Sciatica: What a Pain in the Behind!

Hip Arthritis: There's Nothing Hip About It

Hip arthritis generally results from osteoarthritis, or “wear-and-tear” arthritis. In a nutshell, osteoarthritis progressively wears away the cartilage of the joint it affects. Without cartilage in the joint to make movements smoother, the hip bones begin to grind and cause pain. Hip arthritis is typically found in individuals who are:

· Over 50 years old

· Overweight – in fact, weight loss has a tendency to lessen the symptoms of hip arthritis.

· Genetics - if the condition runs in your family, your chances of developing it are much greater.

· Trauma – injuries to the hip, including fractures, can increase risk.

There’s no way to tell for sure who will develop hip arthritis, but there are a few measures you can take to avoid this debilitating condition:

• Lose weight. More weight = more compression on all joints. Weight loss can dramatically decrease symptoms.Seek the help of your physical therapist or exercise professional. We can teach you exercises to better distribute the pressure on your joints from everyday movements.
• Modify your activities. Limit activities that are painful. Continue with ones that are not. Aquatic exercise is a great option to perform exercises without increasing joint compression. Use walking aids. We can show you the right way to use a cane/crutch to help alleviate your pain.
• Ask your doctor about trying anti-inflammatory medications.
• In severe cases, you may need to talk to your doctor about hip replacement surgery.

· As soon as you start feeling the symptoms of hip arthritis, including limited range of motion, joint stiffness, and pain in the hip area, see your doctor. If you receive a diagnosis of hip arthritis, following the steps outlined above. The goal is to avoid a hip replacement surgery, which should always be your last resort. Our well trained staff will help you make the most of your condition so you can carry out your day to day activities with less pain.

Becoming a Couch Potato Won’t Save Your Hip

It's a common misconception that less activity (being sedentary) will “save” your hip from further decay. On the contrary, medical experts recommend that you remain as active as your comfort level will allow. You certainly don’t want to force activities that will result in more pain down the road.

If you or a loved one have any hip discomfort, it is IMPERATIVE that you consult our staff right away for recommendations on exercises and activities that will be right for your condition.

The Importance of Heat and Stretching

Before exercising, use heat to loosen the muscles in preparation for stretching exercises. The best method is a warm shower or bath for 10-15 minutes. You can also use a heating pad or a towel warmed in the microwave, but remember, warm heat gets into the joint better than dry heat! Then, STRETCH daily!. Some common stretching we recommend include:

• Knee-to-chest pulls. Start in a comfortable position lying on your back with knees bent and feet flat on the floor. Bring one knee to your chest and hold it with your hands for 10 seconds. Do not bounce. Lower your leg and repeat the process with the other leg. Repeat the sequence 5 times.

• Hamstring stretch. Lie on your back in a doorway, with one leg through the open door. Slide your leg up the wall to straighten your knee. You should feel a gentle stretch down the back of your leg. Hold it for 10 seconds. Be careful to not arch your back, or bend either knee. Remember to keep one heel touching the floor and the other heel touching the wall. Do not point your toes. Repeat with your other leg.
• .

Physical therapy is a critical step in the management of pain associated with hip arthritis. We will work with you to create a treatment plan that includes exercise and other specialized techniques to relieve your pain.

Exercising with Osteoarthritis

Exercise is considered the most effective non-drug treatment for reducing pain and improving movement in osteoarthritis.

Joints and muscles need exercise to prevent stiffness and weakness. Exercise also makes you feel better and helps you maintain a healthy weight. Excess body weight places extra force and pressure on arthritic joints, causes osteoarthritis to progress more rapidly, and is a risk factor for the development and progression of osteoarthritis.

For each pound of weight you gain, your knees gain three pounds of added stress and your hips have six times the pressure on the joints. However, shedding extras pounds can reduce the pain in osteoarthritic joints, which in turn will make you feel better. When introducing exercise into your daily routine, some doctors may suggest that you take a supplement of either Glucosamine or Chondrotin. These are two nutritional supplements that have been reported to help arthritis.

Preliminary reports indicate that glucosamine may indeed relieve the pain and stiffness associated with osteoarthritis, especially when combined with exercise, weight loss, physical therapy, and other measures.

Stretching exercises help prevent stiffness and injury. Stretching correctly provides an easy method of reducing arthritis pain that takes only minutes each day. Done properly, these stretching regimens serve to enhance and speed the healing process by reducing pain and increasing mobility.

Strengthening exercises help strengthen the muscles and ligaments surrounding a joint, which helps protect and reduce stress on the joint.

By building muscle, strength training helps you stay strong and get around better. Strong muscles absorb shocks andreduce the strain on joints, which helps protect your joints from injury. In addition, strength training helps build strong bones as well as improves physical functioning.

Several studies have shown the benefits of exercise for people with osteoarthritis. Exercising can help by:

• Aerobic exercises help to condition your body, thus reducing fatigue so you have stamina throughout the day.

• Aerobic activity also helps you sleep better and improves your mood.

• Improved posture and balance in older adults, and helps to reduce the chances of falling.

• Improved hip and knee joint function and movement.

• Improved function in individuals with knee osteoarthritis, and it may delay or prevent the need for surgery.

Exercising will not wear out a damaged joint; however, not exercising will progress the affects of osteoarthritis.

Please be careful and plan well before starting any exercise program. Feel free to consult with one of our therapists to learn what exercises are best for you.

For more articles from our April Newsletter, please click on the link below!

April Newsletter

Headaches

Headache is one of the most common maladies. There is scarcely anyone who has not had a headache at some point in their lives. For many, a headache is an occasional painful inconvenience easily controllable with an over-the-counter medication. But for others, the headache is frequent and can disable them and cause missed work or damage social and family aspects of life. There are about three hundred causes of headaches but only the most common ones will be discussed here.

The International Headache Society (IHS) broadly divides headache into two categories: primary and secondary headaches. Primary headaches are a constellation of clinical symptoms and not a result of another disorder.

Primary headaches include:

- Migraine headache and its variants
- Cluster headache
- Tension type headache

Secondary headaches are headaches caused by an underlying medical condition such as sinus disease, brain tumor, or stroke. There are numerous causes that could be listed for secondary headaches. A thorough evaluation by a trained professional is aimed at investigating causes for the headache.

Getting help - What to Expect

Getting help for frequent and severe headache starts with an expert who is experienced in the evaluation and treatment of headaches, especially if a clear diagnosis and/or effective treatment is not forthcoming.

A headache expert takes a thorough medical and dental history. Common questions include asking about diet, depression, anxiety, work, and family, as well as past evaluations and treatments. Of primary importance will be the nature, frequency and location of your headaches and any other symptoms that accompany them.

After taking the history, the doctor performs a thorough examination including examination of the cranial nerves in the head and neck, examination of the ears and eyes, and palpation of head, neck and jaw muscles.

Diagnostic tests may include magnetic resonance imaging (MRI) and computer assisted tomography (CT). Other tests, such as blood tests and urinalysis, may help to diagnose diseases that secondarily cause headaches.

After assembling all information, a diagnosis is made and treatment is planned. Simple treatment, such as identifying and eliminating causes of headache (such as eating certain foods), is tried first. Trials of one or more medications may be indicated. Other treatments, such as those performed by psychologists, physical therapists, chiropractors, and acupuncturists, may help as part of overall medical/dental treatment. Before initiating any of these treatments, the doctor explains the diagnosis and treatment plan as well as risks or side effects.

Common Forms of Headache and Their Treatment

Migraine Headache and its Variants

Migraine headache affects over 23 million Americans. Women are affected three times as often as men and there is a hereditary component in many migraine sufferers. Research has shown that migraine and other forms of headache result from neurochemical changes in the brain and are not the result of psychological problems. We know that anxiety and depression often accompany headache and comprehensive treatment should address these conditions. Understanding these scientific advances led researchers to discover better treatments than in the past.

Migraine with Aura

Migraine with aura is the "classical" migraine headache. This kind of migraine has four phases - the prodrome, the aura, the headache, and postdrome or after effect of the headache.

The prodrome occurs anywhere from 2 to 24 hours before the start of the headache and can include such symptoms as lightheadedness, funny smell, upset stomach, dizziness, and sometimes a general feeling of something not being quite right. The aura occurs several minutes to an hour before the headache starts and can include disturbances in vision, numbness, muscle weakness, speech disturbance, lightheadedness, and nausea. If the aura lasts more than one hour, the patient may be referred to a neurologist to rule out possibly dangerous problems that seem like migraine with aura, but aren't. During the headache phase, patients experience moderate to severe head, neck, facial or oral pain, often, but not always, accompanied by nausea and vomiting. The headache is usually one sided and may or may not have a pulsating quality that lasts from four hours to three days, sometimes longer. Most migraine sufferers complain that light and sound bothers them during the headache and they prefer to lie down in a dark, quiet, cool room.

Doctors sometimes divide migraine into categories related to the cause of the headache; for example, migraine occuring monthly in a woman relating to the menstrual cycle is referred to as "menstrual migraine", or a migraine that started after head injury might be called "traumatic migraine".

Subtypes of Migraine Headache

Many, if not most, migraine sufferers have headache without a prodrome and/or aura but still suffer with debilitating headaches associated with light and sound sensitivity and nausea and vomiting.

Migraine can occur anywhere in the head, neck, face, or mouth. Often, it is one sided and concentrates around one of the eyes.

In some patients, the migraine is started by specific stimuli. These stimuli may be poor sleep, increased stress, or diet. Specific foods that can trigger a migraine headache include those containing monosodium glutamate, citrus fruits and drinks, red wines, aged cheeses, and chocolate.

The treatment of migraine often falls into three categories - behavior modification, physical therapy and exercise, and medications. Commonly, several treatments are used in combination.

Behavior modification can include dietary avoidance, stress reduction techniques, and avoidance of headache triggers. Patients can learn to avoid stressful situations when possible and also learn simple relaxation exercises to "turn off" their anxiety. Erratic sleep schedules, smoking, altitude changes, and hormonal changes are other examples of triggers that can be changed.

Often times, the patient will note radiating pain into the muscles of the face and more often the neck. While this may represent a pain referral pattern from the area of the brain that causes the migraine, many patients experience at least partial relief from doctor prescribed stretching and other exercises aimed at alleviating muscle soreness in the head and neck. Patients can be taught to apply heat and cold and to massage these areas, giving them a tool to obtain some relief.

The most common way to control migraine headache is through the use of medication. The two most common approaches are those medications aimed at preventing the headache and those that stop or "abort" the headache once it has begun. These two approaches are often used in combination. New medications are being developed constantly and have vastly improved over the last several years.

Preventive medications are prescribed when the headaches are frequent, long lasting, and/or severe enough to change activities of daily living, family and social interactions, and ability to work. These preventive medications lower the frequency and intensity of headaches and, in some patients, may prevent them all together. Often a medication originally intended for another purpose, for example, lowering blood pressure, will be chosen to prevent headache. Other medications commonly used to prevent headache are anti-seizure and anti-depressant medication. Use of these medications does not indicate that your doctor believes you are depressed, but that research and experience have shown these are effective drugs.

Abortive medications include various forms of over-the-counter and prescription medications. The newest groups of abortive medications are taken orally, by nasal spray, or injected.

Whether using preventive or abortive medications, or a combination of both, the doctor tailors the doses and kinds of medication, taking into consideration the particular headache pattern, the patient's past experiences with medication, other medications being taken at the time, and other medical problems.

Pain anywhere in the trigeminal nerve's distribution, which includes the jaw joints (TMJ's), jaw muscles, neck muscles, teeth and other oral structures, can trigger headache. A thorough headache treatment regimen should include evaluation and treatment of any active or latent sources of stimulation within the trigeminal system to reduce the potential they will trigger a headache.

Cluster Headache

Cluster headache is extremely painful, most often affecting middle-age men. Patients may describe pain in or behind one eye and describe the feeling of the headache as an "ice pick" kind of pain. The headache may be accompanied by a runny nose and tearing of the eye. Cluster headache patients may be in so much pain that they need to pace around the room and are restless and agitated.

The headaches occur in clusters of one to seven days, last from 20 to 60 minutes and often awake the patient from sleep. While the medications used for cluster headache are similar to those used for migraine, the cluster sufferer will often get quick relief from inhaling 100% oxygen. A variant of cluster headache affecting mostly women is known by the complicated name "Chronic Paroxysmal Hemicrania" or CPH for short. These headaches are short, between 5 and 20 minutes, but can occur as many as 15 times in a single day. Fortunately, these headaches frequently respond to an anti-inflammatory drug called Indomethacin.

Tension Type Headache

Tension Type Headache (TTH) is the most common kind of headache. They usually affect both sides of the head and can range in location from the base of the neck to the temples, top of the head and to the eyes. The causes of TTH vary and are not always readily identifiable and may or may not be associated with stress. The cause of the headache may be as common as a stressful work environment or a difficult personal relationship. What are often described as "sinus headache" or "eye strain" can actually be TTH.

Tension Type Headache can be chronic, occurring over long periods of time, or they can be episodic. They may or may not be accompanied by muscle pain in the head and neck.

Orofacial pain specialists often see patients that clench or grind their teeth at night or during the day. Many of these patients complain of daily headache, sometimes accompanied by other symptoms such as tooth pain, ear pain, facial pain, jaw clicking or popping, pain around the eyes and even pain in the neck and shoulders. This is thought to be tension type headache.

The treatment for TTH can very but often includes anti-inflammatory medications, muscle relaxants, anti-depressants and pain medication to control the headache. A great deal of attention has to be paid to stress management and physical conditions that may bring on and/or maintain the headache and, therefore, relaxation training, counseling, and physical therapy are important treatments. It is necessary to stress that while the name of this headache contains that word "tension", it is not certain that psychological factors play a role in causing these headaches.

Chronic Migraine

Migraine patients who take prescription or over-the-counter medications for a long period of time may experience an increase in frequency and a change in the quality of their pain. What started as episodes of migraine can then change to a chronic daily headache. This phenomenon, although very common, often goes unrecognized and undiagnosed. Once diagnosed, there are treatments that can break the chain of daily medication-induced headache and make the residual headache amenable to treatment.

What is Lymphedema?

Lymphedema occurs when a clear fluid known as lymphatic fluid builds up in the soft tissues of your body, usually in an arm or leg. The lymphatic system consists of lymph vessels and lymph nodes that run through your body. Lymph vessels collect a fluid that is made up of protein, water, fats, and wastes from the cells of the body. Lymph vessels carry this fluid to your lymph nodes. Lymph nodes filter waste materials and foreign products, and then return the fluid to your blood. If your vessels or nodes become damaged or are missing, the lymph fluid cannot move freely through the system. The fluids can then build up and cause swelling, known as lymphedema, in the affected arms or legs.

There are two types of lymphedema:

< Inherited lymphedema, sometimes called primary lymphedema, in which you are born lacking lymph vessels and nodes. The swelling usually appears during your adolescence and affects your foot or calf. A rare form of primary lymphedema develops in infancy and is called Milroy’s disease; and

< Acquired lymphedema, sometimes called secondary lymphedema, in which an injury to your lymphatic system causes lymphedema. It is much more common than primary lymphedema.

What are the symptoms?

If you have lymphedema, you may not develop symptoms immediately. Sometimes symptoms occur 15 or more years following an injury to your lymphatic system. When symptoms eventually occur, they can include:

< Aching, weakness, redness, heaviness, or tightness in one of your limbs;

< Less flexibility in your wrist or ankle; and < Tight-fitting rings or shoes.

What causes lymphedema?

The most common causes of secondary lymphedema are surgery or radiation treatment for certain types of cancer, such as breast and testicular cancers. Other causes of lymphedema include surgery on the blood vessels in your limbs or other surgical procedures, like liposuction, as well as burns.

Some people develop chronic lymphedema, which can last for the rest of their lives. Chronic lymphedema can be difficult to treat. Swollen limbs may become vulnerable to infection. Even a minor injury to the skin, such as a cut, scratch, insect bite, or even athlete’s foot between the toes can cause a severe infection, which physicians call lymphangitis. Lymphangitis affects the connective tissue under the skin. Repeated infections can cause scarring that makes the tissue vulnerable to more swelling and infection. This leads to the tissue hardening, called fibrosis, which is characteristic of advanced chronic lymphedema.

What tests will I need?

First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. Your physician or therapist may also measure your affected limb or body part.

Though not required, to confirm a diagnosis of lymphedema, your physician may order tests, including one or more of the following:

Lymphoscintigraphy, (also known as lymphangioscintigraphy) which uses a low-dose injected radioactive substance to trace the flow of lymph fluid through your lymphatic vessels;

Magnetic resonance imaging (MRI), which uses radiowaves and magnetic fields to detect patterns in your internal tissues that are characteristic of lymphedema;

Computed tomography (CT) scanning, which creates images of your internal tissues from a series of cross-sectional x-rays;Duplex ultrasound, which uses high-frequency sound waves and Doppler technology to show vessels and real-time blood flow on a screen, often necessary to rule out a blood clot in your leg; and

Lymphangiography, which uses contrast (dye) directly injected into the lymphatic vessels, is now used less frequently.

How is lymphedema treated?

If you are at risk for developing lymphedema, you can act to prevent it. Initially, if you have mild lymphedema, you can act to keep the condition from worsening. You can take the following precautions to prevent or minimize symptoms:

Clean your affected limb regularly. Remember to dry it thoroughly and apply lotion; Wear gloves while gardening and cooking; If you shave the affected area, use an electric razor ; Don't go barefoot; Do not cross your legs when you sit; and Do not carry a handbag with your affected arm.

In addition, if you are at risk for lymphedema, avoid having injections and blood pressure readings performed on your affected limb. You can also wear a special bracelet or necklace to notify medical personnel of your risk for lymphedema and the risk for complications, such as infection.

Physicians have not agreed about how to best treat chronic lymphedema. Some people have benefited from manual lymphatic drainage. This treatment uses a highly specialized form of massage to stimulate your weakened or impaired lymphatic system. Other treatment components include special exercises that you can do while wearing compression bandages. After goals of therapy are achieved, a compression garment may be enough to control the swelling.

The treatment protocol that combines these treatments with lifestyle changes is called complex decongestive therapy. At Therapy Concepts, our program is called comprehensive decongestive physiotherapy as we provide additional components in addition to those listed above. Please feel free to request the handout that fully describes our treatment program.

Medication cannot cure lymphedema. However, your physician may prescribe medications to treat associated conditions. For example, antibiotics play an important role in combating infections that can worsen lymphedema. Diuretics are not treatment for lymphedema, as the edema is not the result of retaining too much fluid. Your physician may recommend surgery after successful therapy, to remove excess tissue if your limb becomes so large and heavy that it interferes with your ability to move it.

Treating your lymphedema does require time and your participation. Because lymphedema can be physically limiting and alter your lifestyle, you may benefit from individual counseling. You can also join one of our support groups that provide practical advice as well as social and emotional support. Nutritional counseling to help support the immune functions of the lymphatic system and control other conditions that contribute to the severity of lymphedema, such as diabetes or cancer, is also of tremendous benefit.

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Join us in welcoming Mayura Shah to our team. Mayura is a certified yoga teacher from the Lakulish Institute of Yoga, in India. With over 15 years of experience and well versed in Hatha Yoga, Ashtanga Yoga as well as Pranayama and Meditation, Mayura is a knowledgeable, caring, passionate and experienced teacher.

Her teaching approach helps her students develop flexibility, strength and endurance by honoring sound principles of proper alignment, breath awareness and relaxation. Currently, Mayura teaches Kid’s Yoga classes we well as special groups in Johnson County. Mayura is also a volunteer for the

Touched by Cancer Foundation, and is now offering classes for cancer survivors at our facility.Classes begin March 17th, and will run every Wednesday from 10:00-11:00 am. The cost is $11.00 per session with a 10% discount for cancer survivors.Class size is limited, so please call us at Therapy Concepts at 913-438-8000 or the Touched By Cancer Foundation at 913-381-8488 to reserve your place!

Cancer Patients Benefit from Resistive and Aerobic Exercise

It’s no secret to any of us that exercise is important to maintain good health. But, in the case of patients with cancer, exercise is generally not prescribed as a means of promoting recovery. In fact, because fatigue is a significant factor in those undergoing cancer treatment, exercise is often avoided. A recent review of several studies involving cancer patients and exercise suggests a need to change that view.

The review involved thirty-three trails gathered through an extensive process that included searching databases and a reference list of review articles as well as contacting twenty experts in the field to inquire about whether they might be aware of other studies involving cancer patients and exercise. The trials included:

u Thirteen involving breast cancer patients during or after adjuvant therapy.

u Eleven involved only adult patients with cancer.

u One involved pediatric cancer survivors.

u The rest of the trials included patients receiving treatment for a variety of cancers.

Two reviewers thoroughly read all of the studies and compiled details on:

u Study design u Interventions u Results

u Participants u Outcome measures u Conclusions

Once the data was collected, the reviewers created tables to summarize the material and to determine if they could pool statistics based on at least four studies using a similar population group and having a similar outcome. Though pooling, the reviewers were able to look at specific results, such as the effect of exercise on the physical function of patients being treated for breast cancer. It also allowed them to specifically look at the effect of exercise on fatigue.

The review showed that patients who participated in aerobic exercise programs for six to twenty-five weeks had a statistically significant improvement in timed walk distances or in aerobic capacity. Results of particular importance were:

uOne study indicated that patients who were undergoing chemotherapy showed less loss of

physical ability when they exercised during their hospital stay.

uThree studies showed that patients who performed resistive training had improvement in

muscular strength.

uTen studies showed a reduction in cancer-related fatigue.

Considering the positive effects exercise (both resistive and aerobic) has shown on the health and recovery of cancer patients and the fact that the studies did not show an adverse effect on symptoms of fatigue, it seems a reasonable conclusion that patients with cancer could benefit from a prescribed regimen of exercise.

Patients referred for therapy have the opportunity to work with a therapist to develop an exercise routine to help maintain physical strength and function in a safe manner. Physical therapists in conjunction with the patient’s referring doctor can closely monitor the effects of the exercise therapy and make alterations to address the individual’s specific needs.

Stevinson, Clare, Debbie. A., Fox, Kenneth R. Exercise interventions for cancer patients: systematic review of controlled trials. University of Bristol, Centre for Sport, Exercise and Health; Bristol (UK). 2004