Study Gets to the Core of Back Pain in Runners

Study Gets to the Core of Back Pain in Runners

The onset of back pain among runners may stem from a general weakness in their deep core muscles, new research indicates.

Such deep muscles are located well below the more superficial muscles typified by the classic six-pack abs of fitness magazine fame, the researchers noted.

Using computer simulations, they found that runners with relatively weak deep core muscles end up relying more and more on their superficial muscles to keep on running. The result is a higher risk for back pain.

“We measured the dimensions of runners’ bodies and how they moved to create a computer model that’s specific to that person,” said study lead author Ajit Chaudhari. “That allows us to examine how every bone moves and how much pressure is put on each joint.”

Chaudhari is an associate professor of physical therapy and biomedical engineering at Ohio State University’s Wexner Medical Center.

The investigators found that “when your deep core is weak, your body is able to compensate in a way that allows you to essentially run the same way,” Chaudhari said in a medical center news release, “but that increases the load on your spine in a way that may lead to low back pain.”

The study team said it’s not uncommon to find avid athletes who fail to put sufficient focus on their deep core strength, perhaps because superficial muscle maintenance tends to get a lot more public attention.

However, Chaudhari said, “working on a six-pack and trying to become a better runner is definitely not the same thing.

“If you look at great runners, they don’t typically have a six-pack, but their muscles are very fit,” he said. “Static exercises that force you to fire your core and hold your body in place are what’s really going to make you a better runner.”

The study was published online recently in the Journal of Biomechanics.

More information

The American Academy of Family Physicians has information on low back pain.

SOURCE: Ohio State University Wexner Medical Center, news release, Jan. 3, 2018

Electrical Pulses May Ease Pain From ‘Slipped’ Disc

Electrical Pulses May Ease Pain From ‘Slipped’ Disc

Radiofrequency ablation:

A new treatment that aims electrical pulses at irritated nerves around the spinal cord appears effective at relieving chronic lower back pain and sciatica, a preliminary study suggests.

The minimally invasive procedure, called image-guided pulsed radiofrequency, eased lingering pain in 80 percent of 10 patients after a single 10-minute treatment. Ninety percent were able to avoid surgery.

“Given the very low risk profile of this technique, patients suffering herniated disc and nerve root compression symptoms may undergo a safe and fast recovery, going back to normal activities within days,” said study author Dr. Alessandro Napoli. He’s an interventional radiologist at Sapienza University, in Rome, Italy.

“In fact,” he added, “one of the dramatic advantages of this technology is that we can perform it in a day-surgery setting, without anesthesia, and [patients] go home the same day.”

Napoli’s study is scheduled for presentation Wednesday at the Radiological Society of North America’s annual meeting, in Chicago. Studies presented at scientific conferences typically haven’t been peer-reviewed or published, and results are considered preliminary.

About 8 in 10 people suffer from lower back pain at some point in their lives, according to study documents. This pain can be due to a herniated disc in the lower spine. Sciatica is radiating leg pain caused by a pinched nerve in the lower spine, which also may be due to a herniated disc.

Also called a slipped or ruptured disc, a herniated disc occurs when the spongy material inside a spinal disc squeezes through its tough outer shell because of aging or injury. This material can press on surrounding nerves, causing pain and numbness or tingling in the legs, according to the American Academy of Orthopaedic Surgeons (AAOS).

Conservative, nonsurgical approaches typically ease symptoms of a herniated disc over time, according to the AAOS. These treatments include rest, gentle exercise, pain relievers, anti-inflammatory drugs, cold or hot compresses and physical therapy.

However, about 20 percent of those with acute low back pain don’t find relief through these measures. That leads some to decide on surgery to remove disc material pressing on their spinal nerves. For these people, Napoli said, image-guided pulsed radiofrequency treatment may become a viable option if larger studies reinforce his findings.

Napoli’s research included 80 people who had experienced at least three months of low back pain from a herniated disc that hadn’t responded to conservative treatments.

Image-guided pulsed radiofrequency treatment uses computed tomography — a CT scan — to help physicians insert a needle to the location of the herniated disc and surrounding nerves. A probe that’s inserted through the needle tip delivers pulsed radiofrequency energy to the area over a 10-minute period, resolving the herniation without touching the disc, Napoli explained.

More than 80 percent of the 80 study participants were pain-free a year after a single treatment. Six people required a second treatment session.

Pulsed radiofrequency has been widely used in pain medicine for other types of chronic pain, Napoli noted.

He said the treatment works by “eliminating the inflammation process” in nerves surrounding the herniated disc, hindering painful muscle contractions. “The aim was to interrupt this cycle and give the body the chance to restore a natural healing,” he added.

Dr. Scott Roberts, a physiatrist with Christiana Care Health System in Wilmington, Del., said the new findings showed “an impressive drop in pain and improvement in function.” However, he noted that the research didn’t include a control group for comparison with people not given the treatment.

“With no control group, we don’t know how much of the improvement we’re seeing would have happened anyway,” Roberts said. “I was very encouraged by [the study] because its results are significant, but it’s far from conclusive without a control group.”

Boxer’s Fracture

Boxer’s Fracture

What is a boxer’s fracture?

A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It gets its name because the injury is common in inexperienced boxers.

The metacarpal bones are the intermediate bones of the hand found inside the flat of the hand. They connect the bones of the fingers (the phalanges) to the bones of the wrist (the carpals). The fifth metacarpal is the metacarpal of the fifth (pinky) finger. The neck of the metacarpal bone is where the main shaft of the bone starts to widen outwards towards the knuckle.

Boxers are not the only people who can get a boxer’s fracture, but usually the injury results from direct injury to a clenched fist. The force fractures the neck of the metacarpal bone below the pinky.

Your doctor will need to distinguish boxer’s fractures from other metacarpal fractures, which break the shaft of the metacarpal, or fractures of the base of the small finger. These injuries may need different treatments.

Metacarpal bones, in general, are some of the most commonly fractured bones in the hands. A large percentage of these qualify as “boxer’s fractures.”

What causes a boxer’s fracture?

Usually, a boxer’s fracture happens when you punch a wall or another solid object at a high speed. You also might get a boxer’s fracture if you fall hard on your closed fist. The neck of the metacarpal bone is its weakest point, so it tends to fracture here.

What are the symptoms of a boxer’s fracture?

Symptoms of a boxer’s fracture can include:

  • Painful bruising and swelling of the back and front of the hand
  • Tenderness of the back of the hand in the region of the fractured fifth metacarpal
  • Bent, “claw-like” pinky finger that appears out of alignment
  • Limited range of motion of the hand and of the fourth and fifth fingers

Your knuckle may also not have its normal bumpy shape. Your symptoms may vary in severity depending on the complexity of your fracture. You might have only mild pain, or the pain might be more severe.

How is a boxer’s fracture diagnosed?

Your doctor will ask you about your symptoms, how you injured the hand, and your past medical problems. Your doctor will also examine your hand carefully, checking for tenderness, strength, misalignment, range of motion, breaks in the skin, and other features.

An X-ray of the hand can clearly confirm a boxer’s fracture.

How is a boxer’s fracture treated?

Your treatment depends on how severe the fracture is. Initial treatment might include:

  • Washing any cuts that are present in the skin
  • Getting a tetanus shot if you have a cut and haven’t had a shot for several years
  • Resting your hand for a few days
  • Keeping your hand above the level of your heart for a few days
  • Icing your injury several times a day
  • Taking pain medicine (prescription or over-the-counter)
  • Wearing a splint for several weeks

Before your doctor puts your hand into a splint, he or she may need to put your bones back into alignment. Usually, you’ll receive a local anesthetic to keep you from feeling any pain, and your doctor will physically manipulate the bones back into place. In some cases, your doctor might have to open up your hand surgically to get the bones back into alignment.

You also may need to work with a physical therapist for a while as your fracture heals. You’ll learn exercises to strengthen the muscles of your hand and keep them from getting stiff.

If you have an unusually severe boxer’s fracture, you may need immediate and more complicated surgery. For example, if your bone has broken through the skin, or if it has broken in several places, you will probably need surgery. You might also need surgery if you have a job or significant hobby that requires a lot of fine-motor movement of the hand, like playing the piano.

Even if you don’t need surgery right away, you might need it at some point. If your hand doesn’t heal as well as expected, surgery might be an option.

What are the complications of a boxer’s fracture?

An untreated boxer’s fracture can lead to a decrease in your ability to grip, limited range of motion of the finger, and an abnormal looking finger. With proper treatment, these complications are usually minor, if present at all.

What can I do to prevent a boxer’s fracture?

Avoid fistfights and punching solid objects to prevent many cases of boxer’s fracture. If you box, make sure you use the correct technique and the proper equipment.

How to manage a boxer’s fracture

Your doctor may give you some instructions about how to manage your boxer’s fracture, such as:

  • Keep your bones strong by eating a healthy diet with enough vitamin D, calcium, and protein
  • Stopping smoking, to help your fracture heal more quickly
  • Keeping your splint from getting wet

Your hand will be very easy to reinjure for 4 to 6 weeks after your splint is gone. You may need to use a hand brace if you return to contact sports during this time. Talk with your doctor about what makes sense for you.

When should I call my healthcare provider?

Call your doctor if:

  • You have numbness or tingling in your fingers
  • You fingers look blue
  • You have severe pain or worsening swelling
  • Your splint gets damaged and you need a new one

Key Points

A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It usually happens when you punch an object at a high speed.

  • Symptoms of a boxer’s fracture include pain and swelling of the hand, limited range of motion of the pinky finger, and misalignment of the finger.
  • Your doctor can diagnose your boxer’s fracture with a medical history, physical exam, and X-ray.
  • You might need treatment with simple rest, ice, pain medicine, and splinting.
  • You might need surgery for your injury if it is severe.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Everyone should strengthen their ankles!

Everyone should strengthen their ankles!

Injuries of the ankle are common among athletes and amateurs in many different sports and exercises. Working out at the gym, enjoying summer jogs, or playing any type of sport are typical ways to injure your ankle. Unfortunately, spraining, rolling, or fracturing your ankle is easy to do and will often occur again without the proper rehabilitation and strengthening of your ankle joint. Strengthening your ankles is also a great way to do thing outside of sports – such as wear high heeled shoes without wobbling!

There are many exercises and stretches you can do to strengthen your ankles, which can help to prevent future injury or help to recover from a previous ankle injury.

Balance Training

Working on your balance strengthens your ankles, as they are the joints that hold your weight steady on your feet. Try holding your weight on one foot, grabbing your opposite ankle behind your back. Work toward increasing the amount of time you balance on each foot. Eventually, work up to catching and throwing a ball while standing on one foot, or doing one-legged squats.

Band Exercises

You can purchase the resistance bands you would find at your physical therapy gym for very little cost. Wrap them around the top of one foot and curl your toes to stretch your foot and ankle. Make sure to match the number of repetitions on the other foot. These bands can be used to stretch the foot and ankle is a variety of ways and directions – consult your physical therapist for proper form and technique.

Jumps and Skips

Another way to strengthen your ankles is to do exercises that require jumping or skipping. These work the muscles in your foot and your ankle. They get your ankles used to landing and absorbing that impact, as well as aiding your balance.

You can do jumping squats, scissors kicks, or do skips or bounds if you are exercising in a large area.

Obesity to Blame for Epidemic of Knee Dislocations, Complications

Obesity to Blame for Epidemic of Knee Dislocations, Complications

Need another reason to keep your weight under control?

Excess weight can cause dislocation of your knee and may even lead to a complication that results in amputation of your leg.

A new study attributes a surge in dislocated knees to the U.S. obesity epidemic.

“Obesity greatly increases the complications and costs of care,” said study lead author Dr. Joey Johnson, an orthopedic trauma fellow at Brown University’s Warren Alpert Medical School.

“As the rate of obesity increases, the rate of knee dislocations increases. The total number of patients who are obese is increasing, so we are seeing more of these problems,” Johnson explained.

Knee dislocations result from multiple torn ligaments. Vehicle crashes or contact sports, such as football, are common causes.

For the study, the researchers analyzed more than 19,000 knee dislocations nationwide between 2000 and 2012. Over that time, people who were obese or severely obese represented a growing share of knee dislocation patients — 19 percent in 2012, up from 8 percent in 2000.

Obesity is also linked to more severe knee dislocations, longer hospital stays and higher treatment costs, according to the study published recently in the Journal of Orthopaedic Trauma.

And the chances that a knee dislocation would also injure the main artery behind the joint and down the leg were twice as high for obese patients than for those whose weight was normal, the findings showed. This severe complication of knee dislocation — known as a vascular injury — can lead to leg amputation if not treated, the study authors said.

Patients with a vascular injury averaged 15 days in the hospital, compared with about one week for other patients. Their average hospitalization costs were just over $131,000 and $60,000, respectively.

The study authors said doctors should be especially watchful for vascular injury in obese patients whose knees are dislocated.

“That subset of obese patients who come in with complaint of knee pain need to be carefully evaluated so as not to miss a potentially catastrophic vascular injury,” said study co-author Dr. Christopher Born, a professor of orthopedics at Brown.

Reducing obesity rates could help reverse the growing number of knee dislocations, the researchers suggested.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on knee problems.

SOURCE: Brown University, news release, Nov. 3, 2017