When Lovers Touch, Their Breathing and Heartbeat Syncs While Pain Wanes

Summary: Study explores how interpersonal synchronization could help to decrease pain.

Source: University of Colorado at Boulder.

Fathers-to-be, take note: You may be more useful in the labor and delivery room than you realize.

That’s one takeaway from a study released last week that found that when an empathetic partner holds the hand of a woman in pain, their heart and respiratory rates sync and her pain dissipates.

“The more empathic the partner and the stronger the analgesic effect, the higher the synchronization between the two when they are touching,” said lead author Pavel Goldstein, a postdoctoral pain researcher in the Cognitive and Affective Neuroscience Lab at CU Boulder.

The study of 22 couples, published in the journal Scientific Reports last week, is the latest in a growing body of research on “interpersonal synchronization,” the phenomenon in which individuals begin to physiologically mirror the people they’re with.

Scientists have long known that people subconsciously sync their footsteps with the person they’re walking with or adjust their posture to mirror a friend’s during conversation. Recent studies also show that when people watch an emotional movie or sing together, their heart rates and respiratory rhythms synchronize. When leaders and followers have a good rapport, their brainwaves fall into a similar pattern. And when romantic couples are simply in each other’s presence, their cardiorespiratory and brainwave patterns sync up, research has shown.

The new study, co-written with University of Haifa Professor Simone Shamay-Tsoory and Assistant Professor Irit Weissman-Fogel, is the first to explore interpersonal synchronization in the context of pain and touch. The authors hope it can inform the discussion as health care providers seek opioid-free pain relief options.

Goldstein came up with the idea after witnessing the birth of his daughter, now 4.

“My wife was in pain, and all I could think was, ‘What can I do to help her?’ I reached for her hand and it seemed to help,” he recalls. “I wanted to test it out in the lab: Can one really decrease pain with touch, and if so, how?”

Goldstein recruited 22 long-term heterosexual couples, age 23 to 32, and put them through a series of tests aimed at mimicking that delivery-room scenario.

Men were assigned the role of observer; women the pain target. As instruments measured their heart and breathing rates, they: sat together, not touching; sat together holding hands; or sat in separate rooms. Then they repeated all three scenarios as the woman was subjected to a mild heat pain on her forearm for 2 minutes.

As in previous trials, the study showed couples synced physiologically to some degree just sitting together. But when she was subjected to pain and he couldn’t touch her, that synchronization was severed. When he was allowed to hold her hand, their rates fell into sync again and her pain decreased.

“It appears that pain totally interrupts this interpersonal synchronization between couples,” Goldstein said. “Touch brings it back.”

Goldstein’s previous research found that the more empathy the man showed for the woman (as measured in other tests), the more her pain subsided during touch. The more physiologically synchronized they were, the less pain she felt.

It’s not clear yet whether decreased pain is causing increased synchronicity, or vice versa.

“It could be that touch is a tool for communicating empathy, resulting in an analgesic, or pain-killing, effect,” said Goldstein.

Image shows a painting of lovers embracing.

Further research is necessary to figure out how a partner’s touch eases pain. Goldstein suspects interpersonal synchronization may play a role, possibly by affecting an area of the brain called the anterior cingulate cortex, which is associated with pain perception, empathy, and heart and respiratory function.

The study did not explore whether the same effect would occur with same-sex couples, or what happens when the man is the subject of pain. Goldstein did measure brainwave activity and plans to present those results in a future study.

He hopes the research will help lend scientific credence to the notion that touch can ease pain.

For now, he has some advice for partners in the delivery room: Be ready and available to hold your partner’s hand.

ABOUT THIS NEUROSCIENCE RESEARCH ARTICLE

Funding: Funding provided by Binational Science Foundation.

Source: Lisa Ann Marshall – University of Colorado at Boulder
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Full open access research for “The role of touch in regulating inter-partner physiological coupling during empathy for pain” by Pavel Goldstein, Irit Weissman-Fogel & Simone G. Shamay-Tsoory in Scientific Reports. Published online June 12 2017 doi:10.1038/s41598-017-03627-7

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Abstract

The role of touch in regulating inter-partner physiological coupling during empathy for pain

The human ability to synchronize with other individuals is critical for the development of social behavior. Recent research has shown that physiological inter-personal synchronization may underlie behavioral synchrony. Nevertheless, the factors that modulate physiological coupling are still largely unknown. Here we suggest that social touch and empathy for pain may enhance interpersonal physiological coupling. Twenty-two romantic couples were assigned the roles of target (pain receiver) and observer (pain observer) under pain/no-pain and touch/no-touch conditions, and their ECG and respiration rates were recorded. The results indicate that the partner touch increased interpersonal respiration coupling under both pain and no-pain conditions and increased heart rate coupling under pain conditions. In addition, physiological coupling was diminished by pain in the absence of the partner’s touch. Critically, we found that high partner’s empathy and high levels of analgesia enhanced coupling during the partner’s touch. Collectively, the evidence indicates that social touch increases interpersonal physiological coupling during pain. Furthermore, the effects of touch on cardio-respiratory inter-partner coupling may contribute to the analgesic effects of touch via the autonomic nervous system.

“The role of touch in regulating inter-partner physiological coupling during empathy for pain” by Pavel Goldstein, Irit Weissman-Fogel & Simone G. Shamay-Tsoory in Scientific Reports. Published online June 12 2017 doi:10.1038/s41598-017-03627-7

Forearm Exercises to Build Strength and Reduce Wrist + Elbow Strain

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Treatment options for tennis elbow

Tennis elbow is a painful condition that usually comes from overuse or repetitive use of the muscles and tendons of the forearm and the elbow joint.

Several layers of treatment can be implemented at home or after consulting a physician.

First, rest is important. The rest allows the tiny tears in the tendon attachment to heal. Tennis players treat more serious cases with ice, anti-inflammatory drugs, soft tissue massage, stretching exercises, and ultrasound therapy.

[man with tennis elbow]
Racquet sports and other activities that put strain on the forearm can cause tennis elbow.

Stretches and progressive strengthening exercises involving use of weights or elastic bands to increase pain-free grip strength and forearm strength can be helpful.

Physiotherapists commonly advise racquet sports players to strengthen their shoulder rotator cuff, scapulothoracic, and abdominal muscles. This can help to reduce overcompensation in the wrist extensors during gross shoulder and arm movements.

Soft tissue release or massage can help to reduce muscular tightness and decrease the tension on the tendons. Strapping the forearm can help realign the muscle fibers and redistribute the load. A physician may recommend immobilizing the forearm and elbow by using a splint for 2 to 3 weeks.

If symptoms are very painful, and the condition is making movement difficult, a steroid injection may be recommended.

Cortisone is a steroid that can help to reduce inflammation. After a steroid injection, the person should rest the arm and avoid putting too much strain on it too quickly.

Ice massage and muscle stimulating techniques can help the muscles to heal.

Other treatments include injections of botulinum toxin, also known as Botox and extra-corporeal shock wave therapy, a technique that is thought to trigger healing by sending sound waves to the elbow. Heat therapy, low level laser therapy, occupational therapy, and trigger point therapy are other options.

A new type of therapy is an injection of platelet-rich plasma (PRP), prepared from the patient’s own blood. PRP contains proteins that encourage healing. The American Academy of Orthopaedic Surgeons (AAOS) describe this treatment as promising but still under investigation.

Between 80 percent and 95 percent of patients recover without surgery, but in the rare cases where nonsurgical treatment does not solve the problem in 6 to 12 months, surgery may be needed to remove the damaged part of the tendon and relieve the pain.

In a discussion published in the Canadian Family Physician, Finestone and Rabinovitch, refer to a number of exercises using dumbbells that have helped with muscle conditioning in patients with tennis elbow. They point out that the patient should “be compliant and have some tolerance for pain.”


Forearm Supports Reduce Upper Body Pain Linked To Computer Use

Providing forearm support is an effective intervention to prevent musculoskeletal disorders of the upper body and aids in reducing upper body pain associated with computer work, according to a study in The British Journal of Occupational and Environmental Medicine.

Reported in the April issue, the study shows that use of large arm boards significantly reduces neck and shoulder pain as well as hand, wrist and forearm pain. “Based on these outcomes, employers should consider providing employees who use computers with appropriate forearm support,” said lead author David Rempel, MD, MPH, director of the ergonomics program at San Francisco General Hospital and professor of medicine at the University of California, San Francisco.

Study findings also show arm boards and ergonomics training provide the most protective effect, with a statistically significant reduction in both neck and shoulder pain and right hand/wrist/forearm pain in comparison to the control group, who did not receive forearm support. The boards reduced the risk of incidence of neck and shoulder disorders by nearly half.

According to the authors, musculoskeletal disorders of the neck, shoulders and arms are a common occupational health problem for individuals involved in computer-based customer service work. Specific disorders include wrist tendonitis, elbow tendonitis and muscle strain of the neck and upper back. These health problems account for a majority of lost work time in call centers and other computer-based jobs. “Extended hours of mouse or keyboard use and sustained awkward postures, such as wrist extension, are the most consistently observed risk factors for musculoskeletal disorders,” Rempel added.

The one year, randomized study evaluated the effects of two workstation interventions on the musculoskeletal health of call center employees — a padded forearm support and a trackball. The forearm support is commonly called an arm board and attaches to the top front edge of the work surface. The trackball replaces a computer mouse and uses a large ball for cursor motion.

The researchers tested employees from two customer service center sites of a large health maintenance organization. Employees had to perform computer based customer service work for a minimum of 20 hours per week in order to qualify for the study. For one year, 182 participants filled out a weekly questionnaire to assess pain level in their hands, wrists, arms, upper backs and shoulders.

Participants were randomized into four groups, each receiving a different intervention: ergonomics training, training plus a trackball, training plus forearm support, or training with both a trackball and forearm support. Outcome measures included weekly pain severity scores and diagnosis of a new musculoskeletal disorder in the upper extremities or the neck-shoulder region based on physical examination performed by a physician.

The trackball intervention had no effect on right upper extremity disorders. “The trackball was difficult for some participants to use,” said Rempel. “Employees with hand pain may want to try them, but they should stop if it is difficult to use.”

The researchers also performed a return-on-investment calculation for the study to estimate the effects of ergonomic interventions on productivity and costs. Their calculations predicted a full return of armboard costs for employers within 10.6 months of purchase.

“Based on this study, it is in the best interest of the company and the employees to provide forearm supports and training,” Rempel concluded.

In the study, the authors also outline other ergonomic-specific tasks that employees who use computers can do to relieve pain on their own. They suggest employees take scheduled breaks, maintain an erect posture, adjust chair height so thighs are parallel to the floor, adjust arm support and work surface height so the forearms are parallel to the floor, adjust the mouse and keyboard location to minimize the reach, and adjust monitor height so that the center of the monitor is approximately 15 degrees below the visual horizon.

###

Co-authors of the study include Niklas Krause, MD, PhD; Robert Goldberg, MD; Mark Hudes, PhD; and Gary Urbiel Goldner, MS, from the division of occupational and environmental medicine, UCSF; and Douglas Benner, MD, occupational health, Kaiser Permanente of Northern California.

Heel Pain, caring for your feet

What causes heel pain? 8 possible conditions

Your foot and ankle are made up of 26 bones, 33 joints, and more than 100 tendons. The heel is the largest bone in your foot. If you overuse or injure your heel, you may experience heel pain. This can range from mild to disabling.

If you develop heel pain, you can try several methods at home to ease your discomfort. For example:

  • rest as much as possible
  • apply ice to the heel for 10 to 15 minutes twice a day
  • use over-the-counter pain medications
  • wear shoes that fit properly
  • wear a night splint, a special device that stretches the foot while you sleep
  • use heel lifts or shoe inserts to reduce pain

If these home care strategies do not ease your pain, you will need to see your doctor. He or she will perform a physical exam and ask you about your symptoms and when they began. Your doctor may also take an X-ray to determine the cause of your heel pain. Once your doctor knows what is causing your pain, he or she will be able to provide you with the appropriate treatment.

In many cases, your doctor may prescribe physical therapy. This can help to strengthen the muscles and tendons in your foot, which helps to prevent further injury. If your pain is severe, your doctor may provide you with anti-inflammatory medications. These medications can be injected into the foot or taken by mouth.

Your doctor may also recommend that you support your foot as much as possible — either by taping the foot or by using special footwear devices.

In very rare cases, your doctor may recommend surgery to correct the problem, but heel surgery often requires a long recovery time and may not always relieve your foot pain.

Treatment for plantar fasciitis

The vast majority of patients recover with conservative treatments (designed to avoid radical medical therapeutic measures or operative procedures) within months.

Non-steroidal anti-inflammatory drugs

(NSAIDs) – medications with analgesic (pain reducing), antipyretic (fever reducing) effects. In higher doses they also have anti-inflammatory effects – they reduce inflammation (swelling). Non-steroidal distinguishes NSAIDs from other drugs which contain steroids, which are also anti-inflammatory. NSAIDs are non-narcotic (they do not induce stupor). For patients with plantar fasciitis they may help with pain and inflammation.

Corticosteroids

Heel with ice-pack
Home care such as rest, ice-pack use, proper-fitting footwear and foot supports are often enough to ease heel pain.

a corticosteroid solution is applied over the affected area on the skin; an electric current is used to help absorption. Alternatively, the doctor may decide to inject the medication. However, multiple injections may result in a weakened plantar fascia, significantly increasing the risk of rupture and shrinkage of the fat pad covering the heel bone. Some doctors may use ultrasound to help them make sure they have injected in the right place.

Corticosteroids are usually recommended when NSAIDs have not helped.

Physical therapy (physiotherapy)

A qualified/specialized physical therapist (UK: physiotherapist) can teach the patient exercises which stretch the plantar fascia and Achilles tendon, as well as strengthening the lower leg muscles, resulting in better stabilization of the ankle and heel. The patient may also be taught how to apply athletic taping, which gives the bottom of the foot better support.

Night splints

The splint is fitted to the calf and foot; the patient keeps it on during sleep. Overnight the plantar fascia and Achilles tendon are held in a lengthened position; this stretches them.

Orthotics

Insoles and orthotics (assistive devices) can be useful to correct foot faults, as well as cushioning and cradling the arch during the healing process.

Extracorporeal shock wave therapy

Sound waves are aimed at the affected area to encourage and stimulate healing. This type of therapy is only recommended for chronic (long-term) cases, which have not responded to conservative therapy.

Surgery

The plantar fascia is detached from the heel bone. This procedure is only recommended if nothing else works. There is a risk that the arch of the foot is subsequently weakened.

 

See a list of possible causes in order from the most common to the least.

1

Plantar Fasciitis

Plantar fasciitis occurs when too much pressure on your feet damages the plantar fascia ligament, causing pain and stiffness.

Read more »

2

Sprains & Strains

Sprains and strains are injuries to the body, often resulting from physical activity. These injuries are common and can range from minor to severe, depending on the incident. Most don’t require medical attention.

Read more »

3

Fracture

This condition is considered a medical emergency. Urgent care may be required.

A fracture is a broken bone. Learn about the risk factors, symptoms, and treatments for different types of fracture.

Read more »

4

Achilles Tendonitis

Achilles tendonitis occurs when the tendon that attaches the calf muscles to the heel becomes painful or inflamed due to overuse injuries.

Read more »

5

Bursitis

Bursae are fluid-filled sacs found about your joints. They surround the areas where tendons, skin, and muscle tissues meet bones. The lubrication they add helps reduce friction during movement.

Read more »

6

Ankylosing Spondylitis

Ankylosing spondylitis is a form of arthritis that primarily affects your spine. It causes severe inflammation of the vertebrae that might eventually lead to chronic pain and disability.

Read more »

7

Osteochondrosis

Osteochondroses directly affect the growth of bones in children and adolescents. Learn more about these disorders.

Read more »

8

Reactive Arthritis (Reiter’s Syndrome)

Reactive arthritis is a type of arthritis triggered by an infection in the body.

Read more »

Yoga, Physical Therapy, or Education for Chronic Low Back Pain

Background:
 

Yoga is effective for mild to moderate chronic low back pain (cLBP), but its comparative effectiveness with physical therapy (PT) is unknown. Moreover, little is known about yoga’s effectiveness in underserved patients with more severe functional disability and pain.

 

Objective:To determine whether yoga is noninferior to PT for cLBP.

Design:12-week, single-blind, 3-group randomized noninferiority trial and subsequent 40-week maintenance phase. (ClinicalTrials.gov: NCT01343927)

Setting:Academic safety-net hospital and 7 affiliated community health centers.

Participants:320 predominantly low-income, racially diverse adults with nonspecific cLBP.

Intervention:Participants received 12 weekly yoga classes, 15 PT visits, or an educational book and newsletters. The maintenance phase compared yoga drop-in classes versus home practice and PT booster sessions versus home practice.

Measurements:Primary outcomes were back-related function, measured by the Roland Morris Disability Questionnaire (RMDQ), and pain, measured by an 11-point scale, at 12 weeks. Prespecified noninferiority margins were 1.5 (RMDQ) and 1.0 (pain). Secondary outcomes included pain medication use, global improvement, satisfaction with intervention, and health-related quality of life.

 

Results:
 

One-sided 95% lower confidence limits were 0.83 (RMDQ) and 0.97 (pain), demonstrating noninferiority of yoga to PT. However, yoga was not superior to education for either outcome. Yoga and PT were similar for most secondary outcomes. Yoga and PT participants were 21 and 22 percentage points less likely, respectively, than education participants to use pain medication at 12 weeks. Improvements in yoga and PT groups were maintained at 1 year with no differences between maintenance strategies. Frequency of adverse events, mostly mild self-limited joint and back pain, did not differ between the yoga and PT groups.

 

Limitations:Participants were not blinded to treatment assignment. The PT group had disproportionate loss to follow-up.

Conclusion:A manualized yoga program for nonspecific cLBP was noninferior to PT for function and pain.

Primary Funding Source:National Center for Complementary and Integrative Health of the National Institutes of Health.

Low back pain is the leading cause of disability globally (1). Total annual back pain–related costs in the United States exceed $200 billion (2). Chronic low back pain (cLBP) affects approximately 10% of U.S. adults (3), but overall patient satisfaction with cLBP treatment is low (4). The impact of cLBP is greater in racial or ethnic minorities and in people of lower socioeconomic status (SES) (5). Physical therapy (PT), comprising individually tailored stretching and strengthening exercises, is the most common evidence-based, reimbursable, and nonpharmacologic physician referral for cLBP (6, 7). Clinical guidelines (8, 9), meta-analyses (10), and several large randomized controlled trials (11–13) also support yoga, a practice including physical poses, breathing exercises, and meditation, as an effective cLBP treatment.

To improve cLBP care, physicians, patients, and payers need to know how novel therapies like yoga compare with established treatments like PT. Noninferiority trials determine whether a new therapy is statistically as effective as an accepted treatment (14). This is particularly useful when the new therapy may have other potential benefits, such as lower cost. The U.S. Food and Drug Administration uses noninferiority as one criterion for approving new pharmaceuticals (15). Although no criteria have been established for when a new nonpharmacologic therapy should be integrated into mainstream clinical practice, demonstrating noninferiority to effective, reimbursed, and nonpharmacologic treatments is one reasonable requirement. Thus, we conducted a randomized controlled comparative effectiveness trial testing whether yoga was noninferior to PT in adults with cLBP.

Methods

Design Overview

The study protocol (16) and treatment manuals (17–20) were published previously. We conducted a 52-week, assessor-blinded randomized trial of yoga, PT, and education (a self-care book and newsletters) for adults with nonspecific cLBP. The study was advertised as a comparison of 3 credible cLBP treatments. All participants had access to usual medical care. The study consisted of a 12-week treatment phase and 40-week maintenance phase. The primary hypothesis was that yoga is noninferior to PT in the treatment phase for improving both back-related function and pain intensity. The secondary hypothesis was that both yoga and PT are superior to education for improving function and pain.
The maintenance phase compared the effectiveness of different strategies for ongoing yoga and PT. Yoga participants who completed 1 or more yoga classes in the treatment phase were randomly assigned at 12 weeks to yoga drop-in classes or home practice. Physical therapy patients who completed 1 or more PT appointments in the treatment phase were randomly assigned to PT booster sessions or home practice. We hypothesized that at 52 weeks, yoga drop-in classes are superior to yoga home practice and PT booster sessions are superior to PT home practice.
Participants were recruited from June 2012 to November 2013. Follow-up was completed in November 2014. The original research protocol and a summary of protocol changes are in Supplement 1.

Setting and Participants

The study was done at a large academic safety-net hospital and 7 affiliated, federally qualified community health centers located in diverse neighborhoods. Staff doing data collection, entry, and analysis were masked to treatment assignment. The Boston University Institutional Review Board approved the study before data collection.
We enrolled English-speaking adults aged 18 to 64 years who reported nonspecific low back pain lasting at least 12 weeks with an average pain intensity in the previous week of 4 or greater on an 11-point (0 to 10) numerical rating scale. Persons with specific causes of cLBP (for example, spinal stenosis) were excluded. Eligibility criteria are in Table 1 of Supplement 2. Recruitment strategies included clinician referrals, mailing letters to patients with cLBP who were identified through electronic health records, and distributing flyers in clinics and surrounding neighborhoods.

Randomization and Interventions

After initial telephone screening, staff confirmed eligibility and obtained written informed consent during in-person meetings. Staff entered participants into StudyTRAX (ScienceTrax), a data management platform. StudyTRAX generated a randomization sequence using permuted block randomization with varying block sizes and a 2:2:1 ratio of yoga, PT, and education. After participants completed baseline surveys, unmasked staff informed them of their treatment assignments. Enrollment and randomization proceeded in 4 sequential cohorts of approximately 80 participants each.
Yoga participants who attended at least 1 class in the treatment phase continued into the maintenance phase and were randomly assigned to weekly drop-in yoga classes or home practice only. Physical therapy participants with at least 1 PT visit in the treatment phase were randomly assigned to attend 5 booster sessions or home practice only during the maintenance phase. Education participants continued into the maintenance phase without additional randomization.
A manualized yoga protocol (18) of 12 weekly 75-minute classes was adapted from previous studies in similar populations (21, 22) with input from expert yoga instructors, investigators, and former study participants (Table 2 of Supplement 2). Thirteen yoga instructors completed 8 hours of training and taught classes at 6 sites. Instructor assignments ensured a participant–instructor ratio of less than 5:1. Each class began with relaxation and meditation exercises, yoga breathing, and yoga philosophy. It continued with yoga poses and concluded with relaxation. Pose variations and aids (such as chair, strap, and blocks) accommodated various abilities. Thirty minutes of daily home practice, facilitated by a DVD, a manual, and take-home yoga supplies, was strongly encouraged. Participants recorded time spent practicing. Staff observed approximately 10% of classes to assess protocol fidelity by using a checklist. Maintenance phase classes were similarly structured except for a higher participant–instructor ratio (approximately 8:1).
The manualized PT protocol (Figure 1 and Table 3 of Supplement 2) incorporated treatment-based classification (23, 24), graded exercise (25), and screening for fear-avoidance beliefs (26). Eight physical therapists delivered the intervention in 1 hospital-based and 2 community-based PT clinics. Physical therapists completed 8 hours of in-person training and Web-based modules (27). Participants were advised to attend fifteen 60-minute appointments over 12 weeks. Appointments included one-on-one work with the therapist and supervised aerobic exercise. All participants completed the Fear-Avoidance Beliefs Questionnaire (28). For PT participants with a high fear-avoidance score (≥29 on the work subscale), therapists provided The Back Book (29) and reinforced its psychologically informed principles to lower fear avoidance. Participants received written instructions and supplies for home practice and logged the number of exercises completed daily. Staff assessed protocol fidelity by reviewing therapists’ treatment flowsheets. Participants randomly assigned to booster sessions during the maintenance phase were advised to see the therapist at 4, 6, 8, 10, and 12 months.
Education participants received The Back Pain Helpbook (30), which includes information on cLBP self-management, stretching, strengthening, and the role of emotions and fear avoidance. Previous cLBP trials (11, 12, 31) used this book as a credible control intervention. We provided a recommended reading schedule (Table 4 of Supplement 2). Every 3 weeks, participants received a 1- to 2-page newsletter (32), summarizing main points from assigned chapters, and a 5- to 10-minute check-in call from staff. In the maintenance phase, we made brief check-in calls every 6 weeks to encourage continued review of the book.

Outcomes and Follow-up

Coprimary outcomes were change from baseline to 12 weeks in scores on the modified Roland Morris Disability Questionnaire (RMDQ), a 23-point measure of back-related function with higher scores indicating worse function (33), and in pain (using an 11-point numerical rating scale for average intensity in the previous week, where 0 indicated no pain and 10 indicated worst pain possible) (34). Secondary outcomes included self-reported pain medication use in the previous week (yes or no), global improvement (7-point scale from extremely worsened to extremely improved), patient satisfaction with interventions (5-point scale from very dissatisfied to very satisfied) (35), and health-related quality of life (Short Form-36 Health Survey) (36). We collected data on work productivity, a secondary outcome, and will report them separately in a cost-effectiveness analysis. We also plan to report data on other exploratory measures collected (such as fear-avoidance beliefs, pain self-efficacy, depression, anxiety, and sleep) separately. Attendance at all yoga and PT sessions was recorded. Participants attending at least 9 yoga or 11 PT sessions (≥75% or ≥73% of sessions, respectively) were defined as adherent a priori. Education participants were asked how much of the book they had read. Those reporting having read at least 75% were defined as adherent a priori.
After baseline data collection, study staff that was blinded to treatment assignment collected paper surveys completed at 6, 12, 26, 40, and 52 weeks. Adverse events were elicited directly from participants and in surveys. Participants received $100 gift cards after completing surveys at 12 and 52 weeks and $50 gift cards after the baseline questionnaire and surveys at 6, 26, and 40 weeks.

Statistical Analysis

The study was designed and powered to detect if yoga was noninferior to PT at 12 weeks for both primary outcomes. Noninferiority margins were prespecified for RMDQ (1.5) and pain (1.0) by halving the minimal clinically important difference (37). Although some controversy exists about the minimal clinically important difference for RMDQ (38, 39) and back pain intensity (40, 41), 3.0 and 2.0, respectively, are reasonable and commonly used. Because we required noninferiority for both primary outcomes, adjustment for multiple testing was unnecessary. Assuming 20% attrition and previously published variances (11, 12), the target sample size of 320 provided 81% and 90% power to detect noninferiority at 12 weeks of yoga to PT for function and pain, respectively.
We used analysis of variance and chi-square tests to assess between-group differences in baseline variables. For coprimary outcomes during the treatment phase, we did 1-sided 2-sample t tests to determine whether yoga was noninferior to PT for change from baseline to 12 weeks. We controlled for potential confounders, defined a priori by a baseline imbalance between groups (P < 0.10), by using multiple linear regression. To comply with the journal editors’ recommendations for handling missing data in our primary outcome analyses, we present findings based on multiple imputation using regression modeling in SAS PROC MI. Variables used in the imputation were treatment group, baseline values, and week-6 scores. Any missing week-6 values were imputed before imputation for week-12 values. Ten imputed data sets were created. Using these, the analysis for back pain score was unadjusted, whereas the analysis of RMDQ was adjusted for baseline RMDQ. Analyses using the last observation carried forward, our prespecified approach for handling missing values, are presented in Supplement 2.
For secondary outcomes, we used the last observation carried forward to manage missing data and did not adjust for multiple testing. We did 2-sided 2-sample t tests to determine whether yoga and PT were superior to education.
We also performed responder analyses comparing the proportion of participants in each group with clinically meaningful change (≥30% decrease from baseline to 12 weeks) (40). Self-reported pain medication use at 12 weeks (any vs. none) and medication subtypes (nonsteroidal anti-inflammatory drugs, acetaminophen, or opioids) were examined using logistic regression adjusted for baseline use. Global improvement and patient satisfaction were compared using multiple logistic regression. Health-related quality of life was compared using multiple linear regression. Per protocol analyses of the treatment phase included participants meeting a priori definitions of adherence. Adverse events were compared using the Fisher exact test.
For the maintenance phase, we did longitudinal analyses with a 5-part treatment variable (yoga drop-in classes, yoga home practice, PT booster sessions, PT home practice, and education), incorporating all RMDQ and pain measurements from weeks 12 to 52 (42). The general linear model for correlated data using SAS PROC MIXED with a repeated statement was used with an unstructured covariance and a treatment-by-time interaction examining differences in patterns over time. Specific hypotheses were tested using contrasts. Missing data points were not replaced.
All analyses were performed with SAS, version 9.3 (SAS Institute).

Role of the Funding Source

This study was funded by the National Center for Complementary and Integrative Health. This agency had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; or decision to submit the manuscript for publication.

Results

Study Population

From June 2012 to November 2013, we screened 1663 people. Of these, 479 (29%) met eligibility criteria and 320 (19%) were enrolled and randomly assigned to yoga, PT, or education (Figure 2 and Table 5 of Supplement 2). Most study participants were women, were nonwhite, were not college graduates, and were earning $30 000 or less annually (Table 1; Table 6 of Supplement 2).

On average, participants reported moderate to severe functional impairment and pain. More than two thirds used analgesics for back pain. Baseline mean between-group differences were present for RMDQ, sex, and body mass index (P = 0.032, 0.088, and 0.099, respectively). However, only baseline RMDQ was identified as a confounder for the RMDQ analyses.

Table 1. Demographics and Baseline Characteristics of All Participants, by Treatment Group*

Image: M162579tt1_Table_1_Demographics_and_Baseline_Characteristics_of_All_Participants_by_Treatment_Gr

Adherence to Interventions and Loss to Follow-up

During the treatment phase, median yoga attendance was 7 classes (interquartile range, 3 to 10). Median PT attendance was 7 appointments (interquartile range, 2 to 12). Home practice was reported by 95 yoga participants (75%) and 83 PT participants (64%). Of these, yoga participants practiced a median of 27 minutes (interquartile range, 17 to 35 minutes) 4 days per week. Physical therapy participants did a median of 4 exercises (interquartile range, 3 to 5) 4 days per week. Fewer than half of the participants met adherence criteria: 56 yoga (44%), 46 PT (36%), and 28 education (44%) participants. Of 59 participants randomly assigned to yoga drop-in classes during the maintenance phase, 31 (53%) attended at least 1 drop-in class (median, 13; interquartile range, 4 to 22). Of 54 participants randomly assigned to PT booster sessions, 30 (56%) attended at least 1 appointment (median, 2; interquartile range, 1 to 3). Follow-up was lower in PT than in yoga or education at 12 weeks (88% vs. 98% and 95%, respectively) and 52 weeks (84% vs. 93% and 93%, respectively).

Primary Outcomes

Improvement in RMDQ for yoga (mean within-group change, −3.8 [95% CI, −4.6 to −2.9]) was noninferior to that for PT (mean within-group change, −3.5 [CI, −4.5 to −2.6]) (Table 2 and Figure). The mean difference in RMDQ between yoga and PT was −0.26 (1-sided CI, −∞ to 0.83).

Decreased pain for yoga (mean within-group change, −1.7 [CI, −2.1 to −1.4]) was noninferior to that for PT (mean within-group change, −2.3 [CI, −2.7 to −1.9]). The mean difference in pain between yoga and PT was 0.51 (1-sided CI, −∞ to 0.97). Noninferiority plots for primary outcomes are shown in Figure 3 of Supplement 2. Analyses using the last observation carried forward to account for missing data yielded similar results (Table 7 of Supplement 2).

Table 2. Primary Outcomes at 12 Weeks*

Image: M162579tt2_Table_2_Primary_Outcomes_at_12_Weeks

FIGURE.

Primary outcomes from baseline to 52 weeks.

The study was divided into a treatment phase (baseline to 12 wk) and maintenance phase (12 to 52 wk). Intention-to-treat analyses are shown. Plotted values in the treatment phase derive from models using multiple imputation to handle missing data. Values in the maintenance phase derive from longitudinal models using all available data. 95% CIs are shown. Data points are slightly offset from each other to aid interpretation. RMDQ = Roland Morris Disability Questionnaire.Top.Mean RMDQ scores adjusted for baseline scores and anchored at the study population mean at baseline.Bottom.Mean unadjusted back pain scores.

Image: M162579ff1_Figure_Primary_outcomes_from_baseline_to_52_weeks

Secondary and Exploratory Outcomes

Yoga and PT were not superior to education at 12 weeks for RMDQ (Table 2). However, both yoga and PT were more likely than education to have clinically meaningful responses in RMDQ (Table 3). Forty-eight percent of yoga participants versus 23% of education participants responded (odds ratio, 3.1 [CI, 1.6 to 6.2]). Thirty-seven percent of PT participants responded (odds ratio [vs. education], 2.0 [CI, 1.0 to 4.0]). For pain, yoga was not superior to education (mean between-group difference, −0.33 [CI, −0.97 to 0.32]) but PT was (mean between-group difference, −0.84 [CI, −1.5 to −0.18]). The only significant between-group difference in clinically meaningful response in pain was in the PT group compared with education (43% vs. 25%; odds ratio, 2.3 [CI, 1.1 to 4.5]).

Table 3. Secondary Outcomes at 12 Weeks*

Image: M162579tt3_Table_3_Secondary_Outcomes_at_12_Weeks

At 12 weeks, yoga and PT participants were 21 and 22 percentage points, respectively, less likely than education participants to use any pain medication (Table 3). Although PT participants were less likely than education participants to use acetaminophen, there were no other significant differences in medication subgroups. Self-rated global improvement and satisfaction with the intervention did not significantly differ between yoga and PT. Global improvement for PT, but not for yoga, was superior to that for education. Satisfaction with yoga and PT were both superior to that with education. No significant between-group differences were seen in Short Form-36 Health Survey scores.
Given the low proportion of participants meeting prespecified adherence criteria (36% to 44%), per protocol between-group comparisons are highly susceptible to bias and are not presented. However, mean within-group RMDQ changes for adherent participants at 12 weeks were −4.6, −5.7, and −2.7 for yoga, PT, and education, respectively (Table 8 of Supplement 2). Clinically meaningful improvement in RMDQ scores occurred in 57%, 56%, and 21% of participants, respectively. For pain intensity at 12 weeks, mean within-group changes for adherent participants were −2.1, −2.6, and −1.3 for yoga, PT, and education, respectively. Clinically meaningful improvement in pain intensity occurred in 50%, 52%, and 14% of participants, respectively.
In the maintenance phase, RMDQ or pain changes did not significantly differ between yoga drop-in classes and yoga home practice or between PT booster sessions and PT home practice (Figure; Table 9 and Table 10 of Supplement 2).

Adverse Events

Adverse events, mostly mild self-limited joint and back pain, were reported in 9 yoga, 14 PT, and 1 education participants. Yoga and PT did not differ significantly in frequency or severity of adverse events (Table 11 of Supplement 2).

Discussion

In a trial of yoga, PT, and education for predominantly low-income, racially diverse participants with moderate to severe nonspecific cLBP, intention-to-treat analyses found that a 12-week standardized yoga program was noninferior to individually delivered PT for change in back-related function and pain. Our secondary hypothesis, that yoga is superior to education for both function and pain, was not supported. However, participants in both yoga and PT were more likely to have clinically meaningful improvements in function than were education participants. Yoga and PT participants were also more likely than education participants to discontinue pain medication. Improvements in yoga and PT groups were maintained at 1 year regardless of whether patients were assigned to ongoing yoga classes, PT booster sessions, or home practice only. All interventions were relatively safe.
Compared with previous trials of yoga for cLBP (11–13), our trial enrolled a more racially diverse, lower SES population. For example, Sherman and colleagues’ study of yoga, stretching classes, and education recruited 228 patients with cLBP, 87% of whom were white, 62% college graduates, and 84% with incomes greater than $45 000 (12). Research has documented racial and socioeconomic disparities in disability and pain (5). Minorities with back pain receive fewer specialty referrals (43) and less-intensive rehabilitation for occupational back injuries (44) than do whites. Despite pain’s disproportionate impact on minority and low SES groups, few cLBP studies and even fewer yoga and PT trials have targeted these populations. Barriers exist for low-income minorities to access nonpharmacologic treatments, such as yoga and PT. Non-Hispanic white adults are twice as likely as non-Hispanic black adults to use yoga (45). Yoga classes are often unavailable in predominantly low-income minority neighborhoods, and fees can be prohibitive (46). People with higher education are more likely to receive PT; people covered by Medicaid are less likely (47). Some insurance plans require expensive PT copayments that may deter patient access (48).
In Sherman and colleagues’ study, yoga classes and stretching classes were superior to the same self-care book used in our study (12). Although both our study and Sherman and colleagues’ study found similar improvement for patients who used the book (for example, −2.5 vs. −2.2 for RMDQ), our yoga intervention did not perform as well (for example, −3.8 vs. −5.2 for RMDQ). One possible explanation for the modest effect of yoga and PT in our trial is lower adherence. Our yoga participants attended a median of 7 classes compared with 10 in Sherman and colleagues’ trial. This can be attributed in part to obstacles often facing lower SES populations, including inconsistent telephone service, difficulties with transportation, serious illnesses and injuries in family members, conflicting life demands (such as work, child care, and elder care), homelessness, and incarceration (49). The greater effect of yoga and PT among our adherent patients highlights the challenges and importance of compliance in exercise interventions (50). Another reason for the modest effect of our interventions may be the severity of our participants’ back conditions. Baseline mean back-related disability and pain scores were 63% and 57% more severe, respectively, in our study than in Sherman and colleagues’ study. Opioid use, obesity, depression, and other comorbid conditions were also more common.
Strengths of this study include an assessor-blinded randomized design, adequate power to assess noninferiority of yoga to PT at 12 weeks, and standardized interventions delivered by providers in community-based settings. Although blinding of participants in nonpharmacologic trials is not possible, we presented the study as comparing 3 credible treatments. Limitations include disproportionate loss to follow-up for PT. This attrition bias could increase or decrease the observed effectiveness of PT depending on the likelihood of dropouts doing worse or better than those with follow-up. Mean baseline RMDQ, a coprimary outcome, modestly differed between groups and required adjustment. The lack of difference between maintenance phase groups is difficult to interpret because only approximately half of eligible participants attended any yoga drop-in classes or PT booster sessions. Per protocol analyses were not powered to assess noninferiority and should be interpreted with caution. Because the per-protocol population is a subgroup, differences between adherent and nonadherent participants may confound the analyses. In addition, analyses for change in use of medication subtypes, such as opioids or nonsteroidal anti-inflammatory drugs, were underpowered.
These findings suggest that a manualized yoga intervention designed specifically for cLBP is similarly effective to PT for improving physical function and reducing pain in a diverse underserved population with high levels of impairment. These results are likely generalizable to other safety-net settings and to less-impaired, higher SES patients. However, the results may not generalize to typical nonmanualized, community-based yoga classes. Similarly, our education intervention was more time-intensive than typical office-based education and therefore was probably more effective. Future studies should focus on pragmatic trials of nonmanualized yoga classes, testing of strategies to enhance adherence, and cost-effectiveness analyses.
In conclusion, we found that yoga was noninferior to PT for improving moderate to severe nonspecific cLBP in a diverse, predominantly low-income population. Yoga and PT participants had greater improvement in function and pain than education participants; however, these differences were not uniformly significant. Yoga and PT participants were more likely than education participants to stop taking pain medication. The effectiveness of yoga and PT was most evident in adherent participants. Improvements in yoga and PT were maintained at 1 year, and all interventions were relatively safe. A structured yoga program for patients with cLBP may be a reasonable alternative to PT depending on patient preferences, availability, and cost.

Stomach pain, skin issues, insomnia and headache should be monitored early on to prevent future chronic diseases

Health monitoring early on when we are young can provide a picture of our future health. Predicting our future health using data from wearables is a way of prevention.

The following symptoms can tell an underlying health issue that might become a chronic health disease if not managed early on or given attention to heal the body from these disrupting health issues:

Stomach Aches and Constipation

Constipation can be a sign that our digestive system is not functioning well. A regular bowel movement is important in cleansing our body from toxins.  The most frequent reason for abdominal pain are gastroenteritis (13%), irritable bowel syndrome (8%), urinary tract problems (5%), inflammation of the stomach (5%) and constipation (5%). In about 30% of cases, the cause is not determined. About 10% of cases have a more serious cause including gallbladder (gallstones or biliary dyskinesia) or pancreas problems (4%), diverticulitis (3%), appendicitis (2%) and cancer (1%).[1] More common in those who are older, mesenteric ischemia and abdominal aortic aneurysms are other serious causes.[2]

A more extensive list includes the following:

Insomnia

Our brain detoxes our body during sleep. Some medications can cause insomia.

Insomnia can occur independently or as a result of another problem.[2] Conditions that can result in insomnia include psychological stress, chronic pain, heart failure, hyperthyroidism, heartburn, restless leg syndrome, menopause, certain medications, and drugs such as caffeine, nicotine, and alcohol.[2][3] Other risk factors include working night shifts and sleep apnea.

Symptoms of insomnia can be caused by or be associated with:

Headaches

Headaches can occur when we lack sleep or have taken some medications or under stress.  90% of all headaches are primary headaches. Primary headaches usually first start when people are between 20 and 40 years old .[6] The most common types of primary headaches are migraines and tension-type headaches.[6] They have different characteristics. Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light) and phonophobia (sensitivity to sound). Tension-type headaches usually present with non-pulsing “bandlike” pressure on both sides of the head, not accompanied by other symptoms.

More serious causes of secondary headaches include:[5]

  • meningitis: inflammation of the meninges which presents with fever and meningismus, or stiff neck
  • bleeding inside the brain (intracranial hemorrhage)
  • subarachnoid hemorrhage (acute, severe headache, stiff neck WITHOUT fever)
  • ruptured aneurysm, arteriovenous malformation, intraparenchymal hemorrhage (headache only)
  • brain tumor: dull headache, worse with exertion and change in position, accompanied by nausea and vomiting. Often, the person will have nausea and vomiting for weeks before the headache starts.
  • temporal arteritis: inflammatory disease of arteries common in the elderly (average age 70) with fever, headache, weight loss, jaw claudication, tender vessels by the temples, polymyalgia rheumatica
  • acute closed angle glaucoma (increased pressure in the eyeball): headache that starts with eye pain, blurry vision, associated with nausea and vomiting. On physical exam, the person will have a red eye and a fixed, mid dilated pupil.
  • Post-ictal headaches: Headaches that happen after a convulsion or other type of seizure, as part of the period after the seizure (the post-ictal state)

Gastrointestinal disorders may cause headaches, including Helicobacter pylori infection, celiac disease, non-celiac gluten sensitivity, irritable bowel syndrome, inflammatory bowel disease, gastroparesis, and hepatobiliary disorders.[8][9][10] The treatment of the gastrointestinal disorders may lead to a remission or improvement of headaches.

Skin issues

Our skin is the largest organ in our body. It tells a picture of our health. Age spots can show liver health.  Skin itching can occur when we ingested toxic food or medications. It is easily affected by our environment and lifestyle.

As skin ages, it becomes thinner and more easily damaged. Intensifying this effect is the decreasing ability of skin to heal itself as a person ages. Consult your dermatologist and internist for any skin itching, discoloration and abnormal growth. A teacher brushes off skin itching that she died of breast cancer.

Among other things, skin aging is noted by a decrease in volume and elasticity. There are many internal and external causes to skin aging. For example, aging skin receives less blood flow and lower glandular activity.

A validated comprehensive grading scale has categorized the clinical findings of skin aging as laxity (sagging), rhytids (wrinkles), and the various facets of photoaging, including erythema (redness), and telangiectasia, dyspigmentation (brown discoloration), solar elastosis (yellowing), keratoses (abnormal growths) and poor texture.[19]

Cortisol causes degradation of collagen,[20] accelerating skin aging.

Lemon grass or Tanglad to fight insomia

The health benefits of lemongrass include relief from stomach disorders, insomnia, respiratory disorders, fever, aches, infections, rheumatism and edema. The defensive antioxidant activity of the lemongrass herb protects against antibiotic-resistant Staphylococcus aureus and helps in maintaining optimum cholesterol levels, cellular health, nervous system, healthy skin and immune system. It is also effective in treating type 2 diabetes, cancer, and obesity, while also aiding in detoxification. It is extensively used in aromatherapy and helps to combat fatigue, anxiety and body odor.

Lemongrass – An Aromatic Healer

Cymbopogon citratus also known as Lemongrass is an herb which belongs to the grass family of Poaceae. It is well known and utilized for its distinct lemon flavor and citrusy aroma. It is a tall, perennial grass which is native to India and tropical regions of Asia. It is a coarse and tufted plant with linear leaves that grows in thick bunches, emerging from a strong base and standing for about 3 meters in height with a meter-wide stretch.

In addition to its culinary usage, lemongrass offers a wide array of medicinal benefits and is in extensive demand due to its antibacterial, anti-fungal and antimicrobial properties across Southeast Asia, as well as the African and American continents.

The genus Cymbopogon comprises of 55 species of grass, two of which are referred to as Lemongrass. These are West Indian lemongrass or Cymbopogon citratus which is famously preferred for culinary use and East Indian lemongrass or Cymobopogon flexuosus which is used in the manufacturing of various products such as fragrances because of its extended shelf life, owing to the low amount of myrcene in that variety.

Nutritional Value Of Lemongrass

Lemongrass is an aromatic storehouse of essential nutrients providing a wide array of health benefits. It is a source of essential vitamins such as vitamin A, vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B5 (pantothenic acid), vitamin B6 (pyridoxine), folate and vitamin C. It also provides essential minerals such as potassium, calcium, magnesium, phosphorous, manganese, copper, zinc and iron, which are required for the healthy functioning of the human body. It offers no harmful cholesterol or fats.

Health Benefits Of Lemongrass

Lemongrass contains antioxidants, flavonoids and phenolic compounds such as luteolin, glycosides, quercetin, kaempferol, elimicin, catecol, chlorogenic acid, and caffeic acid, all of which help in providing an impressive range of medicinal aids. The main componentof lemongrass is lemonal or citral, which has anti-fungal and antimicrobial qualities, while also providing a distinct lemony smell. Some of the most well known health benefits of lemongrass include:

Cholesterol: Lemongrass possesses anti-hyperlipidemic and anti-hypercholesterolemic properties that support healthy cholesterol levels. Studies have shown that the regular consumption of lemongrass has shown significant results in sustaining healthy levels of triglycerides and reducing the LDL cholesterol in the body. This helps in preventing the accumulation of lipids in the blood vessels and promotes the unobstructed flow of blood in the arteries and prevents various cardiac disorders such as atherosclerosis.

Detoxification: Lemongrass helps in cleansing and flushing harmful toxic wastes out of the body, as a result of its diuretic properties. Detoxification helps in better regulation of various organs of the body, including the liver and kidney, while also helping to lower the levels of uric acid. The diuretic effect of lemongrass helps in increasing the quantity and frequency of urination, which helps in maintaining digestive health, eliminating accrued fats, and assisting in maintaining a clean system.

lemongrassCancer: Lemongrass is effective in treating various types of cancers without affecting the healthy normal cells of the body. Research conducted to prove the anti-cancerous activity of lemongrass has shown promising outcomes in the prevention of skin cancer. Studies have shown that a certain component, citral, which is present in lemongrass, helps in inhibiting the growth of hepatic cancer cells during the initial phases and prevents any further production of cancerous cells. Another study has provided supporting evidence regarding the anti-proliferative effect of citral in impeding the growth of human breast cancer cells and the induction of apoptosis.

Staphylococcus aureus: Studies have shown that lemongrass essential oil has an anti-biofilm capacity and is beneficial against the infection caused by Staphylococcus aureus. It contains phenols which possess the capability to spread quickly through the body tissues and cure biofilms located anywhere in the body. It disrupts the growth and communication of germs which helps in inhibiting the formation of biofilms. The essential oil of lemongrass is useful for application both topically as well as internally in the diseases diagnosed with biofilms, such as Lyme disease.

Stomach Disorders: Studies have shown that lemongrass essential oil has anti-microbial and anti-bacterial properties which help in fighting the infections caused by various pathogens such as Helicobacter pylori and Escherichia coli. It is beneficial in the prevention of gastrointestinal disorders such as gastric ulcers, helps in stimulating the bowel function, and improves digestion. The anti-inflammatory properties of lemongrass are beneficial for treating constipation, ulcerative colitis, diarrhea, nausea and stomach aches.

Insomnia: Lemongrass aids in calming the muscles and nerves which helps in inducing deep sleep. Research has shown that lemongrass tea has sedative and hypnotic properties which help in increasing the duration and quality of sleep.

Respiratory Disorders: Lemongrass is widely used in Ayurvedic medicine for its healing effects in treating coughs and colds. Along with other beneficial components, the vitamin C content present in it helps in providing relief from nasal blockages, flu and other respiratory disorders such as bronchial asthma.

Fever: Lemongrass is a febrifuge and is also known as the ‘fever grass’, owing to its beneficial effects in lowering  fevers. The anti-pyretic and diaphoretic effect of lemongrass is extensively used in Ayurvedic medicine for curing fevers by inducing sweating.

Infections: Lemongrass works as an antiseptic and is effective in treating infections such as ringworm, sores, Athlete’s Foot, scabies, and urinary tract infections because of its antimicrobial and anti-fungal properties. Studies have shown that lemongrass exerts healing effects on dermatological infections, such as yeast infections, by inhibiting the growth of pathogens. Another study provided supporting evidence that demonstrated the efficacy of lemongrass over thyme, patchouli and cedar wood oil in the treatment of various diseases such as oral or vaginal candidias.

Aches: Lemongrass helps in alleviating the pain and discomfort caused by headaches and migraines due to its analgesic properties. The phytonutrients present in it improve the blood circulation and help in relieving spasms, muscle cramps, sprains, and back aches. It is valuable in treating sports wounds, including dislocations, internal injuries and bruises.

Nervous System: Lemongrass is a nervine and has been proven to be an  tonic for the nervous system. It stimulates the mind and helps in combating convulsions, nervousness, vertigo and various neuronal disorders such as Alzheimer’s and Parkinson’s disease. It is used in therapeutic baths, which assist in calming the nerves and help in alleviating the symptoms of anxiety and fatigue caused by stress.

Type-2 Diabetes: Lemongrass has been proven beneficial in treating Type-2 diabetes. Studies have shown that the citral present in it helps to maintain optimum levels of insulin and improves the tolerance of glucose in the body.

Rheumatism: Lemongrass is effective in relieving the pain and discomfort caused by rheumatism. It can be applied topically on both lumbago and sprains and helps in relieving neuralgia and other painful sufferings.

Immune System: Lemongrass helps in restoring the vital systems which are operational in the body, including digestion, respiration, excretion and nervous system. This assists in better absorption of nutrients and strengthens the immune defense mechanism of the body. Lemongrass extracts have a beneficial effect on the inflammatory actions of cytokines, which are the signaling molecules through which the cells communicate and respond in the body. Studies have shown that lemongrass exerts anti-inflammatory action and its constituents such as citral may be the cause behind its inhibitory effects on cytokine production.

Skin Care: Lemongrass has been treasured as a skin tonic and makes an effective cleanser for oily or acne-prone skin, due to its astringent and antiseptic qualities. It helps in strengthening the skin tissues and toning up the pores while also sterilizing them. Care should be taken while using lemongrass products, as the undiluted application might lead to dermal irritation in some cases.

Cellular Health: Lemongrass possesses antioxidant qualities and help in protecting the body cells from the oxygen-derived free radicals. It also helps in the cleansing of blood and strengthens the spleen to discard the tarnished red blood cells. It supports the function of the thymus glands which helps to produce white blood cells. It helps in stimulating regeneration of cells. The folate and potassium content in the stem and leaves of lemongrass aids in DNA synthesis and promotes cell division.

Edema: Lemongrass is effective in curing the condition of water retention or edema. It has a cleansing effect on lymphatic congestion and helps to soothe the swelling.

Degenerative Joint Disease by Dr Axe

DJD 2DJDThe primary goals of all degenerative tissue disease/osteoarthritis or arthritis treatments are to lower inflammation/swelling, control pain, improve mobility and joint function, help maintain a healthy weight so you put less pressure on fragile joints, and to improve your mood — so you’re better able to handle the stress of battling a degenerative disease.

1. Stay Active

While most people with osteoarthritis usually have joint pain and some movement limitations, many find that they feel better and experience less symptoms overall when they keep moving. In fact, exercise is considered one of the most important treatments for degenerative joint disease. Like the old saying goes, “Move it or lose it.” In other words, the more you strengthen and stretch your body parts, the better intact they’ll stay into older age.

Exercise is important for lowering inflammation, increasing flexibility, strengthening muscles (including the heart), boosting circulation and supporting a healthy body weight. It helps keep joints and bones strong and limber, improve heart health/cardiovascular fitness, extend the range of motion of joints, and move synovial fluid throughout the body better. Plus, let’s not forget about the mental benefits of exercise. Getting regular exercise is a powerful way to lower stress, improve your mood, control stress hormones like cortisol and help you sleep better.

Because every DJD patient is different in terms of physical abilities and pain level, the amount and form of exercise prescribed depends on each person’s specific condition and how stable the joints are. You want to ideally do a combination of three types of exercises for osteoarthritis: (5)

  • strengthening exercises targeted at improving strength in muscles that support effected joints — such as knee strengthening exercises
  • aerobic activities to improve blood pressure, circulation and inflammation
  • range-of-motion activities to keep joints flexible and help you become more comfortable with daily movements

Some of the most beneficial, and least painful, types of exercise include walking, swimming and water aerobics. If exercise is painful at first or you’re just beginning to become more active, your doctor and/or physical therapist can recommend specific types of exercise that would be safest and most helpful. Start slowly and find ways to sneak more fitness into your day while you build up resilience and strength.

2. Lower Inflammation and Support Cartilage with a Nutrient-Dense Diet

Research suggests that a poor diet increases inflammation and might increase enzymes that destroy collagen and other proteins important for maintaining healthy tissue. Cartilage is about 65 percent to 80 percent water, and the remainder is made up of three components: collagen, proteoglycans and chondrocytes.

Collagen is a type of fibrous protein that acts as the body’s natural “building blocks” for skin, tendons, bone and other connective tissues. Proteoglycans interweave with collagen to form mesh-like tissue that allows cartilage to absorb shocks and vibrations, while chondrocytes mostly produce cartilage and help it stay intact as we get older.

Some of the ways you can help the body hold on to precious cartilage and lower inflammation is to load up on all sorts of natural anti-inflammatory foods. These provide essential fatty acids, antioxidants, minerals and vitamins that support the immune system, lower pain, and help with healthy tissue and bone formation.

Focus your diet around these foods as much as possible:

  • fresh vegetables (all kinds): Aim for variety and a minimum of four to five servings per day
  • whole pieces of fruit (not juice): three to four servings per day is a good amount for most people
  • herbs, spices and teas: turmeric, ginger, basil, oregano, thyme, etc., plus green tea and organic coffee in moderation
  • probiotic foods: yogurt, kombucha, kvass, kefir or cultured veggies
  • wild-caught fish, cage-free eggs and grass-fed/pasture-raised meat: higher in omega-3 fatty acids and vitamin D than farm-raised varieties and great sources of protein, healthy fats, and essential nutrients like zinc, selenium and B vitamins. Vitamin D has been shown to help support arthritis patients, so consider adding in more raw dairy if possible too. (6)
  • healthy fats: grass-fed butter, coconut oil, extra virgin olive oil, nuts/seeds
  • ancient grains and legumes/beans: best when sprouted and 100 percent unrefined/whole
  • Bone broth: contains collagen and helps maintain healthy joints

Limit or eliminate these foods that promote inflammation:

  • Refined vegetable oils (like canola, corn and soybean oils, which are high in pro-inflammatory omega-6 fatty acids)
  • Pasteurized dairy products (common allergens) and conventional meat, poultry and eggs, which contain added hormones, antibiotics and omega-6s that contribute to inflammation
  • Refined carbohydrates and processed grain products and added sugars (found in the majority of packaged snacks, breads, condiments, canned items, cereals, etc.)
  • Trans fats/hydrogenated fats (used in packaged/processed products and often to fry foods)

 

Degenerative joint disease stats - Dr. Axe

 

3. Maintain a Healthy Body Weight

Carrying excess body weight puts strain on joints that are already delicate. (7) Osteoarthritis patients who are overweight should try to reach a healthy body weight in a realistic way, using a well-balanced diet and adding in more movement. This should be viewed as a long-term lifestyle change, not a quick-fix diet that’s very low in calories and will likely result in nutrient deficiencies that are needed to limit further injuries.

4. Get Enough Rest/Relaxation

When you don’t get enough sleep, downtime and relaxation in your life, your joints and muscles have a harder time repairing themselves, while your stress hormones, body weight and inflammation all tend to rise. You need to get enough sleep every night (seven to nine hours usually) in order to relieve joints from stress, keep stress hormone levels balanced, regulate your appetite and repair damaged tissue. Learn to recognize your body’s signals, and know when to stop or slow down and take a break, so you avoid becoming anxious, overexerted and run-down.

5. Control Pain Naturally

Dealing with pain can be one of the hardest things about battling degenerative joint disease, since it takes away from your quality of life, ability to do your job well and independence. Many doctors prescribe anti-inflammatory medications (like NSAIDs) or even surgery to dull pain if the situation becomes bad enough, but you can also use non-drug pain-relief techniques that are just as effective. Some popular complementary and alternative therapies that help fight pain include:

  • Acupuncture: Studies show that patients receiving acupuncture normally have less pain than patients in placebo control groups. Acupuncture is proven to help lower symptoms of back and neck pain, muscle aches and joint stiffness, osteoarthritis, and chronic headaches. (8)
  • Massage therapy: A professional massage can help improve circulation, bring blood to sensitive areas, relax the mind and lower stress.
  • Reflexology: Reflexology has been used for hundreds of years to stimulate the nervous system and help the body handle stress, fatigue, pain and emotional problems.
  • Infrared sauna treatments: Both heat and cold (or both together, used at different times) can be useful for loosening up joints and muscles and lowering swelling or pain. (9) At home you can use warm towels, ice packs, hot packs or a hot shower to reduce pain. Also consider trying infrared saunas, which are a type of sauna that uses heat and light to help relax the body by creating heat and causing you to sweat and release stored toxins. They’ve been shown to lower pain and are believed to have a parasympathetic healing effect, which means they help the body handle stress better.

What Causes Osteoarthritis/DJD?

People with DJD don’t maintain enough healthy cartilage as they age, which means movement becomes more painful as bones rub closer to one another, instead of being blocked by the slippery substance that’s supposed to act as a buffer between the bones. We need cartilage to help bones “glide” and also to absorb vibrations or shocks we experience when we move around, which is why most people with degenerative joint disease find it hard to go about normal day-to-day activities.

When the disease progresses enough, bones rub together in a way that causes inflammation, swelling, pain, loss of mobility and sometimes changes to the shapes of joints.

Here’s a quick overview of how joints work. Joints are the point where two or more bones are connected, and they’re made up (in most cases) of the following parts: cartilage, joint capsule (tough membrane sacs that enclose all the bones), synovium (located inside the joint capsules and responsible for secreting lubricating synovial fluid) and synovial fluid (buffers and lubricates the joints and cartilage). (10)

In people who don’t suffer from DJD or other forms of joint damage (like rheumatoid arthritis), their joints are encased in smooth cartilage and lined with synovial fluid that helps with the “sliding” of cartilage against bones, bones against muscles and muscles against connective tissues.

In severe cases of degenerative joint disease, joints start to become smaller and also to change shape while small deposits of bone (osteophytes, which are sometimes also called bone spurs) can also form around the edges of the joints where they shouldn’t be. The main problem with bone spurs is that at any time they can break off from the cartilage they grow on and make their way into the space where the joints are, further causing pain and complications.


Connie’s comments: My 82 yr old mother has DJD and is taking the following: supplement with turmeric and ginger, omega 3 oils, Vitamin B complex and Vitamin C, exercise, destress, massage oil with ginger, coconut and other essential oils of rosemary, eucalypytus and tea tree and whole foods of greens and yellow colored foods.