Wednesday 19 December 2012

Laughter; the best medicine

A study done at Oxford University by a professor of evolutionary psychology have shown that laughter causes the release of natural opiates. After watching funny videos people's pain thresholds went up but not if they viewed factual documentaries. We tend to view laughter as an emotion but it is in fact a form of exercise and by doing this type of exercise where we perform repeated forceful exhalation of air from our lungs by using the diaphragm we increase the production of endorphins which in turn will increase the pleasure of being made to laugh

Proceedings of the Royal Society 2012

Thoughts on assisted dying

This article was written by a friend of mine, Dr Duncan Stewart

Three elderly clerics are discussing the point at which Life begins.  The Anglican, slightly pompously, begins with “As soon as a newborn baby cries, Life has started.”  “Oh, No” responds the Catholic priest, who presumably has no firsthand experience of conception, “Life begins much earlier. It starts when the sperm fuses with the egg” They both look at the Rabbi who strokes his beard and slowly announces “In my opinion Life begins when the children leave home and the dog dies.” A very important debate about the end of life, with some equally whimsical moments, is swirling around the corridors and leather benches of our Parliament . The supporters of Assisted Dying are making progress in spite of sustained opposition to a change in our laws from senior religious figures whose predecessors obstructed the passing of more progressive social legislation than any group except the aristocracy.

It is generally agreed that life has ended and the undertaker can confidently be called when the heart beats for the last time .There is  less agreement about  those “not quite dead” states in which death is both inevitable and imminent , as  when other organs like the liver and kidneys fail or that “Old man’s friend ” pneumonia intervenes. Fortunately, in these forms of terminal illness, pain is not a prominent symptom so fewer ethical problems arise. We all fear uncontrolled pain but sufficient doses of  opiate drugs can control any pain and if the dose required causes a coma that is only ended by death , so be it. But what if you have a condition which is not only painful and terminal but has deprived you of speech, movement and continence? What then? If you could somehow summon effective help in such a situation, you would not request the presence a homeopath nor a priest, you require the help of doctor with a syringe driver full of Morphine .

  I can understand the importance to a   believer in an afterlife of being reassured  of this by the his priest but we live in an increasingly secular society so why does  religious thinking still dominate this territory? The opportunity to rob your neighbour, murder his noisy children or seduce his wife, has now passed.  In any case why do God’s earthly representatives object to doctors relieving pain and anguish  when all  the other  parties involved ; the patient, physician  and relatives , have all agreed after much careful debate that to end  life remains  the only humane act? I refuse to accept that anyone’s god is going to be seriously offended if a few souls smelling strongly of barbiturates reach him a few days ahead of schedule.
For myself, I imagine my final day lying in a comfortable bed surrounded by friends and family sorry to see me go but thinking, perfectly reasonably, about my last will and testament.  As  life slips  gently away I  will be reviewing my few successes , my many more numerous acts of timidity and unkindness and finally trying to compose a  witty last utterance. Maybe.

Forget the rising cost of living and ponder on the cost of prolonged dying.  I intend  to  vote for whoever wants to repopulate the House of Lords and legalize Assisted Dying and to  give more generously to our 2 superb local hospices, The Martlets and The Beacon to whose running costs our parsimonious government contributes only a miserly  30%. I will also check that my having made a Living Will, which lawyers refer to as an Advance Decision, is known to my family, solicitor and GP. This simply states one’s wish not to be resuscitated where this is clearly inappropriate and while it cannot override existing legislation it may help all who participate in that decision. You can download the paperwork very simply. I will also dust off my organ donor’s card in case any of my organs have a bit more mileage left in them.

You are probably aware that Switzerland, Holland Belgium and Luxemburg have succeeded in creating carefully crafted legislation which acknowledges the right of some, but by no means all, terminally ill and seriously disabled people, to decide when their life ends. Three states in the overtly God-fearing USA : Montana Washington and Oregon allow assisted suicide in similar situations. Simply wishing to die clearly does not qualify, it is suicide.

 Our 3 clerics would all have accepted the Paediatricians’ assertion that the first 12 hours of life, whenever it starts, are the most dangerous; but they are not as hazardous and uncertain as the last 12.  RIP

Tuesday 18 December 2012

Physical activity should be done in moderation to look after your joints

People who engage in excessive high-intensity physical activity and those who do very little physical activity might be damaging their knee cartilage, according to research presented at the Radiological Society of North America 98th Scientific Assembly and Annual Meeting.
The loss of cartilage is progressive and irreversible. "Once the cartilage is gone, it is gone for good and cannot be recovered," said senior author Thomas M. Link, MD, PhD.  "This is why it is so important for people to do physical activity in moderation and to use safe practices when they do sports such as running and playing tennis. He also said  "I have seen people in their 20s who have completely destroyed their cartilage surface and I wonder what is going to happen to them. They are going to live another 50 or 60 years. They cannot walk on bone, so they will need a total joint replacement, perhaps several, over their lifetime. Each time the bone gets thinner and weaker because bone does not react well to total joint replacement. This is going to become a serious problem," he said   "People need to learn how to protect their joints when they do physical activities, he said. "People should be active, but they should make sure they're exercising in a safe way and not destroying their joints."
Radiological Society of North America (RSNA) 98th Scientific Assembly and Annual Meeting: Abstract LL-MKS-SU1B. Presented November 26, 2012.

Packing up smoking

Patients with spinal disorders who quit smoking may experience substantial improvements in back pain
Caleb Behrend, MD, from the University of Rochester Medical Center in New York, and colleagues present their findings in an article published in the December issue of the Journal of Bone & Joint Surgery.
The authors mention that smoking has been identified as a modifiable risk factor for chronic pain disorders. "Furthermore, with regard to chronic pain disorders, smokers have reported an increased magnitude of pain when compared with nonsmokers," the authors write. 
In the study, the authors reviewed questionnaires for 5333 patients . Patient-reported pain scores were assessed using a visual analog scale (VAS) of 1 being the least pain and 10 being the worst.
Compared with never-smokers, current smokers reported significantly greater pain scores at the latest follow-up ; mean VAS score, 4.49. 
Patients who quit smoking reported significantly greater improvements compared with current smokers in worst weekly pain.
In addition, nearly 2-fold more patients who quit smoking reported a more than 30% decrease in worst pain than current smokers (32.0% vs 16.6%), and never-smokers reported a greater mean improvement in disability. 
It was concluded that smoking cessation programs are needed to improve chronic pain among patients with spinal conditions. 
J Bone Joint Surg Am. 2012;94:2161-2166. Abstract

If you'd like help reaping the rewards associated with giving up smoking NLP and Hypnotherapy can help. Find out more at the Physio Therapy Centre

Thursday 13 December 2012

Taking Glucosamine, Chondroitin, and Fish Oil may reduce inflammation

Regular use of glucosamine, chondroitin, or fish oil supplements reduces high-sensitivity C-reactive protein (hs-CRP) by 16% to 22%, a marker of inflammation, according to a new study. Inflammation is now recognized as a factor in cancer and cardiovascular disease as well as many rheumatoid diseases. A number of over-the-counter dietary supplements are being marketed for the purpose of reducing inflammation, but data supporting the claims are limited.
In an article, published online  in the American Journal of Epidemiology, the researchers report that regular use of glucosamine, chondroitin, or fish oil significantly reduced serum hs-CRP.
In participants who regularly used a supplement, the researchers found hs-CRP reductions of 17%  with glucosamine, 22%  with chondroitin, and 16% with fish oil compared with participants who did not take the supplements. The analyses were adjusted for age, gender, race, smoking history, and body mass index.
Effects Limited to Women
The anti-inflammatory effects of glucosamine and chondroitin in the overall study population were driven by effects in women. Effects in men were small and nonsignificant.
The supplements methylsulfonylmethane, garlic, ginkgo biloba, saw palmetto, and pycnogenol were not associated with reduced inflammation.

Am J Epidemiol. Published online November 8, 2012. Abstract

Wednesday 12 December 2012

A study of the effects on mortality of muscle strength in young people


Although multiple studies have focused on the relationship between aerobic fitness and the risk for mortality, less research has been conducted on the possible association between muscle strength and mortality outcomes. Ruiz and colleagues addressed this issue in a study published in the July 1, 2008, issue of the BMJ. They found that higher muscle strength in the legs and chest among men between 20 and 80 years old was associated with reduced rates of overall mortality and cancer mortality. After adjustment for the degree of cardiorespiratory fitness, muscle strength did not significantly affect the risk for cardiovascular mortality.
Young adults have a very different epidemiology of mortality vs middle-aged and older adults. The current study by Ortega and colleagues evaluates the effect of muscular strength on the risk for early mortality among young people.


It is well known that hypertension and high body mass index during adolescence are associated with premature mortality. Now, a long-term prospective study of more than a million Swedish adolescents has turned up yet another risk factor: low levels of muscular strength.
The study was published online November 20 in the BMJ.
The authors of the study, led by Francisco Ortega,  point out that muscle strength in adulthood has been linked to all-cause and cardiovascular mortality in adults. Until now, however, similar data have been lacking in adolescents.
Similarly, they say, better cardiorespiratory fitness is associated with better mental health in adults, but there has been scant evidence whether muscle strength at any age is associated with future mental health and suicide mortality.
"This study provides strong evidence that a low level of muscular strength in late adolescence, as measured by knee extension and handgrip strength tests, is associated with all cause premature mortality to a similar extent as classic risk factors such as body mass index or blood pressure," the researchers write.
Ortega and colleagues followed up 1,142,599 young men aged between 16 and 19 years who were evaluated for service in the Swedish military. During a median follow-up of 24 years, the researchers assessed the extent to which muscle strength in adolescence was associated with all-cause premature mortality, which they defined as death before age 55 years. 
Participants who scored high on the knee extension and handgrip muscle strength tests had a 20% to 35% lower risk for death from any cause and from cardiovascular disease compared with those who scored low on the strength tests. Further, the researchers note, those differences were independent of body mass index or blood pressure status.
Ortega and his colleagues conclude, "Low muscular strength should be considered an emerging risk factor for major causes of death in young adulthood."
BMJ. Published online November 20, 2012. Full text


  • Study data were drawn from Swedish military conscripts registered between 1951 and 1976. Researchers focused on individuals who were 16 to 19 years old at the time of baseline testing.
  • Participants also completed strength testing at baseline, including handgrip, elbow flexion, and knee extension power.
  • Participants were observed until the time of death or immigration away from Sweden. Death registers were used to follow the main study outcome of early mortality, which was defined as death before age 50 years.
  • Researchers focused on the relationship between muscle strength at baseline and mortality outcomes, with particular attention to death from suicide, cardiovascular disease, and cancer.
  • The study outcomes were adjusted for year of birth and conscription office.
  • 1,142,599 men provided data for study analysis. The mean follow-up period was 24.2 years.
  • 26,145 men (2.3% of the study sample) died during follow-up. Suicide and unintentional injuries comprised nearly half of the deaths recorded. Cardiovascular disease was responsible for 7.8% of deaths, and cancer accounted for 14.9% of deaths.
  • Overall, higher levels of muscle strength reduced the risks for early overall mortality and cardiovascular mortality by 20% to 35%, but strength did not affect the risk for cancer mortality.
  • A mortality benefit of improved muscle strength was evident regardless of body mass index at baseline.

Thursday 6 December 2012

Keep your heart healthy with the BBC

Activity for a healthy heart

Athlete stretching
Prevention is always better than cure. This section outlines how regular exercise can give you a healthier heart and how relaxing can help reduce stress levels.

Healthy heart

Educating people about the risk factors of heart disease and persuading them to adopt a healthier lifestyle can have an impact on the number of people dying from heart disease and stroke.
Encouraging people to stop smoking, drink less, eat better and exercise regularly are particularly important. Doctors can help by asking about smoking habits and encouraging patients to use nicotine replacement treatment, such as nicotine patches.
Even if you've already been diagnosed with heart disease, making lifestyle changes can help you live a longer, healthier and more enjoyable life.

Active heart

Being active is essential for a healthy heart for the simple reason that your heart is a muscle. Even if you haven't been active for some time, your heart can become stronger so it's able to pump more efficiently, giving you more stamina and greater energy. Becoming more active will also improve the ability of your body's tissues to extract oxygen from your blood, help you maintain healthy levels of blood fats and speed your metabolism.
If you are overweight, you're 80 per cent more at risk of heart disease. The best way to control your weight is to eat a healthy diet and take regular exercise.
Three types of exercise are vital for all-round fitness: aerobic, resistance training and flexibility.

Aerobic exercise

Aerobic, or cardiovascular, exercise is particularly important in the prevention of coronary heart disease. This is any kind of activity that increases your breathing rate and gets you breathing more deeply. These activities include walking, running, swimming, dancing or any of the aerobic (cardiovascular) machines at the gym, such as the rowing machine, treadmill, stepper or elliptical trainer.
These are designed to increase the strength of your heart muscle by improving your body's ability to extract oxygen from the blood and transport it to the rest of the body. Aerobic exercise also enhances your body's ability to use oxygen efficiently and to burn (or metabolise) fats and carbohydrates for energy.

Resistance training

Resistance training helps to make your muscles stronger, strengthens your bones and protects your joints from the risk of injury.
This type of exercise can involve the use of free weights and weights machines such as those found in the gym, or any kind of activity in which you load your muscles. For example, carrying heavy shopping bags or exercises such as press-ups, lunges and squats, and some of the yoga exercises in which you use your body weight, are all good for resistance.
Resistance training doesn't increase the fitness of your heart like aerobic exercise, but it can help to control your weight because muscular tissue burns more calories than fat.
This type of exercise isn't recommended for people with uncontrolled high blood pressure or heart disease, so if you are affected by those conditions, check with your doctor.


Stretching helps relax and lengthen your muscles, encourages improved blood flow, and helps to keep you supple so you can move more easily. Experts say it's good to stretch for five to 10 minutes every day.
There are a number of simple stretches you can find in virtually any book about exercise, or be taught by the instructor at the gym.
If you want more organised stretching, yoga and Pilates are safe and gentle for people with heart problems, as they help calm the mind and body and reduce stress. That said, there may still be some exercises or postures that are not recommended if you have heart disease, so check with your doctor first and tell your instructor if you have high blood pressure or heart disease.

Where to exercise

There's no need to join a gym or take part in organised sport, unless you want to. Simply incorporating more activity into your daily life and doing activities such as walking, gardening and cycling can be just as effective as a structured exercise programme.
Your aim is to be moderately active for 30 minutes most days of the week. If you find it hard to fit this into your life, split it up into shorter periods. You should feel that your heart rate is increasing and that you're breathing more deeply and frequently. You should be able to walk and talk at the same time - if you can't, the activity is too strenuous.

Safety first

If you experience any or all of the following, stop exercising immediately and consult your doctor:
  • Chest pain
  • Dizziness, light-headedness or confusion
  • Nausea or vomiting
  • Cramp-like pains in the legs (intermittent claudication)
  • Pale or bluish skin tone
  • Breathlessness lasting for more than 10 minutes
  • Palpitations (rapid or irregular heart beat).
  • Continued fatigue (lasting for 24 hours or more)
  • Fluid retention (swollen ankles, sudden weight gain)


All content within BBC Health is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. The BBC is not responsible or liable for any diagnosis made by a user based on the content of the BBC Health website. The BBC is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service mentioned or advised on any of the sites. See our Links Policy for more information. Always consult your own GP if you're in any way concerned about your health.

Monday 3 December 2012

On your bike..

Just read an interesting article on why riding a bike is pretty special. The rite of passage from little kid to big kid when you get your first proper bike, dump the stabilisers and whizz away.

Interesting work by researchers in the Netherlands showed that riding a bike can tell us stuff about the brain and how it functions. Patients suffering with Parkinson's disease are often affected with tremors,  involuntary muscle movements and can have problems with balance, co ordination and  limb control. One such patient, a 58 year old man  had "gait freezing"where he was incapable of normal walking, needed visual guides to help him step one foot in front of the other and often lost his balance so that he needed to sit in his wheelchair. Yet put him on a cycle and he was able to ride it with out any problems. The video is available on YouTube and it shows him initially shuffling down a corridor with help and after a few steps he stumbles and falls. The second video shows him riding a bike with no signs of tremor pedaling at a consistent pace with perfect balance and coordination then he gets off the bike and he is once more unable to walk. This phenomenon is called kinesia paradoxia and the study of which  may lead on to different forms of physiotherapy treatment.  Further research is going on to study how the human is able to ride, how the cyclist interacts with the bike and the environment and all the requirements that are need to make what is a very complicated procedure look so simple

Wednesday 28 November 2012

Good Grief!

As part of the human condition and as I think that this blog relates to that through my occupation as a physiotherapist, the article on grieving, written by Vaughan Bell in the Observer related to the psychology of grief,  was worthy of discussion

Mourning can take many different forms across different cultures, based on many different understandings of death. Claims that there is a universal psychology of grief  fails when viewing the diversity of humankind. Aboriginal Australians have a taboo about naming or encountering representations of the dead. On the Pacific coast of Colombia there is a belief that the death of a young child is marked by celebrations as it is believed that dead becomes an angel and goes directly to heaven. The Ganda people in Uganda  have a strict prohibition of sexual activity during mourning whilst the Cubeo tribe in Brazil have sex as part of the wake.

 I was led to believe that when we grieved we followed through  certain stages or phases and that this popular belief was normal and it was somehow abnormal if you did follow through these stages. It was the Swiss psychiatrist Elizabeth Kubler-Ross who first put forward the idea of DABDA; an acronym for denial, anger,bargaining,depression and acceptance and that somehow we moved through these stages of adjustment, and that sometimes you didn't and you got stuck in one or other stage and was then unable to move through the grieving process; or that you could go from denial to acceptance in one move and miss out all the other stages and so on. It turns out that she was talking about ones own acceptance of death and also  her ideas were wildly over-applied.

Elsewhere a psychologist George Bonanno followed individuals who were bereaved over years and found that there were no evidence of stages. Being plunged into despair and then slow recovery turns out to be exaggeration  It seems that sadness is a common response but deep debilitating anguish is an exception not a rule. Most people experience the heartache of losing someone but feel the  loss in different ways. There are no rules to dealing with loss; we all do it differently. No stages just personal journeys

Saturday 17 November 2012

Vit D can help in musculo skeletal pain

 Vitamin D supplements can improve nonspecific musculoskeletal pain in non-Western immigrants, according to research from The Netherlands.Dr. Schreuder and colleagues investigated the effects of high-dose vitamin D  supplementation on nonspecific musculoskeletal symptoms in 79 non-Western immigrants (mainly from the Middle East, Turkey, northern Africa, and Somalia).

Patients were initially randomized to vitamin D or placebo. After six weeks, those initially randomized to vitamin D were randomized to another dose of vitamin D or placebo and those initially randomized to placebo all received high-dose vitamin D.

After the first six weeks, significantly more patients in the treatment group reported improvement in pain (34.9% vs 19.5%; p=0.04).
Also at six weeks, significantly more patients in the vitamin D group reported improvement in their ability to walk stairs ( 21.0% vs 8.4%; p=0.008).

Ann Fam Med 2012;10:547-555

Knee replacements and obesity

Obese patients are nearly twice as likely to incur infection after a total knee replacement, more than 2 times likely to incur deep infection, and slightly more likely to require a surgical revision than those who are not obese, according to a meta-analysis published in the October 17 issue of the Journal of Bone and Joint Surgery.

J Bone Joint Surg Am. 2012;94:1839-1844

Too much sitting is bad for you

The more time people spend sitting, the greater their risks of diabetes, cardiovascular events, and death, a new meta-analysis has shown

One of the authors of this paper, Dr E Wilmot says  "that a number of important messages have emerged from the research. People don't think about sitting as being dangerous, and it's quite a change, having to think, 'how can I reduce my sitting?' rather than just 'how much exercise can I do?' We've traditionally been focused on making sure we meet the physical-activity guidelines of 30 minutes per day, but with that approach we've overlooked what we do with the other 23 and a half hours in the day. If you sit for the rest of the day, that is going to have an impact on health, and that's essentially what our meta-analysis shows,"

Wilmot and colleagues say the hazards of high levels of sitting were first highlighted in the 1950s, when a two-fold increase in the risk of a myocardial infarction was identified in London bus drivers compared with active bus conductors. But since then, the "potentially important distinction" between sedentary (sitting) and light-intensity physical activity has been "largely overlooked" in research, they observe. They add that estimates have put the time the average adult spends in sedentary pursuits at around 50% to 60% of their day

The greatest sedentary time compared with the lowest was associated with a doubling of diabetes risk, around a 2.5-fold increase in the risk of cardiovascular events , a 90% rise in risk of cardiovascular death  and a 49% higher risk of all-cause mortality .

Sitting seems to have an immediate effect on how our bodies metabolise glucose. When we sit, our muscles are not used, and we quickly become more insulin resistant." Studies have shown that people who sit after eating have 24% higher glucose levels than people who walk very slowly after a meal#

  1. Wimot EG, Edwardson CL, Achana FA, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: Systematic review and meta-analysis. Diabetologia 2012; 55:2895-2905. 

If you're worried about being too sedentary and plan on embarking upon a new regime of exercise, be sure to look after your body and remember physiotherapy can help.

Exercise is good for intermittent claudication(calf pain)

A program of supervised exercise for 30 minutes, twice a week, was as effective as endovascular revascularization( passing a catheter balloon through the vessel to improve blood flow)  in terms of functional outcomes and quality of life in patients with intermittent claudication, according to a randomized controlled study reported at the  In addition, the improvement seen with both interventions was sustained out to seven years

In his trial, 150 patients with intermittent claudication were randomized to either supervised  exercise therapy(SET), which involved walking on a treadmill for 30 minutes twice a week (n=75), or endovascular revascularization (n=75). Baseline characteristics of the patients were similar, he noted. Patients in both groups were advised to walk at home as much as possible.

Dr Farzin Fakhry, one of the authors of this paper said that  “ the one- and seven-year results indicate that SET and endovascular revascularization were equally effective in improving functional performance and quality of life,". The study had 36 patients in the exercise group and 47 in the revascularization group who were available for the longer follow-up of seven years, he noted.

The number of patients with one or more secondary interventions was higher in the SET group (32 patients underwent at least one secondary intervention compared with 17 in the endovascular-revascularization group; p=0.01), although the average number of secondary interventions did not differ between the groups (2.0 in the SET group vs 2.8 in the revascularization group [p=0.10]). Two patients in the exercise group underwent minor amputation, and three in the revascularization group had a major amputation.

"The study supports the use of a SET-first treatment regimen in the care of patients with intermittent claudication," Fakhry concluded.

Exercise as Good as Revascularization in PAD.  Medscape. Nov 12, 2012.



Saturday 10 November 2012

Self management and low back pain

Self-management interventions are widely recommended for patients with low back pain (LBP), but a systematic review with meta-analysis by Australian researchers suggests that its effects on pain and disability are likely to be small and are supported by only moderate-quality evidence.
The authors conclude, "Although effective when compared to minimal intervention, we are unsure if self-management provides worthwhile effects in the management of LBP. This result challenges the endorsement of self-management in treatment guidelines."
Arthritis Care Res. 2012;64:1739-1748. Abstract

Knee Osteoarthrosis may be linked to Vit D deficiency

Vitamin D deficiency may be a risk factor for increased knee osteoarthritic pain in black Americans, according to a study published online November 7 in Arthritis & Rheumatism.
A study was conducted in which 94 adults completed questionnaires and underwent sensory testing for heat and mechanical pain.  Participants were 75% women, they had an average age of 55.8 years, 45 were black, and 49 were white.
The researchers collected serum vitamin D levels at the beginning of sensory testing. They measured the heat pain threshold as when sensation "first becomes painful," and the pain tolerance as when the pain reaches the level of "no longer feel able to tolerate the pain." The researchers found that 38 of the 45 black participants (84%) had low vitamin D levels. On initial assessment, the researchers identified the most painful knee as the study index knee. Low levels of vitamin D were significantly associated with lower heat pain thresholds on the index knee as well as pressure pain on the index knee
In a news release, first author Glover said, "Our data demonstrate that differences in experimental pain sensitivity between the two races are mediated at least in part by variations in vitamin D levels. However, further studies are needed to fully understand the link between low vitamin D levels and racial disparities in pain. Although rare, vitamin D toxicity is possible and older adults should consult with their primary care provider regarding supplementation. It may be warranted that older black Americans with chronic widespread pain be screened for vitamin D deficiency to reduce disparities in pain."
According to the news release, the authors also plan to pursue research to test whether improving vitamin D status in older black and white patients affects their experience of chronic pain.
This study was supported by the National Institutes of Health/National Institute on Aging and the UF Clinical and Translational Science Institute. Glover is a John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Scholar and a Mayday Fund grantee. The other authors have disclosed no relevant financial relationships.
Arthritis Rheum. Published online November 7, 2012. Abstract

Thursday 8 November 2012

Get 10% fitter with a 60  second blast

One of the journals I read is  Mens Running', a Uk publication described as " for runners with balls"!  I noticed a short piece that  stated  that 60 seconds of of high intensity exercise three times a week can improve your fitness by 10%. The research took two groups that both did a 10K cycle time trial. Then one lot did high intensity interval training, cycling flat out for 6 seconds, resting 1 minute , then repeating the same thing 10 times. The other maintained their nomal regime. After 2 weeks of  this regime 3xper week, both groups retook the 10K cycle time trial and those that had followed the high intensity regime attained a 10% higher speed. The suggested reason was that high intensity regimes  slow lactate build up and that short sprints make it possible for the body to use the lactate more efficiantly.

Tuesday 2 October 2012

Does Spinal Manipulation Relieve Low Back Pain?

In patients with chronic nonspecific low back pain, spinal manipulation/mobilization therapy followed by an 8-week program of specific active exercises has been shown to decrease immediate pain and improve functional ability vs sham therapy plus active exercises, according to these findings(Balthazard et al 2012)

This study aimed to assess whether spinal manipulation/mobilization therapy had an analgesic effect.

A total of 37 patients with chronic nonspecific low back pain were monitored through 8 therapeutic sessions delivered for 4 to 8 weeks. A single physiotherapist with 15 years of experience performed the active intervention

By contrast, the sham therapy used a detuned ultrasound device, and the patient was unaware that the ultrasound device was inactivated.

Active exercises were used in both groups and included pelvic tilt and low back lateral flexion exercises that were performed with the patient in the supine position. The participants also engaged in stretching, motor control, and strengthening exercises during the 8 weeks of sessions.

"This study confirmed the immediate analgesic effect of [spinal manipulation/mobilization] over [sham therapy]," the study authors note. "Followed by specific active exercises, [spinal manipulation/mobilization] reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group," they add and it confirms the clinical relevance of spinal manipulation/mobilization as an "appropriate treatment" of chronic nonspecific low back pain.

BMC Musculoskelet Disord. Published online August 28, 2012.

Tuesday 18 September 2012

Meta-Analysis Finds No CV Benefit of Omega-3 Fatty Acids

September 13, 2012 (Ioannina, Greece) — A new meta-analysis looking at the effects of omega-3 fatty acids in patients at high risk for cardiovascular events has shown that the supplements have no effect on hard clinical outcomes, including all-cause mortality, cardiac death, sudden death, MI, or stroke. There was a trend toward benefit in the prevention of sudden death, but the reduction failed to reach statistical significance, a finding the researchers believe refutes any supposed antiarrhythmic-mediated effect of omega-3 fatty acids.
"The meta-analysis, taking into account the recent and previously published trials, showed that omega-3 fatty acids did not significantly reduce the incidence of cardiovascular events," senior investigator Dr Moses Elisaf (University Hospital of Ioannina, Greece) told heartwire. "However, there was a trend toward benefit in terms of sudden death, about a 13% reduction, and myocardial infarction, about a 10% reduction, but the decrease was not statistically significant. So, we can conclude from this meta-analysis and other recently published trials that the effect of omega-3 fatty-acid supplementation in high-risk patients is rather low. They are without side effects, but without significant efficacy."
The study is published in the September 12, 2012 issue of the Journal of the American Medical Association

Acupuncture Superior to Placebo, Usual Care for Chronic Pain

September 10, 2012 — Acupuncture is superior to both sham acupuncture and standard care for the treatment of different types of chronic pain, suggesting that the effects of acupuncture are more than just placebo effect, a new meta-analysis shows.
The analysis found that about 50% of patients who got acupuncture had improvement in pain compared with 30% who didn't get acupuncture and 42.5% who had sham acupuncture.
"In other words, 20% of patients were feeling better because they had acupuncture; about one third of those would only feel better if the right needles were put in the right points to the right depth, and two thirds of them would feel better getting any kind of acupuncture," lead study author Andrew J. Vickers, DPhil, attending research methodologist, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, told Medscape Medical News.
Dr. Andrew J. Vickers
So in contrast to other interventions, for which the placebo effect is typically about one third of the effect of the treatment, "in acupuncture, it looks like it's two thirds," said Dr. Vickers. "That's quite a large benefit and that's what the patient will actually experience in real clinical practice," where the decision is not whether to have true or sham acupuncture but whether to get a referral for acupuncture or not.
The analysis is published online September 10 in Archives of Internal Medicine.

Saturday 8 September 2012

UK Paraplegic Woman First to Take Robotic Suit Home

By Chris Wickham

LONDON (Reuters) Sep 04 - A British woman paralyzed from the chest down by a horse riding accident has become the first person to take home a robotic exoskeleton that enables her to walk.
The exoskeleton is activated by the wearer tilting their balance to indicate the desire to take a step. It supports the body's weight and also allows the person to go up or down stairs, as well as sit or stand up independently.Although bionic exoskeletons have been used in hospitals and rehabilitation centers, Claire Lomas is the first to take the ReWalk suit home for everyday use.

Lomas earlier this year used the suit to complete the London Marathon in 17 days, raising about 200,000 pounds ($317,900) for research into spinal damage, and she was recently given the job of lighting the Paralympic cauldron in Trafalgar Square.
But she said more routine activities are equally gratifying.
"One of the best experiences was standing at a bar," she said. "To be stood up in this means everything to me."

It costs 45,000 pounds  and although clinical studies are ongoing that could back a case for health authorities to fund purchases of the device, the developers argue that savings on the treatment of ailments related to inactivity could offset the cost.Paralyzed people are prone to pressure sores and a loss of bone density, as well as problems linked to poor posture. Jasinski said estimates on the cost of treating these range from $500,000 to $3 million over a patient's life.

The company estimates that of the SIX million wheelchair users in the U.S. and Europe, around 250,000 could be suitable for using the ReWalk device.

Research into exoskeletons goes back 50 years but advances in software management systems and sensors have only recently made them practical.Argo, which is backed by Israeli venture capitalists SCP Vitalife and Israeli Healthcare Ventures, is working on a similar device for quadriplegics, as well as a brain interface that could allow more intuitive 'thought control' of the exoskeleton.
Although Jasinski says this is still years away, scientists have recently unveiled devices that can be controlled in real time by thought using advanced brain scanning.

Others are working on materials that can interact with human nerves and tissue that could eventually lead to prosthetics that are fused with the body and controlled directly by the nervous system.
In June, a team at Maastricht University in the Netherlands unveiled a device that uses functional magnetic resonance imaging, which monitors blood flow in the brain, to allow people to spell out words simply by thinking of each letter.

Another experiment reported in July saw fMRI used by a man at Bar-Ilan University in Israel to control the movements of a robot thousands of miles away at Beziers Technology Institute in France.
Lomas said that after her accident, she rejected pleas from doctors to give up on the idea of using her legs, saying that as a young, active woman before her 2007 accident, "I didn't want to have a big stomach and spindly legs."

Since the accident she has got married, had a child, and next year plans a London-to-Paris bicycle ride using a so-called Functional Electrical Stimulation bike that artificially stimulates the paralyzed rider's own muscles to propel it along.

Tuesday 7 August 2012

Beat Alzheimer disease by being active

Every 68 seconds someone is diagnosed with Alzheimer disease. It's a devastating diagnosis for patients, their families, and their caregivers. Nearly 5.5 million Americans already have it. By 2050 expect that number to approach 16 million unless something can be done to stave off the disease.

One American study showed why it's important to stay active and exercise. It included more than 700 dementia-free patients enrolled in the Memory and Aging Project at Rush University Medical Center. The volunteers self-reported physical and social activity. There was also a monitor and actograph on their wrists that tracked their activity for about 10 days. They were followed for 3.5 years; 71 of them developed Alzheimer disease.

The results suggested that activity and exercise matter. The slow movers, those in the bottom 10% of activity level, were more than twice as likely to develop Alzheimer disease as the top 10% of exercisers, the ones that moved the most. Cooking, cleaning, and gardening also counted and seemed to help. The average age of the patients in this study was 82 years, so you're never too old and it seems it's never too late to start. More physical activity can equal slower cognitive decline.

Wednesday 18 July 2012

FYI; Coffee is good for you and have a postive effect on Alzheimer

A recent study was carried out by the National institutes of Health/American Association of Retired Persons  They enrolled more than 400,000 participants from age 51 to over 70 years, and more than 52,000 deaths were accrued from the National Death Index. It included participants from 6 states plus Atlanta and Detroit. 
The investigators looked at people who drank no coffee, less than 1 cup, 2-3 cups, 4-5 cups, or more than 6 cups, and then they tallied the rates of deaths in people with heart disease, stroke, diabetes, respiratory disease, cancer, and the other usual conditions you look at.

Then they adjusted for other factors, such as white meat intake, red meat intake, total calories, smoking, and the kind of coffee consumed.  When the data were adjusted for those other factors, the clear offender was cigarette smoking and,  in fact, the more coffee you drank, it seemed, the lower the risk for all of these other conditions.

Of interest, all of the people who drank more than 6 cups of coffee a day had less college education, ate more red meat and less white meat, ate fewer fruits and vegetables, and had less vitamin supplementation and other supplements -- all the things we think aren't good for us.
Another recent report says that coffee may actually delay or possibly prevent Alzheimer disease. We do not know whether tea would do this, we do not know whether other caffeinated beverages would, or whether it is an effect of caffeine. There are many, many elements in coffee, including antioxidants and other components, that could be responsible for this benefit.

Thursday 5 July 2012

Why to coloured taping

Why are athletes wearing coloured tape?

Italian striker Mario Balotelli Mario Balotelli revealed his stripes (and got a yellow card) when he took off his shirt during Euro 2012


Why are athletes wearing coloured tape?

In the Euro 2012 Championship, Italian striker Mario Balotelli was sporting three tramlines of blue sticky tape on his back.

And at Wimbledon, Serbian tennis player Novak Djokovic has had his elbow patched up with the same stuff.

So what's behind this latest sporting fad?

The Japanese makers of Kinesio tape say it gives players an edge by mending injuries.
Sticking plaster?
Although it might seem like a new idea, the tape has been around since the 1970s.

Dr Kenzo Kase says he came up with the design because he found standard taping techniques, like conventional strapping, too restrictive for his patients.

Although standard strapping provides muscle and joint support, it limits movement and, according to Dr Kase, gets in the way of the healing process by restricting the flow of inflammatory fluids below the skin.

Kinesio tape is different, he says, because it lifts the skin to assist this lymphatic flow, which, in turn, reduces pain and swelling.

However, Dr Kase admits there have been to prove these scientific claims.

Dr Kase says people have been using his tape with success for more than 30 years. But he recognises that only solid scientific evidence can silence critics.

"We have many people researching but the society of Kinesio taping therapy itself - the International Kinesio Taping Association - is only five years old. We need more evidence. We do not have research reports. Part of the reason people are using Kinesio tape is to find the science."

Novak Djokovic Novak Djokovic has been wearing the tape during his Wimbledon matches

Another element to consider is the power of persuasion or "placebo effect" - if you believe something will work then you will see results.

John Brewer, a sports professor at the University of Bedfordshire, said: "Personally, I think it is more of a placebo effect. There is no firm scientific data to show that it has an impact on performance or prevents injuries.

"My concern is that there is little that you can put on the skin that will have a real benefit for the muscles that lie deep beneath.

"The power and stress going through the joints is immense.

"But, saying that, I can't see it would cause any real problem, other than making you lose a few hairs."

In theory, anything that can lessen the oscillations or vibrations that go through the muscle when you are doing intense sport will be beneficial, he said.

Phil Newton, a physiotherapist at Lilleshall, one of the UK's National Sports Centres, said: "It's a multimillion-pound business, yet there's no evidence for it. There's a whole host of companies making this tape now.

"A lot of medical practitioners do use it.

"It is different to the various types of tape that physios have been using for donkey's years to strap sprained ankles and so on.

"This is a relatively new type of tape that is thin and light weight. The idea behind it is fascial unloading - reducing pressure in the tissue below the skin."

Dr Newton remains dubious. "Looking at the tensile strength of the tape I don't see how it could do it unless it is down to stimulating the senses. The power of placebo is very strong and shouldn't be underestimated."

He predicts the Olympics will be awash with the stuff. "It'll be a show of multicoloured tape.

"We'll probably see athletes in the Olympics sporting a few union jacks made out of it," he said.

Dr Kase certainly hopes so.

He said: "Olympians are very top athletes. Top athletes are very different from regular athletes. They are hypersensitive and they worry. My tape will give lots of comfort to them. This is not drugs."

Chronic pain

Physios welcome pain report’s goals

5 July 2012
People with chronic pain need rapid access to treatment and support, says the final report of the English Pain Summit, which was launched yesterday in the House of Commons.
The report, Putting Pain on the Agenda, identifies four key priorities for action that will improve the quality of life of those who live with pain.
These include
  • the development of clear national standards for clinical practise and education
  • the need to raise public awareness of pain
  • the development of comprehensive guidance for commissioners
  • a national strategy to cope with the problem.
Healthcare professionals were joined by patients and parliamentarians at the launch of the report - the findings of which are based on the first ever English Pain Summit which took place in November 2011.
Physiotherapist Kate Jolly, who is studying an MSc in "pain, Science and Society" and is also involved in the all party parliamentary chronic pain group, welcomed the report’s recommendations.
‘Physiotherapists are ideally placed to embrace this report as our distinctive qualities of listening and taking time to understand patients enables us to give the necessary empowerment required to fulfill these goals,’ she said.
‘This is not exclusive to the field of musculoskeletal pain but spans our diverse skills in cancer pain, headaches, abdominal syndromes such as IBS and neurology, to name but a few.’

Wednesday 16 May 2012

PhysioTherapy Centre goes live with a new web site

At the end of May 2012 the Physio Therapy Centre goes live with a new web site and on line booking for the first time... and this blog plus twitter site are the start. What we want to do is make a place where you can learn a bit about physio and what it can do for you, give advice to help with a problem and feed it back to you. twitter and blog handle is physios4u. lets see what happens, Could be interesting