Monday, June 11, 2018

How to Manage an Overuse Injury: Tennis Elbow

Sports Overuse Injury:  Tennis Elbow

Back in December, I played tennis outside in Long Island.  The temperature was 49 degrees.  I returned one of my daughter’s ferocious serves and wow my elbow hurt.  We played the next day again and it hurt worse.  My 12 year old daughter and I had a weekend rivalry;  it was always a close game.  Everything was fine until it got cold.  Why did my elbow hurt?
Because she is a FIERCE player and in order to compete with her I have to grip hard to serve hard, return hard, volley hard and lunge for shots that put me in positions that compromise the arm/elbow/wrist/grip mechanism… leading to TENNIS ELBOW!!Besides all the gripping and smashing, the repetition of 2 matches within 24 hours was a major pain contributor.    The cold contributed too as I had to grip harder because my fingers felt numb! This onset of elbow pain had all the indicators of trouble:  2 sessions close together, changing playing style in the cold and playing through the pain.   
How did I make it through the game?
I tried to focus on hitting the ball in front of me.  I let the balls that were out of position go (easier to do that when you are playing against your child!)  And I realized when I was picking up or receiving balls I was much better off using my opposite hand and not scooping with my racket or hitting it in the air to stop the ball.  I conserved the use of my right forearm muscles to light activities, applied ice a few times a day and it bothered me very little. 
The pain started to return when I became obsessive about knitting January through February.  Thick, heavy yarn.  Knitting for an hour a night.  I finally had to put away the needles and my elbow pain resolved, only to return in March when I had to run through the airport twice in a week carrying overnight bags.  My tennis elbow came back.  Worse than ever.  In fact it was so bad one night it kept me up and I even wondered if something was seriously wrong.  Night pain is a sign you have bad pain. 
But some strong anti-inflammatories, some office treatments and rest improved it.
Now it is tennis season again.  A  month ago I still had pain with each shot.  Physical therapy and taping was the answer. In fact I was  miraculously better.  Home exercises and icing help too. 
Since this is my business, I knew what to do.  For those of you who do not, here are the steps to resolving your pain from tennis elbow, golfers elbow, knee pain, ankle sprain, shoulder pain, wrist tendinitis and any other overuse injury. 
1)ICE: If you feel even a hint of soreness, ice the area after play, working out, lifting, or anytime it is sore.  Also ice it at the end of the day…Just for 5-10 minutes
2) LIMIT PAINFUL ACTIVITY to what you really love.  If you don’t want to give up tennis, don’t take up any other activity that may bother it such as fishing or golfing. 
3) CONSIDER MEDICATION: If the pain bothers you at rest, take an anti-inflammatory (ibuprofen or naproxen) as directed on the bottle. 
4) CONSIDER A BRACE: A brace that limits motion will decrease irritation and let the joint heal.

If your pain persists despite a week of these instructions, see a health professional.  In New York, you can also start directly with physical therapy which may be the ultimate cure.  If 1 or 2 visits do not help schedule a doctor appointment.  An accurate diagnosis will guide more effective treatment.  Your doctor can also prescribe stronger medications and may recommend change in treatment or even an injection.  There are non-cortisone injections that are very effective.    

Final tips include returning gradually back to the irritating sport.  I am currently playing only 30 minutes of tennis twice a week and gradually building up.  Consider scheduling a lesson as good technique can reduce the offending motion.  Equipment is also important  In the case of tennis elbow, changing to a lighter racket with less vibration and the proper grip size is essential.  When it comes to lower body injuries, a new pair of well cushioned, stable shoes can be the final cure. 
While you are healing, cut the activity down to pain free motion, and make up for it with a new activity.    It’s the time of year when outside sports prevail.  I am loving biking, jogging, and kayaking!  And keep that ice pack in the freezer just in case…. 


Friday, April 27, 2018

Don't Let Stress Damage Your Health!

Don’t Let Stress Damage Your Health

Whenever a patient says they are “stressed,” I ask: “good or bad?”  Being out of a comfort zone, time constraints, high demands, and feeling unprepared is often bad stress.  Good stress may be due to a job change, a move, a new pet or baby, or a busy work or social schedule.  Good stress allows you to accomplish goals and meet time challenges.  Bad stress can leave you feeling tired and distracted, unable to focus, and frequently making mistakes. Overwhelming or uncontrolled stress, whether good or bad, can lead to self-destructive “coping” behaviors like heavy drinking, overeating, or skipping healthy habits such as exercise or sleep.

When you feel the physical signs of stress—heart racing, muscles tensing, breathing changing, and sweating—you are experiencing the body’s fight or flight response.  This response and release of adrenaline is designed to keep you alive under physically stressful conditions.  Modern day mental stressors trigger the same response. Stress in manageable amounts can allow you to build up “stress immunity.”  Stress in overwhelming, frequent amounts, can lead to potential health disasters. 

Prolonged stress has been known to be the cause of medical misfortunes such as high blood pressure, heart disease, obesity, diabetes, asthma, arthritis, headaches, skin conditions,  and digestive issues.  Illnesses such as viruses and infections can become more frequent and severe. Pre-existing medical conditions are made worse by stress.   When combined with a diagnosis of depression, stress can actually be deadly.    A recent study in the Journal of Circulation reported combined high levels of stress and depression raises the death risk by 48 per cent. 

When stress is constant and overwhelming, anxiety disorders and panic attacks may occur.  These detrimental side effects can trigger serious health problems including high blood pressure or heart arrhythmias.  Stress often leads to sleep deficits such as insomnia, frequent night waking, or not enough sleep time.  This can result in memory problems, hormone imbalances, and overall poor performance which may put jobs and relationships at risk.  Mental stress can also lead to physical accidents due to feeling distracted and exhausted.  These accidents may result in health compromising surgeries or other serious medical situations. 

So what should you do?
If you feel your health is at risk, or you are experiencing repeated symptoms such as headaches, digestive issues, shortness of breath or tingling, see your doctor to evaluate underlying or secondary medical conditions.  Medications to help with sleep, anxiety, blood pressure, or gastrointestinal disturbances can be life changing.  Often just talking with a health professional including a therapist is therapeutic.

Just as you take care of your body with exercise and good nutrition, taking care of your mind to manage stress will lead to improved health.  How you perceive a stressor is as important as what the stress and body’s response is.  Studies have shown that seeing a stressor as a challenge instead of a threat makes it less stressful. As Dr. McGonigal writes in seeing The Upside of Stress,   feeling stressed is evidence you are successful!  

Getting rid of unnecessary stressors will go a long way to preserving your mental and physical health.  If you are the type to volunteer for everything, learn to say no.  If you can hire extra help to make your work or home life easier, do it.  If you are the one who does it all in your family, ask for help. Reevaluate your most stressful days, eliminate the tasks you don’t need to do,  learn to delegate responsibilities to others, and don’t feel obligated to make excuses for saying no. 

Finding a pleasurable activity and making it part of your daily or weekly routine is also key and something everyone deserves.  Your stress relieving activity should be easy, relaxing, calming and restorative.  Mindfulness is a current buzzword linked to stress management and implies being present and appreciating sights, smells and sounds that surround you.   This can be mentally healing; focusing on small positives allows the mind to filter out negative thoughts and replace them with positive calming happy thoughts. Mindful, stress relieving activities should be individual to you but may include singing, playing and listening to music, coloring, deep breathing, or even hobbies such as crafting and cooking.  Of course, activities such as yoga and tai chi have proven stress and health benefits. 

Other credible stress reducers are the healthy habits of exercise and sleep. Sleeping a bit longer or napping 20-40 minutes in the afternoon can clear out brain waste and assist in mental health which allows better coping with stress.    Exercise does not have to be exertional.   20 minutes light exercise… walking, sweeping, yoga, biking is all you need. 

Find instant stress stoppers that work for you.  Make sure you can do them in a minute or 2, like taking deep full breath, counting backwards from 10 repeatedly, playing with a pet, drinking a cup of tea, reaching out to a supportive friend, reading a funny joke, looking at a beautiful scene or picture, chewing gum, or squeezing a stress ball. Do these stress stoppers when you start to feel your body’s stress signals such as shoulder shrugging, quick breathing, finger tingling, the start of a headache or sugar or alcohol cravings.  Stress signs and stoppers will be individual for you.
Final tips to help you preserve your health by controlling stress:
Be aware of your own physical signs of stress so you can prevent it from becoming unmanageable
Think of stress as a challenge, not a threat
Keep a list of mini relaxing activities you can do instantly
Prevent overwhelming stress by scheduling a pleasurable activity daily
Talk about your stress with a supportive friend or family member or a professional therapist
Say no to nonessential stressors

Remember every day is a new day to try your stress management techniques.  Don’t give up!  With practice, you will be a stress management maven! 

Thursday, March 8, 2018

Finding Daily Moments for Self Care

Just this week, I witnessed 3 working women break down with the realization that they haven’t felt they had time for self-care.  One devoted woman has been caring for her chronically ill neighbor since his recent surgery, spending every dime on meals for him and his sister, missing her beloved dog, running from home to hospital to work back to hospital.  Another, a working Mom looking very tired, hair undone, told me she has not had any time for grooming due to sick kids and a travelling husband.  Another, a doctor/mom seeking care for her (made worse by stress) neck pain described her life as if her hands are always holding a plate of marbles only able to focus on the marble that is rolling off. 

With our modern day hectic schedules, we often put ourselves last. Things like exercise, healthy eating, and sleep need to be added to the calendar in order to be accomplished.  And usually there is a trade-off such as less income, less time for relaxation or less time for family.  We can’t create more minutes in a day, so what can we do?

Consider a different approach.  Rather than changing your life, work on changing your state of mind.  Psychologists advise modifying your mental perspective as a way to cope with any difficult situation. Pondering this and my stressful day ahead one morning, I realized that pausing to take my fiber and B complex supplements represents a tiny moment of self-care.  Just realizing this gave me comfort.  

When I had time to think about it more later, I realized that there ARE times we build in our day for ourselves: preparing a delicious beverage, grooming, meals, a phone call to a friend or loved one.   Rushing through these rituals saves only seconds to a few minutes; time we can often actually spare. 

Make this advice your own to re-visit how you see your daily routines and habits and identify those that are purely for you. Smell your coffee, give your hair an extra brush, scrub your back during your shower, call someone who makes you laugh. These seconds of self-love and self-care will pay off with moments of less stress, more happiness, and ultimately, better overall health.  Enjoy the moments!