Proverbs 22:1

During the recent downpours and thunderstorms, a significant number of our patients reported increased join and musculoskeletal pains. Some arthritis sufferers claim that they can predict weather conditions with accuracy surpassing local meteorologists. In spite of widespread beliefs in weather change-induced pain, scientific evidence on the matter is sparse and non-conclusive. During the conducted studies, some patients with chronic pain claimed increased pain on rainy days, some before the weather changes, while others have not experienced any correlation to the weather pattern.
Although there are limited clinical trials, and their data is not statistically significant, physicians and physical therapists working with patients who have arthritis have to consider changes in pain behavior in their clinical treatments. One leading theory points out how atmospheric conditions, such as barometric pressure and humidity, can affect symptoms of painful conditions such as arthritis, fibromyalgia, or migraine headaches. Barometric pressure is the pressure exerted by the air around us. To illustrate the phenomenon, imagine the barometric pressure as the compression stockings that are worn on our lower extremities. The high barometric pressure pushes against the body, and prevents tissues from expanding, similar to the way of a compression stocking. If the barometric pressure drops before a storm and the compression subsides, the internal expansion around an arthritic joint may irritate the nerves, causing pain.
According to J. Parvizi, MD., PhD, director of clinical research at the Rothman Institute at Jefferson, and associate professor of Orthopedic Surgery at Jefferson Medical College of Thomas Jefferson University in Philadelphia, the pressure change in the environment causes the pressure inside of the join, and the amount of fluid to fluctuate. This especially effects patients with arthritic joints, as they have less cartilage to provide cushioning. Change in barometric pressure may also cause loss of equilibrium in body pressure, which can result in sensitization of nerve endings.
Psychosomatic nature of pain complaints should also be considered. On rainy and gloomy days, we lack vigor and fell more anxious and depressed. With the return of the sunny weather, spirits tend to rise and we start to feel better. By going outdoors and resuming our activity level, we produce more endorphins, and our brain tends to override an unpleasant sensations of pain. During weather changes, some patients will need to increase their pain medication, but they should still try to take proactive steps to manage their pain with alternative measures. So, to our patients, our advice is to keep moving, go to the gym, or exercise at home to loosen up stiff joints. Always try to prevent swelling by using compression stockings, make sure to elevate painful joints, and use ice to reduce inflammation. If the rainy weather keeps you indoors, lighten up your diet, reduce sodium intake, and don’t let the weather affect your mood! Be patient, the sun and barometric pressure are both going to be up soon!
Maggie Garbiec, PTA
Thomas Jefferson University Hospital (2008, June 3). “People With Joint Pain Can Really Forecast” Retrieved July 2.

Research done over the last thirty years or so has consistently shown that prolonged stretching is the key to improving muscle and tendon flexibility and length. The body’s tendons are charged with the task of attaching muscle to bone, with your fascia binding together muscle fibers. Tendons and fascia are made of a connective tissue known as collagen, which is a viscoelastic tissue. A viscoelastic tissue is a type of tissue made up of “Viscous” and “Elastic” properties, meaning it has the ability to stretch and lengthen, and then return to its normal form slowly. If a constant load or stretch is placed upon a viscoelastic tissue, it will lengthen and maintain that length for a certain amount of time even after the load has been removed, depending on how long the load was present. The tissue will stretch, and then it will stay stretched for awhile before returning slowly to it’s original length.
For the increased length to be maintained, the tissue must reach what is known as “Creep.” “Creep” is a phenomenon in which the connective tissue deforms and “creeps” in length, typically occurring after stress relaxation of the muscle has taken place. During those ten to thirty second stretches that many people consider to be efficient stretching, the only tissue lengthening that occurs is due to stress relaxation of the tissue, and does nothing to improve flexibility and decrease injury risk.
When it comes to stretching, the rate of deformation is load, frequency, and time dependent. Low Load prolonged stretching is considered ideal because it is more comfortable, and the tissue will elongate without causing tissue breakdown. To properly perform a low load prolonged stretch, one should begin the stretching motion until you feel the initial stretching sensation, holding the stretch in that position. As that stretching sensation lessens, you should gradually increase the stretching motion until the mild stretch sensation returns. An effective duration of a stretch is anywhere from three to five minutes per stretch, but can be maintained for as long as thirty minutes. (Some research indicates that these thirty minute stretches can help to achieve greater tissue elongation in a shorter period of time.) Remember that stretching is time and rate dependent, so the less time the stretch is held, the more frequent the stretch will have to be performed in order to increase flexibility. The opposite is also true, that the longer the stretch is held, the less frequently the stretch must be performed. You should consider performing a warm up at least eight minutes prior to stretching; but keep in mind that stretching is also ideal during or after a work out as well, because your tissue temperature is peaked during these times.
Here at First Choice Physical Therapy, our patients are instructed to perform their injury specific stretches for at least three to five minutes, twice a day, in order to improve their flexibility. Our patients are also educated on why this particular length of stretching is ideal, along with the notation that stretch durations less than three minutes require more frequent stretching sessions.
If you currently have an injury, or history of a reoccurring muscle or tendon injury, poor flexibility is likely one of the factors contributing to the problem. If you think this sounds like you, any of our Doctors of Physical Therapy would love to help heal and treat your injury, all the while instructing and educating you on how to reduce the occurrence of these injuries and the disruption they cause in your every day life!
Brett Frank, PT, DPT