These shoes are made for running!

The weather is getting warmer and spring is fast approaching, so many of you will start running.  Some of you may be continuing your current cardiovascular exercise program while others may be jogging for the first time.  Either way, it is important to know the basic facts about your running shoes.  Exercising in shoes that are worn out from too many miles of usage is one of the leading causes of injury in the lower extremity, so before you hit the road we’re going to give you a test to see just how much you actually know about your running shoes. 

  1. At what mileage should running shoes be replaced?
  2. How much shock absorption is lost after 50, 150, 250, or 400 miles of running on a pair of shoes?
  3. What are some tips to prolong the life of your running shoes?
  4. Where are the best places to buy running shoes?
  5. What are signs of wear to look for on your current shoes?

Click here for the answers.  And check out the Physical Therapy/Sports Medicine page of our website for more information about the services we offer to students.  If you’re having any problems with your muscles or joints, we can get you back on track and help you hit the ground running again!

Pamela Bork, PT
Student Health Services
The Ohio State University

My doctor said that my vitamin D level is low. Is that really bad?

It’s well established that Vitamin D is important in the regulation of the body’s calcium levels and bone development.  If people don’t get enough, they are at risk of diseases like rickets and osteoporosis.  But researchers have more recently discovered that vitamin D receptors are found on almost all tissues of the body.  This has caused a “boom” in vitamin D research; scientists are investigating its role in everything from heart disease and diabetes to depression, cancer and the common cold. 

You get Vitamin D in two ways: by consuming it in foods or supplements, and by making it in your skin when sunlight hits it.  Vitamin D doesn’t occur naturally in a lot of foods – unless you’re a really big fan of cod liver oil or mackerel, you wouldn’t get nearly enough – so many foods are fortified with it.  Almost all of the milk sold in the U.S. is fortified with Vitamin D, as are many cereals, juices and yogurts. 

This time of year in Columbus ain’t exactly the most Vitamin D friendly environment – the sun seems to head south for the winter – so it’s not unusual for people around here to have a low Vitamin D level.  But what does that really mean?  How low is too low?  And does having a low Vitamin D level increase your risk for depression, high blood pressure, the flu?  We don’t know for sure.  There’s even a lot of debate going on right now about whether or not the current cut off for a “normal” Vitamin D level is too high and that a lot of people are being told they have a deficiency when they really don’t. 

That being said, people build up the majority of their bone density during their twenties so it wouldn’t hurt to take a daily adult multi-vitamin containing around 600 IU of Vitamin D to help prevent osteoporosis later in life.  It’s also a good idea to get some regular sunlight exposure whenever you can; even if it’s cold, it’ll turn on your skin’s Vitamin D factory.  But don’t overdo it – taking too much (over 4000 IU) can cause damage to the heart, blood vessels and kidneys.  And excessive uv radiation exposure can damage your skin and put you at risk for really bad things.   

The National Institutes of Health has a great site about Vitamin D supplements, and the Mayo Clinic also provides a lot of good information.  And of course, you can always make an appointment to see us if you’re worried about your Vitamin D level.   

John A. Vaughn, MD
Student Health Services
The Ohio State University

Stick a needle in me, I’m done. Or am I?

When I was pregnant I developed tennis elbow, or lateral epicondylitis, in my left arm. It persisted until long after I was pregnant and drove me to distraction. The pain eventually drove me to sticking a needle full of cortisone in my arm, after which I felt much better.  But was I better?  Ever since that fateful jab, I’ve had recurring problems with that devilish elbow.

The conventional wisdom has long been that acute pain in our tendons, or tendinopathy, was the result of dreaded inflammation. Corticosteroids (not anabolic steroids) are just about the most potent anti-inflammatory we have and for certain tendon pain syndromes – like tennis elbow – the standard of care has been to jab a needle near the tendon, infuse the medicine, and let it work its magic.  

Not so fast, Captain Cortisone!  A major review of steroid injections for tennis elbow and other tendinopathies published recently in The Lancet dispels this notion. Inflammation, it would seem, plays much less of a role than we thought; tendon wear and tear probably plays more.  The authors concluded that steroid injections numb the pain in the short term but do nothing to make the underlying problem better.  In fact, 6 and 12 months down the road, patients who’d had injections had more pain and disability than patients who hadn’t received the shots.  The authors suggest that suppression of local healing processes by the steroids probably causes this effect.  In other words, steroids get in the way of your tendon’s ability to repair itself. 

Does this mean that we have nothing to offer?  Not at all.  We’ve always had effective ways of managing the pain and helping to support your sore joints as they heal up.  Non-steroid anti-inflammatory pills like Ibuprofen (Advil, Motrin) and Naproxen (Aleve) can help a lot, and in severe or chronic injuries, physical therapy can work real magic.  There are also some cool new “injectables” under investigation now, including botulinum toxin and hypertonic glucose.  That’s right folks… botox and sugar for your elbows.   

The take-home message?  Bring us your troublesome tennis elbow, your aching Achilles, or your ripped rotator cuff.  We’ll get it sorted out, and we’ll probably do it without poking you with any needles.

Victoria Rentel, MD
Student Health Services
The Ohio State University

Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomized controlled trials. Coombs, BK; Bisset, L; Vincenzo B. The Lancet, In Press, Corrected Proof, Online October 21, 2010.

Can Chiropractors really help my neck and back pain? Are they safe?

BuckMD Readers – We received a couple comments on this earlier post. Take a look, and add your own comments!

 I don’t know a lot about chiropractors.  I’ve never worked with any, didn’t learn much about them in my medical training, and don’t refer a lot of patients to them since a lot of insurances don’t cover chiropractic treatment.   

But a lot of people swear by them.  And I have a few medical colleagues who recommend them for certain patients.  And our very own medical center has a Center for Integrative Medicine that provides chiropractic treatment (you can see their take on what a chiropractor does here).

There’s obviously something to it, so I have scoured the medical literature to provide you with the most objective information I can find.  Here goes…

Do people suffering from chronic neck or back pain benefit from chiropractic treatment?

Spinal manipulation has been shown to be mildly beneficial in the treatment of uncomplicated low back pain.  Uncomplicated means that there is nothing more serious going on, like severe arthritis, pinched nerves or slipped discs.     

There’s just not enough good information about whether or not spinal manipulation is beneficial in the treatment of neck pain.  Some studies showed it might be; others showed it was only helpful if used in conjunction with exercise, and others showed no benefit. 

There is no evidence that spinal manipulation is beneficial in the treatment of headaches.

Is the cure temporary or permanent?

That’s hard to say.  Most problems that cause back or neck pain are chronic and recurrent so the treatments don’t “cure” the condition but rather relieve the symptoms of an acute flare-up.  If the symptoms come back, it’s not necessarily that the treatment didn’t do what it was supposed to.

Are there any adverse effects of chiropractic treatment?

Minor complaints are fairly common after spinal manipulation, occurring in a third to a little over half of patients.  They include headache, fatigue, and pain at the site of manipulation.  Some people report dizziness and nausea, but these are less common.

Serious adverse effects from spinal manipulation (slipped disc, stroke or torn blood vessels in the spinal column) are pretty rare.  Since the cervical spine (i.e. neck) is so much more mobile than the lumbar spine, it may be at higher risk for these problems.  Because of this – and because spinal manipulation doesn’t have any proven benefit in treating neck pain – you should probably avoid seeing chiropractors for neck pain. 

If you’re having back or neck pain, come in and see us at Student Health.  We have a full-service Physical Therapy and Sports Medicine Department right here in the building and we will be happy to discuss all of your treatment options with you after we figure out what the problem is.

John A. Vaughn, MD (OSU SHS)

Ice or Heat

photo: wikimedia commons

Q: I’ve heard of using both ice and heat after an injury. How do I know which one to use?

A: Ice and heat are both mainstays of treating orthopedic injuries (sprains, strains, pulls, even broken bones).  In general, a good way to figure out which one to use is to decide if the injury as acute or chronic. 

Acute injuries are ones that happened recently – think ankle sprain.   They usually cause pain, swelling and bruising (bleeding under the skin) in the area affected.  We usually recommend using ice after an ankle sprain or a pulled muscle.  Ice causes vasoconstriction – it makes the blood vessels clamp down – so it reduces blood flow to the area and decreases swelling and inflammation.  The cold temperature also numbs the area, which helps with pain.

Chronic injuries occur are slow to develop and have been around a while.  They usually result from overuse injuries – think muscle strains, tendonitis, and arthritis.  Heat is good to use before taking part in activities that involve chronic injuries because it increases tissue elasticity and promotes blood flow.  If you’re sore after taking part in those activities, you should switch back to ice for the reasons mentioned above. 

Never ice or heat an injury for longer than 20 minutes.  Prolonged ice exposure can cause tissue injury and even frostbite.  Heat should never be used for extended periods of time; you don’t typically get any extra benefit after 20 minutes and prolonged heat exposure can lead to burns.  Moist heat, like a warm washcloth, is a safer option than a heating pad because they are less likely to cause burns.

Adam Brandeberry, Med IV (OSU COM)

John A. Vaughn, MD (OSU SHS)

Enough with the Frickin’ Flip Flops Already!

You would not believe the number of students I see at the Student Health center complaining of foot, ankle and back pain that I can diagnose before I even walk in the exam room.  Do I have ESP?  X-ray vision?  Super Medical Spidey Sense?  No.  I hear the pitter patter of their feet walking down the hall and I know exactly what the problem is.  Two words… two cute, tiny, terrible words… Flip. Flops.

I hate flip-flops.  Hate ‘em!  Yes, they’re affordable.  Yes, you can get them in any color to match any outfit.  Yes, they’re fashionable and look cool with jeans that are 6 inches too long.  But they are terrible for you!  Terrible!

Flip-flops offer no arch support (yeah, I know Crocs and some other more expensive brands say they do, but I’m not buying it).  They don’t have the heel cushion or shock absorption that normal shoes do.  They may be fine when you’re running around on the beach or popping out to the store, but when you wear them all day, every day – especially when you’re hiking around campus with a 40-pound backpack – you’re setting yourself up for some serious pain: stubbed toes and blisters from cheap plastic, sprained ankles, broken toes, heel pain from plantar fasciitis, leg pain and low back pain.

I know you won’t listen to me – I’ve seen students walking on the oval in flip flops with a foot of snow on the ground! – but at least try to wear them in moderation.  Give your feet and back a break and throw on some sneakers every once in a while.

Angela Walker, Med IV (OSU COM)

John A. Vaughn, MD (OSU SHS)