Let's Talk About Stress

a. What is the meaning of stress?
Stress is a normal physical response to events that make you feel threatened or upset your balance in some way.But beyond a certain point, stress stops being helpful and starts causing major damage to your health, your mood, your productivity, your relationships, and your quality of life.

b. Why we can get Stress?
The stress response is the body’s way of protecting you. When working properly, it helps you stay focused, energetic, and alert. In emergency situations, stress can save your life – giving you extra strength to defend yourself, for example, or spurring you to slam on the brakes to avoid an accident. When you sense danger – whether it’s real or imagined – the body's defenses kick into high gear in a rapid, automatic process known as the “fight-or-flight” reaction, or the stress response

c. Cause Of Stress?
External Factor :

• Major life changes
• Work
• Relationship difficulties
• Financial problems
• Being too busy
• Children and family

Internal Factor :

• Inability to accept uncertainty
• Pessimism
• Negative self-talk
• Unrealistic expectations, perfectionism

d. Stress Symptom :

Cognitive Symptoms	Emotional Symptoms
Memory problems Inability to concentrate Poor judgment Seeing only the negative Anxious or racing thoughts Constant worrying	Moodiness Irritability or short temper Agitation, inability to relax Feeling overwhelmed Sense of loneliness and isolation Depression or general unhappiness
Physical Symptoms	Behavioral Symptoms
Aches and pains Diarrhea or constipation Nausea, dizziness Chest pain, rapid heartbeat Loss of sex drive Frequent colds	Eating more or less Sleeping too much or too little Isolating yourself from others Procrastinating or neglecting responsibilities Using alcohol, cigarettes, or drugs to relax Nervous habits (e.g. nail biting, pacing)

e. What is effect cronic of stress?
The body doesn’t distinguish between physical and psychological threats. When you’re stressed over a busy schedule, an argument with a friend, a traffic jam, or a mountain of bills, your body reacts just as strongly as if you were facing a life-or-death situation. If you have a lot of responsibilities and worries, your emergency stress response may be “on” most of the time. The more your body’s stress system is activated, the easier it is to trip and the harder it is to shut off.

Long-term exposure to stress can lead to serious health problems. Chronic stress disrupts nearly every system in your body. It can raise blood pressure, suppress the immune system, increase the risk of heart attack and stroke, contribute to infertility, and speed up the aging process. Long-term stress can even rewire the brain, leaving you more vulnerable to anxiety and depression.

Many health problems are caused or exacerbated by stress, including:

Pain of any kind Heart disease Digestive problems Sleep problems

Depression Obesity Autoimmune diseases Skin conditions, such as eczem

d. How to manage the stress??

• 
• Alter the situation : manage your time better, be willing to compromise etc.

• Adapt to the stressor : reframe problem, focus on the positive etc.
  

• Accept the things you can’t change : share your feelings, learn to forgive etc.
  

• Make time for fun and relaxation : do something you enjoy every day, humorAdopt etc.
  

• A healthy lifestyle : Exercise regularly, reduce caffein & sugar etc.
  

Author : Melinda Smith, M.A., Ellen Jaffe-Gill, M.A., and Robert Segal, M.A

Guide To Healthy Sleep

The following ten tips can help you achieve sleep and the benefits it provides. These tips are intended for "typical" adults, but not necessarily for children or persons experiencing medical problems.

You can find information on this site about children and sleep and NSF recommends that persons treated for medical conditions consult their doctor – check our resource, "Sleep Talk with Your Doctor."

Finally, if you have trouble falling asleep, maintaining sleep, awaken earlier than you wish, feel unrefreshed after sleep or suffer from excessive sleepiness during the day or when you wish to be alert, you should also consult your physician. Be sure to tell him/her if you have already tried these tips and for how long. To check for possible sleep problems, go to our checklist, "How's Your Sleep?"

1. Maintain a regular bed and wake time schedule including weekends

Our sleep-wake cycle is regulated by a "circadian clock" in our brain and the body's need to balance both sleep time and wake time. A regular waking time in the morning strengthens the circadian function and can help with sleep onset at night. That is also why it is important to keep a regular bedtime and wake-time, even on the weekends when there is the temptation to sleep-in.

2. Establish a regular, relaxing bedtime routine such as soaking in a hot bath or hot tub and then reading a book or listening to soothing music.

A relaxing, routine activity right before bedtime conducted away from bright lights helps separate your sleep time from activities that can cause excitement, stress or anxiety which can make it more difficult to fall asleep, get sound and deep sleep or remain asleep. Avoid arousing activities before bedtime like working, paying bills, engaging in competitive games or family problem-solving. Some studies suggest that soaking in hot water (such as a hot tub or bath) before retiring to bed can ease the transition into deeper sleep, but it should be done early enough that you are no longer sweating or over-heated. If you are unable to avoid tension and stress, it may be helpful to learn relaxation therapy from a trained professional. Finally, avoid exposure to bright before bedtime because it signals the neurons that help control the sleep-wake cycle that it is time to awaken, not to sleep.

3. Create a sleep-conducive environment that is dark, quiet, comfortable and cool.

Design your sleep environment to establish the conditions you need for sleep – cool, quiet, dark, comfortable and free of interruptions. Also make your bedroom reflective of the value you place on sleep. Check your room for noise or other distractions, including a bed partner's sleep disruptions such as snoring, light, and a dry or hot environment. Consider using blackout curtains, eye shades, ear plugs, "white noise," humidifiers, fans and other devices.

4. Sleep on a comfortable mattress and pillows.

Make sure your mattress is comfortable and supportive. The one you have been using for years may have exceeded its life expectancy – about 9 or 10 years for most good quality mattresses. Have comfortable pillows and make the room attractive and inviting for sleep but also free of allergens that might affect you and objects that might cause you to slip or fall if you have to get up during the night.

5. Use your bedroom only for sleep and sex.

It is best to take work materials, computers and televisions out of the sleeping environment. Use your bed only for sleep and sex to strengthen the association between bed and sleep. If you associate a particular activity or item with anxiety about sleeping, omit it from your bedtime routine. For example, if looking at a bedroom clock makes you anxious about how much time you have before you must get up, move the clock out of sight. Do not engage in activities that cause you anxiety and prevent you from sleeping.

6. Finish eating at least 2-3 hours before your regular bedtime.

Eating or drinking too much may make you less comfortable when settling down for bed. It is best to avoid a heavy meal too close to bedtime. Also, spicy foods may cause heartburn, which leads to difficulty falling asleep and discomfort during the night. Try to restrict fluids close to bedtime to prevent nighttime awakenings to go to the bathroom, though some people find milk or herbal, non-caffeinated teas to be soothing and a helpful part of a bedtime routine.

7. Exercise regularly. It is best to complete your workout at least a few hours before bedtime.

In general, exercising regularly makes it easier to fall asleep and contributes to sounder sleep. However, exercising sporadically or right before going to bed will make falling asleep more difficult. In addition to making us more alert, our body temperature rises during exercise, and takes as much as 6 hours to begin to drop. A cooler body temperature is associated with sleep onset... Finish your exercise at least 3 hours before bedtime. Late afternoon exercise is the perfect way to help you fall asleep at night.

8. Avoid caffeine (e.g. coffee, tea, soft drinks, chocolate) close to bedtime. It can keep you awake.

Caffeine is a stimulant, which means it can produce an alerting effect. Caffeine products, such as coffee, tea, colas and chocolate, remain in the body on average from 3 to 5 hours, but they can affect some people up to 12 hours later. Even if you do not think caffeine affects you, it may be disrupting and changing the quality of your sleep. Avoiding caffeine within 6-8 hours of going to bed can help improve sleep quality.

9. Avoid nicotine (e.g. cigarettes, tobacco products). Used close to bedtime, it can lead to poor sleep.

Nicotine is also a stimulant. Smoking before bed makes it more difficult to fall asleep. When smokers go to sleep, they experience withdrawal symptoms from nicotine, which also cause sleep problems. Nicotine can cause difficulty falling asleep, problems waking in the morning, and may also cause nightmares. Difficulty sleeping is just one more reason to quit smoking. And never smoke in bed or when sleepy!

10. Avoid alcohol close to bedtime.

Although many people think of alcohol as a sedative, it actually disrupts sleep, causing nighttime awakenings. Consuming alcohol leads to a night of less restful sleep.

If you have sleep problems...

Use a sleep diary and talk to your doctor. Note what type of sleep problem is affecting your sleep or if you are sleepy when you wish to be awake and alert. Try these tips and record your sleep and sleep-related activities in a sleep diary. If problems continue, discuss the sleep diary with your doctor. There may be an underlying cause and you will want to be properly diagnosed. Your doctor will help treat the problem or may refer you to a sleep specialist.

author : http://www.sleepfoundation.org

Low Back Pain

Most people will experience back pain during their lifetime. Some patients fear the worst, especially when pain is severe. Although back pain can be caused by fracture, disc disorder, or tumor, the most common cause is sprain or strain.

Sprains and strains often result from excessive physical demands on the back. Lifting something too heavy, a sudden fall, car crash, or sports injury can cause soft tissues (ligaments, muscles, tendons) to stretch too much.

Sprains · Strains
The spine includes vertebrae (bones), discs (cartilaginous pads or shock absorbers), the spinal cord and nerve roots (neurological wiring system), and blood vessels (nourishment). Ligaments link bones together, and tendons connect muscles to bones and discs. The ligaments, muscles, and tendons work together to handle the external forces the spine encounters during movement, such as bending forward and lifting.

Sprains and strains are similar disorders affecting different soft tissues in the spine. Sprains are limited to ligaments whereas strains affect muscles, tendons, or muscle-tendon combinations.

Ligaments are strong flexible bands of fibrous tissue. Although ligaments are resistant to being stretched, they do allow some freedom of movement. Muscle is made up of individual and segmental strands of tissue. When back muscles encounter excessive external force, individual strands can stretch or tear while the rest of the muscle is spared injury.

To illustrate a sprain or strain, consider what happens when lifting something heavy. Initially muscles are recruited to manage the load. When the load or force exceeds the muscles' ability to cope, the force is shared with the ligaments. When a ligament is stressed beyond its strength, it can tear.

Local tissues swell when ligaments, muscles, tendons, or combinations become overstretched, overused, or torn. Swelling causes pain, tenderness, and stiffness; swelling serves to protect the injured back by restricting movement - similar to a splint on a broken leg.

author : Jean-Jacques Abitbol, MD, FRCSC, Edgar G. Dawson, M.D., Regis W. Haid, Jr., MD

a. Symptom and Diagnosis Back Pain

What is acute low/mechanical back pain?
Acute low/mechanical back pain is a common medical problem. Acute pain is pain that has been present less than 4 to 6 weeks. Mechanical means the source of the pain may be in the spinal joints, discs, vertebrae or soft tissues. Acute mechanical back pain may also be called acute low back pain, lumbago, idiopathic low back pain, lumbosacral strain or sprain, or lumbar syndrome.

What causes low/mechanical back pain?
A precise cause of low/mechanical back pain can be identified 20 percent of the time. Sometimes, a specific trauma or strenuous activity may cause the pain. However, 80 percent of the time, the specific source of pain is not found.

It implies the source of pain is in the spine and/or its supporting structure. The surrounding muscles and ligaments may become inflamed and irritated.

Less than one percent of people who develop acute low back pain have a serious cause, such as cancer or infection, to explain their pain.

What are the symptoms of low/mechanical back pain?
Most people experience pain primarily in the lower back. The pain may spread (radiate) to the buttocks, thighs or knees. Many people may also experience spasms with mechanical back pain. The symptoms of low/mechanical back pain are generally more noticeable with flexion of the back and when lifting heavy objects.

Back pain is usually more severe than leg pain (sciatica). Sciatica is usually the result of a pinched nerve, when a protruding disc is putting pressure on a spinal nerve. With sciatica, the pain frequently extends below the level of the knee.

How is back pain diagnosed?
A careful evaluation of your medical history and a physical examination will help your health care providers determine if you have mechanical back pain. Then, they will work with you to create an appropriate treatment plan.

If your health care provider has determined your back pain is mechanical, additional testing is not usually necessary. If your symptoms or examination suggest the possibility of infection, malignancy or a pinched nerve, additional tests may be necessary. Additional testing may include blood tests, X-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI), and/or nerve conduction studies.

b. Exercise For Back Pain

1. What is Physical Therapy?

Physical Therapy (PT) is considered a conservative treatment method addressing the treatment, healing and prevention of injuries and disabilities. PT focuses primarily, but not solely, on pain relief, promoting healing, and restoring function and movement associated with injury. Other areas within physical therapy are ergonomic (body mechanic) training, fitness/ wellness, and especially education and prevention.

2. What can a Physical Therapy program do for me that I cannot do on my own?

Many patients may think that they know how to properly exercise, manage their pain and rehabilitate themselves. I have commonly been given explanations from patients for why they do not need therapy - for example, "I have had this before and I know what works for me" or "I know what is causing this, because my neighbor had the same thing so I will just do what she did" and attempt to manage themselves. A Physical Therapist is a specialist skilled and educated specifically in proper rehabilitation. We are continually educated as to management for different dysfunctions, differentiation of one dysfunction/injury from another and work closely with the referring physician in the development of a rehabilitation program specifically designed for each individual. The other important aspect to remember with physical therapy is that each individual is different. We all have different types of bodies, different patterns of movement, alignments and habits. A physical therapist, along with their trained staff, monitors each individual and attempts to correct improper movements, alignments and habits.

Most importantly with therapy comes education. Because of healthcare guidelines and reimbursement changes, your physician may not have the time needed to explain exactly what your injury/dysfunction/disability is and why/how it occurred. Your therapist is specialized in this and many times is the person who will educate you about the specifics of your problem and what the course of action will be to correct it and hopefully prevent it from reoccurring. PT focuses on education, correction and prevention.

3. How long is it going to take?

This is such a popular question. It seems that everyone has to have timelines, which is understandable because we all have lives to lead. Your physical therapist is aware that rehabilitation can be an imposition. I explain that because each person is different, rates of healing are different. I can usually get an idea of your progress within two weeks. I explain to my patients that even though they have other things to do, rehab is important. Although rehab takes time, it also took time for the injury to progress to the point of causing pain or contirbuting to injury.

Physical therapists want their patients to understand that although we are here to teach and rehabilitation them, their Home Program it is their responsibility. The Home Program is a major contributing factor to how quickly the patient recovers.

4. Who benefits from physical therapy?

Many and all can benefit from physical therapy. As an active therapist, I work out and always observe others. I very rarely come across individuals with perfect body mechanics, training techniques or movement patterns. This is where wellness comes into play. Typically, the most appropriate patients are those who have been in accidents (work, auto, or falls), athletes with overstress injuries, patients with arthritis, pre- and post-operative patients, and people with general deconditioning or strains.

5. What will I have to do in physical therapy?

PT generally encompasses pain relief, strength and flexibility training, proper postural alignment, regaining movement or range of motion, improving and correcting posture, endurance training, relaxation and stress relieving techniques, balance and coordination training, proper walking, education, safety awareness and development/implementation of a home exercise program.

Remember that each individual is different, so each rehab/physical therapy experience and program is different. Be patient with yourself, your physician and your physical therapy staff. Healing takes time, diligence and compliance. If you think you may be a candidate for physical therapy, speak to your physician or to a therapist. We never will say "no" to questions.

author : Dana L Davis MPT