Friday, November 8, 2019

Cancer Rehabilitation: Restoring Quality of Life Through Personalized Health Care Treatments

Currently “Movember, ” raising awareness of prostate and testicular cancer, and on the heels of Breast Cancer Awareness month, learning about the consequences of cancer and its treatment is timely.  While surviving cancer is a tremendous victory, living with potential limitations can be challenging. The statistics suggest that cancer patients are three times more likely to have health, psychosocial and physical impairments.  Pain is very common and present in 30% to 90% of survivors.  Surgical site scarring, limited joint motion or overall mobility issues can result.  Swelling and or weakness secondary to chemotherapy, radiation, or the cancer itself is common.  Sometimes side effects of treatment are so problematic and pervasive it is difficult for a patient to be grateful for surviving at all. 

Rehabilitation is the process of returning to activity and function after illness or injury. It covers many dimensions including pain management, speech and swallowing, mobility, self-care such as showering and dressing, and advanced activities including work, driving and exercising. 
Medically directed pain management and rehabilitation empowers a cancer survivor to return to their pre-cancer life and activities faster and more fully.  Following are the types of rehabilitation available to anyone with symptoms of pain, weakness, limited range of motion and or decreased activity levels:

Medical:  Doctors diagnose the source of the pain or movement limitation and treat with individually prescribed therapy, medications, procedures, and injections as needed

Physical Therapy:  Personalized treatment sessions usually in a gym-like setting to address large limb and lower body function, getting up and down, and walking; includes guided exercise

Occupational Therapy:  Hands on upper body and fine motor rehabilitation; includes vocational therapy (homemaking and job retraining)

Speech Therapy:  Training that aids in swallowing, communication, memory and facial and vocal functioning 
(Neuro)psychology:  Evaluates and treats cognitive and mood disorders resulting from cancers of the brain or neurological side effects of chemotherapy or radiation. 

Orthotics and Prosthetics:  Bracing and limb replacement to return to maximum mobility and function


Rehabilitation professionals are encouraging, reassuring health care providers who patiently teach practical lessons to restore quality of life. This includes personalized assessment of  all aspects of day to day activities and improving mood through positive feedback and encouragement.   Sometimes recovery can take over a year.  Returning to pre-cancer treatment activity level is the goal.  Anyone who has undergone cancer treatment should consider rehabilitation (which is often covered by health insurance!) to improve their everyday well-being.  Through medically guided therapy, medications as needed, and psychological support to ensure quality sleep, nutrition and fitness, cancer survivors will be able to feel like the champion that they are.

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.