Knee pain may not be a knee problem

Posted on September 14, 2012 by askdrjames
Left knee-joint from behind, showing interior ...

Left knee-joint from behind, showing interior ligaments. (Lateral meniscus and medial meniscus are cartilage.) (Photo credit: Wikipedia)

Knee injuries and knee pain are very common, however, knee pain is not always caused by a problem with the knee. What I usually tell my patients is that the knee works like a hinge; it takes on the stress from above and below. The root cause of many non-traumatic, chronic, recurrent or gradual onset of knee pain actually comes from below the knee (ankle/foot) or above the knee (pelvic/hip or higher).

Below the knee: Overpronation of the foot during gait increases stress in the inner knee with repetitive movement such as running or simply daily walking over time. That’s why having good running shoes and general supportive foot wear, or orthotics, are so important. However, if you have severe pronation, you should also consider having supportive footwear inside the home as well. Most people who have flat feet usually have overpronation of the feet as well, but not everyone does. The best thing is to get your feet checked. If you have overpronation and orthopedic tests reveal that the root cause of the knee pain is originated from the feet, orthotics are usually recommended along with therapy. Study shows that foot orthoses with stretching/strengthening exercises for eight weeks significantly reduces knee pain during running and stair walking than a control group who only did the exercises.[i] This is an important take home point. While your orthotics serve to minimize stress in the knee from overpronation of the foot, you still want to make sure that the supporting muscles for your knee are balanced and functionally strong.

How do I know if my muscles are strong and balanced? Simple, your health practitioner can do simple functional muscle testing for you.

Above the knee: Rotation of the pelvis can also cause muscle imbalance in the IT band as well as quadriceps muscles. This may lead the muscles pulling on the knee cap excessively toward the outer aspect of the knee, resulting in runner’s knee (or cyclist’s knee). When the knee cap (patella) tracts improperly, the knee cap grinds excessively against the knee joint and also results in weakening of the inner knee muscle (distal fibre of the vastus medialis).

However, rotation of the pelvis may also be a compensation of the upper body as well. If your right shoulder is rotated forward, your left pelvis will rotate forward to counterbalance or compensate for your posture in order to reduce stress and strain. That’s how our body reacts and compensates to minimize pain and other symptoms. That’s why we emphasis full body posture assessment in our clinic. Postural exercises such as yoga or those prescribed by your health professionals are highly recommended. The more you do them, the more likely your posture will improve and STAY improved.

Can I take any supplement for my knee pain? How about glucosamin? Nutritional support is obviously important. Studies show that glucosamine helps with some knee pain. However, if the cause of the knee pain is due to overpronation of the feet or pelvis rotation or muscle imbalance, it will only mask the symptoms. If your knee pain is chronic, you may consider using glucosamine to protect the knee cartilage from further damage whilst addressing the mechanical issues simultaneously. Even if the glucosamine alone reduces your knee pain, it won’t stop the damaging effect from the daily faulty biomechanical stress.

Other cause of knee pain: overweight or inflammatory conditions such as rheumatoid arthritis. If these are the cause of your knee pain, you are likely to experience early degeneration in other joints such as lower back or ankles. Weight loss progress with healthy eating habits would be beneficial. Omega-3[ii] as well as cumerric BCM-95[iii] can help to reduce inflammation as well.

If you decide to seek professional help for your knee pain, make sure that your feet, pelvis and posture are all addressed.

Risk factors and Warning signs:

  • overpronation of the feet, or flat-feet
  • clicking in the knees
  • morning stiffness in the knees
  • poor balance on one leg squat
  • unable to keep the knee pointing straight during a full squat
[i] Eng JJ, Pierrynowski MR. Evaluation of soft foot orthotics in the
treatment of patellofemoral pain syndrome. Phys Ther 1993;73(2):62-68.
[ii] Cleland LG, James MJ, Proudman SM. The role of fish oils in the treatment of Rheumatoid Arthritis. Drugs. 2003;63(9):845-53
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Roasted Beet Salad with Dill, Walnuts and Goat Cheese

Posted on September 7, 2012 by askdrjames
English: A bundle of organic beets from a loca...

English: A bundle of organic beets from a local farm food co-op program. (Photo credit: Wikipedia)

Beet root is rich source of B-complex vitamins such as niacin (B-3), pantothenic acid (B-5), pyridoxine (B-6) and minerals such as iron, manganese, copper and magnesium. Raw beets are also a very good source of folate. Something that is less commonly known is that beet root is rich in a phytonutrient group called betanins, such as betanin, which are antioxident.  Betaine has the property of lowering homocysteine levels within the blood. High levels of homocysteine in the blood promotes platelet clot as well as plaque formation. I love to have beet on a burger. That’s right. You heard me. Try it and you will love it.

A diabetic individual may worry about eating beet because of its glycemic index (69: medium to high), however, beet has a low glycemic load because there are not many carbohydrates in a single serving of beets. So this is a good news for a diabetic individual.

The following beet salad recipe is provided by Vanessa Yeung, Chef and owner of Aphrodite Cooks. (416-792-3212. info@aphroditecooks.com)

Ingredients: (serve 6)

  • 8 medium sized, red or golden beets
  • 2 tablespoons dill, chopped
  • 1/3 walnuts, chopped and toasted
  • ½ cup goat cheese, crumbled
  • 3 tablespoons red wine vinegar
  • 6 tablespoons olive oil
  • Salt and pepper

Method:

  1. Preheat oven to 400 F.
  2. Place raw beets on a baking sheet lined with foil or parchment paper.
  3. Roast beets for 40 minutes or until when a knife is inserted and goes through without any force.
  4. When cooked remove beets from and allow it to cool until comfortable enough to handle.
  5. Peel and slice beets into ½ inch thick rounds, or into wedges.
  6. While still warm season with vinegar, olive oil and salt and pepper.
  7. Lay beets on a platter. Garnish with walnuts, dill and goat cheese.
  8. Serve immediately.
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Walnuts Appear to Improve Sperm Quality in Healthy Men

Posted on September 5, 2012 by askdrjames

A randomized, parallel, 2-group, dietary intervention trial shows that daily consumption of 75 g of whole-shelled walnuts appears to have positive effects on the vitality, morphology, and motility of sperm in healthy men after 12 weeks.

Walnut02The study was conducted by Wendi A. Robbins, PhD. and colleagues from the University of California, Los Angeles. 120 healthy men between ages of 21 and 35 years were recruited. Approximately 50%

of the men were randomly assigned to a control group, the other 50% were assigned to walnut supplementation group for a 12-week trial. The authors revealed that sperm vitality, motility and morphology were significantly improved in the walnut group compared with the control group after 12 weeks. In addition, serum omega-3 and omega-6 fatty acid levels were significantly improved in the walnut group after 12 weeks. The prevalence of sperm missing a sex chromosome were significantly lower in the walnut group after 12 weeks of supplementation. (read more)

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Kinesiotape – What is the big deal?

Posted on August 30, 2012 by askdrjames
Kinesio tape

Kinesio tape (Photo credit: tö)

What is the colourful tape on all those olympian’s bodies? Could it help my injuries?

2012 Olympic games are over, the buzz of the colourful tape continues. If you have been watching the Olympics, you would have noticed the strips of coloured tape on many of the athletes bodies.  What are they? They are called Kinesiotape.

Much like the typical white athletic tape, Kinesiotape helps people recover from injuries and also protect them from injuries or re-injuries. However, the typical white athletic tape tends to limit range of motion, while the kinesiotape allows much greater functional range of motion and protects the muscles and joints.

Kinesiotape Traditional white athletic tape
Ease of use
  • Easy to apply and take it off
  • It sticks right on the skin
  • Latex-free
  • Moisture and air flow through it’s porous fabric
  • Minimizes skin irritation and allows the tape to be worn continuously for three to four days
  • also use in aquatic sports
  • Often requires a “pre-wrap” and use of chemical spray on the skin for the “pre-wrap”
  • Should be taken off after a practice or game. Should not be left on overnight due to skin irritation.
Functional benefit Allows greater range of motion while facilitating muscle function, thereby protecting the injured area. Protects the injured area by limiting the range of motion
Application
  • can also be used on acute injuries with swelling in many cases
  • can be used in rehabilitation setting
  • can be stretched up to 140%
  • Generally not recommended on acute injuries with swelling.
  • Not used for rehabilitation setting
  • Does not stretch

I have been using kinesiotape tape on my patients for many years. I found it to be very useful for certain repetitive injuries such as tennis elbow, golfer’s elbow, knee or shoulder injuries as well as wrist/thumb pain due to computer overuse. It is a great tool for patients as an adjunct treatment as well as a form of home therapy, like stretching and braces.  In turn it allows faster recovery by minimizing the repetitive stress in the injured area in between visits.

Again, kinesiotape should be used in conjunction with actual therapy with your therapist or doctors. Not to be used alone if there is an existing injuries.

Related articles
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How to Recognize Early Memory Loss

Posted on August 27, 2012 by askdrjames
DSC02646

DSC02646 (Photo credit: Jacob & Kiki Hantla)

Starting to recognize uncharacteristic memory loss can be confusing and even terrifying, and often loved ones are embarrassed to mention it.

Memory loss that becomes a pattern and not an occasional isolated event may be of concern.  The misplacement of keys or getting to the supermarket only to forget what you came for is normal, unless you feel it is happening more frequently or in different ways than it used to.

If you are unsure whether your loved one is having early memory loss, here are 5 signs to look for and discuss with their health care professional:

  1. Confusion or difficulty in completing familiar tasks or following directions such as recipes or driving directions.
  2. Repetition of stories or forgetting significant life events when they talk about them.
  3. Rationalization of memory loss as a normal part of aging can indicate denial about a more serious problem.
  4. Decrease in judgment such as putting themselves in dangerous situations or being careless with money.
  5. Uncharacteristic changes in personality or mood.  True, our personalities change as we age, but people with memory loss or dementia tend to show sudden changes such as hostility, anger, confusion or sadness.

Contributed by Premier HomeCare Services

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Meditation Reduces Proinflammatory Gene Expression

Posted on August 23, 2012 by askdrjames
Big Budda

Big Budda (Photo credit: Hindrim)

In  my previous blog “weight loss myth 3: I can’t lose weight! It’s my genes.”, it mentions that we can influence our gene expression with our lifestyles and environment, although we may not be able to change our genetics. An example of this is that our sleep pattern can influence our “fat gene”.
Another recent research shows that a 8-week mindfulness-based stress reduction (MBSR) meditation program can significantly reduce loneliness and pro-inflammatory gene expression in older adults. This just adds to a growing body of evidence that is showing the positive benefits of a variety of  exercises involving meditation, such as tai chi and yoga. (see full article) You can improve your  health by meditation. Very cost-effective!

 

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Calcium Part3: What affects Calcium absorption?

Posted on August 7, 2012 by askdrjames

Calcium dietary supplement tablets.What affects Calcium absorption?  Not all calcium consumed is actually absorbed in the gut. Humans absorb about 30% of the calcium in foods, but this varies depending upon the type of food consumed.[i]

  • Calcium absorption depends on your body’s available calcium and on the total amount of elemental calcium consumed at one time
  • Dosage: Absorption is highest in doses < 500 mg[i]. The efficiency of absorption decreases as calcium intake increases. Therefore, separate doses into twice or three times daily for optimal absorption. [ii]
  • Age: As we get older, absorption efficiency decreases. In order word, there may be increase need of calcium.
  • Vitamin D: many studies are now showing that many people are deficient in vitamin D
  • Combining with food containing high level of phytic acid and oxalic acid: spinach, collard green, sweet potatoes, rhubarb, beans, whole grain products, wheat bran, beans, seeds, nuts and soy isolates. Phytic acid and oxalic acid bind to calcium and can inhibit its absorption.[iii] However, if one eat a variety of foods, these interactions probably have little or no nutritional consequence.
  • Acidogenic diet: Metabolic acids produced by diets high in protein and cereal grains increase calcium excretion[iv], therefore it is thought to negatively affect calcium status.

 Importance of vitamin K2 in Calcium:

The role of Vitamin K2 in calcium is binding calcium to the bone matrix after calcium is absorbed.

Calcium Deficiency: Although frank calcium deficiency is uncommon, inadequate intakes of dietary and supplemental calcium below recommended level would have negative health impact over the long term

  • other symptoms may include muscle cramps, numbness and tingling in the fingers
  • poor appetite, abnormal heart rhythms, poor teeth
  • osteopenia (early stage of osteoporosis)

Groups at Risk of low Calcium

  • Individuals with lactose sensitivity, intolerance or cow’s milk allergy
  • Postmenopausal women
  • Amenorrheic women: Amenorrhea, the condition in which menstrual periods stop or fail to initiate in women of childbearing age, results from reduced circulating estrogen levels that, in turn, have a negative effect on calcium balance.
  • Vegetarians
    Vegetarians might absorb less calcium because they consume more plant products containing oxalic and phytic acids and because of their avoidance of dairy foods[v],[vi]. In the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition, bone fracture risk was similar in meat eaters, fish eaters and vegetarians, but higher in vegans, likely due to their lower mean calcium intake[vii].

Interactions with Medications

Calcium supplements have the potential to interact with several types of medications. Individuals taking these medications on a regular basis should discuss their calcium intake with their healthcare providers.

Calcium can decrease absorption of the following drugs when taken together: biphosphonates (to treat osteoporosis), the fluoroquinolone and tetracycline classes of antibiotics, levothyroxine, phenytoin (an anticonvulsant), and tiludronate disodium (to treat Paget’s disease)[viii],[ix],[x]

Thiazide-type diuretics can interact with calcium carbonate and vitamin D supplements, increasing the risks of hypercalcemia and hypercalciuria. [xi]

Both aluminum- and magnesium-containing antacids increase urinary calcium excretion. Mineral oil and stimulant laxatives decrease calcium absorption. Glucocorticoids, such as prednisone, can cause calcium depletion and eventually osteoporosis when they are used for months. [xi]

References:

[i] Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.

[ii] http://orthopedics.about.com/od/osteoporosistreatment/f/calciumtype.htm

[iii] Weaver CM, Heaney RP. Isotopic exchange of ingested calcium between labeled sources: evidence that ingested calcium does not form a common absorptive pool. Calcif Tissue Int 1991;49:244-7. [PubMed abstract]

[iv] Fenton TR, Eliasziw M, Lyon AW, Tough SC, Hanley DA. Meta-analysis of the quantity of calcium excretion associated with the net acid excretion of the modern diet under the acid-ash diet hypothesis. Am J Clin Nutr. 2008 Oct;88(4):1159-66. [PubMed abstract]

[v] Janelle KC, Barr SI. Nutrient intakes and eating behavior scores of vegetarian and nonvegetarian women. J Am Diet Assoc 1995;95:180-6. [PubMed abstract]

[vi] American Dietetic Association, Dietitians of Canada. Position of the American Dietetic Association and Dietitians of Canada: vegetarian diets. J Am Diet Assoc 2003;103:748-65. [PubMed abstract]

[vii] Appleby P, Roddam A, Allen N, Key T. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr. 2007 Dec;61(12):1400-6. [PubMed abstract]

[viii] Shannon MT, Wilson BA, Stang CL. Health Professionals Drug Guide. Stamford, CT: Appleton and Lange, 2000.

[ix] Jellin JM, Gregory P, Batz F, Hitchens K. Pharmacist’s Letter/Prescriber’s Letter Natural Medicines Comprehensive Database. 3rd ed. Stockton, CA: Therapeutic Research Facility, 2000.

[x] Peters ML, Leonard M, Licata AA. Role of alendronate and risedronate in preventing and treating osteoporosis. Cleve Clin J Med 2001;68:945-51. [PubMed abstract]

[xii] Jellin JM, Gregory P, Batz F, Hitchens K. Pharmacist’s Letter/Prescriber’s Letter Natural Medicines Comprehensive Database. 3rd ed. Stockton, CA: Therapeutic Research Facility, 2000.

Related articles
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Heirloom Tomato and White Bean Salad

Posted on August 3, 2012 by askdrjames

This tomato salad recipe is provided by Vanessa Yeung, Chef and owner of Aphrodite Cooks. (416-792-3212. info@aphroditecooks.com)

Balsamic and Caper Vinaigrette

  • 1/2 cup extra virgin olive oil
  • 2 tablespoons balsamic vinegar
  • 1 tablespoon sherry wine vinegar
  • 1 tablespoon capers
  • 1 clove of garlic
  • 1/2 teaspoon caper juice
  • Salt and pepper to taste

Method: Combine all ingredients together in a blender and puree for 1 minute. Set aside.

Tomato Salad

  • 1 clove of garlic
  • 6 vine ripened tomatoes cut into 1 inch chunks
  • 1/4 cup thinly sliced red onion
  • 1/4 cup of fresh basil, torn
  • 1/4 cup of Italian parsley, chopped
  • 1/2 English cucumber, diced
  • 1/2 cup of low sodium white kidney beans, drained and rinsed
  • salt and pepper to taste
  • 12 kalamata olives
  • 1 pint of heirloom cherry tomatoes, or yellow grape tomatoes
  • 1/2 cup crumbled feta cheese

Method:

  1. To make the croutons, preheat the oven to 350 F..
  2. To make the salad combine the tomatoes, onion, basil, parsley, cucumbers, white kidney beans, olives, feta cheese and the vinaigrette in a large bowl. Toss well and season with salt and pepper.
  3. Serve and enjoy.
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Tomato for your bone health

Posted on August 3, 2012 by askdrjames
Lycopene

Lycopene (Photo credit: krossbow)

Summer reason is also known as the BBQ season for many people, especially in Canada. We love to have tomatoes on the burgers, salad and use them for appetizers as well. However, did you know that tomatoes are a good source of lycopene, which is a bone-protective antioxident.

Studies show that 30mg of lycopene a day significantly reduced both oxidative damage and bone breakdown. Other studies showed that as little as 12.64 mg lycopene a day lowered fracture risk. So you can double or even triple the tomato slices on your sandwich next time.

This tomato salad recipe is provided by Vanessa Yeung, Chef and owner of Aphrodite Cooks.  Heirloom Tomato and White Bean Salad

Balsamic and Caper Vinaigrette

  • 1/2 cup extra virgin olive oil
  • 2 tablespoons balsamic vinegar
  • 1 tablespoon sherry wine vinegar
  • 1 tablespoon capers
  • 1 clove of garlic
  • 1/2 teaspoon caper juice
  • Salt and pepper to taste

Method: Combine all ingredients together in a blender and puree for 1 minute. Set aside.

Tomato Salad

  • 1 clove of garlic
  • 6 vine ripened tomatoes cut into 1 inch chunks
  • 1/4 cup thinly sliced red onion
  • 1/4 cup of fresh basil, torn
  • 1/4 cup of Italian parsley, chopped
  • 1/2 English cucumber, diced
  • 1/2 cup of low sodium white kidney beans, drained and rinsed
  • salt and pepper to taste
  • 12 kalamata olives
  • 1 pint of heirloom cherry tomatoes, or yellow grape tomatoes
  • 1/2 cup crumbled feta cheese

Method:

  1. To make the croutons, preheat the oven to 350 F..
  2. To make the salad combine the tomatoes, onion, basil, parsley, cucumbers, white kidney beans, olives, feta cheese and the vinaigrette in a large bowl. Toss well and season with salt and pepper.
  3. Serve and enjoy.

Tomato products and lycopene content

Tomato product               Serving Size          Lycopene content

Tomato paste                          1cup                             75.4 mg

Tomato puree, canned          1 cup                            54.38 mg

Tomato sauce, canned           1 cup                           34.25 mg

Pasta sauce, canned               1 cup                           31.66 mg

Vegetable juice cocktail         1 cup                           23.38 mg

Tomato juice                            1 cup                          21.91 mg

Tomato soup                            1 cup                          13.05 to 22 mg

Tomato, raw                             1 cup                          4.6 mg

The chart shows that a cup of tomato paste contains much more lycopene than a cup of raw tomato. Studies show that the lycopene content and its antioxident level increase substantially when the tomatoes are cooked. The take home point is to eat as much varieties of food as possible, some raw, some lightly steamed and some cooked. You will get all the benefits you need from food.

If you are sensitive to tomatoes, you can also enjoy other red fruits and vegetables such as watermelon, gac (a Vietnamese fruit) or pink grapefruit.

References:

  1. Leticia G. Rao, Nupura Krishnadev, Katharine Banasikowska, and A. Venket Rao. Journal of Medicinal Food. July 2003, 6(2): 69-78
  2. Sahni, S et al., Protective Effect of Total Carotenoid and Lycopene Intake On The Risk Of Hip Fracture: A 17 Year, Follow-Up From the Framingham Osteoporosis Study, JBMR, Vol. 24, No.6.2009
  3. Mackinnon, ES et al., Supplementation with the Antioxidant Lycopene Significantly Decreases Oxidative Stress Parameters In The Bone Resorption Marker N-telopeptide  Of Type I Collagen In Postmenopausal Women.  Osteoporosis international (2011) 22:1091-1101
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Doctor-chiropractor team can ease low back pain

Posted on July 26, 2012 by askdrjames
Back pain!

Back pain! (Photo credit: Mike Souza)

Family doctors working closely with chiropractors to ease a patient’s low back pain can lead to fast and effective treatment, a pilot project found.

Doctors reported sending fewer patients for tests and surgical specialists after an assessment and recommendations by a chiropractor during the Ministry of Health-funded study by the Ontario Chiropractic Association.

Cutting the long wait for tests and specialist referrals is a huge relief for patients, said Jan Kasperski, chief executive officer of the Ontario College of Family Physicians.

“That period of waiting for a definitive diagnosis and wondering if they’re going to end up with surgery is really difficult for them,” Kasperski said. (see full article)

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