Age and Professional Sports

Athletes and AgeThe prime of our lives is in our 20s. During the decade of time from age 20 to 30 years of age, our bodies and brains become fully mature. We are at our peak performance both physically and mentally. The body is the most flexible and heals quickly from minor trauma. Mentally, the brain becomes mature and can perform at a high level. For most sports, the best athletes are at their prime when the body reaches physical maturity. The length of time at a prime level is often about ten years. After that time, the body starts showing signs of wear and tear.

Professional athletes stress their bodies to the extreme on a daily basis to maximize training for their sport. Most are a bit sore every day from the hours of training and stressing of the muscles and joints. In general, the level of exercise completed is usually a bit beyond what the body was meant to endure. Structures of the body slowly start wearing out. Multiple injuries often start occurring, and it takes longer and longer for the person to return to full health.

The good news is that most of us our not professional athletes, so we are not dependent on an extreme level of activity for our livelihood. The bad news is we still are wearing out our bodies over time, but just not as fast as most athletes. Activity keeps us healthy as long as we do not overexert our bodies. Doing strength training keeps muscles strong and bones healthy. Aerobic conditioning is necessary to maintain good cardiovascular health. Being normal weight for our height keeps us from stressing the body structure as a whole. The average body starts to show signs of wear and tear in our 40s and 50s.

Historically, the body was designed to get us to about age fifty. In centuries past, before modern medicine and the industrial revolution, death often came by age fifty due to trauma, disease, or other natural causes. Now, we have learned to survive into our late seventies or eighties. As we grow older, age affects every organ including the muscles, tendons, joints and bones. The degeneration often causes aches and pains as we try to compensate for the changes that are occurring.

As I’ve said before, your body is like a car. A new car is beautiful and performs well with very little maintenance. As the car gets older, it takes more and more care to keep it running smoothly. If it is not maintained, it will likely fall apart. If we drive it hard and beat it up, it will fall apart sooner. If we baby it, it will become a precious antique. The body is not much different. We last longer and stay healthier if we take care of our body. Doing the work to keep healthy is beneficial to live a happy life.

Men and Women Similar When It Comes To Chronic Pain

Men and WomenAlthough there have been previous studies that suggest women have a higher pain tolerance than men, a new study out of the University of Malaga suggests that a person’s resiliency, not their sex, determines how well they handle chronic pain.

For their study, researchers analyzed numerous traits among 400 patients suffering from chronic spine pain (210 women and 190 men). What they found was that personal qualities, not genetic differences, was the best indicator of how a person dealt with chronic pain.

In essence, certain men and women have a very difficult time managing chronic symptoms, while others are able to work through the discomfort. The people who don’t let the pain bog them down are the same people you’d want on your basketball team when you’re down 10 points in the fourth quarter or if you need a big last week to meet your quarterly sales goals, because the research suggests that how a person handles adverse circumstances is the primary quality linked to an individual’s pain tolerance and how they adjust to chronic pain.

According to the researchers, the findings suggest more similarities than differences between men and women.

“More resilient individuals tend to accept their pain, that is, they tend to understand that their ailment is chronic and they stop focusing on trying to get the pain to disappear, to focus their energy on enhancing their quality of life, despite the pain, said Carmen Ramirez-Maestra, the study’s lead author. “In this regard, patients who are able to accept their pain feel less pain, they are more active on a daily basis and have a better mood.”

So remember, treating chronic pain is only half the battle. Dealing with, accepting, and not letting pain wear you down are other pieces to the pain puzzle.

Related source: Daily Digest News

Practicing What You Preach

Dr. CohnThere is an old adage that suggests a person should be wary to trust a skinny chef, and a similar principle can be applied to the medical world. Would you trust a doctor who is obese, waddles into the room, and smells of smoke to advise you on diet, exercise, and healthy living? Probably not, because they are not following their own advice.

At some level, the medical practitioner must be able to communicate and relate to their patients. Sometimes, it is their level of knowledge and experience that is obviously superior that helps invoke trust. At another level, sometimes it is the personal experience that may make an added difference.

As a Physical Medicine physician specializing in pain medicine, I have spent years studying and providing care to thousands of patients. I try to keep up with new research and treatments, reading journals and even attending conferences. During the course of countless evaluations, a doctor learns how to address a problem and that there may be many different treatment approaches to the same problem. One thing I didn’t expect to learn was that I would have to apply my knowledge to my own problems.

Back pain affects about 85% of the population at some point in their lives. My first bout occurred during my second year of medical school. I was lifting free weights with the bar at an awkward angle, and the next thing I knew my back had given out. Since I had no weakness, just pain, the physician treated it conservatively with ice, heat, physical therapy and anti-inflammatories. It took months to resolve, but as long as I was careful about using proper body mechanics when lifting, I was fine.

Years later, when I was in my late forties, I started noticing my back more regularly, and it occasionally flared with bouts of pain down my legs. This was when I underwent my first MRI – 25 years after my back was first injured. The scan showed a significant L5/S1 spondylolisthesis with narrowing where the nerve roots exit. A radiologist friend who read the scan asked me which colleague I planned to see for surgery. I tried injections, massage, exercise and anti-inflammatory medications to control pain at times, but they only stifled the pain, they didn’t resolve it. Aerobic conditioning was probably the most helpful, but I still dealt with pain from time to time.

Unfortunately, a couple of years ago it flared worse, brought on by no special aggravating factor. A new MRI showed severe narrowing where the nerves exit at the L5/S1 level. A couple of injections calmed my spine down, and I again was given a lesson in the importance of exercise. Regular exercise has been essential to control symptoms. If I do not exercise, my back begins to ache. Stretching and loosening up the back muscles is necessary multiple times a day, and anti-inflammatories help control stiffness. I also use a neuropathic medication to keep some of the sensitivity of the nerves down.

Despite back pain, life can still go on and be pretty normal. I do most everything I want to do, but running and jogging is off my list. I still exercise, but strengthening my core is not optional any longer. Core strengthening is definitely boring, but it helps immensely. I prefer aerobic activities like biking, using an elliptical or walking long distances. Long walks usually require stretching breaks, but as my dog gets her exercise, so do I.

So far, I have no absolute loss of muscle function in my legs and no trouble controlling my bladder or bowel related to my back. Still the most important aspect of treatment is taking care of myself and exercising. To get that done, I have to wake up very early each day and make it a priority. If a doctor does not take care of himself, it is not possible to take care of others. At this time, listening to my own advice of exercise, take your medications, don’t complain and stick with the routine are working for me. For me, I must practice what I preach.

Pain As We Age – Why Your Body Is Like A Car

Elderly PainOur bodies are similar to our cars. When new, everything is beautiful and works as it should. As they age, it takes regular maintenance to keep things running correctly. Initially, we may have to fix little things, like bumps and bruises. As we get older, the problems are more complex. Things start to show wear, and parts may need significant repair or replacement. Keeping everything looking good becomes an effort since the beast is being used and abused daily.

Every part of our body ages as we age. The joints that allow us to move smoothly all eventually show some degeneration. The muscles, tendons and ligaments that control motion get strained and sprained. The body fatigues and moves less well at 40 then at 20 years, and as we get past 50, most of us can readily feel the changes. Despite the wear and degeneration, the trick is to keep moving and do the daily maintenance to keep the body going. If one does not do the work to keep the body maintained, just like an old car, it will definitely stop working.

Pain and Aging

Everyone has pain in their life at some point in their life. When you are young, it is due to injury, it is acute, and it is short term. As we get older, it may become chronic, and it usually becomes more persistent. Acute injuries are usually related to trauma, and are isolated, small and heal quickly. Chronic injuries stem form repeated wear and tear, degeneration and aging. Chronic damage can be permanent and tends to cause ongoing stimulation of the sensory nervous system. The older we get, the more likely we are to have degeneration. The expectation that one would have no pain as we age is unrealistic.

The goal in life is to stay healthy and minimize the trauma to body. Unfortunately, many of the things that we have done to stay healthy may cause extra wear to the body. The sports we play often stress the joints of our bodies like the shoulders when we throw, or our hips, knees and feet when we run. We do heavy lifting regularly, and have accidents that cause whiplash and injury to the low back and neck areas. Being healthy means being active, moving and using the body.

The human body is amazing in its design and ability. We have tried to make robots as sophisticated as we are, but at best they are currently crude approximations. Historically, the human body has been designed to last between 40 and 50 years. In the 1700 and 1800’s, the average lifespan was about 45 years. Trauma, injuries, infection, and heart disease and many other problems would kill us. The design of our bodies was to maximize our abilities for that life span. As the world became more industrialized, science and medicine discovered ways to fight disease and prolong our lives. However, the sophistication and design of our bodies is the same. We have not evolved into any different species or body design. The life expectancy has gone from 40 to 75-80 years. Our bodies are the same, they are just getting older.

Life is tough on our bodies. We are out living the design of the parts, and they are degenerating slowly. With degeneration, the body sends us signals that everything is not working smoothly. Those sensory signals are perceived as pain. However, most of the time it is ok to acknowledge the signals and keep moving to stay healthy. Staying active, maintaining strength and aerobic conditioning helps the body and prevents further deterioration. Age and pain signals often go together. The goal is to understand the signals and keep moving forward. Life without pain is unlikely, just keep up the regular maintenance and keep going. Don’t become a couch potato.

Spinal Disc Imaging and Discograms for Back Pain Problems

Back PainThe spine has discs between each vertebral body in the cervical, thoracic, and lumbar spine. These discs are dynamic spacers between the bones and facilitate the motion between segments. The structure of the disc varies between the cervical, thoracic and lumbar levels. The differences in structure lead to different stabilization patterns in each area of the spine. The strongest discs are in the lumbar region and the weakest are in the neck, with the thoracic discs being of moderate strength.

The discs have two components, the outer anulous fibrosus, and inner nucleous pulposus. The outer ring is made of interlaced collagen fibers. The nucleous is a loose fibrous network with a gelatinous acidic mucoprotein. The combination of the outer core and inner gel is to provide the ability to absorb forces between the bones as the body moves. Extreme forces and sudden movements as well as age can damage the disc integrity. The strength and weave of the fibers is the strongest in the lumbar region and the weakest in the cervical region. Lifting and twisting heavy objects is main primary reason a person suffers a low back injury, while whiplash injuries account for the majority of neck problems. Repetitive activities and age can also damage the discs throughout the spine. Damaged discs can bulge, crack and leak, and herniate. The discs injuries can be very painful, and treatment should not be ignored.

Diagnosing Disc Injuries

Studying the spine is done in multiple ways. The simplest is by an X-ray; They can give basic information on the integrity and alignment of the bones, the height of discs, and the presence of degenerative changes. In a young person, X-rays are usually normal, but in the older person they tend to show age related changes. The problem with an X-ray is that it often can identify the area of pain, but it gives very little information about a cause of pain. CT-scans are sophisticated computer enhanced X-rays that give significantly more information about the bony structure of the spine and some limited information about the discs and spinal nerves. An MRI scan can give significant information about the discs, spinal nerves and cord, joints and bones of the spine. Electromyography can map whether the nerves of the spine are functioning properly. Discograms pressurize the disc with contrast and then they are viewed under X-ray or CT scan to determine the integrity of the disc and whether they are painful. Your doctor will determine which method is best for identifying your issue.

Discograms can tell valuable information in the lumbar region, however, in the thoracic and cervical region the data is of questionable value. In the lumbar region, a discogram can help identify whether a disc has internal disruption and if it is painful. If only one disc is painful, a doctor may be able to preform routine surgery to address the problemed disc. That said, multiple painful lumbar discs do poorly with surgical management. Often, MRI scans can give sufficient information such that a discogram is not necessary. In the thoracic region, a discogram would not clarify surgical options since the MRI can provide sufficient information along with physical exam. The nature of the discs in the cervical region makes discograms vary unreliable for useful information.

I typically suggest that a patient undergoes an MRI if they are experiencing back pain, as it provides a comprehensive look into the inner workings of the back. If you are plagued by constant low back, spine or neck pain, stop in for an assessment. We’ll work with you to find a solution to your pain.

Marijuana and the Reduction in Painkiller Overdoses – Part 2

Medical Marijuana mnLast month we discussed the new study published in JAMA (The Journal of the American Medical Association) showing that drug overdose deaths due to opioids declined in 13 states that legalized medical marijuana. The study just looked at death rates overall due to opioids and noted that they happened to decline up to 30% in states that legalized medical marijuana. Today, I expand on the findings.

This study is great, sensational news, but in reality, it is a leap of faith that these two subjects are truly correlated. Opioid overdose and deaths are a very complex issue. The overdose of opioids is linked to many things, especially recreational use. The death rate from overdose is related to many factors, including whether the overdose was accidental or on purpose, such as a suicide. Furthermore, the access to treatment for overdose is important, especially whether first responders can recognize it and provide drug reversal rapidly and then get a person to a hospital for support. So, if you are using opioids to get high, it does not matter if marijuana for medical use is legal since they are not using it.

Medical marijuana is used for a variety of problems, including nausea related to cancer, seizures, and glaucoma. None of those conditions have much to do with opioids and drug overdoses. So if marijuana is legal for glaucoma or treating seizures, why would death rate due to narcotic overdose change? Rationally, it would not.

Unfortunately, this is just another example of a study finding a nice statistic that has no true correlation to the data. This study did not specifically look at factors that are related to opioid overdose death. If the study actually looked at reasons related to opioid overdoses, treatments, and deaths, there may be some validity. Rewarding medical marijuana with this lofty success is poor research and data interpretation. A prestigious journal, JAMA, should do much better at critically analyzing research and publishing articles. This is an amazingly poor job of data analysis and conclusions with an over simplification of causes of opioid related deaths.

Causes and Symptoms of Pelvic Pain

Pelvic PainBoth men and women can be plagued pelvic pain, but it is more common in women. Common causes include bladder infections, stones, and bowel issues. In women it can include endometrial issues and ovarian cysts. Treatment is based on the cause, and these pains usually end once the acute condition resolves. Pelvic pain is usually caused by issues like:

  • Hormonal changes
  • Tissue scarring
  • Bladder issues
  • Hernias
  • Sensory nerve degeneration, entrapment, etc.

Below, we examine these causes.

Hormones, Bladder and Hernia Issues Causing Pelvic Pain

Chronic pelvic pain in women is often related to several problems related to the unique pelvic anatomy. Endometriosis and fibroids are uterine tissues that form outside the normal uterine location. Their growth is stimulated by the normal hormonal cycles. The tissue eventually causes scar tissue in the pelvic region and the scarring can cause sporadic pelvic pain. Surgery is often used to help resolve some of the problems. Physical therapy and neuropathic medications can be helpful for long-term management.

Chronic interstitial cystitis is an issue in mainly women, and is often referred to as irritability of the bladder. The lining in the bladder becomes scarred, has pinpoint bleeding, and then the bladder becomes shrunken and stiff. Frequency of urination (up to 60 or more times a day) and constant pelvic pain occur. Bladder distention can be helpful and sometimes medication is instilled into the bladder. Bladder stimulators are sometimes implanted to help control symptoms.

Hernias more commonly appear in men than in women in the pelvic region. The muscle wall in the groin region weakens and abdominal contents push out of the injured area. The patient and doctor can decide if surgery is the best option, but if left to heal on its own, nerves can get entrapped in the resulting scar tissue. Physical therapy to release scarring, medications, and sometimes steroid injections are used to relieve symptoms.

Nerve Problems

There are multiple small sensory nerves in the pelvic region and they can become entrapped, irritated, or damaged by trauma in the area. Feedback from these sensory nerves can cause ongoing pain. Evaluation by a pain specialist or neurologist often clarifies the specific nerves involved. Sometimes physical therapy or manipulation of pelvic tissue can release these nerves or relieve the pain. Medications including anti-inflammatories and neuropathics (seizure or antidepressant drugs). At times, local steroid injections help or more regional sympathetic nerve blocks are useful.

Pelvic pain can be extremely difficult to diagnose and treat. Virtually any of the structures in the pelvis can be the eventual source of pain. Often it is a combination of structures causing pain. When the initial treatment is not working, the problem may be more complex, and a pain specialist may be helpful at finding the sources and recommending a combination of interventions that manage the symptoms. Sometimes there are permanent changes in the body and damage that is not reversible, and the goal needs to be managing the symptoms. A pain specialist can be especially helpful in designing a program that meets the needs of any particular individual.