Month: February 2023

I recently saw a car vanity plate that read “LBODOC” (as in elbow doc). The driver — probably an orthopedic doctor or arthritis specialist — was clearly a fan of the elbow, an unassuming joint and a surprisingly central player in many daily tasks. I could relate: throughout my medical career, the elbow has been my favorite joint.

Here’s why we should give praise to elbows and do all we can to protect them.

What if we didn’t have elbows?

Let’s face it: the human experience would be quite different without elbows.

Imagine your arm without a joint that bends at the elbow. You’d be unable to easily feed yourself, put on makeup, shave your face, or brush your teeth. It’d be tough to get dressed or throw a ball without elbows. And, importantly, wiping yourself after using the bathroom would be nearly impossible.

Yet, when it comes to joints and joint disease, we hear little about elbows; hips and knees get most of the attention. So, let’s consider for a moment what the lowly elbow does and why it deserves more credit.

How do your elbows work?

Three bones come together at the elbow joint: the humerus, which is in the upper arm, and two long bones called the ulna and radius in the lower arm.

Your elbow has two main motions:

• Flexing and straightening. Flexing your arm allows you to bring your hand toward your body (flexion), which you do when bringing food to your mouth or putting your hands on your hips. Straightening your arm (extension) allows such motions as putting your arm in a shirt sleeve or reaching your toes.
• Turning up and down. You can also flip your palms from facing the ceiling (supination) to facing the floor (pronation). These motions are important for many common movements, such as turning a key or a doorknob.

Bumping your elbow: Why is it called the funny bone?

Probably for two reasons:

• The humerus in the upper arm sounds just like the word humorous, meaning funny.
• Bumping your elbow often puts pressure on the ulnar nerve, since it’s located between the bones of the joint. Pressure on this nerve can cause a funny tingling sensation that runs down your arm.

Elbow trouble: Four well-known problems — and a surprising fifth

Like so many overlooked and underappreciated things, most people think little about their elbows until something goes wrong. Here are some of the most common elbow problems:

• Arthritis. Several types of arthritis can affect the elbow, including rheumatoid arthritis, psoriatic arthritis, and gout. Interestingly, the most common type of arthritis, osteoarthritis, doesn’t usually affect the elbow unless there’s been prior damage to the joint.
• Bursitis. The bursa is a saclike structure that surrounds the tip of the elbow. Bursitis develops when it becomes swollen or inflamed, due to infection, gout, or bleeding.
• Tendonitis. Tendon inflammation (tendonitis) may develop on the inside part of the elbow (called “golfer’s elbow”) or the outside (called “tennis elbow”). Despite these names, you don’t have to play any particular sport to develop elbow tendonitis.
• Trauma. Everyday activities and athletic pursuits put the elbow at risk. A bike accident, falling off a skateboard, or just tripping on a curb and falling onto your arm can cause significant elbow injuries. These include ligament damage, broken bones, or bursitis.

And the surprising fifth problem? Cell phone-induced nerve irritation: holding your elbow bent for a long time can lead to “cell phone elbow” due to pressure on the ulnar nerve. This can cause numbness and pain down the arm. The solution? Put the phone down — or at least go hands-free.

How can you protect your elbows?

Considering all our elbows do for us, we need to do our best to protect them. That means:

• Wear elbow protectors when engaging in activities likely to injure the elbows (like skateboarding or roller blading).
• Learn proper technique for activities that can stress the elbow like racquet sports, baseball, weight training, or repetitive motions in carpentry and other types of work. For example, a trainer or coach can help you improve your tennis stroke to avoid overstressing the elbow joint and its tendons or ligaments.
• Use appropriate equipment. For example, avoid using a tennis racquet that’s too heavy for you.
• Train well. Strengthening forearm muscles and stretching can help avoid golfer’s elbow.

The bottom line

As the junction between hand and shoulder, our elbows play a pivotal role in everyday function. It’s high time we recognized them for what they do for us. Even if the elbow isn’t your favorite joint — as it is for me — perhaps it should be in your top five. After all, think of all the things you couldn’t do without them.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

As wildfires become more frequent due to climate change and drier conditions, more of us and more of our communities are at risk for harm. Here is information to help you prepare and protect yourself and your family.

How does wildfire smoke affect air quality?

Wildfire smoke contributes greatly to poor air quality. Just like fossil fuel pollution from burning coal, oil, and gas, wildfires create hazardous gases and tiny particles of varying sizes (known as particulate matter, or PM10, PM2.5, PM0.1) that are harmful to breathe. Wildfire smoke also contains other toxins that come from burning buildings and chemical storage.

The smoke can travel to distant regions, carried by weather patterns and jet streams.

How does wildfire smoke affect our health?

The small particles in wildfire smoke are the most worrisome to our health. When we breathe them in, these particles can travel deep into the lungs and sometimes into the bloodstream.

The health effects of wildfire smoke include eye irritation, coughing, wheezing, and difficulty breathing. The smoke may also increase risk for respiratory infections like COVID-19. Other possible serious health effects include heart failure, heart attacks, and strokes.

Who needs to be especially careful?

Those most at risk from wildfire smoke include children, older adults, outdoor workers, and anyone who is pregnant or who has heart or lung conditions.

If you have a chronic health condition, talk to your doctor about how the smoke might affect you. Find out what symptoms should prompt medical attention or adjustment of your medications. This is especially important if you have lung problems or heart problems.

What can you do to prepare for wildfire emergencies?

If you live in an area threatened by wildfires, or where heat and dry conditions make them more likely to occur:

• Create an evacuation plan for your family before a wildfire occurs.
• Make sure that you have several days on hand of medications, water, and food that doesn't need to be cooked. This will help if you need to leave suddenly due to a wildfire or another natural disaster.
• Regularly check this fire and smoke map, which shows current wildfire conditions and has links to state advisories.
• Follow alerts from local officials if you are in the region of an active fire.

What steps can you take to lower health risks during poor air quality days?

These six tips can help you stay healthy during wildfire smoke advisories and at other times when air quality is poor:

• Stay aware of air quality. AirNow.gov shares real-time air quality risk category for your area accompanied by activity guidance. When recommended, stay indoors, close doors, windows, and any outdoor air intake vents.
• Consider buying an air purifier. This is also important even when there are no regional wildfires if you live in a building that is in poor condition. See my prior post for tips about pollution and air purifiers. The EPA recommends avoiding air cleaners that generate ozone, which is also a pollutant.
• Understand your HVAC system if you have one. The quality and cleanliness of your filters counts, so choose high-efficiency filters if possible, and replace these as needed. It's also important to know if your system has outdoor air intake vents.
• Avoid creating indoor pollution. That means no smoking, no vacuuming, and no burning of products like candles or incense. Avoid frying foods or using gas stoves, especially if your stove is not well ventilated.
• Make a "clean room." Choose a room with fewer doors and windows. Run an air purifier that is the appropriate size for this room, especially if you are not using central AC to keep cool.
• Minimize outdoor time and wear a mask outside. Again, ensuring that you have several days of medications and food that doesn't need to be cooked will help. If you must go outdoors, minimize time and level of activity. A well-fitted N95 or KN95 mask or P100 respirator can help keep you from breathing in small particles floating in smoky air (note: automatic PDF download).

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD

Health guidelines recommend adults get at least 150 minutes per week of moderate-intensity aerobic exercise, or at least 75 minutes of vigorous exercise. Which activities you choose don’t matter as long as they get you moving.

But what if an injury, illness, health condition, disability, or even normal aging makes being active hard for you? In those cases, adaptive sports could lend a much-needed hand.

What are adaptive sports?

Adaptive sports are competitive or recreational sports or activities for people with disabilities or physical limitations. They often run parallel to traditional endeavors, but are modified to support people’s specific physical abilities.

“Eventually, almost everyone will experience some kind of disability that impedes regular exercise, whether it’s mild arthritis, requiring a knee or hip replacement, limited vision, or a more significant physical disability,” says Dr. Cheri Blauwet, an associate professor in physical medicine and rehabilitation at Harvard Medical School, and a former wheelchair racer who is a seven-time Paralympic medalist and two-time winner of both the Boston and New York City Marathons. “But today, because of advanced technology and supportive infrastructure, people can find almost any kind of sport or activity that takes into account their abilities and helps them stay active.”

Why is it important to stay active?

Not getting sufficient regular exercise increases the risk of heart disease, stroke, obesity, diabetes, and cancer. It also affects mood. And people with disabilities are especially vulnerable because of the challenges of staying active, says Dr. Blauwet. “Adaptive sports are a way for us to continue to exercise regularly and support our health and well-being going forward.”

Research backs this up. According to one study, people participating in adaptive sports and activities report better overall health, quality of life, and social life.

How can you learn about options for adaptive activities near you?

You can find state and local adaptive sports programs and accessible activities through the websites of the National Center on Health, Physical Activity and Disability and the Challenged Athletes Foundation. “These programs also can help you find mentors, coaches, and the support system that you need to be successful,” says Dr. Blauwet.

What kind of sport or activity you choose ultimately depends on your interests and level of function, but many options are available.

Build on strengths and consider new activities

Dr. Blauwet shares other strategies that can help you transition to adaptive activities.

Look at your current form of exercise. “Almost any kind of sport or activity can be adjusted to accommodate people with disabilities, so there is a good chance you can continue with a favorite endeavor,” says Dr. Blauwet.

For instance, as part of her ongoing therapy, former Arizona representative Gabby Giffords, an avid cyclist who lives with a brain injury after an assassination attempt, now rides a recumbent bike because of paralysis on her right side and balance issues. (A recumbent bike is a three-wheel bicycle that places the rider in a seated or laid-back reclining position.)

Other sports and activities can be altered similarly. For example, specialized golf carts can help you stand and stabilize your body while swinging the club. Sledge hockey uses sleds to skate across the ice.

Focus on your strengths. Don’t dwell on what you can’t do, but focus on what you can. Running no longer an option? How about power walking using walking poles for support? Can’t use your legs? Focus on upper body activities like swimming or kayaking. Low vision? Guides are available to help you walk, run, and cycle.

Join a team. Many adaptive sports have organized team leagues with adjusted rules and formats, like wheelchair basketball and tennis, and “beep” baseball and kickball for individuals with low vision. “These are a great way to build more awareness about your new endeavor and build a community with other peers with similar disabilities,” says Dr. Blauwet. “Plus, a little competition provides extra motivation.”

Try something new. Use your new functional status as an opportunity to attempt a different sport or activity. “Test the waters and try something that has always interested you,” says Dr. Blauwet. “Now might be the ideal time to explore waterskiing, windsurfing, horseback riding, or rock wall climbing.”

It may be mentally and emotionally tough to embrace adaptive sports and activities, as it can feel like your disability has become magnified. But don’t let that dissuade you, adds Dr. Blauwet. “Staying committed to being active and investing in your health can help reduce and eliminate any negative stigma you feel. Participation in adaptive sports is not a lesser way of living, but a way to live better.”

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan