Articles - Ask Dr. P - The Pain Doc

Can You Grow Cartilage By Eating Certain Foods or Supplements?

by Pain Doc | Feb 21, 2011 | Uncategorized

Cartilage, specifically, hyaline cartilage is the tissue that lines the articular (contacting) surfaces of bones. If the cartilage deteriorates it can lead to pain and inflammation in the weight bearing joints, mostly the knees and hips, as nerve endings in the joint get exposed to abrasive action. This can force the sufferer to elect for knee or hip replacement surgery, as well as artificial disc surgery. Smaller joints such as in the fingers can be affected as well.

Cartilage is made by special cells called chondroblasts. These cells make the extracellular matrix of cartilage, comprised of Type II collagen and ground substance, which is comprised of proteoglycans and elastin. Another important constituent is hyaluronic acid, which improves the resiliency and hydration of cartilage. Without going into too much detail, a proteoglycan is a protein molecule with a chain of sugar molecules attached called glycosaminoglycans, or GAGs. The two GAGs that are best known to the public are glucosamine sulfate and chondroitin sulfate, the key ingredients in most cartilage and bone supplements. Glucosamine sulfate is the one found in the exoskeletons of shellfish, as well as some fungi.

Persons suffering from the various forms of arthritis such as osteoarthritis and rheumatoid arthritis have cartilage tissue that is undergoing inflammation and degradation, either mechanical in nature or auto-immune.

Collagen is a group of naturally occurring proteins found mostly in animal connective tissues– tendons, ligaments, and skin. What makes collagen useful in cartilage is its ability to withstand pressure and return to its original shape (deform and rebound). This is what is necessary in joints of the human body, which are subjected to forces multiple times throughout the day. The simple act of sitting or standing places enormous pressure on the joint surfaces of the feet, knee, hip and lower back. Using one’s hands to type or grip things places pressure on the smaller joints of the fingers and wrists.

So, if your have thinning cartilage in your knees, can you grow it back simply by taking glucosamine sulfate and chondroitin supplements? Unfortunately, the latest research on their ability to reduce joint pain show minimal improvement. Why is this?

It’s because that, just because you give the body supplements through your diet, it doesn’t guarantee that your body will do things you want it to do with these nutrients. They could be going somewhere else besides you joint, which is more likely the case.

The harsh reality regarding all muscle and connective tissue building dietary supplements such as collagen, bone broth, protein powder, etc. is that they get broken down in your GI tract into their amino acid constituents, and need to be reassembled. But as mentioned, your body will not reassemble them into the desired tissue 100%. These proteins may go to your skin, hair, nails, or may be made into an enzyme or cell receptor. In other words, the amino acids in those glucosamine sulfates pills may wind up forming new hair, not cartilage.

That being said, if you hope to build cartilage through your diet, it may be more effective to eat the actual cartilage. At least it consists of the actual amino acid sequences in the proper percentage the body uses to build cartilage..

Consider consuming bone broth soup regularly if you are suffering from achey joints; or do so as a preventative measure. Most butcher shops in the grocery store will have large joints of beef or pork, usually the hips, knees and spine. And they are cheap, usually less than $2.00 a pound. They will saw them in small pieces for you if you request. What’s great about them is that they still have tendons and cartilage pieces attached. Get a large pot, add a gallon of water and bring to boil; lower temperature and boil for two hours. The broth will be rich in nutrients that your body can use to help regenerate damaged cartilage.

For preventive measures to protect the health of your joint cartilage, remember to:

do functional exercises regularly to improve whole-body muscle & joint responsiveness
avoid sitting for too long at your work
avoid activities that require repetitive trauma to the joints such as long distance running
avoid ingesting toxins like cigarette smoke, alcohol, and highly processed food
get enough daily rest to allow your body to regenerate
drink filtered water (not distilled)
get enough sun exposure for Vitamin D synthesis

Burt’s Bees Res-Q Ointment for Minor Injuries

by Pain Doc | Feb 17, 2011 | Uncategorized

Today, a patient of mine returned from a trip to Australia. She relates how her vacation was interrupted by the recent flooding in that country, and by something else– a nasty spider bite.

Now, if you’ve ever watched Discovery Channel and saw one of those nature shows on extreme insects, you’ll know that many come from Australia. There’s something about that country, perhaps its isolation that makes it a haven for dangerous, poisonous creatures.

Anyways, this patient says she was bitten on the leg by a black spider (probably a funnelweb spider). She said she “saw” the poison slowly work its way up her leg towards her knee (there was probably some reddening/ inflammation that spread outwards from the spider bite). Her companion told her not to move her leg, as it would spread the poison faster. Panicking, she took out the only first aid item she had on her– a small tin of Burt’s Bees Res-Q ointment— and rubbed it around the spider bite.

Almost instantly, she started to feel relief. An hour or so later, the swelling was gone. She said that the product literally “saved her life.” She was absolutely thrilled, from not knowing whether she would die from this bite, to feeling much better in a matter of minutes. She couldn’t say enough good things about the Res-Q ointment, and made sure I knew about it.

Curious, I decided to check it out. The main ingredient in Res-Q is comfrey, a controversial herb that has shown to have therapeutic benefits, but may also cause liver toxicity if taken internally. Comfrey contains allantoin, a cell proliferant that speeds up the natural replacement of body cells.

Historically, comfrey was used in an attempt to treat a wide variety of ailments ranging from bronchial problems, broken bones, sprains, arthritis, gastric and varicose ulcers, severe burns, acne and other skin conditions. It was reputed to have bone and teeth building properties in children, and have value in treating “many female disorders”.

Most recently, in a placebo controlled study comfrey was found to decrease back pain when used topically.

If you visit the Burt’s Bees website and check out their Res-Q product, you will notice a lot of positive reviews– people raving about how the product helped reduce the “red nose of colds,” bruises, skin irritations, minor burns, bug bites, and cracked and chapped skin.

While these reviews are no substitute for a properly conducted scientific study with control group, most doctors agree that anecdotal evidence can be equally compelling when evaluating a particular therapeutic product or procedure.

Now, time to sign off to buy a can of Res-Q myself…

How to Improve the Ergonomics of Your Computer Workstation Set Up

by Pain Doc | Feb 11, 2011 | Uncategorized

If you have a job that requires continuous sitting and typing at a computer workstation, it is extremely important to ensure that your workstation is set up ergonomically, with respect to your body.

“Overuse injuries,” or repetitive strain injuries (RSIs) can develop in the fingers, hands, wrists, forearm, elbow and shoulder if you are not careful. RSIs, if allowed to take root can lead to chronic, recurring pain in some people, even when they stop the offending movements. I”ve seen extreme cases where the individual developed bilateral carpal tunnel syndrome and resorted to surgery in both wrists, all because of repetitive use on the keyboard.

A key factor in these types of injuries is the placement of the keyboard. It needs to be placed low enough and close to your body so that you aren’t required to lift your upper shoulders and arms to type. The shoulders should be loose and relaxed; upper arm in line with the torso, elbow at 90-110 degrees, and wrist straight.

In most cases, an adjustable computer keyboard tray that fits underneath the desk surface is necessary. Most desk surfaces are simply too high to be able to use your keyboard and mouse without having to contract your upper trap and arm muscles.

However, with wireless technology it is much easier to accomplish. All you need is a portable keyboard/laptop flat table, a space-saving wireless keyboard, and a wireless mouse. Place the keyboard flat table on your lap, place the wireless keyboard and mouse on the table (don’t forget to turn them on), and you’ll be all set.

Melatonin for Migraine Headaches

by Pain Doc | Feb 10, 2011 | Headaches

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If you suffer from migraine headaches, take note: a small study done in Brazil concluded that taking melatonin 30 minutes before bed time can reduce migraine frequency and intensity.

The study involved 34 subjects; 29 of which were female. The participants reported experiencing 2-8 migraines per month, on average. Some had migraines with auras– visual disturbances such as seeing wavy lines, spots, or sparks.

Of the 32 participants completing the study, more than two-thirds said their migraine frequency was reduced by half or better after taking melatonin for three months.

This included eight patients who reported no migraines, seven who reported a 75% drop in migraines, and 10 who said their migraine frequency decreased by 50% to 75%.

The findings, which come from a team of researchers led by Mario F.P. Peres, MD, PhD, of Hospital Israelita Albert Einstein in Sao Paolo, Brazil, show that melatonin may be used as a preventive therapy for frequent migraine sufferers. However, since it was a small study with no control group, the researchers suggested a controlled study to test the idea further.

What Makes a Migraine a Migraine? (everydayhealth.com)
Could oxygen help a migraine? (zocdoc.com)
Migraine Surgery Seems To Have Nearly 90% Success (lockergnome.com)

Recommended Back Exercises

by Pain Doc | Jan 18, 2011 | Low Back Pain

I am a firm believer that strengthening and conditioning the core, back and leg muscles is the best way to guard against getting back pain.

If you’re prone to having your back “go out”, then these exercises are the best way to guard against recurrence. Don’t wait until you get degenerative disc disease, because once you reach this point the chances of living a pain- free life take a big nosedive. The reason is that the best exercises for strengthening your back are more risky for those with disc degeneration.

What typically happens is the disc degeneration patient will naturally stay cautious or apprehensive and will avoid back exercises for fear of re-injuring his back. This eventually leads to back muscle weakness and loss of muscle coordination–precursors for back injury and chronic pain.

So, if you don’t have back pain or degenerative joint disease (weak, thinning and/or herniated discs with accompanying bone spurs and cartilage degeneration) consider yourself lucky. Make sure your exercise regimen involves engaging the primary muscles of the trunk primarily, and the whole body, secondarily.

Do functional exercises which force the muscle groups to work synergistically rather independently. Such exercises can mimic common body movements; for example, carrying something on your shoulder while walking.

In strengthening the back, I like to do squats using a 20 lb bar on my back with feet apart in different distances.

Throwing a 12 lb. medicine ball using your whole upper body is another great functional exercise. Get a partner and have him stand 10 feet to your right. Throw the ball to your partner while using your core as well as arms. This simple exercise will strengthen your abs, your paraspinals, arms, and even your leg muscles.

Next, use a Freemotion or similar cable-weight machine where you can raise an arm above your head. With both hands, grip the cable handle and swing it down towards your feet, as though you were chopping wood with an axe. Boy, this is a great exercise as you will feel just about every muscle in your back, arms and chest work together to move the weight.

Pain in Calf While Jogging

by Pain Doc | Dec 23, 2010 | Uncategorized

Muscle strain to the calves can occur while engaging in heavy leg use, such as jogging, hiking (especially uphill), cycling, and basketball or other sport that requires frequent running. This is due to damage to the muscle fibers, tendon, fascia (muscle covering) and/or blood vessels.

But before you assume that your calf pain is a muscle strain, know that calf pain can also be caused by a thrombus, or blood clot. This is a medical emergency that demands a visit to your physician and special tests. For more information on blood clotting in the legs (deep vein thrombosis or DVT), read this article.

Strains occur in different grades. The most simple strains and sprains (Grade I) occur when there is mild tearing of some muscle fibers. Grade III sprains and strains involve complete tears to the muscle and/or ligament (the ligaments are on the ends of the muscle and connect it to bone) and joint damage. Grade III sprains and strains are emergency in nature and will most likely require surgery.

If you get leg (lower) cramps when jogging, you’ll probably need to stop or risk getting a “pulled” calf muscle. This can be painful enough to force you to get off your feet and sit on the ground. A pulled calf muscle starts with a twitchy sensation in the calf, followed by an involuntary, painful contraction that forces you to bend your knee for relief. It signifies a strained gastrocnemeus muscle, tendon or fascia and is related to abnormal muscle physiology due to muscle exhaustion.

You see, muscle contraction involves very complex biochemical reactions. Calcium, sodium and potassium ions modulate the actions of actin and myosin, the specialized protein structures that make up skeletal muscle and enable changes in muscle length. Lactic acid builds up as the muscle contracts and relaxes continuously during running. It is flushed out of the area by normal biological pathways but eventually builds up as the activity continues.

If you get calf pain after engaging in heavy leg use, use the PRICE protocol:

Protect the muscle from further injury
Rest the muscle
Ice the muscle for 20 minutes using a frozen gel pack*
Compress the ice around the muscle (use two long socks or ace wrap)
Elevate your leg for gravity-assisted swelling reduction

If you keep getting calf pain during heavy physical activity, it could be that your legs need more exercise/ conditioning before attempting to engage in such activities. This is usually the case for those who spend a lot of their time sitting. You can do the following leg exercises at home to strengthen your calves:

1. Lunges. Find a place where you can walk 10 yards doing lunges; switch legs.

2. Squat/knee bend exercises. Even better if you can hold a 10-16 pound medicine ball while doing.

3. While standing (bare feet) go up on the balls of your feet, hold one second and go back down; repeat 20 times and hold the last three (on the balls of your feet) for 20 seconds each.

4. Calf stretch. Stand two feet in front of a wall, put one leg back, bend the other. Keep the bottoms of both feet touching the ground (don’t let your heel come off the floor). Bend your front leg; keep your rear leg straight and keep bending until you can tolerate the maximum stretch to your rear leg. Hold for 10 seconds; release. Repeat five times.

The Top 5 Best Calf Exercises (projectswole.com)
Study: High heels may alter anatomy of calves (abclocal.go.com)

Reduce Headaches with Peppermint Oil

by Pain Doc | Dec 21, 2010 | Headaches

Peppermint (Mentha piperita L.) is one of the most widely consumed single ingredient herbal teas. Medical research shows that peppermint oil can reduce spasm of smooth muscle (the type of muscle that comprises the esophagus, stomach, lungs, intestines) and can therefore provide some relief for conditions like IBS (irritable bowel syndrome), esophageal spasm, and spastic colon. In lab tests, peppermint has significant antimicrobial and antiviral activities, strong antioxidant and antitumor actions, and some antiallergenic potential.

Animal model studies demonstrate a relaxation effect on gastrointestinal (GI) tissue, analgesic (pain reducing) and anesthetic (nerve desensitizing) effects in the central and peripheral nervous system, immunomodulating actions and chemopreventive potential.

: Image via Wikipedia

The effects of peppermint oil and eucalyptus oil preparations on headaches and cognitive function were investigated in 32 healthy subjects in a double-blind, placebo-controlled, randomized cross-over design.* Four different test preparations were applied to large areas of the forehead and temples using a small sponge and their effect was evaluated by comparing baseline and treatment measure. The combination of peppermint oil, eucalyptus oil and ethanol increased cognitive performance and had a muscle-relaxing and mentally relaxing effect, but had little influence on pain sensitivity. A significant analgesic effect with a reduction in sensitivity to headache was produced by a combination of peppermint oil and ethanol (rubbing alcohol). The essential plant oil preparations often used in empiric medicine can thus be shown by laboratory tests to exert significant effects on mechanisms associated with the pathophysiology of headache.

The evidence suggests that peppermint can somehow relax smooth muscle. Since blood vessels are also comprised of smooth muscle, and some types of headaches are caused by spasms in the blood vessels that lead to the head, taking peppermint either as a tea or concentrated oil may provide relief.

*Göbel H, Schmidt G, Soyka D, Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia. 1994 Jun;14(3):228-34; discussion 182.

Foot Pain Can Be Caused By This

by Pain Doc | Dec 20, 2010 | Foot and Ankle Pain

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If you have pain in your feet, it could be that your feet’s intrinsic muscles are weak and are not supporting and moving your foot bones properly during gait (walking). As a result, certain bones can bear more weight pressure than others and develop pain; for example the first metatarsal-phalangeal joint (big toe joint).

Muscles can become weak when they are underused, or immobilized in some way over a long period of time. For example, if you fracture your lower leg and had to wear a cast for three months, that leg would be smaller than the non-injured leg after taking off the cast. This is because the calf muscle in the injured leg would experience some atrophy due to three months of decreased muscle activity. You would most likely feel the difference in leg strength as well, after removing the cast.

But what would cause the foot muscles to weaken? It’s a very simple action just about everyone does in the morning before going to work, and that is putting on shoes. Shoes, especially snug fitting ones like lace-up formal leather shoes with hard heels constrict the feet and don’t allow proper engagement of the foot joints when walking. Basically, shoes act like a cast or splint on your feet. Imagine wearing a shoe-equivalent on your hands, lacing them up tightly for nine hours a day. Your hands would weaken eventually, and probably experience pain.

So what’s the solution? Realize that the feet are designed to grip the ground with the toes/ forefoot, and elongate slightly at the arch to build up energy for toe-off during gait. The toes splay out when bearing weight to increase stability to the body above. Wearing shoes inhibits all these actions and can have an adverse effect on foot biomechanics.

Therefore, it is a good idea to exercise your feet by walking barefoot; preferably on a non-flat surface. Find a grassy park and try running barefoot. These activities will offer badly needed exercise (strengthening and stretching) for your feet. If you’re like most people who have been wearing shoes most of their lives, your feet will be highly sensitive to the pebbles and small objects on the ground; this is normal. Keep walking and running barefoot as much as you can, breaking them in but obviously avoiding sharp objects on the ground. This will strengthen your feet and make it more resistant to developing foot problems.

If you arent’ into going barefoot, the next best thing is to wear the Vibram Five Fingers KSO – Men’s walking “shoe.” It offers the protection of a shoe, while offering the most freedom of movement of your feet.

Stenosing Tenosynovitis

by Pain Doc | Sep 22, 2010 | Hand and Wrist Pain

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Stenosing tenosynovitis translates to “tendon inflammation due to narrowing passageways.” It is entrapment and inflammation of the extensor pollicus longus tendon, the muscle that moves the thumb up in a “hitchhiker sign.” It is also known as DeQuervain’s Syndrome.

The passageway in question is a tunnel formed by ligaments that hold the extensor pollicus longus tendon to the distal radius (lateral wrist), one of the two bones of the forearm.

The onset is gradual over a few days. There is a very sharp, unrelenting pain at the radial styloid, the bony prominence at the lateral wrist right below the wrist crease. There is no loss of muscle strength in the thumb. Bending the affected thumb inward towards the palm while bending the wrist sideways towards the ulna (in direction away from the pain) makes the pain much worse.

Causation is believed to be related to overusing the thumbs, such as BlackBerry use, or frequent bending of the wrist while carrying weight, such as in cradling a baby several times a day. However, there are documented cases of stenosing tenosynovitis occurring with no apparent trigger (idiopathic causation).

What is known is that the synovial sheath that covers the portion of the tendon in the tunnel gets inflamed and undergoes degenerative changes. It triggers a chronic, localized inflammatory response. Pain comes from tiny nerve endings in the synovial sheath that are irritated by rubbing against the ligament holding it to the distal radius, and perhaps also by exposure to the products of inflammation.

The condition is known to be self limiting, running its course for a few months and then resolving as the body regenerates the synovial sheath. However, during its acute stage it is quite unpleasant, despite the fact that only about an inch of tendon is involved.

TREATMENT:

Wrist immobilization (wrist brace with thumb splint) to limit movement of the adductor pollicus longus is recommended for 1-3 weeks. Wear most of the day and night; remove every hour or so to do ice therapy.

Ice massage is helpful in temporarily reducing the pain by numbing the area and constricting blood vessels, which tends to suppress production of inflammatory chemicals. A wrist ice wrap can also be effective. Apply ice for 10-20 minutes directly onto the painful area.

Topical ointments may be helpful in reducing the severity of the pain. Narayan oil and products containing capsaicin (don’t use together) are worth trying. Rub into inflamed tendon gently.

Chinese herbal patches may be helpful in temporarily relieving the pain as well.

Cortisone injection into the tunnel can be effective in neutralizing the pain; however it still may take a few weeks to months for the pain to go entirely away.

Whey Protein – Great Supplement for Healthy Tissue Healing

by Pain Doc | Sep 16, 2010 | Uncategorized

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Whenever you suffer an injury to the musculoskeletal system, there is some degree of tissue damage. In minor sprains and strains, it is microscopic tears to the fascia, muscle fibers, tendons and ligaments; in major sprains and strains it is complete rupture or tearing of large groups of muscle, ligament and/or tendon fibers.

The first thing the body does at the onset of the injury is initiate the inflammatory response. Various biochemicals constitute inflammation; each having an important role. Inflammation confines the injury to the injury site and is actually the first step in tissue repair. It is only when it is overproduced that it becomes a problem in itself (which is why you should use ice therapy to mediate swelling the first few days after an injury).

At some point, the body sends special cells called fibroblasts to the injury site. These cells synthesize connective tissue comprised of collagen to close the tears of the injury.

Collagen is the main protein of connective tissue in animals, making up 25%-35% of the total protein content . It forms as elongated fibrils (long chain of amino acids in a strand formation) and is mostly found in fibrous tissues such as tendon, ligament and skin, as well as other places in the body.

Therefore, after sustaining an injury, the body needs a ready supply of protein in order to properly heal itself. If you recently sustained a soft tissue injury such as a sports injury to a joint, whiplash car accident, or sprained your lower back from heavy lifting, make sure you are eating enough protein. I recommend whey protein due to its ability to be digested very rapidly, making it available for use shortly after consumption. Whey is a protein-rich byproduct that is formed during cheese formation, usually from cow’s milk.

Body builders and athletes drink whey protein shakes after workouts to help increase amino acid levels in the blood, which are taken up by the muscles to ultimately increase mass. During exercise, whey helps improve blood flow by inhibiting an enzyme that constricts blood vessels; this allows better flow of nutrients to needed areas to help repair and rebuild muscle tissues.

Leucine is an amino acid found in whey protein shakes. When leucine is ingested in high amounts it stimulates protein synthesis, which may speed recovery and adaptation to the stress that occurs from heavy exercise and injuries.

Another good source of protein is eggs. Eggs are a complete source of protein, especially the yolk. Cook them at low heat; and if you have the stomach for it, eat them raw.