The Importance of Regular Summer Exercise

May 26, 2015 / Thomas Cohn, MD

The unofficial start of summer has come and gone as the Memorial Day weekend is in the rearview mirror, and that means we are in full swing of the outdoor season. Spring cleaning and all the summer chores also have come. It is now the time to become a weekend warrior, and using a bit of wisdom is necessary to prevent injuries. None of us are immune to injury, but using some common sense may go a long way to prevent injury.

One way to prevent injuries during the summer is to stay fit. Fitness involves two aspects – cardiovascular aerobic strength and muscle power strength. Both parts of conditioning are equally important, but many people want to do just one of the two. Without both aspects, injury is more likely.

Aerobic and Muscle Training

Aerobic conditioning is exercise that stresses the endurance strength of the body. It allows us to continue activities for a prolonged time. The classic aerobic exercise is running. It increases the heart rate and promotes the efficient use of energy. Any activity that increases the heart rate qualifies for aerobic conditioning. This can be fast walking, swimming, bicycling, tennis, or any sport that requires continuous movement. The goal is for most people is at least 30 minutes of day, and this should be outside of “work” so that the brain gets the benefit of relaxation. To further promote this, obtain a fitness tracker, such as a Fitbit and log 10,000 steps a day. Hitting an aerobic goal of 30 minutes of exercise and 10,000 steps will help maintain overall fitness and help with other things such as weight control.

As a pain specialist, strength conditioning has two parts. The first is overall muscle strength throughout the body. The second part is core strength, the muscles that stabilize the spine. Working out at a gym or lifting weights generally works on the large muscles in the body, the arms and legs. Good general strength allows us to do many activities and not hurt later. Core strength is much harder and targets more specific muscles. To strengthen these muscles, one needs to concentrate on working these specific muscles with very targeted exercises. The workout for the core does not require much equipment, often just gravity and body positioning is sufficient to work these muscles. Good resources for core strengthening are available on the web, use the Google search term, “lumbar core strengthening”. A good starter site is available via Princeton. Additionally, many smartphones have good apps for general muscle strengthening exercises.

A good exercise program will help prevent injury. It will give a person more ability to do the jobs around the house and not be to sore afterward. It is okay to be sore for a day or two, but if one is sore longer than that, then one is likely doing too much repetitive work on a single occasion. It is time to become more active, work on both strength and endurance, and spend some time having fun.

Tiger Woods is Great, But…

April 13, 2015 / Thomas Cohn, MD

The Masters is over, and for first time in a long period Tiger made the cut and finished a tournament. To no one’s surprise, Tiger did not make a run for the leaderboard on Sunday, but he certainly opened some eyes by finishing tied for 17th. At 38 years of age, he is no longer in his prime and now appears fortunate when he makes the cut and finishes. In the future he may have a few more outstanding tournaments, but they will likely be few and far between, and it is likely he will only win a few more tournaments throughout the remainder of his career.

Tiger has now had lumbar back surgery, knee surgery, and may have hip problems besides the above, not to mention he injured his wrist in Sunday’s final round. He pulled out of a tournament earlier this year when he aggravated his back. Most likely, for him to play well, the conditions must be perfect, and he has to have a good day when his pain is controlled. To play at a high enough level routinely is unlikely since either his back or joints will cause just a slight issue such that he will not be good enough to play against the younger and healthier players.

Gold is a Young Man’s Game

To win at a professional level, one must be a top athlete in perfect physical and mental health. All sports at this level require one to be in the best physical shape to master the skill necessary to play a perfect game. After having the physical skill, one needs to have absolute mental concentration for the game. If one has physical pain, the concentration for the perfect game is not present. If one has had back and knee surgery, one also does not have the perfect physical balance to be at the top of one’s game.

As we age, there are many changes that occur in the body, and after age 25, for most sports, we are slightly past our prime for physical ability. By the late 30’s we are definitely past our prime for almost all intense sports, especially individual events. There are a few older athletes who are competitive later in life, but this is generally a rare event. The best athletes perform as well as they do because their bodies and minds are in perfect condition for their sport.

For professional golf, a new leader is likely to emerge in the future, and that leader could easily be 21-year-old Jordan Spieth, who ran away from the competition at Augusta this weekend. Tiger was the first very young winner to take the stage. Now, it will likely be someone who is in the young twenties and has great mental strength to deal with the pressure of winning, which sounds a lot like Spieth or Rory McIlroy. I think they’ll be the face of professional golf for the next 5-10 years.

5 Tips To Prevent Joint Pain While Exercising

April 10, 2015 / Thomas Cohn, MD

Regular exercise is extremely important, especially if you are dealing with a pain problem. Although it can be difficult to find the motivation to work out, exercise will help build strength in your muscles and actually provide some temporary pain relief. Some people have the motivation to work out, but exercise causes their joint problems to flare up. Today, we provide five tips to help prevent joint pain during your workout.

1. Stretch – Jumping straight into your exercise routine is a quick way to trigger your joint pain. Much like a car in the winter, it takes some time for our joints to start moving fluidly. Just like it’s not good to floor it five seconds after starting your car when it’s -10 degrees outside, it’s not smart to jump on the treadmill without letting your joints warm up.

2. Switch up your routine – Try to work out different areas of the body throughout the week. Going for a run every day is fine, but you’re leaving yourself open to overuse injuries, and you’re putting a lot of stress on your feet and knees. Instead, work out your upper body on Monday and Thursday, and strive for a lower body workout on Tuesday and Friday. This gives your joints some time to recover between workouts.

3. Find what works – This may sound obvious, but find a workout that works for you. If you have joint pain in your knees, consider exercising on a stationary bike or in a pool to help with weight bearing. If your back pain flares up while biking, try going for a walk or a run. Keep a log of what works best for you so you can create a pain-free exercise routine.

4. Try alternative methods – There are plenty of ways to get your exercise in without going for a run or a swim. Some more popular alternatives for people with joint pain are yoga and Pilates. These low-impact activities help increase joint mobility and flexibility. Additionally, yoga has been shown to ease pain and swelling in people with rheumatoid arthritis. If other exercises are causing too much joint pain, give yoga or Pilates a try.

5. Don’t overdo it – The right amount of exercise if great for your body, but overdoing it can actually make pain problems work. When developing a workout plan, start slow and progressively work your way up to longer routines. Additionally, if you begin to feel pain, stop your workout or transition to a different exercise that doesn’t impact that part of your body.

Understanding Pain Centralization States

March 30, 2015 / Thomas Cohn, MD

One of the newer ideas that is gaining better understanding in the pain community is the concept of pain centralization. This is the general category that a lot of other pain problems fall under. The most common condition is Fibromyalgia, but other conditions such as TMJ, irritable bowel syndrome and some tension headaches are similar. The main characteristic is that the disturbance is processed differently by the brain, and a diffuse increase to pain fiber stimulation then occurs. There are an altering of levels of neurotransmitters affecting pain transmission.

The key finding in all the conditions characterized by centralized pain states is a significant increased sensitivity to sensory stimuli. Chronic pain is often found in multiple regions of the body over a period of time. Multiple other types of symptoms also occur including fatigue, sleep difficulties, mood changes and memory problems. Symptoms are often triggered by a stressful event, such as an infection, brain injury or trauma. Multiple discrete areas of pain are found, and can be present with other diseases such as rheumatoid/osteoarthritis and hyper-laxity conditions like Ehlers-Danlos or Marfans Syndromes.

These conditions are a continuum of pain problems starting from acute peripheral pain to chronic centralized diffuse pain. It affects from 2-8% of the population, and is about twice as common in females. There is a strong familial correlation and it can be worsened with stress and anxiety.

New Understanding of Centralized Pain

Research has now shown there are definite abnormalities present in these patients. Functional MRI scans have shown an increased connectivity in regions of the brain that sense pain signals and decreased activity in areas that inhibit signals. Along with this is a change in the balance of neurotransmitters, those that facilitate pain reception including Substance P, Glutamate, Serotonin, and Nerve Growth Factor are elevated. Those transmitters that inhibit pain are decreased, such as Norepinephrine and GABA.

Treatment of these conditions is difficult. Nothing works in everyone; it is a matter of using multiple strategies. Medications that have have proven effective include some antidepressants like tricyclic’s, cymbalta and cyclobenzaprine, and seizure medications like gabapentin and lyrica. Tramadol, low dose naltrexone and cannabinoids have shown modest benefits, but they aren’t typically as effective. What absolutely does not work and sometimes makes things worse are opioids. Other beneficial treatments with strong evidence include aerobics, strength training and cognitive behavioral therapy. There is little benefit from acupuncture, massage, chiropractic and manual therapy, and most injections including trigger points.

In a lot of chronic pain conditions, a common thread is emerging. There appears to be a short circuit in the brain and the volume control for pain sensitivity is turned to high. Normal signals become overly amplified in the brain and are considered painful. The normal ability of the brain to inhibit pain signals for the periphery is also decreased. The brain then becomes stuck in a state of hypersensitivity. The new directions of research is to find ways to correct the changes seen in these centralized pain states.

Water Therapy for Chronic Pain

March 11, 2015March 18, 2016 / Thomas Cohn, MD

People are always asking about things they can do to relieve their chronic pain on their own time. We’ve talked about plenty of home remedies on the blog before, but one avenue we haven’t explored is water therapy.

Water therapy is growing in popularity as a treatment for chronic conditions because of its numerous benefits, including:

Chronic pain relief

Reduced recovery time

Increased movement function

Decreased load bearing

Decompression of inflamed joints and discs

Relaxation

General exercise

What is Aqua Therapy?

Aqua therapy, otherwise referred to as pool therapy, involves preforming an exercise program or a set or exercise in the water. Oftentimes patients with chronic pain can’t preform regular exercises because the movements serve to exacerbate the pain, but aqua therapy can provide the relief they need. Because the load bearing in joints is decreased while in the water, patients can move their body without putting extra stress on painful areas of the body.

Aqua therapy is beneficial for patients with numerous health conditions, including:

Chronic and acute pain

Back pain

Neck pain

Fibromyalgia

Arthritis

Nervous system disorders

Joint or muscle pain

Muscle weakness

Migraines or headaches

As we’ve mentioned before, chronic pain affects more than 50 million Americans every year. A chronic pain specialist can help you with injections or other hands-on treatment options, but it’s going to take some work on your own to rid yourself of your pain. If other home treatments have failed, or you simply want to explore a new exercise technique, give water therapy a try.