Blame it on the barometric pressure: Any change in pressure, or the weight of the air pressing against the surface of the earth, can trigger joint pain or headaches in some people.

So when your great-aunt said she could “feel” a storm coming on, she was likely right.

“Arthritis affects everything else within the joint itself, including the joint lining, which we call the synovium, as well as the ligaments that are within the joint,” Dr. James Gladstone, co-director of sports medicine at The Mount Sinai Hospital in New York City, told weather.com. “All of those tissues have nerve endings in them, so they’re going to feel changes in the weather as tightness in the joint, or stiffness.”

Although research conclusions on this have been mixed, anecdotal evidence from patients — and most experts — support a link between the two. According to a survey published in the journal Pain, two-thirds of people living with chronic joint complaints in San Diego, Nashville, Boston and Worcester, Massachusetts, believed there to be a link between their pain and weather changes.

The same goes for migraines, which patients also say are linked to weather patterns. Barometric pressure changes, as well as changes in humidity and temperature, might affect the pressure in the brain, or the way the brain blocks pain, Dr. Steven Graff-Radford, director of the program for headache and orofacial pain at the Cedar-Sinai Medical Center in Los Angeles, told weather.com last year, though the mechanism is somewhat unknown. “What’s quite clear, however, is that overcast, cloudy and rainy days produce more migraine headaches,” he said.

Depending on how severe joint or headache pain is, patients should see their doctors to create a changing-weather treatment plan, Dr. Gladstone said.

As the seasons shift, weekend warriors who don’t typically have joint pain should take extra precautions, as well, he added. “Anything cold causes muscles, ligaments and tendons to sort of tighten up, and that makes them stiffer,” Dr. Gladstone said. “So if you’re going to be doing stuff in cold weather, you want to make sure you warm up well first, and as importantly, have protective clothing on, so you don’t get too cold.”

Stretching indoors, jogging in place (if you’re going for a run), heat creams and heating pads can all help loosen up stiff joints, Dr. Gladstone said, adding. “The main thing is to make sure you warm up well.”

As for weather-related pain, it hurts, but it’s only temporary: Your joints should return to normal as soon as the weather changes.

The most common soft tissues injured are muscles, tendons, and ligaments. These injuries often occur during sports and exercise activities, but sometimes simple everyday activities can cause an injury.

Sprains, strains, and contusions, as well as tendinitis and bursitis, are common soft-tissue injuries. Even with appropriate treatment, these injuries may require a prolonged amount of time to heal.

Soft-tissue injuries fall into two basic categories: acute injuries and overuse injuries.

• Acute injuries are caused by a sudden trauma, such as a fall, twist, or blow to the body. Examples of an acute injury include sprains, strains, and contusions.
• Overuse injuries occur gradually over time, when an athletic or other activity is repeated so often, areas of the body do not have enough time to heal between occurrences. Tendinitis and bursitis are common soft-tissue overuse injuries.

Acute soft-tissue injuries vary in type and severity. When an acute injury occurs, initial treatment with the RICE protocol is usually very effective. RICE stands for Rest, Ice, Compression, and Elevation.

• Rest. Take a break from the activity that caused the injury. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
• Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
• Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
• Elevation. To reduce swelling, elevate the injury higher than your heart while resting.

Sprains

A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connect the end of one bone with another. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect the thighbone with the shinbone, enabling people to walk and run.

The areas of your body that are most vulnerable to sprains are your ankles, knees, and wrists. A sprained ankle can occur when your foot turns inward, placing extreme tension on the ligaments of your outer ankle. A sprained knee can be the result of a sudden twist, and a wrist sprain can occur when falling on an outstretched hand.

A twisting force to the lower leg or foot is a common cause of ankle sprains.

Reproduced from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.

Sprains are classified by severity:

• Grade 1 sprain (mild): Slight stretching and some damage to the fibers (fibrils) of the ligament.
• Grade 2 sprain (moderate): Partial tearing of the ligament. There is abnormal looseness (laxity) in the joint when it is moved in certain ways.
• Grade 3 sprain (severe): Complete tear of the ligament. This causes significant instability and makes the joint nonfunctional.

While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains. Treatment for mild sprains includes RICE and sometimes physical therapy exercises. Moderate sprains often require a period of bracing. The most severe sprains may require surgery to repair torn ligaments.

Injuries often occur when people suddenly increase the duration, intensity, or frequency of their activities. Many soft-tissue injuries can be prevented through proper conditioning, training, and equipment. Other prevention tips include:

• Use proper equipment. Replace your athletic shoes as they wear out. Wear comfortable, loose-fitting clothes that let you move freely and are light enough to release body heat.
• Balanced fitness. Develop a balanced fitness program that incorporates cardiovascular exercise, strength training, and flexibility. Add activities and new exercises cautiously. Whether you have been sedentary or are in good physical shape, do not try to take on too many activities at one time. It is best to add no more than one or two new activities per workout.
• Warm up. Warm up to prepare to exercise, even before stretching. Run in place for a few minutes, breathe slowly and deeply, or gently rehearse the motions of the exercise to follow. Warming up increases your heart and blood flow rates and loosens up other muscles, tendons, ligaments, and joints.
• Drink water. Drink enough water to prevent dehydration, heat exhaustion, and heat stroke. Drink 1 pint of water 15 minutes before you start exercising and another pint after you cool down. Have a drink of water every 20 minutes or so while you exercise.
• Cool down. Make cooling down the final phase of your exercise routine. It should take twice as long as your warm up. Slow your motions and lessen the intensity of your movements for at least 10 minutes before you stop completely. This phase of a safe exercise program should conclude when your skin is dry and you have cooled down.
• Stretch. Begin stretches slowly and carefully until reaching a point of muscle tension. Hold each stretch for 10 to 20 seconds, then slowly and carefully release it. Inhale before each stretch and exhale as you release. Do each stretch only once. Never stretch to the point of pain, always maintain control, and never bounce on a muscle that is fully stretched.
• Rest. Schedule regular days off from vigorous exercise and rest when tired. Fatigue and pain are good reasons to not exercise.
• Avoid the “weekend warrior” syndrome. Try to get at least 30 minutes of moderate physical activity every day. If you are truly pressed for time, you can break it up into 10-minute chunks.

Whether an injury is acute or due to overuse, if you develops symptoms that persist, contact your doctor.

WASHINGTON — The night his administration’s Affordable Care Act passed in 2010, President Obama described the victory the way he hopes historians will: as a “stone firmly laid in the foundation of the American dream.”

But Mr. Obama’s prospects for a legacy of expanding health care coverage in the United States for generations have rarely seemed as uncertain as they do today. The Supreme Courtis expected to rule by the end of the month on a critical provision of the Affordable Care Act — insurance subsidies for millions of Americans — and even Mr. Obama’s closest allies say a decision to invalidate the subsidies would mean years of logistical and political chaos.

“Will that have, in the history books, an impact on the president?” said Kathleen Sebelius, who as secretary of health and human services led the fight in Congress to pass the health care law. “I’m sure. I know Republicans like to focus on how this would be a great blow to the president. But for heaven’s sake, they would have a mess on their hands.”

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In the Supreme Court case, King v. Burwell, conservatives have challenged the federal government’s right to subsidize premiums for people who signed up for insurance through a federally run health marketplace. If the government loses, more than 6.4 million of those policy holders could see their premiums triple, or worse. Insurance companies could abandon marketplaces across the country. Mr. Obama’s attempt to engineer a private-sector solution to the country’s health insurance crisis could all but collapse.

“It would be a huge, devastating blow to the country,” said Tom Daschle, a former Democratic senator from South Dakota. “It is cataclysmic, from an insurance perspective.”

Health care experts say the elimination of subsidies would collapse the individual health care marketplaces in dozens of states and largely mean the end of the requirement to buy insurance in those places. But other parts of Mr. Obama’s law should survive, including the guarantee of coverage regardless of pre-existing conditions, an expansion of Medicaid, rules allowing young people to be covered by their parents’ insurance until age 26 and requirements that new health plans cover certain preventive care.

Republicans, who control Congress, say they are aware that Americans may look to them for a solution, and could blame them if bickering and gridlock get in the way. But many say they are gleeful that the court may do with a single decision what Republican lawmakers could not accomplish in five years: Cripple one of Mr. Obama’s signature achievements.

“This is the beginning of the end of the Affordable Care Act,” Representative Paul Ryan of Wisconsin, the chairman of the House Ways and Means Committee, said in an interview.

Mr. Ryan said Republicans were preparing legislation that would protect policy holders from losing subsidies until 2017, when Mr. Obama would no longer be in office. At that point, Mr. Ryan said, Republican lawmakers would try to work with the new president to fully dismantle the health care law and replace it with a more conservative approach.

“The key is to get into 2017,” Mr. Ryan said. “That’s why the court ruling is so devastating to him. It will expose this law, and make it certain that Congress will be rewriting this law fully once he’s gone.”

The president’s allies still hold out hope that the court will not undermine the president’s health care law, noting that even some Republicans believe that Congress intended to allow the subsidies when it passed the legislation. Mr. Daschle said he put the odds of the court’s allowing the subsidies to continue at about 50-50.

Mr. Daschle said Mr. Obama had helped bring about other long-term changes to the country’s health care system that would endure even if the court struck down the subsidies. As an example, he said, hospitals are moving away from the fee-for-service model of payment that has helped drive up the cost of health care.

“There’s an inexorable quality to all of this,” Mr. Daschle said. “With each week, each passing month, each year, it becomes an integral part of the health care system.”

Making the changes part of the fabric of the American health care system was the essence of the White House strategy in 2009 and 2010. Mr. Obama and his top aides, led by Rahm Emanuel, who was the White House chief of staff, pushed Congress to pass a health care overhaul quickly to capitalize on Democratic control of Capitol Hill. They also wanted Mr. Obama to have time to put into action whatever law passed.

Over time, they believed, the changes would burrow their way into public expectations of what government should provide, much as Medicare and Social Security, and, in the process, become a major influence on the way Mr. Obama is remembered.

“For millions of Americans, the Affordable Care Act is embedded and is a reality,” said David Axelrod, who was a senior adviser to Mr. Obama when the health care law was debated in the first term. “That’s not something to be trifled with.”

Polling suggests that public opinion is split about the health care law. In the latest New York Times/CBS News poll, 47 percent of those surveyed said they approved of the law, while 44 percent said they disapproved.

Still, most Americans do not appear eager to see the law’s most critical benefits overturned by the court. In the survey, 70 percent said they thought that the government should continue to provide financial assistance to buy health insurance. That percentage included nearly nine in 10 Democrats, three-quarters of independents and four in 10 Republicans. If the court rules against the government, nearly two-thirds of those surveyed said, Congress should pass a law to reinstate the subsidies.

Even so, a ruling against the government by the Supreme Court would mean years of uncertainty for the Affordable Care Act.

Mr. Obama would leave office in January 2017 without knowing whether millions of people would remain stuck in the ranks of the uninsured. After years of blocking Republican attempts to tinker with the health care law, he would depart knowing that it remained under attack by his opponents. But it would be up to the next president and Congress to decide whether, and how, to fix it or abandon it altogether.

For the president’s closest allies, that prospect is galling.

Mr. Axelrod, the protector of Mr. Obama’s political brand, said the president was not “sitting there thinking about his legacy.”

“He’s thinking about what’s the best thing for the country,” Mr. Axelrod said.

But he is also a veteran campaign operative who spent much of the previous decade trying to get Mr. Obama into the Oval Office. He said the history books would record the president’s efforts to pass a health care law against tremendous opposition, and the effect that the law has already had on millions of Americans.

“The reality is that people’s lives have been affected in a very positive way,” Mr. Axelrod said. “That’s not a legacy that’s going to be erased easily.”

Ms. Sebelius said she worried most about the people who have been able to afford health insurance for the first time because of the subsidies. Some of those people would have to stop treatment if they suddenly lost their insurance because of the court’s decision.

“That, to me, is what would be so wrenching and heartbreaking,” Ms. Sebelius said. “There are people whose lives had changed forever for the better. I don’t know what then happens to them.”

But Mr. Ryan, who vowed to unwind the Affordable Care Act when he was a vice-presidential candidate in 2012, predicted the court would rule against the law.

“I think they cut corners trying to get this bill into law,” Mr. Ryan said. “Those chickens are coming home to roost.” If the court rules against Mr. Obama, he added, “I think it’s a huge blow to his efforts to create a le

After a year of legislative wrangling and premature forecasts of death, historic legislation overhauling the nation’s health insurance system has passed the Congress and been signed into law by President Obama. The measure that finally prevailed, the Patient Protection and Affordable Care Act, is the same legislation the Senate had approved on Christmas Eve of 2009, although it was amended somewhat by a separate “budget reconciliation” measure that President Obama also signed into law.

Because the core health reform measure enacted is the Senate version, much of what we wrote in our earlier article, “The Effects of Health Care Reform on Long-Term Care,” still applies. Just substitute “the newly enacted law” wherever “the Senate bill” appears in the earlier article. The legislation that President Obama signed still contains:

• The nation’s first publicly funded national long-term care insurance program, the Community Living Assistance Services and Supports (CLASS) Act. Its original sponsor, the late Sen. Edward M. Kennedy, did not live to see one of his legislative dreams enacted into law; [Update: the Department of Health and Human Services has stopped implementing this provision of the law.]

• A number of provisions aimed at ending Medicaid’s “institutional bias,” which forces elderly and disabled individuals in many states to move to nursing homes;

• Provisions that will help protect nursing home residents and other long-term care recipients from abuses, and give families of nursing home residents more information about the facilities their loved ones are living in or considering moving to; and

• The Elder Justice Act, which will establish an “Elder Justice Coordinating Council” and provide federal resources to support state and community efforts to fight elder abuse.

Help for Medicare Recipients and Early Retirees

Of perhaps greatest interest to seniors, the law will eventually close the Medicare Part D coverage gap known as the “doughnut hole.” As most seniors know, the Medicare Part D prescription drug program covers medications up to $2,960 a year (in 2015), and then stops until the beneficiary’s out-of-pocket spending reaches $4,700 in the year, when coverage begins again. Many seniors fall into this “doughnut hole” around Labor Day, at which point they have to pay for the medications out of pocket through the end of the year.

The law starts the process of closing the gap by providing a $250 rebate to Medicare beneficiaries who fall into the doughnut hole in 2010. Then, beginning in 2011 there will be a 50 percent discount on prescription drugs in the gap, and the gap will be closed completely by 2020, with beneficiaries covering only 25 percent of the cost of drugs up until they have spend so much on prescriptions that Medicare’s catastrophic coverage kicks in, at which point copayments drop to 5 percent.

In addition, starting January 1, 2011, Medicare will provide free preventive care: no co-payments and no deductibles for preventive services such as glaucoma screening and diabetes self-management. Also, the legislation increases reimbursements to doctors who provide primary care, increasing access to these services for people with Medicare.

The law provides help for early retirees by creating a temporary re-insurance program that will help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64. Scheduled to run from June 21, 2010 through January 1, 2014, the reinsurance program will pay 80 percent of eligible claim expenses incurred between $15,000 and $90,000.

The law calls for an increased Medicare premium for those individuals earning more than $200,000 a year and married couples whose income exceeds $250,000. The law also applies the Medicare payroll tax to net investment income for couples earning more than $250,000 a year or individuals earning more than $200,000 a year.

Most of the cost savings in the law are in the Medicare program, which has made many seniors fearful that their benefits will be cut. The cost-saving measures do not affect the basic Medicare benefits to which all enrollees are entitled, but they may affect those enrolled in private Medicare Advantage plans. Medicare has been paying insurers who offer these plans more than it spends on average for Medicare beneficiaries. The original idea of Medicare Advantage was to save money by paying them less, the idea being that private insurers could be more efficient than the federal government. The opposite turned out to be the case.

Health care reform will pay the private insurers less, meaning that some will choose not to continue their plans and others will curtail extra benefits they offer enrollees, such as reimbursement for gym membership or free eyeglasses. But the cuts will be gradual, with the largest not beginning until 2015. The law also offers bonuses to efficiently run Advantage plans.

Another provision in the law will cut Medicare reimbursements to nursing homes by about $15 billion over the next decade. While nursing homes get only about 13 percent of their revenue from Medicare, the industry relies on the money to make up for low Medicaid reimbursement.

A combination of the additional revenue and savings are estimated to extend the life of the Medicare Part A trust for an additional 7 to 10 years from its current insolvency date of 2017.

Scammers Vote ‘Yes’ on Health Reform

The new law has also created opportunities for scam artists, some of whom are peddling bogus policies through 1-800 numbers and by going door to door, claiming there’s a limited open-enrollment period to buy health insurance, warns secretary of Health and Human Services Kathleen Sebelius. For more on the fraud alert, click here.

The Food and Drug Administration is warning doctors against over-prescribing testosterone-boosting drugs for men, saying the popular treatments have not been established as safe or effective for common age-related issues like low libido and fatigue.

Testosterone supplements may increase the risk of heart attack, stroke and other heart problems, FDA said. Drugmakers must add information about that potential risk to their prescribing labels and conduct a long-term study to further examine the issue, the FDA said.

The agency says drugmakers must clearly state in their labeling and promotions that the drugs, currently taken by millions of U.S. men to the tune of $2 billion, are only approved to treat low testosterone levels caused by disease or injury, not normal aging.

The FDA action follows years of industry marketing for new gels, patches and injections that promise relief from low testosterone or “Low-T.” Promotions from AbbVie, Eli Lilly & Co. and others link the condition to a variety of common ailments in aging men, including sexual problems and low mood.

“There’s been a very successful advertising campaign to make men feel that whatever their problem is, the answer is to buy more testosterone,” said Dr. Sidney Wolfe of Public Citizen. The consumer advocacy group petitioned the FDA last February to add a boxed warning — the most serious type– to testosterone drugs about heart risks. But the FDA rejected the petition in July, saying there was “insufficient evidence” for such a warning.