Pain Doc - Ask Dr. P - The Pain Doc

Two Modalities to Heal Low Back Pain in Half the Time

by Pain Doc | Oct 20, 2021 | Low Back Pain, Pulsed EMF, Red light therapy, Self Treatment

Hey, I know there are millions of pages on the internet on how to fix low back pain. It can be a dizzying experience searching through them. It’s information overload.

I began blogging on this site around 2010, but actually have been writing articles on things like exercises for low back pain, neck pain, sprains and strains and so forth, since about 1994 when the internet was in its infancy. Fast forward 28 years, and now there are tons of articles and videos online, including mine. Much of the online content for treating low back pain is good: well-written, easy to understand and follow, and backed by evidence. Others are mediocre; just a re-hash of old-school approaches to treating back pain (rest, ice, no heavy lifting, etc.).

If you know me, when it comes to teaching others how to self-treat pain, I like to write fresh, interesting and innovative content. I figure that there are more than enough good videos on stretching and exercising for low back pain. What I like to do is explain the etiology of pain and propose interventions to prevent that pain from developing or getting worse.

If you have acute (recent onset) low back pain, research shows that in most cases, it will go away on its own if you just take it easy for a couple of days. Sure, icing, applying hot packs and no heavy lifting are obviously recommended to prevent re-aggravating the condition. The problem is that most people can’t afford to wait that long, and don’t like being in pain. They have a job, they have responsibilities to other people, and, they want to have fun and do the things they want to do.

For these individuals, there are a couple of home therapies I recommend, to shorten the healing time.

When you have low back pain, muscles and ligaments in and around your spine are generating pain. Something was disrupted mechanically, and inflammation is going on – blood vessels are releasing histamine and heparin and the inflammatory cascade is active—heat, redness, swelling, pain. The inflammatory chemicals irritate sensory nerves, causing some of the pain; as well as the pressure from the swelling. The nerves themselves may be over-firing; generating a level of pain that is not really proportional to the amount of tissue injury.

So with that, my go-to home therapy is a combination of Pulsed EMF and Red Light. Pulsed EMF is an externally-applied, pulsed electromagnetic field. The field, which is similar in frequency to the body’s own natural EM fields, passes through your body and essentially energizes the membranes of cells.

Cell membranes let things in and out of the cell, especially synthesized proteins, nutrients, oxygen, and waste products. They do this via active and passive transport, which both rely on membrane potential—a weak voltage created by negatively charged ions on the outside of the cell, and positive ions on the inside. Like how a battery’s voltage can power a light bulb, a cell’s weak voltage along its membrane powers the exchange of molecules in and out of the cell.

When cells (in this case muscle, bone, nerve, blood vessel cells) are physically damaged or weakened, this exchange is hampered and the tissues are slow to recover and return to a normal, non-pain state. Pulsed EMF lends a boost to this energy, helping cells become more robust in their healing and recovery activities.

Red Light therapy also can energize weak cells, but via photobiomodulation. Cells absorb red light in the 660-720 nanometer wavelength (electromagnetic energy), due to their molecular composition. Photons strike the nucleus, mitochondria and membrane, which changes the oxidative state of the cell. When this happens, it triggers cell signaling pathways related to metabolism and energy production. The cells increase their ATP output, which gives them more energy to repair damaged sites and synthesize needed repair proteins.

Pulsed EMF devices for home use are very easy to operate. Usually, it’s a matter of just pressing the power button, and sometimes a Mode button and Timer button. One of the better models is the BioBalance. You can order it with a full body mat, or a pad. Simply find a comfortable place in your home such as your sofa; place the mat on it, and lie down so that your low back is directly over the mat. No need to remove clothing; the pulsed EMF field passes right through. Do it 3x day for 20-30 minutes/ day to help your body heal and recover.

Another option is the OMI full body PEMF mat. It is lower power than the BioWave, but sometimes that works just as well, as the EM fields are very subtle. You don’t want fields that are too strong. Remember, your body already produces weak magnetic fields; you just want to complement them with a boost of comparable energy.

Red Light therapy is also a great investment in your health. I recommend getting a red light LED wrap, or LED panel. The wrap is a flexible pad embedded with red light LEDs emitting red light and infrared light (660, 820 nm). The red light diodes create photobiomodulation while the infrared diodes provide deep penetrating heat to dilate blood vessels and increase oxygen delivery to cells.

Red Light panels come in different sizes. The small ones are popular for treating facial skin conditions and beautification. The larger panels are better for treating pain. You can mount or hang the panel on the wall, and position yourself so that you are exposed to the red light (usually requires standing up).

In summary, if you are prone to getting lower back pain or have chronic pain issues, Pulsed EMF and Red Light Therapy are two, powerful and safe modalities that can be used at home for self-treatment and are easy to operate. Best of all, they have a long history of medical research to support their use in treating pain and healing injury. It does require a modest investment, but what is more important to your health and well-being? Without this, nothing else matters.

Do You Burn the Same Amount of Calories Walking vs. Running?

by Pain Doc | Sep 3, 2021 | Low Back Pain Exercises

If you ran one mile, would you have burned the same number of calories as if you had simply walked?

Intuition tells us that, for equal distances, running requires more energy than walking and therefore burns more calories. After all, running is a lot more sweaty and uncomfortable!

But …does it?

In order to find the answer, we need to define three important terms and understand how they are related.

The first is Energy. In physics, energy is the quantitative property that must be transferred to something physical in order to perform work on it, or to heat it. A less descriptive definition of energy is “the ability to do work.”

Visualizing energy is elusive, like an invisible force that can change into different forms, but most of the time the presence of energy can be visualized when the transfer occurs. For example, if you burn firewood, the invisible chemical energy in the wood is converted to heat energy, which you can see as fire. With regards to human movement, energy moves through our muscles, joints and bones.

The second is Work. Work is the energy transferred to or from an object via the application of force along a displacement (distance). In its simplest form, it is the product of force and displacement: W=F*d. So, think of work as “energy in action.”

Work and Energy have the same unit, called a Joule, which is the energy required to move 1 kg a velocity of 1 meter/second. So, when you walk one mile, your musculoskeletal system is performing work (W) by moving the weight of your body (F) over one mile (d). Weight is a force, as it is the mass of your body x gravity (acceleration).

The third is Calorie. In food science, one Calorie is the amount of heat needed to raise the temperature of 1 kilogram of water 1 degree Celsius; hence the phrase “burning” calories. Foods that we eat contain calories, which are represented by the energy stored in the bonds of the atoms of carbohydrates, fats and proteins. One gram of fat contains about 9 calories, while one gram of carbohydrate or protein contains about 4.

Calories are important to us because they are central to fat (not water) weight gain and loss. With the overabundance of high-calorie foods, weight loss is a concern for many. And along with calorie restriction (dieting), exercise is the means by which people try to lose weight. Exercise requires energy and work, which in the human body is sourced from calories. For those wanting to lose weight, the calories that are desired for burning are not in the food from a recent meal, but rather in the bonds of stored triglycerides; i.e. fat cells. Those unwanted fat cells are the result of the surplus of calories consumed (more than your body needed) over years and years.

People wanting to lose weight are interested in the best forms of exercise that will help them burn calories and use up those unwanted fat cells.

Before we address the original question of whether or not running one mile burns more calories than walking one mile, lets first discuss the two, main approaches to exercise: cardio and resistance.

Cardio exercises are exercises that result in sustained, increase heart rate. They are characterized by continuous movement of the body. Examples include running, walking, cycling, and the many types of aerobics classes such as cardio kickboxing. The continuous movement of your muscles in cardio exercises, when done for over 20 minutes burns fat and strengthens the heart muscle. A stronger heart is able to pump more blood to cells and increase cardiovascular endurance; hence the name.

Resistance exercises emphasize placing resistance on the large muscle groups, i.e. the legs, arms, back and core. They force the muscles to generate power, which burns calories just like cardio exercises. The resistance can be weights, resistance bands, or the weight of your body (squats, planks, pull ups, crunches).

This brings us to the calorie-burning effects of running vs. walking. Let’s say Tom, who has a mass of 50kg, walks one mile in 12 minutes, then runs a mile in 8 minutes. Did he burn the same amount of calories in both miles?

Since Work=Force x Displacement, the work Tom generated in both cases was as follows:

Force=mass x acceleration (of gravity on Earth, in this case)
Force=50 kg x 9.80 m/s2 = 490.33 Newtons (the unit of force)
Work=490.33 N x 1609.34 m = 789,107.68 Joules = 789.108 kJ

Since 1 calorie is approximately .239 J, Tom burned about 188 calories walking, and another 188 calories running because in both cases, he moved the same amount of force (his body weight) over the same distance…

THEORETICALLY.

The human body’s use of energy is not as easy to calculate compared to a machine. There are many variables in human movement; particularly in the way the muscles are used.

Let’s address the critical factor that will help us answer the original question – the biomechanics of walking vs. running. Do they use the same muscle groups in the same way? Do the muscles perform more work in one vs. the other given the same distance displaced? Is energy use the same in both?

I propose that energy expenditure in running is significantly higher than in walking, and here’s my argument.

If someone walks a mile in 12 minutes, then runs one in 8 minutes, it is conceivable that he burns the same amount of calories each time, because although running burns more calories per unit time (there is more muscle twitching with running), it is over a shorter time than walking. It is sensible that walking that extra four minutes makes up the balance.

Let’s make the comparison even closer: suppose Tom walked a mile in 12 minutes and “ran” the next mile in 12 minutes as well. This can be done at a certain threshold—the point (speed) where one can still walk fast or run at a light pace. It is best realized on a treadmill, because you do not change the treadmill speed but can either walk fast, or use a running movement. You’ll have to try it to know what I mean. For me, that threshold is 4 mph. I can switch between walking fast and running at a light pace. In this scenario, the times for completing both miles are equal (walking one mile in 12 minutes, then running one mile in 12 minutes), which makes the question of which burns more calories more interesting, and definitive.

Have you tried to figure out what specifically changes when you switch between walking fast and running? Lately, I’ve been speed walking a mile using a treadmill and running a mile, at the same pace, and tried to sense what was happening as I switched between the two.

Here’s what I discovered:

I immediately sensed that running made me breathe harder. An increased respiratory rate from exercise signifies a higher metabolic rate in the muscles (more glucose being used up in the citric acid cycle, which demands more oxygen).
Running felt harder to do than walking fast. This is evidence that I was expending more energy running than walking.
My strides were the same running vs. walking. In other words, I was not taking more frequent, shorter strides during running; they were about the same length.
I was bobbing up and down more during running. This was evident from my visual field—I noticed a significant increase in the vertical up and down movement of objects I focused on (the treadmill faced an open window, with trees in the distance). I estimated it to be about 2-3” every stride.
I sensed more muscle expenditure in my lower leg (calf) muscles and foot muscles when walking, compared to running.
I sensed more muscle expenditure in my upper leg (quadriceps) when running; i.e., stronger contraction in my legs compared to walking.

My conclusion is that, although fast walking and light running were done at the same speed, there were differences in the biomechanics of the movements. Unlike walking, running involves a subtle vertical push upwards, generated mainly by the quadriceps muscle starting at the heel strike phase (leg forward position, initiation of propulsion) through the mid stance to toe-off , that lifts the entire body up about 2-3 inches, compared to walking. This was evident even as I tried my best to stay level while running.

running gait

So, my theory is that running a mile burns more calories than walking a mile, and the extra work/ calorie burning in running comes from the stronger concentric contractions (meaning, more muscle fibers firing which uses more glucose) in the leg muscles to generate that extra vertical height against gravity PLUS the stronger isometric contraction that occurs when landing from that extra height, from heel strike to mid stance. So, switching to a running gait gives you a double whammy of calorie burning over walking, even when doing it at the same pace and over the same distance as walking.

Another way to look at it is potential energy. In physics, potential energy is the potential energy associated with gravity, which is released when the objects fall towards Earth. Hydroelectric power comes from the potential energy of water stacked high by a dam, and released at a lower level. The movement of water due to gravity is harnessed by the generator, which produces electricity. This is also a good example of how energy converts to different forms; from potential to mechanical to electrical.

Potential Energy = mass x gravity x height (above ground). When you run, because the biomechanics causes your whole mass to rise 2-3” higher than when walking, potential energy builds up and then releases, which travels through your muscles and bones as a force that needs to be dampened by muscle contraction (or you would collapse), which burns more calories.

So, if you were told that walking a certain distance burns the same amount of calories as running the same distance because of the formula W=F*d, where F and d values are the same in both cases, it’s likely not true. The faulty assumption here is that your body mechanics are the same when they are not. Running 3 miles feels you are doing more work because you are. Your heart rate is faster (this alone burns additional calories), your muscles and joints ache more, and your breathing rate is higher than if you walked the same distance. It’s all because with running, you are expending more energy elevating your body an extra 2-3” with each stride. This effort requires more calories in generating that lift, and absorbing it.

So yes, running is a great cardiovascular exercise to burn calories and lose weight. It does place more stress to your joints, so make sure you can handle this; otherwise, you are better off walking for exercise. But, you will need to walk a greater distance to burn as much calories as running, so it’s going to take you more time to lose weight with walking, compared to running.

If running is just too uncomfortable for you, try speed-walking because ultimately, any movement is better than none when it comes to staying fit and maintaining a healthy weight.

Nicola TL, Jewison DJ. The anatomy and biomechanics of running. Clin Sports Med. 2012

How to Strengthen Your Joints and Avoid a Life of Chronic Pain

by Pain Doc | Jul 21, 2021 | Arthritis, Hip Pain, Knee Pain

When I talk about the nature of joint aches and pain such as hip pain, knee pain and shoulder pain, I explain that the human body is basically a biological (living) machine. Like a machine, it has moving parts comprised of levers connected by some kind of mechanism that redirects force. Think car engines, certain power tools and watches.

In the human musculoskeletal system, those levers are the long bones such as the femur and ulna, and the connecting mechanism/ force redirectors are the joints. Like a machine’s mechanical components, joints will gradually wear out with use. The more hours/years of use, the more likelihood of breakdown. Think football players and those in heavy labor jobs.

When a moving part of a machine gets prematurely damaged from an accident like dropping or overloading, it gets repaired—a replacement part is installed and/or a mechanic puts things back together and makes necessary adjustments. However, the machine is never the same. The accident typically causes moving components to misalign ever so slightly, which results in more friction and accelerated wear and tear, leading to impaired efficiency and eventual breakdown again.

Similarly, if you twist and injure your knee, hip or other joint and get it repaired surgically, or by a chiropractor or physical therapy/ rehabilitation it is never quite the same—most people will lose some degree of functionality because the natural alignment has been permanently altered. You may lose a few degrees of arc of motion; hear some clicking sounds with movement (called crepitus), and lose some strength in the affected joint. Worst case, you will experience chronic pain.

Your joint health obviously plays a huge role in your quality of life. The good things in life involve movement, which depends on joint function. Your joints must be able to first of all exist without pain. They must be able to move your body in the manner you wish to move, without mechanical limitations. And, they must be able to withstand forces while they move your body parts– jumping, climbing, lifting, carrying, etc. That’s the best case scenario.

But what if you are one of the millions of people who have some form of joint pain; either from wear and tear, or from an accident such as a sports injury, work injury, fall, or car accident? These things happen to almost everyone at some point.

It depends first of all on how bad it is. How much structural damage occurred will determine the extent to which your joint can be rehabilitated/ returned to normal.

Unfortunately, the tissues that comprise joints are of the type that do not regenerate very well. This includes tendons, ligaments, cartilage and muscle. As I wrote before, tendons, ligaments and cartilage are classified as connective tissue, which does not contain many living cells, per unit mass. They are mostly protein filaments (collagen, elastin) embedded in a special matrix whose main function is structural. The few cells found in connective tissue are mostly dormant (chondrocytes, fibrocytes) and can effect minor repairs and maintenance: tiny tears of collagen can be repaired, but large tears cannot. Tears/injury to cartilage, such as a meniscal tear or rotator cuff tear, are either repaired by surgical reattachment, or left alone to become chronic leaving the individual with a certain percent loss of function.

Compare this to skin tissue, classified as epithelial tissue, which can heal relatively fast due to the high density of cells (they divide in number to create new tissue) and blood supply. Think of the last time you got a cut– how relatively fast it healed, and is no longer noticeable.

So if you are fortunate to not have joint pain, think proactively now to keep it that way.

If you are experiencing any level of joint pain and/or dysfunction, learn things that you can do to reclaim some of that function AND slow down the progression, which is what I can help you with. Even chronic cases of joint pain can be improved, so don’t give up hope. You may not be able to make the pain go away entirely, but if you can reduce the severity of your pain by 50% and/or increase range of motion by a couple of degrees, that can translate into a dramatic improvement in your quality of life.

The Two Main Approaches to Maintaining Joint Health

Let’s review the main joints involved in everyday movement patterns.

First of all, the weight bearing joints of the lower extremities: hips, knees, ankles, foot joints. We can also include the lumbar spine (low back). These joints have the dual task of bearing the body’s weight (and more than your weight if you do high impact activities) while allowing ambulation—running, walking, climbing, etc. and are therefore larger in terms of surface area contact and number of ligaments.

Secondly, the non-weight bearing joints of the upper extremities: shoulder complex, elbows, wrists, and hands. While they don’t bear as much weight as the hips, knees, ankles and feet, these joints are involved in anything you do with your arms/ hands. They are smaller and generally have more moving parts, so these joints are vulnerable to degeneration as well, especially the glenohumeral joint of the shoulder.

The first course of action in preventing joint degeneration, which tends to start in most people around age of 40, is through diet and nutrition. Eat a wholesome diet rich in phytonutrients; i.e. plants. Phytonutrients are vitamins and minerals naturally found in plants that are important co-factors in numerous biological functions, such as enzymatic activity, tissue repair and anti-inflammation. Some like turmeric are strong anti-oxidants. Think of oxidation, or oxidative stress, as the body’s version of rust. Oxidation is what causes rust and decay in metals; oxidation in the human body damages cell membranes, proteins and DNA. It is caused by excess free radicals— oxygen-containing molecules that have an unpaired electron, making them highly reactive. They take electrons from tissues in order to return to a stable state, which damages them. In fact, oxidative stress is a leading theory of aging and joint wear and tear. Eating a diet rich in phytonutrients—green, leafy plants and plants with hues of blue, purple, and orange equips your body with the nutrients it needs to counteract oxidative stress. Thus, think of a plant-based diet as being protective of your joints.

On the contrary, eating a diet rich in processed foods and added sugar can place a burden on your body. Not only is there a lack of nutrients, there are ingredients that can raise your triglycerides and bad cholesterol; form plaque in your arteries, and even cause toxicity. They must also put a strain on your liver, lymph system and kidneys, the organs involved in detoxifying your body.

Next, move those joints! You’ve got to find the right balance between helpful movement that exercises and strengthens your joints, and the ones that can cause damage. I’m not saying to avoid things like weight lifting and running, because when done properly, they benefit your joints.

Basically, repetitive jumping activities and wrong running technique that “pounds” your knees, hips, feet and spine joints have the potential to cause tiny cracks in your cartilage, which can expand into pits and eventually tears. An example of the movement you should avoid is playing basketball often, where you run on a hard court and jump and land hard to do layups numerous times; often landing on one leg first.

Running is a great aerobic exercise, and I do it myself, being in my mid-50s. But do it wrong, and you are setting yourself up for hip, knee and foot pain. With running, first of all, I highly advise running no more than 20 miles a week. You don’t need that much cardio from running, and running beyond this point every week turns the tables, as the cardio benefit is at the expense of your hip, knee and feet joints. Long distance running is especially not advisable, as it can generate excessive free radicals, causing oxidative damage to your body. Repetitive pounding especially if you are over the age of 40 when cartilage loses its thickness and pliability can cause micro-tears which can expand as you keep doing it, like a tiny, 2mm crack in a car windshield that gradually grows into a really big crack with every bump in the road.

Also with running, definitely do not use a jumping type movement. Think more in terms of really fast walking. Keep your feet close to the ground as you run, and land on the forward half of your foot (toes, ball and arch) rather than your heel. Your head should not bob up and down as you run; or it should be minimal.

Do closed kinetic chain exercises. This means the levers involved in movement (i.e. for lower extrmities, your lower leg and foot) are secured to the ground during force generation. A perfect example are squats and lunges. With this type of exercise, you have more control, and you isolate the muscle better because your leg is secured to the ground with your weight.

For upper extremities, an example is planks and push ups. Chin ups as well — same concept, the levers are firmly secured as you exercise the muscles and joints in a controlled fashion.

Remember, joints are comprised of two bones connected by ligaments. A tendon (the ends of a skeletal muscle) crosses over the joint and connects somewhere on both bones (origin and insertion points). So when you do squats, you are strengthening the ligaments and tendons of the joint, giving it more support. With more support, the joint is more stable and able to withstand forces better; i.e. it will last longer. How does it happen? Wolf’s Law of physiology states that connective tissue increases in mass in response to repeated loads. It’s one of the body’s many survival and environmental adaptation mechanisms. The mechanical stress signals to the brain to mobilize cells to secrete more matrix and collagen to handle the load. This is why resistance exercises are highly recommended for women who are at risk for osteoporosis—it builds up bone mass and turns down bone loss.

Conversely, being sedentary leads to muscle, bone, and connective tissue atrophy. Weak joint components will increase your risk of injury.

But again, be careful not to overdo it. Do the movements slowly and controlled, and focus your mind on controlling the primary mover muscles rather than your rep goal. This will maximize joint strengthening and minimize injury.

Summary of Main Points

Proper joint function is necessary for everyday movements, and therefore is critical to quality of life.
Joints are prone to injury and degradation due to their daily use.
It is advisable to be proactive to ensure your joints stay healthy throughout your life because joint components are comprised of tissues that do not regenerate well. One major injury can mean lifetime dysfunction.
The recommended approaches to maintaining joint health are a plant-based diet rich in phytonutrients, and closed kinetic chain exercises to strengthen your joints so that they are more durable and resistant to injury and degeneration.

Next time, I will discuss more ways to keep your joints healthy, and if you already have chronic joint issues, things you can do to reclaim function.

Three Simple Ideas to Plan and Keep Your Health Goals

by Pain Doc | Jun 26, 2021 | Lifestyle Modification, Nutrition

Photo by Pexels

By Jennifer McGregor

We use a lot of statistics to determine health, but being healthy isn’t just about numbers. Yes, some numbers matter, such as your weight and your blood pressure, but how you feel matters, too. And, truth be told, the numbers and the feelings are all interconnected; if those numbers are too high or too low, it’s likely you already feel out of sorts.

Many people struggle to make physical and mental health and wellness a priority. We often set ourselves up to achieve some pretty unrealistic health goals. Not only does that hurt us mentally, emotionally and physically, but it can also damage us financially, as well. How often do you spend loads of cash on crash diets, exercise equipment, and gym memberships that go unused for the majority of the year?

You shouldn’t feel ashamed of wanting to get healthier or when those goals go unrealized. However, you should feel motivated to pick up and try again. Check out these simple tips to help you start and stick to a head-to-toe health overhaul.

Be Confident in Who You Already Are

You have value just as you are. Working on becoming a healthier version of yourself isn’t a judgment call on your worth; it’s a sign of self-respect. Start by making little changes in confidence now. For example, you can stock up on makeup, skincare, and other beauty items. Consider going on Groupon to get deals on haircuts, facials, nails, and other beauty services to help boost your confidence in the ways you already radiate health and wellness.

Be Flexible in Mind and Body

A regular yoga and meditation practice can help you build strength in mind and body. Studies show that people who take up the practice can better manage stress, reduce the risk of injury, build lean muscle mass and improve flexibility. Being flexible isn’t just about being able to touch your toes (although that is a nice side effect). It’s about being compassionate with yourself when you do lose track. Feeling guilt or shame can keep you in unhealthy patterns.

Focus on Your Dental Health

Similar to the concept of a mind-body connection, your oral health is also linked to the rest of your body. Improper dental care can increase your chances of developing diabetes, for example. Maintaining good dental hygiene can help prevent health problems such as gum disease and heart attacks. In addition to regularly brushing and flossing, it’s crucial that you assess your teeth’s alignment. If they’re misaligned, you may have a harder time keeping your teeth clean, so it’s best to look into a treatment.

When it comes to alignment treatment options, clear aligners are a popular choice since they’re more discreet than traditional braces. However, keep in mind that not all clear aligners look exactly the same. Some aligners may be slightly more visible than others based on their texture. For example, Candid has a “frosted” surface, which can make your teeth look more natural. However, if you find that a “shinier” smile is more attractive, you can go with a smooth texture like the Byte aligners. Make sure you thoroughly research your options and choose the one that will best fit your needs.

Be Conscious of Not Only What You Eat, But Also Why and How

In American culture, we frequently rush through fast-food drive-thrus or pop a frozen entree in the microwave. While doing this from time to time isn’t a crime, you’ll want to make some major changes if those options make up the majority of your diet. It might seem like buying healthier foods will inflate your grocery bill, but you can maximize your finances by joining a meal delivery service. Many of them offer a deep discount on the first month, and even if you do continue the service, the cost per meal is actually often quite cheaper. While you gently shift away from eating fast food and processed meals, be sure to keep a food journal logging when you eat and how you feel. Connecting your eating habits to your feelings, thoughts, and behaviors can help you break some unhealthy associations you have with food.

All too often we try to make big changes happen overnight, and that’s why they are so hard to keep — we often take drastic measures too quickly. So, make progress with small, intentional steps to save time and sustain your success.

If you suffer from fibromyalgia, sciatica, or another type of musculoskeletal pain, you can seek out helpful articles that discuss pain relief strategies at The Pain & Injury Doctor.

How to Manage Hip Stiffness and Pain

by Pain Doc | Jun 14, 2021 | Hip Pain, Pulsed EMF

The hip joints are a key component to stabilization and ambulation of the human frame, so if you are experiencing problems with one or both of your hips, it is going to cause some loss of basic movements required by common activities of daily living, which translates to a reduction in quality of life. It is therefore imperative that you be mindful of your hip health at all times: take care not to place excessive shock trauma and repetitive stress to your hips; engage in exercises and stretches that condition your hip stabilizers.

Hip bone, or os coxae

The hip joint, or acetabulofemoral joint is a ball and socket type joint that supports the weight of the body in a static (standing) position and ambulatory position (running, walking). Its two articulating parts are the femoral head of the femur (upper leg bone) and the acetabulum of the pelvis (coxae), a bowl-like depression lined with cartilage.

Your hips bear quite a bit of repetitious force every day, and if you run and/or play sports that involve jumping and landing such as basketball or gymnastics, then those hip joints are really taking a pounding.

mountain bike shocks

The hip/pelvis complex, like a $10,000 mountain bike, is designed to absorb shock from multiple planes while simultaneously enabling movement. A high-end mountain bike can be ridden over uneven ground and can withstand shock forces from bumpy terrain, drops and jumps thanks to a multiple- jointed frame outfitted with shock absorbers. Like the mountain bike, the hip/pelvis complex enables the human body to absorb shock while ambulating.

The hip joints are balanced under the coxae, with the femoral heads partially inserted into the acetabulae and held in tightly by strong but stretchable capsular ligaments. Smooth, nearly frictionless cartilage lines the femoral head and the acetabulum. Comprised mainly of water molecules bound by proteins, cartilage is able to absorb shock and rebound, since water is incompressible. In youth, cartilage is thicker, suppler and more resilient than in those past age 40 but as you age your cartilage thins and is less capable of absorbing repetitive shock; hence the difficulty of running for exercise as you age.

Major hip muscles

Rear view of the hip muscles.

The Ilia and ischia of the pelvis serve as broad attachment points for the hip stabilizer muscles: gluteus maximus and minimus, psoas, adductor brevis and longus, and the deep hip rotator muscles (gamellus, piriformus). These are the hip mobilizers and shock absorbers that give the hip joints their main function of propelling the body on flat and uneven ground, and stabilizing them when the upper body needs a stationary anchor such as during heavy lifting.

So what are the main types of hip problems?

The most common problem that affects the hips is osteoarthritis. With so much pounding forces absorbed daily, the hips are prone to degenerative changes more so than other joints with the exception of the knees. Tiny fissures appear in the cartilage and gradually expand over time, like a windshield crack that grows longer from the constant dips and bumps of driving. The cracks turn into pits, and the hip joint starts to lose its smooth, fluid movement; giving way to clicking, stiffness, and limited range of motion. Although osteoarthritis is often referred to as a “degenerative joint disease,” this term is not entirely accurate. There is indeed a degenerative process involving progressive loss of articular cartilage, but there is also a reparative process in response to this degeneration that involves new bone formation, osteophyte growth, and remodelling. The dynamic process of destruction and repair determines the final disease picture.

In advanced hip osteoarthritis, the pit erodes all the way down to the bone, and at that point you start getting pain in your hips, and where there is pain there usually is inflammation. The hip capsule may fill up with inflammatory exudate, increasing the internal pressure of the hip joint and adding to the stiffness.

Normal hip joint vs. osteoarthritic hip

Risk factors, or things that will increase your chances of prematurely developing hip osteoarthritis are:

Previous injuries to one or both of your hips – a fall, sports injury, car accident, etc.
Participating in sports or other activities that involve high impact landings
Being overweight for much of your adult life
Smoking, as smoking restricts oxygen to tissues which is needed for maintenance and repair
Genetic factors – having a parent who got premature hip osteoarthritis

The genetic factors likely involve protein mutations that render the cartilage’s ability to bind water less efficient, making it extra vulnerable to shocks. They may also involve abnormal production of synovial fluid by the cells of the synovial tissue that surrounds the joint. Synovial fluid is analagous to motor oil in a car’s cylinder– it minimizes friction between the moving parts, so if production of synovial fluid is low, you will get erosion of the articulating surfaces; i.e. the cartilage on the femoral head and the acetabulum, accelerating the disease process.

Iliotibial band syndrome

Another form of hip pain and stiffness may be from iliotibial (IT) band syndrome. The IT band is a broad ligament that originates on the iliac crest of the hip bone; passes over the greater trochanter of the femur (that hard bump you can feel on the sides of your hips, right underneath the skin); and then inserts into the lateral epicondyle of the proximal tibia (lower leg bone). This is a condition that some runners get, and involves strain to the ligament and tenderness at its insertions points. It most often causes pain on the side of the knee, but can also cause diffuse, broad pain over the entire hip. Tenderness and pain at ligament insertion points (into the bone) typically involve micro-tears from mechanical stress, and/or inflammation to the periosteum, the thin layer of tissue where the fibers attach to the bone.

Xray of an aneurysmal bone cyst affecting proximal femur

Aneurysmal bone cysts, a benign but potentially destructive bone tumor may occur in the femur near the hip. It involves the growth of a tumor inside the bone, filled with fluid and blood. Normal bone is replaced by the tumor, which deforms and weakens the bone, making it prone to fracture. ABCs typically start in the first 20 years of life and can remain into adulthood if not dealt with. Make sure to rule this out before doing any physical therapy for hip pain; aneurysmal bone cysts are easily identified on X-ray.

There are other pathological conditions that affect the hip that can cause pain and stiffness, such as slipped capital femoral epiphysis (another pathology common to youth), fibrous dysplasia and other bone disorders but won’t be discussed in this article. Just know that these can be a long-shot cause of hip pain, and can be usually ruled out on X-ray.

Those with hip pain or discomfort due to progressive hip osteoarthritis know the consequences:

Very stiff hips upon waking in the morning, that improves up to a point as the day goes on.
Laborious walking; takes extra effort to move your legs
Aggressive movements like jumping and running are out of the question
For some, burning pain in the hips
Can’t stand for very long; have to sit

For those who have medical insurance, it’s a matter of time before they elect to have an artificial hip inserted.

So what should you do if you have hip pain from osteoarthritis, and are years away from considering hip replacement?

Here’s what I recommend:

Change your Diet: what you choose to eat day to day has the biggest influence on your health. Make 80 percent of your diet plant-based; and of that amount, about half of it raw (uncooked). Suggestions: green leafy vegetables such as chard, collard greens and spinach for the cooked; red leaf and green leaf lettuce, red cabbage, and endive for the raw. Basically, vegetables with purple and red hues are the best as they are rich in anti-oxidants.

Include protein, about 10 ounces per day. Organic grass fed meat, deep water fish, sardines, and pastured eggs are good choices. Whey protein and pea protein powder are also good.

Include fats high in Omega 3 fatty acids, and some saturated fat. Fats are a component of cell membranes especially in nerves, and they are a needed energy source for your body. Salmon, mackerel, eggs, nuts and seeds are good choices.

And of course, drink water throughout the day to stay hydrated. We humans are almost 80% water, and you lose water from your body with every exhalation.

Reduce daily stress in your life: if your life is stressful, make an effort to remove the stress. Stress has an adverse effect on your health and well-being. It can raise blood pressure, blood sugar, cholesterol and cortisol levels, which promote fat weight gain.

Get some negative ions: negative ions are abundant in nature; i.e. the outdoors. They can neutralize harmful positive ions that are plentiful where there is pollution and electronics; i.e. cities. Take off your shoes and socks, and walk on grass in a nearby park. This will “ground” your body, discharging some of your positive ions and equalizing your electrical charge with the Earth’s.

Do low-impact exercises for fitness: you don’t have to go crazy to get a good workout. Using your body’s own weight is sufficient. Planks, squats, pushups, crunches, and lunges are great. For weights, use kettlebells. Cycling can be a good exercise for those with early osteoarthritis of the hip, as the pedaling moves the hip in a non-weight bearing position.

Lastly, use a Pulsed EMF mat daily. Pulsed EMF is considered “energy medicine.” It is the external application of electromagnetic fields similar to those produced by your body, to augment the potential energy the body uses to help drive biological activity; i.e. molecular movement such as blood flow and nutrient transport. This can improve blood circulation and cell membrane transport of nutrients, proteins and wastes; thus improving cell function. In weak tissues, Pulsed EMF can stimulate healing by energizing reparative cells. Can Pulsed EMF help cause worn cartilage to regenerate? Several studies such as this one found that pulsed EMF can upregulate the expression of a gene that controls cartilage production in chondrocytes. It’s definitely worth a try.

Some studies show that Pulsed EMF can help cartilage regenerate.

Go here for more info on Pulsed EMF.

To recap, your hip joints are essential to a high quality of life. They serve to ambulate you, and enable your body to perform basic movements required of daily living such as lifting, carrying, and bending. They are also prone to degeneration, so be mindful of the health of your hip joints – avoid repetitive, high-impact activities that may accelerate degeneration. If you like running, change your running stride to one that more resembles fast walking, where there is minimal to no change in height of your head as you run and therefore minimal impact to your knees and hips upon heel strike when running. In fact, if you run, focus the impact of your foot on the ball of your foot as it contacts the ground, not the heel. Running can be good for health, and your bones, when done right – not too aggressively; with moderation.