Shin Splints: Causes, Symptoms, and Treatment

Shin Splints, medically known as Medial Tibial Stress Syndrome, refers to a pain along  long bone in the lower leg (Tibia). This condition is a physical activity-related problem that is usually common to athletes(runners), dancers, and military recruits. We often experience this pain, even on a simple activity such as morning jog, brisk walking, or even catching a bus to take a ride to work.

Causes:

Shin splints develop after a vigorous, repetitive physical activity, compromising the bones, muscles, and tendons in the lower leg. As a result of overworked, pain and inflammation will soon be experienced. This condition is common to anyone who just started an activity or a sudden change in the level of activity. A sudden change and/or increase in the frequency, duration, and intensity of an activity will likely cause shin splints. 

Symptoms:

The most common complaint is a dull, throbbing pain and tenderness along the border of the tibia. Pain usually occurs during and after exercise. Mild swelling will also occur in the lower leg.

Risk Factors:

Anyone will likely have shin splints if:

• You are wearing an improper or a worn-out shoes during an activity or exercise.
• You have some foot deformities, such as flat feet and high arches.
• You are a new participant in a sports activity.
• You suddenly increase the frequency, duration, or intensity of an activity.
• You are into military training.

Diagnosis:

We often do home remedies to manage shin splints. If the symptoms continue to persist, it would be better to see your doctor. 

The doctor usually does physical examination and patient interview on symptoms and medical history. X-rays will also be done to rule out other problems that cause the pain, such as stress fractures.




Treatment:

We often do home remedies to manage shin splints. If the symptoms continue to persist, it would be better to see your doctor. 

• Rest. If would be best if you take some time off from an activity or exercise that causes the pain. This will promote faster recovery. Instead, try to engage in low-impact activities that don't give too much stress on your lower leg such as swimming.
• Ice. Never apply ice directly over the skin. Wrap around the ice with layers of towelling.
• Apply icing for 20 minutes, four to six times a day for several days. This will help in reducing pain and swelling.
• Ultrasound, iontophoresis, phonophoresis, and electrical stimulation  can help reduce pain and inflammation.
• Elastic compression bandage will help against swelling.
• Take some over-the-counter pain reliever to reduce pain and swelling, such ibuprofen, Aspirin, Naproxen, or Acetaminophen.
• Range of motion and flexibility exercises to the lower leg muscles helps a lot. See your physical therapist to help you with pain management and your return to sports. Here are some exercises you can do at home.
• Wear shoes with good cushioning to reduce stress on the lower leg.
• Orthotic shoe insert provides foot alignment and stability of your foot and ankle.
• Surgical treatment done in very severe cases. 

Here are some exercises you can do at home.

Toe Curls.

• Standing. Spread the towel in front of you. Place your one foot at the edge of the towel. Slowly bring or pull the towel towards you using your toes. Repeat this procedure with the other foot.

Calf Stretching

• Long sitting on the floor. Loop a towel or resistance band at the bottom of your one foot. Gently pull them towards you into dorsiflexion. Hold it for a few seconds and repeat three times on each leg. Do the same stretching on the other leg.

Shin Resistance Exercise

• Sitting on the floor. Loop a resistance band around the front of your one foot while the other end of the resistance band looped around a stationary object like a table. Dorsiflex the foot against the resistance band. Do this with 10 to 15 reps. Progress with heavier band later on.

Prevention:

• Start a new exercise or activity slowly. Gradually increase the frequency, duration, and intensity as you go along with your exercise or activity. Don't rush.
• Start an exercise with warm up and light stretching to prepare your muscles.
• Stop an exercise the moment you feel pain in your shinbone.
• Try to develop strength in your lower leg before going into high-impact activities.
• Cross training is effective in improving fitness and performance. Incorporate low-impact activities such as jogging and swimming, with your main activity or sports.
• Avoid overdoing an exercise or an activity.
• Wear the right shoes that give comfort and safety.

Frozen Shoulder: Causes, Symptoms, Treatments - All About Physical Therapy

Frozen shoulder, otherwise known as adhesive capsulitis, is a condition in the shoulder characterized by stiffness, pain, and limitation of motion. It is typical in frozen shoulder to involve only one, although, few cases affect both shoulders. 

Causes:

Frozen shoulder usually happen after a recent injury or after a medical procedure or from, a medical condition such as stroke, diabetes, or mastectomy. The inability of moving the shoulder into its full range of motion because of pain results in stiffness of the tissues around the joint. Later on, shoulder movement becomes more difficult and painful.

Symptoms:

This shoulder condition usually develops gradually, becomes worse over time and then slowly resolve over the course of 1 year up to 3 years. Persistent pain and limitation of motion from joint stiffness are the most obvious symptoms seen in people with frozen shoulder. This condition develops in 3 stages and each stage can last up to several months.

Freezing Stage 

• The painful stage. More and more pain is experienced when you do any movement of the shoulder. Limitation of motion starts to become limited.

Frozen Stage

• Pain begins to diminish at this stage, but the stiffness still remain making shoulder movement difficult affecting daily activities.

Thawing Stage

• Shoulder movement slowly improves at this stage.

Risk Factors:

• Age. Common to people aged 40 to 70 years
• Gender.More often to women than in men
• After surgical procedure 
• Recent injury such as fracture
• Medical problems such as stroke, hyperthyroidism, hypothyroidism, diabetes, Parkinson's disease, or cardiac disease

Diagnosis and Test:

• Medical History to include a detailed description of the symptoms, present and past medical conditions, and medications and/or supplements taken.
• Physical Examination to include testing the range of motion of both shoulder joints. The affected shoulder will show limited motion, both active and passive.
• Imaging Test
• X-rays, which shows a clear image of the bone, help find other problems in the shoulder.
• Ultrasound and MRI give a better view of the soft tissues to rule out other problems.

Treatment

The aim of treatment for frozen shoulder is to ease pain and keep the mobility and flexibility of the shoulder. Here are some of the recommended treatment approaches of frozen shoulder.

• Medications. Over the counter pain-relieving and antiinflammatory drugs, such as aspirin and ibuprofen to cut pain and swelling.
• Heat application followed by gentle stretching to increase range of motion.
• Range of motion exercises, given by a physical therapist, to recover shoulder joint mobility.
• Ice and corticosteroid injection will help reduce pain and swelling.
• Transcutaneous Electrical Nerve Stimulation (TENS) give pain relief by blocking pain fiber that carries pain impulses.
• Joint Distention. A sterile water is injected into a joint to stretch the tissue so that movement is easier
• Shoulder Manipulation under anesthesia. You will receive general anesthesia and the doctor do manipulation to break adhesion.
• Shoulder Arthroscopy. This procedure is rarely done. The doctor uses a lighted, tubular instrument inserted into a small incision around the joint to remove scar tissue and adhesions.

Plantar Fasciitis: All About Physical Therapy

Plantar fasciitis is an overuse injury involving the plantar fascia, a strong, thick band of tissue that runs from the heel(calcaneum) up to the toes. An overstretched or overused injury of the plantar fascia will lead to pain and inflammation at the bottom of the foot which makes walking more difficult. This band of tissue provides arch support as well as a shock-absorber of your foot. Plantar fasciitis affect both men and women, but more to active men aged 40 to 70. The involvement can either be one foot or both.

Possible Causes and Risk Factors:

This foot condition develops as the result of repeated small tears in the plantar fascia resulting to inflammation and degeneration of the connective tissues in the fascia. Plantar fasciitis is more likely to develop if you have:

• Flat feet and high arches of the foot.
• Certain occupations that requires prolonged standing.
• Obesity or a sudden weight gain.
• Engaged in long distance running and other intense activities or exercise.
• Tight TA will raise the arches of the foot.
• Incorrect shoe fitting that doesn't support the arch of the foot because this puts more stress on heel.
• A sedentary lifestyle and you do lots running, walking, and jumping.
• Certain type of arthritis, particularly among the elderly people.

Symptoms:

Anyone with plantar fasciitis will likely experience:

• Pain and tenderness at the bottom of the heel with the first step in the morning or even after standing/sitting for a while.
• Limited ankle dorsiflexion secondary to tight TA.
• Mild swelling or redness of the foot.
• Limping or may attempt toe walking to decrease pain which might also develop foot, knee, hip or back problems later on.
• Painful with barefoot walking on hard surface or even stair climbing.
• Pain after an intense activity such as running, jumping, and other related activities that repeatedly put stress or pressure on the tissues.

Diagnosis:

• Physical examination should include patient interview.
• An x-ray may be taken to rule out other problems.
• An ultrasound scan usually shows thickening and swelling of the fascia.

Treatment:

Start your treatment as early as possible before it gets worse. Go and see your doctor. Here are some recommended treatment approach if you have plantar fasciitis.

• Take time to rest your feet , at least for a week. Limiting or even stopping an exercise or activity allows better healing of the tissues
• Apply ice for 15 minutes, at least twice a day, to relieve pain and inflammation.
• Avoid any form of the heating your foot during the first 2 to 3 days.
• Flexibility and strengthening exercises to ankle and calf muscles.

1. Standing with both hands touching the wall at shoulder level. Feet slightly apart, with one foot in front of the other foot.Begin by bending your front knee while keeping your back knee in a straight position and then move forward by leaning on the wall. Hold it for a few seconds and then release. This exercise will stretch your calf muscles. Do this again by switching the position of the two feet to stretch the other calf muscles.
2. Long sitting on the floor. Loop a towel around the ball of your one foot. Pull the toes towards you while keeping your knee straight. Hold this for a few seconds. Do this exercise with the other foot.
3. While sitting on a chair, place a water bottle, a tennis ball, or a drink can under the arch of your foot. Slowly roll the bottle from the ball of the foot to the heel. The massage effect helps reduce pain in the bottom of your foot.

• Athletic shoes or shoe with a well-cushioned sole are usually good choices.
• Heel cups or shoes inserts give added cushion and comfort to your foot.
• Resting night splint may be used to stretch the TA while sleeping.
• Try to reduce weight. Enrolling in a weight-reduction program helps a lot.
• Acetaminophen and Ibuprofen will help reduce pain and inflammation.
• Extracorporeal shock-wave therapy. Better discuss this procedure with you doctor.
• Foot surgery may be needed if all nonsurgical treatment didn't work out.

Preventive Measures:

• Do stretching prior to any activities or exercises.
• Avoid doing exercises on hard surfaces.
• Try to lose some weight if you are obese.
• Change your type of sport. Go into low-impact sports like swimming instead of running or jogging.
• Always check your shoe physical condition. Don't wear worn out shoes.

Morton's Neuroma

Morton's neuroma, also known as Morton's metatarsalgia or interdigital neuroma, is a painful foot condition affecting the nerve passing under the ligament that connect the metatarsals. This foot condition often affects the third and fourth toes, may sometimes develop in the second and third toes. Also, it either affects one foot or both feet. A constant irritation or an excessive pressure on those areas of the foot or both feet develops a thickening of the tissues that surround the nerves leading to the toes. As a result, one may experience a sharp, burning pain at the ball of the foot. The sensation is feeling like as if you are walking on a pebble, a common description of this foot condition. Although it can occur at any age, the condition is more notable in runners and in middle-aged women who loves to wear high-heeled shoes. Besides, the incidence is higher in women than in men.

Causes

Although the exact cause remained unclear, many experts believed that Morton's neuroma is usually associated with irritation or pressure of the nerves between the toes. Aside from wearing high-heeled shoes and participating in high-impact sports like running, anyone with foot deformities such hammertoes and flat feet will also have this foot condition.






Symptoms

A sharp, burning pain felt at the ball of the foot often worsen with activity and wearing tight shoes.
Unpleasant tingling sensation at the toe.
Pain increases over time.

Diagnosis

Examination may show a palpable mass at the toes, which is tender when pressed.
X-ray may help to rule out bone fracture.
A test on the range of motion to find any arthritic or an inflammatory condition of the joints.
Ultrasound and Magnetic Resonance Imaging are both good in visualizing the soft tissues, though quite expensive.

Treatment

The treatment is towards the symptoms. A conservative treatment is the first approach before going into an invasive intervention.

Wearing a orthotic device, those with foot deformities, will help relieve pressure on the toes.
Shoe change will help reduce pressure on the nerves, particularly the athletes.
Avoid high-heeled and tight shoes as well.
Foot massage provides pain relief.
Placing an ice pack at the sole provides pain relief.
Weight reduction  for obese persons to reduce strain on the feet.
Over the counter pain relievers and injections of steroids may help ease the pain and inflammation.
Surgical removal of the thickened tissues deemed necessary if all conservative treatments haven't worked. Although the surgery is successful in most cases, one may still experience the permanent sensation of numbness but not painful.

R.I.C.E Therapy

For the benefits of those who still have no idea on to how handle recent soft-tissue injuries, let me share with you the advantage of RICE therapy and how it promote faster recovery. Anyone, particularly the athletes and other physically active people, can have muscle strain, ligament sprain, bruise, and other soft-tissue injuries. RICE therapy is recommended on acute cases, usually the first 24 to 48 hours after injury. It doesn't mean RICE therapy is already enough, especially serious injuries. Better see your doctor for proper evaluation and management, like drug prescription and physical therapy. RICE, which stands for rest, ice, compression, and elevation, help reduce pain and swelling.

Rest

Right after the injury, take some time off from your activities. Stopping or limiting an activity promote faster soft-tissue healing. Remember, continued stress on the injured part will lead to further damage. If the injury is on the leg or ankle, crutches will help you move around without putting pressure on the injured part.

Ice

This treatment approach help control pain and inflammation. Icing works on reducing the size of the blood vessels, thereby decreasing the bleeding, the swelling, and easing pain. Never apply ice directly over the skin on the injured part, instead, wrap it around with a towel or any clothes. Commercially, there are cold packs available in medical shops. Apply icing for 15 to 20 minutes and repeat the procedure as long as you want. Icing works best during the first 24 to 48 hours after injury.

Compression

Compression,using a bandage, help reduce swelling as well as support to the injured part. Just remember not to wrap too tight to avoid cutting off blood supply to the injured area as well as more swelling below the affected area.

Elevation

While applying the ice, like sitting or lying, elevate the injured part above the heart level to help reduce swelling.

Transcutaneous Electrical Nerve Stimulator (TENS)

Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacologic and noninvasive treatment for pain from a variety of painful conditions. A small, portable, battery-powered device that has leads connected to electrodes. Electrodes (sticky patches) are placed on your skin using self-adhesive pads. 
The TENS unit sends painless electrical impulses through the electrodes to the nerves under your skin, which you feel as a tingling sensation. The electrical impulses can block or reduce the pain signals going to the spinal cord and brain, which can help reduce or relieve pain or muscle spasm. TENS devices also help stimulate your body to produce higher levels of its own natural painkillers, called "Endorphins".

For most people, TENS is a safe treatment with little or no associated side effects. It is available for home use. You should always follow the manufacturer's specific instructions to be safe. Have your physical therapist or doctor to show you the proper way to use the machine, and follow the instructions carefully.

Types of TENS:

1. Conventional(High frequency stimulation) - This high rate and most common mode of TENS can be applied during the acute or chronic phase pain. Onset of pain relief is relatively fast but lasts only for a shorter period of time. Tolerable to most patient. Duration of treatment is 20-60 minutes.

2. Acupuncture-like(Low-frequency stimulation) - A strong low rate TENS can be applied during the chronic phase of pain. Duration of treatment is 30-40 minutes and duration of pain relief is long-lasting(an hour or more). More uncomfortable and less tolerable type.

3. Burst Intense(Pulse burst) - A combined characteristic of both high and low rate TENS but more tolerable than low rate TENS. Onset of pain relief is similar to low rate TENS. Duration of treatment is 20-30 minutes. Duration of pain relief is long-lasting(hours).

4. Brief Intense(High-intensity) - This mode provide rapid onset, short-term pain relief during painful procedures(wound debridement, deep friction massage, joint mobilization or passive stretching). Duration of treatment is usually 15 minutes.         

Electrode Placement:

• Over the painful area
• Over the nerve supplying the painful area
• Acupuncture sites
• Proximal or distal to pain site, or even on the opposite side of the body
• Segmentally related myotomes
• Trigger points

Indications:

• Postoperative pain
• Chronic pain
• Arthritis
• Sports injuries -  bone fractures
• Period pain
• Acute pain relief during labor and delivery
• Phantom pain

Contraindications:

• Cardiac pacemaker or another type of implanted electrical device fitted
• Epilepsy or a heart rhythm disorder(consult your doctor)
• During first trimester of pregnancy
• Allergic reaction to the electrodes (it's possible to get hypoallergenic electrodes)
• Broken skin, varicose veins, recent scarring in the area, or over areas of reduced sensation
• While driving or operating machinery
• Near water, such as in the bath or shower
• Over lower abdominal/uterus during pregnancy
• Over the anterior transcervical area - the front or side of your neck
• Cause of pain is not known or is not diagnosed.
• In the mouth, close to the eyes, or temple area

Procedure:

• Check the area to be treated for contraindications and precautions.
• Check the unit - batteries, knobs, electrodes.
• Turn the control knobs to the off position before you start.
• Use rubbing alcohol to clean the skin where the electrodes will be placed. Let your skin dry.
• Position the self-adhesive pads either side of the painful area, at least 2-3 cm apart.
• Switch on the machine slowly and turn it up gradually until you feel a tingling sensation.
• TENS machines are designed so that you can move around with them working.
• At the end of the session turn the machine off and disconnect the electrodes from the machine.
• Check the area being treated for irritations; clean the area with soap and water.
• Clean the rubber electrodes with soap and water to remove the gel; Do not wash the self-adhesive type of pad.
• Remove the battery from the TENS and replace it with a charged battery. Charge the battery so that it will be ready for another treatment.
• You can use TENS throughout the day for as long as you like provided you do the same process as mentioned above

Bronchitis - Acute and Chronic

Bronchitis is a respiratory disease characterized by an inflammation of the lining of your bronchial tubes. These tubes are large and delicate  that carry air in the tiny branches and smaller cells of the lungs after this air has passed through the mouth, nasal passages, and trachea and then back out from the lungs. Breathing is more difficult  when the bronchi become swollen due to irritants or infections. Bronchitis sufferers also tend to have much more mucus and phlegm. People with asthma may also have asthmatic bronchitis, inflammation of the lining of the bronchial tubes.

The two main types of bronchitis are Acute (lasting from one to three weeks) and Chronic (lasting at least 3 months of the year for two years in a row).
    
                                                                           




ACUTE BRONCHITIS

Acute bronchitis is a type of bronchitis that is short-lived, usually lasts about two weeks. However, coughing may still be experienced for a few weeks even if the infection is gone. Most people recover with no permanent damage to the bronchial tree. Lung irritants or infections may cause acute bronchitis. Infections can be viral or bacterial in origin, but viral origin account in most cases. Influenza, Respiratory Syncytial Virus (RSV), and Rhinoviruses are among the viruses that causes acute bronchitis, while Mycoplasma and Pneumococcus bacterial agents also causes to develop acute bronchitis.

Cause

• Acute bronchitis is generally caused by infections or lung irritants. In most cases, it is viral in origin while others are from bacterial infection. A short-term, high-level exposure to chemical irritants or substances like inhaling or exposing to cigarette smoke (including secondhand smoke), dust, inhaling solvents, or industrial air pollution may lead to acute bronchitis.

CHRONIC BRONCHITIS

Chronic bronchitis is an ongoing, serious long-term condition characterized by an inflammation of the lining of the bronchial tube secondary to constant irritation. This condition often requires regular medical attention. A productive cough  that produces a slimy mucus is usually present for 3 months during two consecutive years. Chronic bronchitis is one of the conditions included in chronic obstructive pulmonary disease (COPD) that the majority of people diagnosed with the disease is 45 years of age or older. Patients with chronic bronchitis are often called "blue bloaters".

Cause

• The most common cause of chronic bronchitis is heavy, long-term cigarette smoking.

SIGN and SYMPTOMS of Acute Bronchitis or Chronic Bronchitis

• Persistent cough which may last up to 20 days. A cough may produce a clear, slimy mucus (sputum). A green or yellowish mucus may indicate bacterial infection. In most cases, the infection is viral in origin. Coughing lingers for several weeks after the inflammation of bronchial tube resolves
• Wheezing is a high-pitched whistling sound made while you breath. The sound is most obvious when you breath out (exhale)
• Slight fever may include sore throat, stuffy or runny nose, vomiting, and headaches
• Chills and malaise
• Chest discomfort
• Shortness of breath (Dyspnea) especially with physical exertion.

RISK FACTORS

• Acute bronchitis are at higher risk for older adults, infants, and young children may be because of low resistance
• Cigarette smoking, second-hand cigarette smoke, and having an existing lung disease greatly increases the risk for bronchitis.
• Repeated exposure or contact with dust, chemical fumes, and vapors from certain  occupations
• Air pollution, infections, and allergies can worsen the symptoms of chronic bronchitis
• History and repeated bouts of acute bronchitis
• Women are more than twice as likely as men to be diagnosed with chronic bronchitis.
• It occurs more often in people who are older than 45 although anyone can have the disease. Also, many adults who develop chronic bronchitis are smokers.

DIAGNOSIS

Medical History

• Presence of symptom - How long been coughing, presence of mucus, breathing problems, chest discomfort, sleeping or work problem, wheezing sound, and fever
• Smoking - Daily consumption  and period of time been smoking
• Ask for another medical condition
• Type of job that constantly irritate the lungs
• Drugs and supplements currently using
• Records of vaccination against pneumonia or annual flu shot

Physical Examination

• A stethoscope is used to hear wheezes, and a prolonged exhalation which are signs of airflow obstruction

Test

• Pulmonary function test - A spirometer is used to measure the amount of air inspired and expired by the lungs
• Blood test (CBC)
• Chest X-ray help rule out other lung problems (pneumonia and bronchial obstructions).
• CT scans of the chest
• Measurement of arterial blood gas
• Sputum Culture

MANAGEMENT

Early diagnosis and treatment, combined with avoidable risk factors such as quit smoking and avoiding secondhand smoke, provide a favorable prognosis. The main goals of treatment are to relieve symptoms and make breathing easier.

Get enough rest, drink plenty of fluids, and aspirin or acetaminophen for fever if you have acute bronchitis. The antibiotic may not work if you have a viral infection. 

Bronchodilator

• This medicine relaxes the smooth muscles that encircle the bronchi, which allows the inner airways to expand making it easier to breathe. It is usually inhaled using an inhaler, but is also available in pill form.

Theophylline

• This medicine relaxes and open the airways to help you breathe better
• Indicated for shortness of breath, wheezing and chest discomfort for patients with chronic bronchitis and for other COPD. They are available in tablet, capsule, solution or in syrup.

Steroids Medication

• Works to reduce the inflammation which in turn decreases the bronchial swelling and secretions, making improve air flow. You can take steroids either with an inhaler or in pill form.

Antibiotics

• As a whole, antibiotics cannot help chronic bronchitis while others prescribed antibiotics during acute exacerbation of chronic bronchitis. May be prescribed if it is from a bacterial infection, but not from a viral origin.

Supplemental Oxygen Therapy

• This will help to get more oxygen supply needed to breathe better. Usually prescribed for severe chronic bronchitis and if the medicine doesn't show improvements. A small finger oximeter for monitoring blood oxygen levels at rest and with activity is helpful.

Exercise

• A regular strengthening exercise help improve strength and general body endurance. Begin with light exercise and slowly progress over time. An exercise frequency of at least 3 times a week is usually recommended. Start with slow walking  and progress the duration and speed later. Consult your doctor or a physical therapist for the appropriate exercise program.

Breathing Techniques

1. Pursed-lip breathing

• This technique will also help to feel better from shortness of breathing. This is done by taking a deep breath (inhale) and then breath out slowly (exhale) through the mouth with pucker lips. Stay relaxed and exhale normally. No holding of breath.

2. Diaphragmatic breathing

• This technique uses the primary muscle of respiration, the diaphragm. To do this, lie down on your back with both knees flexed and supported. Place the hands on the abdomen and notice the marked expansion of the abdomen rather than the chest when breathing.

Over-the-counter (OTC) cough suppressants

• Drugs like Dextromethorphan  and Guaifenesin may be helpful in reducing cough symptoms.

Alternative Remedies

• It is advisable to consult a health care professional before using any of these products.

Medical Complications

• Dyspnea is a medical term to describe shortness of breath
• Respiratory failure will happen if there is not enough oxygen that passes from the lungs into the blood
• Pneumonia is an infection that causes inflammation of the air sacs in one or both lungs.
• Cor pulmonale is an abnormal enlargement and weakness of right heart ventricle due to lung disease
• Pneumothorax is an abnormal collection of air or gas in the pleural cavity of the lung causing lung collapse
• Polycythemia is an abnormally increased concentration of red blood cells needed to carry oxygen),
• COPD (Chronic Obstructive Pulmonary Disease) is a lung disease characterized by chronic obstruction of lung airflow that affect normal breathing and is not fully reversible. These diseases include the emphysema and the chronic bronchitis. Tobacco smoking is the most common cause of COPD.
• High mortality rate 

Preventive Measures:

• Do not smoke and avoid second-hand smoke
• Vaccination - Flu shot every year and pneumococcal vaccination every 5 or 6 years
• Wear an appropriate mask to high-risk areas to limit exposure to chemical fumes, dust, second-hand smoke, and pollution
• Wash your hands to limit viral and bacterial infections
• Maintain a physically active lifestyle and eat a balance diet

Charley Horse - Muscle Cramps

Charley Horse, otherwise known as muscle spasm or cramp, is a painful involuntary muscle contraction that doesn't relax for several seconds or more. In other words, the muscles become hard, stiff, and sore.I think almost everyone experiences muscle spasm, at any age, and occurring any time of the day. It can occur in any muscles, but they are most common in the calf and foot. Muscle spasm also occurs in the thigh, the hands, arms, abdomen, and on muscles in the rib cage area. Normally, spasm usually not prolonged or recurring, but if it continues to persist, better see your doctor to determine the cause and implement appropriate treatment.

Causes and Risk Factors:

Muscle injuries as a result of bruise or contusion
Muscle fatigue
Performing an exercise in excessive heat or cold
A strenuous exercise or overuse of a specific muscle during exercise particularly the calf muscles among athletes.
Stress plays a part and is most often in the neck muscles.
Not having or insufficient stretching prior to actual exercise or activities.
Inadequate blood flow to the leg muscles
Pinched nerve from compression injury of the spine
Side effects to an individual on diuretics may lead to low potassium levels
Deficiency with potassium, calcium, and sodium in blood
Deficiency with calcium to a pregnant woman, a common complaint.
Obesity
Smokers
Older adults and infants

Remedies and Prevention:

Keep yourself hydrated throughout the day.Water alone is not sufficient. Sports drink will help replenish lost minerals.
Heating pads will promote muscle relaxation
Ice pack to follow later on to manage pain
Nonsteroidal Anti-iflammatory Drugs (NSAIDS), like ibuprofen, given if the pain continues to persist
Antispasmodic drugs may be given in severe cases
Nerve irritation may require surgery and physical therapy
Massaging or stretching the foot, ankle or knee in the opposite direction of the spasm may relieve pain.
Eat a well-balanced diet, rich in potassium and calcium
Stretching before and after exercise
Stretching before bedtime will also help
Do not overdo an exercise to the point of fatigue

Guillain Barre Syndrome

Guillain Barre Syndrome (GBS) is a rare autoimmune disorder in which our body's immune system attacks the protective covering, the myelin sheath, that surrounds the axon of many peripheral nerves resulting to axonal degeneration. The resultant inflammation and demyelination of the nerves decreases the nerve conduction velocity leading to weakness or sometimes paralysis of the affected muscles. This disorder predominantly affect the motor fibers.  GBS is known from other names: 

• Acute Inflammatory demyelinating polyneuropathy
• Landry's Ascending Paralysis

Main Types: 

1. Acute Inflammatory Demyelinating Polyneuropathy (AIDP)

• The most common type of GBS, particularly in the US. The myelin sheath of the nerves is damage preventing signals to travel to the brain causing weakness, paralysis, or numbness. It is characterized by motor weakness in a distal to proximal progression.

2. Acute Motor Axonal Neuropathy (AMAN)

• It is the same with AIDP, but purely motor and has no sensory symptoms. Usual cases occur during pediatric age. 

3. Acute Motor-Sensory Axonal Neuropathy (AMSAN)

• A severe form of GBS to include both motor and sensory symptoms. It is more prevalent in Asia and in North and South America. Typically, seen during adulthood.

4. Miller Fisher Syndrome

• This type of GBS is more common in Asia. Paralysis starts in the eyes.
• Double vision, loss of balance, and unsteady gait are some features.

Causes:

The exact etiology is unknown. It is often preceded by previous respiratory infection, stomach flu, viral infection (Influenza), vaccination, or surgery.

Symptoms:

The first symptoms is rapid onset of symmetrical muscle weakness and sometimes paralysis or an abnormal sensation in the legs that travel up the limb from fingers and toes towards the upper extremities and head. GBS symptoms usually last for a few weeks, usually peaks within 2 to 4 weeks. Severe cases involving the respiratory muscles that interfere with breathing require immediate medical attention. Other findings may include:

1. Deep muscle pain/Severe nerve pain 

2. Absence of deep tendon reflexes - Knee jerk

3. Breathing problems such shortness of breath and dyspnea on exertion

4. Heart and blood pressure problems such as paroxysmal hypertension and orthostatic hypotension.
5. Coordination and balance difficulties 
6. Blurred or double vision

7. Bowel and bladder weakness

8. Swallowing, chewing, or speaking difficulties(slurred speech)

Risk factors:

1. This disorder can occur at any age. Usually common to young adults and older adults starting at their 50's.

2. It can affect both sexes, but slightly greater in male population. 

3. Conditions associated with GBS include:

• Viral infection - HIV, Influenza
• Bacterial infection - Campylobacter
• Mycoplasma Pneumonia
• Cytomegalovirus
• Epstein-Barr Syndrome
• Surgery
• Vaccination

Diagnosis:

1. Lumbar puncture - Cerebrospinal fluids contain high protein with little or no lymphocytes.

2. Electromyography measures muscle response or electrical activity in response to stimulation of the nerves of the muscles to determine neuromuscular problems.

3. Nerve Conduction Studies measures the speed of conduction of an electrical impulse through a nerve. 

4. Physical and Neurologic examination

5.  Muscle Strength Testing

6. Medical History/Surgery

Treatment:

There is no known cure for GBS, but still there are several treatment to lessen the effects of symptoms and to help speed up recovery. Most patient may recover from GBS, while some of them may still experience weakness and fatigue. Immediate hospitalization is highly recommended to receive appropriate treatment and a good chance of recovery.

A. Pharmacologic Approach

1. Plasma Exchange (Plasmapheresis)

• A blood-cleansing procedure in which the whole blood is withdrawn and the liquid portion, the plasma, is separated. The affected plasma is replaced with a new plasma, or a  plasma substitute and then transfused back to the person.

2. Intravenous immunoglobulin (IVIGs) help improve immune system.

3. Analgesics, such as NSAIDs or Acetaminophen with added narcotics, is usually recommended for pain relief. Corticosteroids are not recommended in GBS.

B. Cardiac Monitoring for arrhythmias, heart rate, postural hypotension.

C. Mechanical Ventilation during the acute stage to assist breathing problems.

D. Physical Therapy

Rehabilitation will help to:
1. Regain independence and quality of life.

2. Improve balance, posture, and coordination

3. Promote relaxation

4. Promote recovery

5. Increase muscle strength and endurance

6. Increase joint mobility and flexibility.

The rehabilitation is a team effort among physical, occupational and speech therapists, nurse/caregiver, and family. Physical therapy management include:

• Respiratory care to include regular breathing exercise and airway clearance.
• Passive range of motion exercises to prevent joint stiffness.
• Light exercises may be allowed but should avoid overexertion and fatigue to avoid exacerbation of symptoms.
• Resting splints to support the wrist/hands and ankles.
• As the patient condition improves and is out of bed, approach on increasing the circulation is important. Strengthening and endurance exercises may be given as tolerated.
• Swelling is likely to develop in the ankles and hands if it remained immobile.
• Monitor the blood pressure as well as the possibilities of having orthostatic hypotension.
• Compression stocking helps with swelling, blood clots, and achy leg.
• Abdominal binder help support weak abdominal muscles.
• A shoulder joint support will also help prevent shoulder dislocation or subluxation.
• A wheelchair for functional mobility is also prescribed to help patient to move around.
• Gait training to regain independence in walking.
• Education and home program.

Gouty Arthritis

Gout is an inflammatory form of arthritis that develop from excess build up of uric acid in the tissues and blood because of too much production and/or the inability of the kidneys to remove them. These needle-like uric acid crystals deposited in the joints which in turn leads to a sudden, severe episodes of pain, tenderness, swelling, redness, warmth and stiffness of joints. In addition, it may also lead to kidney stone formation, tophi deposits in the skin and other tissues, or urate nephropathy.

The most common affectation is the joint at the base of the big toe. It will also affect many other joints together with or without big toe involvement. Gout typically occurs in the middle age, usually over the age of 40. It is more common in men and in persons with diet problem due high standards of living. Women are usually affected after menopause.





I. Stages of Gout

1. Asymptomatic Hyperuricemia

• This stage appears with higher uric acid level in the blood, but does not manifest  any symptoms. Treatment is usually not required.

2. Acute Gout

• With existing hyperuricemia, a gout attack  is triggered after a series of alcohol or drug intake, eating too much high-purine food such as liver, dried beans and peas. Pain and inflammation usually occurs at night and may last for a few days up to 10 days.

3. Interval Gout

• This stage shows no more symptoms, but gout is still there. This is the ideal time to manage gout to prevent future attacks.

4. Chronic Gout

• The uric acid remained at high level over a long time. Gout attack is more frequent and pain to last longer compared to earlier attacks.

II. Causes:

Uric acid are normally formed by our body and stays in our bloodstream in a dissolved form and end up being flushed out by the kidneys. Having too much uric acid in our blood (hyperuricemia) create a condition called gout. A high level of uric acid or the inability of our kidneys to remove them quickly, uric acid crystals begin to form and deposited in the joints. A longstanding hyperuricemia create tophi (tophus) formation. Tophi are large deposits of uric acid crystals, in the form of monosodium urate crystals, at the surface of joints, or in skin or cartilage.

III. Risk Factors:

1. Beverages, such as tea, coffee, may increase the level of uric acid. Drinking too much alcoholic drinks and fructose-rich sodas increases the risk.
2. Diet of high-purine content, such as red meat, internal organs, seafood, oily fish, dried pea and beans, lentils, or spinach, produces high level of uric acid.
3. Obesity or being overweight increases the risk of developing gout even at younger age.
4. Starvation and dehydration.
5. Certain medical conditions or illness, such as kidney failure, rapid weight loss, polycythemia, high blood pressure, and lead poisoning.
6. Regular intake of aspirin or diuretics.
7. Bypass surgery.
8. Family history of gout.
9. Age and gender. Most common in men over the age of 40. Women are usually affected after menopausal.

IV. Symptoms:

1. Sudden onset of a warmth, red, extreme pain and tenderness, swollen joints, usually the big toe joints (Podagra). Gouty attack usually happen during nighttime.
2. Usually it affect one joint at a time, but may involve other joints (heels, knees, wrist and fingers) if no treatment made.
3. First gout attack stop spontaneously within 1 to 2 weeks even without intervention.
4. With time, gout attack is more frequent and to last longer.
5. At the beginning, it will only involve one or two joints and then progress to affect multiple joints.
6. Tophi formation in skin and other tissues.

V. Diagnosis:

1. A detailed medical history and physical examination. This include:

• Diet
• Medications
• Intensity and causes of pain
• Presence of other symptoms
• Duration and description of attack
• Joints involved

2. Blood Test

• This measure the level of uric acid in the blood.

3. Joint Aspiration

• The most important diagnostic tool. This procedure is by extracting fluid from the affected joint for testing under a microscope. Presence of uric acid crystals suggest gout.

4. X-ray, Ultrasound , CT Scan, or a MRI to look at soft tissues involvement.

VI. Treatment:

Home Management:

1. Take the prescribed medicines, the antiinflamatory drugs during flare-up. Don't take aspirin or diuretics it may only aggravate the symptoms.
2. Elevate leg above the heart level.
3. Use ice packs to alleviate pain and swelling.
4. Use an assistive walking device to lessen weight-bearing on the affected joints.
5. Splinting to immobilize the affected joint(s) is helpful.
6. Stay hydrated.
7. Take a rest to relieve stress.

Medications:

Medicines are given during acute attack as well as to prevent future attack. Some of these medicines may work effectively on some people and some of them may just give problems from side effects. To stay safe, it is still best to call and see your doctor.

1. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, ibuprofen, naproxen for pain and inflammation during acute attack.
2. Colchicine is an alternative medication. Side effects may include abdominal cramps and nausea.
3. Corticosteroids help control inflammation. Usually given if NSAIDs is not available or contraindicated. Administered either orally or directly injected to the joint.
4. Allopurinol and Probenecid both help to lower uric acid level and prevent future attack.
5. Febuxostat is another choice of medication to lower uric acid level.

Physical Therapy:

A management program formulated towards the maintenance or improvement of ROM, strength & endurance, and function. Physical therapy with medications is helpful for gouty sufferer. Begin with low-impact exercises and slowly progress to a more strenuous exercises as tolerated. Stop the exercise if it causes unusual, uncomfortable pain because this might to lead to injury or worsening of the symptoms. Avoid doing any exercises during flare-up instead do it in between flare-up.








Benefits of Regular Exercise:

1. Improve circulation.
2. Improve mobility and flexibility of joints.
3. Improve muscle strength and endurance.
4. Improve posture and balance.
5. Reduce stress and improve general well-being.
6. Alleviate pain and inflammation.
7. Maintain a healthy weight.
8. Lower the risk of gout.
9. Lower the risk of cardiac and pulmonary problems.

Management:

1. Modalities such as ice or a cold compress may help during flare-up to alleviate pain and inflammation.
2. Use a walking aid devices (a cane, walker, or crutches) to reduce weight-bearing of the painful joint and to help in maintaining a normal gait. Limping or incorrect gait may put stress on the other joints.
3. Rest and elevation of the affected joint during acute attack.
4. Range of motion and gentle stretching exercises improve flexibility and mobility of joints. A simple, light self-stretching help a lot to reduce joint stiffness and increase muscle blood flow.
5. Strengthening and endurance exercises, using a light dumbbell, will help your muscles to stay in shape. Slowly progress the exercises as tolerated.
6. Proprioception exercise keep up the joint sense of position.
7. Cardiovascular training recommended to keep a healthy lungs, heart, and circulation. Walking, swimming, and jogging are some of the activities that improve overall fitness.
8. Lifestyle change, such as diet control and avoiding other risk factors, is to consider.