After a Stroke, Your Bones Need Care

After a Stroke, Your Bones Need Care

THURSDAY, April 25, 2019 (HealthDay News) — Stroke survivors often face limited mobility, which quadruples their odds of osteoporosis, broken bones and falls. But most are never screened for these problems, new research reveals.

“Our study adds to previous research that found despite an increased risk, only a small number of people who have recently had a stroke are tested and treated for osteoporosis,” said lead author Dr. Moira Kapral. She is director of general internal medicine at the University of Toronto.

Impaired mobility can result in bone mineral density decline, which is associated with osteoporosis. The condition weakens bones and increases risk of fractures.

In this study, researchers looked at more than 16,500 Canadian stroke survivors, aged 65 and older, from Ontario. Of these patients, only 5% had undergone bone mineral density testing; 15.5% had been prescribed medications for osteoporosis within the year after their stroke, and only a small percentage were prescribed medications for osteoporosis for the first time.

Patients most likely to have bone mineral density testing tended to be younger, female and to have had low-trauma fractures in the year after their stroke.

Patients were more likely to be prescribed medications for osteoporosis after their stroke if they were female, already had the bone-thinning disease, had previously broken bones, had previous bone mineral density testing, or had fallen or broke bones after their stroke.

The study was published April 25 in the journal Stroke.

“This study offers more evidence that there is a missed opportunity to identify people with stroke at increased risk of fractures, and to initiate treatment to prevent bone loss and fractures,” Kapral said in a journal news release.

Less than one-third of older U.S. women are screened for osteoporosis. The maximum treatment rate for some high-risk patients is about 30%, the researchers pointed out.

More information

The U.S. Office on Women’s Health has more about osteoporosis.

SOURCE: Stroke, news release, April 25, 2019

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Step-by-Step Exercises for a Stronger Back

Step-by-Step Exercises for a Stronger Back

THURSDAY, April 11, 2019 (HealthDay News) — Are you neglecting or even unaware of the muscles in your back? If so, you’re putting yourself at risk.

The trapezius is the diamond-shaped muscle that runs from neck to middle back and from shoulder to shoulder across the back. The latissimus dorsi — or “lats” — are the large back muscles that run from either side of the spine to your waist.

Here are two strength-training exercises that will help you develop these muscles for better upper body fitness.

Important: Start with a weight that allows you to complete at least eight reps with proper form, perhaps as low as 2-pound dumbbells. Build up to 10 to 15 reps for one complete set, and progress from one to three complete sets before increasing the weight. Never jerk the weights — controlled, steady movement is what brings results.

Standing dumbbell rows target the trapezius muscles as well as the upper arms and shoulders. Stand straight, feet shoulder-width apart, with a weight in each hand. Your elbows should be slightly bent, the dumbbells touching the fronts of your thighs, palms facing your body. As you exhale, use a slow, controlled movement to lift the weights straight up by bending the elbows up and out to bring the weights to shoulder level. Hold for a second, then inhale as you lower your arms to the starting position. Repeat.

Bent-over one-arm rows target the lats as well as the upper arms and shoulders. To work the right side first, stand to the right side of a bench. Place your left knee and left hand on it for support. Your back should be nearly parallel to the floor. Hold a dumbbell in your right hand, palm facing inward. Using only your upper arm, bend at the elbow to lift the dumbbell straight up to your waist as you exhale. Hold for a second and then lower it with control as you inhale. Complete reps, then switch sides and repeat.

You can also do bent-over rows using both arms at once. Stand with feet about shoulder-width apart. Hold a dumbbell in each hand and, bending from the waist, bring your back to nearly parallel with the floor. Keeping arms close to your sides, bend the elbows to lift the weights, bringing them up to waist level. Hold for a second and then lower the weights with control as you inhale. Repeat.

More information

The American Council on Exercise has more on exercises targeting the back muscles.

Copyright ©2017 HealthDay. All rights reserved.
One-Third of U.S. Kids Have Back Pain, Study Says

One-Third of U.S. Kids Have Back Pain, Study Says

TUESDAY, March 12, 2019 (HealthDay News) — As American kids pack on the pounds, the number of those with back pain is on the rise.

One in three between the ages of 10 and 18 said they had backaches in the past year, according to a survey of about 3,700 youngsters. The incidence rose along with kids’ age and weight and was higher among those who play competitive sports.

Though many people probably associate back pain with older people, the orthopedic surgeon who led the study was not surprised by his findings.

“We see a lot of kids who have pain from overuse injuries or joint pain from playing sports,” said Dr. Peter Fabricant, who treats pediatric patients at the Hospital for Special Surgery in New York City. “Of these kids who had back pain, very few actually required any sort of medical intervention. Most didn’t need treatment at all.”

About 80 percent of adults suffer from lower back pain at some time, according to the U.S. National Institutes of Health.

But this is the first time the extent of back pain among children has been estimated on nationwide scale, the authors said. The youngsters surveyed were equally split by age and gender.

On average, those who reported back pain weighed more and had higher body mass indexes, or BMIs. (BMI is a measure of body fat based on height and weight.)

Back pain was more common among girls than boys (38 percent to 29 percent). And the percentage reporting back pain rose about 4 percent with each year of increasing age, according to the authors. Most often, pain affected the lower back.

Nearly half said they hurt in the evenings and more than 15 percent said back pain interrupted their sleep. Only 41 percent sought treatment, and most who did had physical therapy.

Participation in competitive sports was strongly linked to back pain, with junior varsity and varsity athletes experiencing it more often than younger or recreational players. Most survey participants were active, with basketball the most commonly played sport, followed by dance, baseball, football and soccer.

Another contributor to kids’ back pain is the backpacks they use to tote their stuff, researchers said. Those who used one strap to carry their packs reported significantly more back pain than did those who used both straps.

Those who used rolling backpacks reported back pain the most often. Fabricant said it wasn’t clear whether pain prompted their use of the rolling packs or whether the rolling packs contributed to their pain.

While long-term pain prospects are unclear, Fabricant said “it would certainly stand to reason” that kids who experience backaches would be more likely to do so as adults.

Dr. Henock Wolde-Semait is a pediatric orthopedist at NYU Winthrop Hospital in Mineola, N.Y., who reviewed the findings. He said the results mirror what he sees in his own practice.

“Lots of kids have back pain for various reasons. It seems like it’s on the rise,” he said.

“The majority of them do well [without surgical treatment], which is why in the past this may have been overlooked or taken for granted,” Wolde-Semait added.

Fabricant suggested parents urge their kids to avoid any sport or activity related to their back pain. Physical therapy may help by stretching and strengthening key muscles, he said, and it’s wise to avoid carrying backpacks on only one shoulder.

Wolde-Semait said excessive screen time may also play a role in kids’ back pain. He said youngsters should seek “moderation in every aspect.”

The study is to be presented March 12 at the American Academy of Orthopaedic Surgeons’ annual meeting, in Las Vegas. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

More information

Harvard Health offers tips for a pain-free back.

SOURCES: Peter Fabricant, M.D., M.P.H., pediatric orthopedic surgeon, Hospital for Special Surgery, New York, N.Y.; Henock Wolde-Semait, M.D., pediatric orthopedist, NYU Winthrop Hospital, Mineola, N.Y.; presentation, American Academy of Orthopaedic Surgeons annual meeting, Las Vegas, March 12, 2019

Copyright ©2017 HealthDay. All rights reserved.
Is Your Hand Pain Arthritis, Carpal Tunnel or Something Else?

Is Your Hand Pain Arthritis, Carpal Tunnel or Something Else?

FRIDAY, March 1, 2019 (HealthDay News) — You use your hands nearly every minute of the day, so any time they hurt it’s important to find out why.

Certain conditions can affect people who do the same hand movements for hours every day. Repetitive strain injury can cause pain in muscles, nerves and tendons. Carpal tunnel syndrome swelling compresses a key nerve. The lesser known de Quervain’s tenosynovitis typically affects tendons on the inner sides of the wrist.

An autoimmune disease like rheumatoid arthritis often causes joint pain. Without treatment, it can lead to deformities in your hands. The wrist and finger joints are common targets of osteoarthritis, which occurs over time from normal wear-and-tear.

Treatment might start with an over-the-counter or prescription NSAID to temporarily relieve pain, but their long-term use has been linked to side effects such as liver or kidney damage and elevated heart attack risk.

Stronger medications may be needed to stop a degenerative disease like rheumatoid arthritis. Corticosteroid injections are an occasional option to reduce inflammation. Heat can ease stiffness while a cold pack can relieve soreness. If you have a chronic condition, an occupational therapist can teach you how to limit stress on joints when using your hands. During a flare, he or she might suggest a splint to stabilize your hand.

Sometimes surgery is needed. Dupuytren’s contracture, a thickening under the skin on the palm of the hand, can develop into firm lumps that cause fingers to bend inward. Unless lumps are removed early, it may be impossible to straighten fingers later on. If other options don’t help carpal tunnel and de Quervain’s, surgery might be the answer.

Many conditions worsen without appropriate treatment, so don’t delay in seeing your doctor or a hand specialist.

More information

The American Academy of Orthopaedic Surgeons has more on painful hand conditions.

Copyright ©2017 HealthDay. All rights reserved.
Health Tip: Preventing Carpal Tunnel

Health Tip: Preventing Carpal Tunnel

(HealthDay News) — Carpal tunnel syndrome (CTS) occurs when pressure is placed on a nerve stretching from the arm to the hand.

Often, this is due to stress on the hands and wrists. Adjusting your daily routine can help prevent CTS.

NYU Langone Health offers these suggestions:

Minimize repetitive hand movements.

Keep wrists straight.

Alternate between activities or tasks.

Avoid holding an object the same way for long periods.

Copyright ©2017 HealthDay. All rights reserved.

Physical Therapy Can Help You Avoid Opioids When Joint Pain Strikes

Physical Therapy Can Help You Avoid Opioids When Joint Pain Strikes

People who get prompt physical therapy for pain in the knee, shoulder or lower back may have less need for opioid painkillers, new research suggests.

The study, of nearly 89,000 U.S. patients, found that people given physical therapy for their pain were 7 percent to 16 percent less likely to fill a prescription for an opioid.

The researchers said the findings suggest that early physical therapy is one way to reduce Americans’ use of the risky, potentially addictive painkillers.

“For people dealing with these types of musculoskeletal pain, it may really be worth considering physical therapy — and suggesting that your health care provider give you a referral,” said lead researcher Dr. Eric Sun. He is an assistant professor of anesthesiology, perioperative and pain medicine at Stanford University.

Dr. Houman Danesh, a pain management specialist who was not involved in the study, agreed.

“This study shows how important physical therapy can be,” said Danesh, who directs the division of integrative pain management at Mount Sinai Hospital, in New York City.

Physical therapy does require a much bigger investment than taking pain medication — and, he said, patients may have to travel to find a therapist who is the best fit for them.

“Physical therapy is highly variable,” Danesh said. “Not all physical therapists are equal — just like not all doctors are.”

But the effort can be worth it, according to Danesh, because unlike painkillers, physical therapy can help people get at the root of their pain — such as imbalances in muscle strength.

“You can take an opioid for a month, but if you don’t get at the underlying issue [for the pain], you’ll go back to where you started,” he explained.

The findings, published online Dec. 14 in JAMA Network Open, come amid a growing national opioid epidemic. While many people who abuse opioids are hooked on illegal versions — like heroin and illicitly manufactured fentanyl — prescription opioid abuse remains a major concern.

Medical guidelines, from groups like the American College of Physicians, now urge doctors to first offer non-drug options for muscle and joint pain. Opioids, such as Vicodin and OxyContin, should be reserved as a last resort.

The new findings support those guidelines, according to Sun’s team.

The results are based on insurance records from nearly 89,000 Americans who were diagnosed with pain affecting the lower back, knee, shoulder or neck.

All of the patients had a second doctor visit within a month of the diagnosis, and an opioid prescription within 90 days. So the group included only people with significant pain, the researchers said.

Overall, 29 percent of the patients started physical therapy within 90 days of being diagnosed. Compared with those who did not have physical therapy, the therapy patients were 7 percent to 16 percent less likely to fill an opioid prescription — depending on the type of pain they had.

And when physical therapy patients did use opioids, they tended to use a little less — about 10 percent less, on average, the researchers found.

The findings do not prove that physical therapy directly prevented some opioid use.

Sun explained that, “since physical therapy is more work than simply taking an opioid, patients who are willing to try physical therapy may be patients who are more motivated in general to reduce opioid use.”

But his team did account for some other factors — such as a patient’s age and any chronic medical conditions. And physical therapy was still linked to less opioid use.

While this study focused on physical therapy, Danesh said, there are other opioid alternatives with evidence to support them.

Depending on the cause of the pain, he said, people may find relief from acupuncture; exercises to strengthen particular muscle groups; injections of anti-inflammatory steroids or other medications; platelet-rich plasma — where a patient’s own platelets (a type of blood cell) are injected into an injured tendon or cartilage; and nerve ablation, where precisely controlled heat is used to temporarily disable nerves causing the pain.

It’s also possible that some simple lifestyle adjustments will help, Danesh pointed out. An old worn-out mattress could be part of your back pain woes, for instance. Ill-fitting, non-supportive or worn shoes could be feeding your knee pain.

What’s important, Danesh said, is to get at the underlying issues.

“We have to match patients with the right treatment for them,” he said.

More information

The U.S. National Center for Complementary and Integrative Health has more on managing pain.

SOURCES: Eric Sun, M.D., Ph.D., assistant professor, anesthesiology, perioperative and pain medicine, Stanford University School of Medicine, Stanford, Calif.; Houman Danesh, M.D., assistant professor, anesthesiology, perioperative and pain medicine, and director, division of integrative pain management, Mount Sinai Hospital, New York City; Dec. 14, 2018, JAMA Network Open, online

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