Author Archives: DrNotley

Weather and Pain

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Often I have patients who claim they can predict the weather or that their pain is influenced by the weather. I often assumed that the patient was seeing a correlation that didn’t really exist possibly because they have been told by others that weather influences joint pain. This subject, even in the area of research is controversial. Results of studies have shown connections while others show no effect. I decided to see what some of the research says.

From what I have learned from some of my research is as follows:

1. Low temperature, more often than not, has some effect on pain (osteoarthritis, rheumatoid arthritis)
2. Low temperature makes those 50 – 65 year old 15% more likely to experience rheumatoid arthritis pain
3. Relative humidity has a significant association with hand osteoarthritis pain
4. Absolute change in atmospheric pressure is associated with pain.
5. Limited evidence between fibromyalgia and weather conditions

I admit this isn’t not an exhaustive study of the subject but it is food for thought. Feel free and read the abstracts found below

Dr Notley

Influence of weather on osteoarthritis of the hands

Background: The aim of this work was to investigate the association between meteorological variables and pain, stiffness, and function of the hand in patients with osteoarthritis.

Methods: The survey was carried out over 2 months in 2009, covering July and November. The patients filled out a questionnaire, consisting of visual analogue scales covering the three categories of symptoms that primarily determine the situation with rheumatism of the hands: function, joint stiffness, and pain. The questionnaire was completed on Monday, Wednesday, and Friday for every week in July and every week in November. The meteorological variables recorded included atmospheric pressure, air temperature, relative humidity of the air, and precipitation. The climate records were checked against the variables of functional evaluation of the hands from each patient using bivariate analysis and multiple regression analysis.

Results: In general, air temperature and relative humidity were the variables that displayed statistically significant higher association in all evaluated aspects of the hands, being explained by the influence of temperature in 40-88% (r) and relative humidity in 39-85% (r). In the multivariate analysis, there was a reduction in the number of weather variables that influenced pain. The variation of pain was explained by the average atmospheric pressure of the day of the questionnaire and the temperature the day before and the day after the questionnaire (52-88% [R2]).

Conclusions: The results implied individual variation in perception and quantification of function, stiffness, and pain. The lowest temperature associated with worsening of symptoms of pain and function in osteoarthritis of hands was the variable weather most frequently observed.

Weather conditions may worsen symptoms in rheumatoid arthritis patients:
The possible effect of temperature

Lydia Abasolo, Aurelio Tobías , Leticia Leon, Loreto Carmona, Jose Luis Fernandez-Rueda, Ana Belen Rodriguez, Benjamin Fernandez-Gutierrez, Juan Angel Jover

Objective: Patients with rheumatoid arthritis (RA) complain that weather conditions aggravate their symptoms. We investigated the short-term effects of weather conditions on worsening of RA and determined possible seasonal fluctuations.

Methods: We conducted a case-cross over study in Madrid, Spain. Daily cases of RA flares were collected
from the emergency room of a tertiary level hospital between 2004 and 2007.

Results:245 RA patients who visited the emergency room 306 times due to RA related complaints as the main diagnostic reason were included in the study. Patients from 50 to 65 years old were 16% more likely to present a flare with lower mean temperatures.

Conclusions: Our results support the belief that weather influences rheumatic pain in middle aged patients.

Influence of weather variables on pain severity in end-stage osteoarthritis

Stephen A. Brennan, Thomas Harney, Joseph M. Queally, Jade O’Connor McGoona, Isobel C. Gormley, Fintan J. Shannon

Purpose

Patients often attribute increasing pain in an arthritic joint to changing weather patterns. Studies examining the impact of weather on pain severity have yielded equivocal and sometimes contradictory results. The relationship between subchondral pseudocysts and the role they play in this phenomenon has not been explored.

Methods

Fifty-three patients with end-stage osteoarthritis of the hip completed daily pain severity visual analogue scale (VAS) scores over a one month period. Radiographs were reviewed to determine the presence of pseudocysts. Data pertaining to precipitation, atmospheric pressure and temperature were collected from the nearest weather station. A generalised linear mixed model was used to explore the relationship between weather variables, cysts and pain severity.

Results

Pain levels increased as a function of absolute change in atmospheric pressure from one day to the next. Precipitation, temperature and the presence of subchondral pseudocysts were not shown to influence pain severity.

Conclusions

This data supports the belief held by many osteoarthritic patients that changing weather patterns influence their pain severity.

Influence of Weather on Daily Symptoms of Pain and Fatigue in Female Patients With Fibromyalgia: A Multilevel Regression Analysis

Ercolie R. Bossema, Henriët van Middendorp, Johannes W. G. Jacobs, Johannes W. J. Bijlsma, Rinie Geenen

Objective

Although patients with fibromyalgia often report that specific weather conditions aggravate their symptoms, empirical studies have not conclusively demonstrated such a relationship. Our aim was to examine the association between weather conditions and daily symptoms of pain and fatigue in fibromyalgia, and to identify patient characteristics explaining individual differences in weather sensitivity.

Methods

Female patients with fibromyalgia (n = 333, mean age 47.0 years, mean time since diagnosis 3.5 years) completed questions on pain and fatigue on 28 consecutive days. Daily weather conditions, including air temperature, sunshine duration, precipitation, atmospheric pressure, and relative humidity, were obtained from the Royal Netherlands Meteorological Institute. Multilevel regression analysis was applied.
Results

In 5 (10%) of 50 analyses, weather variables showed a significant but small effect on either pain or fatigue. In 10 analyses (20%), significant, small differences between patients were observed in the random effects of the weather variables, suggesting that symptoms of patients were, to a small extent, differentially affected by some weather conditions, for example, high pain with either low or high atmospheric pressure. These individual differences were explained neither by demographic, functional, or mental patient characteristics, nor by season or weather variation during the assessment period.

Conclusion

There is more evidence against than in support of a uniform influence of weather on daily pain and fatigue in female patients with fibromyalgia. Although individuals appear to be differentially sensitive to certain weather conditions, there is no indication that specific patient characteristics play a role in weather sensitivity.

On the belief that arthritis pain is related to the weather (1996)

D A Redelmeier and A Tversky

Abstract

There is a widespread and strongly held belief that arthritis pain is influenced by the weather; however, scientific studies have found no consistent association. We hypothesize that this belief results, in part at least, from people’s tendency to perceive patterns where none exist. We studied patients (n = 18) for more than I year and found no statistically significant associations between their arthritis pain and the weather conditions implicated by each individual. We also found that college students (n = 97) tend to perceive correlations between uncorrelated random sequences. This departure of people’s intuitive notion of association from the statistical concept of association, we suggest, contributes to the belief that arthritis pain is influenced by the weather.

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Does rain really cause pain? A systematic review of the associations between weather factors and severity of pain in people with rheumatoid arthritis.
Smedslund G, Hagen KB.

OBJECTIVE:

To examine the association between weather and pain in rheumatoid arthritis (RA).

METHODS:

Systematic review of longitudinal observational studies (up to September 2009) with data on the association between weather variables and severity of pain in RA. The methodological quality was rated independently by the two authors according to an adapted Newcastle-Ottawa Scale. We analyzed the data on an aggregated (group) level with a meta-analysis of correlations between pain and weather, and at an individual level as the proportion of patients for whom pain was significantly affected by the weather.

RESULTS:

Nine studies were included. Many different weather variables have been studied, but only three (temperature, relative humidity and atmospheric pressure) have been studied extensively. Overall group level analyses show that associations between pain and these three variables are close to zero. Individual analyses from two studies indicate that pain reporting in a minority (<25%) of RA patients is influenced by temperature, relative humidity or atmospheric pressure. We were not able to relate the findings to methodological quality or other aspects of the studies.

CONCLUSION:

The studies to date do not show any consistent group effect of weather conditions on pain in people with RA. There is, however, evidence suggesting that pain in some individuals is more affected by the weather than in others, and that patients react in different ways to the weather. Thus, the hypothesis that weather changes might significantly influence pain reporting in clinical care and research in some patients with RA cannot be rejected.

Previously published August 1 2013

14 Essential Tips for Healthy Eating

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I must admit eating properly all the time is difficult. We don’t have the time, we are in a rush, healthy food is expensive, or we don’t know what foods are good for us. healthy food. These are all excuses that we are used to giving or hearing.

Throughout my years in health care as a Chiropractor, Athletic Therapist and a Strength and Conditioning Specialist, these are the top tips, in no particular order, which I have found to be excellent pearls of wisdom. I have simplified the tips because it is better to keep your diet simple than complex. Remember; do not get caught up with the fads at the time. Keep it simple. Do your best to follow the Canada food guide.

Incorporating these healthy eating tips will help you achieve better health. To accomplish these tips you must pre-plan and know what and when you are going to be eating. Take a day or two each week to prepare your food for the week and freeze what you can. This simplifies your week. It also means that when you are hungry you can quickly grab something from the freezer and heat it up. That means that it will take you 2 minutes rather than 20 minutes to prepare your food for that meal. Plus you won’t have to do as many dishes either.

If you find that purchasing healthy food is too expensive try purchasing your food when it is on sale and stock up on it. The cost of eating unhealthy food may end up being more expensive when you have to start paying for that medication to help lower your high blood pressure or high cholesterol. Take time and plan ahead with your purchasing. Remember, without a plan failure will happen.

Here are my favorite tips that I like to give to my patients.

  1. Eat slowly
  2. Eat to 80% full
  3. A regular meal pattern including breakfast consumption, consuming a higher proportion of energy early in the day, reduced meal frequency (i.e., 2⁻3 meals/day), and regular fasting periods may provide physiological benefits such as reduced inflammation, improved circadian rhythm, increased autophagy and stress resistance, and modulation of the gut microbiota.
  4. Eat one to two servings of vegetables or fruit on each meal. Pick from all the different colors available. Consider supplementing with a “Greens” product.
  5. Drink plenty or water or green tea approximately 8 cups a day. Avoid fruit juices and other sugar filled beverages.
  6. Minimize the consumption of simple/refined sugar and starchy foods until after moderate to strenuous exercise
  7. Eat a “complete protein” at each meal such as egg, milk, poultry, beans, fish etc.
  8. Consume essential fatty acids daily (Omega 3s) such as fish or fish oil supplements.
  9. Have a Multi-vitamin daily
  10. Choose whole foods rather than processed foods
  11. Choose whole foods that are high in fibre
  12. Chose whole grains as opposed to whole wheat.
  13. Avoid foods that are fried or contain trans fatty acids, hydrogenated or partially hydrogenated oils.
  14. Don’t worry about cheating every once in awhile.

Don’t try and do this all at once.  Take one tip and practice it for the next 3 weeks and then add another tip.

Original document was created  May 2010. Updated January 2 2020.

How do I cure a sore back?

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I recently received a question from someone on Klout.com asking the question, “How do I “cure a sore back”. Here is my response:

“How do I cure a sore back?”

It’s a difficult question to answer since there are multiple reasons for someone to have a sore back. Factors that may influence your lower back soreness may be:

Postural Strain

Staying in a stationary position for extended periods of time. For example, sitting for long periods of time. This is called postural strain.  To help with this, taking mini breaks from that position may help. http://drnotley.com/protect-your-spine-mini-breaks/

Inappropriate movement habits

If you are an athlete or are active then looking at your technique may be needed. Simply having someone help with your technique may be all that you need to take the strain off your back and allow your soreness to improve. A wonderful exercise that may be great for conditioning, like the burpee, may be detrimental to your back if done improperly http://drnotley.com/burpees-and-back-pain-my-thoughts/

Deconditioning

If you are not very active then developing general conditioning may be what you need.  I often see those who have back pain and they are very deconditioned but once they start getting active their pains diminish.

TRX suspension trainer and back pain: challenging the spine

Back Strength: Four for the Core

Unaddressed old injuries

If you have other injuries or an old injury these should be addressed. For lower backs we often need to look at spine posture during the actively, as well, as how the looking at the mobility or stability of the hips, knees, ankles and feet. If there are problems in these areas they can put added stress on the spine and cause pain.   What you may need if these is the case is exercises that will aid in increasing mobility of joints or stability.

Suboptimal health habits

Smoking (http://drnotley.com/chronic-pain-and-cigarette-smoking/), stress, and nutrition (http://drnotley.com/understanding-essential-fatty-acids/) can also cause back pain among other health issues.

Help from a professional

 Above, I have discussed approaches that require an active approach on your part.  These are very important because you are taking control of your health/pain which is very effective but there are passive methods that can be beneficial in the process.  Here are some examples

Pain referring to the back

Back pain/soreness may be as a result of other internal problems. For example, women have sore backs as a result of their menstrual cycle. A number of internal organ problems can result in back soreness.  A rule of thumb is that if you can’t find a position  or treatment that gives you relief or that there are no movements that cause added soreness then seeking out a medical doctor is warranted.

Conclusion

This is a round about way of saying that there are numerous ways to help a sore back.

Dr Notley

P.S. This list may not be all inclusive. If this pain persists seek out a Chiropractor, Athletic therapist, Physiotherapist, acupuncturist, or medical doctor.

Enjoy healthy elbows, wrist and hands, with these circle exercises

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The elbow joint is actually made up of 3 joints. These joints allow the elbow to bend and straighten as well and pronation and supination (turning the palm down and up when the elbow is bent).

To perform this exercise:

  • Begin with your elbow straight and your palm facing forward. Begin to bend your elbow. During this time supinate (turning the pinky side of the hand up towards the ceiling) the forearm as far as you can.

  • Once you have bent your elbow completely, turn the palm over towards the floor, att

  • empting to rotate the thumb to the floor as far as you can (pronating).

  • While you are pronating straighten out your arm.

Wrist, thumb and finger circles 

 

For the wrist:

Flex the wrist down as far as you can and then try and scribe out the largest circle

If you place you hand down on a table with the palm up your thumb can move up and down (abduction and adduction), in towards the pinky and out away from the pinky (flexion and extension) and it can rotate so that the pad of the thumb can touch each finger (opposition).

Start by lifting your thumb up towards the ceiling as far as you can and then towards your pinky circling around to the pads of the fingers and then away from the pinky finally ending up pointing back up towards the ceiling.

This can be performed in the other direction as well

 

The base of each finger can also create a circle as well.

Self myofascial release of the medial pterygoid

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The medial pterygoid is a muscle of mastication (chewing).

It attaches onto the jaw near it’s angle but can’t be easily touched from out side of the mouth because there is bone is in the way.

Most of this muscle is found on the inside of the mouth just behind the bottom molars.

The action of this muscle is to close the jaw and to shift the jaw to the opposite side.

When it is a problem the ability to open the jaw is restricted.
and it can be quite tender to touch.

Pain can often be felt in the mouth but also around the TMJ.

I’m going to show you to methods to methods to treat this muscle. But remember that this muscle can be quit tender to do not be overly aggressive.

Method One

Slide your index finger down the inside of your cheek. The pad side is against the cheek and the nail said up against the molars. When you get to back of the molars you will bump into bone. Open your jaw and slide your finger in to the inner side of that bone . The muscle is right there. Apply mild to moderate pressure and wait for it to relax. Hold until it relaxes. Perform once 1 to 2 times a day.

Method two

Though not direct, this method helps treat the distal part of the muscle. As you can see, the muscle ends up at the angle of our jaw. Take your thumb and tuck it underneath your jaw at this point. Use the pad of your thumb to contact the tender point o this muscle. You will have an easier time getting into this spot if your tuck your chin down. Hold until it relaxes. Perform once 1 to 2 times a day

when trying to contact the muscle from the outside you need to be aware that there are salivary glands near here as well. If you feel like you are starting to salivate that tender spot may be the salivary gland.