Ginger may reduce pain associated with muscle injury after exercising

For centuries, ginger root has been used as a folk remedy for a variety of ailments such as colds and upset stomachs. But now, researchers at the University of Georgia have found that daily ginger consumption also reduces muscle pain caused by exercise. Muscle pain generally is one of the most common types of pain and eccentric exercise-induced muscle pain specifically is a common type of injury related to sports and/or recreational activities.

While ginger had been shown to exert anti-inflammatory effects in rodents, its effect on experimentally-induced human muscle pain was largely unexplored. It was also believed that heating ginger, as occurs with cooking, might increase its pain-relieving effects. Two studies are directed to examine the effects of 11 days of raw and heat-treated ginger supplementation on muscle pain. The researchers recruited 74 volunteers, 34 and 40 respectively, randomly assigned them to consume capsules containing two grams of either raw or heat-treated ginger or a placebo for 11 consecutive days. On the eighth day they performed 18 extensions of the elbow flexors with a heavy weight to induce moderate muscle injury to the arm. Arm function, inflammation, pain and a biochemical involved in pain were assessed prior to and for three days after exercise.

Results showed that supplementation with both raw and heat-treated ginger attenuated muscle pain intensity 24 hours after eccentric exercise. Exercise-induced pain was reduced by 25 percent after daily supplements of raw ginger, and by 23 percent after supplementation with the heat-treated form. The study suggests that ginger may have anti-inflammatory and analgesic properties similar to that of Non-Steroidal Anti-Inflammatory drugs (NSAID’s).

Reference: Black CD, Herring MP, Hurley DJ, O'Connor PJ. Ginger (Zingiber officinale) Reduces Muscle Pain Caused by Eccentric Exercise. J Pain. 2010 Apr 23; DOI: 10.1016/j.jpain.2009.12.013

Dr. David P. Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

Questions on pain relievers.

Several years ago, I worked with a chiropractor who used to tell patients not to take any pain medication. I disagreed with that approach, as I felt multiple strategies are often needed, especially for severe pain. Then he was in a car accident. He found chiropractic care extremely helpful. He also expressed considerable more appreciation for "the little brown M&M's", and he found it necessary to take them every four hours. He became much less dogmatic in telling people how to deal with pain. I feel it's important to not judge people who rely on medication to help with their pain. I also try to use whatever techniques that are available to relieve pain so that medication is ultimately unnecessary.

I get asked about pain medicine a lot. As a chiropractor, I'm not licensed to prescribe medications. I don't make recommendations for starting or stopping any medicine, including over the counter medications. I am not opposed to medicine, and recognize their neccessity in the healthcare of many people. I also feel if you can get by without it, you're often better off. When I'm asked, I'll defer to the patient's primary care doctor. I do need to ask patients questions about medications, especially pain medicines, as it gives me information on what's happening to the patient. It's fairly common for people to come to me because pain medication is not working for them. People often get in the habit of taking pain medicine on a daily basis without asking their doctor. Most over the counter pain medicines recommend that it not be taken for more than ten days without consulting a doctor, some patients I've seen have been taking them daily for years.

A recent Danish study looked at over a million individuals. It found the likelihood of heart attack or stroke increased 29% in patients who took ibuprofen. It was not just people who took medicines for long times. People who took high dosages, even for as short a time as only two weeks, saw an increase in heart problems and stroke. Naproxen was not found to have the same heart related side effects as ibuprofen. This was the first major study that saw this increase in cardiovascular problems in patients who had no prior record of cardiovascular problems. Heart problems were also seen with the less commonly used prescription medicines diclofenac and rofecoxib. As I've said, it's good to talk to your primary doctor if you have questions on changing a medicine. While this study saw benefits with naproxen in terms of heart disease, there are other side effects that may be more relevant to your health.

I was hesitant to blog about this because pain medication is a complex topic. As I said at the start, I'm not inherently against medicine. I don't want people who have to take pain medicine feel bad for taking it. I don't want people who'd be better off taking it to avoid or stop taking it. More studies will come out, likely making this an even more complicated subject. The techniques used in chiropractic are several orders of magnitude safer than pain medications. It's very common for us (the doctors at ABC Clinics) to see painful conditions that we can resolve with chiropractic care and physical therapy. If you have questions how we can help, please call or email.

Good art decreases pain. Bad art, not so much.

A recent study from Consciousness and Cognition found that people looking at art they considered beautiful allowed them to distract themselves from a painful stimuli. They used a laser (not to be confused with the pain-relieving cold laser therapy available at most of our offices) and then directly measured brain waves activated when pain is occurring as well as the subjects opinion on the pain. Neutral or ugly art neither increased or decreased pain on average. Favorites as beautiful were "Starry Night" by Vincent Van Gogh and Botticellis "Birth of Venus", Picasso's work was often chosen as ugly. Interestingly, a few labelled Edward Munch's "The Scream" as beautiful, and noticed pain lessened while looking at it. As doctors focused on relieving pain, we are focused on any reasonable means of reducing pain, and there's certainly no harm in enjoying the art. In addition to encouraging people with pain to use art as a way of feeling better, it has other applications too. Men who are asked their opinion of china patterns, fabric swatches or paint samples could offer concrete evidence that they have absolutely no aesthetic preference. I would personally find this less painful than traditional alternatives. Art critics who claim an uncoventional art is beautiful could have their brain waves measured to see if they're telling the truth, or just being pretentious. If you've got a question on therapy for pain; conventional, unconventional or completely outside the box, feel free to ask any of our doctors.

The importance of sleep habits to pain.

Not too long ago, it was thought that the time of the day was imprinted on our body by a small subset of our genes. In the last few years, the importance of the time of day was increased when it was discovered that just about all of our genes follow circadian rhythms, the patterns of the day. Cortisol, the hormone that is often described as regulating stress, normally follows the clock. It peaks before we wake up and is at it's lowest level around midnight. Given this, it's often questioned if sleep habits effect health. Researchers in Finland found that insufficient quality or quantity of sleep as a 16 year old increased the likelihood of pain. There is a bit of a chicken and the egg issue with the question, as pain can lead to insomnia as well as bad sleep habits leading to bad health and pain. They believe their study sorted this out, and that poor sleep does lead to increases in neck pain, shoulder pain or back pain. Future studies will look at whether changing sleep habits is an effective way of preventing pain.

Poor quality sleep or insomnia due to pain is a common question that the other doctors and I at ABC clinics, located around the Washington DC region, ask about frequently, as it's a common reason for patients to come in. It's considered one of the measures of severity of pain, and a particularly miserable side effect to deal with. Very often your pain may helped by treatment, and there may be postions or techniques that make sleep easier even for quite painful conditions.

Eur Spine J. 2009 Nov 20. [Epub ahead of print]

Is insufficient quantity and quality of sleep a risk factor for neck, shoulder and low back pain? A longitudinal study among adolescents.

Auvinen JP, Tammelin TH, Taimela SP, Zitting PJ, Järvelin MR, Taanila AM, Karppinen JI.

Finnish Institute of Occupational Health, Aapistie 1, 90220, Oulu, Finland, juhaauvi@mail.student.oulu.fi.

The quantity and quality of adolescents' sleep may have changed due to new technologies. At the same time, the prevalence of neck, shoulder and low back pain has increased. However, only a few studies have investigated insufficient quantity and quality of sleep as possible risk factors for musculoskeletal pain among adolescents. The aim of the study was to assess whether insufficient quantity and quality of sleep are risk factors for neck (NP), shoulder (SP) and low back pain (LBP). A 2-year follow-up survey among adolescents aged 15-19 years was (2001-2003) carried out in a subcohort of the Northern Finland Birth Cohort 1986 (n = 1,773). The outcome measures were 6-month period prevalences of NP, SP and LBP. The quantity and quality of sleep were categorized into sufficient, intermediate or insufficient, based on average hours spent sleeping, and whether or not the subject suffered from nightmares, tiredness and sleeping problems. The odds ratios (OR) and 95% confidence intervals (CI) for having musculoskeletal pain were obtained through logistic regression analysis, adjusted for previously suggested risk factors and finally adjusted for specific pain status at 16 years. The 6-month period prevalences of neck, shoulder and low back pain were higher at the age of 18 than at 16 years. Insufficient quantity or quality of sleep at 16 years predicted NP in both girls (OR 4.4; CI 2.2-9.0) and boys (2.2; 1.2-4.1). Similarly, insufficient sleep at 16 years predicted LBP in both girls (2.9; 1.7-5.2) and boys (2.4; 1.3-4.5), but SP only in girls (2.3; 1.2-4.4). After adjustment for pain status, insufficient sleep at 16 years predicted significantly only NP (3.2; 1.5-6.7) and LBP (2.4; 1.3-4.3) in girls. Insufficient sleep quantity or quality was an independent risk factor for NP and LBP among girls. Future studies should test whether interventions aimed at improving sleep characteristics are effective in the prevention and treatment of musculoskeletal pain.

Gingerbread as a functional food.

As we get into the winter season, the common refrain of holiday foods coming to kill us is once more heard. While there are many high fat, high sugar delicacies that may help to do so, there are a few choices we can make that may have some benefits. Gingerbread, a fragrant favorite of the season, maybe one choice. Ginger has been found to have several benefits, one of them possibly being decreasing the pain from osteoarthritis or other causes. This recipe listed here calls for a half cup (24 teaspoons) of fresh ginger, a significant amount. Studies using it for pain control use a teaspoon per day, though no study addressed using gingerbread as a delivery vector. In my chiropractic/physical therapy practice in Silver Spring MD, I have some of the same reservations about using herbs for pain that I do for medication. It's wonderful for people to be pain free, but it's important to first know the cause and significance of your pain. This is best done by coming to see a doctor who focuses on musculoskeletal care, which I and the other doctors of ABC clinics do. But any excuse to make gingerbread is a good excuse.

Warnings: Individuals who have had ulcers, inflammatory bowel disease, or blocked intestines should use ginger supplements cautiously and should avoid large amounts of freshly cut ginger. People with gallstones should use ginger with caution. While ginger has been used in studies for morning sickness without advserse effects seen, it should not be used in large doses during pregnancy without consulting your doctor. There is a theoretical blood thinning effect possible, though no incidences of this have been reported, but people on blood thinners or who have blood clotting conditions should consult their doctor about using ginger regularly.

References:
Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum. 2001;44(11):2531-2538.

Srivastava KC, Mustafa T. Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Medical Hypotheses. 1992;39:343-348.Srivastava KC, Mustafa T. Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Medical Hypotheses. 1992;39:343-348.
http://www.ams.ac.ir/AIM/0584/006.pdf

White B. Ginger: an overview. Am Fam Physician. 2007;75(11):1689-91.

When is an ergonomic writing desk not like an ergonomic writing desk? When it's not set up right.

Rather than try and answer the Mad Hatter's famous unanswered riddle (Why is a Raven like a writing desk?), Dr. Laestadius and other researchers in ergonomics worked with an office at the World Bank to measure the importance of ergonomics to see if they could prevent work related pain and eyestrain. 1500 workers were moving to a new office, and they decided to use the move as an opportunity to do an experiment. One group was given personalized advice in setting up there work stations. The other group was given a list of instructions only. The group that had the benefit of expertise had less musculoskeletal pain and eye strain as long as 18 months afterwards, while the group given only written instructions saw no such benefit.
In my practice, I often address ergonomics, as computer work, using the phone, and paperwork are important potential causes of pain. It's common for neck pain, back pain, shoulder or hand pain (including carpal tunnel) to be caused or aggravated by bad ergonomics. Getting the right set-up is an important, so I often have patients bring in pictures of themselves at their desks, so we can figure out how to prevent their desk from causing problems. If you have questions on this, feel free to contact me at my Wheaton /Silver Spring MD office.

Dr. Charlie Ginsburg

Chiropractor with physical therapy privileges

Texting is a potential pain in the neck and shoulders.

A preliminary study suggests that the number of texts you send may lead to more shoulder pain. For men, the study suggest it's also connected to neck pain.

Dr. Judith Gold, ScD, an assistant professor of epidemiology at Temple University’s College of Health Professions and Social Work, presented a study at this year’s meeting of the American Public Health Association suggesting that the more college students texted, the more pain they reported in their shoulders. In the men tested, more neck pain was reported too. The researcher is not sure why the study did not find an association with neck pain in women.

Texting, like computer work and video gaming, is one of the technical innovations that I believe commonly lead to neck, shoulder, wrist and hand symptoms. Underlying conditions, such as carpal tunnel syndrome or herniated discs may also be aggravated. A simple step you can take is more frequent breaks, ideally with some stretching involved. If pain does happen, non-invasive therapies and basic ergonomics are usually very helpful in alleviating it. Call or email (carefully!) if you have questions, or would like to schedule a consultation.

Dr. Charlie Ginsburg, Wheaton Chiropractic
Silver Spring, Md