Elite Healthcare

Hamstring Injury

The hamstring muscle is a group of large, powerful muscles that span the back of the thigh, from the lower pelvis to the back of the shin bone. The hamstring is the important muscle that functions to extend the hip joint and flex the knee joint.

The hamstring is used in many sporting activities, as well as normal daily activities. Sports that commonly cause a hamstring injury are sprinting sports that involve sudden accelerations. These include track and field, soccer, and basketball.

A hamstring injury can also occur as a result of a direct blow to the muscle, such as being kicked in the back of the thigh, or falling on the back of the thigh. Hamstring contusions are different from pulled hamstrings, although they may cause similar symptoms.

What is a pulled hamstring?
A pulled hamstring, also called a hamstring strain, is a tear of the hamstring muscle fibers. In less severe hamstring strains, Grade I injuries, the tearing is microscopic. The muscle fibers are essentially stretched too far, and some bleeding occurs within the muscle. In very severe hamstring strains, severe Grade III injuries, the hamstring muscle can completely rupture, and may require surgery to repair the torn ends of the muscle.

Muscle strains and tears most commonly occur because of what is called an eccentric contraction. When this occurs, the muscle is trying to contract while another force (the ground, another player, etc.) is forcing the muscle in the opposite direction. This creates tremendous force on the muscle, and if the force is strong enough, it will tear the muscle fibers.

What are the symptoms of a pulled hamstring?
The symptoms of a pulled hamstring depend on the severity of the injury. The hamstring injury is usually sudden and painful. Other common symptoms include:

• Bruising: Small tears within the muscle cause bleeding and subsequent bruising. The bruise begins in the back of the thigh, and as time passes the bruise will pass down below the knee and often into the foot.
• Swelling: The accumulation of blood from the hamstring injury causes swelling of the thigh. This can make further muscle contraction difficult and painful. Wearing a compressive bandage can help control the swelling.
• Spasm: Muscle spasm is a common and painful symptom of a hamstring injury. Because of the trauma to the muscle, signals of contraction are confused, and the muscle may be stimulated. If severe, muscle relaxants can help with spasms.
• Difficulty Contracting: Flexing the knee is often painful after a pulled hamstring, and can even prevent the patient from walking normally. If you are unable to contract the hamstring, the muscle may be completely ruptured.

What is the treatment of a pulled hamstring?
Treatment of a pulled hamstring is dependent on the severity of the injury. Because of bleeding and swelling, athletes should stop their activity and rest immediately. An ice pack and compressive bandage can be applied to control swelling. Crutches may be necessary if walking is painful or if spasms are severe. If the pain is significant, or if the symptoms do not steadily resolve, medical evaluation should be obtained.

Hip Replacements

Hip replacement(arthroplasty) is a surgical procedure that replaces diseased parts of the hip joint with new, artificial prosthesis. Hip replacement surgery improves both mobility and comfort in a painful hip joint.

The most common reason for hip replacements is osteoarthritis of the hip joint. Other disease may also result in a hip replacement when pain and lose of function limit one's daily activities or quality of life.

Before deciding on a replacement, physicians may recommend medications, such as, Nonsteroidal anti-inflammatory drugs, or exercise to strengthen the muscles in the hip joint.

A hip replacement surgery is done by removing diseased tissue and replacing them with artificial parts. Hip replacement surgery usually lasts 2 to 3 hours recovery depending upon the patient's health status.

Physical therapy is required for a fast return to activity. A physical therapist will prescribe exercises that strengthen the hip. Exercise can also reduce joint pain and stiffness and increase flexibility. Many doctors recommend avoiding high-impact activitiesafter surgery. Ideal exercises are low-imapct: cross-country skiing, swimming, walking, and bicycling. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip.

Muscle Cramps

Muscle cramps are very common as recognized as an involuntary contraction of a muscle that doesn't relax. Cramps can occur in any skeletal muscle, but are most common in the legs and feet and muscles that cross two joints (the calf muscle, for example). Cramps can involve part of a muscle or all the muscles in a group. The most commonly affected muscle groups are:

• Back of lower leg / calf (gastrocnemius).
• Back of thigh (hamstrings).
• Front of thigh (quadriceps).
• Feet, hands, arms, abdomen

Muscle cramps range in intensity from a slight twitch or tic to severe pain. A cramped muscle can feel rock-hard and last a few seconds to several minutes or longer. It is not uncommon for cramps to ease up and then return several times before they goes away entirely.

What Causes Muscle Cramps

The exact cause of muscle cramps is unknown, but many experts think it is related to poor flexibility, muscle fatigue or doing new activity. Other factors associated with muscle cramps include exercising in extreme heat, dehydration and electrolyte depletion. Cramps are more common during exercise in the heat because sweat contains fluids as well as electrolyte (salt, potassium, magnesium and calcium). When these nutrients fall to certain levels, the incidence of muscle spasms increases.

Athletes are more likely to get cramps in the preseason when the body is not conditioned and therefore more subject to fatigue. Cramps often develop near the end of intense or prolonged exercise, or the night after.

Treating Muscle Cramps

Cramps usually go away on their own without treatment, but these tips will help speed the process:

• Stop the activity that cause the cramp.
• Gently stretch and massage the cramping muscle.
• Hold the joint in a stretched position until the cramp stops.

Preventing Muscle Cramps

• Improve fitness and avoid muscle fatigue
• Stretch regularly after exercise
• Warm up before exercise
• Stretch the calf muscle: In a standing lunge with both feet pointed forward, straighten the rear leg.
• Stretch the hamstring muscle: Sit with one leg folded in and the other straight out, foot upright and toes and ankle relaxed. Lean forward slightly, touch foot of straightened leg. (Repeat with opposite leg.)
• Stretch the Quadriceps muscle: While standing, hold top of foot with opposite hand and gently pull heel toward buttocks. (Repeat with opposite leg.)

Most muscle cramps are not serious. If your muscle cramps are severe, frequent, constant or of concern, see your doctor.

Scar Tissue

Scar tissue is a type of adhesion made up of dead fibrotic tissue that forms mostly in muscles, tendons, ligaments, fascia, and joints. 

Scar Tissue occurs as a result of injury, surgery, or repetitive motion. When a muscle, tendon or ligament is torn (strained, or sprained) or nerve is damaged, healing occurs in three stages called the inflammatory response: acute inflammation, repair, and remodeling. In acute inflammation, redness, swelling, heat and pain occur. This phase lasts approximately 72 hours. After the inflammation recedes, repair begins. If not treated properly, the damaged tissues heal with adhesions or scar tissue formation rather than the formation of brand new tissue. 

When a muscle tightens up-- through a repetitive motion such as typing, or after it has been injured-- swelling occurs, and it restricts the oxygen supply to the muscles and connective tissues (hypoxia). The lack of oxygen causes scar tissue to form deep within the injured tissues.

That scar tissue can adhere to muscle fibers, preventing them from sliding back and forth properly. It can adhere to connective tissues, limiting the flexibility of a muscle or joint. And it can adhere to nerve cells, leading to carpal tunnel syndrome, chronic back pain, and other conditions. 

Scar Tissue can bind up many layers of muscle and connective tissue, causing varying degrees of limited movement and pain. 

Research has proven scar tissue to be weaker, less elastic, more prone to future re-injury and as much as 1000 times more pain sensitive than normal, healthy tissue. Chronic pain is the result, pain that could remain for years after the initial injury.

To avoid the formation of adhesive scar tissue after an injury, surgery, or excessive muscle's overuse, healing must take place in the presence of full range of movement, and strengthening. 

Regularity is important. To avoid formation of scar tissue, it is highly recommended that you perform 2-3 treatments a week for 2-3 months. 

Note: As you probably already know from scars you may have on your skin, once it forms it is permanent. Properly following your doctor's advice regarding treatment for injuries should reduce or eliminate scar tissue formation as a result of your injuries and allow you the best recovery possible. 

Head Injuries in Children

  

What is head injury?

A head injury is any sort of accident or trauma that affects the head.

Cuts, tears or haemorrhages in the brain tissues and covering membranes can lead to a wide variety of problems, while fractures of the bones of the skull (including the face) can damage delicate tissues and increase pressure on the brain.

Other problems following head injury include damage to the spinal cord (head injuries often involve the neck, too), disruption of sight and hearing, as well as damage to the jaws and teeth, plus possible harm involving the major airways. Because all these important structures are found in the head, head injuries can take a huge toll. They can rapidly be life-threatening and are the major cause of long-term disability following an accident.

Symptoms

Symptoms include the visible effects of trauma to the head, such as a cut, bump or bruising. There may also be loss of consciousness (this may be brief), confusion, drowsiness, dizziness, headache, nausea and vomiting, blurred vision and loss of memory.

Straw-coloured or bloodstained fluid may be seen leaking from the child's nose or ears. This is cerebrospinal fluid, which normally bathes the brain, and is a sign of skull fracture requiring urgent medical attention.

Sometimes there are no, or minimal, immediate symptoms but the child collapses minutes or hours later, with a seizure or blackout. This may be caused for example when there is a slow haemorrhage beneath the skull which gradually puts pressure on the brain – this is known as a sub-dural haemorrhage and it needs urgent treatment.

Causes

Road traffic accidents are the most common causes of head injuries, especially when the child is a pedestrian or cyclist. Other common causes include falls from beds, windows or down stairs and sports injuries. Occasionally what seems to be a very small blow to the head, perhaps during some rough and tumble as kids play, leads to significant problems.

Treatment and Recovery

You should get urgent medical advice if your child loses consciousness (even for a few moments), becomes drowsy, confused, vomits persistently, has seizures, has fluid coming from the ears or nose, or seems unwell. Sometimes a parent just feels instinctively that their child isn’t right – you should always listen to these instincts.

The child may need to be closely observed for 24 hours in hospital, where skull x-rays (to look for fractures), CT and MRI scans (to check for damage to or haemorrhage in the brain tissues) can easily be done. Surgery may be needed to repair damaged skin or bones, or to relieve pressure from bleeding inside the skull.

Further help

Most children are back to normal after a couple of days' rest, but symptoms can persist for a week or two. In severe injuries there may be long-term problems with learning difficulties, loss of muscle movement control, memory loss, personality changes - disruption of almost any aspect of the body controlled by the brain. Always get help if you are worried.

Cushing's Syndrome

What is Cushing’s syndrome?

Cushing’s syndrome is a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol. Sometimes called hypercortisolism, Cushing’s syndrome is relatively rare and most commonly affects adults aged 20 to 50. People who are obese and have type 2 diabetes, along with poorly controlled blood glucose—also called blood sugar—and high blood pressure, have an increased risk of developing the disorder.

What are the signs and symptoms of Cushing’s syndrome?

Signs and symptoms of Cushing’s syndrome vary, but most people with the disorder have upper body obesity, a rounded face, increased fat around the neck, and relatively slender arms and legs. Children tend to be obese with slowed growth rates.

Other signs appear in the skin, which becomes fragile and thin, bruises easily, and heals poorly. Purple or pink stretch marks may appear on the abdomen, thighs, buttocks, arms, and breasts. The bones are weakened, and routine activities such as bending, lifting, or rising from a chair may lead to backaches and rib or spinal column fractures.

Women with Cushing’s syndrome usually have excess hair growth on their face, neck, chest, abdomen, and thighs. Their menstrual periods may become irregular or stop. Men may have decreased fertility with diminished or absent desire for sex and, sometimes, erectile dysfunction.

Other common signs and symptoms include

• severe fatigue
• weak muscles
• high blood pressure
• high blood glucose
• increased thirst and urination
• irritability, anxiety, or depression
• a fatty hump between the shoulders

Sometimes other conditions have many of the same signs as Cushing’s syndrome, even though people with these disorders do not have abnormally elevated cortisol levels. For example, polycystic ovary syndrome can cause menstrual disturbances, weight gain beginning in adolescence, excess hair growth, and impaired insulin action and diabetes. Metabolic syndrome—a combination of problems that includes excess weight around the waist, high blood pressure, abnormal levels of cholesterol and triglycerides in the blood, and insulin resistance—also mimics the symptoms of Cushing’s syndrome.

What causes Cushing’s syndrome?

Cushing’s syndrome occurs when the body’s tissues are exposed to high levels of cortisol for too long. Many people develop Cushing’s syndrome because they take glucocorticoids—steroid hormones that are chemically similar to naturally produced cortisol—such as prednisone for asthma, rheumatoid arthritis, lupus, and other inflammatory diseases. Glucocorticoids are also used to suppress the immune system after transplantation to keep the body from rejecting the new organ or tissue.

Other people develop Cushing’s syndrome because their bodies produce too much cortisol. Normally, the production of cortisol follows a precise chain of events. First, the hypothalamus, a part of the brain about the size of a small sugar cube, sends corticotropin-releasing hormone (CRH) to the pituitary gland. CRH causes the pituitary to secrete adrenocorticotropin hormone (ACTH), which stimulates the adrenal glands. When the adrenals, which are located just above the kidneys, receive the ACTH, they respond by releasing cortisol into the bloodstream.

Cortisol performs vital tasks in the body including

• helping maintain blood pressure and cardiovascular function
• reducing the immune system’s inflammatory response
• balancing the effects of insulin, which breaks down glucose for energy
• regulating the metabolism of proteins, carbohydrates, and fats

The hypothalamus sends CRH to the pituitary, which responds by secreting ACTH. ACTH then causes the adrenals to release cortisol into the bloodstream.

One of cortisol’s most important jobs is to help the body respond to stress. For this reason, women in their last 3 months of pregnancy and highly trained athletes normally have high levels of the hormone. People suffering from depression, alcoholism, malnutrition, or panic disorders also have increased cortisol levels.

When the amount of cortisol in the blood is adequate, the hypothalamus and pituitary release less CRH and ACTH. This process ensures the amount of cortisol released by the adrenal glands is precisely balanced to meet the body’s daily needs. However, if something goes wrong with the adrenals or the regulating switches in the pituitary gland or hypothalamus, cortisol production can go awry.

Pituitary Adenomas

Pituitary adenomas cause 70 percent of Cushing’s syndrome cases,¹ excluding those caused by glucocorticoid use. These benign, or noncancerous, tumors of the pituitary gland secrete extra ACTH. Most people with the disorder have a single adenoma. This form of the syndrome, known as Cushing’s disease, affects women five times more often than men.

Ectopic ACTH Syndrome

Some benign or, more often, cancerous tumors that arise outside the pituitary can produce ACTH. This condition is known as ectopic ACTH syndrome. Lung tumors cause more than half of these cases, and men are affected three times more often than women. The most common forms of ACTH-producing tumors are small cell lung cancer, which accounts for about 13 percent of all lung cancer cases,² and carcinoid tumors—small, slow-growing tumors that arise from hormone-producing cells in various parts of the body. Other less common types of tumors that can produce ACTH are thymomas, pancreatic islet cell tumors, and medullary carcinomas of the thyroid.

Adrenal Tumors

In rare cases, an abnormality of the adrenal glands, most often an adrenal tumor, causes Cushing’s syndrome. Adrenal tumors are four to five times more common in women than men, and the average age of onset is about 40. Most of these cases involve noncancerous tumors of adrenal tissue called adrenal adenomas, which release excess cortisol into the blood.

Adrenocortical carcinomas—adrenal cancers—are the least common cause of Cushing’s syndrome. With adrenocortical carcinomas, cancer cells secrete excess levels of several adrenocortical hormones, including cortisol and adrenal androgens, a type of male hormone. Adrenocortical carcinomas usually cause very high hormone levels and rapid development of symptoms.

Familial Cushing’s Syndrome

Most cases of Cushing’s syndrome are not inherited. Rarely, however, Cushing’s syndrome results from an inherited tendency to develop tumors of one or more endocrine glands. Endocrine glands release hormones into the bloodstream. With primary pigmented micronodular adrenal disease, children or young adults develop small cortisol-producing tumors of the adrenal glands. With multiple endocrine neoplasia type 1 (MEN1), hormone-secreting tumors of the parathyroid glands, pancreas, and pituitary develop; Cushing’s syndrome in MEN1 may be due to pituitary, ectopic, or adrenal tumors.

¹Nieman LK, Ilias I. Evaluation and treatment of Cushing’s syndrome. The Journal of American Medicine. 2005;118(12):1340–1346.

²Govindan R, Page N, Morgensztern D, et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. Journal of Clinical Oncology. 2006;24:4539–4544.

How is Cushing’s syndrome diagnosed?

Diagnosis is based on a review of a person’s medical history, a physical examination, and laboratory tests. X rays of the adrenal or pituitary glands can be useful in locating tumors.

Tests to Diagnose Cushing’s Syndrome

No single lab test is perfect and usually several are needed. The three most common tests used to diagnose Cushing’s syndrome are the 24-hour urinary free cortisol test, measurement of midnight plasma cortisol or late-night salivary cortisol, and the low-dose dexamethasone suppression test. Another test, the dexamethasone-corticotropin-releasing hormone test, may be needed to distinguish Cushing’s syndrome from other causes of excess cortisol.

• 24-hour urinary free cortisol level. In this test, a person’s urine is collected several times over a 24-hour period and tested for cortisol. Levels higher than 50 to 100 micrograms a day for an adult suggest Cushing’s syndrome. The normal upper limit varies in different laboratories, depending on which measurement technique is used.

• Midnight plasma cortisol and late-night salivary cortisol measurements. The midnight plasma cortisol test measures cortisol concentrations in the blood. Cortisol production is normally suppressed at night, but in Cushing’s syndrome, this suppression doesn’t occur. If the cortisol level is more than 50 nanomoles per liter (nmol/L), Cushing’s syndrome is suspected. The test generally requires a 48-hour hospital stay to avoid falsely elevated cortisol levels due to stress.

  However, a late-night or bedtime saliva sample can be obtained at home, then tested to determine the cortisol level. Diagnostic ranges vary, depending on the measurement technique used.

• Low-dose dexamethasone suppression test (LDDST). In the LDDST, a person is given a low dose of dexamethasone, a synthetic glucocorticoid, by mouth every 6 hours for 2 days. Urine is collected before dexamethasone is administered and several times on each day of the test. A modified LDDST uses a onetime overnight dose.

  Cortisol and other glucocorticoids signal the pituitary to release less ACTH, so the normal response after taking dexamethasone is a drop in blood and urine cortisol levels. If cortisol levels do not drop, Cushing’s syndrome is suspected.

  The LDDST may not show a drop in cortisol levels in people with depression, alcoholism, high estrogen levels, acute illness, or stress, falsely indicating Cushing’s syndrome. On the other hand, drugs such as phenytoin and phenobarbital may cause cortisol levels to drop, falsely indicating that Cushing’s is not present in people who actually have the syndrome. For this reason, physicians usually advise their patients to stop taking these drugs at least 1 week before the test.

• Dexamethasone-corticotropin-releasing hormone (CRH) test. Some people have high cortisol levels but do not develop the progressive effects of Cushing’s syndrome, such as muscle weakness, fractures, and thinning of the skin. These people may have pseudo-Cushing’s syndrome, a condition sometimes found in people who have depression or anxiety disorders, drink excess alcohol, have poorly controlled diabetes, or are severely obese. Pseudo-Cushing’s does not have the same long-term effects on health as Cushing’s syndrome and does not require treatment directed at the endocrine glands.

  The dexamethasone-CRH test rapidly distinguishes pseudo-Cushing’s from mild cases of Cushing’s. This test combines the LDDST and a CRH stimulation test. In the CRH stimulation test, an injection of CRH causes the pituitary to secrete ACTH. Pretreatment with dexamethasone prevents CRH from causing an increase in cortisol in people with pseudo-Cushing’s. Elevations of cortisol during this test suggest Cushing’s syndrome.

Tests to Find the Cause of Cushing’s Syndrome

Once Cushing’s syndrome has been diagnosed, other tests are used to find the exact location of the abnormality that leads to excess cortisol production. The choice of test depends, in part, on the preference of the endocrinologist or the center where the test is performed.

• CRH stimulation test. The CRH test, without pretreatment with dexamethasone, helps separate people with pituitary adenomas from those with ectopic ACTH syndrome or adrenal tumors. As a result of the CRH injection, people with pituitary adenomas usually experience a rise in blood levels of ACTH and cortisol because CRH acts directly on the pituitary. This response is rarely seen in people with ectopic ACTH syndrome and practically never in those with adrenal tumors.

• high-dose dexamethasone suppression test (HDDST). The HDDST is the same as the LDDST, except it uses higher doses of dexamethasone. This test helps separate people with excess production of ACTH due to pituitary adenomas from those with ectopic ACTH-producing tumors. High doses of dexamethasone usually suppress cortisol levels in people with pituitary adenomas but not in those with ectopic ACTH-producing tumors.

• Radiologic imaging: direct visualization of the endocrine glands. Imaging tests reveal the size and shape of the pituitary and adrenal glands and help determine if a tumor is present. The most common imaging tests are the computerized tomography (CT) scan and magnetic resonance imaging (MRI). A CT scan produces a series of x-ray pictures giving a cross-sectional image of a body part. MRI also produces images of internal organs but without exposing patients to ionizing radiation.

  Imaging procedures are used to find a tumor after a diagnosis has been made. Imaging is not used to make the diagnosis of Cushing’s syndrome because benign tumors are commonly found in the pituitary and adrenal glands. These tumors, sometimes called incidentalomas, do not produce hormones in quantities that are harmful. They are not removed unless blood tests show they are a cause of symptoms or they are unusually large. Conversely, pituitary tumors may not be detectable by imaging in almost half of people who ultimately need pituitary surgery for Cushing’s syndrome.

• Petrosal sinus sampling. This test is not always required, but in many cases, it is the best way to distinguish pituitary from ectopic causes of Cushing’s syndrome. Samples of blood are drawn from the petrosal sinuses—veins that drain the pituitary—by inserting tiny tubes through a vein in the upper thigh or groin region. A local anesthetic and mild sedation are given, and x rays are taken to confirm the correct position of the tubes. Often CRH, the hormone that causes the pituitary to release ACTH, is given during this test to improve diagnostic accuracy.

  Levels of ACTH in the petrosal sinuses are measured and compared with ACTH levels in a forearm vein. Higher levels of ACTH in the sinuses than in the forearm vein indicate a pituitary adenoma. Similar levels of ACTH in the petrosal sinuses and the forearm suggest ectopic ACTH syndrome.

How is Cushing’s syndrome treated?

Treatment depends on the specific reason for excess cortisol and may include surgery, radiation, chemotherapy, or the use of cortisol-inhibiting drugs. If the cause is long-term use of glucocorticoid hormones to treat another disorder, the doctor will gradually reduce the dosage to the lowest dose adequate for control of that disorder. Once control is established, the daily dose of glucocorticoid hormones may be doubled and given on alternate days to lessen side effects. In some cases, noncorticosteroid drugs can be prescribed.

Pituitary Adenomas

Several therapies are available to treat the ACTH-secreting pituitary adenomas of Cushing’s disease. The most widely used treatment is surgical removal of the tumor, known as transsphenoidal adenomectomy. Using a special microscope and fine instruments, the surgeon approaches the pituitary gland through a nostril or an opening made below the upper lip. Because this procedure is extremely delicate, patients are often referred to centers specializing in this type of surgery. The success, or cure, rate of this procedure is more than 80 percent when performed by a surgeon with extensive experience. If surgery fails or only produces a temporary cure, surgery can be repeated, often with good results.

After curative pituitary surgery, the production of ACTH drops two levels below normal. This drop is natural and temporary, and patients are given a synthetic form of cortisol such as hydrocortisone or prednisone to compensate. Most people can stop this replacement therapy in less than 1 or 2 years, but some must be on it for life.

If transsphenoidal surgery fails or a patient is not a suitable candidate for surgery, radiation therapy is another possible treatment. Radiation to the pituitary gland is given over a 6-week period, with improvement occurring in 40 to 50 percent of adults and up to 85 percent of children. Another technique, called stereotactic radiosurgery or gamma knife radiation, can be given in a single high-dose treatment. It may take several months or years before people feel better from radiation treatment alone. Combining radiation with cortisol-inhibiting drugs can help speed recovery.

Drugs used alone or in combination to control the production of excess cortisol are ketoconazole, mitotane, aminoglutethimide, and metyrapone. Each drug has its own side effects that doctors consider when prescribing medical therapy for individual patients.

Ectopic ACTH Syndrome

To cure the overproduction of cortisol caused by ectopic ACTH syndrome, all of the cancerous tissue that is secreting ACTH must be eliminated. The choice of cancer treatment—surgery, radiation, chemotherapy, immunotherapy, or a combination of these treatments—depends on the type of cancer and how far it has spread. Because ACTH-secreting tumors may be small or widespread at the time of diagnosis, making them difficult to locate and treat directly, cortisol-inhibiting drugs are an important part of treatment. In some cases, if other treatments fail, surgical removal of the adrenal glands, called bilateral adrenalectomy, may replace drug therapy.

Adrenal Tumors

Surgery is the mainstay of treatment for benign and cancerous tumors of the adrenal glands. Primary pigmented micronodular adrenal disease and the inherited Carney complex—primary tumors of the heart that can lead to endocrine overactivity and Cushing’s syndrome—require surgical removal of the adrenal glands.

Points to Remember

• Cushing’s syndrome is a disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol.

• Typical signs and symptoms of Cushing’s syndrome include upper body obesity, a rounded face, skin that bruises easily and heals poorly, weakened bones, excess body hair growth and menstrual irregularities in women, and decreased fertility in men.

• Cushing’s syndrome is caused by exposure to glucocorticoids, which are used to treat inflammatory diseases, or by the body’s overproduction of cortisol, most often due to tumors of the pituitary gland or lung.

• Several tests are usually needed to diagnosis Cushing’s syndrome, including urine, blood, and saliva tests. Other tests help find the cause of the syndrome.

• Treatment depends on the specific reason for excess cortisol and may include surgery, radiation, chemotherapy, or the use of cortisol-inhibiting drugs.

Back Pain

Stretching exercises

Without activity, an injured or painful back will experience progressive stiffness. Therefore, it is necessary to continually push the range of motion as far as can be tolerated (in a controlled manner) for meaningful and sustained back pain relief. Stretching exercises should focus on achieving flexibility and elasticity in the disc, muscles, ligaments, and tendons.

Tightness in the Psoas Major muscle, which runs along the lower spine, is often a cause of back pain in patients who tend to have difficulty standing for extended periods or kneeling. The Psoas Major stretch is an easy, everyday exercise done in a half kneeling position. 

Hamstring stretching is also important, as hamstring tightness limits motion in the pelvis and can increase stress across the low back. There is a wide variety of ways to do hamstring stretching exercises.

Activities like Yoga incorporate both stretching and relaxation, which reduces tension in stress-carrying muscles. Yoga requires that the individual hold gentle poses anywhere from 10 to 60 seconds. Within the pose, certain muscles flex, while others stretch, promoting relaxation and flexibility in muscles and joints. 

Strengthening exercises

Most episodes of back pain that last for more than two weeks should be treated with strengthening exercises to prevent a recurring cycle of pain and weakness. Back and abdominal muscles are essential components of the muscular network of the spine, helping the body maintain upright posture and movement. When these muscles are well conditioned, back pain can be greatly reduced or avoided. Two simple, daily exercises are the Transversus Abdominis (TVA) strengthening and the Gluteus Maximus strengthening exercise

An exercise ball is a versatile, portable piece of equipment that helps strengthen and develop the core body muscles that help stabilize the spine. With the exercise ball, an element of instability is introduced, and over time the muscles used to keep in balance on the ball become stronger. 

Other techniques that gently strengthen the back and abdominal muscles include: Tai Chi, Pilates and Yoga. They all focus on posture and breathing to promote mental focusing and centering. While these techniques can be done in a class or at home with a video or DVD, patients with back conditions are well advised to at least initially consult a trained professional given the difficulty of certain movements. 

Low impact aerobic exercise

Many people with low back pain have trouble finding the right form of exercise that provides a good aerobic workout and is still gentle enough for their back. Aerobic exercise helps to condition and strengthen the muscles and keep the spinal structures healthy. In addition, aerobic exercise increases the body's release of endorphins, a natural pain blocker, which also help reduce anxiety, stress and depression - all of which are common for people suffering from ongoing back pain. Examples of effective, low impact aerobic activities include:

• Riding an exercise bike. Exercise bikes can be used at the fitness center or at home, or a regular bike can be fitted with an inexpensive device (a "trainer") and be used in a stationary position. The bike works for different back problems and different comfort levels, as the seat and handlebars can be adjusted to ensure correct posture. 
• Exercising in the water. Water therapy, as well as swimming, provides a gentle form of conditioning as the water alleviates gravity and provides buoyancy as well as mild resistance. 
• Exercise walking. Walking improves blood flow, which brings important nutrients to structures in the back, and provides a number of additional benefits. Continuous walking at a sustained pace for a minimum of twenty to thirty minutes is required to provide aerobic conditioning.

Anger slows healing process after injury

The adage that laughter is the best medicine has been backed by an unusual investigation which says that people who seethe with anger take longer to recover from injury. 

Previous studies have linked ill tempered behavior, whether brow-beating or road rage, with higher incidence of coronary heart disease, hypertension and stroke, especially among men. 

But the new study is the first controlled experiment that directly measures the impact of ire on the healing process. Researchers at the University of Ohio inflicted minor burns on the forearms of 98 volunteers who were then monitored over eight days to see how quickly the skin repaired itself. The subjects had each taken a battery of psychological tests beforehand to assess how easily and often they felt and expressed wrath, and were then ranked on an "anger scale". People who took certain pharmaceutical drugs, smoked cigarettes or drank excessive quantities of caffeine-laden coffee were excluded, along with individuals who were extremely over- or under-weight. 

The results were startlingly clear: individuals who had trouble controlling expressions of anger were four times likelier to need more than four days for their wounds to heal, compared with counterparts who could master their anger. But the researchers were also surprised to find that anger has its nuances, too. Subjects described as showing "anger out" (regular outbursts of aggression or hostility) or "anger in" (repressed rage) healed almost as quickly as individuals who ranked low on all anger scales. Only those who tried but failed to hold in their feelings of upset and distemper took longer to heal. This same group also showed a higher secretion of the stress hormone cortisol, which could at least partly explain the difference in healing time.

Earlier research has shown a clear link between cortisol and anger. Hostile men who yelled at spouses during marital spats secreted more of the endocrine modulator within minutes, as did teachers experiencing high levels of stress in the classroom. 

High levels of cortisol appears to decrease the production at the point of injury of two cytokines crucial to the repair process.  Cytokines are proteins released by immune-system cells. They act as signallers to generate a wider immune response. 

"The ability to regulate the expression of one's anger has a clinically relevant impact on wound healing," concludes lead author Jean-Phillipe Gouin, a psychologist at the University of Ohio. 

Anger-control therapy could help patients recovering from surgery or injury heal more quickly. 

Low Back Pain

What Is Low Back Pain?

Four out of five adults will experience significant low back pain sometime during their life. After the common cold, problems caused by the lower back are the most frequent cause of lost work days for adults under the age of 45.

The lower or lumbar spine is a complex structure that connects your upper body to your lower body . This important part of your spine provides you with mobility, strength and stability. The mobility allows movements such as turning, twisting or bending; and the strength allows you to stand, walk and lift. Proper functioning of your lower back is needed for almost all activities of daily living. Pain in the lower back can restrict your activity and reduce your work capacity and quality of enjoyment of everyday living.

Low Back Sprain and Strain

The muscles of the low back provide power and strength for activities such as standing, walking and lifting. The ligaments of the low back act to interconnect the five vertebral bones and provide support or stability for the low back. A sprain of the low back can occur when a sudden, forceful movement injures a ligament which has become stiff or weak through poor conditioning or overuse. Sprains and strains are the most common causes of low back pain. Frequently, a combination of other factors may increase the likelihood of injury or disease:

• poor conditioning
• improper use
• obesity
• smoking

The natural effects of normal aging on the body, in general, and low back, in particular, are osteoporosis or decreased amount of bone; decrease in strength and elasticity of muscles; and decrease in elasticity and strength of ligaments. Although you cannot totally halt the progress of these effects, they can be slowed by regular exercise, knowing the proper way to lift and move objects, proper nutrition, and avoidance of smoking. Almost everyone develops “wear and tear” changes in their low back as they age, although for most people it causes little pain or loss of function.

Protruding Disk

The disk is composed of a soft center or nucleus, which, in children and young adults, is like jelly. The nucleus is surrounded by a tougher outer portion called the anulus. With normal aging, the nucleus begins to resemble the anulus. During middle-age, fissures or cracks may occur in the disk. These could be the source of back pain. If the crack extends out of the disk, material from the disk may push out or rupture. This often is referred to as a herniated, or slipped, disk. If the protruded disk presses a nerve, it may cause pain in the leg

How Should Low Back Pain be Treated?

At Elite Healthcare in Dallas, there are many treatments we use to help with low back pain. These include ice and electrical stimulation, light weight training, massages, and adjustment.  At Elite Healthcare in Dallas, we have several trained chiropractors along with licensed massage therapists to help you get to your normal state. We realize that the faster you feel better, the faster you get back to your job and daily life. Our goal at Elite Healthcare in Dallas is to give you the best treatment with the quickest results. 

How Can Low Back Pain be Prevented?

The normal effects of aging that result in decreased bone mass, and decreased strength and elasticity of muscles and ligaments, can’t be avoided. However, the effects can be slowed by:

• exercising regularly to keep the muscles that support your back strong and flexible
• using the correct lifting and moving techniques; get help if an object is too heavy or an awkward size
• maintaining your proper body weight; being overweight puts a strain on your back muscles
• avoid smoking
• maintaining a proper posture when standing and sitting; don’t slouch

The Benefits of Going to Elite Healthcare

There is a significant and very important difference between the way chiropractors and medical doctors approach health problems. 

When evaluating and treating patients, chiropractors take a holistic approach which includes identifying and correcting the cause, or causes, of the patient’s health ailment. In contrast, the medical approach tends to focus more on the treating the symptoms of a condition rather than focusing primarily on the actual causes.

At Elite Healthcare in Dallas, we believe that correcting the cause of the problem provides significant long-term benefits over only treating the symptoms.

 

Short-term and regular chiropractic care at Elite Healthcare have a number of benefits. These benefits include: 

·      spinal and extremity pain relief

·      headache relief

·      increased mobility and range of motion

·      decreased stiffness and muscular spasms

·      arthritic joint pain relief

·      increased joint health

·      increased performance and energy

·      increased sense of well being and relaxation

·      increased balance and coordination

·      reduced degeneration and risk of injury