Health Center for low back pain

Health Center for Low Back Pain
If you have ever experienced low back pain, you are certainly not alone.

According to a 2012 survey by the American Physical Therapy Association (APTA), 61 percent of Americans said they have experienced low back pain, and of those, 69 percent felt it has affected their daily lives.

The good news is that most cases of low back pain are not serious and will respond well to conservative, proven treatments such as physical therapy.

Physical therapists can help prevent and manage your low back pain, in many cases, without expensive surgery or the long-term use of prescription medications.

Symptoms & Conditions
Low Back Pain
Degenerative Disk Disease
Herniated Disk
Spinal Stenosis
Explore other symptoms and conditions.

Low Back Pain: Prevention and Management
Back Pain: Avoiding Unnecessary Treatment
Special Publication
Low Back Pain: Management and Prevention
Back Pain by the Numbers
Low Back Pain Tips
Snow Shoveling
Back Pack Safety
Proper Lifting Tips for Moms
Office Ergonomics
Health and Wellness Tips
Lifting tips
Workplace Wellness
Did You Know
Back Pain Is Often Over-Treated
Early Physical Thearpy Can Be Cost-Effective Treatment for Low Back Pain
Physical Therapy as Effective as Surgery for Degenerative Disk Disease
Additional Information
Explore other Health Centers for additional resources on exercise, health, and wellness.

How can Physical Therapists help those with rotator cuff tendonitis?

Physical Therapist’s Guide to Rotator Cuff Tendinitis

Jump to:

What is Rotator Cuff Tendinitis?
How Does it Feel?
How Is It Diagnosed?
How Can a Physical Therapist Help?
Can this Injury or Condition be Prevented?
Real Life Experiences
What Kind of Physical Therapist Do I Need?
Further Reading
Disorders of the rotator cuff and the tissues around it are the most common causes of shoulder pain in people over 40 years of age. Rotator cuff tendinitis occurs when a shoulder tendon (a bundle of fibers connecting muscle to bone) is irritated and becomes sore. With continued irritation, the tendon can begin to break down, causing tendinosis—a chronic, long-term condition. People who perform repetitive or overhead arm movements, such as weightlifters, overhead athletes, and manual laborers are most at risk for developing rotator cuff tendinitis. Poor posture can also contribute to its development. A physical therapist can help you identify and correct risk factors for rotator cuff tendinitis, and help you decrease your pain while improving your shoulder motion and strength.
What is Rotator Cuff Tendinitis?
The rotator cuff muscles are a group of 4 muscles that attach the humerus (upper-arm bone) to the scapula (shoulder blade). The rotator cuff muscles help raise, rotate, and stabilize the upper arm. A tendon is a bundle of fibers that connect the muscles to the bone. Rotator cuff tendinitis occurs when the tendon connected to the rotator cuff muscles becomes inflamed and irritated. It can be caused by:

Poor posture, such as rounded shoulders caused by leaning over a computer for long periods of time.
Repetitive arm movements, such as those performed by a hair stylist or painter.
Overhead shoulder motions, such as those performed by baseball pitchers or swimmers.
Tight muscles and tissues around the shoulder joint.
Weakness and muscle imbalances in the shoulder blade and shoulder muscles.
Bony abnormalities of the shoulder region that cause the tendons to become pinched (shoulder impingement syndrome).

How Does it Feel?
Rotator cuff tendinitis is characterized by shoulder pain that can occur gradually over time or start quite suddenly. The pain occurs in the shoulder region and sometimes radiates into the upper arm. It does not usually radiate past the elbow region. You may be symptom free at rest or experience a mild, dull ache; however, pain can be moderate to severe with certain shoulder movements. Reaching behind the body to perform a motion, as in fastening a seat belt, can be very painful. So can overhead activities, such as throwing, swimming, reaching into a cupboard, or combing your hair. The pain can worsen at night, especially when rolling over or attempting to sleep on the painful side. You may notice weakness when lifting and reaching for household items. Holding a heavy platter or taking a pan off the stove may become difficult.

How Is It Diagnosed?
A physical therapist will perform an evaluation and ask you questions about the pain and other symptoms you are feeling. Your therapist may perform strength and motion tests on your shoulder, ask about your job duties and hobbies, evaluate your posture, and check for any muscle imbalances and weakness that can occur between the shoulder and the scapular muscles. Your physical therapist will gently touch your shoulder in specific areas to determine which tendon or tendons are inflamed, and special tests may need to be performed to determine this.

How Can a Physical Therapist Help?
It is important to get proper treatment for tendinitis as soon as it occurs. A degenerated tendon that is not treated can begin to tear causing a more serious condition. Physical therapy can be very successful in treating rotator cuff tendinitis, tendinosis, and shoulder impingement syndrome. You will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:

Pain management. Your physical therapist will help you identify and avoid painful movements to allow the inflamed tendon to heal. Ice, ice massage, or moist heat maybe used for pain management. Therapeutic modalities, such as iontophoresis (medication delivered through an electrically charged patch) and ultrasound may be applied.

Manual therapy. Your physical therapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches to get your shoulder moving again in harmony with your scapula.

Range-of-motion exercises. You will learn exercises and stretches to help your shoulder and shoulder blade move properly, so you can return to reaching and lifting without pain.

Strengthening exercises. Your physical therapist will determine which strengthening exercises are right for you, depending on your specific condition. You may use weights, medicine balls, resistance bands, and other types of resistance training to challenge your weaker muscles. You will receive a home-exercise program to continue rotator cuff and scapular strengthening, long after you have completed your formal physical therapy.

Patient education. Posture education is an important part of rehabilitation. For example, when your shoulders roll forward as you lean over a computer, the tendons in the front of the shoulder can become pinched. Your physical therapist may suggest adjustments to your workstation and work habits.

Functional training. As your symptoms improve, your physical therapist will help you return to your previous level of function that may include household chores, job duties and sports- related activities. Functional training can include working on lifting a glass into a cupboard or throwing a ball using proper shoulder mechanics. You and your physical therapist will decide what your goals are, and get you back to your prior level of functioning as soon as possible.

Can this Injury or Condition be Prevented?
Rotator cuff tendinitis can be prevented by:

Maintaining proper shoulder and spinal posture during daily activities, including sitting at a computer.
Performing daily stretches to the shoulder and upper back to maintain normal movement. Tightness in the upper back, or a rounded shoulder posture will decrease the ability to move your torso, and that makes the shoulder have to work harder to perform everyday activities, such as reaching for objects.
Keeping your upper body strong, including the upper back and shoulder-blade muscles will help prevent tendinitis. Many people work the muscles in their chest, arms, and shoulders, but it is also important to work the muscles around the shoulder blade and upper back. These muscles provide a strong foundation for your shoulder function. Without a strong foundation, muscle imbalances occur and put the shoulder at risk for injury.

Real Life Experiences
Mary is a 51-year-old piano teacher with 14 students. She teaches 3 days a week; each session lasts 30 minutes. Mary also plays piano for her church, and for her own enjoyment. A few weeks ago, she began to feel pain in her left shoulder when reaching her arm overhead or behind her body. Her symptoms worsened, and she began experiencing pain even when at rest. Now the pain is so severe, it wakes her up at night; she can no longer sleep on her left side. She contacts her physical therapist.

Mary’s physical therapist performs a full evaluation of her shoulder, and her scapula and upper-back strength and mobility. Mary describes how long she sits at the piano each week. Her therapist gently feels all around her shoulder and finds that it is very tender over the rotator cuff region. She has pain when her therapist performs resistive-muscle testing to the rotator cuff. He also discovers that Mary has tightness in her upper back region that limits her ability to fully twist her body to the right and left. Special tests were performed on her shoulder, and the results indicate the rotator cuff is irritated. Based on these findings, he diagnoses rotator cuff tendinitis.

Mary and her physical therapist work together to establish short- and long-term goals for her treatment. He prescribes ice to help decrease her pain, and teaches her some gentle movement and strengthening exercises. He also shows Mary how to improve her posture when sitting at the piano, and teaches her a home-exercise program of stretching, strengthening, and postural exercises, which he modifies throughout the course of her therapy as her condition improves.

Mary and her physical therapist work together in a 6-week program of 2-3 rehabilitation sessions per week. He performs gentle passive movements of her shoulder, scapula, and upper back to increase her joint motion. Mary learns proper movement patterns for reaching her arm overhead. She finds that using a therapeutic chair helps improve her posture and strengthens her core during her piano lessons.

After a few weeks of diligent therapy sessions and working with her home-exercise program, Mary notices she is able to sleep on her left side again without pain, and can easily reach to get a mug from her upper kitchen shelf.

Mary is soon able to return to all of her daily activities and enjoy her life as a piano teacher—free of pain.

What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat rotator cuff tendinitis. However, you may want to consider:

A physical therapist who is experienced in treating people with rotator cuff tendinitis. Some physical therapists have a practice with an orthopedic or musculoskeletal focus.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you are looking for a physical therapist (or any other health care provider):

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people who have rotator cuff tendinitis. During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Further Reading
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of rotator cuff tendinitis. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Thornton AL, McCarty CW, Burgess MJ. Effectiveness of low-level laser therapy combined with an exercise program to reduce pain and increase function in adults with shoulder pain: a critically appraised topic. J Sport Rehabil. 2013;22(1):72-78. Article Summary on PubMed.

Childress MA, Beutler A. Management of chronic tendon injuries. Am Fam Physician. 2013;87(7):486-490. Article Summary on PubMed.

Scott A, Docking S, Vicenzino B, et al. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012 [erratum in: Br J Sports Med. 2013;47(12):744]. Br J Sports Med. 2013;47(9):536-544. Free Article.

Littlewood C, Ashton J, Chance-Larsen K, et al. Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy. 2012;98(2):101-109. Article Summary on PubMed.

Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466(7): 1539–1554. Free Article.

Senbursa G, Galtaci G, Atay A. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clincial trial. Knee Surg Sports Traumatol Arthrosc. 2007;15(7):915-921. Article Summary on PubMed.

*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Authored by Julie A. Mulcahy, PT, MPT. Reviewed by the editorial board.


How can Physical Therapists help those with Achilles’ tendon injuries?

Physical Therapist’s Guide to Achilles Tendon Injuries (Tendinopathy)

Jump to:

Achilles Tendon Injuries (Tendinopathy)
How Does it Feel?
How Is It Diagnosed?
How Can a Physical Therapist Help?
Can this Injury or Condition be Prevented?
Real Life Experiences
What Kind of Physical Therapist Do I Need?
Further Reading
An Achilles tendon injury (tendinopathy) is one of the most common causes of pain felt behind the heel and up the back of the ankle when walking or running. While Achilles tendinopathy affects both active and inactive individuals, it is most common in active individuals; 24% of athletes develop the condition. Males experience 89% of all Achilles tendon injuries, and an estimated 50% of runners will experience Achilles pain in their running careers. In all individuals, Achilles tendinopathy can result in a limited ability to walk, climb stairs, or participate in recreational activities.
Achilles Tendon Injuries (Tendinopathy)
Achilles tendinopathy is an irritation of the Achilles tendon, a thick band of tissue along the back of the lower leg that connects the calf muscles to the heel. The term tendinopathy refers to any problem with a tendon, either short or long term. The Achilles tendon helps to balance forces in the leg and assists with movement of the leg and the ankle joint. Achilles tendinopathy results when the demand placed on the Achilles tendon is greater than its ability to function. This can occur after 1 episode (acute injury) or after repetitive irritation or “microtrauma” (chronic injury).

The severity of acute injuries is graded based on the amount of damage to the tendon:

Grade I: Mild strain, disruption of a few fibers. Mild to moderate pain, tenderness, swelling, stiffness. Expected to heal normally with conservative management.
Grade II: Moderate strain, disruption of several fibers. Moderate pain, swelling, difficulty walking normally. Expected to heal normally with conservative management.
Grade III: Complete rupture, often characterized by a “pop,” immediate pain, inability to bear weight. Typically requires surgery to repair.
Most often, Achilles tendon pain is the result of repetitive trauma to the tendon. This repetitive strain can result in chronic Achilles tendinopathy, which is a gradual breakdown of the tissue and is most often treated with physical therapy.


Achilles tendinopathy may result from a combination of several different variables, including:

Ankle stiffness
Calf tightness
Calf weakness
Abnormal foot structure
Abnormal foot mechanics
Improper footwear
A change in an exercise routine or sport activity
Pain can be present at any point along the tendon; the most common area to feel tenderness is just above the heel, although it may also be present where the tendon meets the heel.

Achilles Tendon Injury See More Detail

How Does it Feel?
With Achilles tendinopathy, you may experience:

Tenderness in the heel or higher up in the Achilles tendon
Tightness in the ankle
Tightness in the calf
Swelling in the back of the ankle
Pain in the back of the heel
Pain and stiffness with walking, worst with the first several steps

How Is It Diagnosed?
Your physical therapist will review your medical history and complete a thorough examination of your heel. The goals of the initial examination are to assess the degree of the injury and determine the cause and contributing factors to your injury.

It is common for your physical therapist to perform a movement assessment. This may include watching you walk, squat, step onto a stair, or balance on 1 leg. The motion and strength in your leg will also be assessed.

Your physical therapist may also ask questions regarding your daily activities, exercise regimens, and footwear to identify other contributing factors.

Imaging techniques, such as x-ray or MRI, are often not needed to diagnose Achilles tendinopathy.

How Can a Physical Therapist Help?
You and your physical therapist will work together to develop a plan to help you achieve your specific goals. To do so, your physical therapist will select treatment strategies including any or all of the following areas:

Pain. Many pain-relief strategies may be implemented, such as applying ice to the area, putting the affected leg in a brace, or using therapies such as iontophoresis (a medicated patch placed on the skin that is electrically charged and used to decrease pain and inflammation) or therapeutic ultrasound.
Range of motion. Your ankle, foot, or knee joint may be moving improperly, causing increased strain on the Achilles tendon. Self-stretching and manual therapy techniques (massage and movement) applied to the lower body to help restore and normalize motion in the foot, ankle, knee, and hip can decrease this tension.
Muscular strength. Muscular weaknesses or imbalances can result in excessive strain on the Achilles tendon. Based on your specific condition, your physical therapist will design an individualized, progressive, lower-extremity resistance program for you. You may begin by performing strengthening exercises in a seated position — for example, pushing and pulling on a resistive band with your foot. You then may advance to exercises in a standing position — for example, standing heel raises.
Manual therapy. Your therapist may treat your condition by applying hands-on treatments to move your muscles and joints in order to improve their motion and strength. These techniques often address areas that are difficult to treat on your own.
Functional training. Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities. To minimize the tension on the Achilles tendon and your risk of repeated injury, it is important to teach your body safe, controlled movements. Based on your goals and movement assessment, your physical therapist will create a series of activities that will help you learn how to use and move your body correctly to safely perform the tasks required to achieve your goals.
Patient education. Your therapist will work with you to identify, and establish plans to address, any possible external factors causing your pain, such as faulty footwear or inappropriate exercises. He or she will assess your footwear and recommend improvements, and develop a personal exercise program to help ensure a pain-free return to your desired activities.
Physical therapy promotes recovery from Achilles tendon injuries by addressing issues such as pain or swelling of the affected area, and any lack of strength, flexibility, or body control. When the condition remains untreated, pain will persist and may result in a complete tear of the Achilles tendon, which often requires surgery to repair.

If your surgeon decides that surgery is needed, physical therapy will be necessary after surgery for several months. Immediately after surgery, your ankle will be placed in a splint or cast with crutches to allow the repaired tissue to heal. Once sufficient healing has occurred, you will work with your physical therapist to progressively regain your ankle mobility and leg strength. He or she will also help you regain your ability to walk without assistance—and carefully guide your return over time to your desired recreational activities.

Can this Injury or Condition be Prevented?
Maintaining appropriate lower extremity mobility and muscular strength, and paying particular attention to your exercise routine—especially changes in an exercise surface, the volume of exercises performed, or your footwear are the best methods for preventing Achilles injuries.

Your physical therapist will help guide you through a process that will progressively reintegrate more demanding activities into your routine without overstraining your Achilles tendon. Keep in mind that returning to activities too soon after injury often leads to persistent pain, and the condition becomes more difficult to fix.

Real Life Experiences
Kevin is a 45-year-old recreational distance runner training for his second 5K road race. He runs 3 to 4 days each week. Over the past 2 months, he has begun to experience pain in the back of his right heel. His pain is worst at the beginning of his training runs; he also experiences pain and stiffness when taking his first steps in the morning and after standing up from his desk at work. He typically performs stretches for 5 minutes before or after his runs and is wearing running shoes that he purchased 10 months ago.

Kevin is becoming impatient as his pain is not improving, despite the fact that he has decreased the length of his runs. He is worried about his ability to train for and compete in an upcoming race, and consults his physical therapist.

The physical therapist conducts a comprehensive examination of Kevin’s motion, strength, balance, movement, and running mechanics. Kevin describes his typical daily running routine, including distance, pace, and running surface; his stretching routine; and his footwear. Based on these findings, the physical therapist diagnoses Achilles tendinopathy.

Kevin and his physical therapist work together to establish short- and long-term goals and identify immediate treatment priorities, including icing and stretching to decrease his pain, as well as gentle foot and ankle strengthening exercises. They also discuss temporary alternative methods for Kevin to maintain his fitness without continuing to aggravate his injury and prolong his recovery, including swimming, biking, and aqua jogging. Kevin is also prescribed a home exercise program consisting of a series of activities to perform daily to help his recovery.

Together, they outline an 8-week rehabilitation program for Achilles tendinopathy. Kevin visits his physical therapist 1-2 times each week; she assesses his progress, performs manual therapy techniques, and advances his exercise program as appropriate. She also advises him when it is appropriate to resume running, and establishes a day-by-day plan to help him safely build back up to his desired mileage. They also discuss the appropriate running footwear, given Kevin’s foot shape, movement patterns, and injury history. Kevin also performs an independent daily exercise routine at home, including stretching and strengthening activities. After 8 weeks of patience and diligence, Kevin no longer experiences pain or stiffness in the affected leg and resumes his desired training program without pain in preparation for his upcoming 5K race.

What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat Achilles tendinopathy. However, you may want to consider:

A physical therapist who is experienced in treating people with Achilles tendinopathy. Some physical therapists have a practice with an orthopedic or musculoskeletal focus.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you’re looking for a physical therapist (or any other health care provider):

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people who have Achilles tendinopathy.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Further Reading
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of Achilles tendinopathy. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Maffulli N, Longo UG, Loppini M, Denaro V. Current treatment options for tendinopathy. Expert Opin Pharmacother. 2010;11:2177-2186. Article Summary on PubMed.

Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med. 2007;41:211–216. Free Article.

Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med. 2003;22:675-692. Article Summary on PubMed.

* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Authored by Allison Mumbleau, PT, DPT, SCS. Reviewed by the editorial board.

Get your brain in shape

Editor’s note: Jayatri Das is chief bioscientist and lead developer of “Your Brain,” the nation’s largest permanent museum exhibit dedicated to the brain, which opened at The Franklin Institute in Philadelphia this month.
(CNN) — From the outside, the human brain might not be much to look at. What makes it fascinating is hidden within, in the complicated circuitry of neurons that makes you who you are.
Scientists are trying to understand this complex network and find the key to staying sharp as we age. In the meantime, use what they do know: that exercising these neurons can improve your memory and possibly stave off dementia.
Fish oil cited in healing injured brain Brain dead: What it is, what it isn’t We may soon be able to upload memories
In honor of Alzheimer’s & Brain Awareness Month, spend some time getting to know your brain a little better.
The basic building blocks
Neurons, the functional building blocks of your brain, communicate using a combination of electrical and chemical signals. How and when do they fire? How are they wired together? How does that wiring change?
Understanding these fundamental mechanisms isn’t just a trip back to biology class. This knowledge is essential to understanding how you can keep your brain healthy, and why these different strategies work.
The 86 billion neurons in your head are constantly active. Even though the brain doesn’t account for much of your body weight, it uses 20% of your body’s energy to function. It’s a matter of gray and white.
Gray matter, which contains the parts of neurons that carry out thought processing, uses most of this energy. White matter is more efficient. It contains the long axons of neurons that relay signals and coordinate different areas of the brain.
However, it’s not enough for your brain cells simply to fire in the same patterns over and over. From moment to moment, throughout your life, your neurons need to rewire themselves based on your genes and experiences.
The differences in the connections between neurons are what make each of our brains unique, but characterizing those differences is among the biggest challenges facing scientists today. Even if scientists could record the network of a whole brain in an instant, it would only capture a single frame of a lifelong movie.

This story is part of CNN Health’s “Inside your Brain” series.
Keep your brain strong
There are things you can do on a daily basis to help your brain stay sharp.
Most importantly, stay in good physical health. Exercising and eating a healthy diet may sound as trite as “an apple a day,” but repeated studies have shown how these practices help the brain at a cellular level.
Mediterranean diet is brain food
Exercise improves cognitive functions ranging from math to memory across the lifespan, and it can even benefit brain function during the early stages of Alzheimer’s disease. Exercise enhances the growth and survival of new neurons in the hippocampus — a region of the brain essential for long-term memory — which may be able to replace others that degenerate as a result of the disease.
Blueberries, kale, coffee and nuts often get a lot of attention as good “brain foods” because of their high levels of antioxidants. Why?
Negatively charged oxygen compounds are produced as a byproduct of your body’s normal metabolism. They can set off chemical chain reactions that eventually damage or kill cells. Because your neurons are so active, your brain is particularly susceptible, and antioxidants can prevent those chain reactions from occurring.
Give your brain an active lifestyle
You know you need to workout to keep your body in shape. Your mind is no different. Learning and practicing any challenging skill — for example, a second language, reading, or even juggling — can change the structure of your brain for the better.
This is your brain on knitting
This type of mental stimulation can delay cognitive decline associated with Alzheimer’s disease, although there’s evidence that once the symptoms of dementia begin, they progress faster.
Also, stay connected with friends and family — as long as it doesn’t create more stress! Several studies have shown that being part of a larger social network can reduce the cognitive effects of Alzheimer’s disease.
Accept the things you cannot change
The fact that the brain is always changing gives us the opportunity to shape those neural connections through our behavior and environment. But beneath all of those factors lies the unchangeable role of genetics.
How do genes and your environment interact in normal aging, let alone result in diseases such as Alzheimer’s? Neuroscientists are still looking at the effects of lifestyle choices, finding genes associated with elevated risk of disease, and studying the molecular mechanisms through which plaques and tangles of proteins damage neurons.
So far, however, the advances we are making are merely laying the groundwork for a future set of questions. We can only hope that someday, in a future June, we’ll be celebrating a cure for Alzheimer’s instead.

4 surprises from eating vegetables

Editor’s note: Lyssie Lakatos and Tammy Lakatos Shames, also known as The Nutrition Twins, are registered dietitians, personal trainers and authors of “The Nutrition Twins’ Veggie Cure.” Connect with them on NutritionTwins.comPinterestTwitter and Facebook.

(CNN) — You’ve seen Meatless Mondays, vegan restaurants and green drinks become all the rage. You know that vegetables can help you lose weight and fend off chronic diseases. Yet if you’re likemost Americans, you probably still aren’t eating enough of them.

If you need a little motivation to get your share, here are four surprising reasons to increase your vegetable intake:

Cut this food and extend your life

Why Michelle Obama dances with veggies

Schoolchildren eating fruits & veggies

1. They fight bloat

Although you may associate vegetables with creating a bloated belly, most vegetables actually do the opposite. Vegetables are rich in fiber, which flushes out waste and gastric irritants and prevents constipation by keeping the digestive tract moving.

Vegetables can also help you look leaner by counteracting bloat caused by salt. Most American adults get nearly twice the recommended sodium limit. Eating a bacon and egg biscuit, a typical restaurant meal, or instant soup means consuming nearly an entire day’s sodium allotment. Vegetables are rich in both potassium and water, which help flush excess sodium out of the body while restoring the body’s normal fluid balance.

To ease that full feeling in your stomach, try eating fennel, cucumbers, summer squash, romaine lettuce, red leaf lettuce or tomatoes.

If you experience gas when you start to add more fiber and vegetables to your diet, choose steamed vegetables rather than raw ones. The heat from cooking breaks down some of the fiber and will keep gastric distress to a minimum as your body adjusts to consuming the fiber you need.

5 ways to flatten your belly (no crunches needed)

2. They create a youthful glow

Want younger-looking skin? Vegetables prevent unwanted signs of aging and keep skin young and supple thanks to phytonutrients, vitamin C and high water content.

Many vegetables are 85% to 95% water, which helps hydrate the skin and reduce wrinkles. And phytonutrients, found in all vegetables, can guard against premature aging by preventing cell damage from stress, the sun, pollution and other environmental toxins. Vitamin C aids in collagen formation, according to studies.

Choose brightly colored red and orange vegetables and you’ll get an added boost of beta carotene, which can give you a healthy glow as it protects skin from sun damage. Similarly, lycopene, found in red vegetables such as tomatoes, also has been shown to act as a natural sunscreen.

6 common sun myths exposed

Eat vegetables like tomatoes, cucumbers, bell peppers, broccoli and potatoes for vitamin C, and carrots, sweet potatoes, butternut squash and other orange produce for beta carotene.

3. They reduce stress

Stress can make you tired and moody, hindering your ability to make healthy nutrition choices. The result is emotional overeating and binges.

Should you eat more frozen food?

Robin Quivers: Veggies changed my life

Eating right to boost your immune system

Do you know your fruits and vegetables?

Meanwhile, nutrients like magnesium and vitamin C are quickly depleted during stressful times. Luckily, many vegetables contain these very nutrients, as well as tension-reducing omega-3 fatty acids and B vitamins thatfight anxiety and depression.

The potassium and magnesium found in some vegetables can also calm you on the inside as they relax blood vessels and keep your blood pressure down, according to research. And fiber keeps blood sugar levels stable, preventing dips in energy and the associated mood swings.

To reduce stress, eat any vegetable. Mushrooms, leafy greens, squash, potatoes, bell peppers, spinach, bok choy, fennel, string beans and edamame are especially good sources of several vitamins and minerals.

For a no-fuss way to consume more vegetables and combat stress, add leafy greens, mushrooms and peppers to your sandwiches, wraps, soups, pizza, tomato sauce and omelets.

Destress your life in 10 easy steps

4. They protect your bones

Most people think of dairy foods as the bone protectors, thanks to their high calcium and vitamin D content. But some vegetables also have these same nutrients in addition to bone-building vitamin K, magnesium, potassium and prebiotic fiber.

Tomatoes in particular have recently been connected to bone health. A study found that when you remove lycopene-rich foods like tomatoes from the diet, women are at increased risk of osteoporosis.

Eat strong-spined, dark leafy greens like collard greens, turnip greens, kale, spinach (cooked for more calcium!), broccoli and green peas for calcium and vitamin K. Mushrooms contain vitamin D while asparagus, chard, kale, artichokes, onions, garlic and leeks are full of prebiotic fiber.

Tips to keep your bones healthy

7 servings of fruits and vegetables

Study: Eat 7 servings of fruit, veggies daily

You know the saying, “An apple a day keeps the doctor away”? Turns out eating one apple isn’t enough. A new study suggests people who eat up to seven servings of fruit and vegetables a day can cut their risk of premature death by 42% – and that vegetables may be more important than fruit to your overall health.

The study, conducted by scientists in the United Kingdom, was published online Monday in the Journal of Epidemiology and Community Health.

The study

Researchers looked at data from more than 65,000 adults over age 35 who participated in the Healthy Surveys for England study between 2001 and 2008.

HSE surveyors had asked participants about their fruit and vegetable consumption during a 24-hour time period. Portion sizes were defined by the UK’s Department of Health to be about 80 grams (equivalent to just under 3 ounces). The new study authors compared this nutrition information to mortality data for the group over the following eight or so years.

The results

The participants ate an average of 3.8 servings of fruit and vegetables per day. Older, non-smoking women tended to eat more than other demographic groups. Produce consumption was also linked to participants’ body mass indexes; those who ate more fruit and vegetables tended to have a lower BMI.

The researchers found that a diet rich in fruit and vegetables can be protective against cancer, heart disease and all other causes of death. Eating at least seven servings was best, but each serving increase was associated with a lower risk of death.

To make sure they weren’t counting people who were seriously ill at the time of the survey, researchers excluded deaths that occurred in the year following the data collection. When they did so, they found that people who ate at least seven daily servings of fruit and vegetables had a 42% lower risk of death from all causes during the study’s follow-up period than those who ate less than one daily serving.

When researchers broke it down by cause of death, veggie lovers had a 25% lower risk of dying from cancer, and a 31% lower risk of dying from heart disease or stroke during that same period.

Vegetables seemed to provide a greater health benefit than fruit. Eating more than three or four servings of fruit daily didn’t increase a study participant’s chance of survival, the study authors concluded.

Study limits

HSE surveyors only recorded one day of each study particpant’s fruit and vegetable consumption. On that day, the participant could have eaten more or less produce than they would normally consume.

Researchers also did not include participants’ total caloric intake, salt consumption or fat consumption in their analysis.

As the study authors say, their data shows a “strong association, but not necessarily a causal relationship.”


Eat more vegetables. Even if you, like many of the study participants, believe you’re eating an overall healthy diet, you “need to aim higher,” according to an editorial accompanying the study.

This study follows previous research presented at the American College of Cardiology’s annual session last week. Dr. Michael Miedema and his colleagues found that women who ate eight to nine servings of fruit and vegetables in their 20s were 40% less likely to have dangerous plaque in their arteries in their 40s.

“There is value in knowing how the choices we make early in life have lifelong benefits,” Miedema said in a press release.

So fill up on salad. Snack on raw carrots. And yes – eat that apple.

Heatstroke: a summer danger

(CNN) — Heatstroke deaths often surge in summer months as temperatures rise.

Your normal body temperature is around 98.6 degrees Fahrenheit; with heatstroke the body can warm up to 106 degrees F or higher in 10 to 15 minutes.

Unlike heat exhaustion, a milder form of heat-related illness,heatstroke causes the skin to become red or hot; your pulse quickens and becomes stronger. If not treated immediately, heatstroke can lead to death or permanent disability.

Heatstroke symptoms

Heatstroke symptoms include an elevation of body temperature, lack of sweating, headaches, nausea and vomiting. Neurological symptoms, such as confusion and unconsciousness, can also result from extreme exposure to heat, according to the Mayo Clinic.

Elderly people and young children, as well as people with chronic severe illnesses, have the highest risk of developing the condition. People with kidney, liver and heart problems in particular should be extra aware of the heat, experts say, and should talk with their doctors about heat exposure.

How hot cars can kill kids

Heatstroke treatment

If you believe someone is having a heatstroke, the CDCrecommends moving him or her to a cooler location, calling 911 and using damp cloths or a cool bath to help lower his or her body temperature. Do not give the victim any fluids.

In severe cases, patients must be admitted to the intensive care unit, where medical staff watch body temperature carefully.

“If you can get them to treatment fairly quickly, they’ll survive it,” said Dr. Janyce Sanford, chair of emergency medicine at the University of Alabama, Birmingham.

Treatment focuses on cooling the patient down to a normal body temperature. If the patient has a clear airway, breathes normally and has normal circulation, Sanford said medical staff will remove his or her clothes and spray cool water while a fan is blowing. Cool intravenous fluids can also help bring body temperature down.

Heatstroke prevention

To protect yourself, try to avoid strenuous physical activity outside during the hottest time of the day — between 10 a.m. and 6 p.m.

People who must work outside should make sure to drink plenty of water every half-hour or so and take breaks in a cool environment if possible, Sanford said. Wearing lightweight, light-colored clothing and a wide-brimmed hat can also help, according to the Mayo Clinic.

The CDC also stresses that no one should be left in a closed, parked vehicle. In 2013, the number of confirmed heatstroke deaths of children left in cars was 39, reports Jan Null, a certified consulting meteorologist with San Francisco State University.

You can tell if you’re dehydrated by looking at your urine. If you’ve had adequate amounts of water, your urine will be light in color; a darker yellow or orange means you need to drink more.

And make sure you check on the elderly, especially if they don’t have air conditioning. They should spend time in cool places such as a library or a mall to get a break from the heat, Sanford said.

5 tips for surviving extreme heat

CNN’s Elizabeth Landau and Sara Cheshire contributed to this report.

Knee Osteoarthritis: daily walking maintains function

Janis C. Kelly | Disclosures

Patients with knee osteoarthritis (OA) can gain significant benefits and avoid physical function limitations by simply walking more, Daniel K. White, PT, ScD, and colleagues report in Arthritis Care & Research.
“As clinicians, we should be promoting walking in our patients with knee OA. We should have them measure their physical activity with a pedometer, much like people measure their weight with a scale. Those starting on a walking program should get to a target of at least 3000 steps/day and ultimately try to reach 6000 steps/day. This is well below the popular anecdote of 10,000 steps/day, which may be good news to those starting out. It doesn’t take much to get to 3000 steps/day,” Dr. White told Medscape Medical News. He is research assistant professor, Department of Physical Therapy & Athletic Training, Boston University College of Health and Rehabilitation Sciences, Massachusetts.
Long-Term Study Documents Benefits of Walking in Patients With Knee OA
The researchers measured daily steps taken by 1788 people with or at risk for knee OA who were part of the Multicenter Osteoarthritis (MOST) Study, a large multicenter longitudinal cohort study of community-dwelling adults. Mean age was 67 years, mean body mass index (BMI) was 31 kg/m2, and 60% of participants were female.
The researchers measured the number of steps patients walked with an ankle monitor over 7 days. They measured functional limitation at baseline and again 2 years later. The researchers defined functional limitation as walking speed less than1.0 m/s or Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical function score of28 or greater out of 68.
The authors reported, “Among study participants who did not develop slow walking at the two-year follow-up (<1.0 m/s), 80% walked at least 5300 steps/day.” The minimum for preventing functional decline was between 3250 and 3700 steps/day. Walking an additional 1000 steps each day was associated with a 16% to 18% reduction in incident functional limitation 2 years later.
“Our findings add to [the] notion that walking is good for people with knee OA. Specifically, walking that occurs during unstructured activities, a few steps here and there, add up and do seem to make a difference in terms of prevention of functional limitation in this patient population. I hope that these findings will lead to clinicians encouraging their patients to use a pedometer to measure their physical activity and work towards the 3000 then 6000 steps/day goal,” Dr. White said.
Results Mirror Those of Preclinical OA Studies
Giuseppe Musumeci, PhD, research professor of human anatomy, Department of Bio-Medical Science, University of Catania, Italy, told Medscape Medical Newsthat the result from Dr. White and colleagues’ study mirror those his team observed using rat models of knee OA. Dr. Musumeci was not involved in the current study.
“Although the diagnosis of OA was only based on radiologic and clinical features, and the use of StepWatch Activity Monitor could have some limitations, I think that the results are reliable, since they mirror the molecular and histopathologic findings. Unstructured physical activity is an easy and affordable way treat OA, especially for older patients, in whom comorbidity and metabolic diseases are also common. Structured physical activity adapted to age, OA, and comorbidity also could be helpful. Physical activity stimulates the expression of lubricin, a lubricant molecule of synovial fluid that is important for cartilage trophism and that contributes to the delay of OA development,” Dr. Musumeci said.
More Walking Might Reduce Healthcare Costs Associated With Knee OA
According to Dr. White, data from the National Health and Nutrition Examination Survey showed that 80% of patients with OA have some limitation in movement and that 11% of adults with knee OA need assistance with personal care.
“Our findings strongly suggest that walking does work to prevent the onset of problems with physical functioning in the future in people with knee osteoarthritis,” Dr. White said.
Dorothy D. Dunlop, PhD, professor of medicine and preventive medicine at Northwestern University Feinberg School of Medicine, Chicago, Illinois, said, “This paper provides additional evidence of benefits from being physically active for adults with arthritis. A key finding is that the more these adults walked, the smaller was the chance for subsequent functional problems. The benefit from walking demonstrated by this paper is good news, since walking is easy to weave into daily routines and has no cost.” Dr. Dunlop was not involved in the study.
The authors concluded, “Clinicians and policy makers can consider these goals as preliminary levels of physical activity to recommend to people with or at high risk of knee OA. These steps/day thresholds merit further evaluation as improving daily walking may be an inexpensive means of minimizing functional limitations in knee OA.”
“The public health message is adults should be as physically active as possible, including people with arthritis,” Dr. Dunlop told Medscape Medical News. “This paper provides additional evidence of benefits from being physically active for adults with arthritis. A key finding is the more these adults walked, the smaller was the chance for subsequent functional problems. Even an increase as small as 1000 steps/day reduced the chance for developing functional problems.”
Dr. Musumeci added, “I think that we can suggest to our patients to improve their physical activity, and 6000 steps/day could be a good goal. Preventing and delaying OA development could definitely reduce the cost of hospitalization and surgical intervention.”
The authors, Dr. Musumeci, and Dr. Dunlop have disclosed no relevant financial relationships.
Arthritis Care Res. Published online June 12, 2014. Abstract

Certain video games can improve fitness

Laird Harrison | Disclosures

ORLANDO, Florida — Although often implicated as a factor in the worldwide obesity epidemic, video games can improve fitness, a batch of new studies show.
The studies were presented here at the American College of Sports Medicine (ACSM) 61st Annual Meeting.
In a pair of studies by one group of researchers, markers of strength, agility, endurance, and body composition improved significantly in college students after they played Just Dance 4 Kinect for the Xbox (Microsoft) for 2 months.
“Based on our study, we can say that health-related fitness and skill-related fitness could improve,” said coauthor Chieh-Hsin Tsai, from Kaohsiung Medical University in Taiwan.
The Kinect games use sensors to detect players’ movements. “It’s real dancing,” Tsai said. “You don’t need to hold a console because the sensors follow you.”
Previous research has established that people burn calories when playing active video games (Arch Pediatr Adolesc Med. 2012;166:1005-1009). Kinect games encourage such movement, as do Wii games (Nintendo), which involve the use of a console.
The studies presented here reinforce that finding.
But researchers have only recently begun to assess the effects of these “exergames” on health.
For their studies, Tsai and his colleagues randomly assigned college students to play 1 of 2 video games at least 3 times a week for 30 minutes at a time for a period of 8 weeks. Eight students played Just Dance 4 and 5 played a sedentary video game (control group).
The researchers calculated, on the basis of metabolic equivalents, that the dance game met ACSM standards for moderate to vigorous exercise.
At baseline, mean body mass index (BMI) was 27.07 kg/m² in the dance group and 26.86 kg/m² in the control group.
The researchers used oxygen consumption as a measure of cardiorespiratory endurance, long jump distance as a measure of power, the V-sit and reach test as a measure of flexibility, and the number of side-step jumps completed as a measure of agility. Improvements were significant.
Table 1. Changes in Fitness After 8 Weeks

There was no significant difference between the 2 groups in balance, speed, or reaction time after the 8-week period.
In a parallel study, Tsai’s team assessed overweight or obese college students; 7 were assigned to the Just Dance 4 cohort and 7 were assigned to the control group.
After 8 weeks, improvements in the dance group were significant.
Table 2. Body Composition After 8 Weeks

After viewing the posters, Julien Tripette, PhD, from the National Institute of Health and Nutrition in Shinjuku, Japan, told Medscape Medical News that he got similar results in a study of a Nintendo game, but wanted to know more.
“Everyone gets positive effects in 8 weeks,” he said. “But we have fewer data on longer periods. The problem is the adherence of the subjects.”
Over time, people get bored of playing the same game, Dr. Tripette explained. And it’s not clear whether subjects supplied with a free game for the purpose of a study would be likely to buy their own games and continue using them.
Research by 2 other groups presented at the meeting suggests that participating in active video games might not quite take the place of exercising with other people.
Both studies showed that subjects who attended a Zumba fitness class with a live instructor achieved a significantly higher heart rate during the workout than those who used the Zumba Fitness Kinect game.
Mr. Tsai and Dr. Tripette have disclosed no relevant financial relationships.
American College of Sports Medicine (ACSM) 61st Annual Meeting : Abstracts 403, 402, 326, and 324. Presented May 28, 2014.

Myofascial release effective for short term flexibility

Laird Harrison | Disclosures

ORLANDO, Florida — Myofascial release, a type of massage, improves range of motion to the same extent as static stretching in the short term, a new study shows.
And in a separate study, contract–relax stretching was shown to weaken muscles more than static stretching.
The results from both studies were presented here at the American College of Sports Medicine 61st Annual Meeting.
The head-to-head comparison of static stretching and myofascial release showed that, “at least in terms of a single day, myofascial release was as effective as static stretching,” said researcher Rebecca Kudrna, MS, an instructor at DeSales University in Center Valley, Pennsylvania.
Traditionally, athletes have practiced static stretching, in which they hold a stretched muscle or tendon group in 1 position for several seconds. Previous research has shown that this type of stretching over a period of at least 3 weeks can increase range of motion by lengthening muscles.
In addition, static stretching can relax nerves, which can increase range of motion in the short-term; however, it also temporarily weakens the stretched muscles. Previous research has suggested that myofascial release is less likely to have that effect on strength, Kudrna reported.
In fact, many athletes are now using myofascial release instead of static stretching, and some trainers and physical therapists have promoted its use to treat joint and muscle pain.
Some practitioners of myofascial release massage their patients; others teach patients to massage themselves using foam rolls, balls, or other instruments.
But at least 1 previous study found myofascial release ineffective for improving hamstring range of motion over the long term (UW-La Crosse JUR. 2006;IX).
Short-term Benefits, But They Diminish Quickly
To determine the effectiveness of myofascial release, Kudrna and her colleague Zachary Kaminski assessed 12 male and 12 female physically active college students.
After a warm-up period and a baseline assessment, the subjects were randomly assigned to a 14-minute period of static stretching, myofascial release, or sitting still.
The researchers reassessed range of motion 3 minutes and 10 minutes after the 14-minute intervention.
There was a significant increase in range of motion after static stretching and myofascial release at the 3- and 10-minute assessments (P < .05), but not after sitting still for either time point.
Myofascial release was significantly more effective at 3 minutes than static stretching (P < .05), but not at 10 minutes.
In both exercise groups, range of motion diminished between the 3-minute assessment and the 10-minute assessment.
This study supports myofascial release for athletic warm-ups, Kudrna reported. But she acknowledged that short-term benefits to range of motion diminish quickly. “Usually between 10 and 15 minutes, all of your effects go away,” she said.
Myofascial release is “very trendy,” said Trevor Cottrell, PhD, professor of exercise science and health promotion at Sheridan College in Brampton, Ontario, Canada. “Foam rolling is really popular.”
Dr. Cottrell said that his own research has shown that myofascial release does not benefit athletic performance over the long term. “You do tend to get more range of motion,” he told Medscape Medical News. However, “when you objectively measure performance, it does not improve.”
Kudrna noted that other options are available for warm-ups, such as dynamic stretching, in which subjects move gradually from one position to another rather than holding a single position. “Dynamic stretching is very well researched,” she said. “It’s very clear that it increases mechanical flexibility without affecting power.”
She and her colleague are currently conducting a study to see whether myofascial release can produce the kind of long-term muscle-lengthening achieved with static stretching.
Contract–Relax Stretching
In the study of contract–relax stretching, Sidse Balle, MD, from the Nicholas Institute of Sports Medicine and Athletic Trauma in New York City, and her colleagues compared the effects on strength of this approach with static stretching in 20 healthy volunteers.
In contract–relax stretching, a clinician places the subjects muscle into a position of stretch. The subject contracts the restricted muscle, then relaxes that muscle and contracts the opposing muscle.
“We found that both stretching interventions result in muscle strength loss,” Dr. Balle told Medscape Medical News, but contract–relax stretching weakened muscles even more than static stretching.
Ms. Kudrna, Dr. Cottrell, and Dr. Balle have disclosed no relevant financial relationships.
American College of Sports Medicine (ACSM) 61st Annual Meeting: Abstracts 603 and 744. Presented May 28, 2014.