Sunday, November 30, 2008

Kinetic chain release/ Active Release

Active Release Techniques (ART) is a breakthrough in the treatment of injury and provides permanent pain relief. Even better, ART can help in avoiding surgery. When soft tissue is injured, it gets stuck—or adheres—causing inflammation, scar tissue, impeded movement and even entrapped nerves. Using a series of hands-on protocols, ART identifies and removes these muscular adhesions. Adhesions that go untreated often cause a chain reaction of new adhesion cycles in connected tissue structures or musculoskeletal systems that are overcompensating in response to the pain. These chronic stages of soft tissue damage are why so many of us are in pain—even if we lead a healthy, active lifestyle. ART brings permanent resolution to many injuries previously considered untreatable, sometimes in just a few sessions. ART has a 90% success rate with such chronic problems as carpal tunnel, rotator cuff injuries, knee injuries, back pain, sciatica, headaches and many more. Over 500 specific treatment protocols are used to release the adhesions, separate the bound tissue and restore function. Through this process, the core problems that cause sharp or dull pain with inflammation, stiffness, weakness, numbness, and other physical dysfunctions are eliminated—and the pain goes away.If you’re living in pain, ART provides a non-surgical solution to all muscle and nerve pain issues. Active Therapeutics is recognized as the most experienced and comprehensive soft-tissue practitioners in USA. Hence ART is a comprehensive approach i.e. a Soft Tissue Management System that can permanently eliminate pain.

Friday, November 28, 2008


In the mid-1970s Dr John Upledger was the first practitioner to teach some of these therapeutic skills to people who were not osteopathically trained. Dr Upledger had become drawn to exploring primary respiratory motion after an incident that occurred while he was assisting during a spinal surgical operation. He was asked to hold aside a part of the dural membrane system which enfolds the spine, while the surgeon attempted to remove a calcium growth. To his embarrassment, Dr Upledger was unable to keep a firm hold on the membrane, as it kept rhythmically moving under his fingers. He took a post-graduate course in cranial osteopathy and then set out on his own path of clinical research. Over the years, Dr Upledger has done a great deal to popularize craniosacral work around the world.
When Dr Upledger began to teach non-osteopaths, he encountered great opposition from many in the profession who believed that the foundation of a full osteopathic training is necessary to practise the craniosacral approach. Many osteopaths are still of this opinion, and it continues to be a cause of much debate and argument. However, many also believe that this work can provide an integrated approach to health care in its own right and need not remain within the sole domain of osteopathic practice. Nevertheless, one thing is for sure: a good foundation in anatomy, physiology and medical diagnosis is necessary in order to apply craniosacral work with safety and competency. It also takes time and proper training to develop the necessary skills. It is an unfortunate fact that in recent years there are many people who have set up in practice with only minimal training.
Cranial osteopathy and craniosacral therapy.
It was Dr Upledger who coined the term "craniosacral therapy" when he started to teach to a wider group of students. Dr Upledger wanted to differentiate the therapeutic approaches he had developed and, furthermore, the title "cranial osteopath" could not be used by those new practitioners who were not osteopathically trained.
One question frequently asked is, "What is the difference between cranial osteopathy and craniosacral therapy?" Although Dr Upledger states that these two modalities are different, the differences are not always so obvious. They both emerge from the same roots and have much common ground, yet different branches have developed. A variety of therapeutic skills are now commonly used by both osteopaths and non-osteopathic practitioners of this work, so neither cranial osteopathy nor craniosacral therapy can be accurately defined by just one approach. However, in practice, craniosacral therapists often work more directly with the emotional and psychological aspects of disease.
Craniosacral biodynamics.
In the biodynamic view of craniosacral work an emphasis is placed on the inherent healing potency of the Breath of Life. In this approach, the functioning of the body is considered to be arranged in relationship to this essential organizing force. This has practical ramifications for the way in which diagnosis and treatment are carried out. This way of working also has a direct link to the pioneering insights of Dr Sutherland. It's interesting to note that during the latter years of his life, Dr Sutherland focused his attention more and more on working directly with the potency of the Breath of Life as a therapeutic medium. He saw that if the expression of this vital force can be facilitated, then health is consequently restored. Dr Rollin Becker, Dr James Jealous and Franklyn Sills have each added valuable insights into the operation of these natural laws which govern our health.
In the last 15 years there has been a huge increase of interest in craniosacral work. It is now taught and practised in many countries around the world. As this work is largely unregulated by law, professional associations have now been set up in many of these countries.

Tuesday, November 25, 2008

Quantifying the lumbar flexion-relaxation phenomenon: theory, normative data, and clinical applications.

Following is a excerpt form Neblett R et al’s study on flexion-relaxation phenomenon:
The flexion-relaxation phenomenon has been recognized since 1951, and it can be reproducibly assessed in normal subjects with FR unloaded. It can be found intermittently in patients with chronic low back pain. Recent studies have moved toward deriving formulas to identify FR, but only a few have examined a potential relation between inclinometric lumbar motion measures and the surface electromyographic signal. No previous studies have developed normative data potentially useful for objectively assessing nonoperative treatment progress, effort, or the validity of permanent impairment rating measures.
This phenomenon was offer a potentially promising method for individualizing rehabilitation treatment, decreasing unnecessary utilization, identifying potential postrehabilitation treatment failures, and assessing permanent impairment rating validity. Moreover, this is the first study to demonstrate systematically that an absence of FR in patients with chronic low back pain can be corrected with treatment.
Flexion-relaxation measures a point at which true lumbar flexion ROM approaches its maximum in asymptomatic subjects. This also is the point at which lumbar extensor muscle contraction relaxes, allowing the lumbar spine to hang on its posterior ligaments. The gluteal and hamstring muscles then lower the flexed trunk even further by allowing the pelvis to rotate around the hips.

Does the evidence support the existence of lumbar spine coupled motion? A critical review of the literature.

Legaspi and Edmond of USA reviewed the current literature addressing coupled motion between side bending and rotation in the lumbar spine to determine if a consistent pattern exists across articles. They found 24 articles in which 32 analyses addressed their clinical question. Seventeen of the 24 articles identified concluded that some form of coupled motion exists; however, there was little agreement across articles as to the specific characteristics of coupled motion. They found high degree of inconsistency in reported patterns of coupled motion. This suggested that physical therapists should use caution when applying concepts of coupled motion to the evaluation and treatment of patients with low back pain.

Monday, November 24, 2008

Physical therapy for Bell s palsy (idiopathic facial paralysis).

Bell's palsy (idiopathic facial paralysis) is commonly treated by physical therapy services with various therapeutic strategies and devices. There are many questions about their efficacy and effectiveness. To evaluate the efficacy of physical therapies on the outcome of Bell's palsy Teixeira LJ et al in 2008. They searched the Cochrane Neuromuscular Disease Group Trials Register (February 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2007), MEDLINE (January 1966 to February 2008), EMBASE (January 1980 to February 2008), LILACS (January 1982 to February 2008), PEDro (from 1929 to February 2008), and CINAHL (January 1982 to February 2008).
They selected randomised or quasi-randomised controlled trials involving any physical therapy. We included participants of any age with a diagnosis of Bell's palsy and all degrees of severity. The outcome measures were: incomplete recovery six months after randomisation, motor synkinesis, crocodile tears or facial spasm six months after onset, incomplete recovery after one year and adverse effects attributable to the intervention.
RESULTS: They found; in the trials studying the efficacy of electrostimulation (294 participants) and exercises (253 participants), neither treatment produced significantly more improvement than the control treatment or no treatment. There was limited evidence that improvement began earlier in the exercise group. So they concluded that, there is no evidence of significant benefit or harm from any physical therapy for idiopathic facial paralysis. The possibility that facial exercise reduces time to recover yet sequelae needs confirming with good quality randomised controlled trials.

Graston Technique

Graston Technique Changing the way soft tissue injuries are treated. Graston Technique is an interdisciplinary treatment used by nearly 5000 clinicians—including athletic trainers, chiropractors, hand therapists, occupational and physical therapists.

GT is implemented at the following settings:
Out Patient FacilitiesCompanies/IndustrySchools and UniversitiesSports Organizations

For the clinician: It provides improved diagnostic treatment. It help in detecting major and minor fibrotic changes in soft tissue. It also reduces manual stress; provides hand and joint conservation of the clinician. It also increases patient satisfaction by achieving notably better outcomes that further expands business and revenue opportunities
For the patient: It decreases overall time of treatment, fosters faster rehabilitation/recovery, reduces need for anti-inflammatory medication, resolves chronic conditions thought to be permanent
Six stainless steel instruments form the cornerstone of Graston Technique. The curvilinear edge of the patented Graston Technique Instruments combine their concave/convex shapes to mold the instruments to various contours of the body. This design allows for ease of treatment, minimal stress to the clinician's hands and maximum tissue penetration.
Specialty of Graston Technique:
The Graston Technique Instruments, much like a tuning fork, resonate in the clinician's hands allowing the clinician to isolate adhesions and restrictions, and treat them very precisely. Since the metal surface of the instruments does not compress as do the fat pads of the finger, deeper restrictions can be accessed and treated. When explaining the properties of the instruments, we often use the analogy of a stethoscope. Just as a stethoscope amplifies what the human ear can hear, so do the instruments increase significantly what the human hands can feel.

Saturday, November 22, 2008

The weight watchers

Weight watchers has “Four Pillars” of weight loss based on research that includes:
3.Support, and
Each is an important component of a well rounded weight loss program that has lasting results.

Points of weight watchers (USA)

1. Widely available
On the website, enter zip code, and meeting locations and times are presented.
2. No commitments
Can attend meetings once a week for less than an hour. There’s no contract, it is pay as you go.
3.Physician referral
Children between the ages of 10-17 need a doctor's note with a goal weight. Children under the age of 10 are unable to join.
4. Use behavioral components since 1974
Now offers online access and weigh-ins. Message boards are available online and members are encouraged to communicate with one another.
5. Nutritionally sound exchange program
Incorporates the exchange list into the program for individuals choosing the flexible points plan.
6. Convenience
Can meet one hour a week at the nearest location for meetings.
7. Exercise
Incorporated into the plan for individuals cleared to exercise. Offers demonstrations, advice and plans.
8. Online access
Offers recipes and information on foods and special dietary needs. The database contains over 15,000 favorite recipes submitted by the Weight Watchers® community. Has message boards on various topics and e-tools to track progress.

Participants are encouraged to share their own and view other success stories.

Top commercial weight-loss programs of USA

Weight Watchers
Overeaters Anonymous
Nutri System
Diet Center
Health Management Resources
Jenny Craig
Medical Weight Loss Clinic
LA Weight Loss
Curves for Women

Saturday, November 15, 2008

Adherence and effectiveness of 4 popular diets- Weight change at 1-year

Atkins (Carbohydrate restriction): weight loss of 2.1 kg; 21 patients [53%] of 40 patients completed the study.
Ornish (Fat restriction): weight loss of 3.3 kg; 20 patients [50%] of 40 patients completed the study.
Weight Watchers (Energy restriction): weight loss of 3.0 kg; 26 patients [65%] of 40 patients completed the study.
Zone (Macronutrient balance): weight loss of 3.2 kg; 26 patients [65%] of 40 patients completed the study.

Exercise Facts on metabolism & physiological systems

• The role of physical activity in type 2 diabetes prevention is well established. (DPS, DPP)
• Physical activity improves glycaemic control but has no significant effect upon body mass index. (Boule et al, JAMA 2001)
• Physical activity has beneficial effects upon cardiorespiratory fitness. (Boule et al, Diabetologia 2003)
• > 30 minutes of moderate-intensity physical activity on most (preferably all) days of the week. (ACSM)
• To maintain long-term weight loss, studies suggest that more exercise (60-75 mins/day) is needed (Di Loreto, Diabetes Care 2005)
• Post-intervention A1c lower in exercise groups compared with control groups (weighted mean difference –0.66%)
• No difference in body weight (weighted mean difference 0.54kg) (Boule et al, Diabetes Care 2003)

Wednesday, November 5, 2008

Athlete’s knee problems and the cartilage know how:

Knee pain is one of the commonest in athlete. The following are the most common causes:

1. Cartilage Tears
2. Patellar Tendinitis
3. ACL Injuries

The menisci: The two crescent-shaped pads of cartilage are present in both knees. The pad on the inner side of the knee is the ‘medial meniscus’, while the outer one is the ‘lateral meniscus’.

Together they act in four different ways to improve knee function:
1. They spread load across the joint. In standing, this is up to 50% of the supported load; in flexion (bending at the knee) it increases to 90%
2. They improve joint congruency or stability
3. They increase the contact surface area of the main leg bones, helping to spread the weight of the body across a greater area of articular cartilage
4. They help to circulate synovial (joint) fluid around the knee.

Crucially, the menisci have limited healing potential as their blood supply only reaches the outermost 10% to 30% of each meniscus. Within this region tears may heal. But more centrally-located tears have very little chance of healing.

Tuesday, November 4, 2008

Back pain solutions for general readers of this blog.

According to a USA study 90 percent of Americans suffer from LBA at some point of time in life and the gross USA back pain expenditure is around $50 billion per year.
A simple view of why LBA occurs?
First it’s important to understand why we get that back pain in the first place: tendons attach your muscles to your bones. Ligaments attach bones to bones. As you get older, your flexibility decreases. Certain muscles shorten and your joints lose their range of motion—meaning your ligaments get weaker. This can trigger a number of back problems.
A simple technique that’ll rid you of back pain in as little as two minutes a day.

Healthy stretching works by lengthening those ligaments and strengthening your tendons. Problem is most average stretching exercises put stress on your ligature. Not exactly helpful.
The key factor that most folks don’t know—including a lot of yoga teachers and personal trainers—is that you don’t want loose joints. The tighter they are, the more stable and stronger they are. The stronger they are, the less likely you are to sustain an injury in the first place.
So what you want is long and relaxed muscles that can lengthen on demand without resistance.
Follow these techniques closely, they’ll ease your back pain instead of making it worse (like a lot of wrongheaded stretches).
The two parts of your body you want to stretch daily to avoid back pain are the front of your shoulders and the front of your hips.
Shoulder Stretch:
You need to stretch and develop these muscles because they are very susceptible to injury. And tight shoulder muscles contribute to back and neck pain, especially if your head and shoulders droop forward.
How To: Stand in an open doorway. Raising your arm to a 90-degree angle with palm facing out, press your hand and shoulder against the wall and doorjamb. You should feel the wall against your armpit. Slowly increase the tension as you push forward. Hold for a 10 count. Then repeat with the other arm.
Hip Flexors: You need to do this stretch, particularly if you sit all day at work. Sitting all day puts pressure on the hip flexor muscles. This is a major cause of minor lower back pain. Stretching your hip flexors muscles several times a week will prevent this kind of lower back pain.
How To: Stand in a modified runner stance, with right foot forward and left foot back, feet flat on floor. Put your hands on your hips and keep your back and hips in straight alignment. Push forward with your hips, while maintaining your erect posture. Slowly, push your hips forward only until you feel a comfortable level of tension. Hold for a 10 count. Switch sides by reversing your leg stance and repeat.

Surgical treatment of tennis elbow

According to Knudsen R et al (2008) surgical treatment of lateral epicondylitits (LE) has not been investigated sufficiently to allow general guidelines, nor has non-invasive treatment produced sufficiently good results.

The results of 31 mini-tenotomies performed by them to treat lateral epicondylitis. The mini-tenotomies were performed under local anaesthesia and the extensor aponeurosis was cut close to the epicondyl. Surgery achieved its maximal effect on average four weeks after surgery. The present results indicate that mini-tenotomy could be a promising treatment for a selected group with isolated LE.