Lets consider the following:

· For age > 65 y/o, falls are the leading cause of fatal injury and responsible for approximately 2 million ER visits per year.

· Most falls are not truly accidents rather represent affects of physical deficits related to diminished vision, strength and/or balance.

· Ankle strength and range of motion accounts for approximately 50 percent of our balance.

· Hip strength accounts for approximately 20 percent of our balance.

· Numerous muscles of the trunk accounts for the remaining 30 percent of our balance.

· Decreased flexibility of musculature and ligaments away from the ankle also contributes to imbalance.

· Improved visual contrasts in the home and work environments, and keeping floors tidy (free from slip/trip hazards) lessens risk of injury.

Come on Baby-boomers, avoid the injuries. Contact us for additional recommendations.

The patient presents with recurrent pain about the outer aspect of the right elbow. He reports that the pain primarily occurs with forceful gripping and occurs with movements of his right upper extremity characterized as repetitive wrist extension and palm upwards rotation of his forearm (supination).

He reports that the symptoms are recurrent, associated primarily with periods of increased racquet sports activity and fitness training. He reports prior use of OTC and prescription NSAIDs, and receiving a number of local steroid injections.

On physical examination his right upper extremity appears normal, without focal redness or swelling. The soft tissue over the lateral epicondyle is mildly swollen and of a softer, fuller texture compared to that on the left. He demonstrates normal active range of motion at the elbow. He reports slight increase in pain over the lateral elbow (epicondyle) with resisted wrist extension and supination, with mildly decreased strength (pain limited) compared to the left.

Assessment

1. Lateral epicondylitis

Considerations

The diagnosis is not particularly challenging or uncommon. Of significance is that the label is only applicable for a limited period. Tendons attaching at the lateral epicondyle that are repeatedly inflamed may degenerate over time, epicondylitis transitioning to epicondylosis. As such, traditional oral anti-inflammatory treatment and local steroid injections will not be effective indefinitely. Moreover, excessive local steroid injections may hasten deterioration of the tissues.

Treatment

1. Educate the patient about the involved musculature, adjacent soft tissue and function.

2. The patient is to attempt to eliminate contributing causal/exacerbating activities as much as is possible.

3. We discussed his workout routine making adjustments to its content.

4. I recommended that he consider purchasing a lighter weight hybrid/composite tennis racquet and decrease backhand stroke frequency.

5. We discussed applying alternating heat, ice, mild friction massage and local electrical stimulation (TENS) to encourage local circulation with limited concurrent analgesic benefit.

6. I recommended twice a day application of a thin layer of topical DMSO overlaid with a balm composed of one or more of the following numerous substances: menthol, aloe, eucalyptus, cayenne, arnica, Emu oil, devil’s claw, c. indica (as allowed in his State); other agents are also applicable.

Presuming that the tissues have not already degenerated significantly and the patient can make appropriate lifestyle changes, I anticipate a positive response to the treatment plan over time. At follow-up we will address additional evaluation and treatment alternatives depending upon case status and how much of the plan he was able to fully engage.

Contact us with questions about this case and other issues of interest.

Memorial Day is experienced reverently and in celebration of the accomplishments of rites of Spring: cleaning, planting, trimming, and sprucing. The sound of steel wool on barbecue grill surfaces, scrubbing up the fire pits, and scaling off the calcium rings in swimming pools will complement the breezes swooshing through new foliage as we prepare for the onset of summer fun, and joy of Memorial Day.

Many of you should likewise prepare your shoulders for the holiday. Its not because the plates of food and the beverages will wear on your musculature, rather you are ill-prepared for water sport fun.

Swimmer’s shoulder is a term used to describe the shoulder symptoms of a competitive swimmer or the overzealous weekend athlete. The pain is similar to that experienced by many athletes playing positions requiring high volume throwing such as pitchers and quarterbacks. While the orientation of the body differs in swimming, the mechanisms of injury are very similar, repetitive wind-up, backward then forwards motions of the shoulder(s) overhead. In swimming, overhead is simply performed in a horizontal position.

Swimming can be even harder on an overzealous weekend sportsman because even between pitches and passes there are periods of rest. Whereas as long as you are moving through the water, your upper extremities, particularly your shoulders are getting a substantial workout. Moreover, swimming requires above average shoulder flexibility and range of motion to be performed well.

The muscle group most frequently injured is commonly referred to as the rotator cuff. The actual component most often offended is the tendon of the supraspinatus muscle as it inserts into the proximal aspect of your arm at the humerus. As such, the injury is known as supraspinatus or rotator cuff tendonitis.

To avoid the injury this spring, start warming up now. Stretching exercises involving reaching your hands forwards, rearwards, away from your sides, up as high as you can reach, “wing-flapping “ motions, and turning circles with your arms along your sides and/or in front of you as you lean forward slightly. There are more muscles, ligaments and cartilage that make up the rotator cuff and complementary elements than just the supraspinatus. You need to prepare all of them for your holiday fun and the summer activities on the way. Stretch your rotator cuff and avoid a Swimmers’ Shoulder injury.

Contact us with questions about this subject or others of interest to you.

Permanent degradation is not a foregone conclusion when you notice problems with memory. Health, nutrition and fitness habits should be evaluated when memory appears to be flagging. Consider the following possible contributors:

1. Poor sleeping habits it the most common cause of occasional slips in memory. Make time for healthy rest.

2. Acute infection frequently clouds thinking. Chronic illness of any type often precipitates excessive mood changes, which has an untoward effect on memory. Take care of your health in general.

3. Emotional distress often adversely affects memory. A calm mind is a healthier mind.

4. Pharmaceutical agents such as sleep agents, opiates, anxiolytics and some blood pressure medications and a good memory often conflicting objectives. Talk to your doctor about any side effects of medications.

5. Alcohol overuse may both effect your cerebral tissues permanently and have numerous short term adverse effects, including affecting memory. Moderate alcohol use significantly. Moreover, there are much healthier sources of anti-oxidants than red wine.

6. Poor circulation is can be circumferential, effecting your body and mind. Exercise regularly.

Eat well (including vitamin supplementation as needed, e.g., B-12), sleep well and exercise regularly. Take care of your health, nutrition and fitness for the good of your memory.

Chinese Medicine, classical and traditional involves a range practices originating in eastern Asia. Although well accepted throughout China and many other parts of the world, it is considered an alternative medicine. (follow hi-lited text link for more . . .)

Contemporary western health care recognizes the association between tinnitus, experiencing a ringing sound in the ears, and overuse of aspirin. More recent studies suggest that regular use of common pain relievers (acetaminophen, NSAIDs such as ibuprofen and aspirin) also increase the risk of experiencing hearing loss. The data does not point to the mechanism, just the association. Look at our other posts regarding alternative pain treatment strategies. However, to the extent that you use these types of products, use them cautiously and with consideration.

Patellofemoral Syndrome is commonly recognized as pain behind the knee. Knee pain frequently does not localize well relative to medial, lateral and  internal source causes.

Generally, age, gender and history of pain are telling factors. Girls 10 to 17 y/o frequently have overly developed thigh abductor muscles (compared to adductors) causing the patella to be pulled laterally, causing retropatellar pain due to patellar tracking problems. Less commonly, tears in the medial petellofemoral ligament cause instability of the patella and similar tracking problem or outright patellar dislocation.

Weak adductors can be conditioned with exercise. Nominal medial patellofibular ligament tears may heal with knee bracing, but more advanced injuries will require surgery. Additionally, prolonged lateral traction on ligaments of the patella may result in compression  of and friction injury to the lateral retropatellar surfaces.

1. Plantar Fasciitis - If identified early more than ninety percent of plantar fasciitis can be adequately addressed by a combination of weight loss and passive plus active ligamentous/muscular stretches of the feet to develop and maintain balanced, normal motion and wearing good shoes.

2. Iliotibial band - Increased iliotibial band stress often occurs with increased impact force during running. IT band micro-injury often precipitates reactive tightening of the band, resulting in lateral torque force on the patella and related soft tissues. To prevent lateral thigh pain, knee pain and plantar foot pain related to the IT band, perform frequent crossed leg sitting stretches and improve the arch support of your shoes.

3. Balance - Walking is a bit difficult without good balance. Tai Chi, a martial art, has as its most important characteristics that it improves balance, endurance and ambulatory skills amongst its practitioners.

Pain care with medicinal agents is a common practice of western medicine. The following are common medicinal approaches. Test your familiarity with these three significant alternatives in medicinal pain management product families. Guess the product families: A, B, and C.

A – Employed as an analgesic for thousands of years, it was used in the U.S. as well, particularly for neuropathic pain, until approximately 70 years ago. Modern research has demonstrated a scientific basis for the efficacy of synthetic and natural derivatives in pain management based on traditional chemical receptor pathways, both centrally (at the brain) and peripherally (hands, feet). Vaporization of the products allows delivery of the active chemicals at healthier temperatures. However, the development of vaporization technology has been hampered in its development by law. Additional positive health effects have been recognized regarding depression, anxiety, spasticity, tremor, nausea and anorexia to name a few. Excessive euphoria, controlled by behavioral dosing adjustments, is the recognized adverse reaction.

B – A family of products with a common plant ancestry. There are numerous formulations, for immediate and delayed effects, with numerous routes of administration. Used for moderate to severe acute and chronic pain. The range of products allows for ever evolving bioequivalent dose escalation as needed, of course with increased risk of adverse effects. The common side effects seen with these products are sedation, respiratory depression, nausea, and constipation and itching. They may cause pulmonary edema, coma, cardiac and/or respiratory failure.

C – A broad group of products having similar functional characteristics and tolerability. There is little difference in clinical efficacy among these products at equivalent dosing. These are used for treatment of acute or chronic conditions where pain and inflammation are present. The primary adverse effects are the tendency to irritate the gastrointestinal tract (nausea, ulceration, and diarrhea) and their toxicity to the kidneys. They also increase the risk for aggravating hypertension and inducing heart attack in long term, high dose product users.

As an educated consumer, you should know about your product options and their effectiveness and side effects. Read beyond this brief article and increase your familiarity with these three significant choices and numerous others in the armories of alternatives in pain management.

A – cannabanoids , B – opiates, C – NSAIDs.

John Horn at the Los Angeles Times reported that Actress Natasha Richardson dies after skiing accident  The wife of actor Liam Neeson and member of the Redgrave theatrical family was 45.

Natasha Richardson, the luminous British actress from one of the world’s great acting families, died today. She was 45. The wife of “Schindler’s List” actor Liam Neeson and the daughter of actress Vanessa Redgrave and the late film director Tony Richardson died at Lenox Hill Hospital in New York.  Although the official  cause of death was not announced,  she had been hospitalized after suffering a devastating brain injury while skiing Monday.

There are specific legal mandates regarding use of protective headgear in motorcycling, bicycling, and  sports that place the athletes at risk such as football, baseball, softball and lacrosse. However, in spite of the risk of falls and injury, skiers rarely wear helmets.

In a previous posting we noted that numerous investigative resources suggest that we need to reconsider using our head for battering rams, targets in combative sports, or placing them at risk for other injury.  Head-on collisions are now suspected to cause longer-term effects than initially anticipated. A couple of concussions were found to result in slight mental deficits similar to those in Alzheimer patients when studied over time by researchers who recently published in the journal Brain.

Quite unfortunately, this particular sports/pastime activity accident resulted in more than slow degenerative brain disease. We mourn for Mrs. Richardson and her family.  Moreover, we ask all of you to please protect your heads.