Author Archive

Strokes Compounded With Aspirin Resistance

Persons who exhibit a resistance to aspirin may be more likely to have more severe, and larger, strokes than those who still respond to the drug, according to a new study.

“Eventually we may be able to identify people who are likely to be resistant to aspirin and give them higher doses or different drugs to prevent blood clots,” said lead author Mi Sun Oh, MD, of Hallym University College of Medicine in South Korea.

Prior aspirin use has been associated with lower stroke severity and decreased infarction size.

However, the effect of aspirin resistance on stroke severity has been inconclusive.

Doctors do not routinely test patients for aspirin resistance.

STUDY DETAILS

Dr. Oh and colleagues set out to evaluate the effect of aspirin resistance on initial stroke severity and infarct size measured by MRI diffusion weighted imaging (DWI) in 310 patients.

“We enrolled patients with at least 7 days of aspirin before symptom onset, evidence of ischemic stroke on DWI, and aspirin resistance checked within 24 hours of hospital admission,” he said.

A total of 86 patients (27.7%) were resistant to aspirin.

In a multivariable analysis, aspirin resistance was significantly associated with higher initial NIH Stroke Scale score.

Aspirin resistance also was a significant predictor of larger DWI infarction volumes.

The infarct size was 2.8 cc in aspirin-resistant patients compared with 1.6 cc for those who responded to aspirin.

In conclusion, Dr. Oh said: “Aspirin resistance is independently associated with increased initial stroke severity and stroke volume in acute ischemic patients.

However, we need better ways to identify people with aspirin resistance before any changes can be made.

DON’T STOP LOW-DOSE ASPIRIN YET

For now, people who are taking low-dose aspirin to prevent blood clotting and stroke should continue to do so.”

Antiplatelet agents such as aspirin reduce platelet aggregation, the formation of thrombus, and the size and frequency of thrombotic emboli.

When patients do not have adequate platelet inhibition, this may lead to larger and more severe strokes because of larger thrombus and higher rate of thrombotic emboli.

The researchers presented their results at the American Academy of Neurology’s 67th Annual Meeting in Washington, DC, April 18 to 25, 2015.

Abstract title: Aspirin Resistance is Associated with Increased Stroke Severity and Infarction Volume

Erectile, Sexual Function Better in Active Men

The more a man exercises, the better his erectile and sexual function, regardless of his race, according to a new study designed to define a minimum exercise threshold for best sexual function.

Many studies have highlighted the relationship between better erectile function and exercise, but black men have been underrepresented in the literature.

“This study is the first to link the benefits of exercise in relation to improved erectile and sexual function in a racially diverse group of patients,” said senior author Adriana Vidal, PhD, of the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute and Department of Surgery in Los Angeles.

This cross-sectional study included nearly 300 participants from a case-control study that assessed risk factors for prostate cancer conducted at the Durham Veterans Affairs Medical Center.

The men, about one-third of them black, self-reported their activity levels.

The researchers then stratified them into 4 exercise groups: sedentary, mildly active, moderately active, and highly active.

The subjects also self-reported their sexual function, including the ability to have erections and orgasms, the quality and frequency of erections, and overall sexual function.

MORE FREQUENT EXERCISE = HIGHER SEXUAL FUNCTION

A multivariate analysis showed that men who reported more frequent exercise, a total of 18 metabolic equivalents (METS) per week, had higher sexual function scores, regardless of race.

MET hours reflect both the total time of exercise and the intensity of exercise.

A score of 18 METS is the equivalent of 2 hours of strenuous exercise, such as running or swimming; 3.5 hours of moderate exercise; or 6 hours of light exercise.

“Higher exercise was associated with a better sexual function score.

Importantly, there was no interaction between black race and exercise, meaning more exercise was linked with better erectile/sexual function regardless of race,” the researchers stated.

In contrast, exercise at lower levels was not statistically or clinically associated with erectile or sexual function in men of any ethnicity.

Additional contributors to low sexual function included diabetes mellitus, older age, past or current smoking, and coronary artery disease.

LESS INTENSE EXERCISE BETTER THAN NONE

Study coauthor Stephen Freedland, MD, Director of the Center for Integrated Research in Cancer and Lifestyle in the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, cautions that exercise should be tailored for each person.

“When it comes to exercise, there is no one-size-fits-all approach,” said Dr Freedland, who also serves as codirector of the Cancer Genetics and Prevention Program.

“However, we are confident that even some degree of exercise, even if less intense, is better than no exercise at all.”

The researchers published their results online in the March 20, 2015 issue of Sexual Medicine.

Young Diabetes Patients Less Likely to Take Their Medicine

Patients with diabetes who are younger, new to the disease, and receiving few other medications may be at risk for nonadherence to therapy, according to a new study.

Medication nonadherence is fairly common, in about 30% of patients.

There are ‘non-modifiable’ factors associated with lower adherence, such as younger age, being female, and lower income level.

We think it’s helpful to be aware of these factors to increase awareness of risks and also to target programs or interventions to improve adherence,” said M. Sue Kirkman, MD, from the University of North Carolina School of Medicine, Chapel Hill, NC.

“There also are potentially modifiable factors that health care providers could target, such as getting more patients to use mail-order pharmacies or doing more to lower patients’ out-of-pocket costs,” she added.

WHO ADHERES TO MEDICATION

Many prior studies have shown that nonadherence to anti-diabetic medications is associated with many adverse outcomes, including hospitalizations, higher costs, and increased mortality.

Dr. Kirkman and colleagues conducted a retrospective analysis of a large pharmacy claims database to examine patient, medication, and prescriber factors associated with adherence to anti-diabetic medications.

They extracted data on a cohort of more than 200,000 patients who were treated for diabetes with non-insulin medications in the second half of 2010 and had continuous prescription benefits eligibility through 2011.

They used the medication possession ratio, a fairly standard way to assess adherence.

“We pre-specified a number of variables related to patient factors, provider factors, and prescription factors and looked at their association with adherence,” Dr. Kirkman said.

“We then did a multivariate model to look at the independent effects of each variable, since many of them are correlated with one another.”

WHY THEY DON’T TAKE THEIR MEDS

Overall, 69% of patients were adherent.

Nonadherence was associated with a number of factors, including younger age, being female, being new to diabetes therapy, and receiving few other medications.

Nonadherence also was associated with higher out-of-pocket costs and use of retail pharmacies vs mail order.

“We speculate that nonadherent patients may not view themselves as ‘ill’ and may be less likely to take medications for an essentially asymptomatic disease, while older patients who have more comorbidities and are more used to taking medications might be more likely to stay on their diabetes medications,” Dr. Kirkman said, noting that the researchers did not talk to patients directly.

“This suggests that acceptance of a chronic illness diagnosis and the potential consequences may be an important, but perhaps overlooked, determinant of medication-taking behavior,” she noted.

The researchers published their results online January 8, 2015, in Diabetes Care.

New Therapy May Reset Biological Clocks

Biological clocks and sleep schedules may be able to be reset through administration of glucocorticoids, opening up new therapeutic avenues for improving the synchronization of the body’s various biological clocks, according to a new study.

Physiological changes over the course of a day are regulated by a circadian system composed of a central clock located deep within the center of the brain and multiple clocks located in different parts of the body.

“These results lead us to believe that we may one day be able to use a combined therapy that targets the central clock (inverting work schedules, administering controlled light therapy) with a pharmacological treatment that targets the peripheral clocks to ensure that all clocks are adjusted,” said lead author Diane B. Boivin, MD, PhD, Professor in the Faculty of Medicine at McGill University and the Founder/Director of the Centre for Study and Treatment of Circadian Rhythms of the Douglas Mental Health University Institute in Montreal.

In previous studies, Dr. Boivin and her team showed that desynchronized circadian clocks disrupt the sleep, performance, and cardiac parameters of night-shift workers.

The researchers also showed that exposing workers to bright light at night or adjusting work schedules can improve the synchronization of the central biological clock to their atypical work schedule.

“A single therapy can’t address the disruptions that occur in all biological clocks,” stated Dr. Boivin.

“For example, when used incorrectly, light therapy can even aggravate the situation.”

GENES DRIVE BIOLOGICAL CLOCKS

Clock genes drive biological clocks, and these genes are active in all body organs.

Animal studies have shown that the central biological clock in the brain sends signals to the clocks in other organs.

Glucocorticoids appear to play a central role in transmitting these signals.

Glucocorticoids, such as cortisol and cortisone, are essential for the utilization of carbohydrate, fat and protein by the body and for normal response to stress.

This is the first study to demonstrate that glucocorticoids play this role in humans, the researchers stated.

They studied the rhythmic expression of clock genes in white blood cells of 16 healthy volunteers to see how the volunteers adjusted to glucocorticoids administered in the late afternoon.

The results show that 20 mg of hydrocortisone taken orally acutely increased gene expression in peripheral blood mononuclear cell (PBMC) peripheral clocks.

After 6 days of hydrocortisone administration, the phases of central markers were not affected; however, expression of 2 genes in PBMCs were shifted by about 9.5 to 11.5 hours.

This suggests that biological rhythms may play a role in controlling immune function in night-shift workers, the investigators stated.

DOOR OPENS TO INNOVATIVE THERAPIES

The new research opens the door to innovative therapies that adjust circadian rhythms in inverted sleep schedules, combining synchronizing agents for the central and peripheral clocks.

This has possible applications for travelers, night-shift workers, patients who are experiencing sleep disorders and circadian rhythm disorders, and persons with various psychiatric disorders, they stated.

“At this stage, we are not recommending the use of glucocorticoids to adjust the rhythms of night-shift workers, as there could be medical risks,” Dr Boivin said.

The researchers published their results online December 12, 2014 in The FASEB Journal.

Sleep Apnea Risk Swells With Asthma

If you have asthma, you may be at increased risk for sleep apnea, too.

A new study assessed the relationship of asthma with obstructive sleep apnea (OSA) using laboratory-based sleep studies, and found that pre-existent asthma was a risk factor for the development of clinically relevant OSA in adults over a 4-year period.

What’s more, this association was stronger among those who had asthma longer, according to the authors, led by Mihaela Teodorescu, MD, MS, of the William S. Middleton Memorial Veteran’s Hospital and the University of Wisconsin School of Medicine and Public Health in Madison.

OSA is very common and becoming increasingly prevalent among adults with asthma.

It adversely affects health and leads to a higher risk of death.

Earlier studies had suggested an association between asthma and OSA.

This study examined the prospective relationship of asthma with OSA.

OVERNIGHT SLEEP STUDIES

Dr Teodorescu and colleagues used data from the Wisconsin Sleep Cohort Study, a population-based prospective epidemiologic study that included randomly selected adult employees of state agencies, age 30 to 60 years, in 1988.

The patients were recruited to attend overnight sleep studies and fill out health-related questionnaires about every 4 years.

Eligible participants were identified as free of OSA at study entry by 2 baseline sleep studies.

Slightly more than one-quarter of the 81 participants with asthma experienced incident OSA over their first observed 4-year follow-up intervals.

This compared to 16% of the 466 participants without asthma.

With the use of all available 4-year intervals, including multiple 4-year interval observations per participant, those with asthma experienced 45 incident OSA cases during 167 4-year intervals (27%) and those without asthma experienced 160 incident OSA cases during 938 4-year intervals (17%).

The risk of new OSA was increased nearly 40% in participants with preexisting asthma compared with those without asthma after the investigators controlled for sex, age, and baseline and change in body mass index — all factors known to contribute to sleep apnea.

The researchers asked the participants, “Do you have feelings of excessive daytime sleepiness?” to help determine habitual sleepiness.

Asthma duration was related to both new OSA and new OSA with habitual sleepiness, defined as answering “often” (5 to 15 times a month) and “almost always” (more than 15 times a month).

“Studies investigating the mechanisms underlying this association and the value of periodic OSA evaluation in patients with asthma are warranted,” the researchers stated.

“CLINICAL RELEVANCE”

If these results are confirmed in a larger study with more asthma cases, the finding would have important clinical relevance, they suggested.

Dr Teodorescu recommends that physicians “look for OSA symptoms among asthma patients.

The literature suggests that OSA worsens asthma.

Treatment for OSA improves asthma symptoms during the day and night, as well as quality of life and lung function measures.

If you identify and treat OSA, the hope is that asthma control will improve.”

The researchers published their results in the January 13 issue of JAMA.

Headache Imaging Can Spot Brain Tumors

Reducing imaging tests for patients with headaches runs the risk of missing or delaying the diagnosis of brain tumors, according to a new study.

“Patients with brain tumors may present with isolated headaches in the absence of other neurological symptoms and signs.

Early diagnosis of brain tumors allows prompt treatment before more severe symptoms, reduced performance status, and worsened outcomes,” stated the researchers, led by neurosurgeon Ammar H. Hawasli, MD, from Washington University School of Medicine, St Louis.

“As physicians grapple with the difficult conflict between evidence-based cost-cutting guidelines and individualized patient-tailored medicine, they must carefully balance the costs and benefits of discretionary services, such as neuroimaging for headaches.”

Despite recently published guidelines to limit neuroimaging for headache, there has been a progressive increase in neuroimaging for headaches in the United States.

In most cases, diagnosis of migraine and other types of headache can be made in the doctor’s office, without any special tests.

“Nonetheless, neuroimaging in the United States between 2007 and 2010 for migraines and headaches approached $1.2 billion,” the researchers stated.

“Medical providers have likely continued high use of neuroimaging for headaches because of concerns about potential missed diagnoses and medical errors, which would adversely affect patient outcomes and, in turn, affect malpractice liability,” they said.

RECENT GUIDELINES: LAUDABLE BUT INCONSISTENT

The recent guidelines seek to reduce the use of neuroimaging for patients with headaches to limit the use of unnecessary and costly medical tests.

For example, the “Choosing Wisely” guidelines developed by the American College of Radiology and Consumer Reports include the recommendation, “Don’t do imaging for uncomplicated headaches.”

“Although the intentions are laudable, these guidelines are inconsistent with the neurosurgeon’s experience with patients with brain tumor,” the investigators stated.

“Specifically, patients with brain tumors may present with isolated headaches in the absence of other neurological symptoms and signs.”

HEADACHES AND BRAIN TUMORS

The researchers presented their analysis of a series of 95 patients with a confirmed diagnosis of brain tumor.

Nearly half of the patients had a combination of symptoms, such as seizures, cognitive and speech dysfunction, and other neurological abnormalities.

However, about one-fourth of the patients had isolated headaches, no symptoms, or nonspecific symptoms.

In 11 patients, headache was the only symptom of brain tumor; 4 of these patients had new-onset headaches that would have qualified them for neuroimaging under recently proposed guidelines.

The other 7 patients had migraine or other types of headache and would not have been chosen for neuroimaging.

Depending on which set of recent recommendations had been followed, neuroimaging would have been delayed or never performed in 3% to 7% of patients who had brain tumors.

“We support careful and sensible use of neuroimaging in which physicians exercise excellent clinical judgment to reduce waste in the medical system,” the researchers concluded.

“Although we do not recommend routine screening for the general population, we do contend that a substantial number of patients with brain tumors will present with isolated headaches.”

The researchers published their results in the January 2015 issue of Neurosurgery.

Night Shifts Upset Sleep, Up Heart Death Risk

Night shift work not only disrupts sleep patterns but also increases the risk of cardiovascular disease (CVD) and lung cancer deaths, according to one of the largest prospective cohort studies worldwide with a high proportion of rotating night shift workers and long follow-up time.

“Women working rotating night shifts for more than 5 years have a modest increase in all-cause and CVD mortality.

Those working more than 15 years of rotating night shift work have a modest increase in lung cancer mortality.

These results add to prior evidence of a potentially detrimental effect of rotating night shift work on health and longevity,” report researchers led by Eva S. Schernhammer, MD, DrPH, Associate Professor of Medicine, Harvard Medical School, and Associate Epidemiologist, Department of Medicine, Brigham and Women’s Hospital, Boston.

There is substantial biological evidence that night shift work enhances the development of CVD.

In 2007, the World Health Organization classified night shift work as a probable carcinogen because of circadian disruption.

HOW SLEEP AFFECTS THE HEART

Sleep and the circadian system play an important role in cardiovascular health and anti-tumor activity.

The circadian system and its prime marker, melatonin, are considered to have anti-tumor effects through multiple pathways — including antioxidant activity, anti-inflammatory effects, and immune enhancement — and they exhibit beneficial actions on cardiovascular health by enhancing endothelial function, maintaining metabolic homeostasis, and reducing inflammation, the researchers noted.

“Direct nocturnal light exposure suppresses melatonin production and resets the timing of the circadian clock,” they stated.

“In addition, sleep disruption may also accentuate the negative effects of night work on health.

Taken together, substantial biological evidence supports the role of night shift work in the development of poor health conditions, including cancer, CVD, and ultimately, mortality.”

NIGHT SHIFTS AND DEATHS

Using data from the Nurses’ Health Study, the international team of researchers analyzed 22 years of follow-up of nearly 75,000 women.

Night shift information was collected in 1988.

Rotating shift work was defined as working at least 3 nights per month in addition to days or evenings in that month.

The investigators found that working rotating night shifts for more than 5 years is associated with an increase in all-cause and CVD mortality.

Mortality from all causes appeared to be 11% higher for women with 6 to 14 years or more than 15 years of rotating night shift work.

CVD mortality appeared to be 19% and 23% higher for those groups, respectively.

There was no association between rotating shift work and any cancer mortality, except for lung cancer in those who worked the night shift for 15 or more years (25% higher risk).

“A single occupation (nursing) provides more internal validity than a range of different occupational groups, where the association between shift work and disease outcomes could be confounded by occupational differences,” the researchers noted.

“To derive practical implications for shift workers and their health, the role of duration and intensity of rotating night shift work and the interplay of shift schedules with individual traits (eg, chronotype) warrant further exploration,” they added.

The researchers published their results in the January 5, 2014 issue of the American Journal of Preventive Medicine.

Poor Sleep May Add to Dementia

Older men with sleep disturbances appear more likely to have brain changes associated with dementia, according to a new study, adding to evidence that poor sleep may play a role in mental decline.

“These findings suggest that low blood oxygen levels and reduced slow wave sleep may contribute to the processes that lead to cognitive decline and dementia,” said lead author Rebecca P. Gelber, MD, DrPH, of the VA Pacific Islands Health Care System and the Pacific Health Research and Education Institute in Honolulu.

Dr. Gelber and colleagues conducted a prospective cohort study of 167 Japanese American men, mean age 84 years, in Honolulu who underwent at-home sleep studies in 1999–2000.

All of the men were monitored until they died an average of 6.4 years later.

Autopsies were conducted on their brains to look for microinfarcts (tiny abnormalities in brain tissue), loss of brain cells, the plaques and tangles associated with Alzheimer disease, and Lewy bodies found in Lewy body dementia.

Loss of brain cells was more common in men who spent less time in slow wave, or deep, sleep (sleep that is important in processing new memories and remembering facts) than in those who spent more time in slow wave sleep.

People tend to spend less time in slow wave sleep as they age, the researchers noted.

Loss of brain cells also is associated with Alzheimer disease and dementia.

LOW OXYGEN LEVELS LEAD TO BRAIN CHANGES

The researchers divided the participants into 4 groups based on the percentage of time spent with lower than normal blood oxygen levels during sleep.

The lowest group spent 13% of their time or less with low oxygen levels, and the highest group spent 72% to 99% of the night with low oxygen levels.

Microinfarcts in the brain were seen almost 4 times as frequently in the one-fourth of men with the lowest oxygen levels during sleep than in men who had the highest oxygen levels.

There was no association between the sleep measures and the level of plaques and tangles.

The researchers noted that the causes of low oxygen levels during sleep were unclear and that brain changes could have occurred before the sleep tests.

Previous studies also have shown a link between sleep stages and dementia.

But this is the first study to show that certain sleep features are related to brain changes, Dr. Gelber noted.

“More research is needed to determine how slow wave sleep may play a restorative role in brain function and whether preventing low blood oxygen levels may reduce the risk of dementia,” she said.

Although the study did not actually show that sleep apnea per se is related to brain changes, Dr. Gelber noted that a previous study showed that use of a continuous positive airway pressure machine for obstructive sleep apnea may improve cognition, even after dementia has developed.

The researchers published their results on December 10, 2014 in the online issue of Neurology.

The Biggest Sports Injury Story of 2014

The biggest, most pervasive sports injury story of the year has to be the effects of concussions on football players.

From professional to college to high school players, sports-related brain injuries have become a concern in football.

Studies show that the effects of multiple concussions can be long lasting, including depression, cognitive problems, and even an increased risk of Alzheimer’s disease.college football concussions

Thousands of retired National Football League (NFL) players who have suffered concussion-related injuries and disabilities filed a class-action lawsuit against the league, claiming that it did not do enough to protect their health and did not tell them about the long-term dangers of repeated head injuries.

Public awareness of the dangers of concussions was again raised after Ohio State University defensive lineman Kosta Karageorge, who had a history of concussions during his college career, was found dead in late November as the result of an apparent self-inflicted gunshot wound.

In early December, a study found that high school football players may develop impact-related brain changes over the course of a single season.

Players who experienced higher levels of head impacts showed the most changes, even in the absence of concussion.

Denver Broncos wide receiver Wes Welker may have worn a larger helmet to help him prevent further concussions in this year’s Super Bowl game, but even hits to the head that don’t result in concussions can affect athletes’ brains and may impact learning.

This makes some athletes more susceptible to repeated head impacts that do not involve concussions.

NEW LAWS, MORE AWARENESS

The good news is that new laws regulating concussion treatment plus awareness of concussions have resulted in a large increase in the treatment of concussion-related injuries for school-age athletes, according to a new study published online on December 22, 2014 in JAMA Pediatrics.

A University of Michigan study designed to evaluate the impact of new concussion laws found a 92% increase in children seeking medical assistance for concussions in states with the legislation in place.

States without concussion laws showed a 75% increase in those seeking injury-related health care.

“There are two stories here,” said senior author Steven Broglio, Associate Professor at the University of Michigan School of Kinesiology and Director of the NeuroSport Research Laboratory.

“First, the legislation works.

The other story is that broad awareness of an injury has an equally important effect. We found large increases in states without legislation, showing that just general knowledge plays a huge part.”

As of 2014, all states and the District of Columbia have passed laws that outline medical care for young athletes.

The laws differ slightly, but most call for education of coaches or students, the immediate removal of an athlete from a game, or medical clearance before an athlete can return to a sport.

TECHNOLOGICAL ADVANCES

Another way to prevent brain injuries may be to add a vision-based test to evaluate athletes on the sidelines.

This may allow sports medicine doctors to better detect more athletes with concussion more quickly, which is particularly important since not all athletes reliably report their symptoms of concussion, including any vision problems.

Others are taking a more technological approach to protecting players.

Several companies have put sensors or magnets in helmets or mouth guards to detect or absorb the forces of hits to the head, with the hope of further reducing the risk of brain injury to young athletes.

The sensors cannot prevent or diagnose a concussion, but they can alert coaches and trainers to take the proper steps to determine if a player has a concussion.

Let’s hope that these and other safety measures are made at all levels of football and translate into fewer concussions next year.

Most Common Women’s Sports Injuries

A woman’s sports injuries are basically the same as a man’s.

But there are some peculiarities due to differences in anatomy and issues related to the menstrual cycle.

Here’s a look at some of the most common overuse sports injuries suffered by women, including stress fracture, runner’s knee, jumper’s knee, tennis elbow, and frozen shoulder, and how to treat them.

Stress Fracture

Women tend to have a higher incidence of stress fractures then men.

Stress fractures occur from repetitive forces.

They are more common in women who do not menstruate compared to those who do.

A woman with osteoporosis or osteopenia (low bone density) will also be at greater risk of stress fracture because of decreased bone density.

Weight-bearing exercises, such as walking, dancing and jogging, are particularly valuable in reducing bone loss in middle-aged and postmenopausal women, and may help prevent osteoporosis.

Runner’s Knee

Runner’s knee, or patellofemoral pain syndrome, is characterized by a stable, but painful knee.

This is much more common among women because a woman’s pelvis is wider, making the angle between the thigh and the calf sharper, which is known as an increased Q-angle.

This results in greater force toward the front and inner part of the knee.

The tendency is for the kneecap to pull out of line and rub on the side of its groove, causing knee pain.

Conservative treatment includes physical therapy, core strengthening, stretching of quadriceps and hip external rotator muscles, bracing, and biomechanical analysis and correction.

Jumper’s Knee

Jumper’s knee, or patellar tendinitis, is characterized by pain in the front of the knee.

Pain increases with running and jumping, and the pain symptoms may intensify during the night and upon waking in the morning.

The pain comes from inflammation of the tendons that hook into the upper and lower ends of the kneecap.

The more you train and the higher the intensity of your training, the more you feel the pain.

The first treatment is to rest long enough to get over the acute pain, and to take anti-inflammatory agents to reduce the pain, if necessary.

If pain continues or increases, cortisone injections can help manage the pain and swelling, or surgical treatment may be required.

Tennis Elbow

Tennis elbow, or lateral epicondylitis, is an overuse injury to the tendons at the lateral humeral epicondyle, the bands of tissue that connect the arm muscles to the outside aspect of your elbow area.

It is usually associated with lack of forearm strength.

Lateral epicondylitis most often occurs in women between ages 30 and 50.

The tennis backhand stroke, which involves repeated wrist extension against resistance, increases the risk of symptoms at the outside of the elbow.

Conservative treatment should include physical therapy, bracing, and biomechanical analysis and correction of repetitive activity.

In severe cases, surgical treatment may be required.

Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, is seen most often in women between ages 40 and 70.

It is often seen in combination with other shoulder conditions (such as rotator cuff problems) or diabetes mellitus.

The hallmark symptom of frozen shoulder is decreased range of motion and severe shoulder pain.

It often disappears on its own.

Conservative treatment usually involves taking anti-inflammatories to reduce pain and inflammation.

A physical therapist can teach you stretching exercises to help maintain as much mobility in your shoulder as possible.

Relief of symptoms is gradual and recovery takes from 12 to 18 months, on average.

Surgical options for adhesive capsulitis include joint manipulation under anesthesia and capsular release.

Take a Break

Overuse injuries usually require you to suspend activity.

A biomechanical analysis and correction are components to successful recovery and should be performed by sports medicine professionals.

Prevention is also a key component by maintaining a fit and healthy lifestyle.

Core training and strength training of both the lower and upper body can maintain muscular strength and endurance, and help to prevent chronic overuse injuries.