculoskeletal problems, it should be proven that the treatment has a positive benefit for each type of injury or trauma.

Guidelines to make buildings accessible to wheelchair users were set in the 1970s. They worked well then. But in the 40 years since, mobility equipment sizes and designs have changed. However, building codes have not changed to accommodate the wide assortment of power wheelchairs, manual (push-type) wheelchairs, and now the newer scooters many of the older adults are using.

Some of this equipment is pretty heavy and bulky while others are light-weight. The wheel base varies as does the length of the chair and placement of the wheel axes. Some chairs have a front wheel set up while others have a mid-wheel drive or rear-wheel drive. Each one of these designs has its own space requirements for entering doorways, navigating hallways, and managing turns.

So as you are looking, pay attention to doorframe width, hallway width, and the design of the home. Making it around a wall to get into another room can be a simple L-shaped turn but often requires a more complex double-L turn. Rooms must be large enough to allow the wheelchair user to make a 360-degree turn in order to leave the room.

If your wife will need to transfer from the wheelchair to a toilet, then the bathroom will require some additional room. Any home, apartment, or other place of residence can be modified. But modifications can be costly so you want to find the most accessible place possible first and make whatever adjustments are necessary from there.

Currently, there is a real need to update guidelines and standards for buildings (e.g., door and hallway widths, bathrooms). The minimum Wheelchair Turning Space recommended by the Accessibility Guidelines for Buildings and Facilities (ADAAG) back in the 1970s isn’t enough any more.

The goal of updated guidelines is to make sure today’s current wheelchair and scooter users can get in and out of public areas easily. With almost two million Americans in wheelchairs or scooters, this recommendation has the potential to affect the daily lives of many people like your wife.

The scooters that are available now for older adults with physical limitations are very handy to have. They make accessiblity possible for people who can’t walk very far without becoming winded and for those with physical disabilities.

Your conerns about the scooter limiting your mother’s physical activity and exercise is a realistic one. She should really be evaluated by a physician and a physical therapist for mobility needs before purchasing a unit on her own.

Besides determining her need for a scooter, if one is indeed needed, the therapist can prescribe the right kind for her specific situation. Even the compact scooters are fairly large when it comes to navigating narrow hallways in older homes and small living spaces (not to mention public bathrooms). Spending money on a scooter only to find out she can’t operate it or it’s too large for her house can be a frustrating and expensive mistake.

Many people rely on the scooter type mobility equipment for outdoor use only. But they must drive on finished surfaces and avoid uneven terrain. They have some limitations in walking but have good trunk control, can get in and out of the scooter, and operate the hand controls easily. The scooters do work quite well in malls, stores, or other larger shopping areas.