Exercise Accountability and Pain

Fitbits in MinnesotaA recent study in Medicine and Science in Sports and Exercise points out whether we are reliable in reporting our exercise. The answer is that most of us tend to over report our activity level. When using an objective measure of activity, such as a monitoring device of steps and pulse, the record is much more accurate. The best way to keep healthy and reduce pain is to stick to a regular exercise routine. If you are not being accountable, the activity is usually not being done. Very few people have the self-discipline to be consistent with exercise on their own.

Up until recently, the best way to be accountable is to have an exercise partner. Whether it be a yoga classmate or a running partner, if you had to meet someone else, it was much harder to skip the exercise.

Currently, the electronic age can become out partner, as most people now own a smartphone. Both the Android and the Apple phones have fitness apps built into the phone and have electronics that can monitor motion. As long as one has the phone in hand (or pocket), the phone will record your steps. Most people should be aiming at obtaining at least 10,000 steps a day to maintain general cardiac aerobic fitness.

Fitness Trackers and Exercise

A fitness tracker, such as a Fitbit, Vivofit (by Garmin) or Jawbone can be of great benefit. There are now multiple brands of trackers, those at about $100 dollars tend to monitor:

  • Steps
  • Distance
  • Calories burned
  • Steps climbed
  • Sleep patterns

The more expensive ones will add in heart rate monitoring, sometimes blood oxygen levels, and may connect to smartphone notifications. All the fitness trackers have apps that chart your daily, weekly and monthly statistics. Keeping a record of your activity tends to make one more responsible toward meeting fitness goals.

The importance of maintaining physical activity is very evident in the pain patient. My patients who are the most active have the best control of their symptoms and tend to use the least amount of drugs and other interventions. For myself, the fitness tracker keeps me more active, maintaining my aerobic conditioning goals. The more intense aerobic exercise, even for just 15 minutes every day, definitely increases my endorphins (the body’s own pain killers) and decreases my back and leg pain. Without the tracker, I know I would be lazy, and definitely would think I am doing more activity than I actually perform.

Aerobic activity does need to be combined with strengthening and stretching for most pain patients. The areas that are causing pain often need more physical muscle support to prevent symptoms, and strengthening and keeping these muscles healthy is another priority.

The Importance of Regular Summer Exercise

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.

Summer Workout

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.

Visculosupplements for Knee Pain

Visculosupplements for Knee PainDegeneration of the knee is a common condition that occurs as we age. Early problems are often minor injuries to the ligaments and meniscus, and they usually heal with conservative or surgical care. Over the age of forty, we start getting deterioration of the joint space and cartilage. Pain then becomes more consistent, and the knee moves less well and becomes swollen and stiff. Ignoring the knees becomes difficult and walking hurts, so many individuals seek medical attention.

When the simple treatments for degeneration/osteoarthritis do not work, one of the next levels of management is injectable medication. At this point in treatment, a Physical Medicine Pain expert can guide you through the best comprehensive program with the least additional pain. Usually the first level of injection is a cortisone type of injection, best done either with ultrasound or fluoroscopy. Long-acting cortisones include methylprednisolone and triamenacelone, which help control inflammation in the knee for three to six months.

The Benefits of Visculosupplements

Visculosupplements may be beneficial if steroids are not helping. These are injections of buffered hyaluronic acid that promote normal joint fluid production and lubrication. The first compound approved by the FDA was about 20 years ago – Synvisc – and is still used but has significant problems with allergic reactions. Now there are many three-dose regimens that work very well and are very purified without any issues with allergic reactions. The three-dose process may be the best to actually stimulate joint fluid production. In February a single dose regimen, Monovisc, was approved. Whether this will work well remains to be seen. Previous single dose regimens have not been quite as effective.

With all osteoarthritis and degeneration of the knee treatments, conservative measures with injections are necessary. Lifestyle changes including weight loss, exercise, and sometimes using adaptive equipment like braces or canes can be helpful. Using anti-inflammatory medications including creams may also help.

In the United States these visculosupplements are only approved for the use in the knee. In other countries they are used successfully in many different joints. They can be used safely in other joints, but the medication cost would be the responsibility of the patient. They have been used in the hip, pelvis, elbows, and hands.  As a safe conservative treatment especially for the knee, these injections are a time-tested success.

New Pain Treatment: Platelet Rich Plasma

Blood spinning PRPRecently, platelet rich plasma (PRP) has been making news as a treatment for hip bursitis after a presentation at the American Academy of Orthopedic Surgery annual meeting. PRP is blood that has been spun and has concentrated factors that stimulate tissue repair and growth. This concentrated solution can be injected back into the body in affected areas to improve healing in damaged tissue. New areas for use are being found regularly.

Initially, PRP was first used in trials for repair after a heart attack, but it has expanded into areas of tendon repair, nerve injury and bursitis. Most commonly it has been used in sports injuries, and for many of these patients it has been quite successful. Instead of just calming down inflammation like many medical treatments, PRP helps more intensely stimulate the body to repair the injury. The downside to this treatment is that it is still considered experimental and insurance rarely covers the cost which can be in the several thousand dollar range.

PRP for Tendonitis and Bursitis

The most common uses in pain management for platelet rich plasma is for shoulder, elbow, hip and knee pain especially related to tendinopathy, tenosynovitis and bursitis. Blood is taken from the patient and then spun in a centrifuge. The residual plasma is rich in a number of proteins and substances that promote healing in the body. The plasma then is injected with either ultrasound or X-ray guidance into the appropriate area, whether the shoulder, hip or by certain tendons to stimulate healing. A series of several injections may be necessary to fully promote healing.  Since it is an all natural product of the patient themselves, it is very safe, and may be very effective for the right conditions.

Tendonitis, bursitis, joint and ligament pain is always treated conservatively first. Rest, heat and ice, and physical therapy are the first lines of treatment. If the problems are not improving, medications like oral or topical anti-inflammatory drugs combined with exercises and therapy may also be effective. If those treatments do not help, corticosteroid injections may also be indicated and evaluation by a physical medicine pain specialist to guide treatment would be beneficial.

The medical literature at this time is showing that the use of platelet rich plasma may have many benefits in the treatment of some of these joint related conditions of pain and inflammation. PRP is not the first line of treatment; it is used when other courses have failed. Furthermore, insurance has not endorsed its use and the cost will most likely be the responsibility of the patient. As of now, the injections are mainly for athletes or people who can afford the treatment when other avenues have failed.

Does Glucosamine Work for Knee Pain?

Knee pain treatmentsA recent study in Arthritis and Rheumatology has cast new doubt on the use of glucosamine for knee pain. Glucosamine is a natural supplement that has been promoted for years to improve joint health. It is supposed to reduce pain and promote healthy cartilage in all joints. Knee joint pain has been one of the main claims for success over the past years.

The recent study reported that glucosamine had very little if any impact on any aspect of knee health. This study covered treatment over a 6-month time period.  It used medical exams and MRI scans at the beginning and end points as well as periodic X-ray films to objectively measure knee changes. Overall, pain and functional ability were not impacted by the use of glucosamine.

Knees and Age

Degenerative changes of the knees are common as we all get older. As we all age, the joints start showing signs of change including deterioration of the joint space and cartilage. Many of the activities we have done over time may worsen the problem. Sports, bending, twisting, kneeling, as well as being overweight may excessively stress the knee and lead to deterioration.

Treatment of the knees always starts conservatively. Most important is to ensure a patient doesn’t put unnecessary stress on their knees. One of the biggest culprits of knee issues is obesity, so weight control is essential. Keeping active helps facilitate blood flow to joints and maintains tissue health. Strengthening the muscles above the knee is also helpful.

Medication’s Role

The next level of intervention is medication. As noted above, natural supplements have not been found to be especially helpful when studied in a rigorous manner. Over the counter nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen as well as acetaminophen may be helpful. If the above treatments are not helping, seeing a pain specialist for knee joint injections with steroids or viscosupplements may be worthwhile. Lastly, when all else fails, sometimes Orthopedic surgery may arthroscopically clean up the knee joint or at times, the knee is so deteriorated, joint replacement may be a good option.

Knee arthritis is very common, but any treatments are available. So far, natural supplements have not shown significant positive results. If the simple stuff is not working, your doctor can guide you through the other available options.