~Physical Therapy can help Dizziness

By Abby Newman SPT          

Have you ever had the feeling of being off-balance, lightheaded, dizzy, or that the room is spinning? What about ringing in the ear (tinnitus)?  Do you have these symptoms when getting up from bed or a chair or with walking? Are you limited in your ability to perform simple daily tasks or movements because of dizziness or balance? Believe it or not, dizziness can often be easily treated by physical therapy.

Decreasing balance with age is a common problem, but is not a part of normal aging nor is it reserved only for the elderly. Balance is the result of the relationship between the visual system (eyes), the vestibular system (inner ear) and somatosensory system (skin sensations), and the musculoskeletal system (muscles and bones).

The vestibular system (inner ear), is a complex organ with 3 semi-circular canals, labyrinth and cochlea. The semi-circular canals contain liquid which sloshes around moving fine hairs at the base of the canals when you move your head.  These hairs are hooked up to nerves, which tell the brain what position your head is in. From there the brain decides what muscles need activated to keep the head upright with respect to gravity. Otiliths are small organs within the inner ear which are sensitive to gravity and linear acceleration. These organs contain calcium carbonate crystals within a gelatinous matrix. These are the “little rocks” in your inner ear. The movement of these small crystals stimulate small hair cells connected to nerve which tells the brain head position.

A component of the somatosensory system is proprioception. Proprioception is the awareness of the body’s position in space. Through use of sensory receptors in muscle, tendon, joints and skin the brain maps the body’s position in relationship to gravity. Once the brain has received input about body position, it tells the muscles what adjustments if any need to be made to keep the body upright, balanced and protected. This all takes place in less than a second.

The musculoskeletal system contains sensory receptors within muscles, tendons and joints that give the brain information used to control balance or dizziness.  The reaction time of nerves can diminish with age.  Other ways getting older causes problems with balance and dizziness include arthritis, nerve compression, stenosis, or spurs in the cervical spine which are linked to changes in balance and dizziness. Taking multiple medications and blood vessel disorders can also create balance dysfunction, dizziness and cause falls.

What are some causes of dizziness problems that Physical Therapy can help?

-BPPV (Benign Paroxysmal Positional Vertigo)

Benign Paroxysmal Positional Vertigo is common, and typically easily treated with physical therapy. BPPV is caused by disruption of the fluid/ hair cell receptors in the semi-circular canal. With BPPV symptoms include: the sensation that the room is spinning, particularly when one rolls over in bed, dizziness with position changes. The spinning sensation lasts briefly (<1min)  or can be persistent the entire time the head is in that position. There is are simple techniques a PT can use to help adjust the inner ear so it can function properly.

-Labyrinthitis / Neuritis 

Infections can cause vestibular system hypofunction, which means that the system is not functioning correctly which results in balance problems, dizziness, nausea, and vomiting, impaired vision, and impaired hearing. Physical therapy can be used to re-establish proper communication between the vestibular system, vestibular nerve, brain and visual system. The exercises may consist of eye/head movements where you keep a target in focus while moving your head in different directions or at different speeds.

-Cervicogenic Dizziness

This is dizziness related to dysfunction in the neck and is usually accompanied by neck pain.  It may be seen after a trauma such as a car accident.  Physical Therapy can help by addressing the muscle tightness and joint mobility in the neck with manual therapy and exercise.

Balance can diminish with age due to changes in sensation, changes in musculoskeletal system, changes in how well your brain can process sensory information, gait, vestibular dysfunction, visual deficits and other complications such as arthritis and cognitive impairments. A physical therapist is skillfully trained to screen for impairments in all systems involved in balance, and create a treatment program to help you decrease dizziness and improve balance with manual techniques and exercise.

~Tai Chi Improves Fibromyalgia, Balance, and Pain

By Abby Newman SPT

Tai Chi is an ancient Chinese tradition which incorporates slow continuous movements and deep breathing to strengthen the body and mind. Tai Chi is low impact on joints and muscles and is generally safe for most people because it is self-paced and involves slow controlled movements.  It has been found to be useful in helping many conditions, reducing stress and anxiety, improving flexibility, improving balance, improving mood, improving muscle strength, and reducing pain and stiffness.

Tai Chi requires no equipment and can be done at home with a DVD or in an instructor led class.  The slow, controlled and focused movements utilize your arms and legs as weights.  This can improve flexibility, balance, and proprioception (a fancy word to describe your bodies awareness of position in space), which has been shown to reduce falls.  Because of the slow, controlled nature of Tai Chi, it has been shown to improve flexibility and decrease pain in individuals with osteoarthritis.  Also, the weight-bearing nature of Tai Chi creates for an easy transition to functional daily movements, making everyday tasks easier and less painful.

The slow controlled movements are a good way to begin a regular exercise routine which has been shown to decrease pain, stiffness, fatigue, depression, improve sleep quality and quality of life in individuals with fibromyalgia. Also, the deep breathing techniques used while performing Tai Chi help in reducing stress, improving psychological well-being, and decreasing the pain associated with fibromyalgia. The mental focus can help stop the "pain cycle".  As with beginning all exercise routines, individuals with fibromyalgia can have a heightened pain response to muscle soreness post exercise. Because of this, it is recommended to begin exercise in small doses until your body is familiar to the changes in activity.

Marnie's Note:

There are many DVD's out there that can help you start doing Tai Chi.  Check for beginners videos at Netflix, collage video, or at your local library.  You may also have classes in your local area.  Currently in our area the YMCA on Lowndes Hill in Clarksburg has Tai Chi at 9 am M-W-F and 6 pm W. As always, check with your health professional before beginning any exercise program.

~Cranberries for Urinary Infection? Maybe not.

Cranberry juice has long been recommended for prevention or treatment of urinary tract infections (UTI’s) as an old wives remedy.  Many bottles in the juice isle at the supermarket have added cranberry to other flavors to sweeten the drink. There have even been cranberry capsules available recently in the drug stores for people who do not like to drink the tart juice.  It was believed that components in cranberries (D-mannose, quinic acid,  and flavanols) prevented bacteria from sticking to the lining of the bladder.  If the bacteria do not stick, it is flushed out of the bladder with normal urination.

UTI’s can be very uncomfortable and it is understandable that someone would want to prevent or get rid of one as soon as possible.  They cause a lot of bladder and back pain and a general feeling of being tired and sick.  The urine is generally darker, foul smelling, and burns when coming out. It is very tempting to try an easy, over-the-counter solution such as a drinkable juice. 

The most recent review of the available research shows there is likely to be little benefit in using cranberry juice to prevent UTI’s in women who get them frequently.  A Cochrane Library review in 2012 looked at a collection of previous studies to see if cranberry juice consumption, either in capsules or juice, was helpful.  They concluded that current evidence does not support cranberry juice as a means of preventing UTI’s.  They did find that many of the studies had a lot of people dropping out (sour tasting juice!). They also found that many did not specify the amount of the important bacteria-fighting compounds.  This was especially true when using capsules instead of the juice.  Also, when drinking the juice to get some benefit, 5 oz would need to be consumed two times a day indefinitely.  Many people found this difficult to swallow (pun intended).

So what do you do if you have a UTI?  If you have any of the symptoms (painful urination, dark, smelly urine, bladder or back pain), go see your doctor.  The best course of action is to get on antibiotics to kick the infection.  While recovering, it is important to drink a lot of water.  Heat can be used to help with the bladder or pelvic pain.  To prevent a UTI from starting, wash your hands, wipe from front to back to prevent getting bacteria in the urinary tract, take showers instead of baths, and urinate immediately after intercourse to flush the system.

So what about cranberry juice? Based on this new information, it is unlikely to help prevent a UTI.  If you like it, it is fine to try as a part of the increased fluid intake.  The exception to this is people who have interstitial cystitis (IC). With IC the symptoms are similar to a UTI (bladder irritation, frequent urination, pelvic and back pain) but there is no infection.  The only way to know for sure is to see your doctor to rule out a UTI.  If the symptoms are from IC instead, cranberry juice (or other acidic juices) can make the symptoms worse. 

~Calcium Supplements for Osteoporosis

By Abby Newman SPT

Have you ever found yourself staring in confusion in the vitamin isle at the grocery store? Reading all the different brand names and supplement combinations- calcium citrate...calcium carbonate...calcium phosphate...calcium with vitamin D...women's daily vitamins for women under 50..women over 50. Overwhelming! All you know you need to do is take a calcium supplement. Which one is right for you? What are the benefits? Are there any risks?

As we age bone density changes and can become fragile. Bone density changes because your body loses too much calcium, doesn't make enough or both. This lowered density makes an individual more vulnerable to fracture from an injury that in an otherwise healthy individual would not result in fracture.  Some fractures can lead to serious complications with healing and even death.

Osteoporosis is most common in post-menopausal women and can lead to other serious changes in posture and mobility. With osteoporosis, injury doesn't have to occur to sustain a fracture. In more advanced stages, simple movements such as bending forward can cause damage to the spine. Other risk factors for developing osteoporosis include excessive alcohol consumption, tobacco smoking, Vitamin D deficient diets, limited physical activity, low body weight, long-time use of corticosteroids, malnutrition, heredity, and excessive aerobic training.

So how do you know when or if you need to start taking a supplement?

For women, prevention is based on a healthy balanced diet and exercise started early in life when bone is still changeable and is in a growth stage. Typically at age 50, your healthcare provider will start assessing your height, spine and doing bone density testing to check the quality of your bone. Your healthcare provider may advise you to begin a calcium supplement. Most individuals 19-50 years of age need about 1000 milligrams of Calcium a day. A diet rich in dairy can meet these requirements without the need of a supplement. Foods such as milk, yogurt, cheese, broccoli and even some enriched cereals and breads contain calcium. For individuals who don't regularly eat these foods, have allergies, or are lactose intolerant, a calcium supplement may be beneficial.

Here are some recommendations from the National Osteoporosis Foundation and the National Institute of Health.  As always, check with your medical provider before taking supplements.

Calcium Supplelment Do’s and Don’ts 

DO:

1. Get as much of your daily requirement as possible from foods (dairy, leafy greens, yogurt, cheese)
2. Supplement with calcium carbonate if you plan on taking it with food and have no digestive issues
3. Supplement with calcium citrate if you don’t want to take it with food or have digestive issues
4. Spread the daily dose throughout the day to help with absorption and decreased gas, bloating, and constipation
5. Choose a brand with added Vitamin D.  This helps calcium's absorption. Vitamin D requirements are 400-800 IU if under age 50, 800-1000 IU if over 50.
6. Choose brand name supplements with proven reliability.
7. Choose brands with the USP (United States Pharmacopeia) symbol
8. Determine how much calcium you are getting daily from foods and then add enough supplement to get to the required amount for your sex and age: 1000 mg (women up to age 50 or men up to age 71),  1200 mg (women over 50 or men over 71)
9. Talk to your doctor or pharmacist if you take diuretics, antacids, laxatives, or steroids which can affect the absorption of calcium
10. Get plenty of weight bearing exercise for your whole body.  This includes walking, jogging, or weight lifting. Don't forget to lift weights with your arms for upper body bone density.

DON’T:

1. Take with beverages that have caffeine (soda, coffee, tea). This decreases your body's ability to absorb the calcium
2. Take your supplements all at once.  Spread the dose throughout the day to improve absorption.
3. Take more than you need to take.  Look at your daily intake from food and supplement to get the remainder needed.
4. Take more than 500 mg at a time
5. Take calcium without discussing it with your doctor if you are prone to kidney stones.

~Awareness of Endometriosis, Chronic Fatigue, and Sleep Recognized in March

Endometriosis is a condition that causes pelvic pain and infertility.  It happens when the uterine lining sheds during menstruation and end up inside the body cavity.  Then with each menstrual cycle, these lining cells bleed and cause pain and adhesions.  These endometrial growths may end up in the fallopian tubes, bladder, rectum, bowels leading to pain, infertility, severe cramps, heavy menstrual bleeding, constipation, pain during or after intercourse, and other issues.

Chronic fatigue is a sense of debilitating fatigue and lethargy that lasts for a long period of time.  It feels similar to having the “flu” in that it causes extreme tiredness and muscle soreness.  It is a symptom of a variety of conditions including: Chronic fatigue syndrome, fibromyalgia, depression, cancer, multiple sclerosis, irritable bowel syndrome, lyme disease

Physical therapy can help with endometriosis by doing “hands on” therapy to help manage the adhesions leading to pain and blockage of the intestines and bowel.  With chronic fatigue, such as in fibromyalgia, PT can help work with the patient to establish a beneficial exercise program without overdoing it.  People with chronic fatigue can’t simply “just exercise” with recommendations that are given to normal people. A PT knows how to work with this population to get benefits while managing the difficulties.  Sleep is enhanced by proper exercise routines and stress management, all of which a PT can assist with education and establishing proper routines.

Here are a few of my past posts related to these issues.

Fibromyalgia and chronic fatigue think tank

Possibile risk factors for fibromyalgia

Website for fibromyalgia

West Virginians don't get enough sleep

Newsletter : Sleep Issue

Newsletter: Pelvic Pain

 

For more information on these awareness topics:

National Endometriosis Awareness Month:  http://www.endocenter.org/

National Chronic Fatigue Awareness Month:  http://www.ncfsfa.org/

National Sleep Awareness Week March 3-10:   http://www.sleepfoundation.org/event/national-sleep-awareness-week