Thursday, October 3, 2019

Braces, straps and tape: what do they do and do they really help?

The US Open was a prime example of the popularity of taping and straps used by athletes. Many of these elite tennis players displayed support to a vulnerable area:  Serena had her ankles taped, Andrescuu  wore  a thigh and wrist strap plus a spiral cord on her forearm, Nadal taped his fingers, Medvedev had athletic tape on his right arm and left leg. Supports, straps and tapes are fascinating to me;  I like to imagine what injury lies below.  I could not figure out the spiral cord on Andrescuu’s forearm and searched the web for its medical indication;  during the finals I giggled when I learned from the commentators it was an extra hair tie she “just liked the feel of.” 

In truth, many of these voguish looking applications are worn simply because they feel good, easing the ache of joints and muscles. A sore area can feel supported with tape or straps, allowing the athlete better performance.   After repeated wear during successful play, they may become part of the outfit due to psychological dependence.   The placebo effect is huge.

Nevertheless, if they are holding the pros together, they must be worthwhile, right?  I often apply them as treatment in my practice with time limits for use. It is a proactive move towards healing that can give instant relief.  Braces are indicated for instability, such as a sprained ankle or wrist.  Taping is great as a posture and positional reminder.  ACE wraps can hold therapeutic patches on or also serve as more flexible, comfortable support and motion limiters.  Straps are mostly worn during activity serving to dampen the vibration and motion occurring in a tendon.

Braces prevent excessive motion, as ankle, wrist and some knee braces do.  They not only provide rest but also limit irritating activity by stopping the offending motion.  Some braces also lessen the irritating vibration caused by repetitive motion such as a patellar tendon, ITB or elbow strap.   Braces can be very effective as long as they are properly fit and appropriate for the problem they are treating.  If worn all day for over 5 days, they can lead to muscle weakness. If they are recommended to be worn 24/7, a weaning protocol of 4 hours on, 4 hours off, with increasing time off over several     weeks will prevent a flare up due to straining a weakened area. 

Taping is trendy.  Overhead athletes sometimes wear shoulder tape;  the idea is to guide and support the rotator cuff muscles in a direction of normal function.  Taping can also provide mild support depending on how many layers are applied.  Kinesiotherapy tape is most commonly used, made by different companies and providing different amounts of stretch and support.  When tape is used over a muscle area, the idea is to re-enforce the muscle motion pattern and guide a joint into better position and direction.  Athletic tape (usually white) is thicker and less stretchy;  this is used to wrap a joint in layers to restrict motion and provide support. This is commonly used by athletic trainers on the field.  Taping also protects from abrasion. 

With the wide variety of braces, taping methods, and straps available, you will likely need professional help to choose the best treatment for you.  Over the counter products can work, but if you do not get immediate relief, they are not effective.  If you can’t choose, applying an ACE wrap, snugly but not too tight can provide relief.  ACE wraps are comfortable, can be tightened or loosened, and can provide moving support.  I often recommend them to be worn at night with a pain relieving, anti-inflammatory cream such as aspercreme underneath. 

Many of the tapes and braces simply make you feel better by giving the joint a hug and making it feel supported and less vulnerable. The nerve endings in our skin and joints respond to  touch and pressure both positively and negatively.  It it feels good, use it.  If it makes the pain worse, forget it.   If it is doctor recommended but does not feel comfortable, ask for a different kind.  As always, listen to your body signals.  Don’t spend too much money on these products.  And don’t use them as a crutch to push through pain.  If you are having pain for more than a few days that bothers you all day and especially at night, see a doctor.

Friday, July 12, 2019

What is Sciatica?

What is Sciatica?
“My sciatica is acting up” is a common phrase.  People generally use the word to describe butt pain, back pain or leg pain.  To a doctor, sciatica refers to pain travelling down one side of the lower back and or butt down the back of the leg.  Sciatica may stop mid hamstring or continue to the calf and foot.  The term refers to the path of the sciatic nerve, a large nerve bundle that carries sensory (what you feel) and motor (how you move) nerves down the leg from the lower spine.  It is the thickest nerve in the body. 

Sciatica is a broad term which does not specify the cause of the pain; rather, it is a description of symptoms.  Sciatica can result from any of the following:

A pinched nerve in the spine due to a disc, arthritis, or spine slippage
A gluteus or pyriformis (buttock) muscle injury or spasm
A hamstring injury
A soft tissue injury to the hip such as a labral tear
Pressure on the sciatic nerve along its path through the pelvis from any cause

The medical term for sciatica originating from a pinched spinal nerve is radiculopathy.  Radiculopathy is radiating pain from an irritated nerve along the path of that nerve.  (You can also have a radiculopathy down the arm from a pinched nerve in the neck.)  Radiculopathy is often accompanied by burning and shooting pain and can also be associated with weakness and numbness. 

If you are suffering from the symptoms of sciatica for longer than 3 days, see a doctor.  If you have accompanying leg weakness, such as trouble lifting your foot as you walk (a foot drop) see a doctor immediately; you may have a herniated disc.  While this is not life threatening, it can become permanent if not treated early.  Taking steroids by mouth or injection are part of the treatment. 

If ignored, sciatica pain often causes other joint trouble.  Limping to avoid pain can lead to a rotated pelvis, excess stress on the opposite hip and knee, and twisted dysfunctional posture.  This can begin a never-ending cycle of pain that may take twice as long to recover from as the sciatica cause itself.  

With the right diagnosis and treatment, sciatica will resolve.  Strengthening and stretching is always essential to recovery.  Consider a maintenance exercise and stretching routine to prevent sciatica from returning.  Modifying irritating activities are also important to full recovery.  Spine straining exercises such as rowing, medicine ball twists and throws, and heavy lifting may need to be eliminated from your work-out routine for life.  Be wary of moving furniture or lifting heavy items.  Especially avoid combining Bending, Lifting and Twisting motions (BLT).  As with all injury prevention, listen to your body and stop if you feel pain.  

Wednesday, May 15, 2019

How do Wellness, Mindfulness and Health Relate?

Wellness and Mindfulness are buzzwords implied to be associated with Health. The terms seem to be everywhere:  in print and social media, as labels of health and wellness centers, and as titles of corporate lectures geared to improving productivity.  Associated visuals include yoga, herbs, stacked stones, greenery, and water.  The words are often used together but what do they really mean, how do they relate, and, most importantly: what do they do for our health?

Wellness implies a lifestyle of overall happiness, good health and psychological fulfillment.  Wellness has been identified as components numbering between 5 and 8 depending on the source.  The most common five are listed here first:
Physical:  fitness, nutrition, sleep, activity levels and overall health
Intellectual:  creative and mental activities, learning, curiosity
Emotional:  the ability to deal with stress, be flexible, have relationships and a positive outlook
Social: having supportive friends and or family, giving back to the community
Spiritual:  prayer, meditation, religion including love and hopefulness
Occupational:  personal and career satisfaction from work, family, or volunteer responsibilities
Environmental: having pleasant, healthy, stimulating surroundings
Financial:  being satisfied with current and future financial status

Disease risks are suggested to go down as a benefit of wellness.   Longevity is implied, along with a generalized improved feeling of energy, less illness, better mental health, and overall fitness ability.  Wellness encompasses the non-objective measures of health that make you feel better internally.  Wellness measures are individual to each person and are only valid if acceptable to the person they are for. 

Mindfulness is the act of letting go of stressful, negative thought processes and slowing down to be more aware. It includes various techniques and practices such as:
Meditation: a technique used to calm the mind
Relaxation: being free from tension and anxiety
Self-reflection:  thinking about ones’ thoughts and processing
Awareness: consciousness and realization
Gratitude:  thankfulness and appreciation for the good around us

Mindfulness has been practiced for thousands of years as part of Buddhism, Hinduism, and yoga.  It has been brought into non-religious meditation practice and recognized by health providers as a key to stress reduction, stable mental health and overall positive outlook and attitude.  Memory, attentiveness, productivity, creativity, and empathy all benefit from mindfulness.

There are differences between wellness, mindfulness and health.  Objective state of health, as determined by a doctor, nurse or other medical professional can be measured:  blood pressure, blood sugar, blood chemistries, weight, and negative tests for diseases.  In contrast, wellness is a subjective state, thought of by some medical health professionals as counterproductive to overall health.  Wellness is even associated with holistic and alternative health as a contrast to standard medical care.  Mindfulness is often considered an aspect of wellness representing psychological health.

Unfortunately, statistics reveal that despite our new attention to wellness and mindfulness, the US population’s health has declined.  Rates of depression, diabetes and cancer have increased in the past 20 years by 10-30%.  If wellness is tied to alternative medicine, proceed with caution:  alternative medicine ignores all standard medical practice including prescribed medications or regular MD visits and exams. To be clear, wellness and mindfulness are not substitutes for health. 

Still, the ideas behind the words are valuable to living a fulfilling, peaceful and happy life.  Addressing the components of wellness may not actually improve health measures, but will likely keep you feeling grounded and less stressed.  Staying calm and focused through mindfulness techniques will reduce injuries and accidents.  Wellness and mindfulness lifestyles reinforce healthy habits including sleep, nutrition, relaxation, avoiding toxins, spending quality time with friends or family, getting exercise and feeling grateful.  These are unarguably a recipe for overall happiness, less stress and feelings of better health.