Bone Joint and Muscle Problems
Help for What Hurts
To an extent, aches and pains are just part of life--little reminders that you're not 18 anymore . . . and haven't been for a long, long time.
But then there's the deep-down lasting hurt of arthritis. Or the recurring agony of tendinitis. Or the often-excruciating aching-muscle pain of fibromyalgia. What can you do when pain takes off its coat and hat and decides to stay for awhile?
You could reach for aspirin, or even prescription medication, but you may wish to consider nondrug pain-relief options. Yoga, exercise, massage and other alternative therapies provide first-line relief for bone, joint or muscle problems.
NATURAL WAYS TO END THE PAIN CYCLE
Medical doctors often prescribe drugs like steroids, but that remedy could prove to be a vicious cycle after awhile, says David Molony, Ph.D., licensed acupuncturist and executive director of the American Association of Acupuncture and Oriental Medicine, who practices in the northern suburbs of Philadelphia.
"Drugs stop any inflammation straight-out, and if nothing else is wrong with the body, it heals itself," says Dr. Molony. "But if there's a functional reason for the pain, which there usually is, the inflammation comes back and the doctor prescribes steroids again. And that can become a problem."
Dr. Molony says that more than 50 percent of the people who come to see him have some kind of muscle, joint or bone problems. By the time that most people turn to alternative treatments, "everyone else in conventional medicine has played with them and they realize they have something that needs more attention," he explains.
Sometimes the body has been "programmed" to do things wrong. Your muscles may be in constant spasm, or you're getting permanent knots in your shoulders simply because you're tensely hunching your shoulders or allowing your back to slump. Over time, you grow used to it, says Dr. Molony.
If habits like these cause a spasm, "it will come back unless you reprogram the muscle and help it heal," Dr. Molony says. "That's achieved with a mixture of acupuncture and Chinese herbs.
"Acupuncture relieves pain by stimulating the release of endorphins, natural pain-relieving substances in the brain that block pain biochemically. It also balances the body and reduces inflammation so that it heals faster." The combination of acupuncture and herbs can reduce inflammation and increase blood flow, Dr. Molony adds.
Acupressure can also help. When someone applies pressure at specific points on the body, it relieves muscle spasms and helps heal what's causing them, reducing pain in the process in most cases, he says.
In addition, here are some other, specific ways to deal with individual bone, muscle or joint problems.
ARTHRITIS: RELIEF FOR JOINT PAIN
If your hips hurt at the mere thought of a hula, or your wrists give up the ship after a few strokes of the canoe paddle, you could have something worse than rebellious joints. You might have arthritis.
This achy-joint condition comes in more than 100 forms, with osteoarthritis and rheumatoid arthritis being the most common. Osteoarthritis, which usually affects people over age 45, is a degenerative joint disease that is caused by the wear and tear of daily life. Rheumatoid arthritis also involves deterioration of joint tissue, but it usually comes earlier in life and is related to an immunity problem rather than a wear and tear on the joints. Two to three times more women than men get the rheumatoid kind, most often between the ages of 30 and 60.
But achy joints don't have to put an end to an active lifestyle. Alternative practitioners offer the following natural ways to help relieve pain and stiffness.
Get Yourself into Hot Water
Warm water can relieve the pain of stiff joints, says Irene von Estorff, M.D., assistant professor of rehabilitation medicine at New York HospitalCornell University Medical Center in New York City. Spending ten minutes in a whirlpool or a warm to hot shower works magic on the joints. The treatment can also make affected muscles more supple, says Dr. von Estorff.
After the warm soak, you might want to take five minutes or so for limbering stretches, or try some mild exercise. "Heat is very soothing generally--it relaxes the muscles around the joints so that they can move better," she notes.
But this treatment isn't appropriate if you have rheumatoid arthritis. While warm water works well for osteoarthritis, Dr. von Estorff cautions that heat can make an acute attack of rheumatoid arthritis worse by increasing swelling in the joints.
Get Up and Go
Regular aerobic exercise is a great way of improving blood flow and increasing circulation of fluid around the joints, says William Wilkinson, M.D., medical director of the Cooper Institute for Aerobics Research in Dallas. But he has specific advice on how to do it.
Make it low impact. "For women with arthritis, low-impact aerobic and flexibility activities--especially joint-friendly exercise like walking or swimming in a heated pool--help keep the joints mobile," he notes. "It also stimulates the muscles and tendons around it, which improves function and reduces pain." About 20 minutes of walking or swimming three times a week is a good workout. If possible, try to work up to 30-minute sessions five days a week, and avoid exercising when your joints are red, hot or swollen, he advises.
Lift weights--gently. Resistance training can increase range of motion, improve functioning in daily activities and help ease arthritis pain, notes Alan Mikesky, Ph.D., exercise physiologist and director of the Human Performance and Biomechanics Laboratory at Indiana University Purdue University in Indianapolis. Strong muscles help protect the joints from wear and tear. Dr. Mikesky recommends that people with osteoarthritis or rheumatoid arthritis whose pain and inflammation are under control consult their physicians about beginning a low-intensity training program.
The Vegetarian Cure
Vegetarian diets are great natural cures for immune-related conditions such as rheumatoid arthritis, says Andrew Nicholson, M.D., director of preventive medicine for the Physicians' Committee for Responsible Medicine, based in Washington, D.C.
Rheumatoid arthritis is an immunologic process, often in reaction to something foreign entering the body, Dr. Nicholson says. Your immune system can identify the protein in beef, chicken, fish, dairy products and eggs as foreign and attack it. Animal foods, especially dairy products, tend to be among the dietary items that cause the biggest reactions, according to Dr. Nicholson.
By cutting animal food from your diet, you can see improvements in just a few days, says Dr. Nicholson. But other doctors go further than that, he notes. Some precede the change to a vegetarian diet with a medically supervised seven- to ten-day fast using only water or juice, which allows the body to immediately flush out the substances considered troublesome.
Visualize Yourself Pain-Free
Using visualization and imagery to picture your joints smooth and healthy can help ease the pain and even the actual swelling of arthritis, according to Judith Green, Ph.D., professor of psychology and biofeedback in the Department of Behavioral Sciences at Aims Community College in Greeley, Colorado, and author of The Dynamics of Health and Wellness.
"Try to see the joint as a beautiful ball bearing that's smooth and perfect. Picture that several times a day, whenever you have a free minute to visualize the joint as healthy," she advises.
Veggies to the Rescue
Lorraine Hoffman, a 37-year-old housewife in Princeton, New Jersey, says a vegetarian diet relieved the severe rheumatoid arthritis that she had since age 19.
"I'd been on every medication that you can think of--gold shots, prednisone, tons of acetaminophen and others--up to eight pills a night," says Hoffman. "I had to have blood tests done every month because one of the medications that I was taking can ruin your liver and kidneys. X-rays of my joints show that, except for my knees, hips and right ankle, much of the cartilage is gone. In fact, most are just bone on bone.
"I got to the point where I could barely walk from my apartment to the car," says Hoffman. "My husband had to do the wash and clean and help with our baby.
"Then, one day I was talking to an acquaintance on the phone and she said, 'Have I got the doctor for you!'" The doctor that Hoffman consulted put her on a diet that was free of meat, wheat and dairy. The diet also excluded vegetables in the nightshade family, such as potatoes and tomatoes.
"Within five days, I felt a difference in my arthritis," Hoffman continues. "After a year on the vegetarian diet, I was a new woman. I lost 60 excess pounds, and I went off all my medications, including
"I wish I'd found this diet ten years ago," adds Hoffman. "It won't rebuild my ankle, but it helps me stay medication-free."
BACK PAIN: FLEX AWAY THE PAIN
It's almost as common as the common cold but, unfortunately, back pain lingers a lot longer than a case of the sniffles. In fact, back pain results in so many doctor visits--about six million a year--that it's a wonder how all those snowy sidewalks ever get shoveled. About half of working-age adults suffer from lower-back pain each year.
For women, though, more shoveling may be better than less, since too-little activity may contribute to the problem. Experts say that people who sit in front of computers all day often complain of lower-back pain. Before offices went paperless, you had to get up and walk across the room or down the hall every time you needed to retrieve a file or talk to someone. Now all you have to do is click a button or two on a keyboard. The result: no exercise and more stiff backs.
Another troublesome problem for women is pregnancy. The growing fetus puts a heavy burden on backs. Changing hormone levels trigger aches. And after pregnancy comes all the bending and lifting associated with child rearing.
But before you get too sore at back pain, try some alternative therapies. First of all, ice the area immediately, says Dr. von Estorff. Hold an ice pack on the area for 20 minutes with a thin towel between you and the pack to prevent damage to the skin.
Or you can rub an ice cube back and forth over the skin for 2 to 3 minutes. "When you have spasm, you have an awful lot of pain because of severe tightening of the muscles, so the ice slows the pain signals being sent to the brain," notes Dr. von Estorff.
Once you've addressed the immediate pain, you may be ready to try some other approaches.
Flex Your Back with Yoga
Practicing yoga for at least 15 minutes a day helps loosen and strengthen those all-important back muscles, says John Friend, an Iyengar yoga instructor in Spring, Texas. If you're just beginning yoga, practicing yoga in the middle of an acute attack isn't recommended. But stretching the back muscles can head off problems before they become debilitating.
Bend forward, loosen up. To relieve tightness and stiffness in the back, stand in front of a table, with your feet hip-width apart, says Judith Lasater, Ph.D., a physical therapist and yoga instructor in San Francisco and author of Relax and Renew: Restful Yoga for Stressful Times.
Bend forward from where your torso meets your thighs and rest your torso on the table. Your torso should be at a 90-degree angle to your thighs. (If the table is too low, stack a few blankets on the table to create a 90-degree angle.) Stretch your arms out in front of you and breathe slowly while you slightly bend your knees. Hold this pose for two minutes, then brace yourself with your arms and stand up straight.
Lift your leg, stretch your back. For a strained back, Friend suggests this yoga move: Lie on the floor on your back. Bend your left leg in toward your chest, while your right leg stays pressed to the floor. Hold this position for 30 to 60 seconds. Then switch legs. Repeat this stretch three times. Try keeping a gentle curve in your lower back, notes Friend.
Exercise Strengthens a Weak Back
All aspects of exercise are great for back health, notes Nicholas A. DiNubile, M.D., clinical assistant professor of orthopedics at the University of Pennsylvania in Philadelphia and author of The Exercise Prescription.
Studies show that people with better aerobic capacities have less incident of back injury. Overall fitness protects the lower back, including its strength and flexibility, notes Dr. DiNubile. That means doing a 30-minute aerobic activity at least three times a week. In addition, strong abdominal muscles are extremely important, he notes. He warns, however, that rowing machines can be a problem for someone prone to back problems.
Do three sets of 15 to 20 stomach crunches a day. To correctly do a stomach crunch, lay on the floor with your legs bent. Be sure to press your lower back toward the floor so that no space exists between your back and the floor. As you contract your abs, your torso will lift slightly off the ground. Use slow, controlled movements and point your chin toward the ceiling.
Lie and lift. To strengthen the back extensor muscles, Dr. DiNubile suggests the following: Lie on your stomach with your arms out in front of you, like Superman flying. Lift your arms, head, shoulders and legs so that only your stomach is still touching the ground. Hold for three to five seconds. Repeat ten times.
Stretch your hips and hamstrings. Flexibility is also important. Dr. DiNubile recommends the pelvic tilt for the lower-back area and the hamstring stretch for the back of the thighs. (For illustrated instructions for these stretches, see pages 106 and 108.)
Visiting a chiropractor can do wonders for a hurting back, says Scott Haldeman, D.C., M.D., Ph.D., associate clinical professor in the Department of Neurology at the University of California at Irvine and editor of Principles and Practice of Chiropractic. "We use chiropractic manipulation--putting pressure on the spine and moving the bones of the spine as well as pushing on the surrounding tissues and joints. It works very well for back pain."
The average number of visits for back pain is around six or eight, with visits lasting anywhere from 15 minutes to an hour. Some people need more treatments than that, while others may get better after just one treatment, says Dr. Haldeman.
Visit a Hellerworker
Going in for the standard 11 Hellerwork sessions is good for the whole musculoskeletal system, but the back especially reaps benefits, says Sandra Sullivan, a certified Hellerworker and director of practitioner relations at Hellerwork International in Mount Shasta, California. Each Hellerwork session focuses on a different part of the body. Because the back is so important to how the rest of the body feels and moves, every Hellerwork session includes some work on the back. And session six is exclusively for the back.
BURSITIS AND TENDINITIS:
SOOTHE PINCHES AND TWINGES
Your body is actually very chatty. It's shouting, "Hey, take it easy!" when your elbow starts to ache after that fifth set of tennis. And after your third mile of running uphill, it's saying, "Lighten up, buddy!" as your Achilles tendon gets painful and tight.
Tendinitis is caused by inflammation of the tendons, which connect muscle to bone. Bursitis is inflammation in the bursas, or fluid-filled sacs that decrease friction in the body's joints. Both of these problems may be brought on by a sudden increase in activity. And both can be so painful that they sideline you for awhile. Luckily, alternative therapies can help.
Put Your Pain on Ice
When it comes to pain and swelling, ice is the name of the game, notes Dr. von Estorff. "Usually, cold reduces pain more than heat does, so applying ice is best," she says. "Once the pain and swelling have gone away, you can do exercises to help make those muscles strong and less likely to become injured again."
For both bursitis and tendinitis, you want to hold an ice pack on the site of inflammation. Apply the pack for no more than 20 minutes at a time, Dr. von Estorff advises. You can apply the ice pack as often as every hour until the pain or inflammation goes away. Just make sure that you don't resume your normal workout routine until the swelling is gone, she cautions.
Massage: Rub It the Right Way
Tendinitis responds especially well to massage, says Ben E. Benjamin, Ph.D., muscular therapist and president of the Muscular Therapy Institute in Cambridge, Massachusetts. Friction massage is especially effective, according to Dr. Benjamin.
"Rub the tendons very gently, and you'll slowly wear down the scar tissue in the tendon itself," he notes. Such a massage usually takes 10 to 15 minutes. The massage therapist will want to work on you a couple times a week for at least three to four weeks.
For bursitis, however, it's a whole different procedure. A massage therapist won't directly massage the site of your bursitis because that could make the swelling worse, says Dr. Benjamin. "But a massage in the general area can help increase circulation there." (For details on massage therapy, see page 214.)
The Alexander Technique: A Perfect Solution
Because it teaches you how to use your body more efficiently, the Alexander Technique is perfect for bursitis and tendinitis, says Deborah Caplan, physical therapist and teacher of the Alexander Technique in New York City. "Tendinitis, especially, is caused by repeated strain on the tendon and by using the body when it's out of alignment," she notes. "You need to learn to use your body more efficiently so that there's less pull and strain on the tendons."
Caplan shows women new injury-minimizing ways of carrying out daily activities, from sitting at a computer to playing the violin or painting the ceiling. Because bursitis flares up when the bursa is irritated, you're less likely to have the problem if you learn new ways to move. For bursitis in the shoulder, for example, you may want to work on improving the alignment of your head, neck and spine. This can include learning to sit more upright rather than rounding your shoulders and jutting your head forward.
Feldenkrais Restores Balance
A few sessions with a Feldenkrais practitioner might be just what your sore body is aching for, says Mark Reese, Ph.D., certified Feldenkrais practitioner and trainer in San Diego.
"We work on helping you to balance both sides of your body better," Dr. Reese notes. "A lot of people stand primarily on one leg or put their weight on one sitting bone when they sit. Or one arm doesn't swing as they walk, which can throw the whole body out of alignment."
A lot of the problems in your extremities and joints come from not moving from the center of your body, Dr. Reese says. For example, if your tennis swing isn't coming from your pelvis, you could be putting undue stress on your elbow or shoulder.
"Feldenkrais teaches you to swing so that the force originates from the center of your body and out through your arm, reducing stress to the arm," Dr. Reese explains.
FIBROMYALGIA: NEW HOPE FOR MYSTERY ACHES
Explaining fibromyalgia is even harder than spelling it. A painful condition that involves your muscles and connective tissues but not your joints, fibromyalgia leaves you hurting all over and so exhausted that the simplest tasks are impossible. The condition can be depressing as well as debilitating. Experts link fibromyalgia to not being able to sleep well at night. Lack of all-important sleep that produces deep relaxation, they say, causes muscle fatigue.
A Trio of Remedies: Stretching, Massage and Meditation
If fibromyalgia has you down for the count, experts recommend these natural remedies.
Stretch it out. Just moving those stiff, sore muscles can go a long way toward making you feel better, says Donald Goldenberg, M.D., chief of rheumatology at Newton Wellesley Hospital in Newton, Massachusetts, and professor of medicine at Tufts University School of Medicine in Boston. "Muscles tighten severely in response to the pain of fibromyalgia, so stretching makes sense," he says. "Focus on stretching the whole body, including the neck, shoulders and lower back." (For illustrated instructions on stretching, see page 104.)
Schedule regular massages. Getting a massage is another sure way to help ease muscle pain, says Dr. Benjamin. "In fibromyalgia, your body is very tense and there is pain throughout," he says. "A very gentle overall body massage helps reduce muscle tension and increases your body's circulation in general. Massage could help make it easier for those with fibromyalgia to cope with everyday tasks."
Be mindful. Meditating is a great prescription for unwinding--and for thwarting the tension that makes fibromyalgia worse, notes Dr. Goldenberg.
Dr. Goldenberg studied a group of men and women with fibromyalgia who meditated for 20 minutes a day for ten weeks. "We compared 79 people with fibromyalgia who meditated and 42 people with fibromyalgia who didn't. Overall, the people who meditated improved about 60 percent. The others, who didn't meditate, didn't get any better."
KNEE PAIN: HOBBLE NO MORE
It's the prime spot for all kinds of painful dislocations, sprains, bursitis, fractures, arthritis and just plain pain. The knee is so overworked from kneeling, running and walking that about 50 million Americans hobble to the doctor in pain every year, say experts.
But you may not have to suffer if you take these steps recommended by practitioners.
Muscle Up with Exercise
Build up strength in your quadriceps (the front thigh muscles) and your hamstrings at the backs of the thighs, says Owen Anderson, Ph.D., exercise physiologist and editor of Running Research News in Lansing, Michigan. By strengthening those muscles, you'll take the load off overworked knees, he advises.
Start with five squats. When you can do these comfortably, move on to doing another five while holding hand weights down at your sides. The weights can be anywhere from 1muscle up to 5 pounds each.
Another method that you can try is to work your way up to doing the squats with a barbell balanced on the back of your shoulders, Dr. Anderson says.
Yoga for Stronger Knees
Yoga helps to bring optimal range of motion to the knees by strengthening all of the muscles around the knees and creating flexibility in the muscles, says Friend.
Friend recommends the warrior posture: Stand with your feet parallel about four feet apart (about even with your wrists when your arms are outstretched). Then, turn your left foot slightly in and turn your right leg and foot out about 90 degrees. You'll wind up in a pose similar to a lunging fencer's. Keep your chest facing straight ahead while you turn your head and look out over your right knee. Stretch your arms out to your sides and bend your right knee. Look over your right knee to make sure that it is in line with your right foot and vertical over your ankle. Hold that pose for 20 to 45 seconds. Repeat it three times on each leg.
Herbs for Knee Pain
Herbs for Knee Pain
Jeanne Rose, a practicing herbalist and aromatherapist in San Francisco, relieves knee pain with herbs and exercise.
"Ever since a bad skiing accident 40 years ago, I've had bad knees," says Rose. "I tried taking aspirin and prescription medicines for the pain, but medications didn't help very much. When I got involved in herbalism in 1967, I wondered if herbs could help my knees.
"I started weight training and decided to mix one drop of basil and one drop of sage with eight drops of carrier oil and rub them on my knees as an anesthetic. It works. I don't feel the pain at all. So now I can lift weights to help make my knees stronger, and I have no pain. It's really amazing."
MUSCLE CRAMPS: UNKINK THOSE KNOTS
If your muscles were telephone cords, a cramp would be that annoying knot that develops smack in the middle of it, making it impossible to pick up the receiver without a lot of contortions; except that, with a muscle cramp, your muscle has tightened and shortened, usually as a result of overexertion and dehydration. An imbalance of electrolytes--minerals such as magnesium, calcium, sodium and potassium--is often the culprit.
Stretch It, Ice It
Drinking plenty of fluid before and during exercise can help prevent cramps. To unkink a muscle once a cramp occurs, experts recommend these strategies.
S-t-r-e-t-c-h your calf. For a cramp in your calf, which may strike after exertion or in the middle of the night, Dr. Mikesky recommends that you do this: With your hands against a wall or object for balance, put your noncramping leg forward with the cramping leg out behind you. Lean forward, keeping your heels on the floor and your toes pointing straight ahead, until you feel a stretch in the cramped calf, and hold that position for 20 to 30 seconds. Then lower yourself, bending the knee of your noncramped leg so that you stretch the cramp out even farther.
Unkink your hamstring. Keeping your cramped leg straight, sit on the floor or your bed and bend your other leg so that the sole of the foot is on the inside knee of the cramped leg, says Dr. Mikesky. Lean forward at the waist until you feel the stretch in the muscle running from the back of your knee to your buttock. That muscle is the hamstring. Hold the stretch for 20 to 30 seconds.
Be nice with the ice. If your muscles are locked into a contraction that just won't relax, try an ice massage. Rub an ice cube back and forth on the affected spot for 2 to 3 minutes, says Dr. von Estorff. Or, you can place an ice pack wrapped in a towel on the area for 20 minutes. Ice slows the pain signals going from the muscles to the brain, so the hurt won't seem as bad, she says.
Two homeopathic medicines can be very helpful for muscle cramps, says Robert Ullman, doctor of naturopathy and a physician at the Northwest Center for Homeopathic Medicine in Edmonds, Washington.
"Magnesia phosphorica is a general remedy for muscle cramps, especially abdominal cramping that gets better with heat or when you bend over," Dr. Ullman says. For hand and foot cramps, he recommends Cuprum metallicum, which is homeopathically prepared (diluted) copper.
MUSCLE SORENESS: BYPASS THE PAIN
If you wake up in the morning and your muscles are sore, most likely you did more physical activity than you're used to or worked muscles that you normally don't. When that happens, tiny tears or bruises occur within the muscle tissues, and you feel sore. Here are some paths to relief.
Moist Heat, Soothing Oil
Though sore muscles heal on their own, you'll get faster relief with hydrotherapy, aromatherapy and massage.
Warm yourself up. Holding a warm, moist towel on your aching muscles is a quick way to feel better, says Dr. von Estorff. Or, spend some time in a hot shower or bath. The hot water helps relax the muscles and undo the spasm.
Treat yourself to an aromatic massage. Inhale the scent of essential oils as you also massage them onto your body, suggests Jeanne Rose, a practicing herbalist and aromatherapist in San Francisco. She recommends a blend of herbs, barks and spices, including cypress, sage, juniper, basil and lemon peel. Use two drops of each in a one- to two-ounce bottle of vegetable oil. Apply the oil when you start feeling sore. Repeat the application before bedtime and when you wake up, Rose suggests.
Master the massage. Try a compression massage, which involves squeezing the muscle rather than rubbing it, recommends Dr. Benjamin. "Muscle soreness results from lactic acid, a waste product that accumulates in the muscles. Compression massage pumps the blood and helps you get rid of that lactic acid." Just one or two massages will help, he says.
OSTEOPOROSIS: PREVENTION IS PREFERRED
Osteoporosis, a condition marked by weak, brittle, porous bones, is responsible for 1.5 million fractures suffered every year and poses a major public health threat for 25 million Americans, 80 percent of whom are women. That's because after menopause we produce the female hormone estrogen much more slowly. And when estrogen declines, bones regenerate much more slowly. As a result, bones are weakened and more likely to break on impact.
All too often, women don't know that they have osteoporosis until they get a fracture. At that point, their doctors may prescribe Fosamax, a prescription drug designed to help slow the breakdown of bone. By then, much of the damage is done, although further fractures may be avoided.
Experts offers these strategies for taking matters into your own hands.
Get on Your Feet with Exercise
Probably the best prescription for osteoporosis is doing regular weight-bearing exercise, says Susan Bloomfield, Ph.D., assistant professor in the Department of Health and Kinesiology at Texas A&M University in College Station.
After age 35, women start losing bone mass every year, with a cumulative bone-mass loss of 10 to 20 percent over 20 years, Dr. Bloomfield says. "If you are regularly exercising, you can slow that loss or conserve that bone mass. You may also add bone mass," she says.
Work your bones 30 minutes a day. Weight-bearing e