Over the Counter Anti-Inflammatories: Ibuprofen versus Naproxen

Two of the most common non-steroidal anti-inflammatory medications (NSAIDs) are Ibuprofen (Advil, Motrin) and Naproxen (Aleve). What do these drugs do, and how do they help with pain? Read on to learn more.

How NSAIDs Work

NSAIDs prevent your body from making chemicals called prostaglandins. Prostaglandins are made in response to injury. These chemicals can contribute to inflammation, pain, warmth (fever), and swelling. NSAIDs work to reduce or prevent this inflammatory response and help alleviate pain that might be acute (injury, recent surgery) or chronic (arthritis, bursitis, degenerative changes).

Indications and Dosage

Although Ibuprofen and Naproxen are very similar, they are not exactly the same. Ibuprofen tends to be more short acting while Naproxen tends to be more long acting. These differences make Ibuprofen more useful for short term conditions and Naproxen a better option for chronic conditions. Other differences between these two medications include:

Recommended ages:

    • Ibuprofen – any age including children

    • Naproxen – 12 years and older

Frequency/dosage:

  • Ibuprofen – 200 to 400mg every 4 to 6 hours as needed

  • Naproxen – 220 mg every 8 to 12 hours as needed

Side Effects

All medications come with the risk of unwanted side effects. Both Ibuprofen and Naproxen can cause the following:

  • Stomach pain
  • Heartburn/indigestion
  • Decreased appetite
  • Nausea
  • Dizziness
  • Drowsiness
  • Risk of heart, blood pressure, and stroke issues tends to be greater with the use of Naproxen, as this drug tends to be used for longer periods of time.
  • Both Ibuprofen and Naproxen can interact with other drugs such as blood pressure medications, aspirin, diuretics, blood thinners, and certain drugs related to cancer treatment.

Like any medication, do not take more than the recommended dosage unless directed by your physician.  These medications, in conjunction with physical therapy, may help you to overcome a recent injury or manage an ongoing condition. Be sure to consult your physician or pharmacist before taking any new medication.

A New Normal for Athletes

Life is returning to a new “normal.” The world is opening back up, and along with it are sports. Athletes are starting to get back to work. Now is not the time you want to have an injury. It is however, the perfect time to change bad habits and focus on proper strengthening and stretching to help prevent injury.

Knee Injuries by the Numbers

Knee pain and injury plague many athletes every year. As many as 8.5% of non elite athletes will suffer from patella tendinopathy or “jumpers knee.”  Patella tendinopathy can cause pain, interfere with performance and can be career ending in up to 53% of athletes. Another injury that impacts athletes are ACL tears. There are 100,000 to 200,000 ACL ruptures/tears every year. Research shows that girls are anywhere from 2-10 times more likely to tear their ACL than boys.

Injury Prevention Tips

Here are a few simple things you can do to help prevent injury.

1) Start back slowly and listen to your body.

2) Allow time for a proper warm up.

3) Make sure you wear proper shoes. Wear shoes that have a good arch support and control the position of your foot preventing your arch from collapsing.

4) Stretch your calf muscles. Having good flexibility in your calf muscles allows for adequate motion in your ankles to help absorb the impact of landing.

5) Strengthen your core and your gluteal muscles, especially the gluteus medius muscle. Poor strength of the gluteus medius leads to decreased hip and knee control.

6) Maintain flexibility in your hip flexors and quadriceps.

7) Don’t forget about the hamstrings. Your hamstrings, along with the ACL, help prevent your tibia (lower leg) from sliding forward. Focus on making sure you have a good strength in your hamstrings not just your quadriceps muscles.

8) Avoid knee extension machines. Once a staple in every gym this exercise puts a tremendous amount of stress on the knee.

9) Use a hip strategy when landing. Land with your hips back, keeping your knees behind your toes. This helps to protect your knees but also allows you to prepare for the next jump and for more power production.

10) Focus on landing softly and quietly. Land on the balls of your feet allowing your hips, knees, and ankles to bend. Make sure your knees don’t drop in toward each other as you land. Allow your muscles to absorb the impact not your joints.

If, despite these tips, you do experience knee pain or injury we at Foothills Orthopedic and Sport Therapy are available to help.

May is Ehlers-Danlos Syndrome Awareness Month

How AWARE are you? Take this quiz to find out:

1. How many types of Ehlers-Danlos Syndrome are there?

a) 1

b) 4

c) 14

d) 32

2. The Ehlers-Danlos Syndromes affect which body system?

a) skin

b) heart

c) digestive

d) neurological

E) all of the above

3. What do people with Ehlers-Danlos Syndrome look like?

a) pale, tall, and skinny

b) short with a curvy spine

c) covered in scars and bruises

d) sagging skin

e) any, all or none of the above

4. When in the lifespan does Ehlers-Danlos Syndrome onset?

a) birth

b) puberty

c) after trauma or illness

d) parenthood

5. Is Ehlers-Danlos Syndrome life threatening?

a) yes

b) no

c) no, but it can significantly impact quality of life

d) it depends

6. How do people with Ehlers-Danlos Syndrome get around?

a) wheelchair

b) walker/cane

c) braces

d) sensible shoes

e) like a high-class athlete or performer

7. How is Ehlers-Danlos Syndrome treated?

a) vitamins and minerals, nutrition, hydration

b) carefully selected exercise, lifestyle modification, counseling

c) adaptive equipment and supports

d) prescription medications

e) none, it is incurable

8. Why are people with Ehlers-Danlos Syndrome called Zebras?

a) zebra stripes represent the abnormal appearance of the skin in EDS

b) doctors are taught to look for the most common diagnoses instead of being distracted by the possibility of rare disorders like EDS by being told ‘When you hear hoofbeats, look for horses, not zebras!’

c) living with EDS is like being a jungle animal

d) the debate of ‘white with black stripes’ vs ‘black with white stripes’ represents the aspects of the disorder that remain poorly understood

9. What is the easiest way to spot a zebra?

a) look for stripy skin

b) look for a history of doing the splits or entertaining contortions

c) look for joints that seem to bend the wrong way

d) test their Beighton score

10. What do people with EDS need in 2020?

a) to be seen, heard and believed when they relate challenges

b) more public awareness and acceptance of the disorder

c) more healthcare providers who are educated, aware, or simply willing to read about EDS

d) more research into diagnosis, management of EDS

ANSWER KEY (yes, there were a lot of ‘trick questions’)

1. C: there are 14 types of EDS, each named for which body system is most impacted. All the types involve some degree of joint hypermobility. Only the most common types (hEDS and HSD do not yet have identifiable genetic markers that can be tested to confirm diagnosis)

2. E: all types of EDS impact connective tissue, which is part of the composition of every system of the body! Some types impact connective tissue of one system more than others, while the most common types (hEDS, HSD) impact the joints of the body the most and are also associated with GI, neurological, cardiovascular and immune disorders

3. E: Ehlers-Danlos Syndrome is called an ‘invisible illness’ for a reason. Most people with EDS look ‘fine’ or just like anyone else. Some rare types do cause spinal deformities or obviously different appearing skin. In some people, difficulty with chewing/swallowing/digestion/muscle building can cause a gaunt appearance; other people have activity limitations, metabolic changes, or changes in tissue deposition that lead to increased adiposity.

4. A, and B-E too: EDS is genetic, so it is present at birth. In some of the very rare types, it may be diagnosed shortly after birth related to joint dislocations, unexpected bleeding, or failure to develop movement as expected. But most types remain undiagnosed until symptoms begin to significantly interfere with life AND the symptoms are presented to a health care provider knowledgeable about EDS. Puberty, trauma, pregnancy/parenthood can all be a trigger that leads to greater awareness of symptoms. However, many people with EDS wait 5-50 years from the awareness of symptoms to diagnosis due to a lack of knowledgeable providers.

5. D: vEDS, or vascular EDS, and some other rare types of EDS can be life-threatening disorders, especially when undiagnosed; with timely diagnosis precautions and management can allow longer life. Most types of EDS, however, impact quality of life much more than longevity.

6. A-E: mobility varies dramatically among people with EDS. In fact, many individuals can use all these modes of getting around in the same lifetime, and sometimes even the same month. While many disorders are progressive, the progression of EDS is very unpredictable. Many people with the most common types, hEDS/HSD, have phases of very high function, very low function and everything in between despite conscientious management of their disorder. Fun fact: most people diagnosed with hEDS/HSD relate a history of exceptional talent in athletics, music, or the arts. Often, difficulty utilizing these talents are what drives individuals to seek a diagnosis.

7. A-E (again): There is no cure for any types of EDS. All of the listed options can be beneficial in optimizing function and quality of life in EDS. Most treatments are focused on minimizing associated conditions in the various body systems. At various phases of the disorder, medications and adaptive equipment are especially helpful. The need for lifestyle management, right-size exercise and movement, nutrition, hydration, and care for mental health are never ending for those with EDS. Even at the very best phases, the individual is always working to manage life with unique connective tissue.

8. B: This is good advice for young doctors most of the time, but it does a disservice to those who are zebras. Many ‘zebras’ are accused of lying, faking, seeking some sort of gain, or simply dismissed when they don’t respond to treatment as expected or when diagnostic testing is inconclusive. While it’s smart to look for the most common cause of a complaint first, it would be better for all of us if the next step was to look for more rare causes of a complaint like EDS before moving to accusations or dismissiveness.

9. Not A! Probably B & C. Definitely D: The Beighton Scoring System is the most widely accepted way to assess joint hypermobility and is quite easy to check on your own and then show your healthcare provider. This link explains it all: https://www.ehlers-danlos.com/assessing-joint-hypermobility/ CAUTION: moving your body parts to extreme/awkward positions routinely can damage supportive structures, so avoid the temptation to ‘show off’ or do ‘party tricks’ just because you can; taking photos and showing them from your phone is a great way to achieve validation without abusing your body!

10. A, B, C, D: Yes, yes, yes and more yes!

Foothills Orthopedic & Sport Therapy P.C. COVID-19 Action Plan

As communities around the world feel the impact of the coronavirus (COVID-19), we would like to answer some questions about coronavirus and inform you of the steps we are taking at Foothills Orthopedic & Sport Therapy to help protect the health and safety of our patients, guests and employees.

 

What is Coronavirus Disease (COVID-19)?

Coronaviruses are very common and most do not cause serious illness. The common cold is a type of coronavirus. The COVID-19 coronavirus is believed to have jumped from an animal population to people in Wuhan, China. It began to spread from person to person in December 2019 and has since impacted many countries around the globe.

Due to this spread The World Health Organization has declared the outbreak a “public health emergency” and as a result has implemented travel restrictions to China and South Korea.

Of the 97,975 cases reported thus far, 54,124 (55.2%) have recovered and 3,355 (3.4%) have resulted in death. Eighty-four percent (84%) of the current known cases are considered mild. The United States has 245 reported cases of COVID-19 with 15 reported deaths.

The CDC and other global public health entities are aggressively implementing measures to slow the spread of the COVIS-10 virus.

 

How does COVID-19 Spread?

Coronaviruses spread primarily from close person-to-person contact through respiratory droplets such as those produced by coughing or sneezing. These droplets can land in the mouths or noses of nearby people or be inhaled into their lungs. Transmission of the disease typically occurs when:

  • A person is within 6 feet of an individual with the COVID-19 for a prolonged period of time.
  • When an individual has direct contact with infectious secretions (sputum, serum, blood, respiratory droplets) from a person who has COVID-19.

The CDC maintains that the immediate risk of contracting COVID-19 in the United States is low.

There is currently no vaccine for COVID-19 but infectious disease experts are working to develop one with the hope of testing to begin over the next few months.

 

Typical Symptoms and Presentation of COVID-19

  • COVID-19 symptoms range from mild presentations of illness to death. Symptoms include fever, cough, sneezing and shortness of breath.
  • Symptoms of COVID-19 may appear in as little as 2 days or as long as 14 days following exposure.
  • Experts are still uncertain if COVID-19 can be transmitted by individuals who are not yet exhibiting symptoms of the illness.
  • Most people who have contracted COVID-19 have recovered within two weeks. Those with more severe cases generally recover in three to six weeks.

 

What are the best ways to prevent the spread of COVID-19?

  • Avoid close contact with anyone who is sick or is known to have COVID-19.
  • Do not touch your eyes, nose or mouth.
  • If you are feeling ill stay home to prevent spreading your illness to others.
  • Cover your cough or sneeze with a disposable tissue or the inside of your elbow.
  • Wash hands frequently with soap and water for at least 20 seconds (including under the fingernails), especially after using the rest room, before eating, and after coughing, sneezing or blowing your nose.
  • Regularly use hand sanitizer that contains at least 60% alcohol.
  • Regularly clean and disinfect frequently touched objects and surfaces such as your cell phone, keyboard and workstation.
  • Avoid travel to high risk areas identified by the CDC (Centers for Disease Control and Prevention) www.cdc.gov/travel
  • Follow the CDC’s recommendations for use of a face mask.
  • The CDC does not recommend that people wear a face mask to protect themselves from respiratory diseases, including COVID-19.
  • Face masks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others.
  • People who are taking care of a symptomatic individual in close settings should wear a face mask.

 

What we are doing to minimize the threat of exposure to infectious diseases within our offices.

  • Educate our employees and our patients using validated resources such as the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), Occupational Safety & Health Administration (OSHA) and the US Department of Health, on minimizing the transmission of infectious diseases.
  • Evaluate our ability to continue to provide services without increasing the risk of exposure to our patients, visitors and staff.
  • Intensify our housekeeping & infection control procedures to assure that we have minimized risk of infectious disease transmission.
  • Our typical greeting with a handshake will not be extended until the virus is under control, and the official recommendations are updated.

 

What we need everyone to do to minimize the spread of infectious diseases.

Please let us know:

  • If you have traveled to China, South Korea, Iran, Italy or Japan or any other country with high COVID-19 incidents within the past 14 days.
  • If you have had any contact with anyone diagnosed with COVID-19, persons under investigation for COVID-19 or anyone with flu-like symptoms (fever, cough and shortness of breath) where there could have been personal contact (within 6 feet) with the individual.
  • If you have had any symptoms of illness (fever, cough or shortness of breath) in the past 14 days, we request that you stay home except to seek medical attention for your illness. Please contact your physician for guidance regarding your return to community travel – including returning to physical therapy.

 

Additionally:

  • Please do not bring non-essential guests with you to your therapy appointments.
  • Please do not bring children who are not receiving therapy themselves to the office.
  • Please apply our hand-sanitizer or wash your hands in our facility prior to completing paperwork, taking a seat in our reception area or starting treatment.
  • Please use good cough and sneeze etiquette (cover mouth with a disposable tissue when coughing or sneezing or cover your mouth with your elbow if tissues are not immediately available).
  • Please apply our hand-sanitizer or wash your hands in our facility before departing our office.

 

 

We will continue to employ procedures to minimize the spread of COVID-19 according to the CDC and other credible authorities and will keep you informed of any changes in protocols.

Take Care of your Back while Snow Shoveling!

HD Hearts Snow shoveling blog
At Foothills Orthopedic and Sport Therapy, we often treat snow-related injuries. Common injuries include back strain, shoulder injuries, and injuries from slipping and falling on the ice. A 2009 study in the American Journal of Emergency Medicine noted that on average 11,500 people are injured per year in snow shovel-related injuries. Injuries to the lower back accounted for 34.3% of the cases and 95.6% of the cases occurred around the home. So when the next storm hits, here are a few tips to help prevent injury.

Don’t Be Another Statistic

  • Start out easy to warm up. Doing shoulder rolls and back stretches can help.
  • Wear good non-skid footwear to prevent a slip and fall.
  • Use a smaller size shovel when lifting snow to decrease the load on your back and shoulders. An ergonomic handle can help. A larger scoop that you push (versus lift) can lessen low back strain.
  • Bend the knees, keep feet apart, and keep the back straight with lifting. Don’t twist the lower back.
  • Take breaks every 10 minutes or so to stand up and backward bend to decrease the strain.
  • Shovel in shorter bouts early on before the snow piles up deeper.
  • If you do think your back strained with shoveling, go ahead and put a cold pack on your back (cloth covered) for 20-30 minutes to calm things down.
  • Stay hydrated.

 

If, despite theses tips, you do experience injury, we at Foothills Orthopedic and Sport Therapy are available to help you get better.

Stem Cells for Joint Pain

Image result for stem cells

 

Stem cell treatments are all the rage right now. If you watch TV or listen to the radio, then chances are good that you have heard a commercial touting the benefits of this new treatment. It sounds like a wonder cure, but what does the science actually say?

What are Stem Cells?

Stem cells are the precursors to all other cell types. After they divide stem cells have the potential to grow into any other cell type in the body. A stem cell could become a muscle cell, nerve cell, bone cell, or cartilage cell. This is important because stem cells could be used to treat diseased or damaged body parts.

Where Do Stem Cells Come From?

  • Stem cells can be found in the bone marrow of adults
  • Umbilical cord blood
  • Embryos that are 3-5 days old

What Does the Research Show?

The most recent study conducted on stem cells and joint pain was performed in 2013 and the results were published in the periodical “Stem Cells and Development.” This study looked at patients with rheumatoid arthritis. When compared to a control group who received medications only, the group who also received stem cells experienced remission of their disease. The effects lasted for 3-6 months and there were no side effects reported. Although the results of this study are encouraging, it is important to remember that most people with arthritis suffer from osteoarthritis which is very different from rheumatoid arthritis.

Oversight

The Food and Drug Administration (FDA) is responsible for regulating stem cell therapies to make sure the treatments are safe and effective. The FDA released a statement in 2019 warning consumers about the risks of unapproved stem cell therapies. If you are interested in this new therapy, be sure to talk to your doctor to understand the risks involved.

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!