JOINT SPRAINS: SOME COMMON MISCONCEPTIONS

As soon as someone sprains a joint, an ankle or elsewhere, everyone usually runs to apply ice, compression, rest and elevation for the next two or three days. But now, recent information questions the use of both the “ice” and “rest” components of this approach.

Following is the best current advice: First, before attempting any treatment, decide whether you need to see a doctor. With sprains involving the lower extremities, if you can’t walk more than three steps, you should seek medical help as soon as possible to avoid further injury. The same holds true if you are in a lot of pain, the joint looks abnormal (such as bent or displaced}, or if you have considerable swelling. If there is only minor swelling and pain—which allow for a full range of motion—the following measures are now recommended:

1) Avoid ice: For many years, logic dictated that icing right after a sprain or strain reduced swelling and pain. But actual research has refuted this claim. For example, a study published in 2014 by the European Society of Sports Traumatology disclosed that icing injured tissue shuts off the blood supply that brings in healing cells, thus delaying repair. The current recommendation skips ice completely unless the pain is unbearable, and in that case, apply ice packs only two or three times total, for 15 to 20 minutes at a time, which at least an hour in between.

A better option for reducing pain and improving short-term function is to use over-the-counter medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve). But do so only for the first 24-48 hours, because they, too, slow down recovery by suppressing inflammation. For longer periods, if pain continues, consider acetaminophen (Tylenol and generic), which has no anti inflammatory effects.

2) Forget the complete rest. Conventional wisdom previously called for complete cessation of activity until an injury healed. New research, however, suggests that gentle exercise within the first 48-72 hours, such as “drawing the alphabet” with a sprained ankle two to three times daily, is more beneficial. A review of ankle sprains—the most common sprained area—in 2013 by the National Athletic Trainers’ Assoc gave top marks to this type of movement, concluding that “by contracting and relaxing a joint, you improve blood flow, which improves healing.” Supplementing this, balancing exercises are useful for reducing the likelihood of reinjury.

3) Some recommendations remain unchanged: The measures of compression and elevation still hold. So wrapping a mild strain or sprain with an elastic bandage will help reduce swelling. Once swelling subsides; however, unwrap, for evidence shows that injured joints may develop long-term problems, such as premature degenerative changes. Elevation of the involved limb throughout the day and overnight, if possible, by propping a sprained ankle in a pillow, will also help to minimize swelling.

In conclusion, we must always keep and open mind and question so called “conventional wisdom”, for that is how science can make our lives progressively better, longer, and less painful!

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MAGNESIUM: AN UNDERRATED MINERAL

   

    Few people realize that magnesium intake lowers the risk for cardiovascular diseases (CVD). For instance, data from the large Nurses Health Study (180,000 participants) showed that those with the highest intake of magnesium, as well as potassium[1], were at a lower risk of suffering from a stroke. Researchers have estimated that each 100 milligram daily increase in magnesium intake produced a 13% lower stroke risk. As I pointed out in a previous post[2], hard water, which contains significant amounts of magnesium, is also associated with a lower risk of cardiovascular diseases, a finding which was also consistent with many earlier studies. In general blood magnesium concentrations are inversely associated with the risk of total CVD events. Both magnesium and potassium are important in promoting steady functioning of the heart and helping to control blood pressure—the number one risk factor for stroke.

So how do we consume an adequate amount of magnesium? First, it’s likely that the best way to get this mineral is from foods rather than from dietary supplements. But magnesium, as well as beneficial potassium, is usually consumed in suboptimal quantities in the average diet. For adults over the age of 30, approximately 45% The U.S. dietary intake of this mineral is estimated to fall below the average requirement of 320 milligrams for women, and 420 milligrams for men. Moreover, aging beyond 50 complicates this further, for it decreases the body’s ability to absorb magnesium from foods, thus raising these requirements. Aging also tends to enhance loss of this mineral through the kidneys, while decreasing the body’s intestinal absorption. Some medications such as diuretics, laxatives and antacids (proton-pump inhibitors such as Nexium) can also reduce magnesium absorption.

To get you started on the right path, let’s take a look at the magnesium content of various foods that will allow you to do the math. The picture at the top contains other choices.

Kelp, 3/1/2 oz—780 mg.

Garbanzo beans, 3 1/2 oz—230 mg.

Oyisters, 3 1/3 oz. 76 mg..

Wheat germ 3 1/1 oz—440 mg.

Wheat bran, 1/4 cup—89 mg.

Spinach, frozen, cooked, 1/2 cup—78 mg.

Soybeans, mature, cooked, 1/2 cup—74 mg.

Nuts, mixed, dry roasted, 1 oz.—64 mg.

Shredded wheat cereal, 2 large biscuits—61 mg.

Peanut butter, smooth, 2 Tbsp—49mg.

Potato, baked with skin, 1 medium—48 mg.

Pinto beans, cooked, 1/2 cup—43 mg.

Rice, brown, long-grained, cooked, 1/2 cup—42 mg.

Lentils, mature seeds, cooked, 1/2 cup—36 mg.

Fish (cod, salmon, mackerel etc., cooked, 3 oz—90 mg

Bread, whole-wheat, 1 slice—23 mg.

Avocado, cubes, 1/2 cup—22 mg.

Banana, raw, 1 medium—32 mg.

Cocoa, 1 cup—420 mg.

 

This is but a partial list, but those foods comprise the basis of a generally healthy diet. Additional information can be obtained from our good friend, Google.



[1] http://www.mortontavel.com/2013/09/13/potassium-great-dietary-constituent/

[2] http://www.mortontavel.com/2014/03/23/myths-hard-soft-water/

 

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NOTE FOR PHYSICIANS AND MEDICAL CARE GIVERS

For physicians and caregivers: A complete guide for using the stethoscope to examine the heart, together with examination of the jugular veins, can be found in the bedside examination page of this website. Also linked to: http://www.mortontavel.com/bedside-examination/

Comments are welcome:  tavelmorton@gmail.com

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