020718 Avoiding Exercise Rhabdomyolysis

Avoiding Exercise Rhabdomyolysis

A classic case of too much, too often, and too soon is seen in those who suffer the ill and sometimes fatal after effects of working out far beyond their physical capacity.

Rhabdomyolysis in much simpler terms means that the exercise has been so extensive and strenuous that the muscle fibers themselves have not only broken down but have separated from the main fiber itself. This leads to these wayward fibers entering the circulatory system.

Some of these bits of tissue are toxic to the body and can result in kidney damage.

The person most at risk for this condition is inexperienced in exercise and is pushed either by themselves or an incompetent coach far beyond their limits. Others who may be put in the danger zone are military recruits in basic training, those who are dehydrated or suffering from heat related issues, and the circuit trainee under the supposed guidance of a personal trainer and of course the ultra marathon and triathlon athletes.

The clues of this dangerous condition are found in the abnormal and dark colored urine of the individual. This urine will have a dark, red or cola color to it.

This is a danger sign that should not be dismissed. If rhabdomyolysis is suspected, take immediate steps to have the symptoms and potential life threatening condition expertly evaluated by a physician.

Saving the life of another may be at stake here.

260917 Recovering from an exercise session

260917 Recovering from an exercise session

Exercise is a way of life for many people; they stay active longer into their lives while remaining mentally and physically sharper than their non-exercising friends. An active lifestyle requires a firm dedication to living a healthy life through good food choices and exercise. Sometimes being active brings with it a few aches and pains.

There are moments though when, especially after a particularly hard training session, soreness may occur. Even though this may be a cause for concern, there are strategies that may be used to relieve some of this discomfort.

Use a cool down after your session is completed. These few minutes of less vigorous activity help your body to return to its pre-exercise status by lowering your breathing, heart rate, and temperature back to near normal numbers. This time aids in the recovery of the muscles and cardiovascular systems.

Static stretching after the initial cool down gives the muscles a chance to relax and gives you a moment or two to improve your flexibility at the same time. Stretches are particularly effective now because the muscles, tendons and ligaments are all warm and flexible; just what is necessary to be productive.

Athletes generally weigh themselves before and after training sessions. This is to ensure they are staying properly hydrated. A recreational athlete might consider doing the same for the same reasons because a loss of fluids causes a loss of mental and physical sharpness. The rule of thumb is a pint a pound. Therefore, for every pound you lose exercising you need to drink at least 16 ounces. The exception to this is for an extreme endurance athlete or the salty sweater (1), not only is water important but so are the electrolytes.

Give your muscles the nutrients necessary to repair themselves after the session. Low fat chocolate milk is ideal in this situation because it has a good balance of carbohydrates and protein in each pint. Drinking one of these within ten to fifteen minutes pushes the glycogen back into your muscles and this helps them recover faster meaning a quicker return to your favorite activity.

020117 Neurons and sarcomeres

020117 Neurons and sarcomeres

In the neuromuscular system, the neuron provides the link between the nervous system and the muscles. Without this interaction, no activity would take place.

The sarcomere is the smallest and most basic muscle unit. It contains all of the contractile and regulatory mechanisms necessary to function as part of the muscular system.

Muscle fibers contain hundreds to thousands of sarcomere. The muscles themselves are made up of numerous fibers.

Listening to your body

Your body tells you what is going on…if you pay attention to it. Sometimes it is obvious; a muscle tweak or worse, an injury. Often it is just a feeling that you can’t quite describe or put your finger on. In the latter case, it’s the status of your homeostasis being disrupted. You know it on a subconscious, internal sensation, level.

In order to recognize these inputs, you must practice paying attention to them. This observational attitude has to be developed. It is not easy, but can be done with practice. Notice how your body responds to different stimulate, or how the bar feels in your hand as you lift. How does it feel or what is your body doing during these activities that are creating these sensations?

With practice, you will become more and more aware of these ambiguous signs from within your body. You’ll be amazed at the detail provided by the movement and postures that take place during the exercise.

Learn to listen to these vague signals. You will be the recipient of valuable lessons and information. This will enable you to grow stronger and more powerful, both in body and mind.

151016 Paying attention to the red flags of pain

151016 Paying attention to the red flags of pain

Pain is your body telling you something is not right. Maybe it’s simply a little ache that quickly goes away, but what if it is excruciating. Some pain signs are serious red flags that need to prompt attention by a medical professional. Carefully consideration of these signs may be the step that is necessary to prevent further deterioration of a manageable condition. An emergency pain signal, one that should get you moving to an emergency department, is one or more of the following symptoms:

A sudden onset of severe pain that is unrelated to an accident or some other situation that commonly would constitute an accident

Upper abdominal area or chest pain or pressure

Having difficulty in breathing or suffering from shortness of breath that is not normal to your situation

Dizziness, fainting, weakness, particularly if the dizziness and weak condition comes on suddenly

Sudden severe headache or a change in your vision

Difficulty in speaking or understanding others

Confusion or sudden changes in your mental status, a loved one or someone close to you may be the first to notice this change

Uncontrolled bleeding

Persistent and severe vomiting or diarrhea

Coughing blood

Vomiting blood

The major categories of pain-acute and chronic

Acute pain is normally the result of an illness, some sort of injury or occurs after surgery. This type of pain causes the body to automatically stop what you are doing in an effort to protect the body from further harm. This is due to the tissue damage that causes the pain receptors to respond.

Unlike chronic pain, acute pain can be pinpointed. You know exactly where you hurt and can put your fingers in the area where it hurts. Fortunately, this kind of pain generally subsides with time and gradually goes away.

Chronic pain by definition usually lasts six months or longer. It may stem from a chronic joint condition caused by arthritis, peripheral neuropathy or it could be the residual effects of an accident, infection, tumor or surgery that has damaged the nerves. In other cases, the cause of the pain is not understood because there is no evidence of a disease or damage to the tissues that would trigger it.

Changes in pain

Typically, your pain will gradually subside over time with the proper treatment. If this does not happen then a revisit with your doctor is in order just as it would be if the pain changes in character. For instance if your pain moves up the scale from mild to severe or greater then call your care provider and follow their suggestions. A more serious change would be an onset of new symptoms such as tingling or numbness; both demand a consult with your doctor as soon as you can get in to see them. Your doctor should revaluate these changes in the pain characteristics. They will conduct an examination and either eliminate a possible serious threat to your health or change the directions of the present care program.

Low back pain (LBP) is one of the most commonly reported health issues.

Throughout one’s life, there more than likely will be at least one episode of low back pain. The cause can be muscle strains, deconditioning of the body brought on by a sedentary lifestyle, spinal disk damage from accidents and the degenerative diseases of osteoporosis and osteoarthritis. In some cases, the pain escalates into an unbearable situation and must be aggressively dealt with by the medical professional.

In the present case of low back pain, serious red flags that appear need to be heeded and promptly attended to by a medical professional. If you experience the following, it is time to seek outside help.

Fever or chills and or night sweats

An inability to empty your bladder

Incontinence of your bladder or bowels

Weight loss that you cannot explain

Pain that cannot be relieved with rest and relaxation

If you are awakened at night by your pain

The inability of positional changes to alleviate your pain symptoms

Numbness, pain weakness in your legs, either one or both of them

These signs or symptoms could indicate an undiagnosed condition such as an infection, compression fracture of the spinal column due to osteoporosis, nerve root or spinal cord compression, a kidney stone or stones, an abdominal aortic aneurysm[1], spinal cancer or a tumor that may have started elsewhere and spread to the spine. In the case of the latter, these are especially true in the case of prostate, breast and lung cancers. Pay attention to what your body is telling you and don’t let these signals pass without an examination by your doctor.

050616 Getting ready for a joint replacement-part one

050616 Getting ready for a joint replacement-part one

According to the National Institute of Arthritis Musculoskeletal and Skin Diseases, which is a part of the National Institute of Health, there are over 1 million Americans having a hip or knee replaced every year. Research, over the years, has found that even if you are older a joint replacement will increase your ability to move around with less pain.

Even though these types of surgeries are becoming more common, there are still risks involved. You can reduce some of these risks, prior to your surgery, if you make the effort. A few short and sweet physical fitness guidelines lay along these lines: increase your cardiovascular endurance, strengthen the muscles around the joint and most important if you are overweight, lose weight and if you smoke cut back or quit.

As for the mental aspect of the upcoming surgery, you can prepare yourself for the surgery by devouring as much information as possible about the surgery, about what you can expect after the surgery and learning as much as possible about what you can do to make your recovery faster. Perhaps that last portion should read making your recovery easier.

Do both the physical and mental preparations simultaneously. For instance, as you are riding your stationary bicycle increasing your cardiovascular endurance you can be reading up on the surgery, you can be reading up on what to expect afterwards, and you can learn about the different modalities of recovery.

The more you know about getting better the easier and faster your recovery is going to be. Your prime goal during this entire ordeal will be to regain the full functionality of the affected joint. The recovery process is going to hurt. You must realize this point at the get go.

Too many people rely on too many drugs for too long, which in my opinion sets them back. Get off the pain medication as soon as possible and your rehabilitation will go quicker, you will be more mentally alert and more tuned into your body and the effect of the rehabilitation process on it.

When it comes to the point of deciding about having the surgery, don’t be shy about talking with your Doctor about it. Write your questions down before your appointment so you aren’t just going in blind.

Some of the questions you may have will be how long is the surgery going to last, what type of anesthesia is used to (if you have had surgeries in the past and you are nauseous in the recovery room, ask for anti-nausea medication during the anesthesia process. This, in itself, will help you get better sooner. It is hard to focus on recovery when you’re throwing up.

Your prior research into the surgery could reveal common complications, but just in case they didn’t, then ask your doctor about them. Find out how often they happen and what you can do to help prevent them.

If you’re concerned about the pain you going to be in afterwards ask how this can be mitigated. It has been my experience that if you do not have this conversation with the doctor then you are going to leave the hospital with enough pills to kill a horse.

Ask the surgeon how long you can expect to be in the recovery/rehab process. In addition to asking them how long you going to be in this recovery mode, find out what you can do to speed it up without damaging the joint. There is a fine line between speeding up and going too fast. If you cross this line, you can expect a setback in your rehab. A prior contact with your physical therapist will give you a good idea of what to anticipate.

Find out what your limitations are going to be after the surgery. In some cases, you may not be able to the subject the joint to heavy impacts such as skipping rope, running, or doing lower body plyometrics.

As you are making the decision about having the joint replacement surgery keep this in mind, there are no questions that are too trivial for you to ask if it means you are increasing your knowledge and awareness about this surgery.

300516 Keeping your shoulders flexible and pain free part two

300516 Keeping your shoulders flexible and pain free part two

A brief reintroduction to keeping your shoulders pain free continued from last week, just in case you may have missed it during your busy day.

If you have shoulder pain, and if your doctor has cleared you to exercise that area, here are a few tips that many find to be helpful in alleviating their shoulder discomfort. According to physical therapist (PT) Alex Petruska, a senior PT in the Sports Medicine Center at Harvard affiliated Massachusetts General Hospital, the focus in getting pain relief is on three goals:

  1. Increasing your range of motion (ROM)
  2. Strengthening the muscles of the shoulder
  3. Stretching the ligaments and muscles to keep them limber

Standing shoulder stretch

Carefully do this exercise, because due to the leverages involved, it can to put a lot of tension on the shoulder.

  • Start out either standing or sitting with one hand holding onto the top its opposite shoulder. For instance, if you were starting to stretch your right shoulder, your right hand would be on the top of your left shoulder.
  • Hold the arm of the stretched shoulder parallel to the floor with the hand touching the opposite shoulder, take the other hand, and gently push the elbow towards the stretched shoulder. You will feel an immediate stretch in the shoulder of the bent arm.
  • Hold the stretch for 10-15 seconds and release, go to the other side and repeat the sequence 10 times.

Side lying rotations

If you have access to any weights this does not require heavy ones, 1-5 pounds may be enough depending on your strength level. In some cases, contrary to popular opinion, more is not better. This is an external rotation movement. It strengthens one of the four small rotator cuff muscles and you do not need heavy weights while doing so.

  • Lie on your side with one arm bent to 90 degrees, elbow resting on the waist. Some people advise placing a small towel on the waist to keep the elbow up a bit.
  • From this position, slowly, but not glacially slow, raise your hand in a semicircle towards the ceiling. Keep the elbow on the waist during the full movement.
  • Both sides should have the same ROM. If not, work on getting them equal.
  1. Increasing your range of motion (ROM)
  2. Strengthening the muscles of the shoulder
  3. Stretching the ligaments and muscles to keep them limber

Wall walks stretch the muscles and tendons thereby helping to keep them limber.

  • From a short distance away from the wall, face it either sitting or standing. Standing may be a better option.
  • With both hands on the wall in front of you, use your fingertips to walk up the wall. The closer you get to the wall the more difficult this becomes.
  • Go as high as you can and hold for 10-15 seconds.
  • Repeat 10 times.

Another way to do this is to stand, either facing, or with your back to the wall.

  • With your straight arms next to your hips move your arms in a semicircle up over your head. Maintain constant contact with the wall during this motion.
  • Go as far up as possible, hold the top position for 10-15 seconds, and then lower your arms back down and start over.
  • Do this 10-15 times.

Now it is up to you to help protect your shoulders by doing some of these exercises several times a week until they feel stronger and pain free.

090516 Acetaminophen safety

090516 Acetaminophen safety

The season of colds, coughing, and flu bring on an increased use of acetaminophen, which is one of the ingredients in Tylenol and other over-the-counter medications for controlling pain and fever. Accidental overdoses of these products end up with thousands of people admitted to the emergency room each year.

According to the Harvard Men’s Health Watch, 600 and more products contain acetaminophen and inadvertently combining these products can push you into the danger zone. Each dosage, no matter where it came from, adds up. You must be careful not to exceed the daily limits otherwise you risk damaging your liver.

As previously mentioned acetaminophen, helps control pain and fever. It does not reduce inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) help control inflammation. In those individuals who cannot tolerate NSAIDs, due to the irritation these drugs sometimes cause to the stomach and intestinal lining, acetaminophen is tolerated. Thus, an individual attempting to control chronic pain, such as in older adults, may be tempted to use more than the recommended dose per day.

The problem arises when this dosage is exceeded because acetaminophen has a much and narrow wonder of safety when compared with ibuprofen and naproxen. This is not to minimize the danger of NSAIDs because they too can make you sick but it just takes a larger amount of these to reach a dangerous overdose. In the case of an acetaminophen overdose, damage to the liver occurs which sometimes means a liver transplant or death.

This happens when the body breaks down the acetaminophen. During this process, a part of this drug, which is toxic to the liver, is left behind. If too much is taken at one time or over a period of days, an accumulation of this toxic byproduct builds up. If it is more than the body can handle the results are an overdose.

The generally recommended maximum daily dose for an average healthy adult is no more than 4000 mg[1] including all other drugs that contain acetaminophen. In certain cases dosages of 4000 mg daily may still be toxic to the liver. To be on the safe side the recommendation is take only what you need and not exceed 3000 mg a day whenever possible.

Staying within these limits may mean a talk with your doctor or pharmacist to find out what your toleration (danger area) is, which is based on your age, body size, and your present health status.

Avoiding an accidental overdose

  • When purchasing cold and flu remedies look at the label and find out if it contains acetaminophen. If it does, be aware of how much and then stay within the guidelines listed earlier.
  • The over-the-counter acetaminophen products list the milligrams in each pill. Some contain 325, 500, or 650 mg in each pill, which means you have to be especially cautious when taking the 500 or 650 mg pills because you can easily exceed your daily limit by taking too many of these.
  • Follow the recommended dosages. Don’t be tempted to add just a little bit more; it could be hazardous to your health.
  • Drinking alcohol while using acetaminophen causes the liver to convert more of the acetaminophen into the toxic byproducts mentioned earlier. The suggested limit of alcohol consumption is no more than two standard drinks per day for male and one drink per day for a female.
  • Finally, ask your doctor or pharmacist if any of your prescription medications will adversely interact with your acetaminophen.

Acetaminophen: taking it safely[2]

  325 mg 500 mg 650 mg extended release
How many pills at a time? 1 or 2 1 or 2 1 or 2
How often? Take every 4 to 6 hours Take every 6 hours Take every 8 hours
The safest maximum dose per day for the majority of adults 8 pills 6 pills 4 pills
Do not exceed more than this within a 24-hour period. 12 pills (3900 mg) 8 pills (4000 mg) 6 pills (3900 mg)

[1] This is a maximum daily dose for a healthy adult weighing at least 150 pounds.

[2] January 2014, Harvard men’s health watch. “The maximum daily dose for a healthy adult who weighs at least 150 pounds is 4000 mg. However, in some people, taking the maximum daily dose for extended periods can seriously damage the liver. It’s best to take the lowest dose necessary and stay closer to 3000 mg per day as your maximum dose. If you need to take high doses of acetaminophen for chronic pain, check with your doctor first.”