All Posts tagged pain science

Foot Pain? Strengthen your foot ‘core’

Foot Pain? Strengthen your foot ‘core’

As your cold-weather footwear makes the seasonal migration from the back of your closet to replace summer’s flip flops and bare feet, don’t underestimate the benefits of padding around naked from the ankles down.

Barefoot activities can greatly improve balance and posture and prevent common injuries like shin splints, plantar fasciitis, stress fractures, bursitis, and tendonitis in the Achilles tendon, according to Patrick McKeon, a professor in Ithaca College’s School of Health Sciences and Human Performance.

The small, often overlooked muscles in the feet that play a vital but underappreciated role in movement and stability. Their role is similar to that of the core muscles in the abdomen.

“If you say ‘core stability,’ everyone sucks in their bellybutton,” he said. Part of the reason why is about appearance, but it’s also because a strong core is associated with good fitness. The comparison between feet and abs is intentional on McKeon’s part; he wants people to take the health of their “foot core” just as seriously.

The foot core feedback loop

McKeon describes a feedback cycle between the larger “extrinsic” muscles of the foot and leg, the smaller “intrinsic” muscles of the foot, and the neural connections that send information from those muscle sets to the brain.

“Those interactions become a very powerful tool for us,” he said. When that feedback loop is broken, though, it can lead to the overuse injuries that plague many an athlete and weekend warrior alike.

Shoes are the chief culprit of that breakdown, according to McKeon. “When you put a big sole underneath, you put a big dampening effect on that information. There’s a missing link that connects the body with the environment,” he said.

Muscles serve as the primary absorbers of force for the body. Without the nuanced information provided by the small muscles of the foot, the larger muscles over-compensate and over-exert past the point of exhaustion and the natural ability to repair. When the extrinsic muscles are no longer able to absorb the forces of activity, those forces are instead transferred to the bones, tendons, and ligaments, which leads to overuse injuries.

It’s not that McKeon is opposed to footwear. “Some shoes are very good, from the standpoint of providing support. But the consequence of that support, about losing information from the foot, is what we see the effects of [in overuse injuries].”

Strengthening the foot core

The simplest way to reintroduce the feedback provided by the small muscles of the foot is to shed footwear when possible. McKeon says activities like Pilates, yoga, martial arts, some types of dance, etc. are especially beneficial.

“Anything that has to deal with changing postures and using the forces that derive from the interaction with the body and the ground [is great for developing foot core strength],” he said.

McKeon also described the short-foot exercise, which targets the small muscles by squeezing the ball of the foot back toward the heel. It’s a subtle motion, and the toes shouldn’t curl when performing it. The exercise can be done anywhere while seated or standing, though he recommends first working with an athletic trainer or physical therapist to get familiar with the movement.

He notes the exercise seems to have especially positive results for patients suffering from ankle sprain, shin splints, and plantar fasciitis. It’s even been shown to improve the strain suffered by individuals with flat feet.

The payoff could be more than just physical, as there could be financial savings. With strong feet, McKeon suggests that — depending on the activity — consumers may not need to invest hundreds of dollars in slick, well-marketed athletic sneakers (though he doesn’t recommend going for the cheapest of cheap sneakers, either). People with a strong foot core can actively rely on the foot to provide proper support, rather than passively relying on the shoes alone.

“You might be able to get a $50 pair of basketball shoes that don’t have the typical support that you’d expect. Because you have strong feet, you’re just using the shoes to protect the feet and grip the ground,” he said.

The easiest way to get started on strengthening the small muscles of the foot, though, is to kick off your shoes in indoor environments.

“The more people can go barefoot, such as at home or the office, is a really good thing,” McKeon said.

Ithaca College. “Going barefoot: Strong ‘foot core’ could prevent plantar fasciitis, shin splints, and other common injuries.” ScienceDaily. ScienceDaily, 17 November 2015. <www.sciencedaily.com/releases/2015/11/151117181929

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50% of Americans have a musculoskeletal condition!

50% of Americans have a musculoskeletal condition!

An estimated 126.6 million Americans (one in two adults) are affected by a musculoskeletal condition–comparable to the total percentage of Americans living with a chronic lung or heart condition–costing an estimated $213 billion in annual treatment, care and lost wages, according to a new report issued today by the United States Bone and Joint Initiative (USBJI).

Musculoskeletal disorders–conditions and injuries affecting the bones, joints and muscles–can be painful and debilitating, affecting daily quality of life, activity and productivity. “The Impact of Musculoskeletal Disorders on Americans: Opportunities for Action” outlines the prevalence and projected growth of musculoskeletal disorders in the U.S., and recommends strategies for improving patient outcomes while decreasing rising health and societal costs.

“This report provides the critical data needed to understand the magnitude of the problem, and the burden, of musculoskeletal disease in our country,” said David Pisetsky, MD, USBJI president, and professor of medicine and immunology at Duke University Medical School. “The number of visits to physicians for these disorders, the cost of treating them, and the indirect costs associated with pain and loss of mobility, are proportionately much higher than the resources currently being allocated to combat these conditions and injuries.”

“As a nation, we need to establish greater funding for musculoskeletal research, improve our understanding and strategies for prevention and treatment of these injuries and conditions, and ensure that more adults and children receive appropriate treatment sooner, and on an ongoing basis, to ensure quality of life and productivity,” said Stuart L. Weinstein, MD, co-chair of the report’s Steering Committee and a professor of orthopaedics and rehabilitation at the University of Iowa Hospitals and Clinics.

Prevalence and predictions

According to the report, the most prevalent musculoskeletal disorders are arthritis and related conditions; back and neck pain; injuries from falls, work, military service and sports; and osteoporosis, a loss of bone density increasing fracture risk, primarily in older women. An estimated 126.6 million Americans were living with a musculoskeletal disorder in 2012. More specifically:

•Arthritis is the most common cause of disability, with 51.8 million–half of U.S. adults age 65 and older–suffering from the disease.

•With the aging of the American population, the report projects arthritis prevalence to increase to 67 million people, or 25 percent of the adult population, by 2030.

•Arthritis is not just a disease for older Americans, with two-thirds of arthritis sufferers under age 65.

•Back and neck pain affects nearly one in three, or 75.7 million adults.

•Osteoporosis affects 10 million Americans, with 19 million more (mostly women) at risk for the disease.

•One in two women and one in four men over the age of 50 will have an osteoporosis-related fracture, and 20 percent of hip fracture patients over age 50 will die within one year of their injury.

Cost and health care impact

The burden of musculoskeletal conditions is significant in terms of treatment and care, as well as the impact upon of quality of life, mobility, and productivity, and resulting in fewer days at work and in school. In 2011, the annual U.S. cost for treatment and lost wages related to musculoskeletal disorders was $213 billion, or 1.4 percent of the country’s gross domestic product (GDP). When adding the burden of other conditions affecting persons with musculoskeletal conditions such as diabetes, heart disease and obesity, the total indirect and direct costs rose to $874 billion, or 5.7 percent of the GDP in 2015.

Other data on the costs of musculoskeletal diseases and injuries include:

•Eighteen percent of all health care visits in 2010 were related to musculoskeletal conditions, including 52 million visits for low back pain, and 66 million for bone and joint injuries, including 14 million visits for childhood injuries.

•Arthritis and rheumatoid conditions resulted in an estimated 6.7 million annual hospitalizations.

•The average annual cost per person for treatment of a musculoskeletal condition is $7,800.

•The estimated annual cost for medical care to treat all forms of arthritis and joint pain was $580.9 billion, which represented a 131 percent increase (in 2011 dollars) over 2000.

•In 2012, 25.5 million people lost an average of 11.4 days of work due to back or neck pain, for a total of 290.8 million lost workdays in 2012 alone.

•Among children and adolescents, musculoskeletal conditions are surpassed only by respiratory infections as a cause of missed school days.

Opportunities for action

The report provides recommendations to curb the tremendous economic and societal costs of musculoskeletal disorders, including:

•Accelerating research that compares treatment alternatives, develops new treatments and evaluates possible preventative approaches.

•Improving understanding of the role of behavior change in prevention and treatment, including weight loss and self-management of conditions once they arise.

•Ensuring that a higher percentage of the affected population receives access to evidence-based treatments.

•Implementing proven prevention strategies for sports injuries, workplace injuries, and injuries in the military.

•Ensuring that all children with chronic medical and musculoskeletal problems have access to care.

•Promoting better coordination between physicians and other health care providers treating musculoskeletal disorders: primary care physicians, specialists, physical therapists, etc.

•Ensuring that health care providers, especially primary care physicians, have the appropriate training to diagnose, and if necessary, refer patients for appropriate treatment.

•Addressing data limitations, and improve systems, to improve our understanding of these conditions and how best to screen, diagnose and treat them. This includes the impact of sex and gender on musculoskeletal disorders and responses to treatment, and tracking pediatric patients through adulthood to determine the lifelong burden of musculoskeletal disease.

“If we continue on our current trajectory, we are choosing to accept more prevalence and incidence of these disorders, spiraling costs, restricted access to needed services, and less success in alleviating pain and suffering — a high cost,” said Edward H. Yelin, PhD, co-chair of the report’s steering committee, and professor of medicine and health policy at the University of California, San Francisco. “The time to act to change this scenario to one with more evidence-based interventions and effective treatments, while simultaneously focusing on prevention, doing better by our society and economy, is now.”

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American Academy of Orthopaedic Surgeons. “One in two Americans have a musculoskeletal condition: New report outlines the prevalence, scope, cost and projected growth of musculoskeletal disorders in the U.S..”

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Back and Neck Pain : 19 percent have persistent pain

Back and Neck Pain : 19 percent have persistent pain

A new study published in The Journal of Pain reports that 39 million people in the United States or 19 percent have persistent pain, and the incidence varies according to age and gender. The Journal of Pain is the peer-reviewed publication of the American Pain Society, www.americanpainsociety.org.

Researchers at the Washington State University College of Nursing conducted the study. They defined persistent pain as frequent or constant pain lasting longer than three months. The intent of their research was:

• Identify groups at higher risk for persistent pain

• Identify body sites, chronic conditions and disabilities associated with persistent pain

• Assess the relationship between persistent pain and anxiety, depression and fatigue

• Describe the individual experience of persistent pain.

The study was performed using data from the 2010 Quality of Life Supplement of the National Heath Interview Survey (NHIS) to calculate the prevalence of persistent pain. Results of the analysis showed that approximately 19 percent of U.S. adults reported persistent pain in 2010, and older adults were more likely to experience persistent pain than younger adults. Women also had slightly higher risk than men.

The authors noted that persistent pain correlated with other indices of health-related quality of life, such as anxiety, depression and fatigue. Individuals with those conditions were far more likely to report persistent pain.

In 2011, the Institute of Medicine reported that 100 million Americans have chronic pain. The authors explained that the disparity between the estimated pain incidence in their study and what the IOM reported is attributable almost entirely to differences in operational definitions of persistent pain.

In the 2010 NHIS, an estimated 60 percent of adults reported lower back pain in the past three months, and all of them would have been described in the IOM report as having chronic pain. However, only 42 percent of the NHIS study respondents with back pain described their pain as frequent or daily and lasting more than three months.

From a public health perspective the difference is significant. Those with persistent pain have high rates of work disability, fatigue, anxiety and depression. They also are at higher risk for long-term exposure to and dependency on pain medications.

The authors concluded that measuring pain persistence has policy implications because persistent pain is an indicator of an unmet medical need for pain management in the general population, as well as a risk factor for anxiety and depression.

Journal Reference:

Jae Kennedy, John M. Roll, Taylor Schraudner, Sean Murphy, Sterling McPherson. Prevalence of Persistent Pain in the U.S. Adult Population: New Data From the 2010 National Health Interview Survey. The Journal of Pain, 2014; 15 (10): 979 DOI: 10.1016/j.jpain.2014.05.009

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