What Does It Mean To Have Degenerative Joint Changes?

By Dr. John A. Papa, DC, FCCPOR(C)

Have you had a joint problem and been told that you have "degeneration" or "degenerative changes"?  What exactly does this mean?  Is this something that can be fixed?  Let's take a closer look at two common types of degenerative changes and some potential management strategies that can be employed.

 

1.   Degenerative Joint Disease (DJD) is also known as osteoarthritis, and is the most common form of arthritis.  Weight-bearing joints such as the hips and knees are most commonly affected, but DJD can affect any area of the body, including the hands, neck, and low back.

 

Most joints in our body have smooth cartilage surfaces that glide against each other, which allow two or more opposing bones to move freely and perform a specific set of movements.  A joint becomes "degenerated" or arthritic when there is wearing down of these cartilage surfaces, and a change in the composition of the bone underneath the cartilage occurs.  An arthritic joint does not mechanically function like it is supposed to.  This may result in a number of symptoms including:  muscle tightness and weakness, joint pain and stiffness, decreased ranges of motion, creaking in the joints, swelling, inflammation, and joint thickening (i.e. finger nodules, bunions).

 

2.    Degenerative Disc Disease (DDD) specifically affects the spinal discs between each vertebrae and is also considered an arthritic disorder.  Spinal discs allow for some movement between vertebrae, and they also absorb compressive, tensile, and shearing loads with everyday activities.

 

      The centre of the disc, called the nucleus pulposis, is jelly-like and mostly made up of water.  The outside of the disc, called the annulus fibrosis, is tough and thick and contains the nucleus pulposis.  Over time, the water content of the spinal disc diminishes, causing it to dry out and become fibrotic (tough and brittle).  As the disc becomes fibrotic it can develop tears.  This breakdown can result in disc herniations, the development of bony spurs, and sciatica.

 

Risk factors/causes for DJD and DDD are typically multi-factorial, meaning that there is usually no single cause, but rather a combination of several different factors.  These risk factors/causes may include but are not limited to: advancing age, genetic predisposition, mechanical overload from occupational and recreational activities, direct injury to the affected region, cigarette smoking, lack of exercise, and being overweight or obese.

 

Degenerative changes can result in debilitating symptoms for some individuals and can be managed a number of ways.  Maintaining an ideal body weight through a healthy diet and regular exercise consisting of strength, flexibility, and endurance training can reduce the risk of pain and subsequent disability.  Treatment from licensed health professionals who utilize manual mobilization therapies, soft tissue therapy, electrotherapy, acupuncture, exercise and rehabilitation strategies can also significantly help to decrease pain by restoring normal muscle and joint motion, and promote healing of arthritic or injured areas.

 

In the event that you suffer from degenerative joint changes, you should contact a licensed health professional who deals in the diagnosis and treatment of these conditions.  For more information, visit www.nhwc.ca.

 

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

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4 Things Athletes Can Do To Prevent Injuries

Canadian Chiropractic Association

 

With the summer winding down and Fall sports programs opening up, it’s time to consider getting the most out of your athletic preparation, injury prevention, and treatment.

Whether you’re new to a sport or are a seasoned athlete, here are four steps you can take to prevent injuries:

1.    Warm Up: More than 30% of injuries seen in sports medical clinics are injuries to skeletal muscles.¹ Warm ups can 1) improve muscle dynamics to reduce injury and 2) prepare the body for the stresses of exercise. Warm ups may even help you move faster. They should be completed at least 15 minutes before any exercise to maximize the benefits. The warm up should also include a variety of both “static” and “dynamic” stretches. “Static” refers to stretches that are held in a certain position for a period of time (i.e., knee to chest). “Dynamic” refers to stretches that are completed while moving (i.e., forward lunges).

2.    Monitor Food and Water Intake: Current studies show that adequate intake of fluids and nutrients during exercise increases an athlete’s performance.² During high physical activity, electrolytes (like sports drinks), carbohydrates, and proteins are an important part of your pre- and post-workout routine in order to maintain body weight, replenish the energy used by your muscles, provide adequate protein for the healing of tissue, and reduce the risk of dehydration

3.    Rest: Overuse injuries are among the most common injuries seen in sports medicine. Overtraining is a phenomenon that occurs when athletes exercise too much with too little recovery time in-between.³ Overtraining presents with a wide variety of factors including decreased sports performance, suppression of the immune system, muscle damage, decrease in muscle energy stores, as well as fatigue. It is important that athletes follow a program that provides optimal recovery time between training periods.

 

4.    Recognize Injury: Athletes are prone to injuries; whether it’s from training or practice to playoff games, athletes are putting a high demand on their bodies and are expecting a lot in return. This can result in sprains, strains, restricted movements, back pain, neck pain, and swelling just to name a few. It is important that athletes recognize and seek treatment for small injuries to avoid more serious damage. Evidence has suggested that chiropractic therapy can help with these physical ailments using a combination of therapies, including soft tissue therapy, spinal manipulation, electrical modalities, rehabilitation exercises, and athletic taping.

Recreational, amateur, and professional athletes alike have sought chiropractors to be part of their healthcare team.

Chiropractors working with athletes have traditionally been perceived as being spine, muscle, and nervous system experts called upon to treat sports-related injuries. However, treating spine, muscle, and nervous system injuries is not all that chiropractors can do—they may act as emergency care providers, pre-participation examiners, and even as sports injury specialists who work with coaches and other health professionals for the overall benefit of the athlete. These roles all fall under the umbrella the sports healthcare.⁴

For information on what activities and exercises best suit your needs, ask your family chiropractor.

References 1. Woods K, Bishop P, Jones E. Warm-up and stretching in the prevention of muscular injury. Sports Med. 2007; 37(12): 1089-99. PMID: 18027995. 2. American College of Sports Medicine; American Dietetic Association; Dietitians of Canada. Joint Position Statement: nutrition and athletic performance. Med Sci Sports Exerc. 2000; 32(12): 2130-45. PMID: 11128862. 3. Fry RW, Morton AR, Keast D. Overtraining in athletes: an update. Sports Med. 1991; 12(1): 32-65. PMID: 1925188. 4. Miners AL. Chiropractic treatment and the enhancement of sport performance: a narrative literature review. JCCA. 2010; 54(4): 210-21. PMCID: PMC2989393.

 

 

Rehabilitation Of Ankle Sprains

By Dr. John A. Papa, DC, FCCPOR(C)

An ankle sprain is a very common injury that can happen to athletes, non-athletes, children and adults.  A sprain refers to a stretching or tearing of a ligament.  Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  One or more ligaments can be injured at the same time.  Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position.  This may occur while participating in sports and recreational activities, wearing inappropriate shoes, or running, walking or stepping on uneven surfaces.

Inversion ankle sprains constitute 90% of all ankle sprains.  This type of injury occurs when the foot is forced inward (inversion) and produces most of the pain on the outer side of the ankle.  Eversion ankle sprains are less common and occur when the foot is forced outward (eversion), causing the most pain on the inner side of the ankle.  A high ankle sprain is a unique and separate injury in which the ligaments around and above the ankle joint are injured.  This is known as a syndesmotic sprain.

Pain and swelling are the most common symptoms of an ankle sprain.  There may be bruising over the area of injury which may spread down into the foot towards the toes several days following the injury.  Individuals may also experience difficulty walking or weight bearing on their injured ankle.  Most ankle sprains can be managed conservatively.  However, obvious evidence or suspicion of a broken bone, fracture or joint dislocation necessitates the need for emergency medical care.

Initial conservative management of ankle sprains should follow the P.R.I.C.E. principle (Protection, Rest, Ice, Compression, Elevation).  The P.R.I.C.E. principle helps decrease pain and swelling and can be used during the rehabilitative process as needed.  Additional treatment options include electrotherapy, ultrasound, laser therapy, taping, bracing, soft tissue techniques, and manual mobilization to assist in returning to full functioning.  Rehabilitative strategies should also include exercises that incorporate active range of motion, stretching and strengthening for the ankle joint and lower extremity, along with proprioceptive/balance training to minimize the risk of ankle instability and re-injury.

Assuming that proper rehabilitative strategies are employed, successful recovery from an ankle sprain injury will depend upon the severity of ligament damage.  Mild injuries usually heal completely without any residual consequence in 1 to 4 weeks.  Moderate injuries usually require 4 to 12 weeks to heal.  Severe injuries will take longer to heal.  In some circumstances, surgery may be required for severe ankle sprains.

An untreated ankle sprain may lead to chronic ankle instability.  This may also result in secondary foot, knee, hip, and back problems because of subtle changes in movement patterns.  If you are having difficulty with ankle pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Understanding Medical Acupuncture Treatment

By Dr. John A. Papa, DC, FCCPOR(C)

Acupuncture is a 2000-year-old Chinese treatment in which needles are inserted into specific points on the body.  The World Health Organization (WHO) lists approximately four-dozen different conditions that can legitimately be treated by acupuncture.   Acupuncture treatments can be particularly helpful for pain complaints such as:  muscular strains, joint sprains, arthritic pain, neck and low back pain, rotator cuff tendonitis, tennis elbow, hip, knee and leg pain, sciatica, bursitis, migraine and tension headaches.

The term "Medical Acupuncture" refers to acupuncture performed by a licensed health care professional who has training in the health sciences.  Practitioners of Medical Acupuncture derive the concepts of disease, dysfunction, and healing from the western biomedical understanding of pathology, anatomy, physiology and biochemistry.  Under this model, the act of inserting an acupuncture needle into the body is believed to result in the following:

·        Pain Control - Pain-blocking substances are released locally and by the central nervous system to suppress the transmission of pain.

·        Inflammation Control - Natural anti-inflammatory chemicals are released locally, and inflammation control centers are stimulated in other parts of the body.

·        Blood and Lymphatic Flow - Enhancement of blood and lymphatic flow locally and throughout the body allows for the delivery of fresh oxygen and the removal of injury debris from the injury site.

The needles used for acupuncture are much smaller than a standard hypodermic needle.  These needles are solid, not hollow, and have a finely tapered point as opposed to a bevelled cutting-edge point.  The sensations felt during needle insertion range from feeling nothing at all, to mild tingling, to slight numbness/achiness, to small electrical pulsations distant to the site of insertion.  All these sensations typically subside once the needles are removed.  It is common practice nowadays for practitioners to use sterile disposable needles that are discarded following treatment.

As with any health intervention, there is always a potential for side effects and adverse reactions.  The good news is that acupuncture performed by an experienced and knowledgeable practitioner is relatively safe and infrequently yields minor side effects.  These may include but are not limited to: a slight discoloration at the acupuncture site that is temporary and not dangerous; minor bleeding; nausea; short-term fatigue or drowsiness; or a short-term increase in pain before relief sets in.  An experienced and knowledgeable practitioner aims to avoid treatment of certain points during pregnancy, over wounded or infectious areas, to individuals who are hemophiliacs, and to individuals who have needle phobia.

Medical Acupuncture treatments can be safely and successfully employed to help promote healing and recovery from pain complaints including muscle and joint injuries.  Acupuncture treatments are also often utilized in conjunction with other rehabilitative strategies such as exercise prescription, manual adjusting and mobilization techniques, and soft tissue therapy.  For more information visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Fitness Tips For Recreational Athletes

By Dr. John A. Papa, DC, FCCPOR(C)

Physical activity is an important part of a healthy lifestyle.  Being active can help you maintain a healthy weight, reduce blood pressure, build strong bones, relieve stress, and maintain flexibility and good posture.  Included below are some tips to help you protect your body and prevent injury so that you can get the most from your favourite activity this summer season.

1.    Warm-up and cool-down both before and after your game.  Include gentle stretching and range of motion exercises, as well as a brisk walk or gentle jog to loosen the muscles and joints.

2.    Improve your performance by including flexibility and strengthening exercises as part of your training and practice routine.  Muscles act as important shock absorbers and help prevent strains and sprains of vulnerable regions such as the back and neck, along with the shoulder, elbow, wrist, hip, knee, and ankle joints.

3.    Nourish your body by staying hydrated.  Drink plenty of fluids before, during and after physical activity - even in colder weather.  Remember that once you are thirsty, you are already starting to dehydrate.  Dehydration affects your energy level and your physical functioning.

4.    Prepare for the elements.  Avoid sunburn which is a result of overexposure to the sun’s UV radiation and can contribute to certain skin cancers, and a premature aging and wrinkling of the skin.  To protect from sun exposure, apply sunscreen and wear a wide-brim hat and light-colored clothing that covers your exposed skin.  Your eyes should also be protected with UV blocking sunglasses.  Outdoor activities and sports should be limited to the early morning or late afternoon when UV rays are not as strong.  Be cautious on cloudy days, as your skin is still susceptible to burn under these conditions.

5.    Learn the proper technique.  Learn the right technique for your sport from the beginning.  Using the wrong sport-specific technique can create incorrect muscle memory and can make it difficult to break bad habits.  Poor technique can also cause injury to your joints and muscles.

6.    Use the right equipment.  Make sure your equipment is the right fit, height and capacity for you to avoid a sport-related injury.  Recreational athletes should have their equipment professionally fitted and checked before starting out.

7.    Avoid over-training.  Too much.  Too fast.  Too soon.  Over-training is one of the most common causes of recreational athletic injuries.  Take your time and work up to it slowly before pushing yourself too hard.  Remember – rest is as important as training.  Take a training break and give your body a chance to recover.

In the event that you suffer a muscle or joint injury that does not subside, you should contact a licensed health professional.  For more information, visit www.nhwc.ca.  The author credits the Canadian Chiropractic Association (CCA) in the preparation of this educational information for use by its members and the public.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.