How To Really Look After Your Joints
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The Other Ways To Look After Your Joints
When it comes to joint health, most people have two quick go-to items:
- Stretching
- Supplements like omega-3 and glucosamine sulfate
Stretching, and specifically, mobility exercises, are important! We’ll have to do a main feature on these sometime soon. But for today, we’ll just say: yes, gentle daily stretches go a long way, as does just generally moving more.
And, those supplements are not without their merits. For example:
- Effect of omega-3 on painful symptoms of patients with osteoarthritis of the synovial joints: systematic review and meta-analysis
- Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator
Of those, glucosamine sulfate may have an extra benefit in now just alleviating the symptoms, but also slowing the progression of degenerative joint conditions (like arthritis of various kinds). This is something it shares with chondroitin sulfate:
Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis
An unlikely extra use for the humble cucumber…
As it turns out, cucumber extract beats glucosamine and chondroitin by 200%, at 1/135th of the dose.
You read that right, and it’s not a typo. See for yourself:
Reduce inflammation, have happier joints
Joint pain and joint degeneration in general is certainly not just about inflammation; there is physical wear-and-tear too. But combatting inflammation is important, and turmeric, which we’ve done a main feature on before, is a potent helper in this regard:
See also: Keep Inflammation At Bay
(a whole list of tips for, well, keeping inflammation at bay)
About that wear-and-tear…
Your bones and joints are made of stuff, and that stuff needs to be replaced. As we get older, the body typically gets worse at replacing it in a timely and efficient fashion. We can help it do its job, by giving it more of the stuff it needs.
And what stuff is that?
Well, minerals like calcium and phosphorus are important, but a lot is also protein! Specifically, collagen. We did a main feature on this before, which is good, as it’d take us a lot of space to cover all the benefits here:
We Are Such Stuff As Fish Are Made Of
Short version? People take collagen for their skin, but really, its biggest benefit is for our bones and joints!
Wrap up warmly and… No wait, skip that.
Writer’s anecdote: when I was young, my mother—her body already wracked with arthritis, along with post-polio syndrome—warned me that if I did not dress warmly, I would end up like her. In her mind, the cause of her arthritis was having spent too much time exposed to the elements. This is a popular myth, doubtlessly resulting from the fact that barometric changes can worsen the symptoms of already-extant arthritis, so it’s not a stretch to believe that wind and rain caused it. But, while it’s not a stretch, it’s also not scientific.
If you have arthritis, you may indeed “feel it in your bones” when the weather changes. But the remedy for that is not to try to fight it, but rather, to strengthen your body’s ability to respond to it.
The answer? Cryotherapy, with ice baths ranking top:
- Effects of an Exercise Program and Cold-Water Immersion Recovery in Patients with Rheumatoid Arthritis (RA): Feasibility Study
- Effectiveness of home-based conventional exercise and cryotherapy on daily living activities in patients with knee osteoarthritis: A randomized controlled clinical trial
- Local Cryotherapy, Comparison of Cold Air and Ice Massage on Pain and Handgrip Strength in Patients with Rheumatoid Arthritis
Note that this can be just localized, so for example if the problem joints are your wrists, a washing-up bowl with water and ice will do just nicely.
Note also that, per that last study, a single session will only alleviate the pain, not the disease itself. For that (per the other studies) more sessions are required.
We did a main feature about cryotherapy a while back, and it explains how and why it works:
A Cold Shower A Day Keeps The Doctor Away?
Take care!
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10almonds Subcribers Take The Wheel!
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❓ Q&A With 10almonds Subscribers!
Q: What kind of salt is best for neti pots?
A: Non-iodised salt is usually recommended, but really, any human-safe salt is fine. By this we mean for example:
- Sodium chloride (like most kitchen salts),
- Potassium chloride (as found in “reduced sodium” kitchen salts), or
- Magnesium sulfate (also known as epsom salts).
Q: You talked about spearmint as reducing testosterone levels, what about ginseng for increasing them?
A: Hormones are complicated and often it’s not a simple matter of higher or lower levels! It can also be a matter of…
- how your body converts one thing into another
- how your body responds (or not) to something according to how the relevant hormone’s receptors are doing
- …and whether there’s anything else blocking those receptors.
All this to say: spearmint categorically is an anti-androgen, but the mechanism of action remains uncertain.
Panax ginseng, meanwhile, is one of the most well-established mysteries in herbal medicine.
Paradoxically, it seems to improve both male and female hormonal regulation, despite being more commonly associated with the former.
- It doesn’t necessarily increase or decrease testosterone or estrogen levels (but it can, even if indirectly)
- It does improve sexual function
- …and alleviates symptoms associated with conditions as varied as:
- Late-onset hypogonadism (common for men during the andropause)
- Benign prostate hyperplasia (again common for men during the andropause)
- …and also counteracts unwanted side-effects of finasteride. Finasteride is often taken by men as a hair loss remedy or, less often but critically, in the case of an enlarged prostate.
But it also…
- Alleviates symptoms of PCOS (polycystic ovary syndrome, which effects around 20% of women)
- May even be an effective treatment for PCOS (rat model only so far)
- It also may improve female reproductive fertility more generally (the studies are down to fruit flies now though)
Bottom line: Panax ginseng is popularly taken to improve natural hormone function, a task at which it appears to excel.
Scientists are still working out exactly how it does the many things it appears to do.
Progress has been made, and it clearly is science rather than witchcraft, but there are still far more unanswered questions than resolved ones!
Q: I like that the quizzes (I’ve done two so far) give immediate results , with no “give us your email to get your results”. Thanks!
A: You’re welcome! That’s one of the factors that influences what things we include here! Our mission statement is “to make health and productivity crazy simple”, and the unwritten part of that is making sure to save your time and energy wherever we reasonably can!
Q: Do you know if adrafanil is as good as modafinil? It seems to be a lot cheaper for the same result?
A: Adrafinil is the pro-drug of modafinil. What this means is that if you take it, your own liver will use it to make modafinil inside you. So the end result is chemically the same drug.
As to whether it’s as good, it depends what you need. It’s worth noting that anything that taxes liver function can be harmful if you take too much, and/or your liver is already strained for some reason.
If in doubt, consult a doctor! And if it’s something that’s accessible to you, a recent lipids test (a kind of blood test that checks your liver health) is always a good thing to have.
Q: Would love to see your take on polyphasic sleep!
A: Watch this space
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Escape From The Clutches Of Shame
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We’ve written before about managing various emotions, including “negative” ones. We put that in “scare quotes” because they also all have positive aspects, that are just generally overshadowed by the fact that the emotions themselves are not pleasant. But for example…
We evolved our emotions, including the “negative” ones, for our own benefit as a species:
- Stress keeps us safe by making sure we take important situations seriously
- Anger keeps us safe by protecting us from threats
- Disgust keeps us safe by helping us to avoid things that might cause disease
- Anxiety keeps us safe by ensuring we don’t get complacent
- Guilt keeps us safe by ensuring we can function as a community
- Sadness keeps us safe by ensuring we value things that are important to us, and learn to become averse to losing them
- …and so on
You can read more about how to turn these off (or rather, at least pause them) when they’re misfiring and/or just plain not convenient, here:
While it’s generally considered good to process feelings instead of putting them aside, the fact is that sometimes we have to hold it together while we do something, such that we can later have an emotional breakdown at a convenient time and place, instead of the supermarket or bank or office or airport or while entertaining houseguests or… etc.
Today, though, we’re not putting things aside, for the most part (though we will get to that too).
We’ll be dealing with shame, which is closely linked to the guilt we mentioned in that list there.
See also: Reconsidering the Differences Between Shame and Guilt
Shame’s purpose
Shame’s purpose is to help us (as a community) avoid anti-social behavior for which we might be shamed, and thus exiled from the in-group. It helps us all function better together, which is how we thrive as a species.
Shame, therefore, is often assumed to be something we can (and possibly should) use to ensure that we (ourselves and/or others) “do the right thing”.
But there’s a catch…
Shame only works negatively
You may be thinking “well duh, it’s a negative emotion”, but this isn’t about negativity in the subjective sense, but rather, positive vs negative motivation:
- Positive motivation: motivation that encourages us to do a given thing
- Negative motivation: motivation that encourages us to specifically not do a given thing
Shame is only useful as a negative motivation, i.e., encouraging us to specifically not do a given thing.
Examples:
- You cannot (in any way that sticks, at least) shame somebody into doing more housework.
- You can, however, shame somebody out of drinking and driving.
This distinction matters a lot when it comes to how we are with our children, or with our employees (or those placed under us in a management structure), or with people who otherwise look to us as leaders.
It also matters when it comes to how we are with ourselves.
Here’s a paper about this, by the way, with assorted real-world examples:
The negative side of motivation: the role of shame
From those examples, we can see that attempts to shame someone (including oneself) into doing something positive will generally not only fail, they will actively backfire, and people (including oneself) will often perform worse than pre-shaming.
Looking inwards: healthy vs unhealthy shame
Alcoholics Anonymous and similar programs use a degree of pro-social shame to help members abstain from the the act being shamed.
Rather than the unhelpful shame of exiling a person from a group for doing a shameful thing, however, they take an approach of laying out the shame for all to see, feeling the worst of it and moving past it, which many report as being quite freeing emotionally while still [negatively] motivational to not use the substance in question in the future (and similar for activity-based addictions/compulsions, such as gambling, for example).
As such, if you are trying to avoid doing a thing, shame can be a useful motivator. So by all means, if it’s appropriate to your goals, tell your friends/family about how you are now quitting this or that (be it an addiction, or just something generally unhealthy that you’d like to strike off your regular consumption/activity list).
You will still be tempted! But the knowledge of the shame you would feel as a result will help keep you from straying into that temptation.
If you are trying to do a thing, however, (even something thought of in a negative frame, such as “lose weight”), then shame is not helpful and you will do best to set it aside.
You can shame yourself out of drinking sodas (if that’s your plan), but you can’t shame yourself into eating healthy meals. And even if your plan is just shaming yourself out of eating unhealthy food… Without a clear active positive replacement to focus on instead, all you’ll do there is give yourself an eating disorder. You’ll eat nothing when people are looking, and then either a) also eat next to nothing in private or else b) binge in secret, and feel terrible about yourself, neither of which are any good for you whatsoever.
Similarly, you can shame yourself out of bed, but you can’t shame yourself into the gym:
Let it go
There are some cases, especially those where shame has a large crossover with guilt, that it serves no purpose whatsoever, and is best processed and then put aside.
For example, if you did something that you are ashamed of many years ago, and/or feel guilty about something that you did many years ago, but this is not an ongoing thing for you (i.e., it was a one-off bad decision, or a bad habit that have now long since dropped), then feeling shame and/or guilt about that does not benefit you or anyone else.
As to how to process it and put it aside, if your thing harmed someone else, you could see if there’s a way to try to make amends (even if without confessing ill, such as by acting anonymously to benefit the person/group you harmed).
And then, forgive yourself. Regardless of whether you feel like you deserve it. Make the useful choice, that better benefits you, and by extension those around you.
If you are religious, you may find that of help here too. We’re a health science publication not a theological one, but for example: Buddhism preaches compassion including for oneself. Judaism preaches atonement. Christianity, absolution. For Islam, mercy is one of the holiest ideals of the religion, along with forgiveness. So while religion isn’t everyone’s thing, for those for whom it is, it can be an asset in this regard.
For a more worldly approach:
To Err Is Human; To Forgive, Healthy (Here’s How To Do It) ← this goes for when the forgiveness in question is for yourself, too—and we do write about that there (and how)!
Take care!
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What does it mean to be immunocompromised?
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Our immune systems help us fight off disease, but certain health conditions and medications can weaken our immune systems. People whose immune systems don’t work as well as they should are considered immunocompromised.
Read on to learn more about how the immune system works, what causes people to be immunocompromised, and how we can protect ourselves and the immunocompromised people around us from illness.
What is the immune system?
The immune system is a network of cells, organs, and chemicals that helps our bodies fight off infections caused by invaders, such as bacteria, viruses, fungi, and parasites.
Some important parts of the immune system include:
- White blood cells, which attack and kill germs that don’t belong inside our bodies.
- Lymph nodes, which help our bodies filter out germs.
- Antibodies, which help our bodies recognize invaders.
- Cytokines, which tell our immune cells what to do.
What causes people to be immunocompromised?
Some health conditions and medications can prevent our immune systems from functioning optimally, which makes us more vulnerable to infection. Health conditions that compromise the immune system fall into two categories: primary immunodeficiency and secondary immunodeficiency.
Primary immunodeficiency
People with primary immunodeficiency are born with genetic mutations that prevent their immune systems from functioning as they should. There are hundreds of types of primary immunodeficiencies. Since these mutations affect the immune system to varying degrees, some people may experience symptoms and get diagnosed early in life, while others may not know they’re immunocompromised until adulthood.
Secondary immunodeficiency
Secondary immunodeficiency happens later in life due to an infection like HIV, which weakens the immune system over time, or certain types of cancer, which prevent the body from producing enough white blood cells to adequately fight off infection. Studies have also shown that getting infected with COVID-19 may cause immunodeficiency by reducing our production of “killer T-cells,” which help fight off infections.
Sometimes necessary treatments for certain medical conditions can also cause secondary immunodeficiency. For example, people with autoimmune disorders—which cause the immune system to become overactive and attack healthy cells—may need to take immunosuppressant drugs to manage their symptoms. However, the drugs can make them more vulnerable to infection.
People who receive organ transplants may also need to take immunosuppressant medications for life to prevent their body from rejecting the new organ. (Given the risk of infection, scientists continue to research alternative ways for the immune system to tolerate transplantation.)
Chemotherapy for cancer patients can also cause secondary immunodeficiency because it kills the immune system’s white blood cells as it’s trying to kill cancer cells.
What are the symptoms of a compromised immune system?
People who are immunocompromised may become sick more frequently than others or may experience more severe or longer-term symptoms than others who contract the same disease.
Other symptoms of a compromised immune system may include fatigue; digestive problems like cramping, nausea, and diarrhea; and slow wound healing.
How can I find out if I’m immunocompromised?
If you think you may be immunocompromised, talk to your health care provider about your medical history, your symptoms, and any medications you take. Blood tests can determine whether your immune system is producing adequate proteins and cells to fight off infection.
I’m immunocompromised—how can I protect myself from infection?
If you’re immunocompromised, take precautions to protect yourself from illness.
Wash your hands regularly, wear a well-fitting mask around others to protect against respiratory viruses, and ensure that you’re up to date on recommended vaccines.
Immunocompromised people may need more doses of vaccines than people who are not immunocompromised—including COVID-19 vaccines. Talk to your health care provider about which vaccines you need.
How can I protect the immunocompromised people around me?
You never know who may be immunocompromised. The best way to protect immunocompromised people around you is to avoid spreading illnesses.
If you know you’re sick, isolate whenever possible. Wear a well-fitting mask around others—especially if you know that you’re sick or that you’ve been exposed to germs. Make sure you’re up to date on recommended vaccines, and practice regular hand-washing.
If you’re planning to spend time with someone who is immunocompromised, ask them what steps you can take to keep them safe.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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How Useful Are Our Dreams
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What’s In A Dream?
We were recently asked:
❝I have a question or a suggestion for coverage in your “Psychology Sunday”. Dreams: their relevance, meanings ( if any) interpretations? I just wondered what the modern psychological opinions are about dreams in general.❞
~ 10almonds subscriber
There are two main schools of thought, and one main effort to reconcile those two. The third one hasn’t quite caught on so far as to be considered a “school of thought” yet though.
The Top-Down Model (Psychoanalysts)
Psychoanalysts broadly follow the theories of Freud, or at least evolved from there. Freud was demonstrably wrong about very many things. Most of his theories have been debunked and ditched—hence the charitable “or at least evolved from there” phrasing when it comes to modern psychoanalytic schools of thought. Perhaps another day, we’ll go into all the ways Freud went wrong. However, for today, one thing he wasn’t bad at…
According to Freud, our dreams reveal our subconscious desires and fears, sometimes directly and sometimes dressed in metaphor.
Examples of literal representations might be:
- sex dreams (revealing our subconscious desires; perhaps consciously we had not thought about that person that way, or had not considered that sex act desirable)
- getting killed and dying (revealing our subconscious fear of death, not something most people give a lot of conscious thought to most of the time)
Examples of metaphorical representations might be:
- dreams of childhood (revealing our subconscious desires to feel safe and nurtured, or perhaps something else depending on the nature of the dream; maybe a return to innocence, or a clean slate)
- dreams of being pursued (revealing our subconscious fear of bad consequences of our actions/inactions, for example, responsibilities to which we have not attended, debts are a good example for many people; or social contact where the ball was left in our court and we dropped it, that kind of thing)
One can read all kinds of guides to dream symbology, and learn such arcane lore as “if you dream of your teeth crumbling, you have financial worries”, but the truth is that “this thing means that other thing” symbolic equations are not only highly personal, but also incredibly culture-bound.
For example:
- To one person, bees could be a symbol of feeling plagued by uncountable small threats; to another, they could be a symbol of abundance, or of teamwork
- One culture’s “crow as an omen of death” is another culture’s “crow as a symbol of wisdom”
- For that matter, in some cultures, white means purity; in others, it means death.
Even such classically Freudian things as dreaming of one’s mother and/or father (in whatever context) will be strongly informed by one’s own waking-world relationship (or lack thereof) with same. Even in Freud’s own psychoanalysis, the “mother” for the sake of such analysis was the person who nurtured, and the “father” was the person who drew the nurturer’s attention away, so they could be switched gender roles, or even different people entirely than one’s parents.
The only real way to know what, if anything, your dreams are trying to tell you, is to ask yourself. You can do that…
- by reflection and personal interrogation (see for example: The Easiest Way To Take Up Journaling)
- or by externalising parts of your subconscious (as in Internal Family Systems therapy)
- or by talking directly to your subconscious where it is, by means of lucid dreaming.
The idea with lucid dreaming is that since any dream character is a facet of your subconscious generated by your own mind, by talking to that character you can ask questions directly of your subconscious (the popular 2010 movie “Inception” was actually quite accurate in this regard, by the way).
To read more about how to do this kind of self-therapy through lucid dreaming, you might want to check out this book we reviewed previously; it is the go-to book of lucid dreaming enthusiasts, and will honestly give you everything you need in one go:
Lucid Dreaming: A Concise Guide to Awakening in Your Dreams and in Your Life – by Dr. Stephen LaBerge
The Bottom-Up Model (Neuroscientists)
This will take a lot less writing, because it’s practically a null hypothesis (i.e., the simplest default assumption before considering any additional evidence that might support or refute it; usually some variant of “nothing unusual going on here”).
The Bottom-Up model holds that our brains run regular maintenance cycles during REM sleep (a biological equivalent of defragging a computer), and the brain interprets these pieces of information flying by and, because of the mind’s tendency to look for patterns, fills in the rest (much like how modern generative AI can “expand” a source image to create more of the same and fill in the blanks), resulting in the often narratively wacky, but ultimately random, vivid hallucinations that we call dreams.
The Hybrid Model (per Cartwright, 2012)
This is really just one woman’s vision, but it’s an incredibly compelling one, that takes the Bottom-Up model and asks “what if we did all that bio-stuff, and then our subconscious mind influenced the interpretation of the random patterns, to create dreams that are subjectively meaningful, and thus do indeed represent our subconscious?
It’s best explained in her own words, though, so it’s time for another book recommendation (we’ve reviewed this one before, too):
Enjoy!
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How gender-affirming care improves trans mental health
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In recent years, a growing number of states have passed laws restricting or banning gender-affirming care for transgender people, particularly minors. As conversations about gender-affirming care increase, so do false narratives about it, with some opponents falsely suggesting that it’s harmful to mental health.
Despite widespread attacks against gender-affirming care, research clearly shows that it improves mental health outcomes for transgender people.
Read on to learn more about what gender-affirming care is, how it benefits mental well-being, and how you can access it.
What is gender-affirming care?
Gender-affirming care describes a range of medical interventions that help align people’s bodies with their gender identities. While anyone can seek gender-affirming care in the form of laser hair removal, breast augmentation, erectile dysfunction medication, or hormone therapy, among other treatments, most conversations about gender-affirming care center around transgender people, whose gender identity or gender expression does not conform to their sex assigned at birth.
Gender-affirming care for trans people varies based on age. For example, some trans adults seek hormone replacement therapy (HRT) or gender-affirming surgeries that help their bodies match their internal sense of gender.
Trans kids entering adolescence might be prescribed puberty blockers, which temporarily delay the production of hormones that initiate puberty, to give them more time to figure out their gender identities before deciding on next steps. This is the same medication given to cisgender kids—whose gender identities match the sex they were assigned at birth—experiencing early puberty.
What is gender dysphoria?
Gender dysphoria describes a feeling of unease that some trans people experience when their perceived gender doesn’t match their gender identity. This can lead to a range of mental health conditions that affect their quality of life
Some trans people may manage gender dysphoria by wearing gender-affirming clothing, opting for a gender-affirming hairstyle, or asking others to refer to them by a name and pronouns that authentically represent them. Others may need gender-affirming care to feel at home in their bodies.
Trans people who desire gender-affirming care and have not been able to access it experience psychological distress, including depression, anxiety, self-harm, and suicidal ideation. The Trevor Project’s 2023 U.S. National Survey on the Mental Health of LGBTQ Young People found that roughly half of trans youth “seriously considered attempting suicide in the past year.”
How does gender-affirming care improve mental health?
For trans adults, gender-affirming care can alleviate gender dysphoria, which has been shown to improve both short-term and long-term mental health. A 2018 study found that trans adults who do not undergo HRT are four times more likely to experience depression than those who do, although not all trans people desire HRT.
Extensive research has shown that gender-affirming care also alleviates gender dysphoria and improves mental health outcomes in trans kids, teens, and young adults. A 2022 study found that access to HRT and puberty blockers lowered the odds of depression in trans people between the ages of 13 and 20 by 60 percent and reduced the risk of self-harm and suicidal thoughts by 73 percent.
Both the Endocrine Society—which aims to advance hormone research—and the American Academy of Pediatrics recommend that trans kids and teens have access to developmentally appropriate gender-affirming care.
How can I access gender-affirming care?
If you’re a trans adult seeking gender-affirming care or a guardian of a trans kid or teen who’s seeking gender-affirming care, talk to your health care provider about your options. You can find a trans-affirming provider by searching the World Professional Association for Transgender Health directory or visiting your local LGBTQ+ health center or Planned Parenthood.
Some gender-affirming care may not be covered by insurance. Learn how to make the most of your coverage from the National Center for Transgender Equality. Find insurance plans available through the Marketplace that cover gender-affirming care in some states through Out2Enroll.
Some states restrict or ban gender-affirming care. Learn about the laws in your state by visiting the Trans Legislation Tracker.
Where can trans people and their families find mental health support?
In addition to working with a trans-affirming therapist, trans people and their families can find mental health support through these free services:
- PFLAG offers resources for families and friends of LGBTQ+ people. Find a PFLAG chapter near you.
- The Trevor Project’s hotline has trained counselors who help LGBTQ+ youth in crisis. Call the TrevorLifeline 1-866-488-7386 or text START to 678-678.
- The Trans Lifeline was created by and for the trans community to support trans people in crisis. You can reach the Trans Lifeline hotline at 1-877-565-8860.
For more information, talk to your health care provider.
If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Rehab Science – by Dr. Tom Walters
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Many books of this kind deal with the injury but not the pain; some source talk about pain but not the injury; this one does both, and more.
Dr. Walters discusses in detail the nature of pain, various different kinds of pain, the factors that influence pain, and, of course, how to overcome pain.
He also takes us on a tour of various different categories of injury, because some require very different treatment than others, and while there are some catch-all “this is good/bad for healing” advices, sometimes what will help with one injury with hinder healing another. So, this information alone would make the book a worthwhile read already.
After this two-part theory-heavy introduction, the largest part of the book is given over to rehab itself, in a practical fashion.
We learn about how to make an appropriate rehab plan, get the material things we need for it (if indeed we need material things), and specific protocols to follow for various different body parts and injuries.
The style is very much that of a textbook, well-formatted and with plenty of illustrations throughout (color is sometimes relevant, so we recommend a print edition over Kindle for this one).
Bottom line: if you have an injury to heal, or even just believe in being prepared, this book is an excellent guide.
Click here to check out Rehab Science, to overcome pain and heal from injury!
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