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.