Conditioning And Fitness For Chronic Pain

July 23, 2018 / Thomas Cohn, MD

This is part three of our three part blog series on how exercise can help control chronic pain. Click here for Part One and here for Part Two.

Physical fitness has three essential components. A stable and good program has three legs that allow it stand and not fall. Aerobic conditioning is one of the three components of a good fitness program along with strengthening and stretching. All three activities combined contribute to good health.

The first step is just get started moving in an aerobic conditioning program is to simply get moving. If you have had problems with pain, start slow and get a healthcare professional to help address the pain problems. It may take some time to reach your goals, but start moving. Walking short distances for five minutes multiple times a day can be a beginning point. Sometimes it may be easier to move in a pool if you have arthritis or pain problems. It is important to find something that you can do and continue with all year long.

Exercise and Motivation

Many people find working out with others helps with motivation. Joining a fitness facility that has a variety of equipment and classes may be extremely helpful. A shared experience is often easier to keep one going. Having a workout partner that makes one accountable to another is also motivating. Fitness facilities also have knowledgeable athletic trainers that can help develop a personalized program tailored to appropriate goals.

There are other people who are very self motivated. To them, exercise becomes a passion, it is a way to control one’s own health. Increased activity increases one’s own endorphins which are the body’s natural painkillers. It improves endurance and gives one the ability to make it through the day. The American Heart Association recommends thirty minutes of increased activity a day to for good cardiovascular health.

If you have had issues with pain, whether it is neck, low back, or joints, doing a variety of activities may be the best option. Reducing impact on the body is often important. Low impact activities range from walking in a pool and swimming to even running. Outdoor recreation such as walking and bicycling are also excellent. Running works as long as one changes your style to using minimal sole shoes and landing on the ball of the foot like a barefoot runner would. This is the best form physiologically, as it transfers impact evenly throughout the body and does not stress any joints including the feet, knees, or the back.

Other Ways To Get Aerobic Exercise

Indoor fitness can be achieved in a number of ways. Many people like group activities ranging from dance, Zumba, swimming, and cycling or using a variety of exercise equipment. Cycling, ellipticals, treadmills, and swimming pools can provide excellent sources for low impact on the body conditioning. Raising the heart rate is always the goal. It can be monitored by checking your pulse with a watch to using a fitness tracker that checks your heart rate.

Fitness trackers have become an excellent way to track your fitness. Most fitness trackers have associated apps that work with either a smartphone or computer. On a daily basis, it can help you monitor whether you have met an aerobic conditioning goal. If the tracker can monitor your heart rate, then the goal is to get your heartbeat into the “fat burn zone” for 30 minutes a day. More intense exercise would be raising your heart beat cardiovascular zone calculated by the equation 210 – (your age in years), all multiplied by 0.65. If math is not your strength, charts for the various exercise zones can be found easily on the internet by age groups. The best fitness trackers for most people should track heart rate. Monitoring steps taken in a day may be also helpful and motivating but the magical number of 10,000 steps a day unfortunately has no real scientific basis, although it does keep many people up and moving.

Fitness has three pillars, stretching, strengthening and conditioning. Many people are good at doing one or two components of a program consistently. A lot of people find the time to stand on two legs, but the missing pillar of fitness often is a source of ongoing problems with being healthy. Consistently performing stretching, strengthening and aerobic conditioning definitely helps maintain your health. If you have difficulty with any part of a fitness program, seeing a healthcare provider may be beneficial. If you have had an injury or pain problem, see a Physical Medicine and Rehabilitation physician who can guide you to a management program to become independent in your comprehensive fitness strategy.

Strength Training For Chronic Pain Control

July 16, 2018 / Thomas Cohn, MD

This is part two of our three part blog series on how exercise can help control chronic pain. For part one, click here. Part three will be available in a few days.

One essential component of a fitness program is having adequate strength for performing activities. Many athletes and young adults equate fitness with absolute power-type strength. The gauge of strength is how much one can lift for a single time. Often it is free weights on a bar. The goal is often to build up muscle bulk to be able to look good. This may be fine for young adults, but for most everyone a better goal is to maintain good strength and not excessive bulk throughout the body. Strength of muscles is necessary for us to have the ability to withstand the daily demands on our bodies.

Benefits of Strength Training

The studies on strength training are great for a variety of different health benefits. A longer life, lower cardiovascular risk, reduced risk of bone fractures and cancer have all been associated with twice a week strength and resistance training program. Healthy muscle also increases your metabolism and can be helpful in weight control. Good strength of muscles also reduces the risk of injuries to muscles, tendons, and joints. All these benefits are due to the fact that muscles are essential to keep us active, and strong muscles are essential for us to perform almost every function in life.

Strength training does not necessarily need a lot of training or equipment. If you have any medical issues, before you start, see your physician. If you have had significant problems with just being able to do simple activities, starting with a program with a physical therapist is often beneficial such that one learns how to build muscle strength appropriately and work on all your weak areas.

Beginning A Program

The first step is to commit to an exercise program. A good program will work a variety of muscles like upper body, arms, lower body, legs, neck and core muscles. Starting out at a fitness center often is helpful since they usually will have a variety of equipment and also will have athletic trainers on staff. Having a few sessions with a trainer can teach you how to use different equipment correctly, good mechanics to prevent injury, and help one develop a rounded program to do on your own. Starting slow with low weight and not stressing the body too much is important. It is okay to be sore after a workout, but your pain should not need to be medicated or continue into the next day.

For the self starter, most smartphones have numerous apps available with information on a variety of routines for strengthening. There is also a wide variety of information available on the internet for strength or resistance exercises and there are numerous books also available.

Using the body position and gravity is a great way to start a strengthening program. Dividing up the exercises by region helps develop a balanced program that will involve the majority of the muscle groups.

For the lower body – leg squats are excellent. Keeping the head upright, bend down slowly at the hips and knees, maintain the feet flat on the ground with the weight back on the heels. Lower yourself down, stop for a second then return to full standing and up onto the toes, then repeat. This works most of the muscles from the butt, hips, through the upper and lower legs to the feet. Repeating slowly for 7-10 times in a row does the lower half of the body. Doing two or three sets of these is a significant workout for this region.

The back and core muscles which include the abdominal wall can be worked with several exercises. One of the simplest is doing a plank. Begin on a mat or carpeted floor, starting in face down position. Prop yourself up on your bent forearms with your legs fully extended and up on your toes. Keep the body in a straight line like a board and do not push up your hips or let the back sag. Maintain this position for 30-45 seconds and repeat this again two or three times. Once this is easy, you can change it up by balancing on one arm or leg, raising a leg and holding it, doing it on your side, or even using a wobble board for either the arms or legs.

Abdominal muscles and hips can be worked by lying on the back and doing leg raises, holding the legs straight out and stiff with your heals held 6-12 inches off the ground. Opening and closing the legs and raising them all the way up works the hips and pelvic muscles. Also, abdominal crunches, by lying on your back and slightly raising the upper back builds abdominal muscles. Adding a twist to the crunches in each direction further engages more abdominal muscles.

The upper back, shoulder and arm muscles are strengthened safely with resistance bands. Using these is often easier, simpler and safer then getting other bulky equipment. A set of bands or rubber tubing with a variety of strengths, a door to anchor the loop bands through, handles and a simple instruction book can be found on the internet for about fifty dollars. For the shoulders and upper body, anchor the bands from the top of the door. With your back towards the door, exercises include bringing the bands from a position held upwards with the arms and extending to down straight to waist level. Resistance can be adjusted by how much starting tension one has on the bands. Next hold the bands with tension to the chest and bend forward at the waist tensioning upper and lower back muscles. The last set, slowly extend both arms from a bent position to straight out and back like a push up while standing. Once finished while having your back toward the door, turn and face the door and one can do a pull down exercise with the arms standing and kneeling for the upper arms and shoulders. The resistance bands can also be anchored in the side of the door, and a butterfly exercises of the arms can be done facing toward the door and with the back toward the door.

A strengthening program like the one described above can be done in twenty to thirty minutes. It will work the majority of muscles in the body and does not require significant amounts of equipment. When the exercise becomes easy, adding the use of small hand and leg weights ranging from 2-10 pounds can increase the challenge inexpensively. Committing to a strengthening program is one component of a overall fitness program.

Stretching as an Exercise Routine

July 11, 2018July 11, 2018 / Thomas Cohn, MD

Below is part one of a three part series on exercise to control chronic pain. Part one is on stretching, and the next two parts will be on developing an exercise program and the importance of conditioning.

As part of any good exercise program for pain and general conditioning, stretching is an essential component. The other parts are strengthening and aerobic conditioning. Stretching maintains range of motion and proper muscle and tendon length. Poor range of motion with tight tendons, ligaments and muscles often lead to pain.

Stretching can be done as an independent component of an overall program or integrated into an overall program. There are very few restrictions on stretching, but find a system that works for you. A lot of people with back pain have trouble at night and first thing in the morning. Stretching for several minutes before bed and first thing in the morning is often helpful. If you’d like to integrate a stretching program with strengthening, consider yoga and Pilates routines since these will include good stretching routines.

Stretching and Your Needs

Depending on your needs, stretching can be done for any area of the body. If you are a book person, there is one titled “Stretching” by Robert Anderson that covers any region of the body. Nowadays, everyone seems to have a smart phone and with a simple search of the App Store, multiple apps can be found on proper stretching techniques. You can also search the web for information. The Princeton University physical therapy site has good information for neck and low back regions.

For those who have low back pain, a thorough stretching program can significantly help control pain. Often a large portion of symptoms are related to tight muscles in the core and lower half of the body. Stretching needs to include all areas of the low back and legs. In general, it will include flexor muscles as well as extensor. Most people concentrate on increasing flexion of the body to loosen the low back, but ignoring the extensor muscles may leave one prone to hip and pelvic pain.

Stretching in low back pain patients can often open up the neuroforamina where the nerve roots exit the spine and relieve pinched nerves. Just bending forward and touching the toes or the floor while standing does a good job to stretch the low back and legs. 10-30 seconds of a slow stretch may reduce muscle spasms and pain, allowing one to continue activity for a prolonged period. With a diagnosis of lumbar spinal stenosis, simple forward stretches may reduce pinching of the nerves and allow ongoing activity such as walking with minimal pain symptoms.

Stretching Devices

Stretching can also be done in more formal ways using techniques such as traction, massage and adjustments or manipulation of the body. Traction requires a device to appropriately stretch the neck or low back regions. Neck traction devices that are good include those manufactured by Saunders or Pronex and usually should be prescribed by a healthcare provider Lumbar traction can be done with fancy traction devices often used by chiropractors or by using an inversion table. The inversion tables are generally safe as long as they are well built and one is securely restrained at the ankles. Deep tissue massage and chiropractic or osteopathic type adjustments can also be part of a stretching routine.

Stretching on long term basis should ideally be part of an individual’s program that is able to be performed on your own at home. Sometimes equipment is beneficial, but for most people just a set of exercises should be sufficient. Physical therapy may help if you have not been able to move well and are afraid of more pain if you try to move. Stretching is not hard if you are self motivated and willing to learn on your own. If you have pain or are afraid of injury, get help, whether it is from a healthcare professional, physical therapist, or other person.

Psychiatric Disorders and Pain Perception

June 27, 2018 / Thomas Cohn, MD

Chronic pain clearly isn’t just in your head, but according to a new study, psychiatric disorders or mental health issues may lead to an uptick in perceived conditions.

For their study, researchers in Brazil examined more than 200 individuals who believed they were suffering from Gastroesophageal Reflux Disease, or GERD. GERD is very similar to chronic acid reflux, where patients suffer a burning sensation when stomach acid makes its way back through the esophageal sphincter and into their lower esophagus. All individuals received a comprehensive medical exam and were asked to complete a 14-question survey that analyzed their mental health for signs of depression or anxiety.

Anxiety, Depression and Pain Perception

After completing the medical exams and reviewing the survey results, researchers came to an interesting conclusion. Nearly half of the patients who reported having anxiety or depression had normal acidic pH values in their esophagus, suggesting that they most like did not have GERD. However, this doesn’t mean that patients are crying wolf about their perceived symptoms.

“Patients with anxiety and depression or other mental health issues display a ‘hypervigilance’ or ‘hypersensitivity’ to pain sensations,” said lead researcher Dr. Fernando Herbella.

Moreover, researchers uncovered an inverse relationship between anxiety levels and esophageal pH; the more anxious a patient was, the less damage they had in their esophageal lining.

Dr. Vic Velanovich, a co-author on the study, offered a neurological explanation for the link between mental disorders and pain perception.

“It’s called the ‘pain modulation network.’ Pain is converted to electrical signals that travel to the brain. It’s interpreted there by the frontal cortex. So anything happening in the frontal cortex, including mental disorders, makes pain perception worse.”

The subject matter is near and dear to Dr. Velanovich, who worked on a similar study back in 2011. In that study, Dr. Velanovich studied patient satisfaction after GERD surgery. Most notably, surgery satisfied 93.5 percent of patients without psychiatric disorders, but only 11.1 percent of patients with a disorder.

“It was a classic ‘nocebo’ effect,” Velanovich says. “For both groups of patients the GERD pain was greatly relieved. But only anxious patients found the aftereffects of the surgery intolerable. Which tells me that there’s something else going on.”

These two studies highlight the importance of getting a comprehensive medical diagnosis by a pain care provider who knows all the signs to watch for. Unless all the underlying issues are treated, you’re not going to acheive full relief. To learn more about the association between mental health and the perception of chronic pain, or to talk to a specialist about another issue, reach out to Dr. Cohn today.

Chronic Pain and the Summer Heat

May 29, 2018 / Thomas Cohn, MD

Although summer doesn’t officially start for a few more weeks, the temperatures have certainly been feeling like it’s mid-July of late. Summer can be a great time to spend outdoors with friends and family, but it can also present unique challenges for individuals with chronic pain.

Below, we take a closer look at how you can make it through the warm summer months with your chronic pain under control.

Summer and Chronic Pain

Keep these tips in mind to keep chronic pain flareups at bay this summer.

1. Beat the Heat – Try to find shade or other ways to keep cool this summer. Warmer temperatures can lead to an expansion of blood vessels and swelling of our hands and fingers, which can contribute to pain if you’re also dealing with joint inflammation. Whether it involves swimming in the lake or heading to eat in an air conditioned restaurant, find ways to break up long stretches in the summer heat.

2. Sleeping Situation – Warmer temps can also make it harder for people to fall asleep and stay asleep, and you know how problematic this can be if you have chronic pain. Strive to make the bedroom an ideal habitat for sleeping. Turn off devices like the television or iPad, try to go to bed at a regular time, and keep the room cooler if possible, either with air conditioning or a box fan. This will help you achieve long periods of restful sleep.

3. Avoid Overdoing It – Don’t bite off more than you can chew when it comes to summer activities. If you overdo it one day, you’re going to be paying for it for the next couple of days. Know your limits and don’t be afraid to say “no” when it comes to making plans or partaking in certain activities. You know your body best, so avoid overdoing it when possible.

4. Hydration – Another thing to keep in mind this summer is to make sure you’re getting plenty of fluids. Staying hydrated helps joints and blood vessels work optimally, which can help keep you pain free or headache free. Plan ahead so you’re never without a hydration source if you’re going to be out in the sun for a while.

5. Talk With A Specialist – Finally, it’s a good idea to set up a consultation with a pain specialist. They’ll be able to talk about individual challenges that you may face this season and how best to prevent pain from becoming a problem. Whether you need another round of pain injections or want to tweak some therapy exercises, it’s a good idea to circle back with your pain care provider before the summer season gets into full swing.

For more information, or to talk to Dr. Cohn about any issues you may be having, reach out to his clinic today.