Tag Archive for: pain

The Step-by-Step Approach to Pain

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As I wrap up preparations for tomorrow’s Managing Pain Super Bowl Webinar, I wanted to provide you with a little more information—specifically, how I’m going to use a step-by-step approach to deal with pain.

The typical approach used by the medical profession is to try a treatment and if that doesn’t work, try the next step in the recommended treatment plan.

What I’m going to teach you is how to use several modalities or approaches simultaneously to manage your pain. For example, let’s say you have a painful joint. In order to build muscle in that joint, you may begin with using light weights; you may use a dietary supplement to decrease inflammation at the same time. It would also be a good idea to do some fascia stretching to stimulate the breakup of adhesions that contribute to the pain. I could go on, but that’s the idea.

You can still participate in the live webinar if you sign up by Sunday at noon Eastern Time. If you can’t make it, I’ll automatically send you a link for the replay when it’s ready. This is an important webinar because it addresses the one question I get all the time. Join me for an hour Sunday afternoon; it just might make a big difference in your ability to live your life.

What are you prepared to do today?

        Dr. Chet

Managing Pain

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Quick: what’s the location of pain that’s experienced by most adults in the United States, regardless of age?

Pain afflicts everyone at one time or another, but the older we get, research shows that we’re more likely to experience chronic pain. That time you twisted your knee when you played a pick-up game of basketball? When you rolled your ankle playing tennis? That time you were rear-ended in a car? How about when you slipped and fell on the ice? You may have had pain then and recovered, but all of those things could have caused micro-tears in connective tissue and now the bill has become due.

In this webinar, I’m going to cover the most common forms of pain experienced by people of all ages. By the way, the most common type? It’s lower back pain. While the focus is going to be joints and extremities, the approach can be used with other forms of pain such as migraines and fibromyalgia.

The objective of this webinar is to give you a step-by-step approach on how to deal with chronic pain. The goal is that you can use it to help yourself in the future. Every known modality will be discussed.

The Managing Pain webinar will be held Sunday, February 25, at 3 p.m. Eastern Time. If you’re not available at that time, no worries. The replay will be available later that day and for the next six months. The cost of the webinar is $13.95; Member and Insider discounts apply.

There are many places you can be on a Sunday afternoon, but this is an opportunity to help yourself for years to come. Spend a little while with me and learn to change your life. Sign up today.

What are you prepared to do today?

        Dr. Chet

Soreness and Specificity of Training

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The first Super Bowl Webinar I ever did was about specificity of training. A running buddy years ago summarized how to run faster this way: “If you want to run faster, you gotta run faster.” In other words, even short bursts of running very fast would eventually help build speed more than slow, long runs.

The key element of specificity of training is that you can’t run faster by swimming or cycling or weight training; you have to do that by running. The same concept applies to just about any physical endeavor. Chefs can’t improve their knife skills by running or weight training: they have to spend hours chopping and slicing.

If you use an elliptical trainer or recumbent bike or you ride a bicycle, you’re training specific muscles to fire in specific patterns. When you change to another mode of exercise such as walking or running, you’re going to use the same muscles but in different ways; some muscles maintain balance and others maintain posture in addition to those that are doing the bulk of the work moving your body. And they’re different in different modes of exercise; even with all my education and experience, I was surprised at how sore I was when I had to switch from running to walking. Until you’ve trained those muscles for the particular activity, you’re going to be sore. And the sad news is that it gets worse as you get older.

Dealing with Discomfort

The important thing to understand is that this discomfort is temporary; the exception is if you had an orthopedic issue that never has been resolved. For me it was my knee, and now that’s resolved. If you’ve avoided getting something repaired, it’s your call but the longer you wait, the more you risk not getting back the mobility you had.

If you’ve changed your mode of exercise, here are some ways to deal with it:

  1. Start with heat followed by easy stretching. We think that our muscles and connective tissue are like rubber bands while stretching. Not exactly accurate, but warm muscles are more pliable so doing some kind of warm up will help you avoid injury. Easy does it; stretching too far too fast is a recipe for even more pain.
  2. Increase fluid intake to “flush” out some of the breakdown products of muscle and other connective tissue.
  3. Use glucosamine and vitamin C to help the connective tissue repair process. The purpose of breakdown is to build back better, but to do that, you need the nutrients that repair the microtears in the connective tissue.
  4. Ice specific areas, especially the front of the shins; shin splints is the common name for pain in this area. The connective tissue compartment that holds the tibialis anterior muscle (the one that pulls up your toes) isn’t very pliable, so reducing inflammation in that muscle can really help.
  5. Most of the soreness you’re feeling is from inflammation. If you feel you need to, and have no medical reason you can’t, use a non-steroidal anti-inflammatory drug such as ibuprofen; it relieves pain, but reducing inflammation is key to your recovery and continued progress.

The Bottom Line

It can literally be a pain to start to exercise or change your mode of exercise. There’s a price to pay but in comparison to the benefits you’ll get, the cost is minimal. Be sure to start slow: if you push too far too fast, you’re going to set back your progress while you recover. In the long run, you’ll get farther by taking small steps so you can keep going without a pause for injuries.

We’re not done talking about walking yet, but if you have any stories about finding the right shoe for you, let me know. I’m doing background research on that, so I won’t write about it next week—you have time to send me your stories.

What are you prepared to do today?

        Dr. Chet

Should You Take Essential Amino Acids Before Surgery?

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Tuesday’s study left us with a question: what could explain essential amino acids (EAAs) increasing, or at least preventing, muscle loss after total knee replacement surgery? Fortunately, another study examined those factors by obtaining muscle biopsies and blood before and after surgery.

Researchers recruited 41 patients who were having total knee replacement. After randomly assigning them to placebo or experimental group, the experimental group received 20 grams of EAAs twice daily, beginning seven days prior to surgery, until six weeks after surgery. Those in the placebo group were given nonessential amino acids. Muscle biopsies were collected from all subjects the day of the surgery and again either one or two weeks post-surgery with the determination made randomly. Blood was also collected for analysis at the same times as the biopsies.

The researchers found that the subjects taking the EAAs had a significantly increased amount of satellite cells, also known as muscle stem cells that can develop into muscle cells, compared to the placebo group; the ability to build muscle faster could help the recovery process. IL-6 and TNF-alpha were elevated post-surgery in both groups; however TNF-alpha declined by two weeks post-surgery in the EAAs group, which meant inflammation decreased. Based on the changes in cytokine production, inflammation after surgery decreased faster with EAAs than it did in the placebo group.

The researchers concluded that taking the EAAs seven days before surgery increased satellite cells on the day of surgery and promoted a more favorable inflammatory environment post-surgery. That could mean a quicker recovery from surgery and benefits during post-surgical rehabilitation.

The Bottom Line

While there’s more research necessary, I think the use of EAAs before and after knee replacement surgery is helpful. I would extend that even further; I think that EAAs may ultimately prove to be beneficial before and after any type of surgery. In almost every case, muscle tissue is going to be cut and thus will need to repair itself. We don’t know the benefits of EAAs on other connective tissue such as skin and ligaments, but because we’re targeting the key elements of protein with the EAAs, there’s little to no chance of any harm.

Based on these two studies, I think that 10 to 20 grams, spread out in two doses per day, would be the best approach. One important point: take the EAAs 15 to 30 minutes before eating anything or before working out. Those were the protocols used, and it’s the same that I recommend in Aging with a Vengeance for increasing muscle mass as we age.

I’ll be honest: it tastes weird. But I made sure Paula took EAAs before and after her recent carpal tunnel surgery, so you know I think it’s worth the effort.

What are you prepared to do today?

        Dr. Chet

Reference: J Appl Physiol (1985). 2019 Aug 1; 127(2): 531–545.

Eliminating Pain

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Chronic pain afflicts us all at some time. I’ve talked about my knee enough to write a book, but pain can be in many areas: lower back, shoulders, feet, hips, wrists, and deep muscle pain as might occur from fibromyalgia. Should you give the pain time to work itself out? No—that’s the worst thing you can do, because you may be setting yourself up for years of pain that could have been prevented.

Pain Pathways

Chronic pain may develop when pain pathways become established without intervention. While complicated in nature, what happens is that the series of biochemical reactions and different types of sensory neurons that let your brain know that something is painful get stuck in the “on” position. The original cause, whether from an injury, surgery, or a disease or condition, may have healed, but the nerve fibers are still sending pain signals. In order to affect changes in those pain pathways, you must take action.

Relieve the Pain

This seems obvious, but too many people refuse to do it. What I mean is that whether you’ve been prescribed pain medication or use over-the-counter medications, take them regularly. You don’t get hero badges for avoiding medications and staying in pain. You’re also not limited to medications.

There are many supplements that work for some people, including high-EPA omega-3 fish oil, glucosamine and chondroitin, tart cherry juice, turmeric, and others. If you’re going to take them, be consistent. We also now have CBD oil for internal use and creams and sprays for topical use. Some people find it works well for them, while for others they don’t work at all. How to know? Try each one.

If you can relieve the pain, you can return the area to normal functioning. This is especially true for muscles and joints. When you’re in pain, you compensate by changing the way move. That makes matters worse over the long haul. I’m not suggesting that you will be completely pain free, but if you’re able to move better, that will help you with the second part of pain management.

Rehabilitate

If you’ve had surgery on joints or soft tissue, you had to go through a physical therapy program to restore range of motion and function. The exercises that you were given were supposed to continue until you had a complete return to joint function. Most people get part way there and then stop. My father-in-law had surgery on both shoulders; he completely rehabbed his right shoulder after rotator cuff surgery, but he stopped short with his left. As a result, he could get close to putting his right arm fully extended overhead but got to only about ear level with his left.

Besides stretching to get back range of motion, you can also strengthen the muscles directly involved in the motion as well as those that provide stability to the joint. As just one example, the rotator cuff muscles do just that: they rotate the humerus. But the biceps, triceps, pectoralis major, and deltoid all provide stability to the shoulder. The best thing to do is to check with a physical therapist, most likely using an online video service these days, and get the exercises if you don’t know them. Then get to work.

The Bottom Line

In order to live your life fully, you must deal with chronic pain. The keys to pain management are to

  • Reduce the pain
  • Work on improving your movement of the area involved
  • Work on strengthening the area and surrounding tissues
  • If all else fails, consult a pain specialist.

That’s my goal for the next 60 days: to take a weakness and make it as strong as possible without causing any damage. Progress slowly and be methodical in the approach, and if that doesn’t work, get a referral to a pain clinic. Your life is too important to let pain rule you.

What are you prepared to do today?

        Dr. Chet

It Gets Worse Before It Gets Better

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In last month’s Memos, I talked about many different aspects of exercise including flexibility, strengthening, and the various types of fitness and stamina. There’s one more thing you need to know. But first, a story.

Paula has been having an issue with her ankle and foot. She got it checked out with her podiatrist, and it’s a problem with the tendons in her foot including the Achilles tendon. Yesterday we went to see our favorite physical therapist; he did a thorough examination of her foot, ankle, knee, and hips. He recommended some stretching and strengthening exercises as well as some non-impact aerobic exercise. He then said something important: everything may seem worse before it gets better.

I’m going to tell you the same thing as you attempt to work on your body to help you really live instead of merely being alive: you may feel worse before the work you invest begins to pay off and you start to feel better. That’s one reason I ask you to see your doctor before you begin, who’s familiar with your orthopedic issues as well as any conditions that can be impacted by exercise. That’s why you always check first.

If you can get professional help to help you get started, that’s even better—someone to help you choose the right exercises to fit your particular body and limitations. Get a referral to a good physical therapist or find a certified personal trainer with experience helping people who are less fit; you definitely don’t need one of the no-pain-no-gain goons. It doesn’t need to be a long-term relationship, just advice to help you get a good, safe start. And you can probably work out a routine to do at home if joining a gym isn’t your style, but a short-term membership may be helpful in determining which exercises and types of equipment are best for you. For example, don’t buy an exercise bike without trying different types.

For a while, you’ll probably feel worse, especially if it’s been years since you’ve worked on some of these muscles and joints. You may want to refer to the pain scale on drchet.com. Take it slow and let discomfort be your guide. If you overdo it and you’re in pain, back off, ice or heat and rest, and then get going again with a little more caution. After all, you want to live all your days. The work you put in will generate some satisfaction before you may feel the benefits. Better to take longer to get there than stop altogether. The good news is that once you get over that hump, and it may take many months, you’ll feel better than ever.

What are you prepared to do today?

        Dr. Chet

Core Flexibility and Lower Back Pain

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On any given day, lower back pain afflicts 25% of the population; 80% of all adults will experience it as some point in their life, and it’s still a major cause of lost work days and workman compensation claims. Face it, as long as we walk upright, we’re going to have lower back pain of some sort.

Some lower back is due to various kinds of injuries. They must be handled within the parameters set forth by your doctor and orthopedist. Most lower back pain, however, is caused by a group of muscles called our core.

In general, lower back pain is the result of two contradictory conditions: abdominal muscles that are too loose; and lower back muscles, hamstrings, and quadriceps that are too tight. The solution is to stretch the tight and strengthen the weak. As I said Tuesday, there are many online sources to find those stretching and strengthening exercises. The most important point is to do them regularly; if I miss my routine more than two days in a row, I can feel it. If you stop when you start to feel better, you’ll soon feel worse again.

Your core also contributes to the final physical approach to living every day you’re alive. I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: http://bit.ly/33zjJfh

How to Reduce Disease-Related Pain

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The first two memos on pain were relatively easy: joints and nerves. From that point forward, it can get very challenging: Lyme disease, irritable bowel syndrome, shingles—the list of diseases that lead to pain could go on and on. To complicate matters, with the concern over opioid addiction, many people in pain don’t want to even try those medications. What do you do?

The key is to work with your physician and specialists to develop a strategy for pain relief. That will vary by disease. A medication that benefits the nerves for shingles pain may be helped by NSAIDS or other pain relievers, but NSAIDS may not be beneficial for someone with IBS; the absorption of the pain reliever may cause more bowel pain.


Two Strategies to Help

There are two things you can try that may directly or indirectly help with pain. The first is to reduce inflammation and as I mentioned on Tuesday, the supplements that may help are omega-3s, turmeric, and glucosamine. They can help reduce inflammation in more than joints.

The second would be to strengthen the immune system. Lyme disease is bacterial, shingles is a virus, and IBS is an attack on the lining of the intestines. While strengthening the immune system is not directly involved, it may assist the body in dealing with the cause and reduce the pain. To me, that means using probiotics, antioxidants such as vitamin C and E, and using herbs such as echinacea and garlic. As I said, it may not directly affect pain but may indirectly help the body cope with the condition.


The Bottom Line

The two strategies won’t work for every disease. Every form of cancer can result in different pain. Some diseases such as type 2 diabetes can impact the extremities and eyes in ways that require professional guidance. But in general, strengthening the immune system may help over the long term. That also means increasing the intake of vegetables and fruit and getting some exercise within the limitations of the condition. That’s a topic for another time.

What are you prepared to do today?

Dr. Chet

 

How to Reduce Nerve Pain

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Do you ever have pain that shoots down your leg? How about your hands getting numb or painful? Ever get a headache because you’ve clenched your neck muscles so tight due to stress? More than likely, you’re experiencing some form of pain caused by a firing nerve, and these three examples are the ones I’m asked about most often.

It’s always important to get an examination and diagnosis of the potential cause of the pain. If it’s mechanical, that’s one thing. If it’s neural, your approach will be slightly different. The cause of the pain may be a completely different location than where you feel the pain. In the first example, the probable cause is an impingement of the sciatic nerve somewhere; it could be in the spine where the nerve exits the spinal cord or it could be in the pelvic girdle. The second is the classic symptom of carpal tunnel syndrome; the nerves in the neck and shoulder are the primary cause even though the resulting pain is in the wrist and hands.

The critical part of dealing with nerve pain is to try to relieve the pressure on the nerve. Physical therapy and possibly massage that stretches and strengthens the appropriate joints are critical, but they must be done consistently. For some, pain relievers other than non-steroidal anti-inflammatories may be beneficial. Supplements that may help would be high-DHA omega-3s, gingko biloba, and magnesium. If you pushed me to say what’s the best approach, I would say take whatever you can to relieve the pain so you can do the physical therapy. Use the supplements for a longer term solution.

One more type of pain to look at Saturday.

What are you prepared to do today?

Dr. Chet

 

How to Reduce Mechanical Pain

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Every morning, the process of getting my body moving is challenging. My back is stiff and my knee is tender, on the border of painful. The longer I’m up, the better I move. After about 30 minutes, I can get my workout. It takes my knee 10 minutes to warm-up once I start running.

I’m going to talk about pain this week—specifically, three types of pain and what may help. Today it’s mechanical pain. Remember the time you slipped and twisted your knee? Wrenched your shoulder when you picked up something you thought was a lot lighter? Broke your ankle skiing? Those are the types of injuries that can lead to mechanical changes that can result in pain; the injury heals but the tendons, ligaments, and cartilage are not quite the same. It can lead to pain, even many years later. That’s what happened to my right knee.

What can you do about it? Strengthen the supporting tissues to the extent you can. I went to a physical therapist, got an evaluation, was assigned some exercises and I do them regularly. It has strengthened the muscles that directly and indirectly impact the knee. While it’s still tender when I wake up, the swelling is gone and I can run if I choose. To me, that’s the most important thing. But I also take a timed release non-steroidal anti-inflammatory in the morning and use omega-3s, turmeric, and glucosamine twice a day. That works for me. You may need more pain relievers or you may need none.

That’s how you can deal with mechanically-induced pain. On to nerve-induced pain on Thursday and disease-related pain on Saturday.

What are you prepared to do today?

Dr. Chet