Feb
7
2010
Recent research into causes of knee pain in middle age show the importance of muscle strengthening.
If you are over 50, you are also likely to be someone who’s getting pain in the knees. Knee pain can be caused by all sorts of things, from arthritis to conditions that have long names like patella-femoral syndrome, which just hide the fact that doctors haven’t a clue what’s going on.
One of the risk factors for pain in the knees is being overweight or obese. And when people are heavy they also tend to exercise less. So, the question is whether weight loss and muscle strengthening can help?
A recent trial randomly assigned overweight and obese people aged over 45 with knee pain into four groups: a weight-reducing diet, knee exercises designed to strengthen the quadriceps (those are the muscles on the front of your thigh), combined diet and exercises, and a control group – who just got an advice leaflet.
Over a two-year follow-up, the quadriceps exercises were associated with a significant reduction in knee pain, while weight loss wasn’t – although the people in the trial only lost an average of 3kg, which may not be enough for the average knee. People who lost weight, however, did feel less depressed. Nine people had to strengthen their quads for one person to benefit.
So while any weight loss is a good idea for health overall, for your knees you need to get those thighs working.
For Reference
Title: British Medical Journal
Author: Jenkinson CM et al. Effects of dietary intervention and quadriceps strengthening exercises on pain and function in overweight people with knee pain: randomised controlled trial.
BMJ 2009;339:b3170.
http://www.abc.net.au/health/minutes/stories/2009/11/19/2700843.htm
Feb
7
2010
Exercises aimed at improving your sense of control of ankle movements can help prevent re-occurrence of ankle sprains.
Researchers in the Netherlands wanted to see if they could prevent people re-spraining their ankles after their first injury.
They randomly assigned 500 athletes who’d sprained their ankles to either no follow-up care or to an eight-week, home-based training program that gave them exercises specifically designed to improve the person’s sense of control of their ankle movement. They had to do the so-called proprioceptive training for half an hour at least three times a week, and preferably before sport too.
Those doing the program had a one in five chance of a repeat sprain, while the controls had a one in three chance. That was a significant difference, especially considering that only a quarter of them did all the sessions asked of them. For some reason, people who hadn’t been treated by a doctor for their initial injury benefited more.
So, given that ankle sprains are painful, and can mean time lost at work, it may be that proprioceptive training might be advisable for non athletes with ankle sprains – ie klutzes like me.
For Reference
Title: British Medical Journal
Author: Hupperets MDW. Effect of home-based proprioceptive training on recurrences of ankle sprain: randomised controlled trial.
BMJ 2009;339:b2684
From http://www.abc.net.au/health/minutes/stories/2009/12/01/2701059.htm
Feb
5
2010
The phantom promise
Research on amputees has shown that the brain can be tricked into feeling pain. The process could be reversible
Touch something sharp like a pin and it will hurt. Maybe quite a lot, depending on how hard you press on it. Another person doing the same will have to endure the kind of shooting pain that you did.
The idea that people’s perception of the world is built from their senses — how we see, smell, hear and touch things — has long been held as the essence of experience. The sensory data is transmitted along nerves to the brain, where it is decoded and converted into a speeding car, a shrill alarm or a sharp pin prick.
But studies of pain and the brain have, over the past few decades, shown the striking limitations of this conventional view. Neuroimaging has highlighted the multidimensional factors at play, from the obvious sensory alerts — the “don’t touch sharp pins” and “your leg is broken” messages — to the complex mix of cognition, emotion, injury and memory that dictate more chronic sensations. As Irene Tracey, Professor of Anaesthetic Science at the University of Oxford, observes: “For too long pain has been seen as sensory, when really it’s an emotion.”
Our greater understanding of the neurological mechanisms of pain begins to address some intriguing questions. Why is it that the aches and twinges felt after running a marathon or giving birth can be enjoyable when other comparable physical stresses are not? How does the context of pain act as a physiological trigger? And, most tantalisingly, can pain be mentally repositioned so that it is a neutral experience, or even a pleasurable one? This has always been the goal of counselling and behavioural therapies, but by untangling the biology of pain, scientists such as Tracey can now explore precise means of “remapping” the brain so that people think about their discomfort in a positive light.
RELATED LINKS
The drugs don’t work anymore
The phenomenon of phantom limb syndrome has offered particularly useful insights into the brain’s role in the way that pain processes vary. When a person loses an arm or leg after a traumatic injury — such as those suffered by soldiers, or by people in traffic accidents — they will often experience the feeling that the limb is still there. They might have the sensation of a fist forming and unclenching, a leg swinging or, in more severe cases, aching, burning pains emanating from some part of that absent limb.
Conventional thinking suggests that some nerve endings, chopped and traumatised in the injury or amputation, must be misfiring, sending the wrong signals to the brain.
But patients’ experiences have shown matters to be less straightforward. Painful accidents suffered years before the amputation can suddenly “reawaken”. The whole arm may now be gone, but the time the person dislocated a finger on a rugby pitch years earlier may give a specific niggling, even paralysing, feeling.
Craig Murray, a neuroscientist based at Lancaster University, has come across several such phantom limb cases, including examples of multiple memories —unrelated to the traumatic amputation injury — that become simultaneously intertwined.
Murray describes the pain experienced by one adult patient who lost his leg in a road traffic accident. “As a child he had had his foot crushed by a train, then later in adulthood he suffered a serious car accident that resulted in the loss of his leg from above the knee. Yet the pain he feels now is the one in his foot, remembered from years earlier.”
As Murray puts it, such phantom limbs show how pain can be more about brain and body — “representations of the body within the brain acquired through experience” — than specific physical injury.
Such examples of chronic pain, which can be excruciating and last for decades, form part of wider investigations into the mechanics of why things can hurt long-term. And with 20 per cent of the UK population affected — from back problems and migraines to cancer — the potential not only in terms of quality of life, but also healthcare cost and productivity, is enormous.
According to Tracey, the barrage of signals generated by an episode of acute pain cause the spinal cord and brain to undergo changes that “amplify the volume”. The result, which she suggests could be brought on by the sufferer’s genetic or psychological disposition, is a “central sensitisation” that marks the emergence of chronic pain.
“A very small peripheral input — a tiny trickle — can be ratcheted up in the amplification process and activate areas of the brain as if it’s very intense pain. This is not only involved in the generation of chronic pain, but also the maintenance of it.”
For phantom limb sufferers, this understanding of the plasticity of the central nervous system, and the potential for brain reappraisal, has offered innovative solutions to a once untreatable problem.
Groundbreaking work on neural plasticity in the 1990s by V. S. Ramachandran, now at the University of California, first indicated that phantom limbs could be a result of changes in the brain. The cramping sensation often felt by amputees, he suggested, might occur because the person had tried to move the injured limb without success, and the sensory feedback burnt itself into the brain circuitry. The brain had learnt the particular feeling and, when the limb was long gone, returned to it as a best guess at what was being experienced.
Ramachandran developed what he termed “mirror box therapy” to overcome this learned paralysis. Some patients who moved one arm while looking at the reflection in a mirror placed in the position of their other, amputated arm, experienced an alleviation of pain. Not only could they see the phantom limb, but they could also feel it move. Phantom fists could be unclenched, wrists untwisted, even feet uncrushed. For some, the therapy has allowed them to escape decades of pain.
RELATED LINKS
The drugs don’t work anymore
Studies by Herta Flor, Professor of Cognitive and Clinical Neuroscience at the University of Heidelberg, show the correlation between phantom limb pain and changes in the way that peripheral areas of the body are represented in the sensory cortex. The group has devised experiments using mirror boxes and sophisticated prosthetics to explore how this cross-wiring in the primary somatosensory and motor areas of the brain — from where an absent hand or foot used to be controlled — can be encouraged to untangle.
Flor’s research has included mirror training with war veterans, which has offered insights into the close and complicated links between phantom limbs and post-traumatic stress disorder. Once again, mental anxiety appears to have a stranglehold on what was once seen as physical pain.
Playing tricks with the brain’s sensory processing has moved into a further dimension with the use of virtual reality simulations. In Lancaster, Murray is exploring the use of immersive programmes of 3-D graphics involving virtual reality simulations. The physical limitations of a mirror box are overcome as the patient puts on a headset and enters a life-sized virtual world where they have two limbs.
It all leads back to the big question. Can a person, with the guidance of visual imagery and imagination, be encouraged to interpret pain in a different way? Like Tracey and Flor, Murray, and a team at Manchester University, believe such a reorganisation of the sensory cortex to be within our grasp. “Can experiences be reconfigured and reimagined so that they are not painful ones?” Murray asks.
“A person’s capacity to deal with pain and the way they experience it has a lot to do with their individual psychological world. To be able to reorganise this, and alter a person’s pain experiences, is a very exciting proposition.”
http://www.timesonline.co.uk/tol/news/science/eureka/article7011376.ece
Jan
28
2010
Comparison of Active Stretching Technique and Static Stretching Technique on Hamstring Flexibility
Meroni, Roberto PT; Cerri, Cesare Giuseppe MD, PhD; Lanzarini, Carlo PT; Barindelli, Guido PT; Morte, Giancesare Della PT; Gessaga, Viviana PT; Cesana, Gian Carlo MD, MSc; De Vito, Giovanni MD, MSc
Clinical Journal of Sport Medicine:
January 2010 – Volume 20 – Issue 1 – pp 8-14
doi: 10.1097/JSM.0b013e3181c96722
Objectives: To compare a passive and an active stretching technique to determine which one would produce and maintain the greatest gain in hamstring flexibility. To determine whether a passive or an active stretching technique results in a greater increase in hamstring flexibility and to compare whether the gains are maintained.
Design: Randomized controlled trial.
Setting: Institutional.
Participants: Sixty-five volunteer healthy subjects completed the enrollment questionnaire, 33 completed the required 75% of the treatment after 6 weeks, and 22 were assessed 4 weeks after the training interruption.
Intervention: A 6-week stretching program with subjects divided into 2 groups with group 1 performing active stretching exercises and group 2 performing passive stretching exercises.
Main Outcome Measures: Range of motion (ROM) was measured after 3 and 6 weeks of training and again 4 weeks after the cessation of training and compared with the initial measurement.
Results: After 3 weeks of training, the mean gain in group 1 (active stretching) on performing the active knee extension range of motion (AKER) test was 5.7°, whereas the mean gain in group 2 (passive stretching) was 3° (P = .015). After 6 weeks of training, the mean gain in group 1 was 8.7°, whereas the mean gain in group 2 was 5.3° (P = .006). Twenty-two subjects were reassessed 4 weeks after the cessation of the training with the maintained gain of ROM in group 1 being 6.3°, whereas the maintained gain in group 2 was 0.1° (P = .003).
Conclusions: Active stretching produced the greater gain in the AKER test, and the gain was almost completely maintained 4 weeks after the end of the training, which was not seen with the passive stretching group. Active stretching was more time efficient compared with the static stretching and needed a lower compliance to produce effects on flexibility.
Jan
28
2010
Acupuncture for Lower Back Pain: A Review
Lewis, Katrina MD; Abdi, Salahadin MD, PhD
The Clinical Journal of Pain:
January 2010 – Volume 26 – Issue 1 – pp 60-69
doi: 10.1097/AJP.0b013e3181bad71e
Objective: We briefly discuss the history of acupuncture and its postulated mechanisms of action, but our primary objective is to discuss the evidence for acupuncture’s efficacy in low back pain as well as approaches of newer study protocols to define more clearly the true usefulness of this alternative modality in low back pain.
Methods: Pubmed online search of all articles and other literature in the past 50 years related to acupuncture efficacy in low back pain, including case reports, randomized controlled trials and meta-analyses.
Results: Lower back pain and its associated incapacitating sequelae constitute an important healthcare and socioeconomic problem. There have been multiple, generally poor quality studies on the efficacy of acupuncture for this multi-factorial pain condition. Although newer studies seem to show promise, effectiveness has not been clearly demonstrated.
Conclusions: There is a paucity of high-quality research assessing efficacy of acupuncture in the management of LBP. Nonetheless, it continues to play a significant role in our clinical practice, not as a sole therapeutic modality but rather as an adjunct to a multidisciplinary integrative approach of LBP management. Most of the published articles about acupuncture in the biomedical literature consist of case reports, case series, or intervention studies with designs inadequate to assess its efficacy. Thus it is imperative that further research be performed, both preclinical to help elucidate the mechanisms underlying acupuncture, and clinical to justify its clinical application.
Jan
28
2010
Effectiveness of Pain Management Following Electrical Injury
Li, Adrienne L. K. BASc; Gomez, Manuel MD, MSc; Fish, Joel S. MD, MSc, FRCS(C)
Journal of Burn Care & Research:
January/February 2010 – Volume 31 – Issue 1 – pp 73-82
doi: 10.1097/BCR.0b013e3181cb8e94
The purpose of this study was to evaluate the effectiveness of pain management after electrical injury. A retrospective hospital chart review was conducted among electrically injured patients discharged from the outpatient burn clinic of a rehabilitation hospital (July 1, 1999, to July 31, 2008). Demographic data, numeric pain ratings (NPRs) at initial assessment and discharge, medications, nonpharmacologic modalities, and their effects before admission and after rehabilitation were collected. Pain management effects were compared between high (≥1000 v) and low (<1000 v) voltage, and between electrical contact and electrical flash patients, using Student’s t-test and χ2, with a P < .05 considered significant. Of 82 electrical patients discharged during the study period, 27 were excluded because of incomplete data, leaving 55 patients who had a mean age ±SD of 40.7 ± 11.3 years, TBSA of 19.2 ± 22.7%, and treatment duration of 16.5 ± 15.7 months. The majority were men (90.9%), most injuries occurred at work (98.2%), mainly caused by low voltage (n = 32, 58.2%), and the rest caused by high voltage (n = 18, 32.7%). Electrical contact was more common (54.5%) than electrical flash (45.5%). Pain was a chief complaint (92.7%), and hands were the most affected (61.8%), followed by head and neck (38.2%), shoulders (38.2%), and back torso (38.2%). Before rehabilitation, the most common medication were opioids (61.8%), relieving pain in 82.4%, followed by acetaminophen (47.3%) alleviating pain in 84.6%. Heat treatment was the most common nonpharmacologic modality (20.0%) relieving pain in 81.8%, followed by massage therapy (14.5%) alleviating pain in 75.0%. During the rehabilitation program, antidepressants were the most common medication (74.5%), relieving pain in 22.0%, followed by nonsteroidal antiinflammatory drugs (61.8%), alleviating pain in 70.6%.
Massage therapy was the most common nonpharmacologic modality (60.0%), alleviating pain in 75.8%, and then cognitive behavioral therapy (54.5%), alleviating pain in 40.0%. There were pain improvements in all anatomic locations after rehabilitation except for the back torso, where pain increased 0.7 ± 2.9 points. Opioids were more commonly used in high voltage (P < .05), and cognitive behavioral therapy in low-voltage injuries (P < .05). Opioids were used in both electrical flash and electrical contact injuries. Pain in electrically injured patients remains an important issue and should continue to be addressed in a multimodal way. It is hoped that this study will guide us to design future interventions for pain control after electrical injury.
Jan
28
2010
Effleurage massage, muscle blood flow and long-term post-exercise strength recovery
TIIDUS P. M. ; SHOEMAKER J. K. ;
Wilfrid Laurier univ., dep. physical education, Waterloo ON, CANADA
Résumé / Abstract
Manual massage is commonly assumed to enhance long term muscle recovery from intense exercise, partly due to its ability to speed healing via enhanced muscle blood flow. We tested these assumptions by daily (for four days) massaging the quadriceps muscles of one leg on subjects who had previously completed an intense bout of eccentric quadriceps work with both legs. Immediate post-exercise isometric and dynamic quadriceps peak torque measures had declined to approximately 60-70% of pre-exercise values in both legs. Peak torques for both the massage and control leg tended to slowly return toward pre-exercise values through the subsequent four days (96 hrs). There was no significant difference between the isometric and dynamic peak torques between massage and control legs up to 96 hours post-exercise. Leg blood flow was estimated by determining femoral artery and vein mean blood velocities via pulsed Doppler ultrasound velocimetry. Massage of the quadriceps muscles did not significantly elevate arterial or venous mean blood velocity above resting levels, while light quadriceps muscle contractions did. The perceived level of delayed onset muscle soreness tended to be reduced in the massaged leg 48-96 hours post-exercise. It was concluded that massage was not an effective treatment modality for enhancing long term restoration of post-exercise muscle strength and its use for this purpose in athletic settings should be questioned.
Revue / Journal Title
International journal of sports medicine ISSN 0172-4622 CODEN IJSMDA
Source / Source
1995, vol. 16, no7, pp. 478-483 (34 ref.)
Jan
26
2010
Adverse events and manual therapy: A systematic review
Dawn Carnes, Thomas S. Mars, Brenda Mullinger, Robert Froud and Martin Underwood
Objective
To explore the incidence and risk of adverse events with manual therapies.
Method
The main health electronic databases, plus those specific to allied medicine and manual therapy, were searched. Our inclusion criteria were: manual therapies only; administered by regulated therapists; a clearly described intervention; adverse events reported. We performed a meta-analysis using incident estimates of proportions and random effects models.
Results
Eight prospective cohort studies and 31 manual therapy RCTs were accepted. The incidence estimate of proportions for minor or moderate transient adverse events after manual therapy was ~41% (CI 95% 17–68%) in the cohort studies and 22% (CI 95% 11.1–36.2%) in the RCTs; for major adverse events ~0.13%. The pooled relative risk (RR) for experiencing adverse events with exercise, or with sham/passive/control interventions compared to manual therapy was similar, but for drug therapies greater (RR 0.05, CI 95% 0.01–0.20) and less with usual care (RR 1.91, CI 95% 1.39–2.64).
Conclusions
The risk of major adverse events with manual therapy is low, but around half manual therapy patients may experience minor to moderate adverse events after treatment. The relative risk of adverse events appears greater with drug therapy but less with usual care.
Jan
26
2010
Stretching versus strength training in lengthened position in subjects with tight hamstring muscles: A randomized controlled trial
Cecília F. Aquino, Sérgio T. Fonseca, Gabriela G.P. Gonçalves, Paula L.P. Silva, Juliana M. Ocarino and Marisa C. Mancini
Manual Therapy, Volume 15, Issue 1, February 2010, Pages 26-31
Stretching is used to modify muscle length. However, its effects seem to be temporary. There is evidence in animal models that strengthening in a lengthened position may induce long lasting changes in muscle length. The objective of this study was to compare changes in hamstrings flexibility, peak torque angle and stretch tolerance after two training programs: stretching and strengthening in a lengthened position.
Forty-five subjects with tight hamstrings were randomly assigned into three groups: control, stretching and strength training in lengthened position. The interventions were performed three times a week for eight weeks. The subjects were assessed before and after the end of the programs. Data provided by an isokinetic dynamometer were used to assess hamstrings flexibility, peak torque angle, and stretch tolerance.
The data analysis demonstrated that strengthening in lengthened position changed peak torque angle in the direction of knee extension (p = 0.001). No change in flexibility was observed (p = 0.449). Both experimental groups showed an increase in stretch tolerance (p = 0.001). The results demonstrated that strengthening in a lengthened position produced a shift of the torque–angle curve, which suggests an increase in muscle length. Conversely, stretching did not produce modification of torque–angle curve and flexibility; its effects appear restricted to increases in stretch tolerance.
Jan
26
2010
Contemplation is a good thing, and meditation has been known to spawn great ideas and deep insightfulness, But include MOTION, AFFIRMATIONS AND MUSIC, and it improves meditation in a powerful way!
Unique gentle & easy practice Encompassing Mind, Body and Soul Through Movement, Spoken Words, Affirmations & Music
This DVD has 8 sequences, choreographed movements, inspired words, affirmations and music.
It is simple and easy to do yet powerful as a daily practice. Filmed in magnificent locations.
The spoken words are positive, truthful and beautiful. They leave you feeling deeply connected to your power within, still, alive, warm and energised. Just what you need in this face paced over active world.
They are inline with many current ideas and research i.e. Expressing gratitude, the law of attraction, heart centered feelings, forgiveness, self love and respect and living in the present moment all being highly beneficial to the mind and body.
This DVD is available from: http://www.terrarosa.com.au/yoga/affirmotion.htm