FAQ Category: General

A study was done in Canada evaluating the impact of power wheelchairs and scooters on older adults Life-space usage. That’s a fancy term to describe how often they got out, how far they traveled, and what they did during that time.

The group was made up of 60 per cent women, 40 per cent men. Most were power chair users (52 per cent) with 48 per cent scooter users. Half the group had some kind of neurologic problem such as a stroke, Parkinson’s, multiple sclerosis, or brain injury. They could walk indoors (independently or with a walker or cane) and get in and out of their wheelchair or scooter without help.

They found that men were more likely to travel distances farther away from home in their powered mobility device compared with women. Men and women who used scooters were able to go farther more often than those in a wheelchair.

While analyzing the data, factors that might affect power mobility device usage were also examined. These variables included things like sex (male or female), diagnosis, walking ability, type of device used, training to use the device, living status (alone, partner, assisted living), and overall activity level.

Power mobility devices (whether a powered wheelchair or scooter) give older adults the ability to get out more in their own neighborhood. Having a powered mobility device didn’t mean the user would increase the distance to his or her outings — just the frequency (how often) they got out.

People who had specific reasons for wanting a powered mobility device called participation objectives (e.g., go shopping, eat out, take the dog out) did increase their Life-space mobility. The freedom to come and go without help (even inside the home) was considered a definite benefit and well worth the cost.

Like many people in the sandwich generation, you are trying to take care of older parents in one generation while raising a family. Juggling the needs (and wants) of both can be very challenging.

Unless self-motivated, older adults can become very sedentary (inactive). They become stiffer, weaker, and less energetic. That translates into sitting more and doing less, which contributes to deconditioning.

It’s a well-known fact that adults who stay active and get outdoors daily are less likely to experience as rapid or as dramatic of a decline in physical function. They are also less likely to develop new health problems.

Whether or not they have to go farther than around the block is debatable. There is some evidence to suggest that visiting friends and joining in on family activities has some additional benefit. Such activities get people out more and farther away from their TV and comfortable recliner.

Anything you can do to help keep your parents active physically and mentally will pay off in the long-run. Get as much help as you can to keep from burning out yourself. Take advantage of local support groups, Adult Aging Services, Senior Citizens’ volunteers.

In almost every community (even small farming communities), there are usually some services available. Don’t be too shy or too proud to take advantage of these — that’s what they are for! It’s all for your parents’ sake and that should help you get past any personal barriers you may have when letting others step in to assist you with your folks.

Anyone of any racial/ethnic background who is 50 years old or older can develop osteoporosis. The older we get, the greater our risk. Hispanic men seem to have a lower risk for osteoporosis than others. Only about three per cent of Hispanic males over 50 are affected by osteoporosis. This is compared with seven per cent for white males and five per cent for African American men.

The risk of osteoporosis is higher in Hispanic women and especially Hispanic women who have diabetes. And their risk of developing diabetes is twice the risk of Caucasian (white) women. So that tells us this particular group of Hispanic women must be monitored carefully.

In general, anyone of any ethnic background with a diet low in calcium and/or high in caffeine and alcohol has an increased risk of developing osteoporosis. Other risk factors include advancing age, the use of tobacco products, overuse of antacids (containing aluminum), poor diet/nutrition, and taking certain medications.

Don’t make the assumption that you are not at risk for osteoporosis. If you are over 50, 60, and especially 70 or 80, talk to your physician. Find out about your risk factors and what you can do to reduce your risk. Early prevention is the key to avoiding fractures, loss of independence, and disability often caused by osteoporosis.

Osteoporosis is a decrease in bone mass. The bone is less dense, a concept referred to as a decrease in bone mineral density (BMD) — a thinning of the bone, so-to-speak. Left untreated, bones can become brittle and break causing bone fractures and other problems.

Half of all adults over the age of 50 are affected. How can you tell if you have osteoporosis? Your primary care physician is the best person to evaluate and advise you. But educating yourself about this skeletal disease, recognizing your risk factors, and practicing some prevention is a very good idea.

First, who is at risk? Are you? According to the National Osteoporosis Foundation (NOF), there are two categories of risk factors: lifestyle factors and medical risk factors. Lifestyle factors include things like too much alcohol, tobacco, caffeine, and antacids (aluminum). Not enough calcium, vitamin D, and physical activity add to your risk. These are all considered modifiable risk factors, meaning you can do something about them to reduce your risk.

Some of the medical risk factors are nonmodifiable. For example, there’s not much you can do about your age or sex (women are at greater risk than men). A previous fracture, poor vision (contributing to falls), poor balance, and some medications also increase your medical risk of decreased bone mass. Some of these are modifiable, while others are not. Your physician will help you sort out which are your risk factors and how to reduce your risk as much as possible.

Although older Caucasian (white) women (especially after menopause) are the group affected most often, anyone of either sex (male or female) and of any color (racial or ethnic background) can develop osteoporosis. In fact, there is evidence now that not enough calcium and having diabetes mellitus has bumped up the number of Hispanic women affected by osteoporosis.

Men can also develop osteoporosis. This is especially true if they are over 70 years old or have low levels of testosterone hormone and any of the other risk factors already mentioned. Caucasian men are affected most often (seven per cent), followed by African American men (five per cent), and Hispanic men (three per cent). Those figures compare with 20 per cent for both Caucasian and Asian women.

If you have any of these risk factors, you should be evaluated. The next question is what kind of testing is available to see if you do have osteoporosis? The gold standard (number one tool used) is still dual-energy X-ray absorptiometry (DXA, pronounced Dex-uh) scanning. It’s painless, noninvasive, and easy to do. Not only that but it is precise (accurate). In some cases, ultrasound or MRI may be used instead of DXA scans, but the DXA test measure is the most reliable and the most widely used.

If you haven’t done so already, make an appointment with your primary care physician and get some baseline testing done. Once you have a DXA scan result, your physician can calculate your 10-year risk of developing a major osteoporotic fracture using a formula called the fracture assessment tool or FRAX. You can access the FRAX questionnaire yourself at www.sheffield.ac.uk but you will need your DXA scan results in order to complete the formula.

Gout is a disease that involves the build-up of uric acid in the body. About 95 per cent of gout patients are men. Most men are over 50 when gout first appears. Women generally don’t develop gout until after menopause. But some people develop gout at a young age.

Uric acid is a normal chemical in the blood that comes from the breakdown of other chemicals in the body tissues. Everyone has some uric acid in his blood. As your immune system tries to get rid of the crystals, inflammation develops. For the person with too much uric acid, this inflammation can cause painful arthritis.

Gout was the first disease in which researchers recognized that crystals in the synovial fluid could be the cause of joint pain. Synovial fluid is the fluid that the body produces to lubricate the joints. In gout, excess uric acid causes needle-shaped crystals to form in the synovial fluid.

More Americans are suffering from this problem than ever before. Finding safer and more effective ways to treat it has become the focus of new research these days. There are three ways to approach symptomatic gout. All focus on lowering uric acid levels in the body using medications. The first is to increase how much urate the kidneys send out of the body. The second is to keep uric acid from being formed in the first place. And the third introduces into the body the enzyme needed to break down the excess uric acid.

Most of the new drugs are still in the trial phase. Some have been approved for use by certain patients such as those who haven’t been helped by traditional therapies. It sounds like you have your gout under good control. With no symptoms for two years, you are not a typical candidate for the newer agents. But to find out more about what is available and what you should take, see your rheumatologist for a review and update of your current management protocol.

Gout is a form of arthritis with joint inflammation. It’s caused by too much urate (uric acid) in the body because of a missing enzyme (uricase). Excess uric acid causes needle-shaped crystals to form in the synovial (joint) fluid. One of the most distressing symptoms of gout is painful, inflamed, hot, and tender joints. The big toe is affected most often but other joints can become symptomatic, too.

For the last 40 years, treatment has focused on diet to reduce urate levels. Painful inflammation is managed with nonsteroidal antiinflammatory drugs (NSAIDs) and corticosteroids. In 2009, the Food and Drug Administration (FDA) approved a group of new drugs for the treatment of gout. These new medications are the subject of today’s review and include colchicine, anti-interleukin (IL)-1 beta therapy, urate transporter (URAT1) inhibitors, febuxostat, and uricase replacement.

The first drug mentioned (colchicine) isn’t really new. It’s been used for gout for 200 years. But the FDA has never formally approved it. As a result of reviewing the effectiveness and safety of this drug, a new nongeneric drug (Colcrys) has been developed, approved, and is now available. Colcrys has the advantage of stopping the gouty attack quickly but it only worked for half the people who tried it.

Anti-interleukin therapy is a biologic approach designed to prevent the inflammation associated with gout. These medications can also be used to treat inflammation once it begins. Three of these anti-interleukins (Anakinra, Rilonacept, and Canakinumab) are being tested and studied in humans.

So far, Anakinra has been effective in reducing 50 per cent of the painful symptoms associated with gout and it does so within 48 hours. Rilonacept provided 75 per cent pain relief for half of the patients who took it and prevented symptoms in three-fourths of the patients who took it prophylactically (to prevent joint inflammation). Canakinumab is faster in delivering relief from pain (within 24 hours) and seemed to be able to prevent recurrent attacks later.

Besides treating the symptoms of a gouty attack, modern treatment now has new agents to reduce urate levels. This can be done by helping the body get rid of the excess urate or by keeping the body from making so much urate in the first place.
Febuxostat is a new drug that does both at the same time. Compared with the drug that’s been in use since 1963 (Allopurinol), Febuxostat is almost twice as effective. And Febuxostat can be used by patients who have kidney problems if they don’t already have severe kidney failure.

Studies with most of these drugs are in the early phases (human trials) right now. Results look promising, but time will tell. If your husband is not getting the relief he needs from painful symptoms, he should make an appointment with his primary care physician or rheumatologist if he has one. The key to successful management of gout is to prevent symptoms and/or catch them when they first appear. There may be a more effective way to do this than he is currently using.

More and more jobs require repetitive motions like typing, scanning product labels, or grasping tools. As a result, arm pain is becoming a more common complaint. Wrist or elbow tendonitis and/or carpal tunnel syndrome are the most common diagnoses.

Treatment for persistent pain associated with repetitive motion tends to be conservative with antiinflammatories, physical therapy, and sometimes, steroid injections. Amitriptylene, an antidepressant used to treat chronic low back pain, headaches, and muscle pain from conditions like fibromyalgia might be of some benefit.

A recent study from Harvard University Medical School compared the use of low-dose (25 mg) Amitriptyline with a placebo (sugar pill). They found that the Amitriptyline didn’t seem to effect pain levels as much as it helped patients feel better (mood) and therefore able to do more.

When they stopped taking the drug, their function declined once again. That’s called a reversal of positive treatment effects and points to Amitriptyline being more effective than a placebo.

Taking a pill like Amitriptyline one time and gaining benefit from it may in itself be a placebo effect (you think it’s going to help, so it does). This medication has not been fully tested in treating chronic or persistent musculoskeletal pain from repetitive overuse.

If you have not been treated with some of the other conservative approaches, you may want to start there. Ask your doctor to help you find ways to reduce your pain and improve your function. Of course, ask about the use of Amitriptyline as well and see what’s best for your symptoms, diagnosis, and particular clinical picture.

As every patient, physician, and pharmacist knows, medications come with side effects. The goal is to get maximum benefit from the positive effects of the drug with the least (if any) side effects.

Daytime drowsiness is a typical side effect of the antidepressant known as Amitriptyline. Even at low doses (25 mg), patients notice this problem. There is some evidence that tolerance develops meaning your body gets used to the drug and the side effect decreases over time.

It’s best to check with your prescribing physician about what to do. It may just be a matter of waiting until your body accomodates to the medication. Or your physician may want to change the dose you are taking.

Sometimes patients are advised to take this medication right before bed. That way the drug has it’s peak or maximum uptake in the body while you are already sleeping. And sometimes, a different drug is needed. But these are all decisions that will have to be made by you with your physician’s guidance.

Scientists are slowly uncovering the mysteries of fibromyalgia syndrome (FMS). Instead of seeing this condition as a painful musculoskeletal problem, it’s looking more and more like a complex nervous system disorder affecting (in part) how pain messages are processed.

Pain has always been a key feature of fibromyalgia. For a long time, diagnosis has been based on the number and location of tender points. But with the presence of anxiety, depression, and sleep problems, there’s been a shift away from diagnosis by tender points to a more whole person approach.

Besides the typical physical symptoms that characterize fibromyalgia syndrome, there’s also a common past history (e.g., abuse, prematurity, growing pains as a child) and possibly some environmental factors. But since the past can’t be changed, treatment is now what we call multimodal management. That means the many problem areas are addressed all at the same time instead of just treating the painful symptoms.

Patient education is first and foremost for a successful outcome. Affected individuals must understand that their pain, depression, and fatigue can be improved but it may take weeks to months. Patients must be patient with the process.

Moderately intense exercise is prescribed and supervised by a physical therapist. Having a therapist guide individual patients to find the optimum program that works for them is essential. Exercise will help reduce pain and depression, as well as improve sleep. Getting good sleep at night also improves muscle pain and boosts mood.

High-intensity aerobic activity is not the goal. In fact, patients are advised to avoid intense exercise. It’s far better to establish a consistent program of 20 to 30 minutes of physical activity and exercise four to five times each week than to start off at a pace patients can’t keep up with.

There are many things patients with fibromyalgia syndrome can do to manage their own symptoms, In addition to regular exercise, attending a local support group can give patients a place to vent their frustrations and worries, meet other people with similar symptoms and challenges, and find out what others are doing that’s working. Support groups help everyone stay on target with their program and are considered a very valuable part of disease management.

What’s next for patients with fibromyalgia syndrome? Until more is known about how pain is processed and what goes wrong, we can’t fix or cure this condition. The focus will remain on examining different treatment approaches and objectively measuring results. There may be one best treatment method that can be used with all fibromyalgia patients. But for now, it looks like management will remain multimodal and individualized for each patient.

Fibromyalgia syndrome is a collection of wide and varied symptoms including tender points, depression, anxiety, sleep disturbance, cold fingers and toes, fatigue, loss of sexual desire, headaches, and much more.

Approaching fibromyalgia with a plan of care much like a business project may not provide a quick and easy fix. This condition does require a long-term management approach. You should expect to see some change in how you feel (especially your pain and fatigue) in the first six weeks. Many patients continue to report gradual improvement during the next six weeks.

Getting on a daily exercise program and improving sleep go hand in hand with reducing pain and enhancing mood. You may want to consider attending a local fibromyalgia support group. The advantages are that patients have a place to find out what others are doing and compare notes on what’s helping people with similar symptoms. Support groups also give folks a place to share frustrations, challenges, and victories.

More people are involved in weight training than ever before! We’re talking kids to seniors from age six to 100! Many teens have expressed a similar interest as your daughter in starting a weight-training program. Not too surprising, there’s been a huge increase in weight training-related injuries in the last 10 years.

It’s estimated that almost one million weight training-related injuries are seen every year in hospitals across the United States — and that doesn’t include injuries that are never reported or evaluated. So who’s getting hurt? What kind of injuries are being reported? Most of the injuries occur in men (82.3 per cent) but that’s also because many more men than women lift weights. This may change as more teens get involved in weight lifting.

Right now, the data shows an upward trend for injuries among three distinct groups: teens under the age of 13, women in general, and older men (55+). Men of all ages injure their backs and upper trunk most often. They are also more likely to overexert themselves (lift too much, too many times) leading to an injury.

There have been some deaths reported from heart attacks among men lifting weights. We are not aware of any deaths in teens from weights landing on them but there are some (rare) reports of this among men lifting without a proper partner to spot for them.

The largest proportion of injuries occur while using free weights. People drop the weights on themselves or hit themselves with the weights. The use of machines also requires some tips on training. It’s just as easy to overdo on weight machines as it is with free (handheld or dumbbell) weights. Most of the commercially available weight machines used in home gyms and fitness centers are designed for the average sized adult. They are not proportioned for short or tall, small or large people.

No matter what type of weights are used, the key is to provide your daughter with a safe training program under the supervision of a knowledgeable health care professional or fitness trainer. Proper instruction may reduce injuries and help all interested individuals advance at their own pace for a successful injury free outcome.

Your observations are right on the mark. More people are involved in weight training than ever before! And there have been a corresponding increase in the number of injuries. Data taken from 100 emergency departments where weight-training injuries were examined and treated suggest that men make up the largest number of people injured lifting weights (82.3 per cent). But that may be because many more men than women lift weights.

Why are these injuries occurring? Well, believe it or not, the largest proportion of injuries occurred while using free weights, which the individuals dropped on themselves or hit themselves with. There were some cases of getting smashed or crushed under weights and losing balance and falling while holding onto weights.

Older adults (55 and older) tend to use free weights more often than weight machines. Of the injuries reported in patients using machines, the majority of individuals hurt were 55 or older. There’s some thought that perhaps older adults can’t accept limitations as they age. If they refuse to see that their decreased abilities can lead to injuries, they are less likely to modify their activities and approaches to weight training.

Educating young to old about the proper use of weights is important. Anyone starting a weight-training program of any age or sex should start with lighter weights and work up over time. This is called progressive resistance exercise or PRE. Having a knowledgeable trainer to guide beginners of all ages is not just a good idea — it could make the difference between success and painful injuries.

The use of machines also requires some tips on training. It’s just as easy to overdo on weight machines as it is with free (handheld or dumbbell) weights. Most of the commercially available weight machines used in home gyms and fitness centers are designed for the average sized adult. They are not proportioned for short or tall, small or large people.

No matter what type of weights are used, a safe training program under the supervision of a knowledgeable health care professional or fitness trainer is advised. Proper instruction may reduce injuries and help all interested individuals advance at their own pace for a successful injury free outcome. Don’t give up trying to coach, advise, instruct, and otherwise educate your customers!

Universities are institutions of higher learning. They are also very involved in research of all kinds. Freshman entering a university represent a unique group of potential research subjects. Data is often collected as part of the matriculation process.

A survey of the type you describe was probably requested on a voluntary basis. In other words, students were invited to participate but not required to complete the form in order to enroll.

Similar research is being done around the world. For example, a group of universities in Japan recently got together and conducted a survey of their incoming freshman. They were trying to find out if there is any link between sports participation and low back pain. And, in fact, they discovered that higher levels of sports play for longer periods of time (grade school through high school) were associated with a greater incidence of low back pain.

They also showed that students involved in a high level of sports activities were much more likely to have back pain compared with those who either didn’t participate at all or students with low sports involvement.

Reasons for this type of research may vary from university to university. In some cases it’s to help prevent injuries or low back pain. In other situations, it may be to help encourage activity to offset the long hours of sitting, studying, and watching television.

You can certainly contact the school and ask for more information about this particular questionnaire. There may have even been a cover sheet explaining the purpose of the survey and notifying students that filling it out was voluntary and not mandatory.

It’s true that there is a relative risk of injury when participating in physical activities, organized sports, or other similar events. There are even some particular injuries that seem to be sports specific.

For example, throwing athletes tend to injure their shoulder because the stress of the repetitive microtrauma is greater than the tensile strength of the soft tissues involved in the throwing action.

Low back pain is a common problem among many types of activities. According to one study from Japan, volleyball player developed low back pain more often than any other type of athletes.

Soccer had the lowest association with back pain fllowed by baseball, track and field, basketball, swimming, and tennis in between (in that order). Basketball players (or any athletes engaged in activities where the foot is planted while the player is changing directions quickly) are prone to knee injuries.

For inactive individuals, it’s well known that sitting for long periods (studying or watching television) is a risk factor for low back pain. And while it’s true that inactive, sedentary individuals are less likely to experience musculoskeletal and joint injuries, the risk of other problems such as obesity, insulin resistance syndrome, cancer, high blood pressure, diabetes, and many other conditions increases.

Poor diet (lacking in nutrition) and lack of exercise have been linked over and over with all kinds of health issues. When comparing and contrasting athletic injuries for those who remain active with health concerns for the inactive, the balance is tipped heavily in favor of physical activity and exercise. That’s true for all ages, both sexes (males and females), and for every race and ethnic group studied.

The human body has several different types of joints – each one is particular to the body part’s needs. For example, to be able to walk properly, your hip has to have a wide range of motion and to be able to rotate. So, the hip joint is a ball-and-socket type, just as the shoulder is. The shoulder also needs a wide range of motion and the ability to rotate.

That brings us to the knee. We don’t want the knee to rotate as much as the hip – that would make it very awkward to walk – but it does need a bit of rotation. It also has to be able to move back and forth in a straight motion. So, the knee is a complicated type of hinge joint, more complicated than the elbow, which is also a hinge joint. There is also a saddle joint, but there is only one in your body – at the base of your thumb. This particular joint give your thumb a large range of motion.

Other joints, such as gliding joints, allow you to move your wrists and ankles, while condyloid joints allow you to move your fingers and toes. There are also joints in areas you may not consider as being jointed. For example, you have pivot joints in your neck.

Sometimes, a dislocated joint can be put back into place and helped to heal without surgery, while other times, surgery is strongly recommended for proper healing. However, there are times when surgery is recommended but not essential. This is when the surgeon should discuss the pros and cons of the procedure.

If you are trying to decide, some questions you should ask your doctor are:

– What benefit will come from having surgery that I might not have from nonsurgical treatment?
– What complications could result from having surgery?
– What complications could result from not having surgery?
– Why does he or she feel that surgery is a better option?

Only you can make the ultimate decision so you need to feel comfortable with the reasons why the surgery is being proposed.

The United States FDA regulates what the pharmaceuticals can sell to the public. The FDA approves the ingredients of the medications, the doses, what they’re used for, how often they’re taken and how long they are taken for. However, the FDA cannot tell a doctor how to practice medicine. So, if the doctors find that a medication that was originally meant for disease A also is very helpful in treating disease B, they may legally prescribe it for that reason.

It’s important to understand that doctors don’t just choose different medications to use for different illnesses. These extra uses are discovered in the course of using them for their original indication. What happens is doctors may prescribe the medication and then notice that it has effects on other illnesses. Once this is noticed more often, the news spreads and doctors learn more about the medication and other potential uses.

Sometimes, doctors must graft bone on to bone to either replace missing bone or to stabilize bone that is there. Traditionally, bone from another site is taken, but as you say, it can be complicated and painful. In addition, taking some bone involves yet another incision and can result in extra complications, such as infection.

Researchers are trying to come up with options and some of these options, such as a substance called bone morphogenetic protein, are getting good results with adults. As they become more popular, doctors are starting to use them in children, although more research needs to be done to ensure that it is safe for them.

The natural history (what happens over time) and prognosis (final outcome) for complex regional pain syndrome (CRPS) aren’t entirely clear and can vary from person to person. Some people recover slowly and completely. Others seem to linger in a state of constant pain and dysfunction. A few actually get worse over time instead of better. You may fall into this last category.

In order to better understand this phenomenon, scientists have been studying the nervous system in patients with CRPS. There is some evidence that the sympathetic nervous system (SNS) [the rest and digest portion] is disrupted in CRPS. That leads to abnormal automatic responses in blood circulation and blood flow to the skin. Symptoms reflecting these changes include severe pain, increased skin perspiration, unusual hair growth patterns, and altered skin temperature.

Why does this happen? We don’t know yet. There could be other (independent) factors at work here that we simply haven’t discovered yet. Some experts have suggested it’s possible that people who develop complex regional pain syndrome (when others with the same injury recover without incident) may have a faulty nervous system to begin with. Now with an injury on top of it, sympathetic nervous system responses become further impaired.

It might be hard to prove this theory. One way to find out is to measure the sympathetic nervous system function in many normal, healthy adults and follow them their whole lives to see who develops CRPS. That’s a major undertaking but could be done in conjunction with other lifelong studies already underway.

Much has changed in the last 10 to 20 years in the way we think, perceive, and understand chronic pain problems like complex regional pain syndrome. Whereas 20 years ago, the psychosomatic label would have led us to think, Oh, that’s all in your head (brain), we now understand your brain is in your body. What does that mean?

Every thought, every emotion, and every stress or conflict you experience is recorded and analyzed by the brain-body complex via chemical messengers called neuropeptides. These chemicals are formed in the brain but circulate throughout the entire body. They deliver messages to every cell in your body informing the body what’s going on and how to be prepared for stressful situations.

In the case of complex regional syndrome, there is some evidence to suggest that the portion of our brains/nervous system that handles stress (called the parasympathetic nervous system) is disrupted and no longer functions properly.

Without a balance between the sympathetic system (the get up and go portion of the nervous system) and the parasympathetic system (the rest and digest half), patients end up in a constant state of pain and abnormal sensation, temperature, and circulation to the affected body part. It’s only when all stresses are removed that your calming nervous system can override the broken (stuck) sympathetic nervous system.

So a couple weeks on the beach or alone without responsibilities for the care of others can result in significant improvements in symptoms. But once you return to the daily ups and downs of life, the sympathetic nervous system kicks back in and your symptoms can flare.

There are ways to deal with this problem. Relaxation techniques including breathing, yoga, hypnosis, and biofeedback have been found helpful by many people. Physiologic Quieting®, a technique that balances the sympathetic with the parasympathetic nervous system has been developed by a physical therapist for problems like this. Physical therapists are trained in this approach and can get you started on a short program you can do at home to help yourself.