Pinched Nerve / Impingement

Pinched Nerve / Impingement

by | Apr 1, 2022 | Back problems, other, pain

Pinched Nerve Sign

Pinched Nerve/Impingement

A pinched nerve is a common complaint in people seeking medical care. Also known as nerve impingement, a pinched nerve can occur at nerve roots coming from the spine, or in other areas like the wrist and ankle. In either case, it often results in pain and/or numbness and tingling in an arm or leg. Luckily, symptoms are usually treatable with conservative care and don’t require surgery. It’s important to know what to look for, however, because the symptoms aren’t always what you might expect.

What is a Pinched Nerve?

A pinched nerve, or nerve impingement, goes by different names when occurring in different areas of the body. When a nerve root is compressed at the spine, it’s called radiculopathy and is usually caused by degenerating bone or disc. When a nerve is impinged in the arm or leg, it’s called entrapment or compression. To better understand how nerve impingement affects the body, let’s examine the function of nerves.

How Do Nerves Work?

Nerves are our master communicators. They take information from the brain and send it to the rest of the body, and vice versa. The ultimate goal is to maintain a state of balance in the body called homeostasis. Nerves communicate in various ways, triggering sensory and motor reactions to protect the body. For instance, when you touch a hot stove, the nerves in your skin send signals to your brain at lightning speed that danger is present. Your brain responds by sending a burning pain to sensory nerves in your hand, while simultaneously sending a message to your motor nerves to pull your hand away. Nerves, in a nutshell, keep us alive and well. Unfortunately, they are the primary source of pain, too. Peripheral nerves, or nerves that connect our brain to our body, originate as nerve roots exiting the vertebrae from the spinal cord. From here, they branch out and supply, or innervate, muscles to help us move, sensory areas to help us feel, and autonomic areas to activate our fight-or-flight and rest-and-digest responses. When something puts pressure on a nerve root, it affects everything the nerve branches out into. Compression of a nerve root can cause weakness, numbness, tingling, and dull, nagging pain. Irritation of a nerve root can cause sharp, shooting pain, burning, and hypersensitivity.

Types of Nerve Impingement

Nerve root impingement at the spine (radiculopathy), can occur at any of the 3 main spinal sections: cervical, thoracic, and lumbar. Nerve roots in the neck, or cervical spine, primarily affect the arms (upper extremities). Nerve roots in the midback, or thoracic spine, affect the trunk and ribcage. Nerve roots in the low back, or lumbar spine, affect the low back and legs (lower extremities). Pinched nerves can also occur in other areas of the body. Think about when you wear tight shoes to a wedding and feel a tingly sensation in your feet by the time dinner is served. You end up kicking your shoes off to dance after dinner because a nerve in your foot was being compressed. Common areas of nerve entrapment are the carpal tunnel at the wrist and tarsal tunnel in the ankle.

Cervical Impingement

man touching sore shoulder
Nerve impingement in the neck is most common among adults ages 50-54 and is often mistaken for a shoulder or arm injury. Many times, the person feels arm pain or numbness but never has any neck pain. A basic understanding of cervical impingement can help direct proper treatment.

How Does it Happen?

A pinched nerve in the neck, or cervical radiculopathy, occurs when a nerve root is compressed by herniated disc material, a degenerating disc, or aging bone. The body activates the inflammatory response, which causes swelling around the nerve root. This ultimately leads to pain and changes in nerve function.

While internal changes in the neck are the culprit for a pinched nerve, there are often external events that trigger the symptoms to follow. These inciting factors can contribute to the onset of pain with cervical radiculopathy:

  • Poor posture
  • Trauma (such as car accident)
  • Sleeping in uncomfortable positions

What are the Symptoms?

A person with cervical radiculopathy may have symptoms in one or both arms and feel pain and/or numbness and tingling. Symptoms may go all the way into the fingers and follow a dermatome, or sensory nerve root pattern. Neck movements may be painful, the affected arm might feel weak, and the muscles around the neck may be tight. A clinician will likely do in-office testing to rule in the diagnosis, but unless trauma has occurred, further testing is not usually needed. If conservative treatment fails, an X-Ray or MRI may be considered.

How is it Treated?

Most cases of cervical radiculopathy resolve with conservative (nonoperative) management. In fact, in a five year follow up study of patients who had conservative treatment, 90% of patients were symptom-free or only had mild symptoms. Conservative treatment starts with medication, which can include nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxers, opioids for acute pain, and antidepressants for chronic pain. Physical therapy may be prescribed to stretch the neck muscles and strengthen the postural muscles. The physical therapist may also use manual therapy or spinal manipulation to help reduce muscle tightness, joint stiffness and pain. Mechanical traction may be used, where the neck is intermittently placed in decompressive positions. If symptoms persist, an epidural injection may be considered. Only if all these fail is surgery considered. The most common procedure for relieving a pinched nerve is an anterior cervical diskectomy and fusion.

Thoracic Impingement

woman holding lower back
Nerve impingement in the thoracic spine, where the ribs attach, is much less common than in the neck or low back, at least according to reports. It can get missed for months, or even years, however, since it mimics many other potentially life-threatening diseases. Thus, skilled evaluation is imperative with diagnosing thoracic radiculopathy.

How Does it Happen?

Thoracic radiculopathy, or nerve impingement in the thoracic spine, can be caused by degenerative disc disease, rib dysfunction, diabetes mellitus, and placement of spinal cord stimulator. Since it is more rare in the thoracic spine than in the cervical and lumbar spine, thoracic radiculopathy can get overlooked among clinicians. In addition, symptoms of thoracic radiculopathy can mimic heart attack, lung problems, cancer, or other visceral organ dysfunction, making it important for doctors to rule out those conditions first.

What are the Symptoms?

People usually report radiating pain around the ribcage and in the trunk region. Pain may be present in the back near the shoulder blade (scapula) or in the lower abdominal region. Numbness and tingling may also occur, and it can feel painful to take a deep breath.

Treatment

Like nerve impingement in the neck, thoracic radiculopathy typically resolves with conservative management; medications to reduce pain and inflammation, physical therapy to stretch muscles and correct postural imbalances, and activity modification are the first lines of defense. If these methods don’t improve a person’s symptoms, then a procedure called percutaneous vertebroplasty may be considered. In cases of progressive symptoms and neurologic compromise, surgery is necessary.

Lumbar Impingement

It goes by many names—sciatica, lumbar radiculopathy, lumbosacral radiculitis, radicular pain, and pinched nerve, to name a few. This literal “pain in the rear” can be a nuisance, and in some cases debilitating. Spinal nerves are tricky, and a pinched nerve in your back may feel like pain in your foot. Let’s examine why this happens.

How Does it Happen?

Dysfunction of a spinal nerve root in the lumbar spine (low back) is the cause of lumbar radiculopathy. When one is compressed or irritated, a person will develop symptoms of a pinched nerve. Depending on the severity of the compression, the nerve may be affected along its entire course through the body, which is sometimes down to the feet. Here are some common causes of lumbar radiculopathy:

  • Bulging disc
  • Herniated disc
  • Lumbar facet overgrowth (hypertrophy)
  • Spondylolisthesis

People can develop this condition from direct trauma or chemical irritation to the nerve root, inactivity, staying in certain positions too long, using poor body mechanics with lifting, or having weak core musculature. Regardless of the cause, it is important to get an accurate diagnosis in order to treat it correctly. Lumbar radiculopathy, like thoracic radiculopathy, can mimic other conditions, which require different treatments. In rare cases, lumbar radiculopathy can be caused by infection, cancer, vascular disease, or congenital abnormalities. Therefore, quality evaluation and diagnosis from a physician is vital.

What are the Symptoms?

The classic symptoms of lumbar radiculopathy are pain and/or numbness and tingling extending down the leg, with or without accompanying back pain. The compromised spinal nerve root results in pain, weakness, and/or impairment of sensory regions associated with the affected nerve root. The muscles of the back, hip, thigh, and calf may be tight or feel like they are in spasm. This is more likely a result of irritated nerve rather than actual muscle tightness. Typically, the symptoms worsen with certain positions or activities, such as sitting or standing for long periods. Sometimes even lying flat to rest can increase symptoms. When the bones in the spine undergo the aging process, the spaces for nerves and the spinal cord to run through may narrow (spinal stenosis) and impinge nerves on both sides. In these cases, people can experience pain, heaviness, and/or numbness and tingling in both legs while standing upright or walking, which is called neurogenic claudication. The most commonly affected nerve with lumbar radiculopathy is the sciatic nerve, which is where sciatica gets its name. Symptoms specific to impingement of nerve roots of the sciatic nerve are pain and/or numbness and tingling starting in the low back, then radiating into the buttocks, and shooting down the back of the leg into the foot. This can be confused with piriformis syndrome or hamstring syndrome, which also affect the sciatic nerve, but not at the nerve roots. Often people with lumbar radiculopathy experience no back pain but have numbness and tingling in their legs and feet, which explains why people might not initially consider the low back as the source of their pain. It can feel like peripheral neuropathy, diabetic neuropathy, or Tarsal Tunnel Syndrome. However, these conditions are distinct from lumbar radiculopathy and should be treated as such. Neuropathy describes damage to or disease of peripheral nerves, which are outside the spine. Tarsal Tunnel Syndrome, as discussed later, is caused by compressed nerve in the foot. Other more serious conditions should also be ruled out in cases of numbness and tingling in the feet, such as Guillain-Barre Syndrome, autoimmune disease, and infection.

Treatment

Treatment for lumbar radiculopathy, like in the rest of the spine, is symptom-based. In the early stages, the primary goals are to reduce pain and restore any loss of sensation. This can be accomplished through medications, epidural injections, application of topical analgesics, and education on staying active/exercise. Physical therapy can help with reducing neural tension (pain caused by nerve irritation), releasing muscle tightness, and improving strength in core muscles. Research has shown that core musculature weakens during episodes of low back pain, which increases vulnerability to future episodes of radiculopathy. Mechanical traction and spinal manipulation may be used by physical therapists or chiropractors and can relieve symptoms in the short-term. Surgery may be used to decompress a nerve or fuse an unstable spinal segment. While statistics show that lumbar surgery is safe and effective in short-term, it has shown no long-term benefits for pain and function.

Other Types of Impingement

holding wrist

Carpal Tunnel Syndrome

Carpal tunnel syndrome is nerve compression at the wrist. Here, the median nerve passes through bones and tendons and can become entrapped. Sitting at a computer for extended periods increases the risk, which may explain why it is the most reported nerve entrapment syndrome. It is also the most expensive upper extremity disorder in the United States, costing over $2 billion annually. In addition to desk job workers, others at increased risk are industrial workers and elderly. Symptoms include numbness and tingling in one or both hands, weakness of the hands and fingers, and wrist stiffness. Treatment includes activity modification, splinting, ergonomic modifications, occupational therapy, injections, and in serious cases, surgery. When evaluating, clinicians should rule out neck problems, as they can mimic carpal tunnel syndrome.

Tarsal Tunnel Syndrome

Though much less reported than carpal tunnel syndrome, tarsal tunnel syndrome is a nerve entrapment syndrome that often goes undiagnosed because it gets missed. The posterior tibial nerve travels behind the inner ankle bone, where three other ankle muscle tendons also pass through. In anatomical terms, this is called the tarsal tunnel. In the tunnel, the nerve branches into three segments. When compressed, it can cause pain and/or numbness and tingling in any or all three segments, which affect the ankle and foot. Treatment includes physical therapy for stretching tight structures that may be compressing the nerve, strengthening weak muscles to avoid compensations, injection, and surgical release if necessary. Perhaps most important in treating this issue is getting an accurate diagnosis, as it may be assumed to be a pinched nerve in the back.

If you are experiencing pain that you want to discuss further, please make an appointment with Dr. Connor.

Circumcision in Newborns

Circumcision in Newborns

by | Mar 23, 2022 | Infants, other

What is Degenerative Disc Disease

Circumcision in Newborns

You’re the proud parent of a newborn boy. Congratulations! One of the first medical decisions you may face is whether or not to get your child circumcised. Many parents choose to have their child undergo this procedure, while others opt against it. Before making the decision, it is helpful to understand what circumcision is and know the potential benefits and risks.

What Is Circumcision?

Circumcision is a surgical procedure in which a physician removes the foreskin of the penis. The foreskin is a fold of skin that covers the tip of this organ.

Before removing the foreskin, the physician will clean the penis, and apply an anesthetic topically and/or by injection to accomplish a nerve block in order to numb the area with pain-fighting medication/anesthesia. The foreskin is clamped in place, cut, and then removed. The wound generally heals within one week.

Circumcision is most often performed just after birth, while the newborn is still in the hospital. Less often, a male may be circumcised as a child or adult.

Is Circumcision Necessary?

Circumcision is not a necessary procedure. A newborn boy doesn’t have to have this procedure in order to live a healthy life.

Many males are circumcised for religious reasons. In particular, circumcision is an important religious tradition for Jews and Muslims. Some parents also choose circumcision for cultural reasons or because of health benefits.

Some parents choose not to have their child circumcised because of ethical reasons, personal preferences, or concerns about the risks of the circumcision procedure.

How Many Males Get Circumcised?

Researchers have estimated different rates of circumcision within the United States. The number of U.S. males who are circumcised is between 55% and 80%, according to one study. Rates of circumcision vary across the country, with males in the Midwest being circumcised most often and males in the West undergoing the procedure less often. People of different races and ethnicities also tend to choose circumcision at different rates. Overall, circumcision has been declining over the past few decades.

What Do Experts Say About Circumcision?

In 2012, the American Academy of Pediatrics (AAP) released a statement explaining their recommendations surrounding circumcision. This panel of experts identified both benefits and risks for this procedure. They concluded, “although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it.”

This means that the AAP has concluded that circumcision leads to health benefits that outweigh the risks, so parents who want to elect to have this procedure done should be able to have this procedure for their child. However, the benefits are relatively minor, and don’t warrant every male getting the procedure purely for health reasons. The AAP says people should be allowed to choose circumcision if they want.

An article in the American Family Physician Journal states:

Established health benefits of circumcision include a reduced lifetime incidence of urinary tract infections, penile cancer, phimosis, HIV, and several other sexually transmitted infections. A 2017 systematic review concluded that the health benefits of newborn circumcision are greater than the risks associated with the procedure. Despite these benefits, the newborn male circumcision rate has declined in the United States, from 83% in the 1960s to 77% in 2010. There are racial and ethnic differences in the overall circumcision rate: over the past decade, 91% of white males reported having been circumcised compared with 76% of black males and 44% of Hispanic males. In some states, these differences may be related to an increasing Hispanic population and lack of Medicaid coverage.The data used by the AAP and CDC to support their policy statements have largely been extrapolated from adult circumcision studies performed in the sub-Saharan region of Africa. Because of the lack of direct evidence of benefit, some consider newborn circumcision unnecessary. A 2010 systematic review found that although complications are rare, there is little evidence to support circumcision. (Am Fam Physician. 2020 Jun 1;101(11):680-685, citations omitted.)

Thus, many physicians advocate for giving parents the choice to circumcise their newborn. However, some doctors oppose the procedure and believe that males are better off in the long run when they have a foreskin. Circumcision is a somewhat controversial topic, and not all medical experts and healthcare providers are in agreement about whether it should be performed.

Deciding Whether to Circumcise Your Newborn

Degenerative Disc Disease

There are many factors that weigh into a parent’s decision to circumcise their newborn. It is helpful to learn more about the potential good and bad effects that circumcision may cause and how this procedure may affect your child’s health and future experiences, both short — and long — term.No one is legally required to circumcise their newborn as it is a parent’s decision.

Because circumcision is not required, it is considered an elective procedure. This means that not all health insurance policies may cover it. Alternatively, some policies may cover circumcision during the first few days of a child’s life, but not after that time period. When deciding whether to circumcise your child, you may want to check with your insurance provider to get more information about potential costs.

Potential Health Benefits of Circumcision

Circumcision can reduce risk of several different medical conditions. Many parents choose to have their newborns get this procedure for these reasons.

Urinary Tract Infections

Urinary tract infections (UTIs) develop when bacteria enters the bladder, kidneys, or urethra (tubes that carry urine out of the body). Males who have been circumcised are 3.6 times less likely to develop these infections over their lifetime. The benefit is even bigger during the first year of life: circumcised newborns are 10 times less likely to have a UTI.

Although circumcision helps protect against UTIs, these infections are not generally a large problem for men. First, UTIs in males only affect about 13-14% of men. Additionally, it is important to note that some healthcare professionals believe that better hygiene practices will help prevent conditions like UTIs in males with a foreskin. Finally, if a man does contract a UTI, it is not hard to treat. Antibiotics usually work well to clear the infection.

Viral Infections

Several studies have found that men who are circumcised are less likely to become infected with different types of viruses. In particular, circumcision cuts a man’s risk of contracting human immunodeficiency virus (HIV) in half.

The reason for this increased risk of viral infection is not entirely clear although several theories exist. Viruses may be more likely to survive for longer periods of time in the area under the foreskin, which tends to be damper compared to the circumcised penis. Additionally, HIV primarily infects certain types of immune cells within the body. The foreskin contains many of these cells, so it may be easier for HIV to attach to and enter cells when a foreskin is present.

Additional research has also found that other viral infections are also less common in circumcised males. When males are circumcised at birth, they later have a lower risk of becoming infected with viruses such as human papillomavirus (HPV) and herpes simplex virus type 2 (HSV-2). Circumcised men may also be less likely to pass along viral infections, including certain sexually transmitted infections (STIs), to female partners.

Cancer Risk

Circumcision can help protect against cancer of the penis. In fact, men who are uncircumcised are 20 times more likely to develop this cancer. However, penile cancer is rare, making up less than 1% of all cancers seen in men. It is very unlikely that a male will be diagnosed with this condition over the course of his life, even if he remains uncircumcised.

Men who are circumcised are also less likely to develop prostate cancer, a much more common condition. However, the protective benefit of circumcision is slight — uncircumcised men are just 1.2-2 times more likely to be diagnosed with this cancer.

Potential Risks of Circumcision

While circumcision may bring some benefits, it may also lead to certain hazards. There is some indication that leaving the foreskin in place may also be a good thing.

Short-Term Risks of the Procedure

Circumcision is a surgery, and any surgery comes with risks. Experts estimate that about 1 out of 500 newborns experience a complication from circumcision. Most of these complications are mild.

During circumcision, a newborn may experience redness and bleeding. This procedure also leaves a wound that takes some time to heal. Although rare, there is a possibility that circumcision could lead to infection or injure the penis.

Some newborns can’t be circumcised because they have health conditions that would make the procedure too risky. Babies who are born very prematurely usually can’t be circumcised. Other conditions that may prevent circumcision include blood disorders, bleeding problems, such as hemophilia, or infants with certain birth defects, such as penile torsion, epispadias, and a condition known as penoscrotal webbing.

Circumcision is also thought to cause pain for newborns. Ask your doctor what kind of pain-numbing medication will be used for the procedure.

Long-Term Loss of Sexual Sensation

It is a common belief that men who are circumcised have a loss of sensation in their penis that prevents them from experiencing sexual satisfaction in the same way as men who are uncircumcised. Because of this, some experts say that newborns shouldn’t be circumcised. However, the scientific evidence in this area is not entirely clear.

The foreskin contains many nerve endings that help provide feeling. Some studies have found that within uncircumcised men, the foreskin is more sensitive to touch than other parts of the penis. However, some of these studies have also found that there was not a large difference between how sensitive the penis was overall between men who had been circumcised and men who hadn’t.

Other survey-based studies have found that circumcised men are slightly more likely to experience unusual sensations in the penis, experience less sexual pleasure, and have trouble having an orgasm. However, the majority of both circumcised and uncircumcised men said that they never or rarely had problems in this area. Additionally, other studies have found no difference in sexual function when a man is circumcised.

More research is needed in this area, and not all experts agree on how circumcision affects sensation in the penis. However, it is possible that men who are circumcised at birth are more likely to have trouble with sexual satisfaction later on in life.

Caring For Your Newborn After Circumcision

Degenerative Disc Disease

It may take up to a week for the circumcision wound to heal. Make sure to follow your pediatrician’s instructions when caring for the wound. You may need to protect the wound by covering it with ointment or Vaseline (petroleum jelly) when changing your child’s diaper. Your physician may also tell you to occasionally wash the area with mild soap.

After circumcision, your doctor should tell you to watch out for any signs of infection or injury. Contact your child’s physician if the circumcision wound is bleeding or releasing pus from the surgical wound, or if the penis is swollen and red. Additionally, talk to a physician if your child seems to be in a lot of pain.

Caring For a Newborn With an Uncircumcised Penis

If you choose not to circumcise your newborn, you should also know how to provide proper care. In newborns and children, the foreskin will be too tight to be pulled back very far. This is normal. Don’t try to pull or stretch the foreskin away from the rest of the penis. When bathing your child, gently move the foreskin only as far back as it will naturally go, and wash the exposed area with water and mild soap.

The foreskin gradually becomes looser over time. As it begins to separate from the rest of the penis, you can teach your child to begin regularly washing under the foreskin.

Circumcision in Older Males

Occasionally, circumcision happens in older boys, teens, or adults. In this case, the risks of infection and bleeding are higher. Additionally, the wound often takes longer to heal — up to three weeks.

The procedure is handled a little differently when it takes place in an older child or adult. The person will usually be put to sleep with general anesthesia. After the foreskin is removed, the wound is closed with stitches that slowly dissolve as the wound heals.

The patient will usually be able to go home the day of surgery. However, he may have to rest for the next couple of weeks and avoid strenuous physical activity until the wound is healed. Pain medication and ice packs can help relieve pain during recovery.

Conclusions

Currently, circumcision is a controversial issue, and there is no consensus on whether or not it should be performed. Many medical experts and healthcare providers are in favor of allowing circumcision, saying that the religious and cultural traditions and health benefits surrounding the procedure make it worthwhile. Others are against the procedure, noting that the risks do not outweigh the potential benefits when the surgery is not necessary for the health of the child.

Currently, the choice of whether to circumcise a newborn is left up to the parents. If you are struggling to make a decision, it may be a good idea to talk to your child’s physician, who can discuss the risks and benefits of the circumcision procedure for parents to be able to make the best-informed decision for their child and their family.

If you would like to discuss this topic further with Dr. Connor, please make an appointment.

The 8 Best Bidet Attachments, According to a Doctor

The 8 Best Bidet Attachments, According to a Doctor

by | Mar 16, 2022 | other

Read all about bidets in this article in Livestrong.com. Doctor Connor explains who should use them, the different types, which type is best for you, and why you may want to use them. For example, Dr. Connor says that when using a bidet, you are more likely to remove fecal matter than when using toilet paper alone. And because your hands do not have to come into contact with your bottom (like they may while wiping), you are less likely to spread fecal bacteria to the toilet bowl handle, bathroom doors, and sink handles in the bathroom.

HPV

What is Degenerative Disc Disease and What Can You do About it?

What is Degenerative Disc Disease and What Can You do About it?

by | Mar 1, 2022 | Back problems, other

What is Degenerative Disc Disease

Back pain is so common it’s almost inevitable. Like sprouting a gray hair, most people deal with at least one episode of low back pain by middle age. A major cause of back pain can be degenerative disc disease. Various factors, including what’s happening both inside and outside your cells, contribute to getting degenerative disc disease. A combination of wear and tear, poor nutrition in the discs, and neural changes over time lead to degenerative disc disease. In this article, we’ll get into what degenerative disc disease is and how you can treat it.

What is Degenerative Disc Disease?

To better understand degenerative disc disease, let’s discuss the umbrella term under which it lies: low back pain. Low back pain is the fifth most common reason people go to the doctor in the United States. Whether people are extremely active or relatively sedentary, healthy or unhealthy, back pain affects most people at some point in their lives. Of the many causes of back pain, degenerative disc disease is the leading cause of lower back pain and disability. One reason may be because our discs start degenerating much earlier than our bones and muscles, which we’ll go into more detail on later. Let’s start by looking at the spine.

Degenerative Disc Disease

A Brief Look at Spine Anatomy

Most people are born with a spine comprised of 33 bones called vertebrae stacked on top of one another like puzzle pieces. By adulthood we typically have 24 vertebrae because the bones at the bottom of the spine fuse together. The vertebrae differ based on their location in the spine and have different functions in the neck (cervical), mid back (thoracic) and low back (lumbar) regions. While degenerative disc disease can occur in any part of the spine, we’ll focus on the most prevalent, the lumbar spine.

Each lumbar vertebra is comprised of a prominent, round body in front, a pointy spinous process in back, a transverse process on either side, the spinal canal, which houses the spinal cord, and facet joints, which articulate with the vertebra above it. When stacked together, they create the spinal column. The spinal column has 4 main functions: to support the weight of the body above the pelvis, to protect the spinal cord, to act as the central axis of the body, and to control posture and movement.

Degenerative Disc Disease

Where do Discs Come into Play?

In between the bodies of the vertebrae lie intervertebral discs, which act like soft pillows and provide flexibility and cushion to the spine. They also allow for the spine’s natural curvature, or lordosis, to absorb shock, provide stability, and carry heavier loads. Each disc is made up of three parts:

  • Nucleus pulposus: The center of the disc containing the “filling”
  • Annulus fibrosus: Inner and outer rings surrounding the nucleus pulposus
  • Terminal endplates: Cartilage and fibrous tissue

How Discs Degenerate

The nucleus pulposus plays the largest role in disc degeneration. A healthy nucleus pulposus is gel-like, well hydrated, and rich in proteins called proteoglycans. It creates pressure in the disc to separate the vertebra, puts tension on the surrounding rings (annulus fibrosus) to hold the disc shape, and helps evenly distribute pressure over the end plates. As we age, the nucleus pulposus loses proteoglycans, which causes the disc to become firmer, dehydrated, and more vulnerable to damage. These changes cause the disc to lose its height and pressure, which sets off a sequence of events that changes the biomechanics of the spine.

Nucleus Pulposus Over Time

 AGE  FILLING CONSISTENCY
 Young  Jelly
 Middle-aged  Toothpaste
 Older  Chalk

 

Disc degeneration over time is inevitable. But many people going through it never even know it’s happening. Discs begin the degeneration process as early as adolescence, with 20% of young people showing mild symptoms. It’s when these changes cause painful and debilitating symptoms that we refer to it as degenerative disc disease, or intervertebral disc disease.

What Causes Degenerative Disc Disease?

Degenerative Disc Disease

Like many other chronic conditions, such as heart disease and diabetes, no one specific event causes degenerative disc disease. Degenerative disc disease results from a complex interaction of genetics, age, structural changes, biochemical changes, environment, trauma, and activity level over time. Three main factors lead to the progression of degenerative disc disease: wear and tear, decreased nutrition in the discs, and neural changes.

Wear and Tear

Natural disc degeneration can start as early as ages 11-16, but most people begin showing symptoms in middle age, after they have put their spines through some wear and tear. Age-related changes cause an imbalance between building tissue (anabolism) and breaking tissue down (catabolism). This changes the composition of the nucleus pulposus, leaving it dehydrated and firmer. As disc height falls, the dynamics of the extracellular matrix (area surrounding disc cells) change, causing the once perfectly functioning spine to use altered movement patterns.

Decreased Nutrition in the Discs

With age, fewer nutrients are supplied to the discs, causing terminal end plates to harden and calcify. Nutrient loss also causes discs to be less capable of load distribution. As one disc degenerates, it causes surrounding segments to work harder to distribute load and maintain postural stability, which accelerates degeneration of the surrounding discs. This in turn affects other structures, such as joints, ligaments and muscle.

Neural Changes

The discs in the spine are aneural (without nerves) and avascular (without blood vessels). So how do they generate so much pain? When the disc degeneration cycle progresses, a series of reactions are stimulated in which cytokines, the immune responses’ signaling cells, are secreted. An inflammatory response follows, which can cause tears in the annulus fibrosis (fissures), push the disc into nerve tissue (bulge), or even cause the nucleus pulposus to rupture and leak out (herniate). Over time, the spinal canal becomes too narrow (spinal stenosis) and compresses nerve tissue (radiculopathy), which causes pain.

Am I at risk?

Degenerative Disc Disease
If you are getting older by the day (hint: we all are!), then you are at risk of disc degeneration. Since discs begin degenerating much earlier than muscles and bones, many people who experience low back pain associated with degenerative disc disease are of working age. This may explain why degenerative disc disease is the leading cause of work-related disability. Some factors may put you at higher risk for developing degenerative disc disease. Here are a few to keep in mind:

  • Age: The older the individual, the higher the risk
  • Genetics: If one or more family members have been affected, you are more likely to be affected
  • Gender: Men are at higher risk
  • Joint laxity: Imbalances in muscle dynamics can create spinal instability
  • Repetitive loading over time: Healthcare workers, foundry and forest workers, production operators, cabinet makers, truck drivers, locksmiths, bricklayers, and workers who lift, rotate, and/or bend are more at risk
  • Environmental factors: Smoking, obesity, and diabetes mellitus increase the risk
  • Psychosocial factors: Low socioeconomic status and depression increase the risk
  • Nutritional deficiency: Poor disc nutrition accelerates degeneration

How do I know if I have Degenerative Disc Disease?

Degenerative disc disease may be present in 90% of people over age 70. So why don’t 90% of people over age 70 have severe low back pain? Many people with degenerative disc disease are asymptomatic and will never need treatment. Others have episodic bouts of pain that are treatable with conservative interventions, which is why your physician usually won’t jump right to ordering an MRI. Chances are, if you have back pain, an MRI will show some degeneration of your discs. But that won’t necessarily change the course of treatment. Managing symptoms is the priority.

Symptoms

Besides the most obvious symptom of low back pain, the next most common symptom is sciatica, or nerve type pain running down the leg. This type of pain is usually sharp and shooting and may feel numb and tingly radiating down the leg and foot. It can be on one or both sides, and can follow what are called dermatomal patterns, or areas of the leg innervated by certain nerves. Specifying the location of your symptoms can help your clinician determine what level of the spine he or she suspects is involved.

Your symptoms may be aggravated with bending, sitting, turning, coughing, sneezing, and occasionally standing. Typically, if sitting aggravates your symptoms, then standing or laying will alleviate them, and vice versa. However, in an acute case of a disc herniation, it may be painful to be in any position.

Things to Report Immediately

While degenerative disc disease symptoms may be painful, they aren’t usually dangerous. However, there are a few symptoms that require immediate evaluation by a medical professional. These can lead to rare, but potentially life-threatening complications:

  • Change in bowels or bladder accompanying back pain
  • Saddle anesthesia (loss of sensation in the buttocks, perineum, and inner thighs)
  • Fever
  • Drug abuse
  • Recent trauma (car accident, fall, sports injury, etc.)
  • Unrelenting pain

Diagnosis

Degenerative Disc Disease

When seeking evaluation for degenerative disc disease, you must first choose where to begin for proper medical evaluation. Your primary care physician can diagnose your condition, provide recommendations, and possibly medications to help temporarily, and this physician can provide referrals for therapy, whether this be physical therapy or occupational therapy, depending on your condition. Your primary care physician can also help you to find the most appropriate specialist for your condition — and make this referral for you. This physician may be an orthopedic physician, a physiatrist (PM&R physician), a neurologist, or a neurosurgeon. They all specialize in differing capacities in spinal dysfunction. No matter who you choose, it’s always a good idea to know what to expect.

Your physician will ask a series of questions about your medical history, current symptoms, aggravating factors, and alleviating factors, and any medications you’ve taken for this condition. You will be asked specific questions about your pain, such as location, quality, intensity, and frequency. They may test your strength, flexibility, and range of motion. During this time, it is important to be honest: lay it all out there. Don’t be embarrassed to say you fell off the wagon with your diet, or that you haven’t left your couch since Covid-19 began. It’s important for the physician to know what’s going on in your life so you can be diagnosed accurately.

While an MRI is the main imaging technique for degenerative disc disease, it is just one of many diagnostic tools a clinician may use. Remember that more likely than not, you have disc generation if you have low back pain. Since the results of an MRI often don’t change the treatment plan for the individual, physicians typically only order them if conservative treatment fails.

What to do About it

Treatment typically starts with conservative management, which includes physical therapy, oral medications, injections, and education about understanding pain and coping mechanisms. Statistically, 80% of patients respond to physical therapy within four to six weeks.

For those who still suffer from symptoms after trying conservative care, some promising prospects are less invasive than surgery but still being studied. Restorative therapies include molecular therapy, growth factor therapy, cell therapy and gene therapy. Reconstructive methods include percutaneous IVD techniques, mechanical decompression, and biomaterial injection.

The more invasive treatments and typically last resort for symptom relief are decompression surgery, total disc replacement, and rigid fusion. While fusion protects the integrity of the segment, it may compromise other levels of the spine. It also addresses symptoms, not causes of the condition.

If you want to decrease your risk of getting degenerative disc disease, you can start by exercising. Exercise, especially when done in moderate to high volume, with low repetition and frequency, can decrease your risk of having symptoms. Along with a multitude of other health benefits, exercise will keep your postural muscles strong, spine stable, and cardiovascular system healthy.

What Not to Do

If you suffer from degenerative disc disease, don’t lay around hoping it will go away. Bedrest can make low back pain worse. After 1-2 days of rest per new episode, it is important to move your body. Your clinician will direct you on what kind of activities are safe and effective for your case.

Conclusion

Degenerating discs are about as common as getting wrinkles with age. When they become painful and debilitating, however, we call it degenerative disc disease. It is the result of a complex interplay of actions happening both inside and outside of cells, environmental factors, genes, and change over time. If you have an episode of low back pain, you may have degenerative disc disease, but don’t schedule your surgery just yet. Make an appointment with Dr. Connor to discuss your back issues so you can get back to being you!

The #1 Cause of Belly Fat, Says Science

The #1 Cause of Belly Fat, Says Science

by | Dec 15, 2021 | other, weight loss

In an article in Eat This, Not That!, Dr. Connor is quoted saying that when your belly fat is causing health issues, you are at risk. Prevention, or at the very least, early intervention, is key here. Do not wait until your BMI or waist circumference reaches a point to make you wonder if belly fat is the cause; rather, you want to address this earlier in life, and the earlier the better.

Belly Fat
Restless Leg Syndrome: What Is It, What Causes It, and What Can You Do About It?

Restless Leg Syndrome: What Is It, What Causes It, and What Can You Do About It?

by | Nov 29, 2021 | other, sleep

Restless Leg Syndrome 1

For some people, laying down to sleep comes with uncomfortable sensations that make them feel like they have to move their legs. This experience, called restless leg syndrome (RLS) or Willis-Ekbom Disease, can keep a person awake at night, often tossing and turning as they cannot get comfortable. Don’t confuse RLS with leg cramps — these are two different conditions. Leg cramps are sharp pains that develop when muscles in the legs suddenly contract. Leg cramps may last a few seconds to a few minutes. On the other hand, RLS leads to ongoing feelings of discomfort. About five to 10 percent of adults in the U.S. have restless leg syndrome. The condition also affects two to four percent of children. Women develop this condition more often than men. Additionally, older adults are more likely to develop RLS and to have worse symptoms. More than four out of five people with RLS also develop another sleep disorder called periodic limb movement of sleep (PLMS). PLMS causes the legs or arms to regularly move and jerk while a person is sleeping.

Symptoms of Restless Leg Syndrome

RLS causes uncomfortable feelings in the lower limbs. People with RLS feel like they can’t control the urge to move their legs. Often, moving around makes the discomfort disappear, but the feelings usually return once movement stops. People with RLS may also describe feelings of pulling, twitching, crawling, throbbing, burning, or itching. Occasionally, RLS may also affect muscles in the arms or other parts of the body. RLS symptoms often appear later in the day, in the evening or at night. A person may notice restless legs when they are sitting or lying down. Some people may wake up in the middle of the night with twitchy legs and have a hard time falling back asleep. RLS symptoms may also pop up during the day when a person has been sitting for a long time, such as on an airplane flight. Restless leg syndrome may also lead to additional problems during the day. RLS often prevents a person from getting a good night’s sleep, which can lead to memory loss, difficulty focusing, and mood changes. Additionally, when RLS goes untreated, it impacts productivity at work.

Long-Term Effects of RLS

When people don’t get enough sleep, they are also at risk for physical and mental health problems, including diabetes and depression. One study found that people with restless leg syndrome were four times more likely to develop heart disease or experience a stroke. This group was also at risk for developing kidney disease.

Restless Leg Syndrome Causes

Pills
​ Normally, the brain “talks to” the muscles in the legs using nerves. Experts believe that RLS develops when the nerves in the leg muscles can’t communicate with the brain as well as they should. Doctors don’t know why most cases of RLS occur. However, in some cases RLS is linked to genetics, an underlying health condition, or a particular medication.

Genes and Restless Leg Syndrome

Researchers have identified certain gene changes that increase a person’s risk of developing RLS. It’s not yet clear how these gene changes lead to RLS, but they may affect the way nerves develop before a person is born. There also may be other genetic factors that scientists have not yet discovered. This means that RLS can be passed down from parents to children. Most people diagnosed with the condition have a family member who also has RLS.

Health Conditions Leading to RLS

RLS is often linked to low levels of iron. The brain uses this mineral to make a dopamine, a brain chemical, often called a neurotransmitter. Dopamine is needed in order for the brain to control muscle movement. When a person doesn’t have enough iron in the brain, this process may be disrupted. Other vitamin and mineral deficiencies have also been linked to RLS. For example, people with low levels of magnesium or folate, a B vitamin, may also experience RLS symptoms. Other disorders may also lead to restless leg syndrome. These include:

  • Diabetes
  • Multiple sclerosis
  • Rheumatoid arthritis
  • End-stage renal disease (loss of kidney function)
  • Parkinson’s disease
  • Peripheral neuropathy (nerve damage)

Another RLS cause is pregnancy. In this case, the symptoms usually disappear a couple of weeks after giving birth. Some experts think that RLS happens during pregnancy as a result of low iron and folate levels, since pregnancy requires higher levels of these nutrients.

Medications That Cause RLS

Restless legs may be a side effect of certain medications. These can include:

  • Antidepressants
  • Antipsychotics
  • Anti-nausea drugs
  • Cold medications
  • Allergy medications
  • Drugs used to treat hypertension (high blood pressure)

If you notice RLS symptoms after trying a new medication, talk to your health care team. Your doctor may be able to prescribe you an alternate medication that doesn’t lead to restless feet and legs.

How Is RLS Diagnosed?

What causes leg cramps and what to do about them
Doctors may perform a physical or neurological exam if they suspect that a person has RLS. During this time, the doctor will usually ask about what symptoms a person is experiencing, how often the symptoms occur, what medications a person is using, and the person’s personal and family health history.

Doctors can test iron levels with a simple blood test. These tests may show that low iron stores have caused red blood cell levels to drop, in a condition known as iron-deficiency anemia. Blood tests can also be used to look at other aspects of health, including kidney function.

Doctors often recommend a sleep study in order to diagnose sleeping problems. During this test, a person will stay overnight in a clinic or hospital. Also, home sleep studies can be conducted in one’s own bed. Electrodes can help measure body functions like heart rate and brain waves. A video camera may also be used to capture movements while a person sleeps. This test may indicate that a person has RLS or another sleep condition such as sleep apnea or narcolepsy.

Restless Leg Syndrome Treatments

Stretching legs
RLS usually can’t be cured. However, it may be possible to rectify the underlying root cause of the problem. Symptoms may briefly disappear, but they frequently return later. However, remedies are available to help relieve symptoms and improve sleep. Some people with mild symptoms may not need any treatments.

Immediate Treatments

Moving around usually leads to instant relief for restless legs. If you are having a hard time falling asleep because of RLS symptoms, try getting up and walking around for a little bit. Massaging or stretching the leg muscles may also calm the uncomfortable sensations.

Some people also feel better after taking a hot bath. Using a hot water bottle or ice pack may calm restless legs.

Lifestyle Changes

RLS may be partly caused by environmental or lifestyle factors. Some substances, including alcohol, caffeine, and tobacco, may cause RLS or worsen symptoms. Drinking less alcohol and coffee and quitting smoking may help symptoms appear less often. Additionally, getting more physical activity throughout the day can relieve symptoms.

Practicing good sleep hygiene may also make it easier to fall asleep. Try to follow a regular sleep schedule, laying down to bed at the same time each night and setting an alarm for the same time each morning. Additionally, try to keep your sleeping area cool, dark, and quiet.

Diagnosing Other Health Conditions

When RLS is caused by another health condition, diagnosing and treating that condition often provides relief. A good first step when looking for RLS treatments is visiting your doctor and making sure you are in good health.

Iron Supplements

When RLS is caused by low iron levels, taking iron supplements can help. These supplements can be purchased over-the-counter. For those with very low levels of iron, intravenous (IV) iron treatments can also help boost iron levels.

Even when blood tests show that a person has normal iron levels, doctors may still recommend iron supplements. Studies have shown that iron treatments can help everyone, regardless of iron test results. Researchers think that some people may have normal levels of iron in the blood, but low levels of this mineral in the brain. For this reason, iron supplements are often the first treatment a doctor will suggest.

Other Vitamin or Mineral Supplements

Researchers have found that taking folate supplements may also improve RLS symptoms. This treatment has been effective both in people with genetic cases of RLS that run in families, as well as RLS that develops due to underlying health conditions. Folate deficiencies may also be responsible for RLS symptoms during pregnancy. One study found that pregnant women who took folate supplements were much less likely to experience RLS symptoms.

It’s possible that magnesium levels may also be linked to RLS. However, studies have reported conflicting results — some have found that magnesium supplements help people with RLS get a better night’s sleep, while others have not found magnesium to be effective. However, these supplements may be worth a try for some people. Make sure to take the recommended dose of any vitamin or supplement, as high doses can make you sick.

Medications for Restless Leg Syndrome

There are several different drug options that may change the levels of certain brain chemicals in order to help with restless leg syndrome. Doctors may prescribe:

  • Anti-seizure medications such as Horizant (gabapentin enacarbil), Neurontin (gabapentin), and Lyrica (pregabalin)
  • Medications that affect levels of dopamine, including Requip (ropinirole), Mirapex (pramipexole), and Neupro (rotigotine)
  • Antidepressant or anti-anxiety medications
  • Pain medications, including low doses of opioid drugs

These medications often work in different ways. They may affect different brain chemicals or change the way different sensations feel. Additionally, each of these drugs can lead to varying side effects. People with RLS may need to try more than one option before they find something that works well for them.

Drugs that alter dopamine levels often work well short-term but may increase symptoms in the long run. People who use these drugs regularly may need to take increasingly higher doses in order to feel an effect. If this side effect develops, a person may need to stop taking the medication and switch to a different one. Anti-seizure medications don’t have this effect and seem to work better over time to keep restless legs under control.

Medical Devices

Researchers have developed a couple of devices for RLS treatment. Some have even been approved by the U.S. Food and Drug Administration (FDA). You need a prescription from your doctor in order to get these devices.

One device, the Relaxis pad, is a pillow-sized pad that is placed under the legs. The device vibrates as you fall asleep. Some researchers think that the vibrations cause the leg muscles to send certain signals back to the brain. These signals may override the other signals caused by RLS that lead to discomfort. One study found that the Relaxis pad worked as well as RLS drugs, and came with fewer side effects.

The Restiffic foot wrap is another device designed to treat RLS. The wrap puts pressure on muscles in the bottom of the foot. Scientists believe that this feeling of pressure sends signals to the brain, which then tells the leg muscles to relax. In one small clinical trial, the device improved RLS symptoms to a greater degree than medication.

Conclusion

If you are plagued by restless legs at night, it may help to talk to your health care team. Your doctor can recommend or prescribe various treatments and check to make sure RLS isn’t caused by another health problem.

For many people, restless leg syndrome can be treated with simple at-home solutions, including taking iron supplements, getting more exercise, and avoiding alcohol, caffeine, and tobacco. When these strategies don’t work well enough to manage RLS, medications or devices may be effective.

If you would like to discuss RLS, please make an appointment.

Leg Cramps: What Causes Them and What to Do About Them

Leg Cramps: What Causes Them and What to Do About Them

by | Nov 10, 2021 | other

Young woman holding apple

What Is a Leg Cramp?

A leg cramp, also called a charley horse, is a sudden pain in a leg muscle. Leg cramps often develop when a muscle becomes strained during activity or when a person is dehydrated. Less common causes include injury or an underlying condition. Fortunately, there are many things that you can do at home to help treat and prevent most cases of muscle cramps.

Leg cramps develop when there is a problem with one or more muscles in your leg. Muscles that are most often affected include the hamstrings (back of the upper leg), quadriceps or quads (front of the upper leg), or calf (back of the lower leg).

Muscles are made up of many small fibers. Nerves control groups of fibers, connecting muscles to the brain. When you “tell” a muscle to move, the muscle fibers contract — they become tighter, leading to movement.

Leg cramps occur when one of the muscles in the legs contracts suddenly, without you controlling it. Usually, you are able to relax a muscle after moving it, but during a cramp, the muscle stays tightened, and you can’t tell it to relax. Muscle cramps usually lead to pain. A cramp may go away after a couple of seconds, or it may linger for several minutes. In addition to your legs, muscle cramps also commonly appear in the arms, hands, feet, side of your chest, or abdomen.

What Causes Leg Cramps?

Many things can lead to cramping muscles. They may develop as a result of exercise or hydration habits, appear as a symptom of an underlying injury or condition, or occur as side effects of certain treatments.

Physical Activity and Leg Cramps

Leg Cramp

Most often, your leg is cramping because you overused a muscle. You may have strained or pulled one of your leg muscles while exercising or performing physical activity.

Cramping may be a sign that your body can’t keep up with the amount of physical activity you are trying to do. You may need to start using a less intense exercise routine, or taking more frequent breaks during bouts of physical activity.

How Water Affects Muscle Cramping

Dehydration is a very common cause of leg cramps. Dehydration develops when a person doesn’t drink enough water to replace all of the fluids that they lose.

Illness that leads to diarrhea or vomiting can lead to dehydration. The same is true for diseases that cause people to sweat or urinate too much, including kidney disease and diabetes. Both young children and older adults also have a higher risk of dehydration.

Getting a lot of physical activity or spending time in hot temperatures can easily lead to dehydration if a person isn’t drinking enough water. When people sweat a lot, and don’t replace the fluid they lose, they may end up with heat cramps.

Leg Cramps and Electrolyte Imbalances

Even if you’re drinking a lot of water, you may still experience cramping if you don’t get enough electrolytes. Electrolytes are minerals such as sodium, calcium, potassium, and magnesium. Electrolytes are found throughout your body, including in your muscles. They help control how much water enters and leaves different tissues. Electrolytes also help cells absorb nutrients and get rid of waste.

When the body’s fluid balance is thrown off, the levels of electrolytes can become abnormal as well. Dehydration can lead to low electrolyte levels in the muscles, which then make the muscles begin to hurt.

Leg Cramps as a Symptom of Other Conditions

What causes leg cramps and what to do about them

Menstruation sometimes causes leg cramps. During a menstrual period, the muscles of the uterus contract in order to get rid of the uterine lining. This often leads to pain in the abdomen during a period. In some cases, pain can be felt in other parts of the body, such as the back or the legs. Pain during periods is normal for some people, but can also be a sign of a health condition. About half of women with endometriosis experience leg pain during periods.

Muscle cramps can also be a pregnancy symptom. Many pregnant women report cramps in their legs or feet, especially towards the end of the pregnancy. Leg cramps most often appear at night.

Sometimes, leg cramps may actually be a sign of injury in your back or neck. If you have a problem with your neck or spine, such as an injury or pinched nerve, the nerves that connect the brain to the legs may be affected. As a result, the nerve may make the muscle contract when it shouldn’t.

Several other disorders can cause muscle cramping. These include:

  • Thyroid problems: The thyroid gland helps control many different processes within the body. About four out of five people with an underactive thyroid (hypothyroidism) have pain or weakness in the muscles.
  • Nerve disorders: When there are problems with the nerves that control the muscles, a person may experience muscle cramps, pain, or twitching.
  • Kidney disorders: More than one out of three people with kidney disease have ongoing muscle pain.
  • Alcoholism: The more a person drinks alcohol, the more likely they are to have leg cramps, especially at night. Additionally, people with liver damage often have leg cramps.
  • Diabetes: This disorder occurs when the body can’t properly regulate blood sugar levels. This can cause nerve damage, which may lead to leg cramps.
  • Fibromyalgia: People with this disorder often experience muscle pain and stiffness in addition to tiredness, mood changes, memory problems, and insomnia.

Muscle cramps that happen often, don’t go away, or don’t have a clear cause may be a sign of these or other disorders. If your legs cramp frequently or happen along with other health changes, talk to your doctor.

Leg Cramps as a Treatment Side Effect

Certain drugs can cause leg cramps. These include certain diuretics (water pills), asthma medications, cholesterol medications, the high blood pressure medication nifedipine, and others. If you have recently changed which medications you take, or changed a medication dose, ask your doctor whether leg cramps are a possible side effect.

People with kidney failure often need to undergo dialysis treatments. During dialysis, waste and extra fluid is filtered out of the blood. Between 25 and 50% of people receiving dialysis have leg cramps.

Treating Leg Cramps

The most common causes of leg cramps can be treated at home. They usually don’t signal any major problem. However, in some cases, you may need medical care. Talk to your doctor if these strategies are ineffective at preventing or relieving your leg cramps.

Basic Home Care for Muscle Cramps

How to treat leg cramps

Cramping develops when a muscle contracts but doesn’t relax. One of the first things to try when you notice a leg cramp is to stretch the muscle. This may help loosen it. Don’t try to stretch too far or too fast, or you may risk injuring the muscle. Stretching before physical activity may also help prevent a leg cramp from forming. Additionally, some people tend to get leg cramps at night. If this is the case for you, stretch before going to bed. Massaging the muscle during or after stretching may also help.

To stretch your legs, try the following after consulting your physician to ensure they are appropriate for you. Hold each stretch for about 15 seconds:

  • Hamstring stretch: Stand with your feet shoulder-width apart. Bend forward and try to touch your toes, although it’s okay if you can’t reach them. Don’t lock your knees — bend them slightly. You should feel a light pulling in the backs of your thighs.
  • Quadriceps or thigh stretch: Hold on to a wall, chair, or other sturdy object for balance. Stand on your left leg, bending your right knee. Reach down with your right hand to grab your right foot. Pull gently, stretching your foot straight up towards your back. You should feel this stretch in the front part of your thigh. Make sure to stretch both legs.
  • Inner thigh stretch: Stand with your legs a couple of feet apart. Bend your left knee and shift your hips to the left. You should feel a slight pulling in your right inner thigh. Next, stretch the left side by bending your right knee and moving your hips to the right.
  • Calf stretch: Stand a couple of feet from a wall, and place both hands on the wall. Bend your left knee, placing your left foot on the ground near the wall. Move your body forward, towards the wall, while keeping your right knee straight and your right toes and heel planted on the ground. You should feel the stretch in the back of your right leg, below the knee. Repeat on the other side.

You can also use temperature to your advantage to help relieve a leg cramp. Putting a heating pad or hot water bottle on the affected area can help loosen a muscle. Once the muscle is relaxed, try numbing pain with an ice pack.

Hydrate Yourself

Sliced orange

The amount of water needed each day varies a lot from person to person, depending on things like age, sex, activity levels, climate, and health conditions. However, leg cramps may be a sign you’re not drinking enough. Try carrying around a water bottle with you during the day, or switching out other beverages for water during mealtimes. Children, older adults, and lower-income people are less likely to get enough water.

If you develop leg cramps after working outside or undergoing a lot of physical activity, you may be experiencing heat cramps or heat exhaustion. Start rehydrating yourself and eat a snack. Your cramps should start getting better within an hour. If they don’t, seek medical care. Additionally, get medical treatment if you have signs of heat exhaustion such as heavy sweating, cool skin, dizziness, a fast heartbeat, or confusion.

Get More Electrolytes

If you currently have cramps, it may be better to hydrate with a beverage that contains electrolytes. One study found that drinking water after an intense workout actually increased the chances that a person developed cramps. However, when dehydrated people drank electrolytes after finishing a workout, muscle cramps became less likely.

To prevent future leg cramps due to dehydration, make sure to properly fuel your body and drink enough fluids before being active or spending time in hot temperatures. Sports drinks that contain both carbohydrates and electrolytes can help. In one small study, people who had a sports drink before and during physical activity were able to exercise for more than twice as long before developing leg cramps.

In addition to using sports drinks when you are physically active, you can also try getting more electrolytes through your diet. Try eating more foods that contain these important minerals:

  • Potassium: leafy greens like spinach or Swiss chard, sweet potatoes, clams, yogurt, bananas, orange juice, and coconut water
  • Calcium: dairy foods such as milk, yogurt, and cheese, as well as leafy green vegetables, tofu, sardines, and salmon
  • Magnesium: nuts, seeds, beans, leafy green vegetables, and whole grains

Medication for Leg Cramps

Pain from basic leg cramps can often be relieved with over-the-counter medications. A good option to try is non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or high-dose aspirin. In more severe cases cases, doctors may be able to prescribe medication such as muscle relaxers to help with cramped muscles.

NSAIDs may also help when leg cramps are caused by a menstrual period. Additionally, taking an oral contraceptive (birth control pill) can reduce menstruation symptoms including pain.

Other Treatments for Leg Cramps

If leg cramps are caused by an underlying health condition, treating that condition may help this symptom improve. Additionally, if cramping is caused by a medication, you may be able to talk to your doctor about switching to a new treatment plan.

In some cases, leg cramps occur because a health condition or treatment prevents enough blood from getting to the leg muscles. Massage can help stimulate blood flow, causing people to have fewer leg cramps.

When To Get Medical Help

Talk to your doctor if your legs cramp frequently and don’t go away after trying home remedies. You should also talk to a doctor if your cramps lead to severe pain or don’t disappear after a few minutes. Additionally, if leg cramps appear along with other symptoms like weakness, redness, swelling, or warmth, they may be a sign of something more serious.

Conclusion

Leg cramps can have many causes. However, most often cramping is simply a sign that you need to take it easier or drink more water. Stretching out the cramped muscle, grabbing a sports drink, and taking an NSAID are strategies that can help in the moment while the muscle is cramping.

If these simple treatments don’t work, leg cramps may be a sign that something else is going on. It may be time for a conversation with your doctor. Most causes of leg cramps can be managed with proper treatment, once you have a better understanding of the cause.

If you are concerned about muscle cramps and would like to discuss with Dr. Connor, please make an appointment.

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