Adult Repetitive Strain Disorders, Part Two

Post provided by Barbara Bergin, MD

In the last post we discussed what repetitive strain disorders are, why we get them, and what you can do about them. Today's post continues with getting back to what you love after getting better and how to prevent repetitive strain disorders.

Once I get well can I go back to doing things like I was before?

- Probably not. Most people get these disorders because they are somehow anatomically predisposed to getting them, or because they are not put together to participate in certain activities. Frankly, most human beings are not put together to perform certain sports activities on a regular or high intensity basis. Our joints just will not tolerate repetitive strain for extended periods of time. Sometimes it is just a matter of conditioning ourselves to participate; like building up to run or swim long distances. But most of the time we get repetitive strain disorders because we are just wearing out our parts. We must make permanent changes. Again, that can mean minor alterations of the way we do things around the house, but it can also mean changing the way we participate in a sport or even discontinuation of that sport. I'm sorry to say this, but it's true. Most of these repetitive strain disorders occur in people who are 40+. I just don't see them in twenty year olds. If you refer to an earlier post, "Having Peace with Your Pain, " you'll understand a little more about my thoughts on that subject.

- Treating these conditions is kind of like treating hypertension. If your doctor says you have to take an anti-hypertensive medication, do you think you can just take that for a short period of time and your hypertension is cured? Can you stop taking the pill? Will your hypertension come back? Are you ever truly cured of hypertension? No. Occasionally there are people who will make major lifestyle changes and can lower their blood pressure but most people have to continue taking the medications for the rest of their lives. This is the same with most of these repetitive strain disorders. They will come back if you go back to doing things exactly the way you were doing them before. If you make 90% of the modifications permanent, you might be able to continue to enjoying some of the activities which previously caused you pain! You can live with that!

How can I prevent repetitive strain disorders?

- Some of them might be unavoidable, but general principles can always be applied: maintain a healthy weight, exercise in moderation, avoid extremes of high impact and high intensity exercises as you age, and maintain flexibility. It's also important to recognize repetitive strain pain and address it early, either by seeing your orthopedic surgeon (that's me) or your primary care physician, or by making the modifications yourself. It's common for people to try to "work through" the pain, thinking that it's better to work it than rest it. This kind of approach to pain probably stems from the idea that you have to "work through" the conditioning pain of getting into a higher intensity exercise like running. The first time you run a half mile, it hurts; your lungs, your feet, your legs. But as you continue to run and run longer distances, it gets better. This is not the philosophy to take with the pain you experience in a tendon or joint as the result of a certain activity or after that activity. Learn to recognize the difference and address it. Rest it. Ice it. Take Aleve or Advil (if your doctor says it's okay). Then modify it!

Adult Repetitive Strain Disorders, Part One

Post provided by Barbara Bergin, MD

Why do we get repetitive strain disorders?

- Because our bodies wear out and we do a lot of repetitive activities. As our population ages we're seeing more and more of these disorders. I see a different set of repetitive strains in younger aged individuals, mostly related to participation in sports. Of course an older person can get repetitive strain disorders from playing sports, but they can also get them from hanging up clothes in the closet and getting milk cartons off the top shelf of the refrigerator. Just because you go out and throw a ball a little, doesn't mean the milk carton wasn't the culprit. And just because your grandson can throw the ball to you all day, doesn't mean you can return it all day.

What are repetitive strain disorders?

- There are some very common disorders. They include:

- impingement syndrome: a disorder of the rotator cuff tendons. I also group shoulder bursitis and rotator cuff tears (partial and complete) with impingement syndrome.

- greater trochanteric bursitis: a disorder of the fluid filled sac that is on top of that prominent bone on the side of the hip. I see this more often in woman than in men. It's related to the shape of our pelvis and the way we move.

- plantar fasciitis: a common disorder of the foot, also seen more commonly in women. It results in pain on the bottom of the heel and is commonly called a heel spur. It's not due to an actual heel spur.

- lateral epicondylitis: Also known as tennis elow.

There are many other, less common repetitive strain disorders involving just about every tendon and muscle in the body.

What can I do about repetitive strain disorders?

- Rest: This doesn't always mean putting it in a splint, cast or brace. It usually means modifying the painful activity. As soon as you notice pain due to some repetitive activity and you can reproduce the pain by doing the activity, you should modify it. That might mean bracing the extremity involved. It could mean stopping that activity altogether. More often it means changing the way you do the activity; lessening the number of times you do it, decreasing the intensity of the activity, modifying the way you do it. For example, if I have pain in my shoulder when I get a large milk carton out of the top shelf of the refrigerator, I will start buying 1/2 quart containers and lower the shelf on which I put the larger bottles!

- Anti-inflammation: This can range from the application of ice to prescribing medications.

- Exercise: This might include some stretches or some strengthening exercises depending on the condition and the level of pain you are experiencing.

Austin Medical Relief for Haiti has a website!

www.austinhaiti.org

Check it out and please send to anyone who would like to know more about what we do, who we are, and how we are helping restore hope and health to Haiti. We are in need of donations for our continuing medical projects in Haiti. Currently we are working with MOH to build a hospital on MOH property. Donations will be directed towards the completion of the hospital and the hiring of medical workers in the US and Haiti to help staff and run the hospital. Spread the word!

Check out the new video, courtesy of Seema Mathur!

http://surfacetoairstudios.com/haiti/haiti.html

New Prosthetics Lab

Peace with your Pain

Post provided by Barbara Bergin, MD

I’ve been an orthopedic surgeon in Austin for 23 years and as my practice and I have aged I have come to believe in a different set of rules and expectations for both me and my patients than I had when I first hung up my shingle. Here’s the bottom line: humans weren’t meant to last as long as we do. As an organism we just weren’t put together to stay around for 80 years. The average age of death for Americans is over 80.

Look at the archeological record. No one is finding fossils of old cavemen and cavewomen. Women died in childbirth. If a man sprained his ankle he was dinner for a bigger predator! People died when they were 20. We see these documentaries on octogenarians who run the Boston marathon or some little group of Japanese mountain people who look like they’re 40 when they’re 100, and we think we should be able to be like that. But what they don’t show you are the 10,000 people who tried to train for the Boston marathon and couldn’t because of stress fractures, iliotibial band syndrome and degenerative meniscus tears.

So, what’s my point here? Do I just not want to see any patients? No, I love to see patients. It’s what I do! But the point is…we’re hunter-gatherers, and were made to last about 20 years.
I find myself giving this lecture over and over to my many patients who suffer from degenerative disorders of their bones and joints, as well as those patients who suffer from repetitive strain disorders.

No cave man/woman ever lived long enough to suffer from greater trochanteric bursitis, shoulder rotator cuff impingement syndrome, plantar fasciitis or degenerative meniscus tears.
If it’s frustrating for me to treat some of these conditions, it is certainly frustrating for my patients to have them. I’ve personally experienced many of these repetitive strain conditions. Frankly we have to learn to have a certain level of peace with them. We have to look at pain from a different perspective. We’re lucky to have lived long enough to experience these conditions. If we are fortunate enough to be treated and saved from a heart attack, we may live long enough to experience some other disease. It could be a rotator cuff tear. It could be cancer.
Sometimes my patients ask, “Why am I having these problems? My grandparents and my parents didn’t have them!” There are several reasons for this:

-We may not inherit the same set of genes each of our parents had. Just as your eyes or your hair might not look exactly like either of your parents, your muscles, tendons and joints may not be the same either.

-We live differently than our parents and grandparents. As a whole, we are more active than our parents were. We started playing organized sports at a younger age. We do some crazy, harmful exercises our parents didn’t even think to do. We continued playing sports late into life. As a whole we are larger and heavier than our ancestors. And we live longer so unfortunately, we have longer to suffer!

-Our expectations are different than our forefather’s were. Our grandparents did not have an expectation of being treated and “cured” of their aches and pains. So why complain? Why go to the doctor? Everyone tells us that we can be cured. There is treatment. And there is! But because of that, we have an expectation of wellness and therefore we complain.

You will most certainly be able to think of a situation which contradicts my analysis. My parents are both in great shape and they’re out tango dancing without an ache or pain. Well, in my most educated opinion…that’s just good luck…for me and for them!

Prosthetics Update in Haiti

We are borrowing a computer from a missionary couple here on site so I have to type quickly and my thinking will most likely be a bit choppy...

Haiti is amazing. The country is beautiful and the people are very sweet. The amount of destruction due to the earthquake is hard to wrap my brain around. Last night the lead doctor on site told us her earthquake story. We have heard many things since coming down that I wish I did not have in my head. I know it helps to understand the level of need and the people we are working with but much of it is beyond horrible.

We currently have 5 legs in the works. I have taken on the role of prosthetic technician and Tim is teaching me alot. Yesterday the lead Haitian orthopedic surgeon brought 5 amputees to our lab and we spent the afternoon making casts and taking measurements for prosthesis. The surgeon had removed 3 of the patients legs using a saw. The level of trauma the Haitians have experienced is overwhelming. It is impossible to talk with someone and not break down as the tell you their earthquake story. Everyone here has been effected.

Today we drove an hour and half to the border of haiti and the Dominican republic to another orphanage/clinic where 47 amputees are being held while they wait for prosthetic teams to come by and make them legs and arms. We saw one woman who is missing her left arm and right leg, a 10 year old boy who is missing half of his foot, a dozen men and women missing an arm or a leg, two 5 year old girls who both lost a leg, and more I cant remember right now. It was overwhelming to know all of these 47 people lost their limbs due to the earthquake. Many were still experiencing phantom pains as they continued to adjust to life without their leg or arm.

On the way to the Love a Child clinic we drove up on two men who had just been hit by the local taxi truck (called a "tap tap"). One was slowly regaining consciousness and the other was not moving. A woman dumped a bucket of cold water on both of them to see if they would wake up. The first man walked dazedly to the side of the road and the second was not moving. The RN and PT who went with us jumped out to help and very quickly realized a large crowed was beginning to form and we needed to move on before anything more exciting started. It was hard to drive by knowing their was no medical help for miles but we had no other option. Just another day in Haiti...

It has rained the last two nights which has been exciting considering we are in a tent. It is also incredibly hot and humid which is wearing. We are working with a group of 50 from Canada as well as smaller groups from Ohio and Michigan. Everyone thinks its really cool that we are from California :).

There is alot of work to do and only a few more days to do it. We are trying to set up a system to pass along the current projects to the next prosthetist who will be coming next week. Since the prosthetic lab has only been open for 2 weeks, its all new for everyone.

Dinner is in about 30 minutes and we are going to walk down to the mid-week worship service going on at Church of Hope on site.


Blessings,

Tim and Amber

Team 12 in Haiti

Orthopedic surgeon: Frederic H. Pollock, MD (Charleston WV)
Family Practice: Myron Rosen, MD (Baylor, Dallas TX)

Joan Vega, RN (Scott and White Austin, TX)

Julie Manning RN (Austin TX)

Paramedic: Curtis Rhodes (Oklahoma)

Paramedic: Evalina Kadic (Canada, Halton EMS)

Paramedic: Ron Sonada (Canada, Halton EMS)
Supply/Med Student: Gabriel Pollock (Charleston WV)

PT: Helen Day (UK, Mercy Ships)

Prosthetist: Paul Morton

They will be joined by medical staff from Fallsview Church and Chapel Group.

Picture: Dr. Fred using a glove as an incentive spirometer on "Broken Man" in the ward