Friday, January 30, 2009

The relation between CRP, inflammation & heart disease & importance of EXERCISE:

A recent story in The New York Times revealed the “newly discovered” importance of C-reactive protein (CRP). Apparently, a drug company-sponsored study showed that people who had high CRP levels had fewer heart attacks and strokes when taking statins (cholesterol-lowering drugs). However statins increase risk of heart disease by robbing you of the heart critical nutrient CoQ10.
CRP level is important. CRP measures inflammation in your body. Inflammation is the real cause of heart disease. Tests that can measure CRP to detect heart disease & this test is recommended annually. Healthy people have less than one unit. Four units or above can indicate heart disease. Inflammation comes from stress or damage to your blood vessels when they don’t get the nutrients they need. They can get cracked and weak, and the body responds by sending plaque to repair the damage. Continuous lack of nutrients can cause this plaque to build up – leading to heart attack or stroke.

One may not really need statin drugs to protect from high CRP levels. To lower the CRP levels in your blood – lower the inflammation in your body. One of the best ways to lower CRP is to exercise. Studies clearly show that people who went from couch slouching to exercising lowered their CRP as much as 30%.1 To get the most benefit in the least amount of time, exercise efficiently.
Traditional cardio exercises aren’t the most effective to lower CRP. To lower your CRP level in the shortest amount of time, try PACE of DR. ALSEARs (PACE Program walks you through, step-by-step, a revolutionary way to better heart health in 10 minutes a day). If you don’t have my PACE program, here’s a simple exercise you can do (of course check with your doctor/ cardiac physiotherapist/ exercise physiologist if you haven’t been exercising for a while):

1. Instead of a slow, steady pace on a bicycle or treadmill, try going 80% of your maximum for 2 minutes.

2. Rest for 1 minute

3. Go at 90% for another two minutes

4. Rest for 1 minute

5. Go at 100% for 1 minute

6. Recover

That’s it! This exertion/rest cycle is much more effective than traditional cardio and will burn fat and build your heart and lung strength (and lower your inflammation) much faster.


Reference:
1 Church T, Barlow CE, Earnest CP, et.al. Association between cardiorespiratory fitness and C-reactive protein in men. Arteriosclerosis and Thrombosis: Journal of Vascular Biology.2002 Nov 1;22(11):1869-1879

Thursday, January 29, 2009

Sportsmedicine: The pain game

sports medicine evolution:
Sportsmedicine as an apparent subclass of medicine has developed apace over the past 30 years. Its recent trajectory has been evidenced by the emergence of specialist international research journals, standard texts, annual conferences, academic appointments, and postgraduate courses. A major advance in this emerging field is the ability to appropriately diagnose and treat sports-related injuries and to develop ongoing research related to better diagnosis and more effective treatment of pain and tissue healing. This approach will ultimately impact return-to-play performance.


It is noteworthy that sportsmedicine physicians recognize the athlete and the entire rehabilitation team as being a special breed that is determined and progressive in their thinking. It is not sufficient to deprive them of the very thing that motivates their lives by simply saying "Stop what you are doing and the pain will go away." Instead, our challenge is to diagnose and find the most appropriate treatment which will not only reduce pain but also induce a rapid tissue healing process. Pagliano, correctly points out that appropriate treatment resulting in return to the playing field is the major goal of the sportsmedicine physician. He states, "Not only will the athlete be delighted, but it will give the practitioner immense satisfaction to see the athletes happy and running." While there have been many anti-pain treatment modalities widely utilized in the field, including sports massage, prescription drugs, phonophoresis, cryotherapy, sonotherapy, pulsed electrical stimulation, transcutaneous electrical nerve stimulation (TENS), high-volt pulsed current, iontophoresis, dry needle and electro acupuncture, magnetic field therapy, and biofeedback, scientists have pointed out the pitfalls of research related to these treatment modalities. A universal problem in the assessment of efficacy related to all these modalities involves the clinical usefulness of the placebo method. Brooling et al found that a total of 94% of physicians and 98% of scientists, but only 44% of athletes, indicated a good understanding of the placebo effect. A majority of scientists (63%) and physicians (59%) administered placebo at least once a year. Most scientists (95%) and a majority of physicians (71%) either mildly or strongly encouraged use of the placebo in their clinical practice to assess the medical status of their patients, especially as it relates long lasting to pain. About 60% of athletes indicated they would not care if they were unknowingly administered a placebo; however, 30% of them would not appreciate being misled. This kind of data is at least 1 stumbling block in separating real benefits of the many modalities utilized in the treatment of pain in sportsmedicine.

The author of this article K.blum et al recognized that a number of modalities including electrotherapeutic devices may have some benefit, the need for a nonpharmacologic analgesic alternative having tissue healing properties requires significant attention.

Thursday, January 22, 2009

Poor Cycling Technique and Myofascial Low Back Pain

This following article is taken from the following source..............
Green B, Johnson C, Maloney A. Effects of Altering Cycling Technique on Gluteus Medius Syndrome. Journal of Manipulative and Physiological Therapeutics, Feb. 1999;22(2), pp108-13. Reprints: Tel: (800) 325-4177, ext 4350; Fax: (314) 432-1380
This study was inspired by a 24-year-old male chiropractic patient's report that he was experiencing numbness and tickling in a small region of his upper right buttock. His chiropractor noted that the condition had developed in the few days since the man's most recent bimonthly adjustment. A physical exam and close scrutiny of the patient’s history revealed that the complaint was probably gluteus medius syndrome (GMS) resulting from the man’s activities as an amateur cyclist.Because overuse hip injuries are rare in cycling, the authors found little research documenting such cases. Although this paper reports only a single-case study, it offers detailed and specific findings that may be of genuine value to clinicians whose patients include cyclists and others who engage in repetitive exercise and sports placing special demands on muscles and supporting structures. The case report also reviews the manifestations and treatments options reported in the literature that pertain to myofascial pain.The subject’s chiropractor learned that the ailing cyclist had just begun riding a new bicycle. Because the new bike had different gearing than his previous bicycle, by continuing to use his customary riding technique, the patient was fatiguing and straining himself, as he hadn't done before getting the new bike. The patient's cycling technique was modified to accommodate the changed gearing of the new machine. After only 2 days, the GMS symptoms resolved and did not return-results attributable to altering a cycling technique that was damaging him and interfering with his favorite pastime.
The authors conclude: "Taking more time to elicit pertinent historical data and having a working knowledge of patient activities, including sports equipment, may play a decisive role in alleviating pain of myofascial origin."

Tuesday, January 20, 2009

Rotational Field Quantum Magnetic Resonance (RFQMR)- the New treatment of OA

The root cause of osteoarthritis is wear out of “cartilage”. If this cartilage is regenerated to its original healthy amount, no more pain in the knees – a permanent, one-time cure for osteoarthritis. Recently a device called Cytotron has been developed to produce the afore said effect. The technology Cytotron uses is Rotational Field Quantum Magnetic Resonance (RFQMR) is used to stimulate the growth of cartilage cells in the knee, so the root cause of arthritis is gone
It is claimed that:
1. It is highly successful, (RFQMR is a patented technology)
2. It is totally non-invasive but it is highly desirable alternative to knee replacement surgery.
3. There is no pain, no medicines and no side effects of application of this machine.
4. It is claimed that in 21 day treatment and the patient can be walking without pain in 60 days.
5. It is claimed that it enables natural growth of cartilage, as against placement of a foreign substance in the body, which is done during a knee replacement surgery.
About the Innovative RFQMR treatment
On a normal healthy human body, like other tissues, bone and cartilage are constantly being built up and broken down by a variety of metabolic and physical influences. In other words, when one takes a step, putting weight on the joint, it compresses the cartilage and thereby displaces the fluid. As long as there is sufficient amount of cartilage, it provides a cushion between the bones. It is the wear out of this cartilage that causes pain in the knees and is called osteoarthritis.
1. RFQMR utilizes an innovative technology to deliver highly complex quantum EM (non-thermal) beam to alter the cell membrane potential in a highly controlled fashion for regeneration of chondrocytes thus reversing the negative cycle of degeneration of cartilage. These beams alter the proton spin inside and outside the cells generating streaming voltage potentials resulting in stimulation of cartilage growth.
2. High intensity quantum Magnetic Resonance beams are precisely controlled by a new computer controlled device (called Cytotron) delivered from specially designed guns and focused onto target tissues. This technology is similar to the diagnostic Magnetic Resonance Imaging (MRI) device. However, the Radio Frequency used in RFQMR is lower compared to the frequency used in MRI. These frequency ranges come in the non ionizing-non-thermal category.
3. The International Commission for Non-Ionising Radiation Protection (ICNIRP) has defined emission levels that are considered safe for human use. Both electric and magnetic field emissions from RFQMR exposure are well below the levels specified by ICNIRP.
Benefits of this treatmentThe benefits of this treatment would make anyone think twice before they opt for a knee surgery –
1. RFQMR is a pioneering, unique, effective and non surgical procedure for treatment of Osteoarthritis
2. RFQMR treatment for osteoarthritis significantly decreases pain
3. RFQMR has no side effects
4. RFQMR cure is long lasting
5. RFQMR enables natural growth of cartilage and increases its thickness as against placement of foreign substance
6. RFQMR is a cheaper alternative to knee replacement
7. Both knees can be treated simultaneously in RFQMR
8. RFQMR increases mobility in patients
9. RFQMR improves stability and power of the knee joint

Sunday, January 18, 2009

Correctly Identifying Causes of Leg Pain

This following article is taken from work of following authors:
Korkola M, Amendola A. Exercise-induced leg pain. The Physician and Sportsmedicine June 2001:29(6). Available at www.physsportsmed.com.
"Shin splints," a form of exercise-related leg pain, may account for up to 60% of leg pain syndromes, but this term has too often been used to describe leg pain caused by multiple disorders.The multiple causes of exertional leg pain are difficult to discern as the source of the problem, but in many cases are associated with repetitive stress.The authors of this review of the literature prefer to name exercise-related painful symptoms in the leg as "exercise-induced leg pain" until a clear diagnosis is made. Through appropriate physical examination and other procedures, such as diagnostic imaging or nerve conduction velocity tests, the doctor can arrive at an appropriate diagnosis.
This paper provides an overview of several common leg complaints related to exercise. Some information gleaned from this paper is represented below:
* Periostitis (medial tibial stress syndrome) is the most common cause of exertional leg pain.
* Tibial stress fractures, occurring in 10-20% of all athletic injuries, are difficult to examine using plain film radiographs because findings may not be visible for up to 12 weeks.
* Peripheral neuropathy may be linked to ankle sprains when the peroneal nerve is compressed where it passes around the fibular neck.
* Spinal stenosis is most common in middle-aged or older patients, who may have a history of low back pain. This condition can cause leg pain.
* Peripheral vascular disease causes an aching cramp when walking; symptoms usually resolve during rest.
Management options for the disorders presented are briefly discussed and several lifestyle modifications are suggested for these problems. Rehabilitation plays a crucial role in recovery.
Conclusion: A detailed history and physical examination are crucial when treating exercise-induced leg pain. Although this problem is difficult to treat, positive results can be achieved through an accurate and timely evaluation combined with multidisciplinary treatment.
Note: The authors of this paper provide a brief overview of each condition in a clinically relevant fashion. Information from this paper can be immediately used in practice.

Sciatica Indicates Sevirity of LBA

Following article is Extracted from paper of folowing author(s):
Selim AJ, Ren XS, et al. The importance of radiating leg pain in assessing health outcomes among patients with low back pain. Results from the Veterans Health Study. Spine, Feb. 1998;23(4), pp470-74.
Patients with sciatica may suffer significantly more disability than patients with lower-back pain alone. For this reason, evidence of nerve root irritation should be taken into account in the assessment of patients with low-back pain. Four hundred twenty-eight patients were studied to determine a method of categorizing patients with low-back pain, by combining patient reports of radiating leg pain with the results of straight-leg-raising tests. Results demonstrated that this method worked well in identifying patients with different levels of low-back-pain intensity.
Patients were placed into four groups: 1) report of low-back pain alone; 2) report of low-back pain radiating into the thigh; 3) report of low-back pain radiating below the knee with negative straight-leg-raising tests; and 4) report of low-back pain radiating below the knee with positive straight-leg-raising tests.
The method also seemed to correspond well with differences in health-related quality of life scores and disability days which were assessed during the course of the study. The study method of categorizing patients with low-back pain appears to be a practical approach to characterizing low-back pain. It may be important for future research to develop a case-mix adjustment for low-back pain based on factors that determine both the pain intensity and the extent of radiating leg pain.

Thursday, January 15, 2009

Straight Leg Raise ROM Explained in Mechanical Terms

The following article is taken from Medicine & Science in Sports & Exercise, June 1998;30(6), pp928-32, 1998 (Vol. 01, Issue 06)

SLR:

Musculoskeletal flexibility is typically characterized by maximum range of motion (ROM) in a joint or series of joints.

Resistance to passive stretch in the mid-range of motion is a function of passive mechanical restraints. However, an active contractile response may contribute to resistance at terminal ROM.

This study investigated whether maximum straight leg raise (SLR) ROM is limited by passive mechanical forces, or stretch-induced contractile responses to stretch. An instrumented hip flexion stretch was applied to the right leg of 16 subjects, ending at the point of discomfort. Torque was measured with a load cell attached to the ankle. An electrogoniometer was placed on the hip, and the knee was braced in extension. Surface electrodes were placed over the rectus and biceps femoris muscles. Straight-leg ROM was positively related to total energy absorbed and negatively related to both the increase in torque and the energy absorbed from 20-50 degrees.

Joint torque measured during passive stretch seemed to be a function of the passive mechanical restraints to joint motion, rather than a contractile response to the stretch. These findings suggest that flexibility can be explained in mechanical terms rather than by a reflex response which facilitates active contractile resistance to a slow passive stretch.

The authors:

McHugh MP, Kremenic IJ, et al. (1998)

For patients who are following this blog.

There are three main types of exercises to include in a basic exercise program:
Range-of-motion exercises - These lessen stiffness and help with improving flexibility. "Range of motion" refers to the area within which the joints move naturally or on a daily basis. Although these range-of-motion exercises can be performed every day, it is recommended that they be done at least every other day.
Strengthening exercises – There are two types of strengthening exercises; isometric or tightening the muscles without moving the joints, and isotonic, moving of the joints for strengthening muscle movements. It is recommended to do these sets of exercises every other day, unless you are suffering from more than mild joint pain or swelling.
Endurance exercises – The objective of these is to increase stamina. They also help with improving your inner personal / mental strength and with improving weight control and sleep. Some of the most popular endurance exercises are stationary bike riding, walking and water exercising. And unless you are suffering from more than mild joint pain or swelling, a 20- to 30-minute workout or two to three short 10-minute bouts during the day is what is recommended, an average of three times each week. Be kind to your body, and it will be kind to you.
Let’s sum up exercise with a few tips for all:
1. Establish your own unique, exercise program so that it meets you personal health needs, budget and environment. Make sure it is safe by checking with your own professional healthcare advisor and workout trainer. And take it slow and steady like Aesop’s turtle in the race.
2. Be kind to yourself. Stop if something hurts. And experiment with applying heat before exercising and warming up. Then cool off afterwards with cold packs.

Wednesday, January 14, 2009

Regular Exercise Promotes Wound Healing in Elderly Patients

This following research belongs to :
Emery CF, Kiecolt-Glaser JK, Glaser R, et al. Exercise accelerates wound healing among healthy older adults: a preliminary investigation. Journal of Gerontology: Medical Sciences 2005;60A(11)1432-1436.
As adults age, the body's ability to heal in a timely fashion decreases, which increases the risk of infection. Certain health behaviors appear to have an effect on wound healing and immune function. This is especially true of physical exercise, which has been shown to improve both immune and endocrine function, and to reduce the effects of psychological stress (which itself has been shown to influence wound healing).To determine the effects of fitness and exercise on wound healing and neuroendocrine function, scientists recruited 28 sedentary older adults (average age: 61.0 years) into an exercise group and a control group. Subjects in both groups received a small puncture wound on the back of the upper arm. One month before the wound procedure, patients in the exercise group began participating in an aerobic exercise program conducted three days per week for approximately one hour each day. Wounds were measured three times per week to calculate the rate of wound healing. Participants also completed assessments of endurance, salivary cortisol, and self-reported stress at baseline and at the conclusion of the study.
Results: Wound healing occurred at a significantly faster rate in the group that exercised (average 29.2 days) compared to the group that did not exercise (39.8 days). In addition, exercise participants "achieved significant improvements in cardiorespiratory fitness." Exercise patients also demonstrated a significant increase in cortisol secretion, which the researchers did not expect to occur. They hypothesized that the increased cortisol levels "may be associated with additional neuroendocrine and immune function changes relevant to the wound-healing process."
Conclusion: "This study demonstrates a beneficial effect of exercise activity on would-healing rates among healthy older adults. Moreover, exercise was associated with an enhanced neuroendocrine response among the exercise participants. ... From a practical perspective, the results provide empirical support for the relevance of considering exercise activity as a component of medical care among patients who have sustained dermal wounds or who are recovering from surgical procedures."

Tuesday, January 13, 2009

Know why many people complain lower extremity symptoms when CPA to cervical spine is administered

Discovery of Dural Attachments in the Cervical Spine:

The cervical spine is stabilized posteriorly by the ligamentum nuchae and other ligaments. While previous research has described the ligamentum nuchae in general terms. A study (byMitchell BS, Humphreys BK, O'Sullivan E) attempted to describe more detailed attachments to the cervical posterior spinal dura and to posterolateral parts of the occipital bone.
10 cadavers were sectioned to reveal the ligamentum nuchae and its connection to the cervical posterior spinal dura, allowing for particular attention and reference to the deep aspects of the suboccipital triangle and upper cervical region.
In the midline between the first and second cervical vertebrae, researchers found a fibroelastic ligamentous attachment to the cervical posterior spinal dura derived from the ligamentum nuchae. As the ligamentum passed cranially, part of it passed bilaterally to the posterior aspect of the base of the occipital bone, as far superiorly as the inferior nuchal line and as far laterally as the sutures with the temporal bones.This study reveals a more complex morphology of the ligamentum nuchae than has previously been described. The bilateral attachments of the nuchae to the occipital bone reaffirm its role in stabilizing the head during rotation of the cervical spine.
These findings may have implications in the understanding of facial and cervical pain and associated disorders.
Reference:
Attachments of the ligamentum nuchae to cervical posterior spinal dura and the lateral part of the occipital bone. Journal of Manipulative and Physiological Therapeutics, March/April 1998;21(3), pp145-48.

Monday, January 12, 2009

The Causes of Posterior Knee Pain

This following article is useful for both seasoned and new physios.....


Because pain in the posterior knee is relatively uncommon, its cause is often difficult to surmise. Among several of the known causes of posterior knee pain, and attempts to provide practitioners with a list of potential disorders and tips to consider when conducting a physical exam. The importance of obtaining a good history to elicit information leading to appropriate diagnosis can not be overemphasized. Of particular note is the determination of the precise location of the patient's discomfort within the posterior knee.

Clinicians should try to isolate the location of pain as being in the posteriolateral aspect, medial aspect or center of the posterior knee. Also critical is the knowledge of whether the pain truly arises from the posterior knee, or whether it is being referred from a more distant source.


Among the major disorders that elicit posterior knee pain:

*injuries to support structures and tumors, such as Baker's cyst, soft-tissue tumors, bone tumors, and meniscal tears;

*tendon strains/injuries, such as those to the hamstring or popliteus tendon, or calcification of the gastrocnemius tendon;

*ligament injuries, such as injuries to the posterolateral corner;

*vascular and nerve injuries, such as popliteal artery entrapment syndrome, common peroneal nerve entrapment and tibial nerve entrapment;

*iatrogenic injuries, such as postsurgical arthrofibrosis and placement of bioabsorbable tacks;

*other conditions, including degenerative joint disease.

For diagnosing specific pain generators details of anatomy and biomechanics are essential. One such tool is the use of a popliteus muscle test that places a load on the politeus to determine if it is causing pain.

conclusion:

"examiners should have a comprehensive understanding of potential pain generators about the posterior knee. While many different sources can cause posterior knee pain, review of potential causes should give providers a firm understanding of disorders to consider in their diagnostic workup."There is a nice table of disorders commonly involved in posterior knee pain, and their characteristic signs and symptoms.

cervical pillow

Cervical pillows support your head in a proper sleeping position to provide relief, especially in the neck. Our two most popular pillow types are foam and fiber. Which you choose is a matter of personal preference.
Foam pillows feature a support lobe for targeted cervical support, which is best if you sleep on your back. For additional support, choose a foam pillow with a core in the lobe. If you tend to sleep on your side, fiber pillows offer better support. Fiber pillows also look and feel more like traditional pillows.

Friday, January 2, 2009

IR Saunas


STORY OF THE AGE-OLD SAUNA
The sauna has existed in a variety forms for thousands of years, most notably in the ancient country of Finland, which gave us the word "sauna". Well-known too are the sweat-lodges of Native North Americans. Other cultures knew the relief of exposing the body to periods of elevated heat, as in steam-baths or hotsprings. The sauna's purpose, as a cleansing and relaxing enclosure, has not changed much over time, but advances in technologies can give convenient new ways to enjoy the warmth of the sauna.

WHAT IS FAR INFRARED?
The sun is our principal source of infrared heat. As the sun's rays hit the surface of the earth, the heat we perceive is in fact Far Infrared waves. Infrared heat is essential for all life. When you lie on the beach you are soaking up infrared heat. Unfortunately you are also receiving direct damaging ultra-violet rays. FIR heat provides the healthy benefits of natural sunlight without any of the dangerous effects of solar radiation. The invisible and very safe Far Infrared heat produced by an Infrared sauna is able to penetrate well below the skin, which enables the body to sweat at air temperatures of 110 - 140 ° F (much lower than conventional saunas). Far Infrared heat can provide topical heating to raise tissue temperature; for the temporary relief of minor muscle and joint pain, arthritis and muscle spasms; relieving stiffness; and promoting relaxation of muscle tissue.

WOODEN SAUNAS AND PORTABLE SAUNAS
A portable Infrared Sauna incorporates the same elements as a (furniture-sized) wooden Infrared Sauna, and gives the same revitalizing results to the body inside it. The same FIR technology heats the body in an enclosed space. The portable sauna is significantly more affordable, but without a loss in effectiveness.

FIR- far infrared radiation


What the Researchers say about FIR

Far Infrared energy is not only safe, but highly beneficial for our bodies. Far Infrared lamps are actively used for medical treatments by doctors, chiropractors, acupuncturists, physical therapists, and massage therapists for arthritis, joints pain, stiff muscles, injuries to tendons and ligaments to promote a faster self body healing effect.
Infrared heat is "radiant" heat. Radiant heat is simply a form of energy that heats objects directly through a process called conversion, without having to heat the air in between.Radiant heat is also called Infrared Energy. The infrared segment of the electromagnetic spectrum cannot be seen, but can be perceived as heat.
Our sun produces most of its energy output in the infrared segment of the spectrum. Our atmosphere has a "window" in it that allows infrared engergy rays in the 7 ~ 14 micron range to safely reach the earth's surface. When warmed, the earth radiates infrared rays in the 7 ~ 14 micron band with its peak output at 10 microns.
According to Dr. Tsu-Tsair Oliver Chi, in his summation on the mechanism of actions of infrared devices tuned to the human body; tissues needing a boost in their output selectively absorb these rays. The internal production of the infrared energy that normally occurs within our tissues is associated with a variety of healing responses and may require a boost to a maximal level to insure the fullest healing response possible in a tissue, which is being repaired. After boosting a tissue's level to its maximum, the remaining rays pass onward harmlessly. This phenomenon is called "resonant absorption."
Regular use of a sauna may be as effective as a means of cardiovascular conditioning and burning of calories as regular exercise!!!!!!!!