June is Myasthenia Gravis Awareness Month

MYASTHENIA GRAVIS (MG), which means “grave muscle weakness,” is an often misunderstood and underdiagnosed autoimmune neuromuscular disease that affects voluntary muscles. It strikes people of all ages, races and genders—currently at least 70,000 people in the U.S.—and while treatments are available to
improve muscle strength, there is no known cure.

Symptoms include weakness in muscles that control eye movements and eyelids, chewing, swallowing, coughing, facial expressions, arm and leg movements and breathing. A rare disease, it is frequently not diagnosed correctly because many of its symptoms are similar to those of other disorders. A doctor can confirm a diagnosis of MG via several types of diagnostic tests.

This is the 12th year that the Myasthenia Gravis Foundation of America has conducted an awareness campaign in June. The theme this year, “Uniting for a Cure: Together we are Stronger,” is geared to promote an understanding of the scope of this disease, to further the foundation’s mission of facilitating the
timely diagnosis and optimal care of individuals affected by MG and to fund research to find a cure. To learn more about this disease and about ways you can help, visit www.myasthenia.org.

The road to recovery

Tips on the best way to tackle sports injuries

Avoiding Injury

  • Pre-hap is better than rehab. By recognizing your weaknesses you can train away red flags before they become problems.
  • Dramatic increases in the time you spend training, the resistance you use or the distance covered makes injury more likely. Have a proper development program and don’t be tempted to get ahead of yourself.
  • People tend to think fast-paced at the gym. Team cardio and weights with gyrotonics or Pilates, which teach you to stretch and control your movements by utilizing auxiliary muscles as well as the bigger, more obvious muscle groups, for better all-round control.

Pain Relief

  • Consider alternatives to anti-inflammatories – like localized steroid injections or topical creams, if possible. Standard anti-inflammatory medications (such as Ibuprofen, Naproxen and Diclofenac) reduce swelling but inhibit collagen production, which is vital in repairing tendons, and diminish blood flow to the kidneys. This increases toxins in the blood, causing a dull, hangover-like feeling.
  • Protect your gut. Anti-inflammatory medicine can cause holes in the lining of the small intestines, causing irregular bowel movements, IBS-like symptoms such as bloating and noticeable changes in stools. Probiotics, supplements such as L-glutamine (2,000mg a day to heal gut ulceration) or slippery elm back (two level teaspoons a day) and aloe vera juice will all help defend against that.
  • An alternative to anti-inflammatory drugs, homeopathic arnica strength 30C (available from Boots) taken for three days aids pain-relief and reduces swelling in muscular and skeletal strains, has not drug interactions and won’t affect the gut. Paracetamol is perfectly safe when taken as directed and works independently of arnica. If there’s no improvement after three days, seek further medical opinion.


  • Niggling pain is not normal. Headaches can be muscular in origin and postural problems can lead to a tight upper neck, which can lead to dizziness, among other symptoms.
  • See a physio sooner rather than later. Treatment is most effective the first time you injure yourself. Ignoring the problem altogether can have a cascade effect on other areas of the body as muscles compensate.
  • Keep scar tissue supple with massage. People with appendix scars who develop back pain as the scar tissue inhibits normal muscle movement. Deeply massaging scar tissue in lots of different directions helps break it down, but it’s essential to get your consultant to confirm it’s healed first.

The New P.E.

It’s 8:30 a.m., and a group of high school students are dancing? This is the new face of physical education.

In the old days, P.E. had a set schedule where we had basketball and volleyball. Now we’re getting into more variety.”

This variety includes:

Rock Climbing,

They hope the variety will help improve these numbers:

Ten-year-olds today weigh 11 pounds more than 10-year-olds in 1973.
Today’s kids are also exercising 25 percent less than children in the 1970’s.

P.E. teacher Paul says students love the variety, and they’re becoming much healthier. “I wish that I could take all of the old phys-ed teachers, shake them by the shoulders and say this is the way you need to go.”

He adds, “You’ve got to keep them interested so they are active for life, and I think that’s the key, to keep them moving and active throughout their lives. So we try to get them into lots of different things.”

Even calisthenics have gotten a makeover. Heart monitors help students regulate their pace. However, they’re not pushed into becoming super-athletes.

“I used to be one of those people who used to push kids to do more because I thought they all needed to fit within a certain mold. Well, now I know better. And so those kids are enjoying it,” says Paul. He hopes his work will produce a new generation of healthy adults.

How To Choose A Personal Trainer

The diagnosis is overuse and part of the prescription is: get a personal trainer. It just may be one way to stay out of the doctor’s office.

The weekend warrior: on the court, on the track, in the gym, Saturday and Sunday. In the doctor’s office on Monday.

Roch, M.D., orthopedic surgeon:
“Those patients end up with tendonitis or bursitis or other inflammatory-type conditions.”

When Kat injured her back playing softball, she tried overcoming her chronic pain herself.

Kat, back pain sufferer:
“I had tried doing sit-ups at home, had tried doing different stuff that I had learned through books, through school like that, and always had the problem my back was still hurting.”

After a doctor diagnosed pulled muscles, Kat sought the help of sports performance expert to help strengthen her back. So what should you look for in a personal trainer?

Mackie, Sports Performance manager:
“I think you need to know something about that person….their philosophy. What do they believe in? Is that philosophy consistent with what your doctor desires?”

Personal trainers should know the doctor’s diagnosis, the treatment and what the doctor recommends. Personal trainers are not physical therapists but depending on the diagnosis, they can complement the doctor’s orders.

Roch, M.D.:
“They can work in substituting other modalities, other equipment, other exercises, other stretching programs that can work as an acceptable substitute for the patient.”

Check over a personal trainer’s credentials. Look for certification and experience. A good trainer will educate, motivate and make the program simple enough that you can eventually do it on your own.

If you’re involved in a program that hurts, or if you feel pushed beyond your level, it might be time to shop around for another personal trainer.

Treating and Preventing Golfers Elbow

Almost everyone has heard of tennis elbow and many people have suffered from it. However, about ten percent of all elbow overuse injuries are a result of medial epicondylitis — golfer’s elbow.

Golfer’s elbow, also called pitcher’s elbow, is an inflammation of the tendons in the flexor muscles where they insert on the bony, knobby, inside part of the elbow (with the palm up). Golfer’s elbow usually affects the right arm in righthanders and the left elbow among lefthanders. It is not to be confused with tennis elbow, which typically affects the outside part of the elbow (again, with the arm down, palm up).

Golfer’s elbow is caused by repeated stress to the muscles that allow the forearm to flex. The pain shoots up from the forearm flexors to the point where their tendons connect to the bone. In golf, that area is placed under stress near the top of the back swing as well as when the arms move downward to strike the ball.

The symptoms of golfer’s elbow usually come on slowly. There will be pain on the inside, bony part of the elbow that juts out toward the body when you try to rotate the forearm inward or flex the wrist toward the body. Although it’s called golfer’s elbow, any athlete who uses a strong down and in wrist snap as part of the motion is at risk. That includes golfers, rowers, javelin throwers, elite tennis players, and baseball players.

It is essential to get treatment. Otherwise, the arm can deteriorate, develop bone chips, scar tissue, and even arthritis. The immediate care includes relative rest (it’s okay to exercise other parts of the body) and applications of ice, just as you would with tennis elbow. Ibuprofen and aspirin will relieve pain and reduce the inflammation.

It usually takes two weeks for the symptoms to subside, then the athlete can begin exercises to strengthen the forearm flexors. Start by simply flexing and extending the elbow through a full range of motion. Then sit with the forearm flat against a table top, with the palm down. Rotate the forearm so that the back of the hand is positioned against the table. Complete both of these exercises 15-30 times, three times a day. It may take six to eight weeks for full recovery; more than that in cases of surgery.

Preventing golfer’s elbow makes more sense than treating it. Wrist rolls, wrist curls, and reverse wrist curls are some of the exercises effective in strengthening the flexor muscles of the forearm.

Shoulder Injuries Q&A

What exactly is the rotator cuff?

The rotator cuff is about four muscles with a common tendon. They have as their function primarily to internally rotate and externally rotate the arm. It’s an important stabilizer of the shoulder of throwing athletes, such as professional pitchers or quarterbacks.

Are there different levels of injury, can you sprain it as opposed to tear it?

Excellent question. The answer is yes, you can have rotator cuff weakness or tendinitis, or inflammation of the rotator cuff and you can have what we call partial thickness tears. All of those things cause some symptoms and weakness but don’t require a full open repair. The significance is that again, in a throwing athlete that has high demand on his shoulder it can upset the timing or the stabilization feature of the rotator cuff and when that function is lost it can then set the person up for additional injury. So for example, it’s very important with a professional pitcher to have them keep their rotator cuff very, very strong because weakness alone will allow things to get out of place and cause problems.

What exactly is a shoulder strain?

A strain in general just means that tissue has been stretched, and that tissue which is most often muscle or a tendon is simply stretched but not broken.

What are the symptoms to show that it’s stretched as opposed to being broken?

Usually there’s soreness that improves without any demonstrable instability. Because if tissue tears then as you violate the integrity of it there’s usually some element of either non function or significant weakness. Or in the case of a ligament say it would be a true instability.

How can you prevent a shoulder strain?

By staying in shape and doing sport specific exercise. For example, if somebody is a recreational tennis player and is proud of their serve and over hand smashes and wants to keep doing that they shouldn’t be a housewife or business man who goes out and just plays on the week end and does nothing with their shoulder all week long. They should say, “O.K., I’m using these muscles I need to keep them conditioned.” Educate them with a series of exercises designed in strengthening their rotator cuff. That would be primarily internal and external rotation, and maybe abduction.

Would warming up before exercise be a separate issue?

It’s a separate issue but a very important issue.

How does that help decrease the possibility of an injury?

Number one it raises the body core temperature and that alone allows muscles to become more stretchable. In addition a good warm up should include stretching which begins to tension the muscle and get it out to length so that if it’s a little stiff it doesn’t react well and now responds better. Very much like and airplane wing let’s say, it needs to flex and be mobile rather than stiff because being mobile it absorbs stress rather than retains because of the implication of stress.