Breathing Difficulties

Q: Some days when I am walking I can’t take a full breath. When I am done it becomes easier. What could the possible cause be? It only happens with lots of exertion or exercise.

A: You may be experiencing exercise induced or intrinsic asthma. Extrinsic asthma is induced by airborne allergens such as pollen, dander, and molds causing a hypersensitivity reaction. The immune system generates an IgE mediated response (hyper sensitivity) to the above allergens. Your description pointing toward intrinsic or exercise induced asthma is one not caused by a hypersensitivity reaction but rather a bronchial reaction from exercise and possibly colder air. This kind of attack can be gradual to acute with the symptoms showing up as shortness of breath to wheezing and coughing. The best way to diagnose exercise induced asthma is through pulmonary function test measuring lung capacity and heart function. Specific allergen testing is also helpful since both intrinsic and extrinsic asthma can occur together. Treatments can vary from simple diet changes to taking vitamins and minerals known for preventing spasms of the bronchial passages. Both vitamin C and magnesium are helpful for the reduction of bronchial spasm. Inhalers can often be beneficial when the more simple measures do not work. Herbal compounds can also be used to soothe and heal inflamed tissues, as well as act as expectorants and antispasmodics. If simple measures are not working seek help from a physician for correct diagnosis and treatment.
— Dr. Lindsey Nelson

Knee Pain

Q: I have right knee pain. I would like to know what the straps are that people wear around their knees while walking and running. Should I use one?

A: The common brand name for the strap you refer to is the Chopat Strap. It is placed around the knee joint just under the knee cap. It is used to assist the tracking of the patella (knee cap) during flexion and extension of the knee. It can be helpful in a pinch for minimizing stresses placed on the infrapatellar tendon, but for the most part ineffective for resolving the problem causing pain. Most of the time a muscle imbalance causes altered motion of the patella and pain develops over time especially with more distance or intense walking. The best way to balance patella tracking is to strengthen the vastus medialis oblique (VMO) muscle. It is located on the inside of your leg just above the knee and it helps keep the knee cap correctly positioned during knee flexion and extension.

Two good exercises for strengthening the VMO are squats with a pillow or volleyball between the knees and the leg extension machine with toes pointed outward approximately 15 degrees. Remember to take the time to stretch after walking, the quads are strong muscles and once warmed up from exercise respond much better to stretching. Holding times should be 45 to 90 seconds for each side to get a thorough stretch.
— Dr. Jacob May

Toeing-Out

Q: It is difficult to point my feet directly straight when I walk, and I am getting conflicting information as to how much my feet should stay straight or my toes point off. Is there a normal range?

A: There is actually an average range for how much your foot should toe-out‚ away from midline when you step or stand. It is referred to as the Fick Angle. For adults, the average angle of toe-out from midline is 12 to18 degrees, although as small an angle as 5 degrees is normal in children. As we grow and spend more time walking and standing, our angle increases from that 5 degrees to somewhere in the normal adult range between 12 to18 degrees. A well-used pair of shoes will show if you have been walking in the average range, as the heel will be worn on the outside edge, and the center of the shoe will show wear underneath the ball of the foot, and the third site of wear should be on the first and second toe areas. This reflects friction area from toe-off.
— Dr. Bryan Baisinger

This Issue’s Experts
Lindsey Nelson, ND, is a naturopathic primary care physician and can be reached at 503-279-0205 or by email at: lindsey@clearh2o.org.
Jacob May, DC, brings careful thought and analytical thinking blended with a
holistic approach to medicine. To contactDr. May, call 503-279-0205 or email jacob@clearh2o.org.
Bryan Baisinger, DC, is owner of Clearwater Chiropractic & Massage. To contact Dr. Baisinger call 503-279-0205 or email bryan@clearh2o.org.