Do CBD Products Decrease Pain?

CBD products are becoming more socially acceptable and more widely available. Because of this people often ask whether CBD products can help their pain. Here is what we know about CBD so far.

How CBD Creates its Effects

  • All compounds that are taken into the body must bind to a cell receptor to have an effect on some body process. Receptors are like the locks on a door, and chemical compounds are like the keys that fit into the locks. When the two bind together they “unlock” the cell and change how that cell functions.
  • CBD binds to cannabinoid receptors in the body.
  • These CBD receptors are found in nerve and joint tissues. When CBD binds here it will create some change in the function of nerve or joint tissue cells. This forms the basis for why we believe CBD has pain-relieving effects.

Research Studies of CBD

  • A study of rodents showed that CBD decreased joint inflammation that results in pain from rheumatoid arthritis.
  • Human subjects with rheumatoid arthritis showed a small but significant change in their pain and quality of sleep following 5 weeks of CBD use.
  • A systematic review of four studies did show that CBD improved pain in patients with rheumatoid arthritis, fibromyalgia and osteoarthritis; however, these patients reported side effects including dizziness and cognitive problems.

Summary Recommendations

  • At this time, there is a lack of good quality studies, so it is difficult to make recommendations. Much of the support for CBD is based on anecdotes which are not strong evidence.
  • Different studies use different strains of the drug in different amounts and with different delivery systems. This is why it is so hard to compare the results and come up with evidence-based recommendations.
  • If this is a treatment you are interested in, then you should speak with your primary care physician. CBD can have interactions with other medications, especially medications that have psychoactive properties. So talk with your doctor first before trying anything new in your pain management regimen.

 

October is National Physical Therapy Month

Physical therapy is an excellent treatment option for managing pain. When you see a physical therapist for the first time the therapist will help you develop a treatment plan. The therapist will spend time asking you questions about your medical history, but this is not a one-sided interview. As the patient it is important for you to ask questions too so you understand the recovery process. The following questions were developed by the American Physical Therapy Association (APTA) to help you better understand your pain management options.

Pain Questions

  • Why do I have pain?
  • How long will it take me to heal from this injury (or surgery?)

Self Management Questions

  • What should I do?
  • Are there any activities that I should avoid?
  • How can I speed up the healing process?
  • Can I get back to doing what I did before my pain started?
  • Is there anything else I can do to feel better?

Medication Questions

If your doctor prescribes medications, these questions are good to ask.

  • Why are you giving me this medication? What will it do? How long do I need to take it?
  • What will happen if I take this medication? If I don’t take this medication?
  • Is this medication an opioid? Is there another medication I can take instead?
  • Are there other options, such as physical therapy treatment, that I can try instead of (or in addition to) this medication?

Asking questions will help you and your therapist to work together as a team to achieve your pain management goals.

Gender Differences Affect Running Biomechanics

That men and women are built differently is obvious. However, most people probably don’t know how these subtle differences affect sport performance.  This month we will look at the ways women are unique from men and how these differences affect running.

Differences in Body Structure

  • The female pelvis is wider than the male pelvis. This causes an increased angle at the knee, called a “Q angle.” This increased Q angle causes the ankle to roll more, a movement called pronation.

Image result for q angle

  • In general women have smaller and weaker muscles than men.
  • Women tend to be much more flexible than men. Additionally, their ligaments are more lax, especially in the ankles and feet. This allows the ankles and feet to absorb the stresses of running so there is less strain on the knees.
  • The forefoot-to-heel width ratio is larger in women.

Implications for Female Athletes

  • Women have a higher risk of ACL tears than men due to their larger Q angle. Injury prevention is important for women who play impact sports, especially soccer and basketball.
  • Overuse injuries can be more likely to occur in women because of how the lower extremity absorbs the forces during running. Because the female ankle pronates more than the male ankle, female runners tend to develop more plantar fasciitis and Achilles tendonitis.
  • Researchers are recognizing that women likely require a different support platform (shoe type) than men. Many companies are developing specific shoes for women that take into account the unique biomechanics of the female ankle and foot.

If you are a female runner and you are experiencing difficulty or pain with running, you may benefit from a running gait analysis and evaluation by one of our skilled physical therapists.

 

Long Term Impacts of Ankle Injuries

Ankle sprains are very common injuries, and most people recover from this type of injury quickly without any specialized care. However, new research shows that simple ankle injuries can have long-lasting effects.

What We Know

  • 30-80% of people who injure their ankle will develop chronic problems such as joint laxity, weakness, and increased risk for recurrent sprains.
  • Ankle ligaments do more than hold the joint together. The ligaments have sensors that tell your brain the position of the joint. When the ligament is damaged this sensory function is lost.
  • Because the brain has a hard time recognizing where the ankle is positioned in space, this changes how your brain controls your posture, movements, and reflexes.
  • Changes can be seen in the posture control centers of the brain following an ankle sprain.

Recovering from an Ankle Sprain

  • RICE: rest, ice, compress, elevate. Follow these simple steps following a sprain.
  • Seek supervised rehabilitation. Evidence shows a decreased risk for recurrent injuries in people who complete at least 4 weeks of physical therapy.
  • Prevent another ankle sprain for 12 months and your risk of re-injury returns to baseline.
  • Call our office soon after your injury so we can help you on your road to recovery!

 

Getting Ready for a 5K Race

 

Image result for 5k race

Are you interested in participating in a 5K race? This distance (5 kilometers or 3.1 miles) is very approachable for novices. Whether your goal is to be able to walk, jog, or run this distance, preparation is important. It can take several weeks of consistent effort to condition your body. Following a training schedule will help you increase your fitness gradually so you do not injure yourself. Below are some tips that will get you race ready.

Select a Training Schedule

There are many online resources available. Use a search engine to help you find a schedule that works for you. Some training schedules are designed to get you in shape in as little as 2-3 weeks. If you are just getting into exercise for the first time or your fitness level is low, then you may want to try the “Couch to 5K” plan that will help you build your strength and endurance over the course of nine weeks.

Remember to Warm-Up

Before you do your walk/jog/run it is important to warm-up your muscles. Again, the internet is a great resource. Search YouTube for dynamic running warm-up routines that include movement-based stretching versus static stretching. After you warm-up for a few minutes, then begin your walk/jog/run following the prescribed intervals from your training schedule.

Cooling Down

Ending your work-out with a cool-down is just as important as beginning with a warm-up. This period allows you to bring your heart rate back down to normal. Finish your walk/jog/run with 3-5 minutes of slow walking and then do static stretching. Be sure to stretch your calf muscles, hamstrings, quadriceps, and glutes (buttock muscles) to prevent tightness from developing. Hold gentle stretches for 20-30 seconds.

Stay on Track

Be sure to start your training schedule far enough in advance of your race day to allow yourself to complete the entire schedule. Keep track of your workouts on a calendar and chart your progress as  you go. This is a great way to stay motivated and to help you count down to race day. Your effort will pay off when you cross the finish line!

 

 

 

Benefits of Aquatic Exercise

Image result for stand up paddle board

It’s summertime and that means fun in the sun. Many of us look forward to being in, on, or around the water on a hot summer’s day. Following are some ideas for incorporating aquatic activities and exercises into your summer routine.

Unique Properties of Water

Exercising in water provides many benefits due to the unique properties of water. Buoyancy is the upward pressure exerted by water that causes you to float. Viscosity is the tendency of water to resist flow. It can also be described as thickness. Consider how water is different than honey. Honey is much thicker (viscous) and resists flow; however, water is also resistant to flow but to a lesser extent.
  • Buoyancy reduces joint impact. Exercising in water can be beneficial for people with arthritis of the low back, hips, knees, ankles or feet. It allows them to engage in exercise while protecting their joints from stress.
  • The viscosity of water means that the faster you push against the water the more resistance you will feel. This type of exercise in water can help strengthen muscles and is a great way to cross train.

Aquatic Exercise Options

There are many different types of water-based activities/sports depending on your needs and interests. Below are some ideas.
  • Aquatic based arthritis classes
  • Aquatic aerobics classes
  • Stand-up paddle boarding
  • Kayaking/canoeing/rafting
  • Lap swimming
  • Water polo
  • Fly fishing
  • Water skiing
  • Wake boarding
Whatever you choose, have fun and remember to wear sunscreen!

May is Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorder Awareness Month

Learning the basics starts with learning a few acronyms —

Generalized Joint Hypermobility (GJH)

Medically, GJH is defined by scoring above a certain threshold on a test called the Beighton Scale.  The Beighton Scale includes assessment of flexibility of the fingers, thumb/wrist, elbows, knees, and hips/back.  GJH often coincides with being considered very flexible or ‘double jointed’ (those with GJH don’t really have any extra joints, though!).  GJH can be related to a person’s genetics or it can be accumulated through experience or training (unintended stressors that lengthen tissues or training that increases flexibility like gymnastics or yoga).

Ehlers-Danlos Syndromes (EDS)

The Ehlers-Danlos Syndromes are a group of genetic disorders of the connective tissue.  As of 2017, there are 13 distinct types of Ehlers-Danlos Syndromes, each named for the most significant feature of the syndrome (vEDS for vascular EDS, etc).  Of those 13 syndromes, 11 are extremely rare (all except cEDS and hEDS) and 12 have molecular identifiers (can be confirmed with genetic testing).  The most common form, Hypermobile Ehlers-Danlos (hEDS), can not be confirmed with any medical test.  This form is currently diagnosed by meeting standardized criteria on a clinical exam while ruling out other testable disorders.  All forms of EDS include GJH as a characteristic.

Hypermobility Spectrum Disorders (HSD)

HSD can include GJH or even localized joint hypermobility with no symptoms on the milder end of the spectrum, while the severe end of the spectrum includes GJH with limiting symptoms in multiple body systems in addition to joint problems.  HSD is only diagnosed when a patient has symptoms related to joint hypermobility, but does not meet the criteria for other diagnosable disorders with similar symptoms (including the Ehlers-Danlos Syndromes).

Symptoms, Signs, & Associated Conditions of EDS/HSD

At first glance, symptoms of EDS/HSD can seem random and unrelated:

  • Joint pain
  • Fatigue, disruptive sleep
  • Brain fog, anxiety, depression
  • Dizziness
  • Difficulty standing
  • Digestive troubles
  • Sensitivities/atypical responses to medications and/or environmental triggers
  • Headaches/migraines

However, knowing that EDS/HSD are connective tissue disorders, the symptoms can all be connected by an understanding of the role of connective tissue in the body.  Connective tissue is found throughout the body.  In many areas it serves as the ‘wrapper’ of body structures (for example: internal organs, blood vessels, digestive tract, airway, muscles, nerves, brain and spinal cord).  In many other areas it connects body parts and holds them in place providing strength and elasticity (for example: skin, muscle, tendon, bone, organs).  In EDS/HSD the connective tissues are not standard-issue because the genes that make the connective tissue have mutations.  Depending on which genes are involved, the signs of altered connective tissue vary widely among the different EDS/HSD types and even among individuals with the same type of EDS/HSD.

Some of these signs include:

  • Stretchy and/or soft/velvety skin
  • Joint subluxations or dislocations during every day activities
  • Dental crowding with high/narrow palate
  • Prolonged time in orthodontia
  • Atypical scars; easy bruising; fragile skin
  • Striae (stretch marks) unrelated to weight gain/loss
  • Slower than expected healing of soft tissues after injury or surgery
  • Hernias and/or organ prolapse
  • GI dysmotility (food not moving through the digestive tract or into the blood stream as expected)
  • Dysautonomia (abnormal management of fight/flight vs. rest/digest/repair by the nervous system)
  • Mast cell activation disorder (abnormal immune system activity that is not allergy or autoimmune in nature)

The Basics of Care for EDS/HSD

At the present, there are no treatments or cures that can change the connect tissue of EDS/HSD to be more like standard-issue connective tissue.  However, there are treatments available for almost every symptom and associated condition related to EDS/HSD.  The most important factor is recognizing that individuals with EDS/HSD have special connective tissue that requires special care.

Lifestyle can have a much greater impact, positive or negative, on an individual with EDS/HSD.  Optimal fitness, exercise, activity, and nutrition are essential for management.  Unfortunately, determining ‘optimal’ is incredibly difficult to determine and usually requires guidance from skilled professionals experienced with EDS/HSD.  Medications can also be helpful for managing symptoms, signs and associated conditions.  Here again, it is important that these are prescribed by providers who understand EDS/HSD to avoid triggering additional problems.

  • Care can and should be basic, but for many, it is not!

One of the most challenging aspects of having EDS/HSD is finding a provider who can deliver appropriate care.  Here at Foothills Orthopedic and Sport Therapy, we understand EDS/HSD.  Not only do we do our best to provide optimal physical therapy in a supportive environment, we also work hard to connect our patients to necessary providers and resources.  Our goal for people with EDS/HSD is to live their best life in the body they have!

Links to more information:

www.ehlers-danlos.com

* I especially recommend this EDS Society web site  and this site for patients, loved ones and friends to learn more about EDS

* This comprehensive article may be appropriate for your primary medical provider: Hypermobile Ehlers-Danlos Syndrome

* Sign up for this FREE virtual training at Project ECHO

Safe Hiking This Spring

Image result for hallett peak rocky mountain national park

 

The weather is getting warmer, the days are getting longer, and the mountains are calling. Before you hit the trails this spring, keep the following tips in mind to ensure a good start to your hiking season.

Physical Preparation

  • It’s a good idea to perform a few weeks of pre-season exercise to get ready for hiking. This could include walking, bicycling, swimming, elliptical, or any combination of aerobic activities to build your endurance.
  • Treadmill walking on an incline, especially with a light backpack, can be very helpful. This activity most closely simulates hiking and will give you the most specific adaptations.
  • Choose an easy to moderate trail for your first hike of the season and use good judgement when you decide how long to hike for the first time. If you haven’t hiked for six months, then don’t hike 10 miles your first time out for the season!

Trail Safety

  • It’s best to start your hikes earlier in the day to avoid hot afternoon temperatures. Additionally, if you are hiking at higher altitudes, it’s a good idea to get off the mountain by early afternoon in order to avoid thunderstorms.
  • Watch for wildlife and give animals plenty of room. Talk with a park ranger or volunteer about the types of animals you may encounter on the trail and how to behave if you do cross paths.
  • Be a good steward of our beautiful trail systems. Staying on marked trails not only preserves the landscape and prevents trail erosion, but it will keep you safe and prevent you from getting lost.
  • Always hike with a buddy!
  • Bring plenty of water, snacks, sunscreen, a map and/or compass, and light layers. Expect changes in weather conditions, especially if you are hiking at higher elevations.

Being prepared will keep you safe, healthy and injury-free. Most importantly, it will help you have fun! If you have any concerns about your fitness for the upcoming hiking season, please contact us. Our skilled therapists will perform a comprehensive examination and help you to develop a tailored exercise program to get you ready to explore our great outdoors!

Dancing and Your Brain

 

Image result for older couple dancing

We all know that exercise is important for maintaining our physical health and function as we age. But did you know that certain types of exercise also help maintain your brain? This month we will look at some of the cognitive benefits of dancing. Get ready to kick up your heels!

The Brain Changes With Age

Aging is associated with gradual changes in our memory and attention. It is important to preserve these abilities so that we can live safely and independently into our old age. Dancing has been shown to help maintain these functions. Exercise (such as dancing) causes the release of growth factors in the brain. These chemicals help to nourish the connections between nerve cells (1).

The Effects of an Enriched Environment

Enriched environments are stimulating to the brain. They provide the brain with lots of interesting information to work with. This keeps the brain active and using its numerous connections. Research has shown that animals living in enriched environments have delayed changes in their brains (1). Attending a dance is an example of being in an enriched environment. Dancing includes being physically active, moving in rhythmic ways, using memory and recall of dancing patterns, and balance reactions. Dancing also involves social interactions, emotions, and music. All of these factors add up to powerful stimulation for the brain.

 

So get out there and dance to keep your brain young!

 

1) Kattenstroth JC, Kolankowska I, Kalisch T, Dinse HR. Superior sensory, motor, and cognitive performance in elderly individuals with multi-year dancing activities. Front. Aging Neurosci., 21 July 2010. https://doi.org/10.3389/fnagi.2010.0003. 

Physical Therapy and Hip Osteoarthritis

Image result for hip arthritis

 

Osteoarthritis (OA) is a common condition that can affect many joints in the body. It is often seen on x-rays as narrowing of the joint space. Sometimes bone spurs are present. Often the lining of the joint is inflamed. This can cause significant pain and difficulty performing daily activities. If this condition is affecting your life, you may be wondering what your treatment options are. A recent article in the journal Physical Therapy discuses the most current evidence-based treatments for OA of the hip(1).

Conservative Care

The international community recommends conservative care first. This includes a combined approach using education, exercise and weight loss to manage hip pain and improve function. Exercise provides numerous benefits for hip OA including:

  • Improved muscle strength. When supporting muscles are strong they absorb impact forces so the hip joint doesn’t have to.
  • Increased joint range of motion. Good flexibility is important because it lessens the stress on joints.
  • Decreased joint pain.
  • Better physical function.

Secondary Recommendations

  • Pain medications. Over the counter medications are recommended first. These include non-steroidal anti-inflammatories, often called NSAIDs.
  • Joint replacement surgery. This option is reserved for people who have significant pain and limitations in daily activities and who have failed conservative treatments.

If you are suffering from hip pain and find yourself limited in the things you enjoy doing, contact our clinic for a physical therapy assessment. Our staff of trained therapists looks forward to helping you decrease your pain so you can get back to your normal daily routine.

 

 

  1. Poquet N, Williams M, Bennell KL. Exercise for osteoarthritis of the hip. Physical Therapy. 2016; Volume 96 (11): 1689-1694.