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Can you virtually improve your knee pain?

A study of people with osteoarthritis of the knee found that at the end of the study period, those participants who received more personalized attention via the web (including physical therapy sessions and information about pain management) had less pain and better movement function.

Is there hope for leg cramp sufferers?

Despite the lack of a universally recognized therapy for nighttime leg cramps, a few approaches may be worth trying.


Image: Monkey Business Images/Thinkstock

Few things are more jarring to a night's sleep than shooting calf pains. If you have nocturnal leg cramps, you have lots of company. Although they can strike people at any time of life, they become more common with age. Among people over 60, almost half report having leg cramps, a third say they are awakened by cramps at night, and 15% report weekly episodes.

What causes leg cramps?

Preventing cramps

There are no FDA-approved medications for leg cramps, and the U.S. Preventive Services Task Force hasn't issued guidelines for treating them. However, the American Academy of Neurology (AAN) has issued the following advice on common therapies, based on scientific evidence of effectiveness.

Stretching exercises. The AAN says that there are not enough data to say for sure that stretching helps reduce the frequency of muscle cramps. That doesn't mean that the exercises are ineffective or harmful, and doing them can help contribute to the flexibility of your legs.

Quinine. There is solid evidence that quinine and quinine derivatives are effective in reducing the frequency of muscle cramps, although the magnitude of benefit is small. However, quinine is out-of-bounds for most people. The FDA has issued repeated warnings against using quinine (which is approved only to treat certain types of malaria) to prevent or treat leg cramps because it may cause serious side effects, including bleeding and kidney damage. Although doctors can still prescribe quinine, it is recommended only when cramps are disabling and when the person can be carefully monitored for side effects.

Vitamin B complex. There is some evidence that taking a daily capsule containing eight B vitamins—B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6, B7 (biotin), B9 (folate), and B12—may prevent cramps.

Calcium-channel blockers. Evidence indicates that one calcium-channel blocker—diltiazem (Cardizem, Dilacor XR)—is possibly effective.

Ineffective therapies. The AAN found enough evidence to indicate that magnesium supplements and gabapentin (Neurontin) aren't likely to help.

Other remedies

In situations like nighttime leg cramps, where there are no widely accepted treatments, unproven remedies may be worth a try. The following are low-risk and have enthusiastic proponents.

  • Soap. If you don't mind sharing the bed with a bar of soap, you might want to try securing one under the bottom sheet near where your legs usually rest. Despite scores of testimonials to its effectiveness in letters to news media and comments on websites, no one has offered a hypothesis for how soap might work. Yet it's inexpensive and harmless.

  • Mustard or pickle juice. Swallowing a teaspoon of mustard or an ounce of pickle juice before bedtime also has enthusiastic advocates. In fact, the pickle juice preventive has become a staple among athletes who want to avoid being sidelined by cramps. However, if you have gastroesophageal reflux disorder or are trying to cut back on salt, you might want to check with your doctor before trying this approach. Scientists think the foods might stimulate ion channels in the mouth, esophagus, and stomach to send signals to the central nervous system that inactivate overexcited neurons.

  • HotShot . This 1.7-ounce dose of cinnamon, ginger, lime juice, sweeteners, and capsaicin (the active compound in chili peppers) was developed by Dr. Bean and Dr. Rod MacKinnon, a Nobel Laureate in Chemistry at Rockefeller University, as a remedy for cramping during rigorous exercise. It works along the same principle as mustard and pickle juice, but has longer-lasting effects. It is currently available commercially as a sports beverage. "Although I am aware of people using it for nocturnal leg cramps, it has not yet been formally tested for that use," Dr. Bean says.

Boning up on osteoporosis

The disease strikes more women, but men are also at risk.

Osteoporosis is often considered a woman's disease, but men also need to be concerned about this bone-weakening condition. About 2 million men have osteoporosis and another 12 million are at high risk, according to the National Osteoporosis Foundation.

In fact, older men have a greater risk for an osteoporosis-related fracture than for getting prostate cancer, and about one in four men older than 50 will break a bone because of osteoporosis during his lifetime.

Numb fingers? Icy toes? It may be Raynauds.

Raynaud's phenomenon—an extreme reaction to cold—can be annoying, or it may signal a serious chronic condition.


 Image: Bigstock

If you live in the northern latitudes, you may have already had an episode in which your fingers froze or your nose, toes, or earlobes grew cold, pale, and numb. And if you're a southerner, you might have neighbors who migrated to avoid such episodes. While some people with chilly fingers just have cold sensitivity, others—especially women—may have Raynaud's phenomenon.

What is Raynaud's?

Two forms of Raynaud's

Primary Raynaud's phenomenon, which has no known cause, is much more common in women than in men and often begins in adolescence. Although it can be annoying and even painful, it usually doesn't require medical attention.

Secondary Raynaud's phenomenon occurs later in life in people who have injuries from operating vibrating tools or who have autoimmune disorders that affect connective tissue, such as scleroderma, rheumatoid arthritis, or lupus. These conditions can damage blood vessels and change their response to cold or stress. If you develop Raynaud's later in life, you should get a medical evaluation to determine whether you have secondary Raynaud's and, possibly, another underlying condition that warrants treatment.

Living with Raynaud's

 

 

 

Give grip strength a hand

Your ability to grab, hold, twist , and squeeze is essential for many everyday functions.


Image: JannHuizenga/Thinkstock

Think how much you rely on a strong grip every day. It helps you open cans, grip a golf club, hold a steering wheel, brush your teeth, and pick up a grandchild. "The ability to stay active and independent often begins with our hands," says Maria Cole, a physical therapist with Harvard-affiliated Spaulding Outpatient Center. "Weak grip strength can limit your enjoyment of many life pleasures, so you need to ensure your hand and grip strength always are up to the task."

A measure of health

A grip on mobility

Grip strength also may predict your future loss of mobility. A May 2014 study in The Journal of Gerontology Series A: Biological Sciences and Medical Sciences analyzed data from more than 20,000 adults ages 65 and older to evaluate the link between weak grip strength and lack of mobility, in this case slow walking speed.

Among the men in the group, those with a weak grip—less than 26 kg using a dynamometer—were seven times more likely to be facing mobility issues compared with men who had normal grip strength.

You can take steps to improve grip strength and possibly avoid problems down the road. "You need to exercise your hands and wrists just like every other part of your body to keep them strong and supple," says Cole.

Exercise your hands

Help for your hands

A few simple exercises can preserve the strength and flexibility of your hands and wrists.


 Image: Thinkstock

There's a reason that "having a good grip on the situation" is used as a metaphor for mastery. In physiological testing, grip strength is one of the indicators of health and vitality. Yet, although we may exercise to strengthen our cores and limbs, most of us don't make an effort to strengthen our forearms and our hands. "We use our hands continually, but we don't take the time to deliberately exercise them," says Joanne P. Bosch, a physical therapist and certified hand therapist at Harvard-affiliated Brigham and Women's Hospital.

That said, it's not a good idea to rush out and buy a device promoted for building a "crushing hand grip" or to start squeezing a tennis ball. "Doing the wrong exercise can actually exacerbate some problems, particularly carpal tunnel syndrome," Bosch says.

What Michelangelo’s hands (can and can’t) tell us about arthritis

A recent journal article describes Michelangelo’s hands as depicted in an attempt to figure out potential joint diseases he may have had. Theories suggest some myths and misconceptions about the causes and symptoms of osteoarthritis and gout. This report has implications for today’s medical care. While a picture may tell a story, there is nothing like a thorough, in person exam to know accurately make sense of signs and symptoms.

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