Jul
14
2010
An Introduction to Psychosocial Genomics: How the body speaks to us about the effects of non-invasive processes such as therapeutic hypnosis
Hill, R. 2010 . Australian Journal of Clinical Hypnotherapy and Hypnosis 31 (1), pp. 5-16
Until recently, therapeutic hypnosis and the mind-body therapies have had little capacity to make empirical measurements of their benefit with an objective, common standard of reference. Among many therapies such as the talk therapy (e.g. cognitive-behaviour psychotherapy, counselling, etc), energy therapies(e.g.reiki,acupuncture,homeopathy) and massage therapies (e.g. remedial, Shiatsu, trigger point), for example, there Is no general agreed upon measure by which they can all be evaluated. Mostly, studies have depended upon phenomenological reporting of improvement In sense of well-being, affect, and other perceptions of health improvement. By its nature, however, phenomenological reporting has a high level of subjectivity. Although subjectivity In itself is not a reason to discount such evidence, it would certainly be beneficial if there was a way of objectively measuring responses In the body. After several decades of prescient study, Ernest Rossi (1986, 2002, 2004, 2007) has found a common, objective measurement, which provides a yardstick that transcends personal subjectivity. He proposes that the new DNA microarray technology provides objective evidence for evaluating all the mindbody therapies. This new field of empirical investigation, which he calls, “Psychosocial Genomics,” measures changes in the deep psychoblological process of “activity or experience-dependent gene expression and brain plasticity”associated with creativity and psychotherapy. By examining which genes are turned on or off before and after therapeutic hypnosis, Rossi has been able to establish that genes beneficial to health and well being are expressed in the hours and days following the use of his Activity-Dependent Mirror Hand Protocol for therapeutic hypnosis (Rossi, lannotti et al., 2008). This paper outlines the conceptions and research of Ernest Rossi into the deep psychoblological basis of consciousness and the nascent possibilities for future research in therapeutic hypnosis and all the mind-body therapies.
Jul
9
2010
Visceral Osteopathy: The Peritoneal Organs
by Jérôme Helsmoortel Thomas Hirth Peter Wührl
Visceral Osteopathy: The Peritoneal Organs is concerned with the application of osteopathic concepts to the abdominal viscera, specifically the organs of the gastrointestinal tract. It lays out a comprehensive manual approach to these viscera based on physiological research and extensive clinical experience.
The visceral paradigm developed in this book is centered on the mechanical expression of the biological forces within the organs themselves. In this paradigm, the most important aspect of the viscera of the gut is their intrinsic, autonomous regulation. The focus is therefore on the inner mechanical architecture and power centers of the viscera.
Visceral Osteopathy offers a comprehensive and clinically sound system of diagnosis and treatment of the digestive organs, and firmly establishes visceral manipulation in the context of contemporary physiological research.
The diagnostic and therapeutic approaches of visceral osteopathy are described in detail and are accompanied by hundreds of photographs and drawings that clearly illustrate each of the techniques, including an original bi-manual form of palpation for all the viscera. A separate chapter is devoted to each of the peritoneal organs.
Available from http://www.terrarosa.com.au/cst/visceral_osteopathy.htm
Jul
9
2010
Orthopedic Assessment in Massage Therapy is written for the soft-tissue practitioner or student seeking to improve their understanding and treatment of soft-tissue dysfunction. Any healthcare practitioner involved in treating soft-tissue disorders with massage will find this text beneficial.
Orthopedic Assessment applies established orthopedic assessment methods to massage therapy evaluation. How soft-tissues function, their roles, and the primary ways in which they are damaged are explored in the first part of the book. The symptoms, causes, and evaluation of numerous common conditions are discussed in detail in the remaining chapters.
Assessment is a mandatory step, without which treatment would be a guessing game based on assumptions, not clinical reasoning. -Whitney Lowe
305 pages
Available from http://www.terrarosa.com.au/book/orthopedic_assessment.htm
Jul
9
2010
Learn the Art of Craniosacral Therapy with interactive techniques along with beautiful 3-D animations that show exactly which structures are involved. Judah Lyons will guide you through progressive Listening Skills in a lifetime journey.
In this 6 DVD home study series, you will be guided on a journey of the most profound and divine nature. Using both lecture and stunning graphic presentations, you will be ushered step by step on the path with this 110 year old system that will not only bring amazing and magical results to your practice, but change you at the deepest level of your being.
This style of Biodynamic Craniosacral Therapy is based on the lineage from Sutherland, Becker, Sills and others, with current concepts of physics, where the human form is perceived as a liquid, crystalline matrix.
Here are just a few of the things you will learn from this DVD set:
* The liquid crystalline nature of our beings and resonant fields
* The practitioner’s mind which separates this work from other models
* The ritual of contact to imbue the field
* Cranial vault holds
* Learning to work from the feet
* The sacrum and its movement patterns
* Still points
* Synchronizing with the mid-tide and the long-tide
* Diaphragm holds
* Inertial fulcrums
* Sphenoid bone and its movement patterns
* Sphenobasilar joint movements
* Directing tide
* Disengagement
* Traction
* And more concepts about the nature of healing
The materials presented in this DVD series will infinitely change the way you do your bodywork forever. Follow the clearly presented instructions in the DVDs and begin a powerfull new way of being in the world. Your clients will appreciate your new skills .
Available from http://www.terrarosa.com.au/cst/craniosacral.htm
Jul
9
2010
The quality of online information about the most common sports medicine diagnoses varies widely, according to a study published in the July 2010 issue of the Journal of Bone and Joint Surgery (JBJS). Therefore, patients who use the Internet to help make medical decisions need to know that the web may not be giving the whole picture.
“The reason that we decided to undertake this study is that patients are presenting to their physicians office with increasing frequency armed with printouts of information obtained from the Internet,” said Madhav A. Karunakar, MD, an orthopaedic surgeon at Carolinas Medical Center in Charlotte, N.C., and one of the study’s authors. “Physicians and patients should be aware that the quality of information available online varies greatly. Additionally, physicians should be prepared to discuss this information with their patients in order to ensure that it is not misinterpreted.”
Nearly three-quarters of the U.S. population has access to the Internet, and more than half of those people go online for health-related information at least once a month. However, quality controls over the health information found on the web have not grown at the same rate that Internet use has.
The study’s authors chose ten of the most common sports medicine diagnoses and reviewed the online information available on them. The diagnoses reviewed were:
* Anterior cruciate ligament (ACL) tear
* Medial collateral ligament (MCL) tear
* Posterior cruciate ligament (PCL) tear
* Rotator cuff tear
* Meniscal tear
* Labral tear (shoulder ligament injury)
* Tennis elbow
* Acromioclavicular joint separation (shoulder separation)
* Patellofemoral syndrome (knee pain)
* Osteochondral defect (joint defect)
Using the two most frequently used search engines (Google and Yahoo), the authors reviewed the top ten search results for each diagnosis, looking for completeness, correctness, and clarity of the information. They also recorded the source of the information—whether the site’s owner was a nonprofit organization, news source, academic institution, individual, physician, or commercial enterprise.
In terms of content, Dr. Karunakar says, nonprofit sites scored the highest, then academic sites (including medical journal sites), and then certain non-sales-oriented commercial sites (such as WebMD and eMedicine). The least accurate information sources were newspaper articles and personal web sites. Commercial sites with a financial interest in the diagnosis, such as those sponsored by companies selling a drug or treatment device, were very common but frequently incomplete.
“About 20 percent of the sites that turned up in the top ten results were sponsored sites,” Dr. Karunakar says. “These site owners are motivated to promote their product, so the information found there may be biased. We also found that these sites rarely mentioned the risks or complications associated with treatment as they are trying to represent their product in the best possible light.”
The study’s authors suggest that patients be counseled to avoid commercial Web sites, with the exception of the most reputable sites, such as WebMD and eMedicine, and look for the seal of compliance for transparency and accountability from the Health On the Net Foundation (HON). Orthopaedic residents and any health-care professional who may use the Internet as a reference tool during their education are similarly cautioned. The AAOS recommends Your Orthopaedic Connection, or orthoinfo.org, as a resource for patient education information, or if specific to sports medicine, the American Orthopaedic Society for Sports Medicine (AOSSM).
“Despite its shortcomings, the Internet is the future of how patients will obtain information to make their healthcare decisions,” says Dr. Karunakar. “Therefore, patients and physicians need to make sure they are getting that information from reputable, accurate sources.”
Jul
9
2010
Even though it is widely used as a therapy for low back pain, a randomized controlled trial finds that patients with chronic low back pain (LBP) and degenerative lumbar osteoarthritis (OA) who took glucosamine for six months showed little difference on measures of pain-related disability, low back and leg pain and health-related quality of life, compared to patients who received placebo, according to a study in the July 7 issue of JAMA.
“Osteoarthritis is a common condition that currently affects more than 20 million individuals in the United States, and this number is expected to increase,” the authors write. “Low back pain is widespread and is the second most common concern expressed by patients in primary care. It poses a diagnostic and therapeutic challenge to clinicians due to the unclear etiology [cause] and the range of interventions with limited effect.” Glucosamine is widely used as a treatment for OA, despite its controversial and conflicting evidence for effect, and is also increasingly taken by LBP patients, even though the evidence of its effectiveness remains inconclusive.
Philip Wilkens, M.Chiro., of Oslo University Hospital and University of Oslo, Norway, and colleagues investigated the effect of a 6-month intake of glucosamine in reducing pain-related disability by conducting a randomized, placebo-controlled trial with 250 patients older than 25 years of age with chronic LBP (for longer than 6 months) and degenerative lumbar OA. Patients took either 1,500 mg. of oral glucosamine (n = 125) or placebo (n = 125) daily for 6 months, with effects assessed after the 6-month intervention period and at 1 year. The primary outcome was pain-related disability as measured with the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes were numerical scores from pain-rating scales of patients at rest and during activity and a quality-of-life measure. Data collection occurred at the beginning of the trial and at 6 weeks, 3 and 6 months, and at 1 year.
At the beginning of the trial, the average RMDQ score was 9.2 for the glucosamine group and was 9.7 for the placebo group. The 6-month average RMDQ score was 5.0 for both the glucosamine and placebo group, and 1-year score was 4.8 for the glucosamine group, and 5.5 for the placebo group. No statistically significant difference in change between groups was found when assessed after the 6-month intervention period and at 1 year for RMDQ, and for measures of LBP at rest, LBP during activity and quality-of-life. Mild adverse events were reported in 40 patients in the glucosamine group and 46 patients in the placebo group.
“Based on our results, it seems unwise to recommend glucosamine to all patients with chronic LBP and degenerative lumbar OA. Further research is needed to clarify whether glucosamine is advantageous in an alternative LBP population,” the authors conclude.
(JAMA. 2010;304[1]:45-52. Available pre-embargo to the media at www.jamamedia.org)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Glucosamine and the Ongoing Enigma of Chronic Low Back Pain
Andrew L. Avins, M.D., M.P.H., of Northern California Kaiser-Permanente, Oakland, Calif., writes in an accompanying editorial that there is a need for quality research regarding effective treatments for low back pain.
“The results of the high-quality clinical trial by Wilkens et al carefully evaluating a widely used treatment for chronic LBP were disappointing but should not be discouraging. Clearly, much more work remains before realizing the kinds of success in the treatment of chronic LBP that other conditions have experienced. With an objective and determined focus, sufficient support, greater collaboration, and a working partnership with patients, there is every reason for optimism, however cautious. The real test will be whether the environment for this success can be created and sustained.”
(JAMA. 2010;304[1]:93-9452)
Jul
9
2010
Approximately 10% of low back pain (LBP) sufferers experience persistent pain and significant disability. In a study published in the August issue of Pain, a group of Australian researchers investigating the relevance of health literacy in patients with chronic lower back pain (CLBP) found that LBP-related beliefs and behaviors affect a person’s disability more than pain intensity or a standard measure of functional health literacy. However, when delving deeper into aspects of health literacy, important factors were identified which might help to explain disability associated with CLBP, highlighting important factors to consider in the delivery of information for CLBP.
Health literacy, the ability to seek, understand and utilize health information, is important for good health. Low levels of health literacy have been associated with poorer health outcomes in many chronic conditions, although this had not been studied previously in CLBP, even though CLBP imposes a significant personal and societal burden.
The health literacy of individuals with CLBP was examined using a mixed methods approach. 117 adults participated, comprising 61 with no history of CLBP and 56 with CLBP (28 with low and high disability, respectively, as determined by a median split in disability using a scoring system for characterizing disability associated with lower back. pain). The sample group consisted of Australian adults from a middle class community with a similar socioeconomic status.
Investigators collected data regarding severity of pain, LBP-related disability, fear avoidance, beliefs about LBP, and pain catastrophizing (the tendency to have a fixation about pain and feel unable to cope with it). Health literacy was measured using the Short-form Test of Functional Health Literacy in Adults (S-TOFHLA). A sub-sample of 36 participants with CLBP (with high and low levels of CLBP-related disability) also participated in in-depth interviews to qualitatively explore their beliefs about LBP and experiences in seeking, understanding and using information related to LBP.
“Although we know a fair amount about the reasons for persistent pain and disability among individuals who experience lower back pain, interventions which aim to modify these factors deliver only modest changes in outcomes. This suggests that we may be overlooking an important factor which influences treatment outcomes – and that is health literacy,” according to lead investigator Dr. Andrew Briggs, School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Australia. “Quantitative data confirmed that LBP-related beliefs and behaviours, rather than pain intensity and functional health literacy skills measured from a standard questionnaire, are important correlates of LBP disability. Less positive beliefs and pain attitudes are associated with persistence of pain and high levels of LBP-related disability. These include beliefs about the inevitable dire consequences of LBP, fear avoidance beliefs and the belief that pain results in a hopeless situation (catastrophizing). Beliefs and subsequent pain-related behaviours and coping strategies are shaped by interactions with health professionals and health information. Therefore, it is plausible that health literacy and LBP beliefs are related and that health literacy may be an important driver of LBP-related disability. We wanted to explore how people with CLBP seek, understand and utilize health information more thoroughly than information derived from a questionnaire, so we included a large qualitative arm to the study.”
High-disability (HD) and low-disability (LD) groups were compared. The HD group reported a greater degree of interference with recreational activities (86%) compared to the LD group (27%). The HD group also reported significantly greater fear avoidance beliefs about physical activity, adopted a more passive coping style and was less optimistic about the future progression of their condition. While all participants with CLBP had adequate health literacy scores measured on a questionnaire (S-TOFHLA), qualitative (interview) data highlighted difficulties in seeking, understanding and utilizing LBP information.
Individuals in both the HD and LD groups identified similar perceived causes for LBP, including sports injuries, incorrect manual handling procedures, and poor posture. Individuals with CLBP-low disability also cited their work practices, in particular sitting at a computer for too long, general “wear and tear,” and heritability as causes of their disability, while individuals with CLBP-high disability cited being overweight and ageing as causes for their LBP.
Participants predominantly sought information from health professionals when their disability or LBP became unmanageable, or when it interrupted their lifestyle. A strong theme that emerged across both high and low disability groups was the perception that physiotherapists and chiropractors had more expertise in the management of LBP than general practitioners and were therefore able to provide more specialized information. However, most participants stated that their understanding of LBP issues was hindered by complex medical terminology.
An important finding from this study was that individuals with CLBP-high disability tended to attribute their pain experience to an anatomic reason, while this trend was not noticed in the CLBP-low disability group. “Although anatomic reasons may be important in some cases of CLBP, international data and guidelines highlight the importance of psychological and social factors in the etiology of CLBP,” commented Dr. Briggs. “The fact that individuals with CLBP-high disability believed anatomic factors were the primary reason for their pain experience highlights that belief systems and information provided to patients are critically important in management.”
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The article is “Health literacy and beliefs among a community cohort with and without chronic low back pain” by Andrew M Briggs, Joanne E Jordan, Rachelle Buchbinder, Angus F Burnett, Peter B O’Sullivan, Jason Y.Y Chua, Richard H Osborne, and Leon M Straker. It appears in Pain, Volume 150, Issue 2 (August 2010)
Jul
9
2010
Researchers at the University of Granada, in collaboration with the Clinical Hospital San Cecilio (Granada) and the University Rey Juan Carlos (Madrid), are applying a 30-minute massage to ease tension headaches, which are increasingly frequent in our society. The results of this pioneer study were published in the American Journal of Manipulative Physiological and Therapeutics
The results have proven that the psychological and physiological state of patients with tension headache improves within 24 hours after receiving a 30-minute massage.
As researchers explained, tension headaches have an increasing incidence in the population. This type of disorder is usually treated with analgesics, that relieve symptoms temporarily. One of the main causes of this type of headache is the presence of trigger points. Recently, new strategies for controlling this disabling pain are being studied.
Physiological improvement
The researcher Cristina Toro Velasco ¬ leader of the study, under Professor Manuel Arroyo Morales supervision- has proven that a 30-minute massage on cervical trigger points improves autonomic nervous system regulation in these patients. Additionally, patients exhibit a better psychological state and “reduce the stress and anxiety associated to such a disturbing disorder”.
Similarly, patients report a perceived relief from symptoms within 24 hours after the massage. This might mean that massages may reduce the pain caused by trigger points, which would involve an improvement in the general state of patients.
The results of this pioneer study were published in American Journal of Manipulative Physiological and Therapeutics.
References:
Toro-Velasco C, Arroyo-Morales M, Fernández-de-Las-Peñas C, Cleland JA, Barrero-Hernández FJ. Short-term effects of manual therapy on heart rate variability, mood state, and pressure pain sensitivity in patients with chronic tension-type headache: a pilot study. J Manipulative Physiol Ther. 2009 Sep;32(7):527-35.
Jul
5
2010
Does massage therapy reduce cortisol? A comprehensive quantitative review
Christopher A. Moyer Ph.D, Lacey Seefeldt B.A., Eric S. Mann B.A. and Lauren M. Jackley
Objectives
It is frequently asserted that massage therapy (MT) reduces cortisol levels, and that this mechanism is the cause of MT benefits including relief from anxiety, depression, and pain, but reviews of MT research are not in agreement on the existence or magnitude of such a cortisol reduction effect, or the likelihood that it plays such a causative role. A definitive quantitative review of MT’s effect on cortisol would be of value to MT research and practice.
Methods
After first performing a comprehensive literature search and retrieval, we use rigorous and conventional meta-analytic methods for calculating between-groups effect sizes. As a point of comparison, we also replicate an unconventional approach taken by other reviewers, in which MT recipients’ within-group cortisol reductions are quantified as a percentage of change, despite the fact that this introduces numerous confounds not addressed by the first approach.
Results
Resultant between-groups effect sizes are almost all small (ds = 0.05–0.30) and nonsignificant. The lone exception is MT’s multiple-dose effect in children, which is larger (d = 0.52) and statistically significant, but which is based on only three studies and vulnerable to the file-drawer threat. Within-group percentage reductions of cortisol in MT recipients are generally smaller than those found by other reviewers, and are generally inconsistent with the more rigorous between-groups results, which illustrates the unsuitability of this unconventional approach to assessment of treatment effects.
Conclusions
MT’s effect on cortisol is generally very small and, in most cases, not statistically distinguishable from zero. As such, it cannot be the cause of MT’s well-established and statistically larger beneficial effects on anxiety, depression, and pain. We conclude that other causal mechanisms, which are still to be identified, must be responsible for MT’s clinical benefits.
Jul
5
2010
How much time is required to modify a fascial fibrosis?
Borgini Ercole MD, Stecco Antonio MD, Day Julie Ann PT and Carla Stecco MD
Various authors suggest that trauma or overuse syndromes can alter the connective tissue and that, in particular, it could become tighter, altering its histological, physiological and biomechanical characteristics. Some suggest an alteration of the collagen fibre composition, while others evidence the alteration of the fibroblasts with their transformation into myofibroblasts, meanwhile others suggest an alteration in the ground substance due to neurophysiological influences and changes in biochemical fluid relationships could be involved.
It is also theorized that different manual and physical techniques could restore the normal physiological state of the fascia, but there is very little scientific evidence about the mode of action of manual therapies in general.
The perception of what appears to be connective tissue fibrosis, and its consequent modification during therapy, is a daily experience for most manual therapists.
The aim of this study was to evaluate the time required to modify a palpatory sensation of fibrosis of the fascia in correlation with changes in levels of patient discomfort in 40 subjects with low back pain utilizing the Fascial Manipulation technique.
This study evidenced, for the first time, that the time required to modify an apparent fascial density differs in accordance with differences in characteristics of the subjects and of the symptoms. In particular, the mean time to halve the pain was 3.24 min; however, in those subjects with symptoms present from less than 3 months (sub-acute) the mean time was lesser (2.58 min) with respect to the chronic patients (3.29 min). Statistically relevant (p < 0.05) differences were also evidenced between the specific points treated.
