Do You Really Need an X-Ray, CAT Scan, or MRI for Knee Pain?

Whether you're a runner, an aspiring athlete, or just someone dealing with the aches and pains of getting older, you've likely at some point felt a twinge of discomfort in your knee. Considered one of the largest and most complex joints in the body, the knee is subject to a lot of wear and tear and overall stress. And while it may seem logical to explore the root cause of any discomfort with the sophisticated tech tools out there -- namely x-rays and magnetic resonance imaging (MRI) - it turns out, that's not always necessary.

"Knee pain is one of the most common sports injuries I see," says Boston-based medical provider Michael Richardson. "It can be very debilitating, which in turn causes a lot of anxiety for my patients and a strong desire to fix things fast. Many patients request either an MRI or x-ray when they get knee pain, but this is not always needed."

Understanding imaging
You've probably heard of or experienced x-rays, CAT scans, and MRIs, but knowing each one's unique function and purpose may help you understand why they're not needed to diagnose and treat every case of knee pain.

X-rays are a type of radiation called electromagnetic waves that create black and white pictures of particular body parts. The varying shades of black and white indicate how much radiation each part of the body part's tissue is absorbing; bones appear as white because they absorb the most, fat and other soft tissue appear gray because they absorb less, and air appears black because it absorbs the least (which explains why the lungs look so dark on an x-ray). Getting an x-ray is usually pretty simple and straightforward and the resulting images will allow your provider to see if there's a fracture, joint dislocation, or some other issue affecting the bone.

Computed (Axial) Tomography (CT or CAT) scans combine the function of x-rays with computers to produce 360-degree, cross-sectional views of different body parts. These scans can show your provider what's happening in the bones, soft tissue, and blood vessels, and can be used to detect a range of injuries and illnesses.

Unlike x-rays and CAT scans, MRIs use a strong magnetic field and radio waves to create pictures of the organs and tissues in the body. MRI scans can depict the soft tissues in your body, such as ligaments and tendons, that aren't detectable on an x-ray. The procedure can be more intensive than an x-ray and a lot more expensive.

Why imaging isn't always the answer for knee pain
If you've been dealing with nagging pain that seemingly originated out of nowhere, imaging may not provide the enlightenment you are looking for. "Injuries that have an insidious onset, meaning came on slowly without a specific traumatic event, rarely needing imaging immediately," Richardson says. "This type of knee pain is often knee pain that comes on after long distance running or biking. These are usually wear and tear injuries that will improve with rest, stretching, and leg strengthening exercises."

Richardson notes that there are some specific cases that may merit more urgent imaging for non-traumatic knee pain - elderly people, very young kids, and professional athletes, for example, may need immediate attention. But for most people, strictly sticking to a self-care routine should help alleviate nagging knee pain. Don't see a difference in your symptoms? Then it may be time to seek medical care. "If there is no improvement in the pain after six weeks of physical therapy, then your doctor may order imaging to see if there is anything odd going on with your knee," Richardson says.

When imaging might be necessary
MRIs or x-rays are recommended for anyone who's experienced a specific injury to their knee that's resulted in pain or discomfort. "Trauma is when imaging is needed more urgently, Richardson says. "Any injury in which the person can not bear weight on the leg or trauma that caused immediate pain, such as failing, someone or something hit you, or any other mechanism that caused extreme force to your knee." Richardson says those types of traumatic events typically warrant an X-ray to look for broken bones or joint misalignment. If the results do not indicate any breaks, doctors typically recommend a few weeks of rest and an exercise regimen to strengthen and stretch the legs.

If, however, the pain and/or instability persists, that's when additional imaging may be necessary. "An MRI is helpful to look for torn internal structures of the knee like your anterior cruciate ligament (ACL) and meniscus," Richardson says. "There is rarely a need for an urgent MRI, so it is reasonable to wait a few weeks before having one done."

Here are the most likely reasons to discuss imaging with your doctor:

• Immediate pain after some sort of trauma
• Unable to bear weight on the knee
• Knee pain that does not improve after 6 weeks of strengthening and conditioning

The 5 best ways to keep your kids safe this summer

School's out and so is the sun, but along with warm weather and outdoor adventures, summer can also bring unfortunate injuries. Kids are especially prone to mishaps since they're so active, so it's important to take special precautions. Here are five ways to keep your kids healthy this summer:

1. Choose the right sunblock.
You know sunblock is essential, but the type you choose is important too. I recommend a physical blocker as opposed to chemical one since it sits on top of the skin and offers superior protection. Just make sure the active ingredients include zinc oxide or titanium oxide and that the label promises broad-spectrum protection against UVA and UVB rays. SPF 30 is perfectly sufficient as long as it's reapplied every two years, and a water-resistant brand is best since it withstands sweat. You can use a small amount of infants, but their primary protection should be long sleeves, a hat, and plenty of shade; it's best to keep little ones under 6 months out of the sun as much as possible.

2. Stay safe in the streets.
Whether your child skates, bikes, or zips around on a hoverboard, a helmet is a must. The most important consideration is size - make sure they try it on in the store to ensure the right fit. And even if your kid isn't on wheels, make sure they know basic street safety like looking left, right, then left again when watching for cars.

3. Practice good pool habits.
Kids as old as 8 should be within arm's reach any time they're in the pool - even if they know how to swim. It only takes a second for accidents to happen, so it's best to stay close. While floaties can be fun, they also make kids overconfident in their water skills, so keep the arm's distance rule even if they're buoyed by floatation devices. And if you have a pool at home, make sure it's surrounded on all sides by a 4-foot safety gate that's child-proof.

4. Prevent and treat mosquito bites the right way.
There are several things you can do to limit mosquito bites. Children 2 months or older can safely wear repellents containing DEET, IR3535 or picaridin, but make sure the concentration is 10 percent or less. Rather than opting for a spray, try to find wipes, which offer more precise application and less fumes. If you'd prefer chemical-free alternatives, citronella, lemongrass, and eucalyptus oils can be effective, but they haven't been studied in children under three. If your child goes get a bite, apply over-the-counter 1 percent hydrocortisone or a baking soda and water paste to stop the itching.

5. Stay hydrated in hot weather.
Drinking enough fluids is important any time of year, but it's especially crucial while running around in hot weather. Kids between ages 4 and 8 should aim for about five cups of liquid a day, and teenagers should strive for seven to 11. Water's the best choice, but milk, as well as limited amounts of juice, can also be hydrating.

With these tips in mind, you and your kids should have a happy and healthy summer full of fun. And if you do need a pediatrician, please stop by a doctor's office.

3 Tips For Managing Caregiver Burnout

Caregivers have an incredibly important role in the health of their family and are often tasked with keeping everyone healthy and happy. These are the people who, when a loved one is in need, step in and manage everything from meal preparation to administering medication to helping out around the house. With so many things to keep track of (including their own young children), it's no wonder caregivers often feel overwhelmed.

The number of people caring for a parent at the same time as their kids has rapidly increased now that more and more couples are choosing to wait until later in life to have children. In 2016,  Harvard Health estimated that around 15 million family members were taking care of 8 million adults aged 65 or older. Almost half of these caregivers were putting about 28 hours per week toward caring for a loved one.

When your attention is divided between taking care of your children and taking care of a parent, self-care and mental health are often the first areas of your life to drop on your list of priorities. When that happens, it can lead to overwhelming stress known as "caregiver burnout."

Wondering if you have caregiver burnout? Here are a few ways to identify the signs and some steps you can take to work towards a more balanced life.

What is caregiver burnout?
Caring for another person can impact your life in ways you didn't expect, like limiting the amount of time you have to spend with friends, causing financial strain, and even draining your ability to perform everyday tasks. "Stressors associated with caregiving situations are often persistent, uncontrollable, and unpredictable, with one-third of all caregivers describing a high burden of care" says the American Family Physician Organization. Caregiver burnout offers when the pressures of looking after the health of another person interfere with your own mental and physical well-being.

What is the impact of burnout on caregiver's health?
The strain on caregivers is significant. Studies show that caregivers have an increased risk for:

• Alcohol and substance abuse
• Anxiety disorders, stress and depression
• Cancer
• Diabetes
• Heart disease
• Obesity

How do you know if you're experiencing caregiver burnout?

According to the American Family Physician Organization, "One in five caregivers describes his or her health as fair or poor, and 17 percent believe that their health has deteriorated as a result of providing care". If you're caring for a loved one (child, adult, or both) and relate to any of the following symptoms, you may be approaching or currently experiencing caregiver burnout:

• Fatigue
• Anxiety
• Insomnia
• Weakened immune system
• Depression
• Increased irritability
• Weight fluctuations
• Lack of motivation

How to stay healthy while caring for someone else

If you're responsible for taking care of a loved one, making sure your own needs are met is of the utmost importance. After all, it's hard to care for someone else when you're not feeling your best. If you think you might be experiencing caregiver burnout, take a look at these tips that may be able to help you manage your stress more effectively.

1. Make time for yourself

Caregivers are faced with an almost endless list of things to do. Communicating with doctors, providing transportation, and taking care of your own household - all while learning about new caregiving practices - can seem to absorb all the time in your day.

This is why it's critical to set aside time for yourself when you're a primary caregiver for someone else. Whether it's meditating, practicing yoga, or just going for a walkin in the woods, it's important to take time for self care before caring for your loved one.

2. Accept help

Accepting help can be one of the most difficult things to do when you feel weighed down by responsibility. Because of the sheer number of tasks to accomplish on any given day, it can often feel hard to let others help. But if someone offers to take over some of your responsibilities, let them. Try having a list ready of items that can be managed by someone other than yourself.

3. Talk to someone if you feel depressed

Caregiving is a strenuous job, and feeling overwhelmed all the time can take a major toll on your mental health. One of the most common issues caregivers face is depression, which can cause feelings of hopelessness and suicidal thoughts.

If you think you might be struggling with depression as a result of your caregiving responsibilities, don't be afraid to seek help. Finding a qualified therapist and taking active steps toward improving your mental health will make a big difference in your ability to continue this important and necessary role.

Being a caregiver is one of the most difficult roles you can take on. If you're having trouble keeping up with your list of responsibilities, know that you're not alone. By setting boundaries and becoming aware of the tools that can make your job easier, you can effectively manage the stress you may be feeling.