Dr Satyajit Mohanty blogs

Abnormal cholesterol metabolism, including low intestinal cholesterol absorption and elevated synthesis, is prevalent in diabetes, obesity, hyperlipidemia, and the metabolic syndrome. Diet-induced weight loss improves cholesterol absorption in these populations, but it is not known if endurance exercise training also improves cholesterol homeostasis. Wilund KR et al (2008) examined this, by measuring circulating levels of campesterol, sitosterol, and lathosterol in 65 sedentary subjects (average age = 59) with at least 1 metabolic syndrome risk factor before and after 6 months of endurance exercise training. Their data indicated that exercise training reduces plasma cholesterol despite increasing cholesterol absorption in subjects with metabolic syndrome risk factors.

Many claim that the use of intermittent cervical traction’s role is redundant. But according to a research paper by a group of Swedish physical therapists (In journal of manipulative physical therapy,2002) cervical spine traction could be considered as a therapy of choice for radiculopathy caused by herniated disks, even in cases of large-volume herniated disks or recurrent episodes. They described the use of intermittent cervical traction in managing 4 patients with cervical radiculopathy in large-volume herniated disks. All 4 patients had neck pain radiating to the arm. The clinical examination was typical in all cases for radiculopathy of cervical origin. Magnetic resonance imaging (MRI) of the cervical spine revealed large-volume herniated disks in all patients. Their treatment consisted of intermittent on-the-door cervical traction. Complete symptom resolution for each patient occurred within 3 weeks. One patient who had an episode of recurrence 16 months after the first treatment

Most spinal conditions are benign and self-limiting. For diagnosis the following are used: history, physical examination, and special studies, including diagnostic imaging, diagnostic blocks, and facet and sacroiliac joint injections. 1. In general, there is much more evidence on diagnostic procedures for the low back than there is for the neck. 2. With regard to the history, a number of factors can be identified which can assist the clinician in identifying sciatica due to disc herniation or serious pathology. With regard to the physical examination, the straight-leg raise is the only sign consistently reported to be sensitive for sciatica due to disc herniation, but is limited by its low specificity. 3. The diagnostic accuracy of other neurological signs and tests is unclear. 4. Orthopaedic tests of the neck, such as Spurling's or the upper-limb tension test, are useful to rule a radiculopathy in or rule out, respectively. 5. In patients 50 year

According to a review in Cochrane Graham N et al (2008) currently literature does not support or refute the efficacy or effectiveness of continuous or intermittent traction for pain reduction, improved function or global perceived effect when compared to placebo traction, tablet or heat or other conservative treatments in patients with chronic neck disorders.

Magnussion P et al reported: With stretching: 1. With repeated stretches muscle stiffness declined, but returned to baseline values within 1 hour. 2. Long-term stretching (3 weeks) increased joint range of motion as a result of a change in stretch tolerance rather than in the passive properties. Where as strength training resulted in increased muscle stiffness, which was unaffected by daily stretching. The effectiveness of different stretching techniques was attributed to a change in stretch tolerance rather than passive properties. Inflexible and older subjects have increased muscle stiffness, but a lower stretch tolerance compared to subjects with normal flexibility and younger subjects, respectively.

The similarity of etiology: The etiology of osteoporosis (OP) and osteoarthritis (OA) is multi-factorial: constitutional and environmental factors, ranging from genetic susceptibility, endocrine and metabolic status, to mechanical and traumatic injury, are thought to be involved. The differences: 1. The anthropometric differences of patients suffering from OA compared with OP are well established. OA cases have stronger body build and are more obese. OA cases have increased BMD or BMC at all sites. OA cases not only have higher apparent and real bone density, but also wider geometrical measures of the skeleton, diameters of long bones and trabeculae, both contributing positively to better strength and fewer fragility fractures. 2. Not only is bone quantity in OA different but also bone quality, compared with controls and OP cases, with increased content of growth factors such as IGF and TGFbeta, factors required for bone repair. 3. Furthermore, in vitro studies of osteoblasts recruit

Fatigue is well recognized as a side-effect of cancer and its treatment. Medical consultants advised people with cancer to rest if they felt fatigued. More recently a number of studies suggested physical exercise as a helpful tool in reducing the fatigue that is associated with cancer. Cramp F et al reviewed the effect of physical exercise on fatigue related to cancer. Twenty-eight studies were included in their review. Result of this review suggested that physical exercise can help to reduce fatigue both during and after treatment for cancer. However it is non clear what is the best type or intensity of exercise for reducing the symptom of fatigue.

I have never written on research methodology in my site. For young researchers I would like to present the following summary of a recent article by Hopewell S et al. Hopewell S et al’s methodology review was to assess whether the time taken to publish the results of clinical trials is influenced by the statistical significance of their results (time-lag bias). If clinical trials with positive findings are stopped earlier than planned and published quicker than those trials with null or negative findings, then new interventions might be mistakenly assumed to be effective. Their review shows that trials with positive results are published sooner than other trials. This has important implications for the timing of the initiation and updating of a review, especially if there is an association between the inclusion of a trial in a review and its publication status. It is of particular concern when one considers reviews containing only a small number of studies.

According to Kroeling P et al’s review of evidence of electrotherapy on mechanical neck disorders 1. Low or high frequency pulsed electromagnetic field (PEMF) compared to placebo, provides immediate post treatment pain relief only for chronic MND, acute whiplash (WAD) (Limited evidence of benefit) 2. Direct and modulated Galvanic current compared to other treatments for pain in acute, subacute, chronic occipital headache (Unclear or conflicting evidence) 3. Iontophoresis compared to other treatments for pain, RTW, and self-assessment of overall outcome in acute, subacute WAD (Unclear or conflicting evidence) 4. TENS compared to placebo for pain in acute WAD, chronic MND (Unclear or conflicting evidence) 5. PEMF compared to placebo for medium or long term effect on pain, patient assessment of improvement, ADL in acute WAD, chronic MND (Unclear or conflicting evidence) 6. Diadynamic current compared to placebo for reduction of trigger point tenderness

Predicted postoperative FEV1 is the most widely used parameter in preoperative risk calculation in the screening of patients for lung resection surgery. Recent evidences have suggested that predicted postoperative FEV1 is not a reliable predictor of postoperative cardiopulmonary complications because of the fact that the resection of a portion of lung in patients with obstructive disease determines only a minimal loss. The FEV1 measured on the first postoperative day may be 30% less than predicted postoperative FEV1.

Tendinopathy is a painful conditions occurring in and around tendons in response to overuse. Recent basic science research suggests little or no inflammation is present in these conditions. Current data support the use of eccentric strengthening protocols.

Cystic fibrosis is associated with low total proximal femur BMD. According to Dodd JD et al (2008) exercise appears to influence total proximal femur BMD more than lumbar spine BMD in Cystic fibrosis. Exercise rehabilitation programs focusing on peripheral strength training may benefit those Cystic fibrosis patients with low total proximal femur BMD.

MannG et al defines anterior knee pain as following: 1. Anterior knee-pain syndrome would best be defined as a painful condition that arises in or around the patellofemoral joint and is insidious in onset and bilateral, with no macroscopic gross pathology. 2. Anterior knee pain as a descriptive term would define the need to search further for a specific cause of pain, because neither patellar cartilage damage nor malalignment would necessarily be correlated to pain. 3. The examining physician should be aware that specifically in adolescents the higher chance would be that, eventually, no clear-cut pathology would be found; thus, great caution should be taken before diagnosing anterior knee-pain syndrome as existing unilaterally. It could be claimed, following the above, that as opposed to the term "anterior knee pain," the term "anterior knee-pain syndrome" is an exclusion diagnosis that can be applied after macroscopic pathology has been ruled out.

Calcific tendinopathy is a condition may present with severe pain. Usually in the supraspinatus tendon a chalky white deposit is seen on a radiograph. Recent Physiotherapy articles recommend local hyperthermia in this condition. A case study by De cesare A et al found; microwave diathermy (hyperthermia) at 434 Mhz three times a week for four weeks to be very effective. The radiographs ware negative after one month. 1 year follow ups ware highly satisfactory assessed by SPADI

The structures within the posterolateral corner of the knee have recently been "re-discovered" providing a very important role in maintaining the stability of the knee. The posterolateral aspect of the knee is stabilized by a complex anatomy of osseous, myotendinous and ligamentous structures. It plays an important role in the stabilization of the knee at low angles of knee flexion. Advanced biomechanical studies have brought additional understanding of both the anatomy and the function of posterolateral structures in knee stabilization and kinematics. Injury to the posterolateral corner is not common but neither is it rare; it is usually damaged in combination with rupture of one of the cruciate ligaments in direct and indirect trauma to the knee. The posterolateral corner has been shown to play a role in the prevention of varus angulation, external rotation, and posterior translation. The potential for long-term disability from these injuries may be related to increased art

sedentary habit produces many ill effects on musculo -skeletal & cardiorespiratory system. both skeletal muscles and cardiac muscles can work in a wide range of contractile activity. cardiac contractility in many ways depends on rate & style of musculoskeletal contraction. the challenge thrown by sedentary habits however is mono directional make both ( musculo -skeletal & cardiorespiratory system) of them UNI-PACED. sacrificing the entire fringe of contractile activity & trading it for sedentary individual comfort makes us prone to loss of many functional capacities more importantly it makes us vulnerable to many diseases.

Some migraine patients find that regular exercise helps in reducing the frequency of headache attacks. Currently many headache experts are recommending exercise in migraine. However, most of these recommendations refer to some anecdotal reports or observational studies in literature stating that regular exercise can reduce the frequency and severity of migraine. Busch V et al investigated whether recommendations for exercise in migraine are based on sufficient data to cope with requirements of an evidence-based modern migraine therapy. The review summarizes 1. Some results are controversial regarding the efficacy of sports intervention in migraine. 2. The majority of studies did not find a significant reduction of headache attacks or headache duration and only indicate a reduction of pain intensities in migraine patients due to regular exercise. 3. The grade of recommendation of exercise in migraine based on evidence based medicine (EBM)-criteria is presently B-C.

The following are 2 case reports by Ross MD et al published journal of physical therapy & journal of orthopedic and sports physical therapy. (Evidence: diagnosis level 4) These case report describes a patient referred for physical therapy treatment of neck pain who had an underlying hangman's fracture that precluded physical therapy intervention. Read the following minutely so that you can pick up clues for your own practice. Case study 1: This case involved a 61-year-old man who had a sudden onset of neck pain after a motor vehicle accident 8 weeks before his initial physical therapy visit. Conventional radiographs of his cervical spine taken on the day of the accident did not reveal any abnormalities. Based on the findings at his initial physical therapy visit, the physical therapist ordered conventional radiographs of the cervical spine to rule out the possibility of an undetected fracture. The radiographs revealed bilateral C2 pars interarticularis defects consistent with a

The effects of eccentric exercises on Achilles tendinopathy are not similar in athletic and non-athletic sedentary populations. According to Sayana MK et al Eccentric exercises, though effective in nearly 60% of our patients, may not benefit sedentary patients to the same extent reported in athletes. In my opinion any body in physical therapy practice confirms the statement. WHY such difference exists?

Ridner SH et al reported a home-based self operated lymphatic decongestive machine called Flexitouch system (developed in USA ,Tactile Systems Technology, Inc.) helps to reduce the following: 1. Participants' use of professional manual lymphatic drainage (MLD) therapy, 2. Self-MLD, and 3. Bandaging A high degree of adherence is reported in the usage of this equipment by both cancer and non-cancer patients. Healthcare professionals should facilitate communication among members of the lymphedema treatment team.

have you seen the manual therapy video of Marc Heller, DC the technique is excellent but be cautious! 1. do not use it in acute & subacute manifestations 2. read the course of sciatic nerve again 3. understand the meaning of each step of the manipulation finally i would recommend that it should be used after the normal SLR is re-gained in a prolapseIVD . i found it responds well to conditions producing restriction of glide where the root constituting the sciatic nerves are not impinged within the TV foramina .

literature exsists on all of the following: 1. big pillows causing neck pain 2. no pillows causing neck pain 3. moderate sized pillow easing neck pain

Hearn A et al (2002) reported clinical efficacy of cervical SNAGs (applied ipsilateral to the side of pain when treating painfully restricted cervical rotation) cannot be explained purely on the basis of the resultant biomechanical effects in the cervical spine.