PFTL News November 2019

SURPRISING THINGS THAT CAN RAISE YOUR BLOOD PRESSURE (from WebMD Sept 2019)

You’ve probably heard to watch the amount of salt you eat, especially if you’re concerned about your blood pressure. That’s because it makes your body hold on to water, putting extra stress on your heart and blood vessels. Salt — and worry, and anger — aren’t the only things that can raise your blood pressure. Although temporary “spikes” aren’t necessarily a problem, numbers that remain high over time can cause serious damage.

Added SugarIt may be even more important than salt in raising your blood pressure, especially in a processed form like high-fructose corn syrup. People with more added sugars in their diet see a significant rise in both their upper and lower numbers. Just one 24-ounce soft drink causes an average 15-point bump in systolic pressure (the top number, or the pressure during a heartbeat) and 9 in diastolic (the bottom number, or the pressure between beats).

Loneliness  – This isn’t just about the number of friends you have — it’s about feeling connected. And being stressed or depressed doesn’t fully explain the effect. It also gets worse with time: Over 4 years, the upper blood pressure of the loneliest people in a study went up more than 14 points. The researchers think an ongoing fear of rejection and disappointment and feeling more alert about your safety and security may change how your body works.

Sleep ApneaPeople with sleep apnea have higher odds of getting high blood pressure and other heart problems. When your breathing is repeatedly interrupted while you’re sleeping, your nervous system releases chemicals that raise your blood pressure. Plus, you’re getting less oxygen, which could damage blood vessel walls and make it harder for your body to regulate your blood pressure down the road.

Not Enough PotassiumYour kidneys need a balance of sodium and potassium to keep the right amount of fluid in your blood. So even if you’re eating a low-salt diet, you could still have higher blood pressure if you’re not also eating enough fruits, veggies, beans, low-fat dairy, or fish. While you may think of bananas as the go-to source, broccoli, water chestnuts, spinach, and other leafy greens are better to get potassium if you’re watching your weight.

PainSudden, or acute, pain ramps up your nervous system and raises your blood pressure. You can see this effect when you put one hand in ice water, press on your cheek or fingernail, or get an electric shock to your finger.

Herbal SupplementsDo you take ginkgo, ginseng, guarana, ephedra, bitter orange, or St. John’s wort? These and others can raise your blood pressure or change how medications work, including drugs to control high blood pressure.

Thyroid ProblemsWhen this gland doesn’t make enough thyroid hormone, your heart rate slows, and your arteries get less stretchy. Low hormone levels also might raise your LDL “bad” cholesterol, another thing that can stiffen arteries. Blood moves through hard vessels faster, pushing on the walls and raising the pressure. Though not as common, too much thyroid hormone can make your heart beat harder and faster, which will also bump up your numbers.

You Have to PeeSystolic pressure went up an average of about 4 points, and diastolic, 3 points, in a study of middle-aged women who hadn’t gone to the bathroom for at least 3 hours. Men and women of different ages saw similar effects. High blood pressure becomes more likely as you age, so you need to get accurate readings. An empty bladder could be one way to help do that.

NSAIDsAll nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen, can raise your numbers — whether you’re healthy or you already have high blood pressure. Though the average rise is only a few points, there’s a wide range, which means it could affect some people much more than others.

Your Doctor’s OfficeYou might see a difference if you compare readings during an appointment to the numbers you get at home. Named for the traditional garb of medical professionals, the “white coat effect” is the rise in blood pressure — up to 10 points higher for systolic (the upper number) and 5 for diastolic (the lower number). DM note – It is wise to question advice about taking meds based solely on the readings in the doctor’s office.

DecongestantsIngredients like pseudoephedrine and phenylephrine can narrow your blood vessels. That means the same amount of blood has to squeeze through a smaller space, like a crowd pushing through a hallway. These drugs can also make blood pressure medications less effective. Your doctor or pharmacist can help you choose over-the-counter products for sinus problems and colds that are safer if you have high blood pressure.

DehydrationWhen your body’s cells don’t have enough water, your blood vessels tighten up. This happens because your brain sends a signal to your pituitary gland to release a chemical that shrinks them. And your kidneys make less pee, to hang on to the fluid you do have, which also triggers tiny blood vessels in your heart and brain to squeeze more.

Hormonal Birth ControlPills, injections, and other birth control devices use hormones that narrow blood vessels, so it’s possible your blood pressure will go up. It’s more likely to be a problem for women who are older than 35, overweight, or smokers. You may want to keep an eye on your blood pressure, checking every 6-12 months. A lower dose of estrogen may keep your numbers closer to normal.

TalkingIt happens whether you’re young or old and no matter where you are. The higher your resting blood pressure, the higher the numbers go when you start speaking. And the effect lasts for a few minutes. It seems the subject and emotional content of what you’re saying matters more than the fact that you’re moving your mouth.

Antidepressants – Medicines that target brain chemicals like dopamine, norepinephrine, and serotonin — including venlafaxine (Effexor), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and fluoxetine (Prozac, Sarafem) — can change not only your mood but also your blood pressure. Selective serotonin reuptake inhibitors (SSRIs) might raise it if you’re also taking lithium or other drugs that affect serotonin.

Have a great Thanksgving holiday!

PFTL NEWS October 2019

HOUSEPLANTS THAT ARE GOOD FOR YOUR HEALTH (from WebMD Sept 2019)

For Allergy Relief – Researchers found that rooms with plants have less dust and mold than rooms without any foliage. Leaves and other parts of the plants act as natural filters to catch allergens and other airborne particles. Common low-light houseplants like Chinese evergreen or the peace lily can do the job. Violets and other plants with textured leaves might be even better trappers. Avoid plants with pollen or spores.

Spider Plants for Moisture – Furnaces and air conditioners can sap humidity indoors, especially in the winter. That can raise your chances for catching a cold or the flu, or make your skin itch. Houseplants add moisture to the air. One study found a collection of spider plants boosted the relative humidity in a bedroom from 20% to a more comfortable 30%. 

Air Purifiers – Carpets, paint, cleaners, printer toners and inks, and many other indoor objects give off pollutants called volatile organic compounds (VOCs). They can build up in the air and irritate your eyes and skin, worsen your asthma, or make it hard for you to breathe. Houseplants can soak up VOCs. Some good air-scrubbers are English ivy, asparagus fern, and dragon tree. 

Herbs for Better Digestion – Mint may help tamp down bloating, gas, and other problems after you eat. Common varieties you can grow in containers include peppermint and spearmint (essential in mint juleps). Basil, another herb for cooking, also can help calm your stomach. Try steeping the leaves in hot water.

Relaxing Lavender – This fragrant purple plant has been an important herbal medicine for centuries. You can inhale lavender oil or massage it on your skin for aromatherapy. You can also boil the leaves for tea. Some studies suggest it may help calm you and help lower any anxiety. But more proof is needed.

Aloe for First Aid – Gel from this plant is a popular home remedy. It can treat sunburns and other minor burns. It can soothe your psoriasis and other skin conditions. Juice from the aloe plant can even help you poop if you’re constipated.

Restful Sleep – Plants take in carbon dioxide and give off oxygen. It’s how they turn sunlight into food, a process called photosynthesis. Some, like gerbera daisies, keep giving off oxygen even after the sun goes down. Put a few cheerful pots in your bedroom and the extra oxygen may help you sleep more soundly.

Stress Relief – Feeling the weight of daily pressures? Try and add a heart-leaf philodendron or a snake plant to your décor. It may help you relax. Several studies have measured people’s levels of blood pressure, heart rate, and the stress hormone cortisol while they handled a tough task or were under mental stress. Being around plants has a calming effect on people.

Sharper Focus – Plants may help raise your test scores, make it easier to concentrate on your tasks, and strengthen your memory. Students in classrooms with three potted plants performed better on math, spelling, reading, and science tests than kids in classrooms without any greens. Bring home a golden pothos or a bamboo palm and you just might clear that to-do list.

Faster Healing – Taking a bouquet of flowers or potted foliage to a loved one in the hospital can be more than just a thoughtful gesture. It may actually help them recover more quickly. Researchers found that people who had surgery got better faster if they had plants in their room or even a view of the nature from their window. They also tolerated pain better and needed fewer medications when surrounded by greenery. Try an orchid or a peace lily.

DISCOUNT AVAILABLE FOR ROADRUNNER SPORTS – WILMETTE

We now have referral cards from Roadrunner Sports, which is located in Eden’s Plaza, Wilmette; these are good for a 10% discount on footwear.  Roadrunner Sports is known for having the world’s most accurate 3D Foot Scanner which analyzes your feet for the perfect fit and shoe. They also have active wear, sports bra, accessories for nutrition, safety and injury prevention. Ask Julie Cohen for a Referral Card.

DIETITIAN, SUSAN STEIN

For many years, we have referred clients who seek nutritional and diet advice to Susan Stein. Susan is a highly qualified registered, licensed dietitian. She understands that everyone is different and no one meal plan will work for everyone. 

Susan has been a Registered Dietitian for over twenty years. She provides individualized nutrition counseling in accordance to the guidelines established by the American Academy of Nutrition and Dietetics.

She works with clients who are dealing with a variety of health issues and with individuals who are seeking a healthier, more fit lifestyle. Ms. Stein is a member of the American Dietetic Association and is certified in both Adult and Childhood/Adolescent Weight Management. She is the coauthor of a children’s book titled Color Me Fit: Nutrition and Fitness for Kids.

Susan will arrange to see our clients on-site at the PFTL studio.  She is offering a package to include a 90-minute evaluation and goal setting session, followed by two 60 minute counselling sessions.  The usual fee is $305, but she is discounting the package by 10% to $275, for PFTL referrals.

Let Julie or Debora know if you would like to be referred to Susan Stein.

ROTARY BOOK DRIVE

Every year the Rotary Club of Wilmette collects books for distribution to inner-city, charter schools in Chicago. The Book Drive runs from October 1 to November 16.  There is a collection box by the front entrance of the studio for gently used books that are suitable for K-12 students.

PFTL News September 2019

UNDERSTANDING CARBS (from WebMD August 2019)

What are Carbs -They’re one of three types of food that give your body energy. The other two are proteins and fats. Together, they provide the fuel your body uses to build and repair itself. Carbs break down into glucose (sugar) that you can use right away.

Your Body’s Fuel – Your body runs on glucose. Your brain, in particular, needs it to work the way it should. Carbohydrates are an almost instant source of it. Your body can break down and use fat for some of the same needs, but not all of them. Plus, fat that’s used for fuel makes compounds called ketones that can raise the level of acid in your blood, and that can be unhealthy.

Workout Prep- Because carbs are a source of energy, they can keep you going strong while you exercise. Experts recommend fueling up 1 to 3 hours beforehand with a combination of carbs and protein, like oatmeal, Greek yogurt, peanut butter, or nuts and raisins.

Full of Nutrients- The best-quality carbs — berries, vegetables, and whole grains — are packed with vitamins, fiber, and antioxidants that are important for good health and well-being. Whole grains have fatty acids, magnesium, B vitamins, folate, and zinc. Fruit and starchy veggies have some of those, plus phytonutrients like flavonoids and carotenoids that help prevent disease. If you skip the carbs, you lose out on those nutrients, too.

Simple Carbs – Think of table sugar as simple carbs in pure form. They’re very small molecules, which makes them especially easy for your body to break down and use. That means they raise your glucose levels (blood sugar) really fast. Things that sweeten any number of candies, pastries, and desserts are loaded with these kinds of carbs.

Complex Carbs- String together a bunch of simple carbs, and you get these larger molecules. Your body has to break them down into simple carbohydrates and then into glucose before it can use them. This takes longer, which means your blood sugar goes up more slowly and they’re less likely to be changed into fat. These kinds of carbs include multigrain breads and pasta, beans, potatoes, and other vegetables.

Storage Tank – Before your body turns leftover glucose from carbs into fat, it stores what it can in your liver in the form of glycogen. This keeps your body going between meals. But your liver can only keep a day or so’s worth at a time. 

If You Have Too Many- If you overdo the carbs, your blood sugar levels can get too high. This causes your body to make more insulin, which tells your cells to save the extra glucose as fat. That can be unhealthy if you’re already carrying a few extra pounds. It can also lead to diabetes

If You Don’t Have Enough- If there aren’t enough carbs in your diet, you could get constipated from lack of fiber and nutrients. Your body is also forced to use protein or fat for energy. Proteins are the building blocks of the body. If you use them as fuel, you may not have enough left to make more cells and keep them healthy

The Right Amount – The number of carbs you need can depend on your gender, size, and how active you are — and that can change as you get older. But as a general rule, about half your daily calories should come from carbs in fruits, vegetables, grains, beans, and dairy products. Just make sure to go with healthy, complex carbs and don’t overdo the simple ones.

Low-Carb Diets – In theory, fewer carbs mean less sugar. And “ketogenic” diets have been shown to help some people lose weight and control their blood sugar in the short term. But these diets include lots of protein, and your body may need to use stored calcium to digest it. Plus, digesting lots of protein can be hard on your kidneys over time. You also tend to eat more saturated fat to replace the carbs, and that can be unhealthy in the long term, too.

Diabetes and Carbs- If you have this disease, you need to watch your carbs carefully because your body has trouble keeping your blood sugar at a safe level. If you have too many, your body may not be able to bring your blood sugar down quickly enough. But if your blood sugar gets too low, a glass of juice or another simple carb might be just the thing to kick it back up again. If you have diabetes, talk with your doctor about the best way to manage carbs.

Where to Get Healthy Carbs- Look for unrefined whole grains like quinoa, rye, and barley instead of highly processed white bread and pastries. Whole unprocessed fruits and vegetables are better than juices. And it’s a good idea to pass on the high-carb potato foods, especially french fries, in favor of beans, chickpeas, and other legumes.

WHEN NOT TO WEAR SUNGLASSES (Excerpted from Time Health August 2019)

Most people know that sunglasses can protect the eyes from damage which can lead to impaired vision or even blindness. There’s evidence that UV damage may raise a person’s risk for macular degeneration, one of the leading causes of age-related blindness. And sun exposure is also linked to eye cancer.

The most important thing is that the sunglasses block 99 to 100% of UVA and UVB rays. Price doesn’t necessarily matter; even inexpensive sunglasses can get the job done—just look for a sticker or tag advertising UV protection. The size of the lenses also makes a difference. The bigger the better.

On the other hand, there are times of the day when shielding your eyes behind sunglasses may not be a good idea. Studies have shown that light-sensing photoreceptors in the eye help to set the body’s circadian clocks, which play a role in regulating sleep, appetite, and much else. Research has found that people who get “high levels” of bright light in the morning tend to sleep better than those who don’t. And wearing sunglasses early in the day may interfere with these processes.

It may be prudent to go without sunglasses until 9 or 10 a.m. Assuming a person isn’t staring straight at the sun, its rays aren’t strong enough in the morning to cause much damage, and exposing the eyes to natural light can help set the body’s “internal clocks”.

ENJOY THE WONDERFUL AUTUMN WEATHER.  NOW IS THE BEST TIME FOR ALL OUTDOOR ACTIVITIES, SO GET OUTSIDE WHENEVER YOU CAN.

PFTL NEWS August 2019

COULD INTERMITTENT FASTING SOLVE YOUR WEIGHT-LOSS PLATEAU?  (Excerpted from Lifestrong.com, 01/08/18; written by Dan Reardon)

There’s been a lot of buzz around intermittent fasting (IF) recently — but what does it really entail? Think about it like this: When you get up in the morning, you eat breakfast. You’re breaking your fast from the previous night.

While you’re sleeping, technically, you’re fasting (unless you’re sleep eating). Conversely, while you’re awake, you’re eating. Intermittent fasting  (IF) can be simply defined as going without food for a longer period of time than sleep and consuming all of your calories within a specific window of time.

Benefits of Intermittent Fasting – Reducing calories (like you do with IF) has been shown to increase the lifespan of cells in the body. In animal models, calorie restriction can actually enhance the longevity of the animals, and limiting food intake might also fight off disease.

From the perspective of body composition, one of the big selling points of IF is your body’s increase in responsiveness to insulin. The hormone insulin is released in response to food. It has the effect of causing the liver, muscle and fat cells to store glucose. In a fasting state, blood glucose levels drop, leading to a decrease in insulin production, which signals the body to start burning stored energy.

There are many potential benefits to intermittent fasting, including:

  • Weight loss
  • Improved mental state
  • Increased energy
  • Improved fat-burning
  • Increased growth hormone production
  • Lowered blood cholesterol
  • Reduction of inflammation
  • Improved cellular repair

Is Intermittent Fasting Right for You? – As of right now, there’s no official test to say whether you should or shouldn’t try intermittent fasting, but there are some general guidelines. You should consider the impact on your lifestyle.

If your IF protocol conflicts with family’s nutrition needs or your work schedule, it might be challenging to commit to an IF schedule. Or let’s say you’re a performance-based athlete: You should consider your nutritional needs, including recovery. Finally, if you’re a woman, intermittent fasting might not be right for you due to hormonal implications.

With any IF protocol, it’s a good idea to talk to your doctor before starting. Will you benefit from IF? Remember, just because your friend did it doesn’t mean it will work for you too.

Ultimately, the only sure way to find out if intermittent fasting is right for you is to try it for yourself.  There are a ton of variations on intermittent fasting, and choosing which one is right for you is often a matter of trial and error. To get you started, here are a few examples of IF protocols:

1. Breakfast Skipper (aka 16/8 Method)

  • Fast for 16 hours, and then eat during an eight-hour window.
  • This is a good protocol for those who are new to IF and would typically eat between the hours of 4 p.m. and midnight.

2. “Leangains”

  • Women fast for 14 hours, while men fast for 16 hours.
  • Similar to the Breakfast Skipper, but the slight decrease in fast length for women is to ensure you’re not messing up your hormones, as females can be more sensitive to signals of starvation.

3. Fast Diet (aka the 5:2 Diet)

  • Eat for five days and significantly cut calories for for two days.
  • This is a more advanced method of fasting in which you eat as you normally would for five days, and then reduce your calories significantly (600 calories for men and 500 calories for women) for two days.

4. Alternating

  • Eat one day, fast the next.
  • With this diet, on the fasting days you should eat a fifth of your recommended daily caloric intake, and then consume a normal amount of calories on feasting days. This is a slightly easier protocol to follow than Fast Diet.

5. Warrior

  • Fast for 20 hours a day and eat one large meal at night
  • This is a more challenging protocol to follow, as you’ll need to ensure you fit all of your important macro- and micronutrients into one meal a day.

There really are a limitless number of variations on the intermittent fasting protocol, so if you’re considering IF, start with one (say, breakfast skipper) and play around with what works with your schedule and hunger levels.

The Impact of Metabolism and Genetics –  As with any nutrition plan, success is largely based on if the diet is right for you. Two factors that play into this equation are your metabolism and genetics.

Suppose you have a fast metabolism and you’re trying to build muscle. Focusing on your calorie intake around exercise means you have lots of energy to work out, with additional energy and amino acids to recover. If you’re a true “hard gainer” or “skinny fat,” IF might help you achieve your goals — not to mention the potential hormonal benefits.

If you have a slow metabolism or you store energy easily, then eating all your calories in a short space of time might make fat loss hard for you because you will hang onto energy even in the fasting windows, so IF might not be a good protocol for you to follow.

PFTL NEWS June 2019

NEW WALKING CLINIC STARTS JUNE 17

This will be the fifth year that PFTL will offer a free walking clinic to our clients and the public.  We will meet Mondays and Thursdays, from 5:30-6:30pm, at the Wallace Bowl in Gillson Park, Wilmette.  Includes warm-up, stretching, intervals, stair climbing, core strengthening and a great way to get some extra exercise.  Contact Julie at 847-251-6834 or [email protected] for more information.  Let us know if you want to be put on our email list for the walking clinic, as walkers are notified when the class is cancelled. Linda Meyer and Leslie Cohen will be assisting with the clinic again this year.

5 SURPRISING WELLNESS PRACTICES THAT CAN REALLY HELP YOU GLOW

(Written by Guest Writer,  Jennifer McGregor co-creator of Public Health Library (http://publichealthlibrary.org/) which provides information about health and wellness topics and creates a forum for sharing reputable health and medical information.)

They say that beauty comes from within, and that’s actually a very true statement. You have to keep your body and mind healthy in order to look and feel your absolute best, but knowing how to take better care of yourself can be a little confusing. Thankfully, we’ve put together a list of some uncommon habits that can have a big impact on your health and wellness.

Protect Your Health and Beauty with Cleaner Air – Above all other elements, you need air to survive, but you need clean air in order to truly thrive. Contaminated indoor air can impair your ability to breathe, leading to increased problems with allergies and asthma. The best way to preserve your overall health is to make sure your air is free from these harmful pollutants. You can use an air purifier, or you can simply change your filters to models with higher MERV ratings. A MERV rating of at least 8, 11 or 13 will trap more particles and prevent smoke, pollen, dander and dust from impacting your breathing and health.

Enhance Your Body and Skin with a Healthier Gut – Better air quality can enhance your beauty and health, but wellness runs even deeper than that. The state of your microbiome may have the most significant impact on how well your body digests food, how strong your immune system is, and even how balanced your mood is each day. Getting familiar with the health of your gut and all of the beneficial bacteria that regulate the processes in your brain and body will help you take more control of your overall health and happiness. If you have skin issues to address, balancing out your microbiome can help you there too. When your microbiome is out of balance, it’s not eliminating toxins as well as it should. Those toxins can end up causing breakouts or other issues with your skin.

Boost Your Skincare from the Outside – There’s a lot of emphasis on skin in this article, and that’s because your skin is so important for protecting the rest of your body. Aside from influencing how you feel about yourself, the presence of healthy skin serves as the first layer of protection against pollutants, toxins and environmental hazards. It’s the largest organ in your body, so make sure you are taking steps to really take care of it. Protect your skin while you’re outside with sunscreen, use mild cleansers when bathing, and choose a good moisturizer to prevent dry skin.

Manage Your Mental Health with More Self-Care – Caring for your skin is not just about aesthetics. When you treat your skin and body well, you are reinforcing your commitment to overall self-care. Self-care isn’t just an option; you need sufficient self-care in order to limit the effects of stress on your mental health. Chronic high stress levels create reactions in your brain that can leave you more vulnerable to depression, anxiety, and other physical health problems. So, start practicing better self-care by taking better care of your skin and body, but don’t stop your efforts there. Research simple self-care practices online, and try a few that feel right for you. You may want to start a new exercise plan or begin morning meditation. You could just need more time to yourself. Know that whatever works for you, self-care is never a selfish way to spend your time.

Look to Your Healthcare Plan – Good health doesn’t stop at trying self-care solutions on your own. You should make full use of the benefits that come with your health plan so you’re getting the most out of your coverage. For seniors, health insurance is especially important to help prevent and treat medical conditions. Check your coverage every year to determine if you need to change it. Depending on your needs, it might be worth considering an alternative healthcare plan like Medicare Advantage, which in addition to Original Medicare also covers dental and vision care and gives you access to nationwide fitness centers. Check with providers like Aetna to find out more. And if you’re not a senior, you should still carefully review your policy to know what’s covered and to check for perks like health and weight loss coaching, 24/7 nursing hotlines, discounts for gym memberships and more. 

It turns out that beauty is more than just skin deep. If you want to be your most radiant and joyful self, you have to pay more attention to all aspects of your physical and mental health. A balanced lifestyle will help you look more beautiful and feel better about yourself.

SOME NICE-TO-KNOW FACTS ABOUT THE SHOULDER  (from ACSM’s Health & Fitness Journal: May/June 2019)

A CURIOUS DESIGN. The human shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone), as well as associated muscles, ligaments, and tendons. Unlike many of the other joints in the body that support movement (e.g., the hip, which has a deep socket), the shoulder has no socket. As such, the ball of the arm bone moves against an essentially flat surface on the shoulder blade.

A BARE CONNECTION. The entire shoulder joint barely has any bony connection to the rest of the skeleton. In fact, the only bony connection is where the shoulder connects to the collarbone via the acromioclavicular joint, which is at the tip of the shoulder, and the sternoclavicular joint, which is at the base of the neck. In essence, the shoulder girdle is designed for very free movement of the arm and shoulder.

EVEN MORE IMPORTANT. The shoulder is more dependent on muscles than any other joint in the body. Given the relative lack of a bony connection between the shoulder and the rest of the body, the lack of a bony socket, and the numerous directions in which the shoulder can move, the eight muscles that control the stability and movement of the shoulder and the arm play a critical role in the process.

A BETTER OPTION. A number of people erroneously believe that they need surgery to fix their shoulder pain/injury. As a rule, they don’t. Rather, they should engage in a plan of action of conservative treatment, including rest, ice, anti-inflammatory drugs, and a gradual return to activity, as well as a well-designed program of stretching and strengthening exercises, which can improve function and decrease pain in the affected area.