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These Seven Gentle Exercises Essence, Sept, 2005 by Hope Wright Mama used to remind you to stand up straight for good reason. Besides showing the world your strength and self-confidence, proper posture promotes joint health. Bad postural habits, on the other hand, can lead to pain and injury. "Over time our daily stances, like slouching at the computer or balancing a youngster on one hip, can create muscle tightness or weakness and pull joints out of place," says Renee Daniels, certified medical exercise specialist, personal trainer and coauthor of Straighter, Stronger, Leaner, Longer (Avery). "Poor posture makes us more vulnerable to muscle strain and stiff joints--conditions that can in turn make us prone to injury." Strong, flexible muscles, which keep joints aligned, are the building blocks of good posture. Daniels, pictured here, offers seven moves inspired by her book that strengthen and stretch muscles. Do this routine every day, and within a month you'll begin to feel the results. Ab Bracing Strengthens core and back muscles Lie on a mat or towel with arms pointed toward ceiling, knees bent and calves parallel to floor, hip width apart. Make sure your stomach is pulled in tight (1). Straighten left leg and lower it to one inch above the floor, while extending right arm as in photo (2) and lowering it until it hovers slightly over the floor. Hold position for three seconds without arching the back. Complete rep by returning right arm and left leg to original position and doing the exercise on opposite side. Do ten reps. Angel Squeeze Strengthens rear shoulder muscles On an exercise ball or chair, sit with legs hip width apart and feet flat on the floor. With elbows bent and held at chest level, press forearms and palms together. Next open arms as you squeeze shoulder blades together as if you're crushing a can between them. Finally, with back straight, lower elbows to waist while lifting chest up to ceiling. Return to original position. Do 20 reps. Side Bend Stretches lower back and hip muscles Sit on floor with right leg straight and left knee bent as pictured. Place right hand on left knee and straighten left arm out to the side with fingertips touching floor. Lift left arm over head and reach diagonally toward the right foot. As you lift, turn head to the left and look toward ceiling. Don't strain. Hold for three seconds. Do five reps, then repeat on other side. Body Curl Releases lower-back tension Sit on the floor with back straight and knees hip width apart. Grab the feet with both hands, bend elbows, tuck in head and pull upper body forward. Keeping abs tight and knees pointed toward ceiling, continue stretch, lowering torso as far as you can, keeping abs tight. Hold for three counts and return to starting position. Do five reps. Rope Stretch Stretches chest and improves posture Sit on exercise ball or chair with legs hip width apart, feet flat on the floor, and back straight. Grasp either end of a rope or towel. Without shrugging shoulders, lift arms straight up over head a little wider than shoulder width apart. With arms straight, reach behind you. Hold for three or four seconds, then return arms to overhead position. Do five reps. The Crossover Releases outer-hip tension Stand next to a wall so that your right elbow meets wall at shoulder level. Rest your right palm and forearm against the wall and let left arm hang at side. Cross left leg over right, keeping weight on right leg. Lean toward the wall for a comfortable stretch. Keep stomach and butt tight. Hold for three seconds. Do one set of eight reps; then repeat on opposite side. The Clam Strengthens hips Lie on your right side, with knees bent and left hand on your hip. Support your upper body with right elbow. Lift left leg, rotating knee toward ceiling. Use hand on hip to avoid rolling hips back as you rotate leg. Hold while squeezing hip and butt muscles. Lower leg to starting position. Do one set of 15 reps on each side. Work up to three sets.
Encyclopedia of Medicine by Richard Robinson Definition Muscle spasms and cramps are spontaneous, often painful muscle contractions. Description Most people are familiar with the sudden pain of a muscle cramp. The rapid, uncontrolled contraction, or spasm, happens unexpectedly, with either no stimulation or some trivially small one. The muscle contraction and pain last for several minutes, and then slowly ease. Cramps may affect any muscle, but are most common in the calves, feet, and hands. While painful, they are harmless, and in most cases, not related to any underlying disorder. Nonetheless, cramps and spasms can be manifestations of many neurological or muscular diseases. The terms cramp and spasm can be somewhat vague, and they are sometimes used to include types of abnormal muscle activity other than sudden painful contraction. These include stiffness at rest, slow muscle relaxation, and spontaneous contractions of a muscle at rest (fasciculation). Fasciculation is a type of painless muscle spasm, marked by rapid, uncoordinated contraction of many small muscle fibers. A critical part of diagnosis is to distinguish these different meanings and to allow the patient to describe the problem as precisely as possible. Causes & symptoms Causes Normal voluntary muscle contraction begins when electrical signals are sent from the brain through the spinal cord along nerve cells called motor neurons. These include both the upper motor neurons within the brain and the lower motor neurons within the spinal cord and leading out to the muscle. At the muscle, chemicals released by the motor neuron stimulate the internal release of calcium ions from stores within the muscle cell. These calcium ions then interact with muscle proteins within the cell, causing the proteins (actin and myosin) to slide past one another. This motion pulls their fixed ends closer, thereby shortening the cell and, ultimately, the muscle itself. Recapture of calcium and unlinking of actin and myosin allows the muscle fiber to relax. Abnormal contraction may be caused by abnormal activity at any stage in this process. Certain mechanisms within the brain and the rest of the central nervous system help regulate contraction. Interruption of these mechanisms can cause spasm. Motor neurons that are overly sensitive may fire below their normal thresholds. The muscle membrane itself may be over sensitive, causing contraction without stimulation. Calcium ions may not be recaptured quickly enough, causing prolonged contraction. Interuption of brain mechanisms and overly sensitive motor neurons may result from damage to the nerve pathways. Possible causes include stroke, multiple sclerosis, cerebral palsy, neurodegenerative diseases, trauma, spinal cord injury, and nervous system poisons such as strychnine, tetanus, and certain insecticides. Nerve damage may lead to a prolonged or permanent muscle shortening called contracture. Changes in muscle responsiveness may be due to or associated with: Prolonged exercise. Curiously, relaxation of a muscle actually requires energy to be expended. The energy is used to recapture calcium and to unlink actin and myosin. Normally, sensations of pain and fatigue signal that it is time to rest. Ignoring or overriding those warning signals can lead to such severe energy depletion that the muscle cannot be relaxed, causing a cramp. The familiar advice about not swimming after a heavy meal, when blood flow is directed away from the muscles, is intended to avoid this type of cramp. Rigor mortis, the stiffness of a corpse within the first 24 hours after death, is also due to this phenomenon. Dehydration and salt depletion. This may be brought on by protracted vomiting or diarrhea, or by copious sweating during prolonged exercise, especially in high temperatures. Loss of fluids and salts--especially sodium, potassium, magnesium, and calcium--can disrupt ion balances in both muscle and nerves. This can prevent them from responding and recovering normally, and can lead to cramp. Metabolic disorders that affect the energy supply in muscle. These are inherited diseases in which particular muscle enzymes are deficient. They include deficiencies of myophosphorylase (McArdle's disease), phosphorylase b kinase, phosphofructokinase, phosphoglycerate kinase, and lactate dehydrogenase. Myotonia. This causes stiffness due to delayed relaxation of the muscle, but does not cause the spontaneous contraction usually associated with cramps. However, many patients with myotonia do experience cramping from exercise. Symptoms of myotonia are often worse in the cold. Myotonias include myotonic dystrophy, myotonia congenita, paramyotonia congenita, and neuromyotonia. Fasciculations may be due to fatigue, cold, medications, metabolic disorders, nerve damage, or neurodegenerative disease, including amyotrophic lateral sclerosis. Most people experience brief, mild fasciculations from time to time, usually in the calves. Symptoms The pain of a muscle cramp is intense, localized, and often debilitating Coming on quickly, it may last for minutes and fade gradually. Contractures develop more slowly, over days or weeks, and may be permanent if untreated. Fasciculations may occur at rest or after muscle contraction, and may last several minutes. Diagnosis Abnormal contractions are diagnosed through a careful medical history, physical and neurological examination, and electromyography of the affected muscles. Electromyography records electrical activity in the muscle during rest and movement. Prognosis Occasional cramps are common, and have no special medical significance. Prevention The likelihood of developing cramps may be reduced by eating a healthy diet with appropriate levels of minerals, and getting regular exercise to build up energy reserves in muscle. Avoiding exercising in extreme heat helps prevent heat cramps. Heat cramps can also be avoided by taking salt tablets and water before prolonged exercise in extreme heat. Taking a warm bath before bedtime may increase circulation to the legs and reduce the incidence of nighttime leg cramps.
Men's Fitness, August, 2003 by Dan Gordon MOST OF US like to wake up gradually. You know--hit the snooze button a few times, drifting in and out of consciousness before facing the day. Which partially explains why being jolted awake by a cramp in the calf muscle is especially harsh. That and the fact that it hurts like a mother. SOME OF US know the feeling better than others do. An estimated 16% of healthy individuals experience nocturnal leg cramps on a regular basis--as often as a couple of times a night several nights a week, with the episodes lasting anywhere from a few seconds to 30 minutes. NO ONE KNOWS for certain why muscle cramps occur. Among the possible explanations:
* overwork * lactic-acid buildup * deficiencies in iron, calcium or potassium * lack of oxygen to the muscle, causing it to contract THE ANSWER IS PROBABLY ALL of the above and then some, depending on the person's physiology, suggests Michael Breus, Ph.D., a board-certified sleep medicine clinician and researcher in Decatur, Ga. Why do our legs cramp up as we're waking up? "Remember that during the sleep process you're not taking in any minerals or vitamins, so your body becomes depleted," he says. If you're prone to leg cramps, Breus recommends adhering to a well-balanced diet and doing stretching or yoga exercises before going to bed and upon awakening. Stretching and applying heat are your best options when the cramp hits, though some still swear by the traditional method: writhing in pain and spitting out expletives.
FDA Consumer, March-April, 2004 by Michelle Meadows Helen Dearman, 52, of Houston, had a broken back for more than a decade and didn't know it. After falling from a ski lift in Mt. Hood, Ore., when she was 23, Dearman was diagnosed with a broken left arm and thought that was her only injury. Her arm healed. But she developed excruciating back pain that made it hard to sleep and move around. "I worked as a teacher, so some doctors suggested that the problem was from standing on my feet all day," Dearman says. "Others told me it was all in my head. For years, I left doctors' offices feeling desperate for help." The pain grew worse during her 30s. One morning, Dearman woke up with stabbing pains in her back and could barely walk. This time, her husband took her to an orthopedic surgeon who specialized in back problems. He took X-rays that revealed three old fractures in Dearman's spine. "When the doctor showed me the X-rays, I cried," Dearman says. "Someone had finally given me the words and understanding for all the pain I had been suffering from for so long." Pain That Persists By definition, acute pain after surgery or trauma comes on suddenly and lasts for a limited time, whereas chronic pain persists. "Acute pain is a direct response to disease of injury to tissue, and presumably it will subside when you treat the disease of injury," says Sharon Hertz, M.D., deputy director in the Food and Drug Administration's Division of Anti-Inflammatory, Analgesic, and Ophthalmologic Drug Products. "Chronic pain goes on and on--for months or even years." Common types of chronic pain include back pain, headaches, arthritis, cancer pain, and neuropathic pain, which results from injury to nerves. In Dearman's case, her untreated back injury caused her spine to twist out of place, not only resulting in severe back pain, but also putting intense pressure on the nerves in her legs. "I often felt pain shooting down my legs," she says, "like a jolt of electricity." Experts say the first step in treating chronic pain is to identify the source of the pain, if possible. Many people with chronic pain try to tough it out, according to research from the American Academy of Pain Medicine. But persistent pain should never be ignored because it could signal disease of injury that will worsen if left untreated. Sometimes, it turns out that the cause of pain is unknown. Fibromyalgia, for example, is characterized by fatigue and widespread pain in muscles and joints. While scientists have theorized that the condition may be connected to injury, changes in muscle metabolism, or viruses, the exact cause is unclear. Regardless of the type of chronic pain, the physical and emotional effects can be devastating. Dearman says, "My teaching career suffered, my children were confused about why I always felt bad, and our finances were ruined." Sometimes, she says, she even considered suicide. Finding Relief Dearman believes the first two surgeries she had to repair the fractures in her back and realign her spine were necessary. But she questions the four surgeries that followed. "I talked myself into the operating room more than once because I was desperate to feel better," Dearman says. "Even when doctors told me there was only a small chance another surgery would help, I wanted to take the chance. " But after several surgeries, Dearman's pain only seemed to be getting worse. The turning point occurred in 1995 when a physical therapist referred Dearman to a pain management specialist, a professional who takes a multidisciplinary approach to managing pain. She was treated by a team of pain experts. Doctors and nurses worked with her to manage pain medications. Psychologists addressed her depression and anger, and physical therapists helped improve her strength and mobility. Dearman finally found effective drug treatment with a pump implanted into her abdomen that delivers morphine through a catheter into the fluid surrounding her spine. The pump, called an intrathecal drug infusion pump, is used for severe pain only after other oral and intravenous drug therapies have failed. The pump is programmed to deliver a controlled amount of medication continuously. Risks include surgical complications, such as infection, and complications with the catheter or pump. "It doesn't take away all the pain, but it's a drastic improvement and allows me to be in control of the pain," says Dearman, who also takes other pain medication as needed. Seddon Savage, M.D., a pain specialist on the faculty of Dartmouth Medical School in Hanover, N.H., says there are times when it's impossible to eliminate pain. "The goal of pain management is to provide as much pain relief as possible and improve functioning," Savage says. Because pain varies from person to person, treatment is individualized. Someone with arthritis may do well with occasional use of an over-the-counter pain reliever, whereas someone else with arthritis may need a prescription pain reliever and regular aerobic exercise to feel good. "Treatment for chronic pain is about much more than medication," Savage says. It can also involve stress relief and relaxation, physical therapy, improved sleep and nutrition habits, and exercise. Dearman says that through a multidisciplinary approach to pain management, she also learned to pace her activities so that she is realistic about how much she can do in a certain time period. Savage recommends that people seek professional help for chronic pain when they feel that pain is interfering with their quality of life. "Start with your primary care physician, who may refer you to other specialists," she says. "Consider asking your doctor about a pain management specialist if you feel that your pain is just not getting better over time." Another reason to seek advice from a specialist is if you are experiencing intolerable side effects from medications. Concerns About Drug Abuse One of Dearman's biggest fears was of becoming addicted to pain medications. "It's a common concern for both patients and health providers," says Savage, who specializes in addiction. "Most forms of chronic pain respond to non-opioid drug treatments," she says. Examples of non-opioid pain relievers, which don't have addiction potential, include aspirin, acetaminophen, ibuprofen, naproxen, and other non-steroidal anti-inflammatory drugs. A combination of different types of analgesic medications at lower doses is often more effective than a single high-dose medication. "But if opioids are prescribed for your pain, you are not abusing drugs if you are taking the medication as prescribed," Savage says. "Taking doses of drugs to relieve pain is not the same as taking drugs to get high." Opioids are controlled substances that are potentially addictive. Pain medications containing opioids include Vicodin (hydrocodone), OxyContin and Percocet (oxycodone), MS-Contin (morphine), Tylenol #2, #3 and #4 (codeine), and the Duragesic Patch and Actiq (fentanyl). June Dahl, Ph.D., director of the American Alliance of Cancer Pain Initiatives and professor of pharmacology at the University of Wisconsin-Madison Medical School, says she recently took a call from a man with cancer who said he stopped taking an opioid pain medication on his own for fear that he was becoming addicted. "But what he described were not signs of addiction, but signs of physical dependence," Dahl says. Addiction is characterized by craving and compulsive use of drugs. Physical dependence occurs when a person's body adapts to the drug. If someone has become physically dependent on a drug and suddenly stops taking it, withdrawal may occur. These symptoms can include muscle aches, watery nose and eyes, irritability, sweating, and diarrhea. Physical dependence is a normal response to repeated use of opioids and is distinct from psychological addiction. Savage says that in prescribing potentially addictive medications, doctors should consider patients' personal and family histories of addiction, as well as psychological and social stressors that may affect medication use. Also, some people who begin taking opioid medications for pain as prescribed may later discover that they are using the medication for its psychic brain effects. Physicians need to be aware of this potential adverse effect, and should educate patients and their families about appropriate use of addictive drugs. To better guide physicians, the Federation of State Medical Boards adopted guidelines for the use of controlled substances for pain treatment in 1998. The guidelines advise physicians on patient evaluations, treatment plans, and medical records. The use of opioids in pain treatment remains controversial for several reasons. The rate of addiction in the properly treated pain population is unknown. The media has highlighted problems of addiction to pain medicine among celebrities. And there has been considerable drug abuse involving OxyContin, which the FDA approved for moderate-to-severe pain in 1995. The FDA strengthened warnings for oxycodone in 2001, while continuing to recommend appropriate pain control for people living with severe pain. But experts say that finding a balance between cracking down on drug abusers and protecting people in pain is an ongoing struggle. "Some doctors fear regulatory scrutiny for over-prescribing these drugs," Dahl says. "And concerns about the small segment of people who abuse drugs ends up interfering with effective pain management for others." Sheryl Kaufman, 40, of Boston, who uses oxycodone and a fentanyl patch for severe pain associated with breast cancer, says she recently filed a grievance with a pharmacy over her struggles to get prescriptions filled. "They made me feel like a criminal," she says. "Sometimes I've had to go without pain medication for two to three days because of delays in filling prescriptions." The Value of Support Dearman's experiences with chronic pain led her to establish the National Chronic Pain Society in 2002. The organization provides peer support for people with chronic pain and their families. "We give people support for dealing with all of the issues that can go along with chronic pain--not having your pain taken seriously, frustration over not finding relief, how to communicate your pain to your doctor, and how to maintain relations with your family," Dearman says. Penney Cowan, executive director of the American Chronic Pain Association, another peer support organization in Rocklin, Calif., says support systems are important because they give people with pain the coping skills needed to take anactive role in their recovery. "Sometimes doctors tell people they'll have to learn to live with the pain," Cowan says. "But too often they stop short of telling them how to accomplish that." Dearman says finding effective treatment and gaining the skills to live with her pain made all the difference. "It's about being a person first and not letting pain define who you are," she says. "Our motto is: Pain may be unavoidable, but suffering is optional." Chronic Headaches More than 45 million Americans have chronic headaches, according to the National Headache Foundation. The most common types include tension headaches, which are associated with muscle tension. These are sometimes described as feeling like a tight band squeezing the head. Cluster headaches are marked by severe pain around one eye. Migraines are characterized by throbbing pain on one side of the head. Most people with migraines also experience nausea and sensitivities to light and sound. Andrew Fano, 38, of Lincolnshire, Ill., who has had migraines since he was 12, says headaches used to wipe him out for days. But things improved in 1992 when the FDA approved Imitrex (sumatriptan), the first drug in a class known as triptans. This class of drugs marked a huge leap forward for headache sufferers. Unlike some previous drugs that dulled the perception of pain, triptans stop the pain by narrowing blood vessels in the brain and reducing inflammation. Fano's migraine treatment now includes a newer triptan called Frova (frovatriptan). Side effects include nausea, dizziness, and dry mouth. He also takes the pain reliever Vicodin as needed, sticks to a regular sleep schedule, and avoids red wine and other migraine triggers. Migraines, tension headaches, and cluster headaches are considered primary headaches because they are not caused by underlying illness. "But it's important to rule out disease, especially when headaches are resistant to treatment," says Seymour Diamond, M.D., founder and executive chairman of the National Headache Foundation. Diamond performed an MRI (magnetic resonance imaging) on Fano a couple of years ago. "We assessed him for a possible brain aneurysm, but luckily, there wasn't a problem," he says. Most headaches can be successfully treated with over-the-counter pain relievers. But you should seek professional help for headaches if they persist or get worse or if the headaches are keeping you from work and social activities. "You should also see a doctor if you've never had headaches before and you start having them, if you get headaches upon exertion, of if headaches are accompanied by a stiff neck, fever or neurological symptoms like dizziness or blurred vision," Diamond says. For more information, contact the National Headache Foundation at (888) 643-5552, www.headaches.org/ consumer/. Pain Basics People usually feel pain when receptors in skin, bones, joints or other tissues are stimulated by an injury or threat to the body. Neuropathic pain is triggered by changes in the nerves themselves, of caused by changes in the brain of peripheral tissues. Pain involves the interaction between several chemicals in the brain and spinal cord. These chemicals, called neurotransmitters, transmit nerve impulses from one nerve cell to another. Neurotransmitters stimulate receptors found on the surface of nerve and brain cells, which function like gates, allowing messages to pass from one nerve cell to the next. Many pain-relieving drugs work by acting on these receptors. For example, opioid drugs block pain by locking onto opioid receptors in the brain. Other drugs control pain outside the brain, such as non-steroidal anti-inflammatory drugs (NSAIDs). These drugs, including aspirin, ibuprofen, and naproxen, inhibit hormones called prostaglandins, which stimulate nerves at the site of injury and cause inflammation and fever. Newer NSAIDs, including Celebrex (celecoxib) and Vioxx (rofecoxib) for rheumatoid arthritis, primarily block an enzyme called cyclooxygenase-2. Known as COX-2 inhibitors, these drugs maybe less likely to cause the stomach problems associated with older NSAIDs, but their long-term effects are still being evaluated. Source: National Institutes of Health
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