Ground-breaking Initiative: Canadian Arthritis Network Surveys Public on Future Arthritis Research Priorities (CCNMatthews) VANCOUVER, BRITISH COLUMBIA and TORONTO, ONTARIO--(CCNMatthews - April 25, 2007) - The Canadian Arthritis Network (CAN) and Arthritis Consumer Experts (ACE) are calling on people with arthritis and the public to tell them what areas of research are of greatest importance to them by launching...
Oh glorious weekend! Can't dispute it. I had several fabulous runs over the weekend, and took the SV650S out for a romp around Toronto Friday night (High Park and Yorkville to be precise).
I experienced a little stiffness after the long rides--mainly my traps and lower back were affected; however, a hot shower offered pleasing relief.
It feels great to ease into training this year. I feel as if a lot of pressure has been lifted. I would like to try and find some routes leaving from Queen's Park that are scenic and enjoyable. Not finding much luck.
Today is another Enbrel day (thank goodness). As you can see from the pictures to the left, I still experience site reactions. This reaction occured after my friend injected me in my upper left arm. The bumps visible in the photo only arise once the site become itchy (not sure of the cause). I have had back pain for the last few days, and yesterday experienced restricted mobility after bending forward to stroke my puppy for approximately 10-15 minutes. I was also very stiff last night, but still managed to get a great night of rest.
This week has been quite stressful. I have been working considerably late in the office on a huge project, in preparation for a presentation to the Premier of Ontario yesterday at 3:30pm. Although I consider this all positive stress, my body does not know the difference and responds in kind. Taking time off of running to allow my right foot to properly heal has been personally stressful, and attending the gym does not satisfy me to the same degree as a challenging run outdoors. I suspect I am tiring of the gym scene.
Here are some medical questions and responses found on the website of The Arthritis Society:
Question: I am 43 and have had ankylosing spondylitis (AS) for over 20 years. I usually get iritis once every 4 years, mostly the same eye. What are your thoughts about having laser surgery for corrective vision? I have heard that if you have arthritis, they do not like to perform this type of eye surgery. Is it best to not consider this type of surgery due to iritis and my AS?
Answer: I agree that it is not a good idea to have laser surgery to correct visual acuity because of the AS and the history of iritis. With autoimmune diseases, the risk of complications is increased and proper healing may not occur. If corticosteroid drops are needed for a flare-up of the iritis right after the procedure, the cornea might not heal properly. Corticosteroid drops could also alter the cornea and negate the benefit of the surgery.
Question: I have been diagnosed with ankylosing spondylitis and sternocostoclavicular hyperostosis. I am also morbidly obese. Would it be a practical step to have the fat surgically removed to prevent further damage?
Answer: There are no studies regarding the acceleration of damage in ankylosing spondylitis and sternocostoclavicular hyperostosis by obesity. However, obesity could further compromise the restricted chest wall expansion in ankylosing spondylitis leading to clinically significant underventillation of the lungs. By increasing pressure on weight bearing joints such as knees, hips and low back, obesity could worsen already damaged joints or hasten the onset of osteoarthritis in previously healthy joints. Obesity may restrict your mobility further and contribute to many other health problems. Weight loss is important. You should consult an expert in obesity for a weight reduction program and on the advisability of including the surgical removal of fat as part of such a program. There are anaesthetic risks as well.
Question: I have ankylosing spondylitis. I am currently 5 months pregnant and can barely walk. I have not taken any medication (I usually take Mobicox) since I began trying to conceive. I am in agony. I try to keep active by walking and have been using heat and cold to help relieve some discomfort. Is there anything else I can do?
Answer: Several of the non-steroidal anti-inflammatory drugs (NSAID’s) are safe to take during the first 6 months of pregnancy, for example, naproxen, ibuprofen, diclofenac, indomethacin and ketoprofen. However, they should be stopped in the last 6 to 8 weeks of pregnancy as they may delay labour, affect a vascular duct in the baby’s heart and prolong bleeding in the mother and baby. They can be resumed during breast–feeding since only trace amounts of these drugs appear in the breast milk. During the last trimester of pregnancy, when NSAID’s should be avoided, low doses of prednisone (a type of cortisone), 5 to 10 mg per day, could be used. The mother’s blood pressure and blood sugar occasionally rise due to the prednisone. These low doses of prednisone are also compatible with breast-feeding. It is unlikely that other measures would help apart from trying the new biologic agents like infliximab and etanercept, but experience with them during pregnancy is limited.
Question: I am a 42-year-old female with active ankylosing spondylitis (AS). My mother and maternal grandfather both died from aortic aneurysms at 56 and 49 years of age. There are several others on my father's side that have AS. Should I request to see a cardiologist given that AS occasionally damages the aorta?
Answer: Ankylosing spondylitis can lead to inflammation of the origin of the aorta where it exits from the heart. As a result, the root of the aorta can become dilated causing the aortic valve to leak (aortic insufficiency). However, aortic aneurysms are not usually associated with ankylosing spondylitis. Aortic aneurysms, in general, can run in families. Rare inherited conditions such as Marfan’s syndrome and Ehler-Danlos are associated with aneurysms. Atherosclerosis is the commonest cause of abdominal aneurysms. Risk factors for atherosclerosis are usually present: smoking, age, high blood pressure, elevated cholesterol levels. There is a family clustering of abdominal aortic aneurysms in 20% of cases. Aortic aneurysms can be associated with such congenital conditions as bicuspid aortic valve and coarctation of the aorta). Inflammation of the wall of the aorta due to infections (e.g. syphilis and other bacteria) or rheumatic diseases (e.g. Takayasu’s arteritis and giant cell arteritis) is also associated with aortic aneurysms. It appears that you inherited ankylosing spondylitis from the paternal side of your family and that aortic aneurysms run in your family on the maternal side. Because ankylosing spondylitis can cause insufficiency of the aortic valve and because there is a family history of aortic aneurysms, you should be evaluated by a cardiologist.
Question: I am 60 years old and was diagnosed 7 years ago with ankylosing spondylitis (AS). Two of my three children (36 and 37 years of age) were also diagnosed with AS. My other child does not carry the gene. I understand that today the laser beam can be extremely fine and work well on very, very minute jobs, e.g. eyes. Can keyhole laser work on the spine - gently, very gently chipping away at the calcified extra bone, thus freeing the spine?
Answer: LASER stands for Light Amplification by Stimulated Emission of Radiation. Photons (units of light energy) are emitted in a narrow beam. The light consists of a single wavelength or hue. The energy range of low level laser light lies between 1 and 500 mW (milliwatts), while for surgical lasers the energy range lies between 3000 and 10000 mW. Low-level laser therapy is the external application of red and near infrared light over injuries or wounds to improve soft tissue healing and to relieve pain and inflammation. The therapy is safe. Light is transmitted through the skin and fat under the skin. However, light waves in the near infrared ranges penetrate the deepest of all light waves in the visible spectrum--up to 30 mm (a little over one inch). There is one article in the Russian literature suggesting that external irradiation of the spine and joints in people with ankylosing spondylitis using an He-Ne laser (20 sessions) was comparable to taking indomethacin at a daily dose of 75 mg. As far as I know, surgical lasers have been used to treat mild degenerative disc disease but not ankylosing spondylitis. The process in ankylosing spondylitis is so diffuse that it would be technically impossible to insert the surgical laser into all the places involved and chip away at the extra bone. I have not heard of anyone even trying this with ordinary orthopedic surgical instruments.
Question: I have had ankylosing spondylitis (AS) for two years and have been able to slowly reduce my medication through daily exercise. Last year, I had surgery on my prostate and have been having trouble with bladder retention. I am being treated for a problem dysfunctional bladder which they are telling me could be related to my spinal cord function. Is there a relationship between AS and bladder retention?
Answer: The “cauda equina syndrome” may develop rarely after many years or decades of ankylosing spondylitis (AS). The cauda equina is the bundle of spinal nerve roots (resembling a horse's tail) that run through the lower part of the spinal canal below the first lumbar vertebra where the spinal cord ends. These nerve fibres innervate the legs, buttocks, rectal area and bladder. In AS, these fibres can be enmeshed in inflammatory scar tissue so that nerve transmission is blocked. As a result, the following symptoms can occur: the gradual onset of pain, muscle weakness and altered sensation in the legs and buttocks, and bowel and bladder dysfunction. The diagnosis is made by MRI scanning of the lower spine.
Question: I am 26-year-old male, that has had ankylosing spondylitis (AS) for 13 years but do not have B27 gene. What other genes are involved in AS? I do not respond well to NSAIDs and I have taken Pamidronate IV and received some benefit (which is gone now). I have read some medical articles regarding K. pnemoniae and mycoplasma. Are there are studies of AS patients taking antibiotics?
Answer: Antibiotics have been used in the past in Reiter’s disease which can lead to ankylosis of the spine. They are not part of the modern day arsenal for AS. Has your physician considered a biologic? You could see if it applies to your case.
Question: I was diagnosed with ankylosing spondylitis in 2002. I am 25 now and still trying to find a prescription that works for me. I am currently taking Naproxen (two 325mg) before bed, but am still waking up in the night with low back pain. My SI joint was fused the last time I went to the doctor in September 2006 and I am worried that it will start going up my spine. Is there anything I can try that will slow down the fusing in my bones?
Answer: Have you seen a rheumatologist? If not, perhaps you should ask your family physician to see one. They could jointly work to control the pain and the inflammation with non pharmaceutical and pharmaceutical therapies. Do you have an exercise program for instance? Have you stopped smoking? Do you have a weight problem? Naproxen may be given at a higher dosage and, eventually, biologics are now available for ankylosing spondylitis that does not respond to traditional measures. Do get help.
Question: I have had ankylosing spondylitis (AS) for over 25 years and it is quite severe. My rheumatologist is suggesting we try an I.V. drug called pamidronate. Are you aware of it's success rate, if any. Is it safer than other treatments for AS? How long has it been around?
Answer: Dr. Walter Maksymowych, a University of Edmonton rheumatologist who is doing research in this area, has helped me with the answer to this question. Pamidronate has been used to treat Paget’s disease of bone, osteoporosis, high calcium levels, cancer metastases to bone and multiple myeloma for about 20-25 years. Dr. Maksymowych would expect this treatment to lead to a good response in about 40% of AS patients and a partial response in perhaps an additional 20%. It is important to note that responses are usually delayed for 3-6 months. It has an excellent safety record, likely superior to currently available therapies. The commonest side-effects are transient low grade fever, fatigue, aching and nausea.
Question: I am a 29-year-old female with ankylosing spondylitis. In the last four years I have tried just about every medication (NSAID, DMARD, etc) with no success. Prednisone (moderate doses) is the only thing that has helped, but the long term use is giving me very bad side effects. I am now quite disabled and would do anything to try one of the new anti-TNF drugs. Is there any sort of Canadian drug program that would help desperate people like myself afford such new drugs?
Answer: Biologic agents, such as infliximab and etanercept, improve pain, stiffness, function and well-being in patients with ankylosing spondylitis. However, it is not known whether they can stop the long term damage in the spine or improve its range of movement. To read more about the biologics in ankylosing spondylitis, go to: http://www.arthritis.ca/look%20at%20research/cochrane%20reviews/ankylosing/biologics/longversion/default.asp?s=1
Each province in Canada has a different set of rules for funding drugs. Many will pay for theses drugs but only for certain indications e.g. for rheumatoid arthritis but not for ankylosing spondylitis. Both you and your rheumatologist should get in touch with the ministry of health in your province. The ministry should be apprised of the positive results of studies using these agents in ankylosing spondylitis. Some private extended health plans will pay for these drugs. You and your rheumatologist could plead with the drug company to release one of these drugs on compassionate grounds. A local charity or benefactor might sponsor your request. If there is a clinical study on the use of these agents in ankylosing spondylitis in an area near you, you might be eligible to enter the study. You should consider joining an advocacy group to push for government funding of these drugs for ankylosing spondylitis. You should check out groups like The Arthritis Society, the Canadian Arthritis Patient Alliance and Arthritis Consumer Experts.
Question: I was diagnosed with ankylosing spondylitis about three years ago. I was taking Bextra for the past two and a half years and it was working great when I suddenly began developing painful cankers - lots of them. After three months and after having exhausted other avenues, I stopped taking the Bextra and they went away immediately. I was then prescribed meloxicam and again, the cankers came back immediately. I am at my wits end! I have been off all medication now for a week and the cankers show no signs of leaving me. Is there anything out there I can take for my AS that won't give me cankers? Or am I having to suffer with them in order to stop the pain of the AS? My doctor just keeps changing the prescription to a different NSAID.
Answer: It should be determined that the canker sores are truly due to the NSAID’s. Canker sores can also be caused by diseases associated with ankylosing spondylitis such as Crohn’s disease, ulcerative colitis and Behcet’s disease. Other drugs, allergies (e.g. certain nuts, spices, chocolate and tomatoes) and gluten sensitive bowel disease can also cause canker sores. An allergist may help to sort this out. If the cankers are due to the NSAID’s, then they should be stopped and consideration should be given to using biological agents like infliximab or etanercept to treat the ankylosing spondylitis. You would have to consult a rheumatologist.
Question: I am a 32 year-old woman who has pain in my si joint, lower back, deep within my left buttock, and my left shoulder & neck. I am seeing a chiropractor and massage therapist right now. I run 50 miles a week and lift weights and have a very strong upper body. I stretch my back constantly, but always have tightness and pain in these locations. Sometimes, for example, I cannot lie or sit without pain. Could I have ankylosing spondylitis? Both my massage therapist and chiropractor are unsure, and my doctor usually rushes me out before I can bring it up.
Answer: You could have ankylosing spondylitis. A simple X-ray of your sacroiliac joints would show the typical changes of ankylosing spondylitis and you would feel a lot better after taking regular doses of an anti-inflammatory drug for a few days if you had ankylosing spondylitis.
Project Details:
The current initiative focuses on a major form of arthritis which until recently has been under-recognized and under-studied in Canada. Spondyloarthritis (SpA), of which the major clinical subsets are ankylosing spondylitis and psoriatic arthritis, has a significant prevalence and high burden of illness in the Canadian population, approximately 1 in 100; it is characterized by chronic inflammation of the spine and is frequently accompanied by arthritis in a number of other joints.
The present study proposes a national research program which extends from genetics through to clinical epidemiology. The studies seek to address the biological basis of these types of arthritis and the impact of the disease on individuals and society, and will do so through a multidisciplinary approach which draws expertise across the spectrum of health research. The primary goal of the research program is designed to improve both the diagnosis and management of Canadians with SpA. With the major advances in new treatments for arthritis in the past 5 years, we are optimistic that we can achieve better results in quality of life and function for these patients.
Investigators on this team have already been involved in breakthrough research pioneering the use of MRI for arthritis, in genetic discovery, and in the use of ground-breaking biological therapies for patients with inflammatory arthritis. We plan to adopt a new interactive model of research in which patients become active participants in the design and execution of the research plan. Our aim is to set a new benchmark for research into chronic diseases in Canada.
This project will include an assessment of SpA patients from across Canada and will help the team develop a better understanding of the genetic basis of expressions of the disease, juvenile aspects of SpA, regional and cultural differences and how it impacts native Canadians. From this data we will be better able to predict, and therefore manage, treatment programs including drug therapies.The research will also evaluate the significance of early diagnoses and treatment.
Because SpA involves the spine and is often slow to develop, and takes patients an average of eight years to receive a proper diagnosis.
Date: Saturday May 5th and Sunday May 6th, 2007
Registration: 9:30am
Location: Renaissance Toronto Hotel, 1 Blue Jays Way (416-341-7100)
Time: 9:30am until 1:30pm
RSVP: 416-663-1500 x 226 or rsvp@stimulushealth.com
Saturday's Agenda
0930: Registration
1000: Dr. Robert Inman-->New Developments in Ankylosing Spondylitis
1045: AS Patient speaks
1100: Break and refreshments
1130: Dr. Edward Ng-->Rheumatoid Arthritis:Beyond the Copper Bracelet
1230: Open Discussion/Q&A
Sunday's Agenda
0930: Registration
1000: Dr. Dafna Gladman-->Psoriatic Arthritis: Not Just Skin & Joints
1045: AS Patient speaks
1100: Break and refreshments
1130: Dr. Jerry Tenenbaum-->Understanding Your Osteoarthritis: Management Strategies
1230: Open Discussion/Q&A
I will be attending the Saturday forum to hear Dr. Inman speak.
What a beautiful day for a race. The sun was shining. It was cold and breezy (not my preference for a run of any sort--I'm a warm weather gal). My pup was there to view her first race. And my right foot felt fine prior to the event.
distracting rhythms. It was here that I could feel the weight of my legs as I lifted them with a drill-like cadence. I finished in 48:39.7. I was pretty much on target and was happy with my performance.A Mayo Clinic study indicates that arthritis drugs Humira and Remicade triple the risk of many types of cancer and double the risk of serious infections . While the overall risk of developing cancer from these drugs remains small, the risk can vary widely by patient. The findings of this new study can be found in the May 17, 2006 issue of the Journal of the American Medical Association. It has been known for years that these treatments increase the risk of certain types of cancer or infection (such as lymphoma and tuberculosis). While even rarer than these previously-known (but uncommon) problems, there appears to be a slightly increased risk for a broader set of cancers and infections in patients undergoing anti-TNF treatment.
This is not the first time studies have indicated an increased risk of cancer and infection associated with these arthritis drugs. However, this study is the first to quantify these risks and discover additional types of cancer linked to Humira and Remicade. Previous evidence suggested that these drugs might increase the risk of lymphoma , a cancer of the lymph nodes. Past research also found that the risk of tuberculosis and pneumonia was greater for patients taking Humira or Remicade.
The study, led by investigators at Mayo Clinic, used "meta-analysis" to combine and assess the results from a large set of clinical studies already in the literature. With the large number of patients and years of treatment represented by these combined studies, less common events associated with treatment can be detected. Overall, the study suggests that the increased risk of cancer (lymphoma, skin, gastrointestinal, breast and lung) or serious infection may be three-fold and two-fold, respectively. These serious side effect risks appear to be greatest when higher doses are used. The risk appears to be mainly in patients receiving high dose treatment (more than 6 mg/kg every 8 weeks; or adalimumab, 40 mg every other week). Researchers also noted that older sicker patients who have taken this medication for an extended time are at the greatest risk for these arthritis drug side effects.
While medical researchers at the Mayo Clinic noted the benefits of Humira and Remicade-including increased range of motion, flexibility, and life expectancy and a reduction in pain-they caution patients and medical providers to be aware of these risks and their symptoms.
Patients taking these medications should seek medical attention at the first sign of infection , such as a fever, cough, or related symptoms. Some patients may wish to consider cancer screenings; those which are recommended to the general public.
Abbott Laboratories and Centocor, the makers of Humira and Remicade, respectively, have criticized the Mayo Clinic's study, claiming that this new evidence does not prove that these arthritis drugs cause cancer and infection. Other experts have raised questions as to whether the increased risk of cancer is actually attributable to the drugs or the disease itself. The exact reason for these increased risks remains unclear.
An additional drug, Enbrel , was not included in this study, as it differs at the molecular level. Researchers say a study on this arthritis drug is in the works.
What a happy existance:
The pain no longer exists in my right foot from the Around the Bay race. I have not run since I promised myself I would treat this as a recovery week to allow my foot to heal.
My career is skyrocketing. I have recently been delegated the lead on two major strategic programs (paediatric and cardiac surgery), and the sole expert on cardiology within my organization. Surgical quality and hospital /LHIN allocations are also part of my portfolio. As a former paediatric cardiac nurse practicing in one of Ontario's five busy academic hospitals specializing in this population, I have the clinical expertise and front-line experience to ensure patients are kept at the forefront of policy decisions. Given all the work to be done, I am spending this long Easter weekend working at home--so much data analysis needs to get done before I head to the spa overnight on Sunday for a little "me" time.
I am getting used to my Enbrel routine. I am not sure if it's having a therapeutic effect as of yet (it took 3 months of injections before taking effect the last time I was prescribed the drug). I have not had any night sweats since starting the medication; however, I still have stiffness and pain in my lower back. My fatigue has subsided which is fabulous. I did experience one new side effect during the early stages of resuming Enbrel: a bilateral rash on the top of my hands that did not disappear for two weeks. That side effect--which I read was experienced by some clinical trial patients--has resolved. I try to inject my stomach the most as it is the least painful location, and my thighs the least as this is the most painful location. Last Wednesday, I had to inject my left thigh (must rotate sites): it was incredibly painful inserting and withdrawing the needle. The lump on my thigh was the size of a plum, and it was red, itchy, and hot to touch. Mind you, compared to the side effects of other medications taken by people with more critical diseases or illnesses, this is bearable.
On a sad note, my grandmother has been admitted to the same hospital in which my grandfather recently died. She has bacterial pneumonia. She also required several pints of blood over several days. I spoke to her in the nursing home and she sounded very tired. Her private nurses are by her side 24 hours a day, along with support from the hospital staff. I hope she is able to return to health soon.
Tomorrow is another race. I can't say I am feeling very prepared for it, given my week off from running. My nutrition has been out of whack for one month now: too many damn JellyBelly jellybeans and nightly outings to restaurants. I've been too indulgent, and it's been sooooo tasty.
Ah well. I am trying not to be too rigid this year with my training, while still being disciplined to follow my training plan. It's all about balance for me this year. I would like to have more fun with friends this year, something I have put aside for years while I focus on training. My friends have been incredibly patient with me...most are convinced I have fallen off the planet (Carlos...Denise...Sam...Jason B...Deanah...Rene...Ainka...Rox...Jason E...Adedoyin: you guys have been tolerant and understanding).
I now have a new training parter who will be following the same training plan as myself with regards to running, nutrition, and weight training. Given that we also both mountain bike and scuba dive, I suspect that my life will be more balanced with social activities than previously. Camping excursions with my dog and a scuba trip to Mexico have already been booked for this year. I am eagerly anticipating the fun.
The second annual Harry's Spring Run-Off 8k & 5k to Fight Prostate Cancer in Toronto will take place on April 7, 2007 at High Park, a month after Harry's Spring Run-Off 8K to Fight Prostate Cancer unfolds on March 11, 2007 in Vancouver's Stanley Park.
Well the good news is that the lateral aspect of my right foot is not broken. The attending physician ordered an Xray to determine if I had a stress fracture--I tried to tell him that Xrays don't determine acute stress fractures until the 3rd week after healing has started to occur. MRIs, CT scans, and 3-image bone scans are more successful in identifying early-stage stress fractures. I was not surprised when the radiology report suggested no abnormal findings. The attending physician then sent me on my way without investigating my pain and bruising further; however, he suggested I could attend the sports therapy clinic in the hospital if I wanted to pursue a diagnosis more aggressively. Naturally, I would pursue this avenue--the pain still exists despite a finding of no fracture and I would like to determine the cause so that I may treat it appropriately without risking injuring myself by ignoring it (this is where I get really frustrated with physicians).
After doing my own research into the matter (until I access the sports therapy clinic to get the opinion of an expert) I suspect possible cuboid subluxation. Cuboid syndrome is somewhat obscure and poorly defined in the literature. When conditions are poorly defined in the literature, this usually means that there is a lack of consensus among doctors as to the etiology (reason for the condition) and the treatment. Cuboid syndrome is a common cause of lateral foot pain in the athletic population and is often misdiagnosed or mistreated. Occasionally the symptoms of cuboid syndrome occur without an obvious injury. The symptoms of cuboid syndrome are very similar to the symptoms of a sprain. Pain is significant when weight is first applied to the foot. Pain increases with the toe off phase of gait as the weight of the body and load from the calf muscle are delivered to the lateral (outside) column of the foot. An athlete with a cuboid subluxation will complain of lateral foot pain and weakness in push-off. Rest, ice, and anti-inflammatory medication (I am taking the Indomethacin I use during my arthritis flares) have been helping. I still can't walk flat on my feet, so I bear all my weight on the ball of my right foot. I would use crutches if I had any because hobbling on the ball of my foot puts too much weight on my left leg which is recovering from shin spints.
One of the fun things about running is that it gives one the opportunity to learn, and it seems as if this never stops. No matter how experienced you are there is always something more to learn. This observation is made relevant by several investigations into overuse injuries in runners. These studies show that experienced runners have about the same rate of overuse injuries as beginners. It is not that experienced runners never learn. Certainly some do not and constantly run, and rerun, into the same injury pattern. However, it is likely that a larger percentage cure one injury then develop and improve until they stumble into the next. This is probably because as one area gets stronger the stress load is subsequently re-applied elsewhere. Injuries, thus, tend to march along what is referred to as the “kinetic chain”. Each runner, however, tends to march to the beat of a different drummer. The specific location for an overuse injury is determined by a multitude of factors (e.g., genetics, previous injuries, training factors, etc.). This means that there is not an etched-in-stone-overuse-injury-sequence through which all runners progress (Feet first, then ankles, then shins, then knees, then … ). Thus, it is a good idea for runners to become aware of regions of the body that may become affected and learn a little about the specifics in each region. Knowledge and early warning are a runner’s best friends.
I am thrilled that I don't have a fracture. I am taking the rest of the week off of running so that I may push myself for my next race on Saturday April 7th. Instead, I am attending the gym and adhering to my nutritional plan with planned cheat-days during the week. Fridays are my cheat day. I enjoyed last Friday with friends for a night of drinks, chocolate, Thai food, and Trivial Pursuit. My evenings have been filled with the company of friends--a great distraction during my down-time from training.
References
Stone DA, Kamenski R, Shaw J, Nachazel KMJ, Conti SF, Fu FH. Sports Injuries, Mechanics, Prevention, Treatment-Second Edition. Philadelphia, Lippincott Williams and Wilkin; 2001. pp381-397.2.
Leerar, PJ. Differential Diagnosis of Tarsal Coalition versus Cuboid Syndrome In An Adolescent Athlete. J Orthop Sports Phys Ther 2001; 31(12)3.
Marshall P, Hamilton WG. Cuboid Subluxation In Ballet Dancers. Am J Sport Med 1992; 20(2).4. Mooney M, Maffey-Ward
L. Cuboid Plantar And Dorsal Subluxations: Assesment And Treatment. J Ortho Sports Phys Ther 1994; 20(4).
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