Treatment and exercise for sciatica

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DRINKING BEET ROOT JUICE BEFORE EXERCISE BENEFITS HEART PATIENTS

A small yet significant study shows that beetroot juice improves exercise function in chronic obstructive pulmonary disease (COPD) patients.

The new research by Wake Forest University looked at a small group of COPD patients who drank beetroot juice as compared to a placebo drink before exercise.

“The intent of this study was to determine if acute ingestion of beetroot juice, which is rich with nitrates, prior to exercising could improve the exercise capacity of COPD patients,” said Michael Berry, chair of Wake Forest’s department of health and exercise science.

COPD makes it difficult for patients to breathe and worsens over time.

In turn, they tend to limit their activities, become more sedentary, and lose fitness and physical function.

The findings showed overall that those patients who drank beetroot juice were able to extend their exercise time and had reduced exercise diastolic and resting systolic blood pressures.

“This is the first study to demonstrate beneficial effects of dietary nitrite supplementation on exercise performance and blood pressure in patients with COPD,” he added. One of the benefits of exercise is that if you get positive results, you are more likely to continue doing it.

“If beetroot juice positively impacts those results, it could motivate COPD patients to continue to be physically active and improve their health,” he added.

The research appeared in the journal Nitric Oxide: Biology and Chemistry.

TOPIC

Exercise to Help Ease Neuropathy Symptoms

As promised yesterday, today's post deals with exercise as a means of relieving neuropathic problems. In the past it was not advised to exercise too much (especially weight bearing exercise) because of the risk of exacerbating various neurological problems. However, more and more specialists now believe in the old adage that, 'if you don't use it, you lose it!' and therefore, advise that it's important to keep your muscles and joints in the best shape possible to avoid atrophy and further invalidity. All well and good for some but I can hear the groans of those for whom every movement is torture and the idea of subjecting your anaesthetised, or painful feet to exercise regimes seems to be just asking for falls and broken bones. It seems reasonable therefore to say, that you must tailor your exercises to your own ability at any given time - you can only do what you can do - but you should at least try the best you can. It's logical that the weaker your muscles and joints become through lack of action, the more restricted your life's going to be.
The article comes from the same source as yesterday; Grandtimes.com (see link below) and refers once again to the book, 'Numb Toes and Aching Soles' by John A.Senneff.

Numb Toes & Aching Soles

PERIPHERAL NEUROPATHY
by John A. Senneff

Coping with Peripheral Neuropathy

It may not be possible for us to feel like we once did before we got stuck with this atrocious ailment— at least not yet, not until some true cure comes along— but there is much we can do now to improve the quality of our lives.

Benefits of Exercise

Most clinicians think the benefits of exercise stem largely from the improvement in blood circulation it produces. This improvement permits oxygen to be carried to various parts of the body (including nerve tissue) where it's needed most. Also a good exercise program will almost inevitably lead to a loss of weight— a desirable goal in itself for most people and one which is believed especially important for people with neuropathy. In any event, as one PNer said plaintively : "At least one good thing about weight reduction is there is less of you to hurt."
Of course beyond any particular PN benefits, there are a number of general health boons from exercise. These include the reduction of low density lipids (LDLs) and triglycerides, the increase of favored high density lipids (HDLs), and the lowering of blood pressure. David C. Nieman, professor of health and exercise science at Appalachian State University in Boone, North Carolina, also points out that moderate daily exercise can boost the body's immune system.
I found one formal study on the value of exercise to PNers. As reported in the October 1997 issue of Physical Therapy, 28 subjects with peripheral neuropathy between the ages of 23 to 84 were followed through a six week period during which half completed a home exercise program. Dr. Richard K. Shields, a professor in the Physical Therapy Graduate Program at the College of Medicine, University of Iowa, was the principal investigator in the study.
Subjects were given stretching bands to exercise the upper body, gradually increasing resistance, with a goal of 10 daily repetitions. They also were instructed to exercise aerobically up to 20 minutes each day, either by walking or bicycling, with enough intensity to achieve a heart rate of 60 to 70% of their estimated maximum heart rate (220 minus their age).
Study conclusions were based on impairment measures which included average muscle scores, handgrip force, walking time and "forced vital capacity." A health survey was also used which dealt with quality of life perceptions.
At the end of the six week period those in the exercise group showed moderate improvements in their strength impairment measures, as could be expected. What was noteworthy were the significant improvements reported in the quality of life surveys. Exercise participants indicated on average a meaningful change in "physical and mental role limitations" (self perceptions of physical and mental disabilities) and "social function limitations" (self perceptions of interference with normal social activities). The study did not, however, demonstrate any overall pain reduction for those participants. From an analysis of the results Dr. Shields concluded that a home exercise program should be an important component of treating people with peripheral neuropathy.
I think the message from this study is that, apart from any direct physical benefits (which can be significant), exercise makes us feel better about ourselves, that perhaps we figure we are not quite as hobbled by our PN as we previously thought, that we look better, have more energy, are generally healthier and happier, etc.

Types of Exercise

Of the various forms of exercise, most PNers seem to agree water aerobics (such as running in deep water while wearing flotation devices) or simply swimming laps, or a combination of the two, is best since it takes the weight off of painful feet while you're exercising. Also it's easier to stretch and work muscles in the water. If you prefer to exercise in the shallower end of a pool you might consider buying a pair of water shoes to give your feet some protection and traction. (Occasionally people simply use old tennis shoes for this purpose.) To get the full benefit of any water workout it's suggested you spend at least 30 minutes in a pool, daily if possible but at least several times a week.
If our feet can handle walking— the faster the better— that also is an excellent form of exercise. Unfortunately running or jogging must remain a memory for most of us who used to enjoy those pursuits. A treadmill provides much the same walking experience but under controlled conditions. (I used to have one but my feet couldn't take it anymore.)
The Stair Master is a step removed (no pun intended) from walking. This machine eliminates the foot impact of walking— though it can still put stress on your feet as you push down. I personally prefer a machine called the Precor, where you slide your legs back and forth in a gliding motion while your feet are planted on "skis." With the Precor you can increase the resistance or raise or lower the height of the ski tips on the control panel. Another so-called elliptical machine is the Body Trek which involves the use of arms as well as legs.
Easier on the feet yet are exercise bikes. A type many favor, me included, are recumbent models where you plop yourself in a "chair" and pedal while sitting back with your legs pumping horizontally. You can read, watch TV or just listen to music, all while getting a great workout.
Many PNers also use strength-building routines such as weight lifting. Well equipped fitness centers offer all kinds of equipment for this purpose.
Physical therapy experts maintain that gradual stretching and strengthening exercises help relieve the stress of chronic pain. An organization called Stretching, Inc., has a web site (www.stretching.com) offering various helpful books on stretching and body building techniques. Incidentally it is always a good idea to have a trained physical therapist formulate your exercise program.
One other form of exercise some PNers use is the Chinese martial arts routine called tai chi. This is a training exercise involving slow, graceful movements such as seen performed in Chinese parks early in the morning. These movements are derived from the movements of animals and follow a natural, relaxed pattern. They increase the body's motion range and are said to exercise the internal organs. (Don't ask me how.) According to practitioners the slow meditative routine aids relaxation, stress reduction, balance and posture, and increases blood flow.
Diabetic PNers are again reminded to check with their physicians prior to engaging in exercise programs.

http://www.grandtimes.com/numbtoes.html

AREA OF BRAIN RESPONSIBLE FOR EXERCISE MOTIVATION DISCOVERED

Scientists at Seattle Children's Research Institute have discovered an area of the brain that could control a person's motivation to exercise and participate in other rewarding activities -- potentially leading to improved treatments for depression.

Dr. Eric Turner, a principal investigator in Seattle Children's Research Institute's Center for Integrative Brain Research, together with lead author Dr. Yun-Wei (Toni) Hsu, have discovered that a tiny region of the brain -- the dorsal medial habenula -- controls the desire to exercise in mice. The structure of the habenula is similar in humans and rodents and these basic functions in mood regulation and motivation are likely to be the same across species.

Exercise is one of the most effective non-pharmacological therapies for depression. Determining that such a specific area of the brain may be responsible for motivation to exercise could help researchers develop more targeted, effective treatments for depression.

"Changes in physical activity and the inability to enjoy rewarding or pleasurable experiences are two hallmarks of major depression," Turner said. "But the brain pathways responsible for exercise motivation have not been well understood. Now, we can seek ways to manipulate activity within this specific area of the brain without impacting the rest of the brain's activity."

Dr. Turner's study, titled "Role of the Dorsal Medial Habenula in the Regulation of Voluntary Activity, Motor Function, Hedonic State, and Primary Reinforcement," was published by the Journal of Neuroscience and funded by the National Institute of Mental Health and National Institute on Drug Abuse. The study used mouse models that were genetically engineered to block signals from the dorsal medial habenula. In the first part of the study, Dr. Turner's team collaborated with Dr. Horacio de la Iglesia, a professor in University of Washington's Department of Biology, to show that compared to typical mice, who love to run in their exercise wheels, the genetically engineered mice were lethargic and ran far less. Turner's genetically engineered mice also lost their preference for sweetened drinking water.

"Without a functioning dorsal medial habenula, the mice became couch potatoes," Turner said. "They were physically capable of running but appeared unmotivated to do it." In a second group of mice, Dr. Turner's team activated the dorsal medial habenula using optogenetics -- a precise laser technology developed in collaboration with the Allen Institute for Brain Science. The mice could "choose" to activate this area of the brain by turning one of two response wheels with their paws. The mice strongly preferred turning the wheel that stimulated the dorsal medial habenula, demonstrating that this area of the brain is tied to rewarding behavior.

Past studies have attributed many different functions to the habenula, but technology was not advanced enough to determine roles of the various subsections of this area of the brain, including the dorsal medial habenula.

"Traditional methods of stimulation could not isolate this part of the brain," Turner said. "But cutting-edge technology at Seattle Children's Research Institute makes discoveries like this possible."

As a professor in the University of Washington Department of Psychiatry and Behavioral Sciences, Dr. Turner treats depression and hopes this research will make a difference in the lives of future patients.

"Working in mental health can be frustrating," Turner said. "We have not made a lot of progress in developing new treatments. I hope the more we can learn about how the brain functions the more we can help people with all kinds of mental illness."

Is Exercise Good for Nerve Pain

To exercise, or not to exercise, that is always the question that nobody seems to agree about. Most neuropathy patients who are in pain, or have muscles that refuse to work without painful protest, will shudder at the very idea. This excellent article from Neurology Now (see link below) puts everything in perspective and looks constructively at the various forms of exercise you can try. We all realise that without exercise, we inevitably just get weaker but getting started is just not that easy. Nevertheless, we should at least read this article and think seriously about what we can do, rather than what seems impossible.

Exercise for Nerve Pain
HAUPT, JENNIFER

John Seneff, 77, a retired attorney in San Antonio, Texas, used to run six miles every day. But in his early fifties, he began noticing that his feet ached after he ran, and the condition just kept getting worse. I didn't want to stop running, but within three years even walking briskly was painful, recalls Seneff, who was diagnosed with peripheral neuropathy in 1997. For me, though, giving up exercise just wasn't an option.

Peripheral neuropathy describes damage to the nerves that run from the brain and spinal cord to the rest of the body, many of which are responsible for sensing touch, temperature, and pain. Neuropathy can be caused by diabetes, rheumatoid arthritis, cancer, HIV, and other conditions, but it can also be hereditary or a side effect of certain medications. Typically, people first experience tingling and numbness in the hands and feet. They often describe the symptoms as burning, shooting pain, throbbing, and aching; some say that neuropathic pain feels like frostbite or like walking on a bed of coals.

An estimated twenty million people in the U.S. suffer with the chronic nerve pain, oversensitivity, and numbness of peripheral neuropathy-and like Seneff, many of them struggle with the question of how to exercise without exacerbating their condition. The rule of thumb used to be that patients diagnosed with a chronic neurological disease were told not to exercise at all, says Richard Shields, P.T., Ph.D., director and professor of the Graduate Program in Physical Therapy and Rehabilitation Science at the University of Iowa. Now, more and more doctors are recommending low-impact exercise instead of inactivity.

Seneff decided to invest in a recumbent stationary bike and an elliptical trainer, which are easier on his feet as well as the joints throughout his body. Other low-impact options for a cardio work-out include walking and water aerobics. You can find water aerobics classes at most health clubs and physical therapy centers; many community pools also offer classes.

WHY EXERCISE?

While the general benefits of aerobic and flexibility exercises are well-known, increasing movement and heart-rate are particularly important for people suffering with peripheral neuropathy. Physical activity can improve blood circulation, which strengthens nerve tissues by increasing the flow of oxygen.

Immobility is a big problem with peripheral-neuropathy patients. It can result in muscular atrophy (shrinkage) and tightening (loss of flexibility), as well as decreased metabolism, which means less energy and high risk for gaining fat, says Greg Carter, M.D., professor of rehabilitation medicine at the University of Washington, in Seattle, Washington, and the author of a recent guide for physicians to rehabilitation for peripheral neuropathy patients, sponsored in part by the National Institute of Health. Aerobic exercise improves not only physical functioning but helps fight depression, maintain ideal body weight, and improve pain tolerance. Aerobic exercise also helps to control blood glucose in diabetics and may lower insulin requirements.

In fact, a recent study from the University of Utah in Salt Lake City reports that exercise and diet work hand-in-hand to reduce nerve pain for patients with impaired glucose tolerance and neuropathy. This is good news for the 15 million people in the U.S. with diabetes, sixty percent of whom also suffer from peripheral neuropathy.

MOOD MEDICINE

In addition to its physical benefits, exercise can also improve your mental health and overall mood. Regular aerobic exercise reduces the amount of adrenal hormones your body releases in response to stress and increases the amounts of endorphins, powerful pain-relieving and mood-elevating chemicals in the brain. Get moving and you'll wind up feeling relaxed and refreshed. You'll probably even sleep better.

Dr. Shields published a study wherein patients with peripheral neuropathy were given moderate exercise programs-stretching bands for the upper body, as well as 20 minutes of low-impact aerobic exercise (walking or biking) daily. At the end of six weeks, patients not only reported improvements in strength, but also felt better about themselves: They were more optimistic about their ability to participate in social activities, and they thought of themselves as less hampered by physical and mental disabilities.

The changes we found were comparable to improvement in some drug trials that were deemed to be beneficial, Dr. Shields explains. We all cope with daily stresses better when we do aerobic exercise, and we just generally feel better about ourselves when we're doing some physical activity.

SLOW AND STEADY

How do you determine what exercise is right for you? The symptoms of neuropathy vary so widely that it's imperative to set up an exercise program with your physician, says P. James B. Dyck, M.D., associate professor of neurology at the Mayo Clinic. For example, if you're experiencing numbness in your feet, you may actually hurt yourself-especially your feet-by running or even walking, and without knowing it.

Any exercise session should start with a warm-up to avoid cramping. Dr. Carter recommends slow, static muscle stretching (that is, 30-second sustained stretches), which also helps maintain flexibility. (See Three Easy Warm-Ups.)

Doing small amounts of flexibility and stretching exercises throughout the day, five or 10 minutes at a time for a total of about 30 minutes, is a good way to avoid muscle fatigue, says Charlotte Hayes, R.D., a diabetes nutrition and exercise specialist in Atlanta and author of The I Hate to Exercise Book for People with Diabetes. Get up once an hour to move around and stretch for even five minutes-it really does add up.

Dr. Carter cautions that patients with peripheral neuropathy are more prone to entrapment neuropathies associated with pressure on the forearms, such as carpal tunnel syndrome. So if you are using weights, make sure they aren't too heavy, and if you're adding weight, do it slowly.

SAFETY FIRST-AND LAST

Before and after you exercise, Hayes suggests that you do a visual check to make sure you don't have blisters or redness from pressure sores. We all have to take safety precautions, like making certain we have the right shoes, clothing, and other gear, Hayes explains. And this is particularly important when nerve numbness, pain, or oversensitivity is involved. (See Gear Up.)

When it comes to exercise, more doesn't necessarily mean better. (See Five Warning Signs of Excessive Exercise.) According to Dr. Carter, excessive exercise can cause muscle damage. Several studies conducted with patients suffering from Charcot-Marie-Tooth syndromes, among the most common hereditary neuromuscular diseases, showed that a 12-week moderate-resistance exercise program resulted in strength gains of up to 20 percent without deleterious effects. However, a 12-week high-resistance program showed no added beneficial effect, and there was evidence of overwork weakness in some of the study participants.

Overwork weakness is actually feeling weaker in addition to severe muscle soreness, Dr. Carter explains. Regular soreness after working out should not be associated with weakness, nor should the pain be that intense.

The bottom line is that exercise, when done wisely, is good for your body, mind, and spirit. I feel like I'm doing something good for myself when I exercise, explains Seneff, who uses his stationary bike or elliptical trainer for 40 to 45 minutes, four times per week. If I've been in pain before working out, I actually feel better afterwards.

Gear-Up: What to Wear and Why

SUPPORTIVE SHOES or inserts to prevent pressure and rubbing from socks.

SOCKS MADE FROM HIGH-TECH FABRICS, such as microfiber acrylic, to reduce friction and wick moisture away from feet.

LAYERS OF CLOTHING because they breathe and can be added or peeled off as needed.

SUPPORTIVE DEVICES such as splints and braces to compensate for loss of strength.

PROTECTIVE PADS to safeguard tender knees and elbows.

Five Signs of Excessive Exercise

Dr. Carter warns that the following are signs you need to slow down:

1. Feeling weaker rather than stronger within 30 minutes after exercise

2. Excessive muscle soreness 24 to 48 hours after exercise

3. Severe muscle cramping

4. Heaviness in the extremities

5. Prolonged shortness of breath

http://journals.lww.com/neurologynow/Fulltext/2007/03020/Exercise_Rx_for_Nerve_Pain.20.aspx