All posts by drbren

Tennis or Golf Elbow…But I Don’t Even Play Tennis or Golf!

What is it? Epicondylitis is inflammation of the bony parts on either side of the elbow where some tendons of muscles attach. The lateral epicondyle is where the wrist extensor muscles attach, and inflammation here is called lateral epicondylitis or “tennis elbow”. The medial epicondyle is where the wrist flexor muscles attach, and inflammation here is called medial epicondylitis, or “golfer’s elbow”.

How did I get it? You don’t have to play one of these sports to experience an injury that causes inflammation at the elbow. Epicondylitis can happen due to repetitive forceful wrist motion, or from trying to keep the wrist stable against an external force, or due to a traumatic injury.

How do I know if I have it? You can tell you have “tennis elbow” if it hurts to touch the lateral epicondyle, and the pain increases when you extend your wrist against resistance. You can tell you have “golfer’s elbow” if it hurts to touch the medial epicondyle, and the pain increases when you flex your wrist against resistance. Your physician can check these maneuvers for you if you are not sure.

How do I treat it? The first and most conservative treatment is rest – take a break from the activity that caused the epicondylitis. You can use ice or heat for 10 minutes three times a day. A counterforce brace to the forearm can be used to decrease the tug of the muscles on the elbow. A counterforce brace is the strap that you sometimes see on athletes encircling their forearm just below the elbow, which you can typically get at your local pharmacy. There are some over-the-counter remedies you can try such as topical Arnica gel, Traumeel ointment, or a Salonpas patch to help decrease pain and swelling.

What if I still have pain? Then, it is time to see your physician. Your physician will perform a physical exam to rule out other diagnoses and to confirm lateral or medial epicondylitis. Your physician may want to order an x-ray to rule out an avulsion of the epicondyle, which is when a little piece of bone gets pulled away with the tendon during a forceful movement. An injection at the location where the wrist muscle tendons attach to the elbow can help decrease the pain. I recommend not injecting steroids because they can weaken the tendon making it more likely to rupture. I prefer to inject natural pain-inhibiting substances like Sarapin and local anesthetics. I also like to use Kinesio tape over the forearm and elbow in a pattern that inhibits the wrist extensor or flexor muscles while the area is healing.

What if it has been more than 2 months, and I still have elbow pain? Then, your body has not fully healed the injury and might need some assistance to do so. Prolotherapy is a series of injections of a safe, proliferative solution to the spots where the muscles and ligaments attach to bones. Prolotherapy stimulates your body to lay down more collagen, strengthening the tendons and ligaments of the elbow, fixing the problem.

My elbow is all better. Can I go back to my activities? How do I prevent myself from getting epicondylitis again? The best thing to prevent future bouts of lateral or medial epicondylitis is a stretching and strengthening program for your wrist flexor and extensor muscles. Start with isometric strengthening, which is when you flex or extend your wrist against resistance without moving it. You should be able to see the muscles in your forearm contracting. You can stretch the wrist flexors and extensors by using your opposite hand to gently push your hand into further flexion or extension than you can achieve on your own and hold for a count of ten. Your physician can teach you these maneuvers or refer you to a physical therapist. Once your elbow is pain-free, strong, and limber, then you can return to your activities.

Contact Dr. Boston at the Akasha Center for Integrative Medicine if you are interested in being evaluated and treated for elbow pain.  The Akasha Center is located at 520 Arizona Ave, Santa Monica, CA 90401.  (310)-451-8880

 

Sacroiliac Joint Pain – It’s a Pain in the Butt!

Sacroiliac joint (SIJ) pain is more common than you think. What is the SIJ? Well, you know those dimples you have at the top of your buttocks, one on the left and one on the right? That is the location of the top of the sacroiliac joints. Imagine an upside-down triangle starting at those dimples down to your butt crack…that is the path of the SIJ’s. The sacroiliac joints connect the pelvis (iliac bones) to the sacrum (the lowest portion of the spinal column), and transfer force and weight between the upper body and the lower body.

These joints have some mobility which increases in women after childbirth. The ligaments holding the pelvis tight are relaxed during pregnancy by a hormone called relaxin. Sometimes the increased SIJ mobility continues indefinitely after the baby is born, and never gets back to the pre-childbearing level of tautness. The SIJ’s are true synovial-lined joints that can swell just like any other arthritic joint. They can cause a radiating pain that starts in the buttock and radiates down the back of the leg, resembling sciatica. In fact, some practitioners believe that most cases of “sciatica” are actually due to SIJ dysfunction.

You ask yourself, “Do I have SIJ pain? Is that what my low back pain is?” To find out whether your low back/buttock pain is due to SIJ dysfunction, your doctor can do some physical exam maneuvers that will stress the SIJ, which if your usual pain is reproduced or increased, makes it likely to be SIJ dysfunction. Imaging techniques such as x-ray or MRI are not always necessary, but can show arthritic changes, inflammation, or sclerosis.

Why do I have SIJ pain? You might have increased mobility at the SIJ due to ligament laxity, inflammation of the joint due to synovitis, arthritis of the joint due to wear and tear (sports, gymnastics, trauma), spondylitis due to an inherited condition, or sclerosis of the joint due to degenerative changes.

What can be done? SIJ dysfunction is a condition that typically has flairs and remissions. There are many treatments that are useful in managing SIJ dysfunction. The first and foremost treatment is prevention (prevention of SIJ pain or prevention of worsening of SIJ pain). This includes maintaining a healthy body weight, because carrying extra weight on the bones of your lumbosacral spine and pelvis is a recipe for pain. Maintaining good nutrition and hydration to keep the bones, joints, ligaments, and tendons of the SIJ region healthy is also necessary. If you have the weight, nutrient, and hydration pieces squared away, but still have SIJ pain, then it is time to institute a targeted exercise program for strengthening and stretching, and some treatment modalities.

Exercises to limber up and strengthen the buttock, low back, hip, and hamstring muscles can be taught to you by a physiatrist, physical therapist or qualified personal trainer. The gluteus maximus, gluteus medius, piriformis, and quadratus lumborum muscles attach in proximity to the SIJ. Targeting these muscles can help to stabilize the SIJ. While you are strengthening the region, it might help to have your physician or physical therapist to use kinesiology tape in a crossing-over fan pattern over the SIJ region to provide proprioceptive feedback.

As strange as it sounds, you can also have your physician or acupuncturist try using a press-tack tiny acupuncture needle on your ear at the lumbosacral site. Some patients find the ear acupuncture treatment extremely helpful at decreasing SIJ pain during flairs. Full acupuncture sessions might also help to bring relief from SIJ pain.

Lastly, there are injections that can be done for SIJ pain. Traditionally, steroids were used when injecting the SIJ to decrease inflammation in the joint, but studies have now revealed that steroids can damage cartilage and cause negative side effects. I prefer to inject natural anti-inflammatory substances into the SIJ to decrease pain and inflammation. If a person has chronic or repeated SIJ pain, then Prolotherapy is a more definitive, longer-lasting treatment. Prolotherapy is injecting a safe, proliferative substance to the whole SIJ region where the ligaments attach to the bones to promote healing of the involved ligaments. After a series of Prolotherapy injections, a person can typically expect to have lasting pain relief unless they reinjure their SIJ at another time.

Dr. Boston treats patients for SIJ pain with a comprehensive approach.  You can contact her at The Akasha Center for Integrative Medicine, located at 520 Arizona Ave, Santa Monica, California,  310-451-8880

New Year Post: Top Ten Tips to Improve Your Health

January is a wonderful time to reflect on the past year and make decisions about the upcoming year.  We can make choices about which behaviors to concentrate on changing to optimize our health and our happiness.

1.  Invest in a reusable 32oz cup.   Fill and drink it twice a day with filtered tap water.

Most Americans need to drink more water.  They are walking around dehydrated all the time.  Every cell in your body requires water.  When we are chronically dehydrated, our tissues (such as spinal discs and ligaments) dry out and become more brittle and prone to injury.  If we wait until we are thirsty before we drink, we are already in 1L water deficit.

2.  Walk for 10 minutes after every meal.

When you walk after eating, you improve the ability of insulin to lower your blood sugar by pumping fresh oxygenated blood to your muscles.  The delivery of glucose to the cells which use it for energy becomes possible when insulin allows the entry of glucose out of the blood stream and into the cells that need it.  A 10 minute walk after eating also helps your intestinal tract mobilize the food boluses which improves digestion.

3.  Eat more fresh, organic vegetables.

Vegetables are the most important source of antioxidants, vitamins, and fiber in your diet.  Truthfully, we all need to eat more vegetables.  A diet high in vegetables has been linked to longevity and a decreased risk of cardiovascular disease and cancer.  Juicing is one way to get the antioxidants, but it eliminates the fiber you need for a smoothly working digestive tract.  In my own quest to eat more fresh vegetables, I have found it very useful to cut the veggies into sticks and dip them into dry spice blends.  My favorite spice blends right now are Penzey’s Murals of Flavor (a salt-free blend that includes shallots and lemon peel) and Penzey’s Pizza seasoning (a distinct fennel flavor I love).  I find it very satisfying to snack on veggies this way rather than crackers or chips.  Another trick I use to get more vegetables in my family’s diet is to add pureed fresh spinach to smoothies and in place of water in recipes.

4.  Eat less processed food.

When I see the professionally marketed boxes and bags of processed food in the grocery, it looks appetizing on the cover.  But, once you look at the ingredients of food that comes in a box or a bag, you see some very unappetizing, sometimes revolting truths.  The chemicals and preservatives and empty, possibly  toxic, calories that lie within are tasty due to their fat, sugar, and salt content.  But, they are terrible for your health.  Try to choose foods with the fewest ingredients possible and those that are closest to the natural state.  Choose whole grains where you can still identify the grain by looking at the product, rather than refined, bleached flours.  If you don’t keep junk food in your home, then you will be much less likely to eat it.  Out of sight, out of mind.  If you have a junk food that  you want to indulge in, then have one encounter with it away from home, and don’t bring the leftovers with you.

5.  Prioritize exercise.  Identify 3 priming songs.

The American College of Sports Medicine says that if you want to reap the cardiovascular and health benefits of exercise, you need to find the time to do moderate exercise 150 min/week.  Another way to put it would be to exercise for at least 30 min a day, five days a week.  The exercise you do should ideally be a mix of aerobic exercise, resistance training, balance training, and stretching.  Regular exercise has been proven to help treat anxiety, depression, diabetes, and cardiovascular disease.

The best way to make sure you exercise enough is to make it fun so that you look forward to it.  If you are not currently exercising on a regular basis, then you need to look at your schedule and see where you can fit it in, and actually write it on your calendar.  Identify 3 priming songs.  Priming songs are songs that when you hear them, you just want to get up and dance or move your body.  Put these songs on your listening device, and use them to get your mind and body ready and geared up for exercise.  I find my priming songs to be incredibly powerful motivators, especially on cloudy days when I am less likely to want to exercise.

6.  Sit less.  Move more.

The human body was not designed to be as sedentary as the typical American regimen has become.  Our hip flexors are shortening from sitting all day, and our low back is straining from the slumped posture that prolonged sitting encourages.  We will feel better and more energized if we move more and sit less.

Build tiny bouts of increased joint range of motion and body-weight strengthening into your daily life.  For example, while you are filling your car with gas or waiting in line, you could use those few minutes to do heel raises, leg extensions (barely placing your straight leg behind you until you feel your buttock muscle engage in contraction), or stretching your arms over head.   For every hour that you spend sitting, you should get up and move for at least 10 minutes.  Take your large joints through their entire range of motion a few times a day.  Stretch your hamstrings.  Feel the improved blood flow and the release of tension that comes with regular movement of your muscles and skeleton.

7.  Eat smaller portions.

As we age, our caloric requirements go down.  This is because our lean body mass decreases and our metabolic rate slows down.  These natural effects of aging can be mitigated by decreasing our caloric intake to match the decreased caloric need.  Low calorie diets have been associated with longevity.  If you eat more calories than you burn, then you gain weight.  The American food portions are often grotesquely large.  There is no need to go around feeling hungry, since you can always eat more fresh vegetables.

8.  Protect your skin barrier.

Our skin is an important part of our immune system.  It is the barrier between our organs and the outside world.  Every part of our internal anatomy is connected to our skin by just a few degrees of separation because our skin involutes to our internal body at our eyes, ears, nose, mouth, urethra, and anus.  As we age, our skin becomes less hydrated and less elastic, making it easier to get micro fissures in the skin.  This can disrupt the natural, protective, healthy bacteria that live helpfully on our skin but should not contact our internal micro biome.  To protect your skin barrier, I recommend using a mild, dermatologist-recommended bar soap, like Dove, in your warm (not hot) shower.  Avoid harsh, anti-bacterial soaps unless you are cleansing your hands after contacting germs.  Women should avoid using soap on their vagina, as it disrupts the natural, healthy flora – just use water.  I also feel it is important to add moisture to your skin daily with a mild, dermatologist-recommended, unscented, daily moisturizer, preferably paraben-free.  Frequent hand-washing can help keep us healthy, but hands should be thoroughly dried afterwards, and a moisturizer applied.  As we age, our feet require more attention to keep the skin healthy and free of fungus, dry skin, and cracks.   Get a professional pedicure monthly or do it yourself to eradicate the thick, dry skin, and use a moisturizing ointment on the soles of your feet every night to prevent the re-accumulation of keratin.  Ointments I use daily on my hands include Un-petroleum by Alba Botanica and  Organic Healing Balm by Honest Company.  I use these products on my children as well.

9.  Improve your sleep habits.

While we are sleeping, our bodies and minds enjoy a restorative period during which our metabolic processes are able to recuperate.  Plenty of scientific literature has shown the benefits of getting 8 hours of sleep a night.  Sleep is not wasted time, but rather an investment in your health and well-being.  Make sure you have a comfortable sleep environment, an ergonomic sleep position (don’t sleep on your stomach), and a routine that helps your mind and body wind down for sleep.  Getting regular exercise and setting aside time to meditate during the day can help you achieve better sleep at night, readying your mind and body for their nightly reward, restful , rejuvenating sleep.

10.  Find gratitude.  Choose happiness.

We all live with some level of stress, yet we can identify others who are enduring much more stress than we.  When we remember there are other humans living in extreme poverty, or as prisoners of war, or as human slaves, or with a life cut short by disease, we should use these remembrances to help ourselves find gratitude amidst our own life stressors.  We are kindred to all the humans on Earth, and we are born into environments beyond our control.  What we can control is how we respond to our situation.  Finding gratitude and not taking our life for granted is key to choosing happiness.  Happiness is a choice, and we can all choose it anew every day.