Category Archives: Sports Medicine

Longevity, Sports Medicine, Wellness

The Anti-Aging Effect of Exercise

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The slippery slope of lean muscle loss begins at a younger age than you would guess. The medical term for age-related loss of lean muscle is sarcopenia, and it starts in our 30’s. Sarcopenia occurs at a rate of 3-5% per decade. Less muscle means less strength, less stability, and less dense bones, which all increase the risk for falls and fractures.

It doesn’t have to be this way. You can fight against the loss of lean muscle mass by actively exercising to maintain and gain back muscle mass. Resistance training 3x per week is recommended by the American College of Sports Medicine, just to maintain muscle mass. If you need to add lean muscle, then you will need to do more. Progressive resistance training, when you add progressively more reps, more weight, or more sets, and isometric holds, when you hold a resisted position for a period of time, will help to hypertrophy your muscles. It is never too late to rebuild lean muscle.

You are what you eat. If you want to add lean muscle mass to your body, you need to eat amino acids, the building blocks of both protein and muscle. You can find amino acids and protein in both plant and animal foods. Good sources of amino acids include beans, wild salmon, organic, free-range poultry and eggs, and of course high-quality protein powders. The best time to eat protein for building muscle is within 30 minutes of workout. A smoothie with a carbohydrate-to-protein ratio of 3-to-1 will allow for optimal post-workout muscle recovery. If your body is deficient in the digestive enzymes that break protein down into amino acids, then you will not be able to benefit from the protein you are eating. Discuss with your doctor if you need to take digestive enzymes.

Supplements and hormone replacement therapies can also play a role in optimizing lean muscle mass in the aging population. Both testosterone and DHEA are associated with increased muscle mass in people who are concurrently participating in progressive resistance exercises. β-hydroxy-β-methylbutyrate (HMB), a metabolite of the amino acid leucine, can be taken as a supplement to reverse muscle wasting when combined with muscle-building exercises. Vitamin D, omega-3 fatty acids, and creatine have also been found to help build muscle strength. Discuss the risks and benefits of these options with your doctor before you decide to treat yourself. Supplements are just that: supplemental. You do not need supplements in order to build lean muscle mass, but they can be helpful for the right candidates.

The most important steps you can take to keep your lean muscle mass are:

1. Progressive resistance exercises to rebuild muscle
2. Eat clean sources of protein for the building blocks of muscle
3. Aerobic exercise at least 5 days a week to burn excess fat
4. Isometric hold exercises to hypertrophy muscle
5. Avoid processed foods, greasy foods, and sugar.

Dr. Bren Boston, MD is a physiatrist and certified personal trainer. She sees patients at the Akasha Center for Integrative Medicine at 520 Arizona Ave, Santa Monica, CA 90401. Call (310)-451-8880 to make an appointment.

Nutrition, Sports Medicine, Wellness

What to Eat to Heal from Surgery

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What you eat can affect how well you heal from an orthopedic injury or surgery. When your body has to repair injuries, create new bonds, and strengthen tissues, its performance will depend on whether it gets the building blocks it needs. Imagine your food being digested into molecules, and those molecules being absorbed into your blood stream to be delivered to the site of healing.

Protein intake should be spread out evenly throughout the day in meals and snacks. Branched-chain amino acids (BCAA) are metabolized in muscles to provide energy and promote protein synthesis. BCAA found organic poultry, grass-fed beef, fish, soybeans, lima beans, eggs and nuts boost healing after musculoskeletal injury.

Vitamin C is required to make collagen to repair tendons or ligaments and heal surgical wounds. Good sources include citrus, broccoli, strawberry, kiwi, and bell pepper.

Zinc enhances wound healing. It is found in free-range beef, oysters, pumpkin seeds, and cashews.

Beta-carotene is a precursor to Vitamin A and promotes stronger bones, healthy scar tissue, and elasticity of skin. Good sources are sweet potato, kale, squash, carrot, prune, apricot, and mango.

Antioxidants (Vit C, flavonoids, Vit A, Zinc, Selenium, B vitamins, folate) neutralize the damaging effects of free radicals and repair cellular damage from injury or surgery. Found in leafy greens like kale, vegetables, fruits, legumes, whole grains, lean meat/poultry, fatty fish, nuts and seeds.

Flavonoids reduce swelling and protect cells. Flavonoids are found in cocoa, tea, red wine, fruits, vegetables, legumes, garlic, turmeric, green tea, blueberries, apples, citrus, and pineapple.

EPA and DHA Omega 3 fatty acids reduce joint stiffness, improve bone health, and provide anti-inflammatory benefits. You can find it in oily fish such as wild salmon, sardines, and anchovies.

Iron is required for oxygen delivery to the site of injury or surgery, and for wound healing. In addition to animal products, iron is found in dark leafy greens, legumes, beets, raisins, and black beans.

Calcium and Vitamin D optimize tendon-to-bone healing after injury or surgery. Calcium is found in dark leafy greens, salmon, rainbow trout, white beans, and fortified foods like almond milk and oatmeal. Vitamin D is found in mushrooms, salmon, tuna, soy milk, and egg yolks.

Healthy fats from avocado, olive oil, coconut oil, nuts, and seeds will improve immune response and help your body absorb vitamins A, D, E, and K.  Avoid partially hydrogenated oil (in processed foods) due to their pro-inflammatory effect.

Fiber is necessary to avoid post-operative constipation. The pain medications required for orthopedic surgery, as well as the anesthesia used during surgery, can cause slowing of intestinal transit and constipation. Up your fiber intake from vegetables, apples, berries, prunes, whole grains, flax and chia seeds.

Pain Management, Sports Medicine

Why I Believe in Prolotherapy

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For someone suffering from joint pain, prolotherapy can be a safe and effective way to get them back to their usual activities. My opinion is that a targeted treatment at the source of the problem is a better option than a systemic treatment that circulates to the entire body. Prolotherapy causes proliferative cells to migrate to the weakened area, targeting the problem.

Chronic joint pain is an astronomically common condition, especially given our aging population. In fact, the majority of people over the age of 65 will have radiographic evidence of osteoarthritis. As we age, body tissues such as vertebral bones, spinal discs, and knee cartilage, lose height due to decreased bone density, loss of vascularity, wear and tear, and disc degeneration. While these tissues lose height, the ligaments connecting the bones remain the same length, causing these supporting ligaments to buckle. These lax, weakened ligaments can lead to segmental instability resulting in pain.

Poor posture (head forward, slumped during prolonged sitting, rounded lower back) exacerbates the laxity of ligaments in the neck and low back. The laxity of ligaments causes an instability which stimulates proprioceptive nerve fibers and can lead to chronic muscle spasm in the body’s attempt to stabilize the area. Prolotherapy is an injection treatment using safe, natural, proliferant substances such as dextrose, to stimulate the body’s natural healing cascade where the ligament and tendon join to the bone. Prolotherapy treats the cause of the chronic pain by correcting the ligament laxity.

Prolotherapy has been shown to be effective in treating knee osteoarthritis by combining intra-articular (inside the joint) injections of proliferant solutions with ligament and tendon injections to stabilize the knee joint. Studies have shown improvement in pain, function, and stiffness when using prolotherapy to treat knee OA.

Clinical trial literature is growing which supports the use of prolotherapy in osteoarthritis, low back pain, ligament and tendon injuries. A newer use of prolotherapy has been gaining momentum called neural prolotherapy. Neural prolotherapy involves multiple subcutaneous injections of proliferent solution to treat the hundreds of small nerve fibers under the skin which can contribute to chronic pain when chronically activated.

While it does not work for everyone, proliferative therapy is a worthwhile technique in the tool kit of treatments for joint pain. Prolotherapy has fewer side effects than medications and fewer risks than surgery or platelet-rich plasma (PRP). Prolotherapy is far less expensive than PRP while studies show the two treatments to have similar outcomes. Prolotherapy is an effective modality when combined with weight loss to offload the joint and a focused exercise program to strengthen supportive muscles.

You can schedule a prolotherapy consultation at the Akasha Center in Santa Monica by calling 310-451-8880.

 

 

 

 

 

Pain Management, Sports Medicine

Prolotherapy for Knee Pain

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If knee pain is stopping you from exercising, then you can expect your knee pain to get worse, not better. Studies have shown that exercise is crucial for people with arthritis. Prolotherapy can help people with knee pain get back to an exercise routine.

Prolotherapy is safe injection technique that can significantly decrease the pain of knee arthritis.

A study looking into the therapeutic effects of prolotherapy for moderate knee osteoarthritis appeared in the April 2015 issue of Therapeutic Advances in Musculoskeletal Disease. The study found that knee pain, range of motion, and function were all improved after 3 monthly prolotherapy sessions, and the benefit was maintained throughout the 6-month study duration.

Osteoarthritis (OA), the most common form of arthritis, typically onsets after age 40.  OA is due to the gradual loss of joint cartilage which can lead to bony endplate changes.

The most important thing we can do to delay or prevent OA is to keep our body mass index (BMI) in the ideal range from 18-25. You can calculate your BMI using your height and weight here: http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
Our body is just a skeleton frame and was not meant to carry lots of extra weight. Imagine if you had to carry 20 lbs of bricks strapped to your back at all times.  That is no different than being 20 lbs overweight.  Extra weight is going to wear down your knees, hips, and the discs in your lower spine.

Keeping your muscles strong and limber is critical for joint health. Muscles, tendons, ligaments, cartilage, and joint-space fluid are the only things standing between bone-on-bone. When you keep the supporting structures in prime health, you protect the intraarticular surface inside the joint.  If you cannot pound the pavement due to knee pain, you can use swimming or a recumbent bicycle to achieve optimal muscle strength and cardiovascular fitness.

Other things we can do to prevent osteoarthritis include eating a healthy diet filled with nourishing antioxidants, amino acids, and nutrients. An anti-inflammatory diet with organic vegetables, fruits, beans, herbs, nuts, seeds, and whole grains like quinoa (not flour products) should make up the bulk of your food choices.  Healthy sources of fats like avocado, coconut, olive oil, nuts, and wild salmon should replace the unhealthy sources of fats found in processed foods.

Staying hydrated is necessary to avoid drying out the cartilage inside the joints. The synoviocytes (the cells that line the weight-bearing joints) produce a fluid that helps buoy the bones like hydraulic fluid.  When this fluid dries out, the joint is more likely to have bone-on-bone friction. The spinal discs contain a gel-like center that tends to desiccate with age, and benefit from daily hydration. Men should drink 3 liters water/day and women should drink 2 liters water/day.

Supplements can be helpful for joint health.  Glucosamine sulfate 1500 mg/day with Chondroitin 1200 mg/day has been shown to help reduce cartilage loss in several studies.  Resveratrol is an antioxidant derived from the skin of grapes that is associated with longevity and may protect joints.  Fish oil (omega 3) has an anti-inflammatory effect.  Anti-inflammatory herbal blends like Akasha’s InflaRegulator are a healthy way to decrease your joint swelling.  Akasha’s Joint Ease is a selective kinase response modulator that is useful for flares of joint pain.

Treatment focus has shifted away from removing damaged cartilage, to preservation of as much cartilage as possible while enhancing the healing cascade.

Prolotherapy is injections of a proliferative fluid to the intra-articular joint space and the extra-articular supporting structures where tendons and ligaments attach to the bone surrounding the joint.  The result is a stimulation of the body’s natural healing cascade and a stabilization of the supportive structures of the joint.

Prolotherapy is available at the Akasha Center for Integrative Medicine in Santa Monica, CA.  Call 310-451-8880 to make an appointment with Dr. Boston.

www.akashacenter.com

Nutrition, Sports Medicine, Wellness

HYDRATION

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Hydration…I consider it my 3rd full time job after being a mom and a doctor. That’s how important it is, and also how much of a hassle.

The human body is 60% water, and all of our cells function optimally when we are well-hydrated. When we don’t drink enough water, our brain feels tired, foggy, and headachy; our muscles and joints feel sore and unlubricated, and our skin looks dry and papery. Our body’s ability to detox is hampered when we don’t drink enough water to flush through our kidneys and liver. Water is also imperative for healthy gut function, avoiding constipation and the build-up of toxic sewage in our large intestines when things aren’t moving along.

So, how much water should you drink? In general, a good rule of thumb is that women should drink about 2 liters of water a day, and men should drink about 3 liters a day.

I use a 20-oz glass water bottle that has a silicone sleeve, and I drink about 4 refills a day of filtered tap water. I make sure I drink my first 20 oz of water before my cup of coffee in the morning as a reward. It is time-consuming and makes me have to stay close to a bathroom, but I notice immediately if I don’t drink enough water…by feeling sluggish, brain-foggy, and tired.

You need even more water when exercising. The American College of Sports Medicine says that you should drink 3-8 oz water every 15 min while exercising for less than an hour, or 3-8 oz of a sports drink every 15 min if exercising for more than an hour.

Can you drink too much water? Yes. If you drink too much water, you can dilute your electrolytes which can be dangerous.

So, stick to the guidelines, and rejuvenate your dry cells to a nourished state every day.

Pain Management, Sports Medicine, Wellness

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

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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

 

Pain Management, Sports Medicine, Wellness

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

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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