Will My Pain Respond To Medication?

CHEMICAL PAIN:
If your pain has a chemical component, it is more likely to improve with medication. This type of pain occurs when chemicals are released in the injured body part, and it includes inflammation. One way to know if your pain is chemical is if it is CONSTANT. This means you have pain throughout every day and it never goes away, no matter what position you are in. It may increase and decrease some, but it is always present. Chemical pain is not changeable with movement.  Typically chemical pain occurs in response to a traumatic injury or repetitive stress on that tissue over an extended period of time. If you have swelling from a new injury, your pain clearly has a chemical component. This type of pain may last for a short or long time, depending on the cause. 

MECHANICAL PAIN:
The other type of pain you may have is mechanical pain. Mechanical pain improves and worsens depending on your movements and positions. If sitting down eliminates your pain, your pain is more mechanical and likely is not chemical.  You fit into the mechanical pain category if you can identify specific activities that remove your pain, such as standing up, walking around, lying down, or stretching. Similarly, you know the specific activities that initiate your pain, such as standing, walking for 5 minutes, bending down, reaching a certain way, or lifting an object. For mechanical pain, moving a joint one way makes it feel worse yet moving it the opposite way decreases the pain. With time, as you find the symptoms improving, your overall joint movement also improves. If you have mechanical pain, it is less likely to respond to chemical treatment (medicine).

PHYSICAL THERAPY VS. PAIN MEDICINE:
It is possible for constant pain to be chemical or mechanical. But if your pain is not constant, you can rule out the chemical component! In that case, find a good Physical Therapist near you! If you suspect both components of pain, you may benefit from both medicine and Physical Therapy.

A new injury will have a chemical/inflammatory component for several days-weeks but as the healing process occurs, the constant pain will decrease so that it is no longer constant. Then the pain will occur mostly with movement of that tissue. If it is stressed excessively during that time (too much exercise or movement), it may cause more inflammation. It is important to follow your healthcare provider's instructions after a new injury. If you do not know when/how to start moving the body part after an injury, you would benefit from Physical Therapy.

Remember that these are not the only components of pain. Be sure to consult your physician about your pain so he/she can assess and diagnose the problem and refer you wherever is most appropriate for treatment.


Source: McKenzie R, May S. The Human Extremities: Mechanical Diagnosis & Therapy. 2000: Spinal Publications New Zealand Ltd, pages 61-72.

Top 10 Healthy Desserts: Made With Fruit

Photo: Ralph and Jenny (Creative Commons)

1. Chocolate-covered strawberries

2. Caramel apple

3. Peaches and cream

4. Banana split

5. Berry/yogurt parfait

6. Strawberry shortcake

7. Fresh fruit w/cream cheese dip

8. Apple crisp

9. Pumpkin pie

10. Carrot cake

If you like sweets yet need to cut calories, this is a perfect combination! Some of us have the willpower to cut out desserts completely from our diet for weeks-months or more, but the rest of us need at least some healthier options to choose from.

One of the single, best ways to lose weight is to eat more fruits and vegetables, which are low in calories and high in nutrients! So why not fit in that extra serving of fruit as you feed your sweet tooth? My husband, kids and I go to the mall (Village at Sandhill) at least once a week for dinner and dessert, so we are very familiar with all the local ice cream shops (Rita's, Marble Slab, Yogenfruz), cafes (Nestle Tollhouse, Panera, Books a Million, Starbucks), and my 3-year-old's favorite: candy stores (The Peanut Man). So whenever we end up at The Peanut Man (they sell popcorn, boiled peanuts, snow cones, candy, chocolate, etc), I have quite a decision to make! Thankfully, they sell chocolate-dipped strawberries and caramel apples, which I love! They taste great and have some nutritional value! 

For those ice cream lovers out there: Marble Slab has a lot of fruit toppings to choose from and even serves frozen yogurt. Yogenfruz sells frozen yogurt that actually tastes like yogurt (not ice cream), so if you are in the mood for ice cream, it may not satisfy your craving. Rita's and Nestle Tollhouse likely do not sell anything with nutritional value, but their desserts are pretty awesome, and you can always order a kid-size serving, which should be enough to make your sweet tooth happy.

The last strategy for dessert-lovers like me is to modify your dessert recipes to add fruit. Bake a cake with applesauce instead of oil (it turns out fluffy and light). Add mandarin oranges (without the juice) to a yellow cake mix. Bake oatmeal raisin cookies instead of sugar or chocolate chip. Let fresh fruit be the star of your dessert tray; no one will turn down juicy strawberries with a dark chocolate dip!

Best Treatments For ARTHRITIS Pain

There are two forms of arthritis: osteoarthritis (OA) and rheumatoid arthritis (RA). This article focuses on osteoarthritis, which is the most frequent form.

Osteoarthritis causes pain in the joints, especially the knees, hips, shoulders and back. It can affect almost any joint in the body. It is most often associated with aging, a long-term result of joint injury, and/or it is genetic. It can also occur as a result of repetitive work tasks, a sedentary lifestyle, or unknown causes.  If you have been diagnosed with this form of arthritis, you likely have been prescribed medication. This is effective for managing many arthritis symptoms but may not be the best or only treatment for you. 

Treatment Options For Arthritis Pain:

Medications

Glucosamine Chondroitin supplements

Fish Oil supplements

Other joint supplements

Physical Therapy

Exercise (in the water may be the most tolerable)

Injections

Bracing/Wrapping/Taping

Surgery (last option, only if all other treatments have failed and pain limits daily function)

How Movement Affects Arthritis Pain:

Even if you have joint pain, it is important to keep that joint moving! If not, it will get progressively stiffer and lose the ability to move in its full range of motion. The joint likely will hurt more if it is not moved for an extended period of time. Exercise is a big part of Physical Therapy treatment of arthritis joint pain. There are some options to make exercise less painful: ice, heat, in the water, and/or with medication. It is important to exercise without worsening the problem. For example, replace jogging with walking, bicycling or swimming. Or replace basketball with yoga or upper body weight training. 

Components of Arthritis Exercise:

1. Range of motion exercise: Move the joint in its full available motion, even if it is painful.

2. Strengthening exercise: Strengthen the muscles surrounding the painful joint, for added stability.

3. Flexibility exercise: Stretch the muscles and tendons to increase their length and allow for better joint motion.

Remember that your pain may be effectively managed with 1-2 months of Physical Therapy treatment! The arthritis does not disappear, but the symptoms may improve significantly. There may be some movements, exercises, postures, or strategies that significantly reduce your joint pain and enable you to do more activities with less pain! Aquatic Therapy (water therapy) may be ideal for you, especially if exercise out of the water is too painful to tolerate. If you belong to a gym, water aerobics may be your best option. Land exercises you may prefer are the stationary bike, walking, or the elliptical machine.

Can Arthritis Be Prevented?

The best way to prevent arthritis pain at an older age is to be healthy and active starting at a young age. Avoid traumatic injuries if possible. Maintain a healthy weight throughout your lifetime. Exercise regularly, including moving all your joints in their full available motions. Practice good posture in your youth and adulthood. Wear proper and supportive shoes with all exercising. Get routine physicals and notify your physician of all minor joint pain. Start a lifelong habit of healthy eating. 

Please comment below if you have found another effective treatment!

Gym Workouts For Beginners

I highly recommend joining a gym, if you can somehow add it to your budget. It is actually not that expensive, compared to other areas of spending, such as cell phone bills and eating out. You should be able to get a membership for $20-$25 per month, which is very reasonable, considering it is an investment in your body. If you are a newcomer to the gym world, it can be very intimidating because you may not know what to do or how to do it. So here are some basics that can help you.

1. Start with CARDIO. All cardio equipment is easy to start. Find the big green button that says Start or QuickStart, and you will start to move. Some cardio machines require that you start moving or pedaling before you press start. The easiest setting is MANUAL, which allows you to increase and decrease your resistance level throughout your workout. It saves you from having to select workout specifics or input your height and weight. Slowly increase to >30 minutes of cardio at a moderate-high intensity (you may need to start at 10-15 minutes at low intensity and progress over several weeks-months). Try to do some cardio every time you are at the gym, even on your strength training days.

2. Don't be afraid of the MACHINE WEIGHTS. They may look complicated, but most of them are very simple to operate. There are instructions written on each machine that explain your seat and angle adjustments. Then you select your weight/resistance. Try different weights until you choose the appropriate amount (moderately challenging; you should be fatigued by the last few repetitions of each set). Then perform 2-3 sets of 8-15 repetitions. For example, start with 2 sets of 10. Progress to 3 sets of  10 in a few visits. Then increase to 3 sets of 15. Once you can do 30-40 repetitions at one weight, you can progress to the next level. Do not be afraid to ask the staff to show you how to use a piece of equipment. I'm not sure why, but there are usually at least 5 staff members at the front desk of my gym.

3. Choose a WORKOUT SCHEDULE. This will help to guide your daily exercise and strengthen all your muscle groups. If you are using the machine weights, each one states which muscles you are working. Do not strengthen the same muscle group on two consecutive days. It may help to divide the strength training into groups, such as arms, shoulders, chest, upper back, lower back, abdominals, legs. Then choose which days of the week you will exercise each muscle group. Try to strength train each body part at least 1-2x/week.

4. Try out some of the GROUP EXERCISE CLASSES. These are ideal for those of you who need extra instruction or are new to the gym. If the class does not make you sweat, it is likely too easy for you.

5. Lastly, borrow exercises from other people. You can get some great ideas from the exercises trainers give their clients. Or find the ab corner of the gym; you will see people doing much more than just crunches and sit-ups.

Weightlifting Safety: How Do I Avoid Injuries?

Photo by:  Official U.S. Navy Imagery

1. Do a 5-10 minute cardio warmup first. If you will be strengthening the legs, warm up on the treadmill, bike, stairclimber, elliptical machine, etc. For upper body warmups, try the arm bike, row machine or elliptical (using both arms and legs).

2. Warm up strength exercises with light weights.

3. Exercise muscles in their full range of motion and at a slow-moderate pace.

4. If performing a new exercise, start with lighter resistance and higher repetitions.

5. Do not lift through joint pain. Either decrease your resistance or select a different exercise to strengthen that muscle group.

6. Prepare appropriately for high-level or maximal lifts. Do not perform without adequate training and strictly proper technique.

7. Use ice after a challenging workout (for example: knees or shoulders).

8. Strengthen opposite muscle groups to maintain balance between front/back/sides of each body part. Use various exercises to strengthen each muscle.

9. Beware of risk for knee injury if squats are performed incorrectly. Do not let your knees go forward past your toes (imagine a vertical line coming up from your toes).

10. Beware of risk for back injury with squats and dead lifts. Do not perform unless you know proper technique.

11. Avoid using wraps and braces for stability. If you train without them, you can slowly increase your weight without needing external supports.

12. Lifting belts are not necessary for back safety if you learn the proper techniques and train without using them. However, if you have trained with a belt, do not attempt a heavy lift without it.

13. Do not neglect strengthening of the rotator cuff, back extensors, hip abductors/adductors.


Source: Baechle TR, Earle RW, editors. Essentials of Strength Training and Conditioning, 2nd ed. 2000: National Strength and Conditioning Association. Pages 48-52.

How Do I Manage Chronic Pain?

First, know your diagnosis. How can you treat a problem that has not been diagnosed? You will not know your traditional or alternative medical treatment options unless you have a specific diagnosis. Whether the condition is fibromyalgia, arthritis or cancer, there are treatment options available for you. Without a diagnosis, you will not receive adequate treatment. So pursue finding the answer for why you have chronic pain, which gives you the opportunity to accept the truth about your body. In that case, you can learn to live and thrive despite a painful diagnosis.

Second, know your body. You must identify the specific activities and movements that increase and decrease your pain and symptoms. You should be able to readily list your aggravating and relieving factors. That is helpful first for your physician, therapist or other healthcare practitioner as they develop your diagnosis and treatment plan.

Third, modify your lifestyle based on your list from #2 (aggravating and relieving factors). Here are some examples. 

a. Lie down on on your back for 10 minutes without a pillow and place ice on the painful area. This may give enough pain relief to get you through the afternoon of chores.

b. Avoid the chair that causes your back to hurt. Find another chair. Or if sitting in that chair for 1 hour causes your back to hurt, stand up and stretch every 30 minutes.

c. Sit in the back row of church so that you can stand up as frequently as needed. This may be the modification that enables you to get back to church again.

d. Do a specific exercise that decreases your pain, and repeat it every hour.

e. Consistently walk for 30 minutes per day because that keeps your pain better controlled.

f. The next time you buy a car, get one that is higher off the ground because getting in and out of a low car always aggravates your pain.

g. Cook for 15 minutes at a time if standing too long aggravates your pain.

Fourth, take medication as prescribed for a time period. If it is ineffective, follow up with your doctor to see what other medicine may be appropriate. Some medicine is most effective when taken consistently, so do not skip doses or days.

Fifth, comply with doctor's orders. This includes lifting restrictions, activity restrictions, lifestyle modifications, prescriptions and other medical treatments (such as Physical Therapy or chiropractic care). If you truly want to get better, what are you doing to make that happen? Are you doing the home exercise program from your PT?

Sixth, be sure you have exhausted your treatment options. Have you tried Physical Therapy, Aquatic Therapy, Chiropractor, Accupuncture, Massage Therapy, Exercise, Weight Loss, Medication, Natural Remedies, Vitamins/Supplements, Topical Rubs/Creams, Ice/Heat, Over-the-counter treatments, Injections, Diet changes, etc? 

Lastly, do your own research and be your own advocate. If you know the answer to #1, then find support groups, websites, books and articles on your diagnosis. Find out the best local or national specialists in your area of chronic pain.

Chronic pain is very difficult to live with, but you ARE still alive! God has blessed you with this life, so learn to best manage your pain so that you can fulfill your purpose for living!

Pregnancy, Exercise and Weight Gain

What Exercises Are Safe During Pregnancy?

The ideal form of pregnancy exercise for you depends on your exercise routines beforehand. In general, cardio is important to continue. Arm/leg strengthening is beneficial. Core strengthening, with some modifications, can remain part of your routine. Prenatal yoga/pilates are ideal forms of exercise to do at least 1-2x/week, in combination with cardio and strength training. The biggest guideline is your heart rate; keep it around or below 140 beats per minute. So if you used to do sprinting intervals, you will have to give those up, at least for these 9 months. Jogging is typically not recommended unless you jogged consistently prior and can slow down your pace appropriately now. Seated exercise of almost all types is appropriate (including leg and arm strengthening with machine weights or free weights). Lying on your side is ok, which may be a position you can do in yoga/pilates or with core strengthening instead of lying on your back or tummy. Standing exercise is good, including leg/arm strength training with free weights. Swimming is ideal, especially if you are having joint pain or discomfort. Most gym cardio equipment is appropriate during pregnancy. Walking is one of the easiest and safest forms of exercise you can do.

Exercise Guidelines based on Prior Fitness Level:

1. If you were minimally exercising prior to pregnancy, then stick to low-level choices such as walking, water aerobics or prenatal yoga/pilates.

2. If you were exercising 1-3x/week consistently prior, then continue the same type of exercise (such as stationary bike, elliptical machine, aerobics class, etc). However, be sure to modify the intensity to keep your heart rate below 140 beats per minute.

3. If you were consistently working out 4-5x/week at a moderate-high intensity prior, then you should be able to continue similar forms of exercise but with modifications. Decrease the intensity/speed in order to keep your heart rate at 140 beats per minute. Remove all plyometrics (jumping) exercise from your routines. Eliminate supine (lying on back) and prone (lying face-down) exercises.

4. If you were an exercise-aholic prior, you obviously will not let pregnancy keep you out of the gym. Let the heart rate of 140 beats per minute be your guide. As long as you are not having morning sickness or joint pain, you should be able to exercise most days per week for an hour or even more, depending on the type of exercise. For example, if you are doing a 1-hour yoga class, you should be able to do 30 minutes of cardio on the same day. Your body/baby will tell you if you are overdoing it. It is urgent to drink more water than you think you need. Do not worry too much about your weight gain; let your OB monitor it and give any needed advice in this area. Most likely, if you love to exercise, you will easily lose all your baby weight after he/she is born.

What Exercises Should Be Avoided During Pregnancy?

You should not lie flat on your back, which eliminates some upper body exercises, core exercises and yoga positions. You should not lie on your stomach, which eliminates some core exercises and yoga positions. Avoid plyometrics or jumping drills. Avoid dangerous exercises/sports that would put you at fall risk. Avoid exercise at high intensities (such as high-intensity interval training). Avoid exercise that causes back pain or joint pain. Do not exercise outside in hot weather. Avoid sit-ups and abdominal crunches. 

How Do I Maintain My Fitness Level During Pregnancy?

You will likely lose some of your cardiovascular endurance and muscle strength/power during pregnancy if you abide by the recommended guidelines because it is not safe to exercise in the pre-baby intensity and manner. However, consistent exercise 3-6x/week at a low-moderate intensity has countless benefits. It will keep you moderately fit, prepare you for childbirth, help to limit your weight gain, and prevent some prenatal medical problems. The most important thing to remember is the safety of your baby, which matters more than how much weight you put on. 25-35 lbs of weight gain is the usual recommended amount, but your doctor's orders may vary depending on your pre-pregnancy weight and other factors.

How Do I Avoid Excessive Weight Gain During Pregnancy?

First, avoid overeating! You only need ~300 extra calories per day during pregnancy. Try to make healthy food choices that are filled with nutrients for you and your baby. Next, stay active! Do not put yourself on bedrest unless your physician does. Do not become a lazy glutton simply because you are pregnant and have people willing to do whatever you ask. Try to continue working or doing your usual daily activities throughout these 9 months. Lastly, exercise regularly! Do so several times per week, as much as possible throughout your pregnancy.