If you are over 50 and don't feel as strong as you used to or don't have as much stamina as you once did, it's not surprising. Just like bone density decreases with age, we also lose muscle mass. The decline in skeletal muscle, a condition called sarcopenia, is a natural process that occurs in everyone over time. It can lead to frailty and increased risk for falls and loss of independence.
"Typically, patients see the rheumatologist on their first visit and come back to see an APP for follow-up visits," says Paczos. "We try to have them see the doctor once a year and the APP in between." She notes that many patients like seeing an APP because they often can spend more time with them.
In the past, TENS units for home use were available only through a physical therapist or other clinician. The units have been simplified, and you can now buy one without a prescription. According to Cleveland Clinic physical therapist Kelly Kinsey, PT, "The old units that came through physical therapists could be set to meet individual needs. The parameters could be altered and varied for comfort and changed to address different types of pain." The simplified TENS units you get without a prescription are not as customizable. They are programmed to the most commonly beneficial settings and comfort level.
When aches, pains and other symptoms stem from a problem with the musculoskeletal system (meaning the bones, muscles, cartilage, tendons, ligaments and joints) your doctor may order an imaging test to help determine the underlying cause.
Getting physical therapy early for musculoskeletal pain was associated with a reduction in long-term opioid use in a study published in JAMA Network Open (December 2018). Opioids are powerful pain medications, but they should be used cautiously due to the potential for addiction. Nondrug methods, such as physical therapy, can be effective for musculoskeletal pain. For the study, researchers analyzed health insurance claims data from 2007 to 2015 on about 89,000 adults with conditions causing shoulder, neck, knee or low back pain. Close to 30 percent of them received at least one physical therapy session within three months of a diagnosis. This was associated with an approximately 10 percent reduction in the number of opioid users three months to one year later. Among those who took opioid drugs, early physical therapy resulted in about a 10percent reduction in the amount of the drug used.
Ultrasound, which uses high-frequency sound waves to look at organs and structures, is a high-spatial resolution modality that provides greater internal detail of a structure. With the same muscle injury, "we can see the individual fibers of the muscle and early changes of the injury," says Dr. Delzell. Both MRI and ultrasound can detect large tears in tissue. "But microtears and chronic injury are better seen on ultrasound," she says.
"You also need a good cervical spine examination because there can be two different injuries, one to the brain and one to the area of the spine where the skull meets the neck," says Dr. Figler. People who have degenerative changes in the spine are particularly vulnerable to cervical spine injury. This may cause headaches and neck pain as well as more dizziness and lightheadedness.
The primary source of this vitamin comes from exposure to the sun. The body already contains precursors for vitamin D. It is converted to a usable form when ultraviolet B (UVB) rays from the sun hit the skin. About 10 to 20 minutes of exposure to the sun (without sunscreen) a day can generate an adequate amount of usable vitamin D. It's important to put sunscreen on after 20 minutes to prevent burning and protect against skin cancer.
"If we're seeing a patient early on, when they have mild-to-moderate changes inside the knee joint, they have a much better chance of the injection lasting a long time," Golnick says. The effects of the injection can last for three months or more in someone with mild-to-moderate arthritis, but those with more severe arthritis could have a return of symptoms within a fewweeks.
About 28 percent of adults age 65 and older fall each year. Falls in older adults can have serious consequences. A study published in JAMA Internal Medicine (December 2018) examined the effectiveness of the rhythmic movement exercise known as tai chi for fall prevention. For the study, 670 adults ages 70 and older who had fallen in the previous year or had impaired mobility were assigned to one of three groups. One group attended twice-weekly sessions of tai chi. The second group had a multimodal exercise (MME) program of balance, aerobics, strength and flexibility activities. The third group did stretching exercises. During the six months of the study, there were 152 falls in the tai chi group, 218 in the MME group and 363 in the stretching group. Falls were reduced by 31 percent with tai chi compared with a multimodal exercise program.
People who play sports, including basketball, soccer and tennis, can rupture the Achilles tendon from bursts of jumping or running. "The classic case is someone who plants his foot and then charges forward," says Dr. Berkowitz. The sudden movement can overstretch the tendon to the point that it tears. While this can happen to anyone, it most often occurs in men ages 30 to 50.
Nuts and seeds contain primarily, but not solely, polyunsaturated fatty acids. There is usually a lot of linoleic acid, which the body converts to omega-6 fatty acids, and a very small amount of alpha-linolenic acid (ALA), which is converted to omega-3 fatty acids. The opposite ratio is found in foods like green leafy vegetables, which are high in omega-3s. "We need these in balance for optimum nutrition," says Dr. Sukol.