Tag Archives: treatment

Not Everyone Breathes While they Sleep: The Dangers of Sleep Apnea

You might think that breathing in our sleep should come naturally – if breathing and sleeping are both physiologically necessary, then we must be able to do them simultaneously right? Unfortunately, almost a quarter of middle-aged American men and nearly 10% of women suffer from sleep apnea, a chronic condition characterized by repeatedly stopping breathing while sleeping. The clinical symptoms seem rather benign – snoring, sleepiness, fatigue during the day or other issues sleeping. However, by far the most dangerous aspect of this disease is that it puts patients at increased risk of high blood pressure, stroke, coronary heart disease, as well as occupational and/or automobile accidents. Over the last several decades, a variety of therapy options have been studied to treat this condition, ranging from drugs to masks to surgery.

One of the earliest documented therapy options is using protriptyline to treat obstructive sleep apnea. Protriptyline is an anti-depressant drug that was used for its ability to clear airway obstructions during sleep; however, it did not gain significant popularity due to its adverse effects including cardiac complications and limited demographics for whom it would be an appropriate treatment.

The next treatment discussed was altering sleep positions for patients suffering from sleep apnea. A seemingly simple idea, a study determined that laying on the back significantly increased the severity of sleep apnea. Interestingly, the difference in severity between back and side sleeping positions was most noticeable in healthy, non-obese patients. The authors believe that lying on the back causes tissues of the throat to obstruct the trachea and prevent smooth airflow during breathing, as shown in the image below, which would explain why obesity can exacerbate sleep apnea.

Diagram of airflow obstruction through mouth and throat
Photo by Habib M’Henni on Wikimedia Commons.

Multiple non-invasive devices were also studied, including oral appliances, sleep posture alarms, and positive airway pressure devices. Oral appliances can either protrude the lower jaw or restrain the tongue; both aim to restructure the upper airway (mouth, trachea, etc.). Sleep posture alarms were suggested to train patients to sleep on either side, rather than on their backs. Positive airway pressure devices (Bi-PAP, CPAP) are the most commonly used treatment for sleep apnea currently; they maintain a consistent air pressure flowing into the mouth to ensure the airways do not collapse during sleep.

Man sleeping while using CPAP machine
Photo by ApneaMed

The final treatment studied was nocturnal supplemental oxygen (NSO), which involves increasing the concentration of oxygen in the air inhaled while sleeping. However, a study comparing use of a CPAP with use of NSO found that CPAP treatment was far more effective at decreasing the patients’ blood pressure and still proved effective in patients already taking blood pressure medication.

Overall, the best method for treating sleep apnea is dependent on the patient and his or her underlying conditions. Changes in sleep posture could greatly enhance the sleep quality of a moderate case of sleep apnea; CPAP would be ideal for someone who can easily tolerate the mask and does not frequently move in his or her sleep. Each of these demographics makes it difficult to define one optimal solution for treating sleep apnea, but the variety of available treatment options provides hope for those patients who suffer from this chronic illness.

Ankle Sprains: An Epidemic in the World of Athletics

Have you ever been out running on a gorgeous fall day, only to have the run cut short by a painful misstep on a tree root covered by leaves? I have, and let me tell you – it’s awful! And even if you aren’t a runner, according to the Sports Medicine Research Manual, ankle sprains are a common, if not the most common, injury for sports involving lower body movements. Now, the solution to preventing this painful and annoying injury could be as simple as avoiding tree roots and uneven ground, but the real problem behind ankle sprains deals with the anatomy of the ankle.

The ankle is made up of many ligaments, bones, and muscles. However, when sprained, it is the ligaments that are mainly affected. Connecting bone to bone, ligaments are used to support and stabilize joints to prevent overextensions and other injuries. The weaker a ligament is, the easier it is to injure. There are three main lateral (outer) ligaments supporting the ankle joint that can become problematic: the anterior talofibular ligament, the calcaneofibular ligament and the posterior talofibular ligament. According to a study from Physiopedia, these lateral ligaments are weaker than those on the interior (medial) of the ankle, with the anterior talofibular ligament being the weakest.

An image depicting the various ligaments of the ankle, both lateral and medial.
Anatomy of the ankle, highlighting the lateral and medial ligaments

The next question that has to be asked is why are these ligaments so much weaker than other ones? The answer to this question is based on their physical make up. Ligaments are made of soft tissue that has various collagen fibers running parallel to each other throughout it. The more fibers there are, the more structure and rigidity there is. Think of the fibers as a rope: The rope can stretch to a certain point, but once it hits that point it will snap and break. But if you have a thicker rope (such as the medial ligaments), it becomes much harder to break.

The ligaments on the outer part of the ankle have fewer collagen fibers than those on the inside of the ankle. Thus, when the ankle is moved in an awkward position, it is more likely that the lateral ligaments will break.

Once you sprain your ankle, the focus turns to treatment. Treatment will differ slightly for every individual depending on the severity of the ankle sprain. The simplest way to treat a sprained ankle is to follow the RICE (Rest, Ice, Compression, Elevation) method. Other forms of treatment include taping the ankle or using a brace to restrict movement and to add support and extra stability. Wearing proper footwear is another way that one can prevent and help treat a sprained ankle, as certain shoes are specifically designed to help avoid such injuries. To prevent future ankle sprains, exercises are recommended to help strengthen and stabilize the joint and surrounding ligaments and muscles.

For more information on ankle anatomy and sprains, check out these articles on BOFAS and SPORTS-Health.

Patellar Tendinitis: The Kryptonite of Jumping Athletes

Volleyball is a sport of quick movements. For hitters, one of the most common movements in the game is the jump, whether that be to block or to hit. Although a higher vertical leads to improvement in game performance, it can increase the risk of developing a serious injury that affects many volleyball players: patellar tendinitis. This condition is associated with pain and tenderness directly below the knee cap that is especially apparent during explosive, jumping movements. But what exactly causes this condition? And what can be done to remedy it?

A schematic of the knee and patellar tendon.
Image from Wikipedia “Patellar Tendinitis”

Since volleyball is such a quick game, muscle memory is required to react to different situations that can occur. The main way to build muscle memory is repetition. Therefore, young volleyball players are encouraged to play the sport as much as possible. For many athletes, this means playing for their school during that season and then playing for an independent club for the rest of the year. Although this increases the athlete’s skill level, it also increases the chance of patellar tendinitis, according to a study.

Besides overuse, lack of ankle mobility can also lead to a higher risk of the condition. A study found that players that couldn’t flex their ankle upward past 45 degrees could have 2 times the risk of patellar tendinitis as players with a higher ankle mobility. This is most likely due to the ankle and calf’s role in absorbing impact upon landing. Less absorption by the ankle causes more force to be put on the patellar tendon. This is bad news for volleyball players who often have poor ankle mobility due to a past injury.

There are a few ways to treat patellar tendinitis. For an orthotic approach, players use straps or tape around their patellar tendon. Some think this is simply due to the fact that the strap or tape makes the athlete feel more stable, which allows them to load the tendon more properly. However, a study done in 2011 analyzed the strain in the patellar tendon using a computational model. The researchers found that the patellar tendon strap increased the angle between the tendon and the kneecap, which caused the strain to decrease. Decreased strain means that the tendon stretches less, which would decrease the incidence of patellar tendinitis. Another way to treat the condition is surgically. One of the more simple surgeries is a removal of the dead or torn tissue of the patellar tendon. This allows new, healthy tissue to form.

A strap being put around the patellar tendon that can ease pain.
Image from Sports Injury Clinic “Patella Tendon Taping”

Patellar tendinitis is a serious condition affecting many high-level athletes. Although there isn’t a simple cure, researchers have brought to light different causes and treatments of the condition. These can be used to help athletes remedy the pain they are experiencing and perform at their best.

Sources:

Study on How Vertical Affects Patellar Tendinitis

Study on How Training Volume Affects Patellar Tendinitis

Ankle Flexion Study

Patellar Tendon Strap Proprioception Study

Patellar Tendon Strain After Applying a Strap

Additional Reading:

Clinical Trial on Patellar Tendon Strap

Ways to Prevent and Treat a Common Annoyance: Headaches

Headaches can range from a mild annoyance to a debilitating condition that results in the inability to complete simple daily tasks. Odds are you have experienced a headache since about 50% of the population has suffered some type of headache. While there are many different variables that may have triggered it (injury, stress, chemical imbalances, etc.), the resulting symptoms are always negative. Scientists have been investigating what causes different types of headaches in hopes that they can help people prevent their occurrence and mitigate their symptoms.

One of the most common types of headaches is a cervicogenic headache – a secondary headache caused by referred pain from the neck to the head and facial regions. The high prevalence of cervicogenic headaches – 70% of people who suffer from headaches – prompted one study using a MyotonPRO device to measure and compare the tone, stiffness, and elasticity of the suboccipital and upper trapezius neck muscles in people who have and have not suffered from cervicogenic headaches.

Human suboccipital muscles located underneath the back edge of the skull.
Modified from BodyParts3D, Copyrightc 2008 Life Sciences Integrated Database Center licensed by CC Display-Inheritance 2.1 Japan.

Human trapezius muscle shown spanning the upper back through the neck.
Modified from BodyParts3D, Copyrightc 2008 Life Sciences Integrated Database Center licensed by CC Display-Inheritance 2.1 Japan.

The results showed that the tone – the degree of tension in a relaxed muscle – and stiffness – movement ability of the muscle – values were significantly higher in people who have suffered from cervicogenic headaches in the past. This can likely be attributed to overuse or high levels of past activity of these muscles. This can cause inflammation or other physiological changes that aggravate the nerve fibers in the neck resulting in a cervicogenic headache. The tone and stiffness data can be used to help educate patients on the importance of properly stretching their neck muscles before and after physical activity in order to keep them from tightening and shortening due to overuse. Muscle relaxing medications could also be used as a type of treatment when someone is suffering from a headache.

Tone and stiffness data for people with and without cervicogenic headaches.
Modified from Park, et al., The Journal of Physical Therapy Science 2017.

Another common type of headache is a migraine – a primary headache that has occurred multiple times throughout someone’s life. While a migraine can also have many different triggers, one study investigated the impact of a chemical imbalance of dopamine. This study found patients who suffer from migraines experience a decrease in dopamine levels before they feel the symptoms. There are a couple theories as to why decreased dopamine levels result in migraine symptoms: 1) decreased dopamine increases sensory sensitivity which may result in normally painless signals becoming painful, 2) decreased dopamine impacts motivation and reward/aversion to a point where patients withdraw and seclude themselves. In general, these findings can be useful for the advancement of dopamine regulating drugs in order to combat migraines. Further reading on different chemical causes of headaches in mice can be found here.

Figure showing dopamine levels decreasing during the onset of a migraine.
Modified from DaSilva, et al., Neurology 2017.

Overall, there are many different headache triggers and a lot more research needs to be done before science fully understands how they work. However, there are some things people can do now in an effort to lessen the probability they will suffer from headaches. Additionally, there are  medications and other techniques that work through different paths to mitigate the symptoms of a headache.