Dr Satyajit Mohanty blogs

According to Haldeman S et al (2001) the notion that headaches may originate from disorders of the cervical spine and can be relieved by treatments directed at the neck is gaining recognition among headache clinicians.. There remains considerable controversy and confusion on all matters pertaining to the topic of CGH. However, the amount of interest in the topic is growing, and it is anticipated that further research will help to clarify the theory, diagnosis, and treatment options for patients with CGH. According to Frese A et al (2008) Upper cervical pain is frequent in different primary headaches and not sufficient evidence for cervicogenic headache (CGH). Biological markers should help to differentiate CGH from other headache disorders. In most cases, imaging techniques of the cervical spine are not helpful for the diagnosis of CGH. Symptoms and signs of neck involvement, such as a mechanical precipitation of attacks, a restriction in range of motion of the cervical spine, and the ...

Runge CF of department of applied economics and law and the center for international food and agricultural policy, University of Minnesota (USA) estimated : Among the incidence of diabetes, 60% can be directly attributed to weight gain. By controling weight this diabetes can be prevented by rational food intake & daily exercise regimen.

Obesity has risen dramatically in the past few decades. However, the relative contribution of energy intake and energy expenditure to rising obesity is not known. Moreover, the extent to which social and economic factors tip the energy balance is not well understood. According to a review article by Bleich S et al (2008), exploratory study estimates the relative contribution of increased caloric intake and reduced physical activity to obesity in developed countries using two methods of energy accounting. Results in many studies in western countries show that rising obesity is primarily the result of consuming more calories. Bleich S et al estimated by multivariate regression models and use simulation analysis to explore technological and sociodemographic determinants of this dietary excess. Their results indicate that the increase in caloric intake is associated with technological innovations as well as changing sociodemographic factors. Many studies have attributed rapid urbanization ...

Over the past two decades, it has become accepted that the rotator interval is a distinct anatomic entity that plays an important role in affecting the proper function of the glenohumeral joint. The rotator interval is an anatomic region in the anterosuperior aspect of the glenohumeral joint located between the distal edges of the supraspinatus and subscapularis tendons and contains the insertions of the coracohumeral and superior glenohumeral ligaments. These structures form a complex pulley system that stabilizes the long head of the biceps tendon as it enters the bicipital groove of the humeral head. Lesions of the rotator interval may result in 1. Glenohumeral joint contractures- adhesive capsulitis 2. Shoulder instability 3. Anterosuperior internal impingement. 4. Lesions to the long head of the biceps tendon.

From the anatomical and clinical viewpoints, impingements are classified as 1. Bone impingement, 2. Soft tissue impingement and 3. Entrapment neuropathy, depending on what impinges on the others. Examples: The most important impingement syndromes of the upper and the lower limbs from the clinical viewpoint are as follows. In the upper limb: 1. Supraspinatus impingement is a frequent cause of shoulder pain in both athletes and the normal population; the painful subacromial arch is a typical sign of the rotator cuff impingement syndrome and of outlet and non-outlet impingement as well. 2. As for the elbow, both medial and lateral impingement. 3. The carpal tunnel syndrome is the most common peripheral entrapment neuropathy of the upper limb; it is caused by compression of the median nerve at the wrist. In the lower limb: 1. Iliotibial band friction syndrome, which is the most common overuse syndrome of the knee and the ankle impingement syndrome. 2. ...

Considered to be most often the result of a degenerative process at the origin of the plantar fascia at the calcaneus, Plantar fasciitis is a common cause of heel pain, which frustrates patients and practitioners alike because of its resistance to treatment. However, neurogenic and other causes of subcalcaneal pain are frequently cited. A combination of causative factors may be present, or the true cause may remain obscure. Approximately 10% of patients with plantar fasciitis have development of persistent and often disabling symptoms. Plantar fasciitis has been associated with obesity, middle age, and biomechanical abnormalities in the foot, such as tight Achilles tendon, pes cavus, and pes planus. Management strategies are: Nonsurgical treatment is ultimately effective in approximately 90% of patients. Nonsteroidal anti-inflammatory drugs, rest, pads, cups, splints, orthotics, corticosteroid injections, casts, physical therapy, ice, and heat. Targeting tissue specific stretching: A ...

The hypothesis that the Ely's test for evaluating rectus femoris flexibility and joint range of motion (ROM) is a reliable clinical tool is challenged by Peeler J et al (2008) the results of their study call into question the statistical reliability of the Ely's test. However according to these researchers more research is required to determine the variables that may confound statistical reliability of Ely's test that is commonly used in a clinical setting to assess function about the thigh region.

Go through the following article by Dolny DG et al (2008): WBV platforms produce frequencies ranging from 15-60 Hz and vertical displacements from ~1-11 mm, resulting in accelerations of ~2.2-5.1 g. 1. With WBV training, younger fit subjects may not experience gains unless some type of external load is added to WBV exercise. 2. However, sedentary and elderly individuals have demonstrated significant gains in most measures of muscle performance, similar with comparable traditional resistance exercise training programs. 3. WBV training also has demonstrated gains in flexibility in younger athletic populations and gains or maintenance in bone mineral density in postmenopausal women. 4. Acute exposure to WBV in sports persons has produced mixed results in terms of improving jump, sprint, and measures of muscle performance.

According to recent studies Busch AJ et al (2008) Aerobic-only training has beneficial effects on physical function and some Fibromyalgia symptoms. Strength-only training may also improve Fibromyalgia symptoms, but requires further study.

LaRoche DP et al (2008) of Department of Kinesiology, University of New Hampshire, Durham, New Hampshire, USA. dain.laroche@unh.edu did a study was to determine whether muscle force, power, and optimal length were affected by 4 weeks of static or ballistic stretching. The study suggested: 1. Individuals can routinely stretch following exercise to maintain flexibility but should avoid stretching prior to exercise requiring high levels of muscle force. 2. Before exercise that requires high muscular forces, individuals may perform dynamic, sport-specific exercises to increase blood flow, metabolic activity, temperature, and compliance of the muscle.

A review of Hambrecht R throws a light on how sports physical therapy has been accepted as a treatment. Over the last 2 decades the clinical application of physical exercise as a therapeutic strategy has developed from rehabilitation to prevention and treatment of cardiovascular diseases. This shift in clinical application was accompanied by a more systematic research approach of the involved mechanisms and the objective clinical assessment of sport interventions using prospective randomized clinical trials. This ongoing process established physical exercise as an evidence-based and guideline-oriented treatment option. 1. In stable coronary artery disease (CAD), exercise therapy has long been used for rehabilitation purposes following an acute myocardial infarction. A recent meta-analysis revealed a significant 27% reduction of total mortality among training patients. Four mechanisms are considered important mediators of the reduced cardiac event rate: improvement of endothelial ...

HIV-infected persons often experience a loss of lean tissue mass, which includes decreases in skeletal muscle mass. This HIV-associated wasting is significant because it has been associated with accelerated disease progression and increased morbidity. In an attempt to counter muscle wasting in HIV-infected persons, treatments have been suggested that target these mechanisms. Nutritional supplementation, cytokine reduction, hormone therapy and resistance exercise training are potential treatments for this condition. Resistance exercise training, which is more easily accessible to this population than other treatments, holds promise in counteracting the process of HIV wasting, as it has been successfully used to increase lean tissue mass in healthy and clinical populations.

Once an initial vertebral fracture is sustained, the risk of subsequent vertebral fracture increases significantly. This phenomenon has been termed the "vertebral fracture cascade". Mechanisms underlying this fracture cascade are inadequately understood. Evidence suggests that non-bone parameters differ between individuals with and those without osteoporotic vertebral fractures. Neurophysiologic properties, particularly trunk control and balance, are affected by the presence of a vertebral fracture.

According to Rhee JM et al (2007): 1. Cervical radiculopathy is a disorder involving dysfunction of cervical nerve roots that commonly manifests as pain radiating from the neck into the distribution of the affected root. 2. Acute cervical radiculopathy generally has a self-limited clinical course, with up to a 75% rate of spontaneous improvement. Thus, nonsurgical treatment is the appropriate initial approach for most patients. 3. When nonsurgical treatment fails to relieve symptoms or if a significant neurologic deficit exists, surgical decompression may be necessary. 4. Surgical outcomes for relief of arm pain range from 80% to 90% with either anterior or posterior approaches.

Non-articular conditions (NAC) cause the majority of painful conditions rather than articular ones in mid age and elderly. NACs appear to be common in older adults with knee pain. They make a significant contribution to knee pain severity and functional limitation and are likely to represent additional, rather than alternative, causes of knee pain/functional limitation to osteoarthritis (OA).

Today patients often need devices for more than one condition, and consideration must be given to the interaction between them. The use of transcutaneous electrical nerve stimulation (TENS) for pain relief is increasing. At the same time the implantable cardioverter defibrillator (ICD) is a routine treatment for malignant tachyarrhythmias. Researchers have reported undersensing of ICD device while co-working with TENS. This might prevent the ICD from delivering shock when it should. Because of the potentially serious consequences of interference do not recommend the use of TENS in patients with ICD.

The piriformis syndrome is one of the non-discogenics causes of sciatica. It results from the compression of the sciatic nerve (SN) by the piriformis muscle (PM) in the neutral and piriformis stretch test position. Following are important things to know about it. 1. The location of the sciatic nerve with respect to consistent bony landmarks: mid way between the greater & the ischial tuberosity. 2. The test position is: 30 degrees adduction 60 degrees flexion and approximately 10 degrees medial rotation position of the hip joint. 3. Morphometric data suggest that after stretch test position, the infrapiriforme foramen becomes narrower; the SN becomes closer to the ischial spine of the hip bone, and the angle between the SN and the transverse plane increases.

A case I saw toay (18.6.2008): Today a 14 year old girl came to me with complain of stiff hip. All the movements ware severely limited. Her parents told that in 2006 dec she suddenly suddenly complained of hip pain. They could not tell any thing on fever. Radiographs showed reduced joint space, irregular joint margin, decreased neck length, osteoporosis in the head and neck of femur. She has been diagnosed with 4 different diseases by 4 different doctors: 1. LP disease 2. tubercular arthritis 3. septic arthritis 4. transient synovitis Following is a topic for 1st hand physiotherapists for quick referrals. Children with a painful hip present a diagnostic challenge since clinical differentiation between septic arthritis, transient synovitis and Perthes disease may be difficult. Septic arthritis, a potentially life-threatening and debilitating medical emergency, requires early recognition for successful treatment, while transient synovitis and Perthes disease may ...

Neuropathic pain is a chronic pain syndrome caused by drug-, disease-, or injury-induced damage or destruction of sensory neurons within the dorsal root ganglia of the peripheral nervous system. Characteristic clinical symptoms include the feeling of pins and needles; burning, shooting, and/or stabbing pain with or without throbbing; and numbness. Hyperalgesia and allodynia are special kind of neuropathic pain that is provoked by mechanic or thermal stimuli. Periphery mechanisms of neuropathic pain include hyperexcitability of cell membrane and periphery sensibilization. Central mechanism includes central sensibilization, central reorganization of alphabeta fibers and loss of inhibition mechanisms. Mononeuropathy, plexopathy, radiculopathy, and myelopathy, lesions of thymus, cortex or brain stem are real cause of neuropathic pain. There is no adequate adaptation and produce suffering without biological helpfulness. The aim of treatment of patient with neuropathic pain is soothing of pa...

The following is a review of Henry JL et al (2008) on Central poststroke pain: Thalamic pain was first described 100 years ago by Déjerine and Roussy and has been described as "among the most spectacular, distressing, and intractable of pain syndromes". Central poststroke pain (CPSP), formerly known as thalamic pain syndrome of Déjerine and Roussy, is a central neuropathic pain occurring in patients affected by stroke. It is one manifestation of central pain, which is broadly defined as central neuropathic pain caused by lesions or dysfunction in the central nervous system. CPSP is characterized by: 1. Constant or intermittent pain and is associated with sensory abnormalities, particularly of thermal sensation. 2. The pain is frequently described as burning, scalding, or burning and freezing, other symptoms are usually vague and hard to characterize, making an early diagnosis particularly difficult. 3. Those who develop CPSP may no longer be under the care o...

The fat contains more than twice the calories compared to macroutrients and it is 7 times more easily converted to body fat than carbohydrates.

The diet that promotes a restricted eating-plan or certain liquid foods lacking sufficient food value is termed as Fad Diet. The fad diets are very low in calories so they cause very fast weight loss. However, quick weight loss may not be healthy and - in most cases - is not fat loss. It is actually water-loss which is quickly regained when the dieter resumes normal eating. The fad diets can cause weight cycling, which means a continuing pattern of gaining and losing weight. The fad diets are considered unhealthy. The common examples of Fad diets include the Cabbage Soup Diet and the Grapefruit Diet etc. baba RAMDEV have been prescribing "LAUKI KI RUS" which is also a fad diat. be careful guys!!!

Pahor S et al did slump test to investigate the effect of ankle inversion sprain on neurodynamic function in 18 subjects. The sensory response and restriction in range of knee extension in the slump test were assessed. Three different foot and ankle positions were used-neutral, dorsiflexion (DF) and plantarflexion with inversion (PFI). Results indicated that: 1. although there was a significantly greater lack of knee extension on the injured side compared to the non-injured side in all three foot and ankle positions, knee extension was most restricted in the PFI position, which is considered to bias the common peroneal tract. 2. The slump test in PFI produced symptoms in the lateral aspect of the lower leg and ankle extending slightly anteriorly and posteriorly and into the dorsum of the foot. This distribution corresponds to that of the superficial peroneal nerve. 3. The slump test in neutral and DF produced areas of response similar to each other, which included the posterior aspect ...

The following is an account of Bolton PS et al (2006) in the journal of medical hypothesis. Manipulation and mobilization are two forms of manual therapy commonly employed in the management of musculoskeletal disorders. Spinal manipulation and mobilization are often distinguished from one another by reference to certain biomechanical parameters such as peak force, duration and magnitude of translation. However, as of yet, there is relatively little research which distinguishes between them in terms of neurological mechanisms or clinical effectiveness. Theories concerning the mechanisms underlying the therapeutic effects of manipulation and mobilization commonly make reference to mechanical events such as the release of entrapped tissue or the disruption of intra-articular adhesions. Relatively less attention is given to neural effects. This article hypothesizes that: 1. At least in part, spinal manipulation preferentially influences a sensory bed which, in terms of anatomical loc...

In a survey we also found a negative bias for pillow exists among doctors reflected in their advice to a patient suffering from acute cervical pain with or with out radiation. Many (23 out of 31 referring doctors to our center) of them during an acute cervical pain episode either advised their patients not to use a pillow or use a thin pillow. There was no specification of how thin the pillow should be for such conditions.

Many cases of dizziness are due to cervical origin. Cervicogenic dizziness is dizziness described as imbalance occurring together with cervical pain or headache. Many of referring doctors feared that I might not help them which in term will produce a bad name for them. The skills ware there with me. One day a monk reported (1st hand) to me that he is having dizziness while prostrating in the temple, while sitting in meditations etc. I used Central PA to C6, C5. Currently I am exploring SNAGs of B.Mulligan. and combinimg both Maitlands & Mulligans. Following is an account of SNAGs helping patents with dizziness of cervicogenic origin: Reid SA et al (2007) found, SNAG treatment had an immediate clinically and statistically significant sustained effect in reducing dizziness, cervical pain and disability caused by cervical dysfunction.

I have a personal experience of mobilization of thoracic spine reducing neck and back pain & dysfunctions. Being the intermediate area of the spine, thoracic spine influences the kinesis & postural attitude of the cervico-capital & lumbo-sacral area. I found a support to my line of thinking from a study by Cleland JA et al (2007). They studied “Short-term effects of thrust versus non-thrust mobilization/manipulation directed at the thoracic spine in patients with neck pain” through a RCT. The results suggested that thoracic spine thrust mobilization/manipulation results in significantly greater short-term reductions in pain and disability than does thoracic nonthrust mobilization/manipulation in people with neck pain.

Martinez-sequra R et al (2006) did a RCT to analyze the immediate effects on neck pain and active cervical range of motion after a single cervical high-velocity low-amplitude (HVLA) manipulation or a control mobilization procedure in mechanical neck pain subjects. The result suggested, a single cervical HVLA manipulation was more effective in reducing neck pain at rest and in increasing active cervical range of motion than a control mobilization procedure in subjects suffering from mechanical neck pain.

few of the machines that produce EM waves we use i.e. SWD, MWD that produce waves of wavelength of few meters to decimeters. But there are machines which produce electromagnectic milimeter waves. explores the use and effects.

Commonly designated idiopathic neck pain and some primary headaches (ie, tension-type headache or migraine) fit the descriptions of referred pain originating in muscle trigger points (TrPs). Some authors found that both muscle TrPs in neck-shoulder muscles and cervical joint dysfunctions contribute at the same time to neck pain perception. Several recent studies reported that both tension-type headache and migraine are associated with referred pain from TrPs in the suboccipital, upper trapezius, sternocleidomastoid, temporalis, or superior oblique muscles. Referred pain elicited by active TrPs mimics the pain areas observed during head pain attacks in these primary headaches. Farnandez-De-Las- Penas C et al (2007) concluded in their of article that the pain profile of neck and head syndromes may be provoked referred pain from TrPs in the posterior cervical, head, and shoulder muscles.

Shoulder impingement symptoms of over head athlete: (1) Acquired glenohumeral anterior instability, (2) Loss of GH internal rotation range of motion, and (3) lack of retraction strength. Based on recent literature, The following guidelines should be used with impingement symptoms (as described above): (1) Shoulder rehabilitation should be integrated into kinetic chain training, not only in the advanced phases of the athlete's rehabilitation, but from the initial phases; (2) Both angular and translational mobilisations can be used in the treatment of acquired loss of glenohumeral internal rotation range of motion to stretch the posterior structures of the glenohumeral joint; and (3) In the rehabilitation of scapular dyskinesis, the therapist should focus on restoration of trapezius muscle balance in the scapular exercises, with special attention to strength training of the retractors.

Sciatica in patients with disk disease was long ascribed to pressure put on the sciatic nerve root by a herniated disk. Following is a review of Mulleman D et al (2006) on role for chemical factors acting in conjunction with this mechanical insult. Suggestion of chemical factor involvement comes from a number of clinical observations: 1. Disk surgery does not consistently provide pain relief, 2. Large disk herniations are not always symptomatic, 3. Severe pain may be present in patients without imaging evidence of nerve root compression, 4. The severity of symptoms and neurological signs is not well correlated with the size of the disk herniation, and conservative therapy is often effective. Experimental studies have provided further evidence for a chemical component: 1. Disk herniations can undergo spontaneous resorption, 2. The intervertebral disk is immunogenic, 3. And mediators for inflammation have been identified within intervertebral di...

People just use their concept of decreasing the calories but they do not realize that they can harm themselves through their own way of fixing their calories. We must take the calories required by us to do the work throughout the day and in order to do that we must eat a balanced diet, but when people start eating less this will cause them to feel fatigued and weak and they tire pretty easily and thus are unable to perform the tasks at hand. Not eating properly also predisposes a person to suffer through infections and results in a weak immune system.

Many exercise training studies have not reported significant changes in plasma LDL-C levels following training, a variable frequently used to estimate CVD risk. However, a lack of change in the concentration of LDL-C following endurance exercise training may mask potentially favorable changes in LDL composition and in the concentrations of LDL sub-fractions. Indeed, Williams and his group have shown overweight men who exercised for one year (with or without diet), 25-50 min per session, 3-5 times per week reported: 1. increased LDL peak flotation rate, 2. as well as LDL peak particle diameter, and 3. decreased small LDL mass concentrations in plasma despite no change in mean plasma LDL-C concentration. Hence lack of change in plasma LDL-C levels may not always adequately reflect changes in LDL concentration and distribution as exercise training may induce simultaneous changes in small LDL, large LDL and IDL-cholesterol levels.

However, as previously discussed, many exercise training studies did not report any significant reduction in body weight. 1. Most training studies have not been designed to investigate the effect of exercise on body fatness, but rather to investigate the potential metabolic effects of exercise training and its relation to cardiovascular disease risk. 2. And in many of these exercise training protocols, there was no control of subjects' caloric intake. These two factors have obviously a considerable impact on the potential reduction of body weight following endurance exercise training and may therefore be partly responsible for the equivocal results reported.

To achieve weight loss through exercise, a minimal prescription of exercise becomes very important as the energy expenditure induced by typical training protocols used to improve cardiorespiratory fitness (3 sessions of 30 minute walk at 75% of Vo2max) will not lead to substantial energy deficit and the magnitude of body weight loss will be generally quite small.

The prevalence of obesity is increasing rapidly in all age groups and is one of the fastest growing epidemics, now affecting 10-40% of the adult population. Obesity increases the risk of serious co-morbidities such as type 2 diabetes, cardiovascular disease, certain cancers and reduced life expectancy, and these complications may account for 5-10% of all health . The risk of diabetes is particularly increased by obesity, and 80-95% of the increase in diabetes can be attributed to obesity and overweight with abdominal fat distribution.

Experts recommend aerobic exercise, strength, flexibility, and balance exercises. Aerobic or endurance activities are good for heart, lungs, circulation, and muscles. Activities to choose from include walking, hiking, dancing, swimming, skating, cycling, and cross-country skiing. Simple walking is one of the best activities to stimulate circulation, improve the pumping of heart, and general better feeling. A more intense workout while walking is swing arms back and forth, lengthening the stride etc are called “pace walking”, or “power walking” by experts.

One study reported a dose-response effect of resistance training intensity and the augmentation of adiponectin. Anti-inflammatory cytokine adiponectin may assume critical importance in exercise induced weight loss.

Amid speculations of enhanced solute load associated with high protein diet that may further compromise nephrological status of the obese; still high quality RCTs compel us to look into such diet protocols comprising of high-protein diet. Meckling KA et al (2007) examined the effects of 3:1 and 1:1 carbohydrate to protein ratios, hypocaloric diets with and without exercise, and risk factors associated with the Metabolic Syndrome in overweight and obese Canadian women. Habitual diets of the subjects were energy restricted and were to contain either a 1:1 or 3:1 ratio of carbohydrate to protein energy. Subjects either exercised 3 times/week or maintained their normal level of activity for 12 weeks. The main outcome measures were weight loss, blood lipids, blood pressure, insulin, body composition, nitrogen balance, fitness, and resting energy expenditure. They concluded high-protein diet was superior to a low-fat, high-carbohydrate diet either alone or when combined with an aerobic/re...

Kriketos AD et al (2000) investigated the contributions of physical fitness and body composition to 24-hour fat oxidation in adults under sedentary conditions in a whole-room calorimeter. The results show that In male subjects under sedentary conditions, 24-hour fat oxidation is positively related to body fat mass and negatively related to VO2max (the marker used here for level of physical fitness). This supports our hypothesis that regularly active males maintain lower body fat stores as the low contribution to daily fat oxidation from a lower body fat mass is counterbalanced by the high contribution to fat oxidation from daily physical activity. The lack of a relationship between VO2max and 24-hour energy expenditure under the sedentary conditions of this study suggests that the major effects of physical activity on total daily energy expenditure and fat oxidation may occur during and relatively quickly after an exercise bout. Further, cessation of regular exercise will likely be as...

According to Tremblay A (1999) for the obese individual complying with an activity programme and healthy food habits, a body weight loss of 10% is a realistic goal before the occurrence of resistance to further loss of body fat.

Visceral fat loss after aerobic exercise training improves glucose metabolism and is associated with the reversal of insulin resistance in older obese men and women ( O'Leary VB , 2006).

Thamer C et al (2003) reported obesity and aerobic fitness are important determinants of intramyocellular lipids (IMCL). Intramyocellular lipids and insulin sensitivity are negatively correlated in untrained subjects. The correlation between the two parameters is modified by the extent of aerobic fitness and cannot be found in endurance trained subjects. Thus, measurements of aerobic fitness and body fat are indispensable for the interpretation of intramyocellular lipids and its relationship with insulin sensitivity.

Décombaz J et al (2001) reported that post-exercise fat intake strongly promotes intramyocellular lipids repletion independently of training status i.e. the replenishment is similar in trained and sedentary subjects. Furthermore, replenishment of intramyocellular lipids can be completed within a day when fat intake is sufficient.

Intramyocellular lipid content is increased after exercise in non-exercising human skeletal muscles but decreased after exercise in exercising muscles.

Van Loon LJ et reported that intramuscular triglyceride stores form an important substrate source during moderate intensity exercise (60% of the VO2max) in endurance-trained male athletes following an overnight fast, with the oxidation rate of muscle- plus lipoprotein-derived TG being decreased with the duration of exercise.

Roepstorff C et al working on “gender differences in substrate utilization during submaximal exercise in endurance-trained subjects” reported no gender difference existed in the relative contribution from carbohydrate and lipids to the oxidative metabolism across the leg during submaximal exercise at the same relative workload.

Schrauwen P et al showed that lean subjects are capable of rapidly adjusting fat oxidation to fat intake on a high-fat diet when glycogen stores are lowered by exhaustive exercise. However, it has been proposed that obese subjects have impaired fat oxidation. Schrauwen P et al studied the effect of low glycogen stores on fat oxidation after a switch from a reduced-fat diet to an high-fat diet in obese subjects. They found, obese subjects are capable of rapidly adjusting fat oxidation to fat intake when glycogen stores are lowered by exhaustive exercise.

Schrauwen P et al showed that lean subjects are capable of rapidly adjusting fat oxidation to fat intake on a high-fat diet when glycogen stores are lowered by exhaustive exercise. However, it has been proposed that obese subjects have impaired fat oxidation. Schrauwen P et al studied the effect of low glycogen stores on fat oxidation after a switch from a reduced-fat diet to an high-fat diet in obese subjects. They found, obese subjects are capable of rapidly adjusting fat oxidation to fat intake when glycogen stores are lowered by exhaustive exercise.

The effects of physical activity on the 24-hour RQ (respiratory quotient) that allows the organism to operate with an average RQ as low as the diet's FQ (fat quotient) in the presence of less body fat. Hence diet's carbohydrate-to-fat ratio can be an important parameter in shaping the interactions between physical activity and body weight maintenance.

There is direct influence of physical activity on the underlying metabolic determinants of energy balance. Physical activity facilitates weight maintenance through direct energy expenditure and improved physical fitness. The latter facilitates the amount and intensity of daily activities. Both components are of importance in relation to energy and substrate balance. Exercise may act as a substitute for an enlarged fat mass, in bringing about rates of fat oxidation commensurate with fat intake. Metabolic effects on lipid mobilization and oxidation and morphological/biochemical changes in the muscle fiber, contribute to this successful regulation of body weight. A limited number of studies indicate that, the minimal level of additional energy expenditure by physical exercise required for protection against gain in excessive body fatness, is around 12 kcal/kg body weight/d.

1. According to Goran MI, resting metabolic rate is the largest component of daily energy expenditure, and physical activity-related energy expenditure is the most variable. 2. There is convincing evidence of susceptible individuals fail to compensate for periodic fluctuations in energy expenditure and become obese. 3. The major dependent variable that needs to be examined in relation to the cause of obesity is not energy expenditure but change in energy balance over time and the ability to regulate body energy stores.

According to the journal of public health and nutrition (2007) the promotion of physical activity is difficult and so the results of treatment of obesity are discouraging for doctors, other health professionals and patients. Proactive efforts from patients and health providers with an intensive feedback between them may be extremely helpful. However, they only lead to modest enduring weight loss, and their limited impact on prevention of complications means they should not be pushed too insistently on patients. When patients want assistance with weight loss, their individual body weight history should be carefully analysed before embarking on a weight loss programme.

To address the persisting controversy regarding medicinal therapies and injections use on primary outcomes (e.g. pain) for adults with mechanical neck disorders and whiplash; Peloso P et al did a review of current articles on the subject which was published in 2007. The treatments subjected to analysis are: oral NSAIDs, psychotropic agents, steroid injections, and anaesthetic agents. 1. For acute whiplash, administering intravenous methylprednisolone within eight hours of injury reduced pain at one week, and sick leave but not pain at six months compared to placebo in one trial. 2. For chronic neck disorders at short-term follow-up, intramuscular injection of lidocaine was superior to placebo, treatment advantage 45% and dry needling, but similar to ultrasound in one trial each. 3. In chronic neck disorders with radicular findings, epidural methylprednisolone and lidocaine reduced neck pain and improved function more than when given by intramuscular route at one-year ...

Kay TM et al (2005) reviewed assess the effectiveness of exercise therapy to relieve pain, or improve function, disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders (MND). They found: 1. Specific exercises may be effective for the treatment of acute and chronic MND, with or without headache. 2. To be of benefit, a stretching and strengthening exercise program should concentrate on the musculature of the cervical, shoulder-thoracic area, or both. 3. A multimodal care approach of exercise, combined with mobilisation or manipulation for subacute and chronic MND with or without headache, reduced pain, improved function, and global perceived effect in the short and long term. 4. The relative benefit of other treatments (such as physical modalities) compared with exercise or between different exercise programs needs to be explored. The evidences they found are: 1. There is limited evidence of benefit that acute r...

When the clinical efficacy of spinal manipulative treatment for spinal pain has been assessed, high-velocity low-amplitude thrust (HVLAT) manipulation and mobilization have been regarded as clinical interventions giving identical and equivalent biologic effects. Hypotheses for lesions that respond to HVLAT manipulation were: (1) Release of entrapped synovial folds or plica, (2) Relaxation of hypertonic muscle by sudden stretching, (3) Disruption of articular or periarticular adhesions, and (4) Unbuckling of motion segments that have undergone disproportionate displacements. Evans W (2002) reviewed is to critically discuss previous theories and research of spinal HVLAT manipulation, highlighting reported neurophysiologic effects that seem to be uniquely associated with cavitation of synovial fluid. Evans W’s comments on 2 separate modes of action from zygapophyseal HVLAT manipulation: 1. Intra-articular "mechanical" effects of zygapophyseal HVLAT manipulation seem to be absolu...

Urban Life Versus Rural Life: There is a huge difference between the Urban life and the rural life. In order to maintain our lifestyle and manage our expenses, we forget the most important thing, and that is us. We eat unhealthy and we do not exercise and this leads us to have excessive weight and it grows to such a level where it is difficult for us to manage it. On the other hand, if we analyze lifestyle in the rural areas, it is seen that people spend most of their time work on cultivation, so that they could eat and this is something that requires strenuous routines and keeps them fit and healthy throughout their lives and they encounter less medical problems than the people living in the urban areas. The American College of Sports Medicine recommends that adults get 30-45 minutes of exercise three to five days each week, maintaining the intensity for the duration of the exercise. Each session should contains a 5-10 minute warm up and cool down period. If weight loss is a major g...

Fascia is a membrane that extends throughout the whole body and numerous muscular expansions maintain it in a basal tension. During a muscular contraction these expansions could also transmit the effect of the stretch to a specific area of the fascia, stimulating the proprioceptors in that area. Histological characteristics of the deep fascia of the upper limb: Specimens taken from the antebrachial and brachial fasciae demonstrated that fasciae are formed of numerous layers of undulating collagen fibre bundles. In each layer, the bundles are parallel to each other, whereas adjacent layers show different orientations. Each layer is separated from the adjacent one by a thin layer of adipose tissue, like plywood. Many elastic fibres and a variety of both free and encapsulated nerve endings, especially Ruffini and Pacini corpuscles, are also present, suggesting a proprioceptive capacity of the deep fascia. Specimens taken from different areas of upper limb [taken at the level of: (a) the e...

Many investigators have defined the presence of innervation in control (no back pain) tissue specimens. In a study to define the innervation of the thoracolumbar fascia (in problem back pain patients who have articular abnormality defined through pain-provocation discography or facet blocks) found that the thoracolumbar fascia may be deficiently innervated in problem back pain patients. In this study sample collected from operating room (form lumbar spinal surgery patients) and later processed and studied under light and electron microscopy failed to identify specific neural end-organs in any of the specimens. Rather these samples show microscopic changes suggestive of ischemia or inflammation in this tissue were found. But recent finding suggest otherwise. In addition to free nerve endings, two types of encapsulated mechanoreceptors (Ruffini's and Vater-Pacini corpuscles) were identified. These findings support the hypothesis that the thoracolumbar fascia may play a neurosensory r...

Hurler syndrome is an autosomal recessive metabolic storage disease. (physios explore more on the disease). Characteristic musculoskeletal findings associated are acetabular dysplasia and failure of ossification of the superolateral femoral head. Genu valgum of variable severity due to failure of ossification of the lateral aspect of the proximal tibial metaphysis are also observed Clinically: 1. All patients were independently mobile, with restriction of internal hip rotation being the most significant clinical finding. 2. Valgus knees and pronated feet were typical associated findings.

manual therapy is being popular & practised by many physios in our country. it is taught by many competent authorities but there was no formal PG in manual therapy. PG in orthopaedic physiotherapy was there which was thought to cover manual therapy. but manual therapy it self is very huge subject. PG manual therapy is available at www.kleuniversity.edu.in check in

Interferential current (IFC) was suggested to improve the skin manifestations of psoriasis vulgaris, possibly by enhancing the intracellular concentration of cyclic AMP. Walker UA et al assessed the efficacy of IFC on psoriatic arthritis. Nine consecutive patients were analyzed at baseline and after 16 weeks of IFC therapy. Bipolar IFC was applied twice daily to hands, feet plus all affected joints. They found: 1. IFC improved SF-36 assessed body pain, but not other SF-36 subscales. 2. Morning stiffness, tender joint counts, and physician assessed disease activity improved. 3. In contrast, visual analogue scale assessed pain, CRP and ESR measurements were unchanged. MRI of the most affected hand or foot documented a tendency towards worsened tendinitis, soft tissue swelling, and new joint space narrowing and erosions. Bone scintigraphy showed a trend towards deterioration. New joints became inflamed within treated sites. They concluded because of above features that; ...

In one of the reputed journals of surgery in UK back in 1995 published an article authored by Weale AE et al titled “who should see orthopaedic outpatients--physiotherapists or surgeons?”. Following are points directly from his paper Weale AE et al: 1. Orthopaedic outpatient waiting lists are long and the majority of referrals are for conditions that do not respond to surgical intervention. 2. Many of these patients are best managed by physiotherapy, orthotics or steroid injections, which can be administered by an appropriately trained physiotherapist. 3. The effectiveness of a physiotherapist with extended training in orthotics and steroid injection was compared with staff grade orthopaedic surgeons in the management of orthopaedic outpatients judged unlikely to require surgery from the general practitioner's referral letter. 4. Some 221 patients with mechanical low back pain and foot and shoulder disorders were seen by a physiotherapist and 97 by staff gra...

Rheumatoid arthritis is encountered here in India with consistent regularity. MCP joints are the commonest joint to be affected. In a chronic RA patient MCP joint is flexed & deviated to the ulnar side. This deformity produces a great functional disability. One of the surgical options is MCP joint arthroplasty. It has been performed for people with rheumatoid arthritis (RA) since the 1960s. For eight to 12 weeks following surgery, patients wear hand splints and perform exercises to maintain and increase motion in the healing hand. Post-operative therapy regimes share common aims of encouraging MCP flexion and extension without the recurrence of flexion or ulnar deviation deformity. In a study by Massy-Westropp N et al (2008) published in Cochrane database reviews compared the effectiveness of post-operative therapy regimes for increasing hand function after MCP arthroplasty in adults with rheumatoid arthritis. The search included: The Cochrane Musculoskeletal Group Register, MEDLIN...