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Understanding Plantar Fasciitis: Causes, Risks, Treatments, and Recovery

by Pain Doc | Dec 10, 2024 | Chronic Pain

Imagine waking up one morning, eager to start your day, only to feel a sharp, stabbing pain in the bottom of your heel as soon as your foot touches the floor. It might ease as you move around, but the discomfort often lingers, especially after periods of rest or extended activity. If this sounds familiar, you may be experiencing plantar fasciitis, one of the most common causes of heel pain.

This condition affects millions of people worldwide and can disrupt daily life. In this article, we’ll explore what plantar fasciitis is, its causes, risk factors, treatments, and what to expect on your road to recovery.

What is Plantar Fasciitis?

Plantar fasciitis is the inflammation of the plantar fascia, a thick band of connective tissue that runs along the bottom of your foot, from your heel to your toes. The plantar fascia acts like a shock absorber, supporting the arch of your foot and aiding in movement.

When the plantar fascia becomes overstretched or overloaded, tiny tears can develop, leading to inflammation and pain. The hallmark symptom of plantar fasciitis is heel pain, often described as sharp or stabbing. This pain is typically worse in the morning or after periods of inactivity, as the fascia tightens when not in use.

Anatomical and Physiological Causes

Overloading the Plantar Fascia

Repeated stress or strain can damage the plantar fascia, causing microtears. Over time, these tears can lead to chronic inflammation. Activities like running, jumping, or standing for prolonged periods on hard surfaces often exacerbate this strain.

Biomechanical Issues

Certain foot mechanics, such as high arches, flat feet, or abnormal walking patterns, can increase tension on the plantar fascia, making it more prone to injury.

Tightness in Surrounding Structures

Tight calf muscles or Achilles tendons can reduce ankle flexibility, putting additional strain on the plantar fascia.

Age-Related Degeneration

As we age, the elasticity of the plantar fascia decreases, making it more vulnerable to injury.

Activities That Increase the Risk of Plantar Fasciitis

Certain activities can significantly increase the likelihood of developing plantar fasciitis. These include:

High-impact sports: Running, dancing, or aerobics place repetitive stress on the heel and arch.

Prolonged standing or walking: Occupations that require being on your feet for long periods (e.g., teachers, retail workers, healthcare professionals).

Sudden increases in activity levels: Abruptly increasing workout intensity or mileage without adequate preparation.

Wearing improper footwear: Shoes with poor arch support or cushioning can fail to absorb shock effectively.

Who is at High Risk for Plantar Fasciitis?

Some individuals are predisposed to plantar fasciitis due to certain risk factors:

Age: It is most common between the ages of 40 and 60.

Obesity: Excess body weight increases the load on the plantar fascia.

Occupation: Jobs that involve standing or walking for long hours increase risk.

Foot Mechanics: People with flat feet, high arches, or abnormal walking patterns are more susceptible.

Athletes: Runners and dancers are particularly vulnerable due to the repetitive impact on their feet.

Medical Treatment Options

If you suspect plantar fasciitis, it’s crucial to consult a healthcare provider for an accurate diagnosis. Treatment typically begins with conservative measures and progresses to more advanced options if necessary. Common treatments include:

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can reduce pain and inflammation.

Physical Therapy

A physical therapist may guide you through stretches and strengthening exercises to relieve tension in the plantar fascia and improve foot mechanics.

Orthotics

Custom-made shoe inserts or over-the-counter arch supports can help distribute pressure evenly across your foot.

Night Splints

Wearing a splint at night keeps the plantar fascia stretched while you sleep, reducing morning stiffness.

Corticosteroid Injections

In severe cases, a doctor may recommend a steroid injection to reduce inflammation.

Shock Wave Therapy

Extracorporeal shock wave therapy (ESWT) involves sending sound waves to stimulate healing in the plantar fascia. It’s often used for chronic cases.

Surgery

Rarely, surgical intervention is required to release the plantar fascia if all other treatments fail.

Home Therapy and Exercises

Many individuals find relief from plantar fasciitis with consistent home care. Key strategies include:

Personal shockwave – as stated earlier, this technology breaks dows scar tissue and improves microcirculation to the injury/pain site, resulting in faster and higher quality healing. Like red light and pemf below, this device is available for direct purchase by consumers; you don’t need to be a doctor to own one, because they are generally very safe to use with minimal to no side effects.

Red Light Therapy – these devices accelerate healing of soft tissue sprains, strains and cuts by ramping up metabolism of the injured tissues speeding up the process.

Pulsed EMF – these devices strengthen the membrane potential of cells, which improves transportation of nutrients and oxygen into cells, and removal of waste products which helps reduce pain and speed up healing

Stretching Exercises

Calf Stretch: Stand facing a wall, place your hands on it, and stretch one leg back, keeping the heel on the floor. Hold for 30 seconds.

Plantar Fascia Stretch: Sit down, cross one leg over the other, and pull your toes back toward your shin to stretch the arch. Hold for 30 seconds.

Strengthening Exercises

Towel Scrunches: Place a towel on the floor and use your toes to scrunch it up.

Marble Pickup: Pick up small objects with your toes to strengthen foot muscles.

Icing

Roll a frozen water bottle under your foot for 15 minutes, 2-3 times a day to reduce inflammation.

Footwear Adjustments

Wear supportive shoes with proper cushioning and arch support. Avoid walking barefoot on hard surfaces.

Rest and Activity Modification

Temporarily reduce activities that exacerbate symptoms. Opt for low-impact exercises like swimming or cycling.

Prognosis and Recovery Timeline

The good news is that most cases of plantar fasciitis improve with conservative treatment. However, recovery requires patience and consistency.

Short-Term Recovery: With appropriate care, symptoms typically improve within 6-8 weeks.

Chronic Cases: For those with severe or long-standing plantar fasciitis, full recovery may take 6-12 months or longer.

Recurrent Issues: Without addressing the underlying causes (e.g., poor footwear, tight muscles), the condition can return.

Conclusion

Plantar fasciitis can be a painful and frustrating condition, but with the right approach, it’s manageable. Early recognition of symptoms and commitment to treatment—both professional and at home—are key to recovery.

By addressing risk factors like poor footwear, tight muscles, or high-impact activities, you can reduce the strain on your plantar fascia and prevent future flare-ups. If you’re dealing with persistent heel pain, don’t hesitate to seek help from a healthcare provider. With time and care, you can regain your mobility and get back to doing the things you love, pain-free.

Understanding Sciatica: Causes, Treatment Options, and Prognosis

by Pain Doc | May 10, 2024 | Chronic Pain, Sciatica

Introduction:

Sciatica is an often debilitating condition that typically appears after age 60 in those affected, characterized by dysthesias: abnormal sensations that can include shooting pain, numbness and tingling radiating (traveling) along the path of the sciatic nerve, the largest diameter nerve in the body, which runs from the lower back, between the deep hip rotator muscles, and down the back of each leg. This condition can significantly impair one’s quality of life, affecting mobility, work, and daily activities. In this post, I’ll delve into the main details of sciatica, exploring its causes, pathology, treatment options ranging from conservative approaches to surgical interventions, and the prognosis associated with each.

Understanding the Pathology of Sciatica:

Sciatica typically arises from compression or irritation of the sciatic nerve roots, also called the cauda equina, most commonly at the lumbar spine level. The sciatic nerve is composed of nerve roots originating from the lumbar and sacral spine (L4-S3). When these nerve roots are compressed or inflamed, they can give rise to the characteristic symptoms of sciatica, including pain, numbness, tingling, and weakness along the nerve’s distribution. The sciatic nerve is comprised of both motor and sensory fibers, but since the sensory fibers are larger in diameter they are more susceptible to mechanical pressure; hence, irritation of the nerves results in mostly sensory dysfunction and less of motor function (leg muscle strength and coordination).

Common Causes of Sciatica

Herniated Disc: One of the leading causes of sciatica is a herniated disc, also known as a slipped or ruptured disc. Intervertebral discs act as cushions between the vertebrae of the spine, providing support and flexibility. When a disc herniates, its inner gel-like material protrudes through the tough outer layer, exerting pressure on nearby nerve roots, including those of the sciatic nerve.
Spinal Stenosis: Spinal stenosis refers to the narrowing of the spinal canal: the passageway formed from the stacking of the spinal vertebrae, which are solid in the front and have a ringed rear portion that when stacked form the canal in which the spinal cord resides. Narrowing can occur due to age-related degenerative changes, such as the formation of bone spurs and thickening of ligaments. The bone spurs and buckled ligaments encroach the canal, narrowing it. This narrowing can compress the spinal cord and nerve roots, or cause them to rub against them during movements especially back extension, leading to sciatic symptoms.
Piriformis Syndrome: The piriformis muscle, located in the buttocks region, plays a crucial role in hip rotation. In some individuals, the sciatic nerve may pass through or under the piriformis muscle, making it susceptible to compression or irritation. This condition, known as piriformis syndrome, can mimic the symptoms of sciatica. The muscles scissor the nerve if they get spasmed, which can produce sciatica symptoms.
Spondylolisthesis: Spondylolisthesis occurs when a vertebra slips out of alignment anteriorly, often due to degenerative changes or trauma (fractured pars). This misalignment offsets the foramen at that level, usually at L4’L5 effectively scissoring the nerve roots and producing sciatica symptoms.
Degenerative Disc Disease: With age, the intervertebral discs undergo wear and tear, leading to degenerative changes such as disc dehydration, loss of disc height, and the formation of bone spurs. These changes can contribute to nerve root compression and the development of sciatica.

Treatment Options for Sciatica:

The management of sciatica aims to alleviate pain, reduce inflammation, improve mobility, and address the underlying cause of the condition. Treatment options may vary depending on the severity of symptoms, the underlying pathology, and individual patient factors.

Conservative Management: Conservative approaches are often the first line of treatment for sciatica and may include:

Pain Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and analgesics can help alleviate pain and reduce inflammation.
Physical Therapy: Targeted exercises, stretches, and manual techniques can improve spinal flexibility, strengthen supporting muscles, and alleviate pressure on the sciatic nerve.
Heat and Cold Therapy: Applying heat or cold packs to the affected area can help reduce pain and inflammation.
Epidural Steroid Injections: Corticosteroids injected into the epidural space can provide temporary relief by reducing inflammation around the affected nerve roots.

Surgical Intervention: If conservative measures fail to provide adequate relief or if there is evidence of progressive neurological deficit, surgical intervention may be considered. Surgical options for sciatica include:

Discectomy: In cases of herniated discs causing nerve compression, a discectomy may be performed to remove the protruding disc material and relieve pressure on the affected nerve roots.
Laminectomy: This procedure involves removing a portion of the vertebral bone (lamina) to alleviate pressure on the spinal cord and nerve roots, particularly in cases of spinal stenosis.
Spinal Fusion: Spinal fusion surgery may be recommended to stabilize the spine and prevent further slippage of vertebrae in cases of spondylolisthesis or severe degenerative disc disease.

Alternative Therapies: Some individuals may find relief from sciatica symptoms through alternative therapies, although evidence supporting their efficacy may vary. These may include:

Acupuncture: The insertion of fine needles into specific points on the body may help reduce pain and improve nerve function.
Chiropractic Care: Spinal manipulation techniques performed by trained chiropractors may help alleviate pressure on the sciatic nerve and improve spinal alignment. Combining chiropractic with a stretching and exercise routine is even better.
Mechanical Traction: Some chiropractic and physical therapy clinics have special tables that can stretch the spine using an electric motor. This may increase space between the vertebrae, retract buckled ligaments and provide temporary relief.
Yoga and Pilates: These forms of exercise focus on strengthening core muscles, improving flexibility, and promoting relaxation, which can be beneficial for individuals with sciatica.
Low Level Laser (LLLT): Lasering the area of the sciatic nerve may alleviate symptoms. LLLT, also known as cold laser (non-thermal) helps by providing deep penetrating light to the nerve tissue. Photons from laser light enter the sciatic nerve and can modulate pain producing biochemical pathways.

Prognosis:

The prognosis for sciatica depends on various factors, including the underlying cause, the severity of symptoms, and the effectiveness of treatment. In many cases, sciatica resolves with conservative measures within a few weeks to months. However, some individuals may experience chronic or recurrent symptoms that require ongoing management. Over time, the neurons in the irritated nerve roots lose some of their ability to conduct sensory signals, and the symptoms tend to be less acute.

Surgical intervention can provide significant relief for those with severe or persistent symptoms, but it also carries risks and requires careful consideration of potential benefits versus potential complications. With advances in surgical techniques and rehabilitation protocols, the outcomes of surgical treatment for sciatica have improved, with many patients experiencing long-term symptom relief and improved function.

Ultimately, the prognosis for sciatica is influenced by factors such as the individual’s overall health, adherence to treatment recommendations, and the presence of any underlying medical conditions. Early intervention, comprehensive management strategies, and a multidisciplinary approach involving healthcare providers from various specialties can optimize outcomes and improve the quality of life for individuals affected by sciatica.

Conclusion:

Sciatica is a complex condition with diverse causes, ranging from herniated discs to spinal stenosis and piriformis syndrome. Understanding the underlying pathology is crucial for guiding appropriate treatment interventions, which may include conservative measures, surgical intervention, and alternative therapies. With timely and comprehensive management, the prognosis for sciatica can be favorable, enabling individuals to regain function and resume their daily activities with minimal pain and discomfort.

What is Causing the Alarming Rise in Cancer Rates in Young People?

by Pain Doc | Mar 27, 2024 | Lifestyle Modification

In recent years, a concerning trend has emerged in the world of cancer care: more and more individuals under the age of 50 are being diagnosed with various forms of cancer. At the time of this writing, Kate Middleton, the Princess of Wales (age 42) recently announced that she has cancer. She had abdominal surgery in January of this year that was at first thought to be non-cancerous, but later diagnosed as cancerous (no details on the type of cancer have been released at this point). This phenomenon challenges the long-held belief that cancer primarily affects older adults, shedding light on a complex issue that demands attention and action.

Recent studies have revealed startling statistics, indicating a significant rise in early-onset cancer cases globally. From 1990 to 2019, the incidence of early-onset cancer increased by a staggering 79.1%, with a 27.7% rise in early-onset cancer deaths. This trend is particularly evident in the United States, where breast cancer tops the list of diagnoses among younger populations, closely followed by gastrointestinal cancers, including colon cancer which are increasing at an alarming rate. Amazingly, the statistics show that someone born in 1990 has over twice the risk of getting colon cancer than someone born in 1950. In other words, today’s 34 year olds are twice as likely to get colon cancer than today’s 74 year olds!

What factors are contributing to this concerning uptick in early-onset cancer? While genetics play a role, it appears that environmental and lifestyle factors are paramount. Changes in nutrition and lifestyle habits over the past few decades have created a perfect storm, with ultraprocessed foods, sugary drinks, smoking, alcohol consumption, obesity, and physical inactivity identified as potential culprits. These factors can disrupt the body’s internal processes, leading to inflammation and metabolic disturbances that increase cancer risk.

Moreover, emerging research suggests a link between changes in the gut microbiome—a community of microbes residing in our bodies—and cancer vulnerability. Poor dietary choices, excessive antibiotic use, and certain medications can disrupt this delicate balance, potentially facilitating cancer development.

As a long time advocate of using scientific thinking in everyday life, I think of the major environmental changes in society that coincided with the birth of millennials, born between 1981 and 1996, for this generation is getting hit the hardest with this uptick in cancer. What new thing did this generation absorb, starting in their early prepubescent years?

The one that comes to mind is cell phone use. Cell phones started to become mainstream in the late 1990s. Ten years later, about 80% of adults had one. Of course, cell phones needed cell phone towers that carried the signals using radiofrequency waves, and today’s 5G networks have a frequency of about 25-52GHz. Could this be a factor? Yes, everyone who lives in modern society gets exposed to these frequencies, but maybe they do their damage when the body is still developing? This may explain why people born in the 50s and before have about the same rates of cancer over the past decades.

Cancer is also associated with genetics. Certain mutations can be the catalyst for cancer development, and maybe these new cell phone frequencies are able to affect DNA, which is passed onto the offspring?

Another possibility for the rising rates of cancer in young adults is the introduction of new industrial chemicals and food additives in consumer products and the food supply. Chemicals are used for many different purposes, such as fire retardants, fabric manufacturing, materials engineering such as hardwood flooring, agriculture, and more. Sometimes the use of these chemicals in consumer products are rushed for government approval and there hasn’t been enough time to conduct experiments on their toxicity to humans. Ultra processed food have preservatives that help big food corporations produce more food that has longer shelf life and have addictive effects on consumers to encourage repeat buying.

Of course, many of these chemicals can find their way into the water supply and atmosphere, where they continue to be ingested, daily. This is why I encourage everyone to invest in a home water filter and air purifier, like the AirDog. You must be mindful of what goes into your body at all times.

Despite ongoing efforts to understand the root causes of early-onset cancer, many questions remain unanswered. While obesity and lifestyle factors explain some cases, there are instances where seemingly healthy individuals are diagnosed, highlighting the complexity of this issue. Additionally, underdiagnosis of early-onset cancers remains prevalent, emphasizing the need for improved awareness among primary care physicians and proactive advocacy by patients.

The consequences of early-onset cancer extend beyond diagnosis and treatment. Younger patients face unique challenges, including concerns about fertility, long-term side effects of treatment, and the impact on daily responsibilities such as work and education. Addressing these challenges requires a holistic approach that encompasses not only medical treatment but also psychological support and long-term care planning.

As we grapple with the implications of this unsettling trend, there is a pressing need for collective action. This includes increased funding for research, education campaigns to raise awareness among both healthcare professionals and the general public, and revisions to screening guidelines to ensure early detection and intervention. Recent recommendations to lower the age for colorectal cancer screening reflect a step in the right direction, but more must be done to address the multifaceted nature of early-onset cancer.

In conclusion, the rise in early-onset cancer cases serves as a sobering reminder of the complexities of this disease and the importance of proactive measures to combat it. By working together to understand the underlying causes, improve detection and diagnosis, and support affected individuals, we can strive towards a future where cancer is no longer a threat to individuals of any age.

Can Pulsed EMF Cure Pain and Disease?

by Pain Doc | Dec 19, 2023 | Pulsed EMF

Over the last decade, research into Pulsed Electromagnetic Field (PEMF) therapy has yielded promising results across various health conditions. Here’s a brief summary of key studies and findings:

Bone Healing and Fractures: Studies have consistently shown PEMF’s effectiveness in enhancing bone healing and treating fractures. In fact, non-union bone fractures (where the ends of the bone fracture fail to fully connect during normal healing) was the first condition that was shown to benefit from magnetic fields.

A notable study published in the Journal of Orthopaedic Surgery and Research (2020) highlighted the acceleration of bone fracture healing with PEMF therapy. This is attributed to PEMF’s ability to stimulate osteoblast activity, essential for bone regeneration. Osteoblasts are the active cells in bone tissue that lay down new bone for maintenance and repair. Given this discovery of PEMF’s effect on stimulating bone-creating cells to work more, it may have similar effects on chondrocytes— the cells that synthesize cartilage, the soft, rigid yet pliable shock-absorbing tissue that lines the ends of the bones that form a joint. This may be a promising treatment intervention to regenerate damaged cartilage from injury and perhaps even from long term wear and tear; i.e. osteoarthritis.

Chronic Pain Management: PEMF has been found effective in managing chronic pain, including lower back pain and osteoarthritis. Research published in Pain Research and Management (2019) showed significant pain reduction in participants with chronic conditions. This effect is thought to be due to PEMF’s influence on reducing inflammation and enhancing endorphin production.

Tendon Healing: Research, including in vitro studies, indicates PEMF’s potential in promoting tendon healing. A controlled laboratory study evaluated the effects of PEMF on tenocyte cultures, demonstrating accelerated closure of ‘wounds’ in these cells, which are crucial for tendon repair. Tendons, like ligaments, have very few active cells and are mostly collagen and elastin protein fibers embedded in a matrix. They have no direct blood supply and therefore have poor injury healing capacity; hence the “season-ending” injuries that occur in sports, from an ankle or knee sprain, for instance.

Animation of a fibroblast synthesizing and laying down collagen fibers.

However, there are cells called fibroblasts and some chondrocytes that can repair mild to moderate ligament/tendon injuries, commonly referred to as sprains and strains. The material they synthesize to close the tear is referred to as scar tissue (if you’ve ever sustained a rough skin laceration and have it heal, it’s that raised, firm tissue where the cut used to be). But it is usually a long process to heal a tendon and ligament, due to the scarcity of these fibroblasts. Pulsed EMF stimulates fibroblastic activity, causing them to work faster and therefore reducing the healing time.

Neurological Disorders: Some studies have explored PEMF’s effects on neurological conditions like multiple sclerosis and depression. The results, though preliminary, suggest that PEMF can help reduce symptoms and improve quality of life in some patients, potentially by modulating neural activity and inflammation. Remember, nerves are made of neurons, which are highly specialized cells that depend on proper membrane function moreso that other types of cells because quality of nerve transmission depends on normal membrane function. PEMF has been shown to improve membrane potential in cells by providing an external magnetic field that essentially polarizes the membrane (strengthens the + and – charges on opposite sides of the membrane). This results in improved transfer of molecules into and out of the cell.

wound healing

Wound Healing: PEMF therapy has been shown to enhance wound healing, especially in diabetic ulcers and other chronic wounds. This is likely due to its ability to reduce inflammation, improve cell membrane function, improve circulation and promote tissue regeneration. Recall from high school science that electrical currents form when charged particles move through a conductor. The charged particles in your body are the various molecules and ions that travel during the course of maintaining your life functions. The conductor is the fluid environment of the body. Magnetic fields form 90 degrees to the movement of the charge particles and can affect their movements (think of a magnet attracting a metal ball bearing). PEMF therefore can affect movement of molecules into (oxygen, nutrients) and out of (waste products; proteins) the cells, improving their efficiency. When cell efficiency is improved, healing improves, then symptoms.

Cardiovascular Health: Limited research suggests that PEMF therapy might benefit cardiovascular health by improving endothelial (inner lining of blood vessels) function and reducing inflammation, although more extensive studies are needed. But given the observations of Pulsed EMF’s therapeutic effects on cells involved in bone, tendon, nerve and skin repair, it is likely that it has similar effects on the heart and blood vessels.

endothelium showing clot formation The endothelium is the site where cardiovascular disease begins. If it gets damaged somehow, whether from wear and tear, weakening, or caustic molecules circulating in the blood, certain things happen that don’t normally occur in the healing of other types of tissue injury since there is a constant supply of blood coursing over the injury (remember, it’s the inside lining of the blood vessel). Fatty molecules get stuck in the injury site; the inflammatory cascade forms a clot over the wound which may block blood flow to an organ (i.e. heart attack, stroke), and macrophages– the cells that clean up debris– are attracted to the things happening at the wound, and they themselves bunch up and add to the clot. Pulsed EMF can be applied to the cardiovascular system and can potentially restore endothelial tissues that are compromised.

These studies highlight PEMF’s potential as a non-invasive and safe therapy for various health conditions. However, it’s important to note that while the results are encouraging, PEMF therapy should be considered a complementary treatment and used in conjunction with conventional medical treatments. Always consult healthcare professionals before starting any new treatment regimen. Nevertheless, its safety record (no noted adverse side effects) and easy operation makes pulsed EMF an ideal home care therapy.

woman lying on mat getting pulsed emf treatment

If you battle a chronic injury or health condition and you’ve completed one or more treatment cycles with your doctor or therapist, but have lingering symptoms, look into Pulsed EMF — it’s got a long history and an abundance of medical research behind it. Best of all, it’s safe to use. Its popularity is growing, and you are likely to find a clinic in your town that offers pulsed EMF. You can also invest in your own home PEMF machine. There are several models and technologies available, differing in field strength and field pulse mode.

What is Stiff Person Syndrome?

by Pain Doc | Dec 19, 2023 | Neuromusculoskeletal Disorders

The singer Celine Dion, whose glorious singing career spanned the last four decades, was recently diagnosed with a condition called Stiff Person Syndrome. Unfortunately, the condition is prevening her from performing, due to its debilitating effect on muscle control, including the vocal cord muscles.

Stiff Person Syndrome (SPS) is a rare, progressive neurological disorder characterized by significant muscle rigidity and spasms, often leading to debilitating physical and psychological symptoms. This article provides an overview of SPS, delving into its causes, symptoms, diagnosis, and current treatment options, as informed by medical research and trusted medical resources.

What is Stiff Person Syndrome?

SPS is an autoimmune neurological disorder primarily causing muscle stiffness and painful spasms. These spasms can worsen over time and vary in symptoms, including an unsteady gait, double vision, or slurred speech, depending on the SPS type. The condition can be severely disabling, often leading to hunched over postures and frequent falls due to impaired reflexes.

Causes of Stiff Person Syndrome

While the exact cause of SPS is unknown, it is believed to be an autoimmune reaction where the immune system attacks glutamic acid decarboxylase (GAD) in the brain and spinal cord. GAD is crucial for producing gamma-aminobutyric acid (GABA), a neurotransmitter controlling muscle movement. Neurotransmitters are protein molecules released from the ends of neurons, which then attach to other neurons causing them to continue the nerve impulse until it reaches the muscle. Disruption in GABA production can lead to continuous neuron firing, contributing to muscle rigidity and spasms seen in SPS. Low GABA levels are also associated with anxiety and depression. Interestingly, SPS often occurs alongside other autoimmune diseases like type-I diabetes, thyroiditis, vitiligo, and pernicious anemia.

Symptoms of Stiff Person Syndrome

The primary symptoms of SPS include progressive muscle rigidity and painful spasms, often triggered by stimuli such as noise, touch, and emotional distress. Initial symptoms typically manifest between the ages of 30 and 60 and can vary in severity and progression. Common initial signs include muscle stiffness and pain, especially in the lower back and legs, potentially leading to difficulty in walking and performing daily activities. Severe cases may require wheelchair use, and there’s an increased risk of anxiety and depression.

Diagnosis of Stiff Person Syndrome

Diagnosing SPS is challenging due to its rarity and symptom overlap with other conditions like Parkinson’s disease, multiple sclerosis, and fibromyalgia. A definitive diagnosis is often made via a blood test measuring GAD antibodies. Most people with SPS show elevated GAD antibody levels. Electromyography (EMG) tests can also be employed to measure muscle electrical activity and assist in diagnosis and monitoring treatment response.

Treatment Options for Stiff Person Syndrome

While there is no cure for SPS, symptoms can be managed through personalized treatment plans focusing on pain management, muscle relaxation, and immune response suppression. Common medications include pain relievers, muscle relaxants, anti-seizure and anti-anxiety drugs, sedatives, and steroids. Non-medication treatments like physical therapy, heat therapy, red light therapy, and pulsed EMF are also beneficial. In cases where medications are ineffective, treatments like Botox, intravenous immunoglobulin (IVIg), and stem cell therapy have shown promise in symptom improvement.

Additionally, a narrative review of available medication treatments for SPS suggests starting with benzodiazepines as a first-line treatment, adding medications like levetiracetam or pregabalin if symptoms persist. For second-line therapy, oral baclofen is preferred over rituximab and tacrolimus. In cases of refractory symptoms, treatments like intrathecal baclofen, IVIG, or plasmapheresis can be effective, with intrathecal baclofen and IVIG being more effective than plasmapheresis.

Conclusion

Stiff Person Syndrome presents a complex clinical challenge due to its rarity, varied symptomatology, and the intricate interplay of autoimmune responses. Understanding its underlying causes, symptom patterns, and current treatment modalities is crucial for effective management. Ongoing research continues to shed light on this condition, offering hope for more effective treatments in the future. For individuals diagnosed with SPS, a collaborative approach involving neurologists, rheumatologists, and physical therapists, alongside personalized treatment strategies, is key to managing this condition and improving quality of life.

And lastly, when your body is struggling with disease, give it assistance by providing it with nutrients, water, sunlight and mild exercise when possible. Mind-body approaches including meditation, flotation therapy, biofeedback, yoga, tai-chi, deep breathing and so on, may provide some relief as well.

Sources:

Johns Hopkins Online

https://www.hopkinsmedicine.org/

National Institute of Neuromuscular Disorders and Stroke

https://www.ninds.nih.gov/

American Brain Foundation

https://www.americanbrainfoundation.org/

Tips for Protecting Your Mental Health During Bad Times

by Pain Doc | Oct 18, 2023 | healthy mindset

We’re living in a world where news never takes a break, and thanks to that ubiquitous smart phone, is a second away from our attention. Unfortunately, negative news gets a lot more attention than positive news; not to mention peoples’ own personal struggles. Just as the pandemic was starting to end, war breaks out in Ukraine and now Israel and Gaza. This barrage of negative, unhealthy emotions on the psyche can affect anyone’s mental health, in different ways, in different people.

An unwell mind can breed dysfunction in the body, thanks to the mind-body connection. It can lead to ulcers, high blood sugar, high blood pressure, depression and so on. It is well known that negative mental states are a risk factor for cardiovascular disease.

So if life starts to overwhelm you, take action. Do not let it brew; nip it in the bud. And, engage in practices that make you resilient to anxiety and depression. Here are some suggestions:

15 Habits and Practices to Nurture Mental Health and Wellness

1. Stay Informed but Limit Media Exposure: While it’s important to stay informed about the crisis, excessive exposure to news can increase stress and anxiety. Set specific times to check for updates and avoid constant news consumption.

2. Maintain Routine: Try to establish a daily routine to provide a sense of normalcy and stability. This includes regular sleep, meals, and exercise.

3. Stay Connected: Social support is vital during crises. Stay in touch with friends and family through calls, video chats, or social media. Share your feelings and concerns with trusted individuals. Talking about it with others is like releasing toxic pressure. Give it a try.

4. Practice Mindfulness and Relaxation Techniques: Mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help reduce stress and anxiety. These techniques can be practiced daily to promote relaxation.

5. Exercise Regularly: Physical activity releases endorphins, which can boost your mood and reduce stress. Even a short walk or home workout can be beneficial. Here’s an example of one that doesn’t require much prep: 25 squats, 50 jumping jacks, and 25 pushups. Just doing that will get your heart rate up, more oxygen to your brain, and even a shot of endorphins.

6. Eat a Balanced Diet: Stress can drive one to reach for junk food and sweets. This can make your stress worse, as you’re not getting essential vitamins and minerals. Proper nutrition has a significant impact on your mental health. Eat a balanced diet with plenty of fruits, vegetables, lean proteins, good fats and whole grains. Try a whey or pea protein shake, too. But, a chocolate chip cookie once in a while is fine, as well as occasional comfort food that doesn’t necessarily quality as “balanced.” Just do in moderation. The “feel good” emotions are worth the calorie hit; just don’t overdo it because you’ll get diminishing returns.

7. Limit Alcohol and Substance Use: Avoid excessive alcohol or drug use, as they can worsen mental health issues. Instead, seek healthier coping mechanisms such as nature walks, hobbies like learning a musical instrument, cooking and gardening.

8. Set Realistic Goals: Break down tasks into smaller, manageable steps. Setting achievable goals can give you a sense of accomplishment and control.

9. Seek Professional Help: If you’re struggling to cope with a crisis, don’t hesitate to reach out to a mental health professional. Many therapists offer remote sessions, making it easier to access support. If you feel your situation is at a crisis-level, the Crisis Text Line is a free service staffed by crisis volunteers.

10. Volunteer or Help Others: Helping others during a crisis can provide a sense of purpose and fulfillment. It can also strengthen your own resilience. There are opportunities for volunteering in just about every town; check with your city hall. Helping others is a nice way to tap into present time consciousness in a world that has many distractions; most of them insignificant.

11. Limit Exposure to Stressors: If possible, try to reduce exposure to stressors that you can control. This might involve temporarily distancing yourself from toxic relationships, social media or other places that cause you to generate negative emotions.

12. Practice Self-Compassion: Be kind to yourself and acknowledge that it’s okay to have moments of difficulty. Avoid self-criticism and negative self-talk.

13. Maintain a Journal: Writing down your thoughts and feelings can be a therapeutic way to process emotions and gain perspective on your situation. Check out this short video by Dr. Benjamin Hardy, an expert on personal growth, where he addresses the mental health benefits of keeping a journal.

14. Stay Creative: Engaging in creative activities like art, writing, or music can be a constructive way to express emotions and distract from stress.

15. Focus on Positivity: Try to find moments of gratitude and positivity each day. This can help shift your perspective and improve your overall outlook.

How Pulsed EMF can benefit Mental Health

Practicing these fifteen habits can help most people keep anxiety and depression at bay indefinitely. For those who feel they need more, you may want to ask your health professional about getting pulsed electromagnetic transcranial therapy (Pulsed EMF for the brain). Studies show that pulsed EMF can be helpful in treating anxiety and depresson, as well as insomnia and mental fogginess.

Many people are having success self-treating with pulsed EMF, as the products are so safe they can be purchased directly by consumers. You can find examples of pulsed EMF device here. The Diamag is the upper end machine that is specially designed for the head/ brain.

Remember that everyone’s response to crises is unique. If you can’t get support from people you know, there’s no shame in seeking professional help. Your mental health is important, and seeking help is a sign of strength, not weakness.

What is the Best Home Air Filter?

by Pain Doc | Oct 16, 2023 | air filtering for health

The air you breathe every day greatly influences your current and future health. In an ideal world, you would only breathe in pure air; however, that’s not the case. The air outside and in our homes are full of various kinds of coarse and fine particulate matter. Fine particulate matter (particles 2.5 microns and smaller) can make it all the way to the alveoli– the microscopic structure where blood gases are exchanged, and some can even jump into your bloodstream and get carried to all your organs, where they accumulate to dangerous levels.

Unfortunately, particulate pollution is not going to go away. Industry, construction and manufacturing will continue to pour billions of pounds of it into our air every day. Cars and commercial jets put out soot and fuel mist that can make it into our homes. In fact, a shocking study found that perchlorate, a toxic component of rocket fuel, was
contaminating virtually all samples of women’s breast milk and its levels were found to be, on average, five times greater than in cow’s milk.

Wildfires all over the planet produce fine soot, which can cross entire oceans and reach populated areas. Droughts produce fine clay dust particles, some containing lead, that travel with the wind from places far from your home.

Because of this constant onslaught of pollution, it is wise to invest in an air purifier. Place one in your bedroom, living room, automobile, and place of work– the places where you spend the most time. You’re not going to be able to escape all of it, but if you can cut your pollutant ingestion down 80%, it’s going to benefit your health significantly. For those who live in a high risk area like downwind of an industrial zone or construction site, the change will be even more dramatic.

There are currently eight main technologies of consumer air purification technology; some that have been around for over 25 years and some relatively newer. Let’s break down the most common types of air purifiers and their key features:

Mechanical Filters (HEPA filters)

How they work: These use a dense web of fibers to trap particles as air flows through.
Key features:
- Can capture particles as small as 0.3 microns (like pollen, dust, and some mold spores).
- Need regular replacement.
- Can be combined with other types of filters/technologies for comprehensive air purification.
Pros: Effective at capturing large to small particles, especially true HEPA filters.
Cons: Doesn’t neutralize odors, chemicals, or gases; filters need replacement.

Activated Carbon Filters

How they work: Made from porous charcoal, these filters absorb gases and odors.
Key features:
- Effective for odors and smoke.
- Often combined with other filter types (like HEPA) for broader effectiveness.
Pros: Great for removing odors, smoke, and some gases.
Cons: Doesn’t trap particulate matter; needs periodic replacement.

Ionic Purifiers (or Ionizers)

How they work: Emit negative ions that bond with positive ions (like dust, pollen) to form larger particles, which settle and are removed from the air.
Key features:
- Some models collect ionized particles on plates, while others let them settle on surfaces.
Pros: Quiet operation, can remove very small particles from the air.
Cons: May produce ozone, which can irritate the lungs and is harmful to the environment; settled particles need to be cleaned.

Ozone Generators

How they work: Intentionally produce ozone to “purify” the air.
Key features:
- Claimed to deodorize, disinfect, and kill/remove contaminants.
Pros: Can neutralize certain odors and contaminants.
Cons: Ozone is harmful to human health and can exacerbate respiratory issues; not recommended for general air purification.

Ultraviolet (UV) Light Purifier

How they work: Use ultraviolet light to kill germs, bacteria, and viruses.
Key features:
- Often used in combination with other filter types.
Pros: Effective at killing microorganisms.
Cons: Only targets microorganisms; effectiveness depends on exposure time.

Photocatalytic Oxidation (PCO)

How they work: Uses a UV light along with a catalyst (usually titanium dioxide) to break down gases into harmless substances.
Key features:
- Targets VOCs (volatile organic compounds), bacteria, and viruses.
Pros: Can neutralize harmful gases and microorganisms.
Cons: Limited in effectiveness against larger particulate matter; some units might produce small amounts of ozone.

Electronic Air Cleaners

How they work: Use electrostatic attraction to trap charged particles.
Key features:
- Can be filterless or use filters.
Pros: Effective at capturing various particle sizes.
Cons: Some models may produce ozone.

TPA (Tesla Plasma Array) Technology:

How it works: Uses an electric field to capture particles, much like an ionic purifier but without producing ozone.
Pros:
- Typically filterless or has washable filters, leading to lower maintenance costs.
- Can effectively capture very small particles.
- Quiet operation as it doesn’t require powerful fans.
Cons:
- The electric plates require regular cleaning.
- May not be as effective against certain gases or odors compared to activated carbon filters.

Be aware that medium to high end air purifiers typically combine several of these technologies, such as the AirDog line of air purification systems.

When comparing specific models or technologies, read the product description and get a sense of what the product is designed to address, such as allergies, asthma, smoke, pets, or chemical sensitivities, and operational features. Some people might prioritize filter replacement costs, while others might look for the most effective particle removal.

Also, pay attention to the room size recommendations, maintenance requirements, and any certifications (like from the Association of Home Appliance Manufacturers, AHAM, or California Air Resources Board, CARB) that validate the purifier’s effectiveness and safety.

Lastly, a final consideration: when it comes to spending on your and your loved ones’ health, it is wise to view purchases not as an expense, but as an investment; especially if it can provide your body the purest air possible. While there are relatively cheap HEPA air purifiers, there are also higher-end air purifiers that offer multiple-stage filtration to extract even the smallest fine particulate matter and harmful gases. Like a home mortgage, this expense is amortized over your remaining life. The more you use it over time, the cheaper its daily cost is.

Disclaimer: Some links used on this site are affiliate links to products that are mentioned in the article. If you purchase the product from the link, it may result in a small commission to our company. This covers the costs of researching and producing free content. Rest assured that all products mentioned on this site and YouTube channel have been carefully researched for quality, safety and efficacy.

What Does Fine Particulate Matter Do to Your Lungs?

by Pain Doc | Sep 30, 2023 | air filtering for health

What Happens in the Lungs When You Breathe in Fine Particulate Matter?

Breathing is a natural process that ensures our body gets the oxygen it needs to function. Oxygen’s main function is to convert your food to energy inside each cell, which needs a constant, uninterrupted supply.

fine particulate matter illustrated t to scale The quality of the air we breathe can have significant effects on our health, particularly when it contains fine particulate matter (abbreviated “PM2.5”). Understanding the consequences of inhaling PM2.5 can underscore the importance of maintaining air quality and safeguarding our respiratory health.

What is Fine Particulate Matter?

Fine particulate matter, or PM2.5, refers to tiny particles or droplets in the air that are 2.5 micrometers (also called microns) in diameter or smaller, which is one millionth of a meter, and which can be man-made or natural.

To put it into perspective, a human hair has a diameter of about 70 micrometers, making PM2.5 particles nearly 30 times narrower than a human hair. These particles can originate from various sources, including vehicle emissions, industrial processes, power plants, wood-burning, and certain natural processes such as wildfires and volcanic eruptions.

fine particulate matter from wildfires, San Francisco in August 2020 In late summer of 2020, the Bay Area of California experienced very dangerous levels of PM2.5 due to wildfires; so bad that people were instructed to remain indoors. And on the day of and weeks following the 9-11 terrorist attacks on the World Trade Center, thousands of people, especially first responders, breathed in the tons of fine particulate matter that were produced from the destruction. Many are suffering from chronic lung problems, and many have died from ingesting these toxins into their lungs.

Air Dog™: Discover the Next Generation of Home and Office Air Purifiers

How Does PM2.5 Enter the Lungs?

When we breathe, air travels through our nose or mouth, down the trachea, and into our lungs via a network of progressively smaller tubes called bronchi. These further divide into tiny air sacs called alveoli, where the exchange of oxygen and carbon dioxide takes place between your blood and the atmosphere.

alveoli of lungs

Due to their minuscule size, PM2.5 particles can bypass the body’s natural defense mechanisms, such as nasal hairs and the mucociliary escalator: the constant upflow of a thin layer of mucus lining the upper and lower respiratory tract, done by cilia, a hair like structure on the surface of all respiratory tract cells. Foreign debris entering with the air gets trapped on this moving layer of mucus, and triggers you to spit it out, or swallow. However, P2.5 is so light and tiny, many of them escape the mucus layer and make it all the way deep into your lungs, down to the alveoli.

Effects of PM2.5 on the Lungs

Inflammation: Once PM2.5 particles reach the alveoli, they can cause inflammation. The body recognizes these particles as foreign invaders and activates immune responses. Inflammatory cells rush to the site, releasing various chemicals that can damage lung tissues.
Aggravation of Respiratory Diseases: People with pre-existing respiratory conditions, such as asthma or chronic obstructive pulmonary disease (COPD), can experience exacerbations when exposed to high PM2.5 levels. The inflammation and irritation caused by the particles can constrict airways, leading to symptoms like wheezing, shortness of breath, and coughing.
Decreased Lung Function: Chronic exposure to PM2.5 can lead to a decline in lung function over time. The damage and inflammation can lead to scarring of lung tissues, which reduces the lungs’ efficiency in oxygen exchange.
Deep Systemic Effects: PM2.5 doesn’t just stay in the lungs. Some particles, especially those carrying toxic substances or heavy metals, can enter the bloodstream through the alveoli. This means that the effects of PM2.5 can be systemic, impacting other organs and systems like the heart and the vascular system.
Increased Risk of Respiratory Infections: The inflammation and damage caused by PM2.5 can weaken the lungs’ defense mechanisms, making individuals more susceptible to respiratory infections like pneumonia.
Lung Cancer: Extended exposure to high levels of PM2.5 has been linked to an increased risk of lung cancer. Some particulate matter can carry carcinogenic substances, which, when inhaled over time, can lead to DNA damage and cancerous growths.

Protecting Yourself from PM2.5

Given the potential risks associated with PM2.5 inhalation, it’s crucial to take steps to minimize exposure, especially in areas with frequent high PM2.5 levels.

Monitor Air Quality: Stay informed about local air quality levels through apps, websites, or local news.
Stay Indoors: During days with high PM2.5 levels, limit outdoor activities, especially strenuous ones like jogging or cycling.
Air Purifiers: Consider investing in air purifiers with HEPA filters that can effectively remove fine particles from indoor air. Even better, get the higher performing models that also include charged electrical fields to trap dangerous, cancer-causing fine particulate matter.
Ventilation: Ensure that homes and offices are well-ventilated. Use exhaust fans, especially when cooking, to reduce indoor PM2.5 levels.
Masks: In severely polluted environments, consider wearing masks like N95 respirators that can filter out fine particulate matter. I would recommend using masks whenever you do things around the house that stir up fine particles, such as sawing wood, spray painting, cleaning up a dusty area, and even working with flour and finely ground spices.

Conclusion

The presence of fine particulate matter in the air poses a genuine health concern. If you live in an area that gets wildfires, or downwind of an industrial zone, or a building demolition site, chances are, you are ingesting more P2.5 than the average person. These tiny particles can deeply penetrate the lungs, and depending on their nature, can lead to a range of health problems from immediate respiratory symptoms to long-term conditions like lung cancer and emphysema. As global urbanization and industrialization continue, understanding the implications of PM2.5 and taking protective measures become increasingly vital for maintaining public health.

Could This be the Best Home Air Purifier Ever Made?

Understanding Impingement Syndrome in the Shoulder: Causes and Rehabilitation

by Pain Doc | Sep 25, 2023 | Chronic Pain, Joint Pain, Shoulder Pain

The shoulder is a marvel of human anatomy, offering an impressive range of motion. However, this mobility comes at a cost, as the shoulder joint is highly susceptible to various conditions and injuries, one of the most common being impingement syndrome. In this article, I will discuss the causes, symptoms, diagnosis, and treatment options for shoulder impingement syndrome, with a primary focus on rehabilitation techniques to help individuals recover and regain full shoulder functionality.

Introduction to Shoulder Impingement Syndrome

Shoulder impingement syndrome is a painful and often debilitating condition that occurs when the tendons of the rotator cuff and the subacromial bursa become pinched or impinged between the bones of the shoulder, primarily the acromion (a part of the scapula or shoulder blade) and the humerus (the upper arm bone). This impingement leads to inflammation, pain, and restricted shoulder movement.

Anatomy of the Shoulder

Before delving into the causes and rehabilitation of shoulder impingement syndrome, it’s crucial to understand the intricate anatomy of the shoulder joint. The shoulder comprises three bones: the humerus, the clavicle (collarbone), and the scapula (shoulder blade). The glenohumeral joint, where the head of the humerus articulates with the shallow socket of the scapula, allows for the remarkable range of motion in the shoulder.

Rotator Cuff and Subacromial Bursa – The rotator cuff is a group of four tendons and muscles that stabilize the shoulder joint and facilitate its movement. These four muscles include the supraspinatus, infraspinatus, teres minor, and subscapularis. They work in unison to control arm movements and maintain joint integrity. The subacromial bursa is a fluid-filled sac that reduces friction between the rotator cuff tendons and the acromion, promoting smooth shoulder motion.

Causes of Shoulder Impingement Syndrome

Understanding the underlying causes of shoulder impingement syndrome is crucial for effective rehabilitation. Several factors contribute to the development of this condition.

Anatomical Factors

Shape of the Acromion

The shape of the acromion can vary from person to person. Some individuals have a flat or curved acromion, while others have a hooked or pointed acromion. A hooked acromion is more likely to impinge on the underlying tendons, increasing the risk of impingement syndrome.

Bone Spurs

Over time, the formation of bone spurs (osteophytes) on the acromion or the clavicle can reduce the space within the subacromial space, making impingement more likely.

Overuse and Repetitive Movements

Overhead Activities

Engaging in repetitive overhead activities, such as painting, swimming, or throwing, can lead to overuse of the shoulder joint. This overuse can irritate and inflame the rotator cuff tendons, increasing the risk of impingement.

Poor Posture

Poor posture, especially slouching or forward-leaning positions, can alter the biomechanics of the shoulder joint, narrowing the subacromial space and leading to impingement over time.

Muscle Imbalances

Muscle imbalances in the shoulder girdle can also contribute to impingement syndrome. Weakness or tightness in certain muscles can alter the mechanics of the shoulder joint, leading to impingement.

Trauma and Injuries

Shoulder injuries, such as falls or accidents, can damage the structures within the shoulder joint, leading to inflammation and impingement syndrome. Additionally, dislocated shoulders or fractures can alter the joint’s anatomy, increasing the risk of impingement.

Signs and Symptoms of Shoulder Impingement Syndrome

Recognizing the signs and symptoms of shoulder impingement syndrome is essential for early diagnosis and prompt treatment. Common symptoms include:

Pain

Pain is the hallmark symptom of shoulder impingement syndrome. The pain is typically located at the front or side of the shoulder and may radiate down the arm. It is often aggravated by overhead movements or reaching behind the back.

Weakness

Individuals with impingement syndrome often experience weakness in the affected shoulder. This weakness can affect the ability to lift objects or perform daily activities.

Limited Range of Motion

Impingement syndrome can restrict shoulder mobility. Individuals may find it challenging to raise their arms overhead or reach behind their back.

Night Pain

Many people with shoulder impingement syndrome report pain at night, particularly when lying on the affected shoulder. This can disrupt sleep and lead to chronic fatigue.

Clicking or Popping

Some individuals may hear clicking or popping sounds when moving their shoulder. These noises can indicate underlying structural issues.

Diagnosis of Shoulder Impingement Syndrome

Diagnosing shoulder impingement syndrome involves a combination of clinical evaluation, patient history, and imaging studies. Healthcare providers typically follow these steps:

Medical History

The doctor will ask about the patient’s symptoms, including when the pain started, its location and severity, and any exacerbating factors like specific movements or activities. Oftentimes, impingement syndrome can gradually appear with no obvious cause, but if you look at the long term history of the patient’s work and/or recreational activities, aggressive shoulder movements are typically included (repetitive lifting above the shoulder; contact sports, tennis, baseball pitcher, etc.).

Physical Examination

During a physical examination, the healthcare provider will assess the range of motion in the affected shoulder, strength, and any signs of inflammation or tenderness. The cardinal sign is pain with shoulder abduction (raising the arm from the side causes a deep, sharp pain inside the shoulder joint; patient has difficulty raising his/her arm above shoulder level due to mechanical restriction and acute pain.

Imaging Studies

Imaging studies, such as X-rays, ultrasound, or MRI, may be ordered to visualize the structures within the shoulder joint. X-rays can reveal bone abnormalities, while ultrasound and MRI can provide detailed images of soft tissues like tendons and the subacromial bursa. However, this is usually only done if rest, physical therapy, and home care do not produce desired results after a week.

Cortisone injection

In some cases, an injection of a local anesthetic into the subacromial space may be performed. If the pain is alleviated shortly after the injection, it can confirm the diagnosis of impingement syndrome. This is because with impingement syndrome, there is swelling and inflammation, and cortisone is a quick-acting anti-inflammatory medication. So, if the pain is alleviated following a cortisone shot, it confirms there is localized swelling, which is likely coming from either the bursae or a tendon.

Non-Surgical Rehabilitation for Shoulder Impingement Syndrome

The treatment of shoulder impingement syndrome typically begins with non-surgical interventions, such as physical therapy and lifestyle modifications. The goals of rehabilitation are to alleviate pain, improve shoulder function, and prevent recurrence.

Rest and Activity Modification

Resting the affected shoulder and avoiding activities that worsen symptoms are essential in the early stages of rehabilitation. This may include temporarily ceasing activities that involve repetitive overhead motions.

Physical Therapy

Physical therapy is a cornerstone of non-surgical treatment for shoulder impingement syndrome. A qualified physical therapist will design a personalized exercise program to address muscle imbalances, improve strength, and enhance shoulder mobility. Common physical therapy techniques include:

Stretching Exercises

Stretching exercises target tight muscles in the shoulder girdle and surrounding areas. This can help improve flexibility and reduce tension that contributes to impingement (see video below).

Modalities

You can use a red light therapy wrap to reduce pain and swelling of your impingement syndrome. Red light therapy wraps use light in the therapeutic wavelengths of red and infrared to accelerate tissue healing and deep heat tissues to increase blood flow and oxygen. See below for an example:

SUMMARY:

Shoulder impingement syndrome occurs when a swollen tendon and/or bursa inside the glenohumeral joint, where your humerus articulates with your scapula, impedes movement of the joint by rubbing against hard structures, particularly the acromion. The goal is to shrink the swollen tendon so that proper movement is restored, and then correct any biomechanical deficiencies in the shoulder complex, such as weak or tight muscles, and subluxated joints affecting the shoulder movements, using exercise rehabilitation, joint mobilization and red light therapy.

Can Air Compression Boots Really Help Lymph Circulation?

by Pain Doc | May 18, 2023 | Lymphatic System

Do your legs, arms, feet and hands often feel stiff? Do they appear puffy/ swollen? If so, it may be that you have impaired lymph flow, or lymphedema. In this article, we’ll discuss the function of the lymphatic system, and what you can do if you have impaired lymph flow.

What are the parts of the lymphatic system?

The lymphatic system is a vital part of the body’s immune system and plays a crucial role in maintaining fluid balance, removing waste products, and fighting infections. It consists of a network of lymphatic vessels that run alongside veins and arteries and form connections at the arteriole/ venule level; lymph nodes, lymphoid organs (spleen, tonsils, thymus, appendix), and lymphatic fluid called lymph. Unlike the circulatory system that has the heart to move blood through it, the lymph has no such organ. Lymph fluid circulates slower than blood and is driven primarily via skeletal muscle contraction, the movements of breathing, and slight contraction of smooth muscle in vessel walls.

Here’s a simplified overview of how the lymphatic system works:

Lymphatic vessels: Lymphatic vessels are thin-walled, one-way channels (made possible by specialized valves that allow flow only in one direction) that carry lymph throughout the body. They are similar to blood vessels but have larger gaps between their cells, allowing fluids, waste products, and immune cells to enter (see diagram below):

Lymphatic vessels connect with arteries and veins to filter out excess fluids and waste

Interstitial fluid collection: Interstitial fluid is a clear fluid that surrounds the cells in body tissues. It is derived from blood plasma that leaks out of capillaries. The lymphatic vessels collect this excess fluid, along with proteins, cellular waste, and pathogens, preventing its accumulation and maintaining tissue fluid balance. It’s important to note that heavy exercise, such as long distance running, increases the pressure in the circulatory system and also increases heart rate and vessel contraction/dilation movement, which can cause more fluids to build up in the interstitial space along with metabolic products of muscle cell metabolism; i.e. lactic acid and carbon dioxide. So, the lymphatic system is very active during and following intense exercise.

Lymph transport: The lymphatic vessels carry the collected fluid, now called lymph, through a network of progressively larger vessels. Smooth muscle contractions in the vessel walls and one-way valves help propel lymph toward the chest where the filtered lymph fluid re-enters the circulatory system at the thoracic ducts.

Lymph nodes: Along the lymphatic vessels, there are small, bean-shaped structures called lymph nodes. Lymph nodes are highly concentrated with immune cells, such as lymphocytes and macrophages, which help filter and cleanse the lymph of pathogens, foreign substances, and damaged cells. Lymph nodes play a crucial role in immune response and can become swollen and tender when fighting infections. They are more concentrated in the neck, axilla (armpit region), and inguinal (groin area) regions, although they are present throughout all parts of the body. Lymph nodes are easily palpated through the skin as the lymph vessels are mostly just under the skin.

Lymph node cross section

Lymphoid organs: In addition to lymph nodes, other lymphoid organs, such as the spleen, thymus, appendix and tonsils, are part of the lymphatic system. These organs house immune cells and contribute to the production and maturation of lymphocytes, which are key players in the immune response.

Lymphatic fluid return: Ultimately, the lymphatic vessels return the filtered lymph back into the bloodstream, near the heart, through the thoracic duct (left side of the body) and the right lymphatic duct (right side of the body). The lymph rejoins the blood circulation, and any remaining waste products are eliminated through the kidneys and other excretory organs.

The lymphatic system acts as a drainage and defense system, collecting excess fluid and waste, filtering it, and helping to mount immune responses against infections. By doing so, it helps maintain tissue health, fluid balance, and overall immune function in the body.

What happens if your lymph system is impaired?

Lymphatic insufficiency, also known as lymphedema, occurs when there is a disruption or impairment in the normal functioning of the lymphatic system. This condition can result in a buildup of lymphatic fluid in the affected area, leading to swelling, tissue damage, and increased susceptibility to infections.

Some common causes of lymphedema are:

Surgery: Lymphedema can occur as a complication of surgical procedures that involve the removal or damage to lymph nodes or lymphatic vessels. This is often seen in cancer surgeries, such as breast cancer or melanoma surgeries, where lymph nodes are removed or radiation therapy is administered to the lymphatic area. Some destruction of adjacent lymph vessels occurs, and flow is impaired.

Radiation therapy: Radiation treatment for cancer can damage lymph nodes and lymphatic vessels, leading to lymphedema. The risk is higher when radiation is directed towards the lymphatic drainage pathways.

Infection: Certain infections can cause inflammation and damage to the lymphatic vessels, resulting in lymphedema. Examples include filariasis (a parasitic infection transmitted by mosquitoes), cellulitis (bacterial skin infection), and lymphangitis (inflammation of the lymphatic vessels).

Primary lymphedema: In some cases, lymphedema can be present at birth or develop later in life due to congenital abnormalities or genetic factors that affect the development or function of the lymphatic system. This is known as primary lymphedema.

Secondary lymphedema: Secondary lymphedema occurs as a result of an acquired condition or event that damages the lymphatic system. Common causes include trauma, burns, severe obesity, chronic venous insufficiency, or surgical procedures unrelated to cancer.

Cancer: Lymphedema can also occur as a result of cancer itself. Tumors can obstruct or invade the lymphatic vessels, impairing lymphatic flow and causing fluid buildup.

It’s important to note that lymphedema can develop immediately after an event (e.g., surgery or radiation) or may manifest months or years later. The severity and progression of lymphedema can vary from person to person.

Here’s what happens in the body during lymphatic insufficiency:

Fluid buildup and swelling: The impaired drainage causes a buildup of lymphatic fluid in the affected area. Initially, this may lead to mild swelling, which tends to worsen over time if left untreated. The swelling is often persistent and may involve the limbs, most commonly the arms or legs. In some cases, lymphedema can affect other areas of the body, such as the face, neck, or genitals.
Tissue changes: Prolonged accumulation of lymphatic fluid results in changes to the affected tissues. The tissues become fibrotic and less elastic, causing them to harden and thicken. Why this happens isn’t clear, but if interstitial fluid that needs to be moved out lingers around instead of being picked up by the lymph system, the waste products in it accumulate and the body responds by laying down fibrous tissue to consolidate it. Over time, this can lead to skin changes, such as thickening, hardening, or a “woody” appearance. The skin may become more prone to infections, ulcers, and other complications.
Increased risk of infections: The stagnant lymphatic fluid creates an environment favorable for bacterial or fungal growth. The compromised lymphatic system also means that the body’s immune response is weakened in the affected area. As a result, individuals with lymphatic insufficiency are at a higher risk of developing recurrent infections, such as cellulitis, lymphangitis, or fungal infections.
Reduced transport of nutrients and waste removal: The impaired lymphatic flow hinders the transport of nutrients, oxygen, and waste products between the tissues and the bloodstream. This can lead to further tissue damage, impaired wound healing, and an increased risk of secondary complications.
Functional limitations: Lymphedema can cause functional limitations and affect the quality of life. The swelling and tissue changes can lead to discomfort, pain, heaviness, and difficulty moving the affected limb(s). The condition may impact daily activities, mobility, and emotional well-being.

How can leg compression boots help lymphedema?

Treatment for lymphatic insufficiency focuses on managing the symptoms, reducing swelling, preventing infections, and improving overall function. This may involve a combination of techniques, including compression therapy, manual lymphatic drainage massage, exercise, skin care, and sometimes surgery. Take note; it is not a good idea to wear tight-fitting clothes as it may worsen the problem, so if you have lymphedema, make sure to wear loose clothing.

The legs are especially affected by lymphedema since they are furthest away from the heart and the fluids there have to work against gravity. Many people with lymphedema are finding success using compression boots. This popular therapy device contains individual air bladder sections, from the foot to the upper thigh, which are filled using a programmable air pump unit. When maximally filled with air, the air bladder compresses that section of your leg. You can control the sequence of filling of these bladders, and the pressure level. The higher end models are capable of generating a strong compression while the cheaper versions do much lighter compression.

For example, the standard program compresses the feet first, then the lower calf, upper calf, and thigh, in that order. It holds the pressure for a couple of seconds, then all the air is released, and the process is repeated. This repeated pattern of compression, from leg to thigh, pushes the lymph upwards towards the heart.

Compression boots for lymphatic insufficiency

You don’t have to suffer from lymphedema to benefit from compression boots. They are great for post-exercise treatment, especially after a marathon or a long hike. The compression waves not only help blood and lymph in your leg vessels to move towards the heart and thoracic ducts, they massage the leg muscles as well. This may even reduce the onset of delayed onset muscle soreness (DOMS), the soreness that often comes a few hours after rigorous exercise involving the legs.

Bottom Line: Compression boots are helpful in alleviating the symptoms of lymphatic insufficiency, and assisting circulation in your legs, post exercise. They offer a relatively inexpensive form of palliative care, and are worth the investment. Lymphatic insufficiency can cause long-term problems such as fibrosis, skin hardening and even toxicity if left unchecked, so it’s best to be active in managing the condition.

« Older Entries

Anatomical and Physiological Causes

Activities That Increase the Risk of Plantar Fasciitis

Who is at High Risk for Plantar Fasciitis?

Medical Treatment Options

Home Therapy and Exercises

Prognosis and Recovery Timeline

Conclusion

Introduction:

Understanding the Pathology of Sciatica:

Common Causes of Sciatica

Treatment Options for Sciatica:

Prognosis:

Conclusion:

What is Stiff Person Syndrome?

15 Habits and Practices to Nurture Mental Health and Wellness

How Pulsed EMF can benefit Mental Health

Could This be the Best Home Air Purifier Ever Made?

Introduction to Shoulder Impingement Syndrome

Anatomy of the Shoulder

Causes of Shoulder Impingement Syndrome

Anatomical Factors

Overuse and Repetitive Movements

Signs and Symptoms of Shoulder Impingement Syndrome

Pain

Weakness

Limited Range of Motion

Night Pain

Clicking or Popping

Diagnosis of Shoulder Impingement Syndrome

Medical History

Physical Examination

Imaging Studies

Cortisone injection

Non-Surgical Rehabilitation for Shoulder Impingement Syndrome

Rest and Activity Modification

Physical Therapy

Stretching Exercises

Modalities

SUMMARY:

What are the parts of the lymphatic system?

What happens if your lymph system is impaired?

How can leg compression boots help lymphedema?

The Ultimate Home Air Purifier

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