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Fitness

Fixing the pain problem

Pain relief doesn’t have to come in a bottle, however. Physical therapists can provide a safe, drug-free alternative for treating pain.

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The world is in the midst of an opioid epidemic. Sales of prescription opioids have nearly quadrupled since 1999. According to the Centers for Disease Control and Prevention, in 2012 alone, enough opioid prescriptions were written for “every American adult to have their own bottle of pills.”

Photo courtesy of American Physical Therapy Association

Photo courtesy of American Physical Therapy Association

Prescription opioids – medications that reduce pain by interrupting pain signals to the brain – only mask the sensation of pain, and they come with side effects including depression, overdose and addiction, plus withdrawal symptoms when stopping opioid use. Pain relief doesn’t have to come in a bottle, however. Physical therapists can provide a safe, drug-free alternative for treating pain.

When to Choose Physical Therapy

In March 2016, the CDC released guidelines urging prescribers to rely less on opioids in favor of non-drug alternatives. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care and end-of-life care, but for most long-term pain management non-opioid approaches are recommended.

The American Physical Therapy Association, through its national #ChoosePT campaign, is reminding patients that they have the right to choose their method of pain treatment. Physical therapists treat pain through movement and patients get to play an active role in their recovery.

Based on the CDC guidelines, patients should choose non-opioid alternatives, such as physical therapy, when:

The risks of opioid use outweigh the rewards. “Experts agreed that opioids should not be considered first-line or routine therapy for chronic pain,” according to the CDC. “Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions.”

Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids. As the guidelines note, even in cases when evidence on the long-term benefits of non-opioid therapies is limited, “risks are much lower” with non-opioid treatment plans.

Pain or function problems are related to low-back pain, hip or knee osteoarthritis or fibromyalgia. The CDC cited “high-quality evidence” supporting exercise as part of a physical therapy treatment plan for those familiar conditions.

Opioids are prescribed for pain. Even in situations when opioids are prescribed, the CDC recommends that patients should receive “the lowest effective dosage” and opioids “should be combined” with non-opioid therapies, such as physical therapy. Clinicians should continue opioid therapy only if there is “meaningful improvement in pain and function that outweighs risks to patient safety.”

Pain lasts 90 days. At this point, the pain is considered “chronic” and the risks for continued opioid use increase. In the US, an estimated 116 million Americans are living with chronic pain, but the danger of masking pain with prescription opioids is clear. More than 165,000 people in the US alone have died from opioid pain medication-related overdoses since 1999, and every day more than 1,000 people are treated in emergency departments for misusing prescription opioids.

If you or a loved one needs help managing pain, talk with your health care provider about safe alternatives to opioids. Additional information on the #ChoosePT campaign, including a pain self-assessment that patients can use to facilitate conversations about their care, is available at MoveForwardPT.com/ChoosePT.

Understanding Pain

Before exploring and choosing long-term treatment options, consider these facts about pain:

  1. Pain is output from the brain. While researchers used to believe that pain originated within the tissues of the body, newer evidence indicates that pain does not exist until the brain determines it does. The brain uses a virtual “road map” to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body to serve as a defense against possible injury or disease.
  2. The degree of injury does not always equal the degree of pain. Research has demonstrated that people experience pain in individual ways. While some people experience major injuries with little pain, others experience minor injuries with a lot of pain.
  3. Diagnostic imaging (MRIs, X-rays, CT scans) results may not show the cause of pain. A 2015 study in Spine, which analyzed MRI results of more than 1,200 individuals ages 20-70 who had no symptoms of lower-back pain, found that 87.6 percent suffered from bulging discs. Even most subjects in their 20s had bulging discs – 73.3 percent of males and 78 percent of females, respectively.
  4. Psychological factors, such as depression and anxiety, can make pain worse. Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient’s experience of long-term pain following the operation.
  5. Your social environment may influence your perception of pain. Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.
  6. Understanding pain through education may reduce your need for care. A large study conducted on military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for lower-back pain less than their counterparts.
  7. The brain can be tricked into developing pain in prosthetic limbs. Studies have shown that the brain can be tricked into developing a “referred” sensation in a limb that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb – or from the “phantom” limb. The sensation is generated by the association of the brain’s perception of what the body is from birth (whole and complete) and what it currently is (post-amputation).
  8. The ability to determine left from right may be altered when you experience pain. Networks within the brain that assist you in determining left from right can be affected when you experience severe pain. If you have been experiencing pain and have noticed your sense of direction is a bit off, it may be because the part of the brain that details a path to each part of the body may be impaired.
  9. There is no way of knowing whether you have a high pain tolerance or not. While some people claim to have a “high tolerance” for pain, there is no accurate way to measure or compare pain tolerance among individuals. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain “feels like.”

Fitness

Treatment options to help overcome knee pain for sports enthusiasts

“Sports-related pain should be evaluated quickly, especially when it’s difficult to put weight on the knee, swelling occurs or there is restricted range of motion,” said Dr. Alexander Meininger, orthopedic surgeon and MACI consultant.

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Millions of people experience chronic pain, with knee pain among the most common. Athletes and active adults know the impact activities like running and skiing can have on their knees, but when chronic knee pain makes it difficult to do those activities, or even day-to-day tasks like walking up the stairs, people may often face challenges.

According to the journal “Cartilage,” unlike other tissues, cartilage does not repair itself and, without proper treatment, can worsen over time and become more difficult to treat. However, options like FDA-approved knee cartilage repair surgery MACI (autologous cultured chondrocytes on porcine collagen membrane) uses a patient’s cells to help repair cartilage defects and may help alleviate knee pain.

“Sports-related pain should be evaluated quickly, especially when it’s difficult to put weight on the knee, swelling occurs or there is restricted range of motion,” said Dr. Alexander Meininger, orthopedic surgeon and MACI consultant.

Justin Keys, a former patient of Meininger and avid skier, knows that the long-term outcomes of knee cartilage surgery can be worth the short-term sacrifices. After several injuries, including an ACL injury, Keys struggled with most activities except walking on flat, paved surfaces. After consulting with Meininger, Keys chose knee cartilage repair to help get back to his active lifestyle.

Keys considered whether to manage the injury as-is or choose MACI and undergo rehabilitation to potentially get back to his favorite activities in the future. He knew he could no longer use short-term relief methods and had to address his pain with a treatment to help provide lasting relief.

For athletes like Keys who want to fix knee pain, it’s important to consider these steps:

Discuss Options with Your Doctor

Patients should talk to their doctors and undergo an MRI to help assess the internal structures of the knee. Meininger recommends patients and their doctors discuss options for long-term knee restoration health, preserving function for future decades and recognizing the short-term sacrifice.

Set Yourself Up for Success

Experts like Meininger suggest patients take steps ahead of surgery to help their recovery.

“The important thing is to be as fit as possible and use the preseason months to undergo surgery and rehab,” Meininger said.

Patients can take steps to prep their home for recovery, which may include:

  • Bringing necessities down from hard-to-reach shelves
  • Moving furniture to ensure clear pathways
  • Installing shower safety handles to minimize potential falls

The Road to Rehab and Recovery

Rehabilitation takes time and everyone’s experience is unique. It can be as much of a mental challenge as it is physical. Committing to a physical therapy regime, staying hydrated and eating well are important aspects to support recovery. Patients should talk to their doctors with questions and before starting any exercises.

IMPORTANT SAFETY INFORMATION

Do not use if you are allergic to antibiotics such as gentamicin or materials from cow or pig; have severe osteoarthritis of the knee, other severe inflammatory conditions, infections or inflammation in the bone joint and other surrounding tissue or blood clotting conditions; had knee surgery in the past 6 months, not including surgery for obtaining a cartilage biopsy or a surgical procedure to prepare your knee for a MACI implant; or cannot follow a rehabilitation program post-surgery.

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Fitness

6 Exercise safety tips

Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.

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In the wake of the COVID-19 pandemic, many Americans are more aware of their health and wellness. Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.

Sprains, strains and injuries can happen to even the most seasoned athletes. When you’re testing your limits, even a minor injury can alter your performance. Consider products and supports like these from the CURAD Performance Series product line, available at Walmart and Amazon, to help you get back in the game quickly and safely.

Find more resources to support your fitness journey at CURAD.com.

Keep Dirt and Germs Away

The more active you are, the harder it can be to find a bandage that stays with you all day or all game long.

Spray Away Sore Spots

Controlling mild pain can help keep you at the top of your game, and a topical analgesic works fast to heal common pain brought on by fitness and exercise, such as pain in knees, feet, shoulders and backs.

Put Pain in the Past

When recovery becomes the name of the game and pain relief is needed after daily workouts or bodily injuries. Cold packs work to heal bruises, reduce swelling and relieve headaches and general pain points while microwavable heat packs provide satisfying heat therapy to address sore and stiff joints, muscle cramps and tension.

Reduce Impact of Knee Strain

Weak, injured or arthritic knees can come from many sources, including tendonitis and a wide range of conditions that result in strain or overuse. An adjustable band can provide support for on-field sports and during workouts or everyday activities.

Manage Pain and Relieve Pressure

If you participate in endurance and strength exercises or certain sports, you may ask a lot of your joints. Kinesiology tape can be configured a multitude of ways to help reduce pain and improve blood circulation, as well as relieve tension and pressure.

Control Back Strain

When your back is strained, your body and performance can suffer. A mild or moderate sprain can benefit from strong support and compression.

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Fitness

Exercise can provide relief for dry, itchy eyes

A significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes.

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Photo by Quinten de Graaf from Unsplash.com

A team led by researchers from the University of Waterloo discovered that a significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes. 

Every time we blink, our eyes are covered in tear film—an essential protective coating necessary for maintaining healthy ocular function. Healthy tear film comprises three layers–oil, water, and mucin–that work together to hydrate the ocular surface and protect against infection-causing irritants like dust or dirt.

When any part of the tear film becomes unstable, the ocular surface can develop dry spots, causing eye symptoms like itchiness or stinging and burning sensations.

“With so much of our activity tied to screen usage, dry eye symptoms are becoming increasingly common,” said Heinz Otchere, a PhD candidate in vision science at Waterloo. “Instead of having to use eye drops or other alternative treatments, our study aimed to determine if remaining physically active can be an effective preventative measure against dryness.”

Fifty-two participants were divided into two groups—athlete and non-athlete—to participate in an exercise session. Participants in the athlete group exercised at least five times per week, while non-athlete participants exercised no more than once per week. Researchers, which included experts from the University of Cape Coast in Ghana, performed visual examinations before and five minutes after each exercise session, where tear secretion and tear break-up time were assessed.

While participants in the athlete group showed the largest increase, Otchere says all participants experienced a meaningful boost in tear quantity and tear film stability after the exercise session. 

“It can be challenging for people to regularly exercise when the demand is there to work increasingly longer hours in front of screens,” Otchere said. “However, our findings show physical activity can be really important for not just our overall well-being, but for our ocular health too.”

The study, Differential effect of maximal incremental treadmill exercise on tear secretion and tear film stability in athletes and non-athletes, was co-authored by Otchere, the University of Cape Coast’s Samuel Abokyi, Sekyere Nyamaah, and Michael Ntodie, and Ghana’s Our Lady of Grace Hospital’s Yaw Osei Akoto. It was recently published in the Experimental Eye Research journal.

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