Beat the effects of Christmas with short daily exercise!

Daily exercise can help ensure guilt-free Christmas

Even if you consume significantly more calories than you burn off this Christmas, a short, daily bout of exercise will stave off most of the negative effects of over-eating and inactivity, according to scientists at the University of Bath.

Whilst earlier studies found that just a few days of eating too much and exercising too little could have long-term negative impacts on the body, a new study, published recently in the Journal of Physiology, shows that daily exercise will counter many of these effects.  

As part of the study, led by researchers in the University’s Department for Health, 26 healthy young men were asked to reduce their physical activity over a period of one week. Half the group then exercised daily on a treadmill for 45 minutes, whilst the other half remained inactive.

Everyone who was part of the study was asked to overeat. The non-exercising group increased their calorie intake by 50 per cent, whilst the exercising group increased theirs by 75 per cent, ensuring everybody’s daily energy surplus (the extra calories they received beyond what they burned) remained the same.

After just one week, both groups had blood insulin measured and biopsies of fat tissue taken, with striking results. The non-exercising group showed an unhealthy decline in their blood sugar control, whilst the exercising group had stable blood sugar levels. The activation of genes within fat cells in the non-exercising group were also found to be negatively changed to those levels needed for a well-functioning metabolism.

Senior author on the paper, Dr Dylan Thompson explains: “A critical feature of our experiment is that we matched the energy surplus between groups, so the exercising group consumed even more energy and were still better off at the end of the week.

“If you are facing a period of overconsumption and inactivity this Christmas, then our study shows that a daily bout of exercise will prevent many of the negative changes in the way in which your body handles sugar, even if you do still gain weight.”

Dr James Betts, one of the researchers also involved, said: “This new research shows that the picture is more sophisticated than ‘energy’ alone. Exercise has positive effects even when we are actively storing energy and gaining weight.”

Commenting on the findings, Dr Jean-Philippe Walhin added: “Short term overfeeding and reduced physical activity had a dramatic impact on the overall metabolic health of the participants and on various key genes within fat tissue. However, even though energy was still being stored, regular exercise prevented many of the long-term negative changes from taking place.”

To find out more about the physiotherapy services we can offer to help you with  exercise and keeping healthy please contact us today for more information and to book an appointment.

To access the research paper see http://jp.physoc.org/content/591/24/6231.abstract  

More than half of UK adults live with unnecessary pain instead of seeking help from qualified health professionals, such as physiotherapists, a survey by Nuffield Health shows.

A survey of 2,000 adults on behalf of charity Nuffield Health shows that 45 per cent are in pain at least once a week, rising to almost three quarters (71 per cent) at least once a month. Of those in pain, more than three quarters (77 per cent) said it negatively affected their everyday life.

Despite this, 59 per cent did not seek help from healthcare professionals, according to the survey.

People are as likely to turn to the internet for advice as visiting a health professional. Young people between16 and 24 years are five times more likely to self-diagnose than see a trained professional.

Liz Adair, director of physiotherapy at Nuffield Health, said: ‘Our physiotherapists often see people who have done more harm than good by trying to deal with pain themselves, or by not doing anything at all.

‘The research suggests there could be serious long term implications of failing to act, including an over-reliance on pain medication.’

CSP chair Sue Rees agreed: ‘Physios can work with other health professionals to help patients manage pain, increase their physical function and achieve the best possible quality of life.’

For information on how to deal with pain visit the Therapy Centre website.

Never too late in life to get active to get healthy

A study looked at over 3000 elder people with an average age of 64. Of these 57% were women.

Comparing participants of the experiment from baseline and 8 years later it was found that those that reported being moderately active were 3x more likely to be healthy. Those that reported vigorous activity were 4x more likely to be healthy.

It was concluded that: "Significant health benefits were even seen among participants who became physically active relatively late in life," 

To find out more about the physiotherapy services we can offer to help you with exercise please contact us today for more information and to book an appointment.

Br J Sports Med. Published online November 25, 2013. Abstract

Pilates and its Benefits

The 6 benefits of Pilates

Pilates targets the muscles of the abdominals,back,hips,pelvis and shoulders and helps to make them strong yet flexible; balanced with good tone;  it helps to give them endurance and helps you cope with stress. Pilates focuses on precise body movements to target different parts of the body and it also helps you develop good breathing techniques, better posture with strength, balance and flexibility.

Strength

Through its tailored exercise programme Pilates can help use your own body weight to provide resistance and help increase strength

Endurance

It can help your muscles to do more for longer as you work through using specific exercises

Flexibility

Tight muscles decrease mobility and can lead to tension and aches and pain. Flexibility is essential for overall fitness and Pilates allows you to achieve this. It will help to improve the mobility of joints and so help in long term maintenance of your body fitness

Posture

Pilates helps make you think about ideal posture which can take off unnecessary stress and strain on joints, ligaments and muscles and so help in the long term to prevent pain

Shape and tone

It can help to improve your muscles "resting tone", Muscles respond quickly to exercise so over time Pilates will help to increase the resting tone of your muscles so that they will feel firmer and look firmer.

Relief of tension

Exercise causes the release of hormones  that improve your  mood and help reduce other hormones that cause stress. Pilates helps with breathing techniques which can lead to enhanced feelings of calm and Pilates will help take you from feelings of stress and anxiety to ones of well-being

To find out more about the physiotherapy services we can offer to help you with  Pilates please contact us today for more information and to book an appointment.

Cyclists beware because what you wear does not reduce the danger. However its much better for your health to cycle than fear to

A new study from the University of Bath and Brunel University suggests that no matter what clothing a cyclist wears, around 1-2% of drivers will pass dangerously close when overtaking.

This suggests there is little a rider can do, by altering their outfit or donning a high-visibility jacket, to prevent the most dangerous overtakes from happening. Instead, the researchers suggest, if we want to make cyclists safer, it is our roads, or driver behaviour, that need to change. 

 The solution to stopping cyclists being hurt by overtaking vehicles has to lie outside the cyclist. Cycling is not made safer by telling cyclists what they should wear. Perhaps by building high-quality separate cycle paths, by encouraging gentler roads with less stop-start traffic, or by making drivers more aware of how it feels to cycle on our roads and the consequences of impatient overtaking may make the difference for safety for the cyclist

Although there are cyclists hurt on our roads, it is important to remember that cycling carries major health benefits from providing regular exercise. This means that, on balance, it is much better for people’s health that they cycle than that they not cycle for fear of injury.

The research team are all regular cyclists. Dr Ian Walker and Dr Ian Garrard cycled together from Land’s End to John o’ Groats this summer.

read more in  Accident Analysis and Prevention:  http://opus.bath.ac.uk/37890/.

Get active as soon as you retire. Don't wait until tomorrow

Retirement may present a critical window for encouraging older adults to be more physically active new research has shown. 

People tend to spend more time being active and less time sitting after retirement. But the older they get, the more they slow down again

It has been found in new research that people at retirement spent about 7% of their time being active and walking around, compared to about 6% among employed people.

And retired participants spent 75% of the week sitting or lying down, compared to 78% for those still working.

One in five older adults met physical activity recommendations by being active for two and a half hours per week, in segments at least 10 minutes long. Retired and employed people were equally likely to meet the recommendations.

"Engaging with community or peer led activity groups (walking clubs, outdoor pursuits etc) would be one simple and effective example of adopting and maintaining any desire to become more active," researchers said.

SOURCE: http://bit.ly/Hyko6r

Age Ageing 2013.

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New knee ligament discovered!

New ligament discovered in the human knee

Two knee surgeons  have discovered a previously unknown ligament in the human knee. This ligament appears to play an important role in patients with anterior cruciate ligament (ACL) tears.

‪Despite a successful ACL repair surgery and rehabilitation, some patients with ACL-repaired knees continue to experience so-called 'pivot shift', or episodes where the knee 'gives way' during activity. For the last four years, orthopaedic surgeons Dr Steven Claes and Professor Dr Johan Bellemans have been conducting research into serious ACL injuries in an effort to find out why. Their starting point: an 1879 article by a French surgeon that postulated the existence of an additional ligament located on the anterior of the human knee.

That postulation turned out to be correct: the Belgian doctors are the first to identify the previously unknown ligament. Their research shows that the ligament, which was given the name anterolateral ligament (ALL), is present in 97 per cent of all human knees. Subsequent research shows that pivot shift, the giving way of the knee in patients with an ACL tear, is caused by an injury in the ALL ligament.

‪Some of the conclusions were recently published in the Journal of Anatomy. The Anatomical Society praised the research as "very refreshing" and commended the researchers for reminding the medical world that, despite the emergence of advanced technology, our knowledge of the basic anatomy of the human body is not yet exhaustive.

‪The research questions current medical thinking about serious ACL injuries and could signal a breakthrough in the treatment of patients with serious ACL injuries. Dr Claes and Professor Bellemans are currently working on a surgical technique to correct ALL injuries. Those results will be ready in several years.

‪ACL tears are common among athletes in pivot-heavy sports such as soccer, basketball, skiing and football. 

To find out more about the physiotherapy services we can offer to help you with your ACL problems please contact us today for more information and to book an appointment.

URL: http://www.kuleuven.be/english/news/new-ligament-discovered-in-the-human-knee

Back pain and what we say to our patients has a lasting and empowering effect

Physio researchers undertook a study to find out why people have particular beliefs about low back pain and also to assess the effect of those beliefs. 

They found that although the study participants use information on back pain obtained from the Internet, as well as from family and friends, they continue to trust their physicians and use them as their primary source of information and advice.

"The current study furthers understanding of how and when various sources of information contribute to beliefs, highlighting that clinicians can have a profound and long-lasting influence," the researchers write. They add that patients' expectations regarding recovery can be strongly influenced by single, perhaps off-hand statements by their physicians. "This finding is important given that low recovery expectations are a strong predictor of poor outcome," they write.

They also note that avoidance of activities because of fear of pain has been associated with poor outcome and that physicians may inadvertently contribute to avoidance beliefs and behaviors by focusing on what patients should not do rather than what they should do.

"Participants viewed lifting techniques, postural control, and muscle strengthening as strategies to protect the back," the authors note. However, they add, evidence does not support the idea that protection prevents pain.

"Our study shows that these protection strategies may result in increased vigilance, worry, frustration, and guilt for patients with low back pain," they write.

The researchers further emphasize that information communicated to patients may influence patients for years to come, so it needs to be appropriate not only for the current episode of back pain but also for any future episodes.

"Our findings also show clear activity advice and appropriate reassurance can be empowering," they write.

They conclude, "We recommend prospective studies to investigate ways of packaging information and advice that enables people to use their back freely, potentially reducing the persistence of disability."

To find out more about dealing with pain and the physiotherapy services we can offer to help you with your back pain, please contact us today for more information and to book an appointment.

Ann Fam Med. 2013;527-534. Full text

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Preparing for winter sport

Some people find that the cold winter weather can play havoc with their joints and muscles, which is why it might be a good idea to visit a physiotherapist if you find yourself seizing up as the temperature drops. 

Even something as simple as shivering or the way we brace ourselves against the cold can lead to discomfort over time, so working with a physiotherapist can help you work through any cold-related pain you might be experiencing.

Physiotherapists can work with you to improve your posture and correct an unusual stance you may have developed after spending lots of time in the cold weather. When we are cold, we tend to tense our muscles to retain body heat, and this can make us more prone to sports injuries, especially if we don’t warm up correctly. 

You may need to learn techniques to warm up more efficiently and to continue playing the sports you love whilst avoiding worsening any existing injuries or creating new ones.

If you are interested in finding out more about how physiotherapy can help you continue to play your favourite sport safely throughout winter, please contact us today for more information about our physiotherapists.

Exercise and depression

The positive effects of exercise have been strengthened by a recent review of the latest evidence of papers related to depression and exercise. There was no conclusion as to the best types of exercise or whether there was any lasting effect if exercising stopped.

Comments made  included distinguishing between curative and useful activities. For instance having  pneumonia benefits from getting out to get more fresh air but it doesn't cure the pneumonia. Exercise in itself will not relieve depression unless it is done to a level that causes the release of endorphins  which would mean running at 6.5 to 6.7 miles per hour for 10 minutes; not often attempted by those suffering with depression.

To find out more about the physiotherapy services we can offer to help you with exercise, please contact us today for more information and to book an appointment.

Cochrane Database Syst Rev. 2013;9:CD004366. Abstract

Barefoot running

Barefoot running is not a panacea for avoiding running injuries; we evolved to run barefooted but this does not make it best for everyone.
There are some theories as to why barefoot running may prevent injuries:
Humans evolved  to run barefoot so putting on shoes may alter the running form.
It may decrease the impact on certain parts of the leg and foot and increase foot strength.
The benefits remain unproven and injuries may be related to many factors including mechanics which vary with the individual. Just going barefoot may not alter the risks
There is a need for controlled prospective injury studies comparing shoes or no shoes and the need to understand how best to progress to barefoot running and gradual slow change with attention to posture and form will play their part. Start on a smooth hard surface. Run for about 100m and assess how you do. Progress from that

To find out more about the physiotherapy services we can offer to help you prepare for barefoot running, please contact us today for more information and to book an appointment.

From British Journal of Sports Medicine
http://bit.ly/16va98X

Getting ready for the ski season

If you’re heading off on a skiing trip this winter, it is important you’re in good shape. Skiing is excellent exercise for the entire body, but it can exacerbate existing joint and muscular problems, so it is important that these are treated before you head onto the slopes.

Seeing a physiotherapist is the best way to ensure you are in the best possible physical condition before you go skiing, and is recommended for everyone from first time skiers to those who have been skiing for many years.

Skiing can be very physically demanding, so if you have pre-existing sports injuries or have simply never seen a physiotherapist before, now could be a good time to take the plunge. You need to be relatively agile and able to respond quickly, especially when you reach the trickier ski runs, so it can be invaluable to have a physiotherapist help you with your posture and work through any potential joint issues that need addressing.

To find out more about the physiotherapy services we can offer to help you prepare for the ski season, please contact us today for more information and to book an appointment.

Ageing, sugar and living longer

Scientists have done work with small round worms on the matter of ageing. They have managed to make these worms live twice as long by partially disabling one of their genes-daf2. The worms appear to be healthy until the end. They also managed to shorten their lifespan by adding sugar which revved up their insulin pathway.

The link between ageing and diet makes sense if one understands that the daf2 gene activates receptors that are sensitive to two hormones, insulin and growth hormone. Too much sugar overstimulates the receptors. People who live to 100 are more likely to have a mutation in the daf2 gene. A drug that prolongs the life of mice is soon to be announced and the direction of this work may lead to drugs that allow us to live longer and healthier lives.

Observer March 2013 Discover in Review

If you're concerned about your own health or the effects of ageing then why not contact the Physio Therapy Centre to see how we can help?

Exercise,diabetes,weight loss.

Exercise helps to control glucose levels in patients with Type 11 diabetes and increases cardiovascular fitness. They also reduced their waist size!
Combined aerobic exercises with resistance training seems to be the most effective.
The exercise was brisk treadmill walking at 50% to 80% maximum respiratory fitness plus weight bearing exercises in the gym

Journal of the American Medical Society 2010

Physiotherapists and how we differ from other therapists

Here at the Therapy Centre we often get asked about the differences between a physiotherapist and a chiropractor or an osteopath for example, to help explain this we've added some new content which you can read by clicking the links above.

We hope that's useful and please don't hesitate to contact us if you've any questions at all about how we can help you.

Risk factors for low back pain

The most consistent factors that predict low back pain are:
Work related psychosocial factors;  high job demands and low job control
Mechanical factors; prolonged standing,awkward lifting and squatting or kneeling
Work-related Psychosocial and Mechanical Risk Factors for Low Back Pain
A 3-year Follow-up Study of the General Working Population in Norway

Tom Sterud, Tore Tynes
Occup Environ Med. 2013;70(5):296-302

If you're worried about back pain then physiotherapy can help, both in the short and long term. Come and see us at the Physio Therapy Centre to find out more

Fish Oil doesn't reduce the chance of death or problems related to heart diease

In a large study with a 5 year follow-up, it was shown that taking daily doses of fish oil did not prevent the chances of death or problems related to heart disease.

New England Journal of Medicine 2013 368:1800-1808

Use it or lose it

Use it or lose it is the message from this study. The elder person who maintains a high level of aerobic fitness will live longer.

While age is associated with decrease in muscle mass, strength, endurance and aerobic fitness the elderly respond well to exercise and it could help in preventing age related problems.

A study looked at aerobic fitness in 2077 hypertensive men aged 70 or over. Overall mortality was 15% lower in those with moderate levels of aerobic fitness; 37% lower in higher levels of fitness. Many of us spend hours sitting through a day and this has a negative effect

American Soc of Hypertension(ASH) 2013 scientific sessions

Also there is a strong association between  mid-life fitness and later heart failure

Circulation:Heartfailure Berey et al 2013

Illness perception,work,back pain, and significant others

People out of work due to persistent low back pain tended to self limit their ability to work and were supported in their beliefs by their partner.

To justify this, this group became fixed in the belief that this was so and it became crucial that the individual with back pain was perceived as completely disabled.

It is suggested that partners of individuals with low back pain are a potentially detrimental source of support. It may be useful to include partners in vocational rehabilitation programmes

Brooks et., Musculoskeletal Disorders 2013 14(48)

Pain in the older person

Older people are different. The physiological changes that occur with ageing, the co-morbidities, prescription of medication, frailty and psychosocial changes mean that  considering pain control for these individuals can be challenging.  The British Geriatric Society and British Pain Society have made some recommendations 

Pharmacology

For many analgesic medicines, a lower initial dose may be required than prescribed for younger adults and should be titrated to response. The first line pharmacological treatment, particularly in musculoskeletal pain is paracetamol. It has demonstrated efficacy and a good safety profile, but it is important that the maximum daily dose is not exceeded. Although NSAIDs are effective analgesics, their side effect profile requires cautious use. If essential, the lowest dose should be used for the shortest period and reviewed regularly. Opioids are effective in the short term, but evidence for long-term efficacy is much more limited and hence patients prescribed opioids should have regular review, both for efficacy and tolerability. Side effects, particularly constipation, should be anticipated and prophylactic treatments prescribed. Excessive sedation can be problematic and should be monitored carefully. Tricyclic antidepressants or anti-epileptics may be considered for neuropathic pain, although side effects often limit their use. Topical analgesics have a role in localised pain; both lidocaine and capsaicin have limited efficacy in localised neuropathic pain and topical NSAIDs may be suitable for non-neuropathic pain.

Combination therapy using different classes of analgesics may provide greater pain relief through synergistic action with fewer side effects compared with higher doses of a single medicine.

Interventional therapies

Interventional therapies in the management of chronic pain include a variety of neural blocks and minimally invasive procedures. The recommendations produced in this section are limited to specific interventions in clinical conditions common in older people. Intra-articular (IA) corticosteroid injection in osteoarthritis of the knee is effective in relieving pain in the short term with little risk of complications and/or joint damage. Hyaluronic acid is also effective but appears to have a slower onset of action and lasts longer than steroids. The evidence for IA injection of other joints, however, is limited.

The evidence for facet joint interventions is mixed, although there is some support for radiofrequency lesioning for both cervical and lumbar facet joint pain in appropriately selected patients. There is also limited data to support consideration of epidural steroid injections 

Psychological interventions

It is well recognised that psychological factors often influence the manner people respond to and cope with pain, and techniques may modify beliefs and attitudes. However, few studies have focused on older adults and sample sizes are small. Nonetheless, psychological interventions such as cognitive behavioural therapy (CBT) or behavioural therapy may be effective in decreasing chronic pain in adults and improving disability and mood. Elderly nursing home residents with chronic pain may benefit from CBT pain management interventions. Psychological interventions may be used as an adjunct to pharmacological intervention and/or other modalities.

 Physical activity

 Physical activity and assistive devices encompass a wide range of

interventions. The available evidence supports the use of programmes that

comprise strengthening, flexibility and endurance activities to increase

 physical activity, improve function and pain.^]There are many different forms of

exercise and the choice of exercise type can pose a dilemma. Given the

 absence of evidence to recommend one type of exercise over another,

 patient preference should be a key factor and programmes should be

customised to individual capacity and need.  A large range of potential

options includes progressive resistance exercise, walking, water-based

exercise/hydrotherapy. Golf , bowls and adaptations of Tai-Chi and Yoga  and

advances in gaming technology such as Wii are also opening up new

possibilities and are useful in balance control

 Complementary therapies

Some types of complementary therapy [e.g. acupuncture, transcutaneous electrical nerve stimulation (TENS), massage] have been used for older adults with painful conditions, although the available studies lack methodological rigour. Acupuncture applied singularly or in combination with other modalities has an impact on pain and quality of life in patients with osteoarthritis. Conventional TENS can be used for relief of musculoskeletal pain. Similarly, percutaneous electrical nerve stimulation combined with physiotherapy reduces pain and self-reported disability for up to 3 months. Other therapies such as massage can be used to treat chronic pain, in particular shoulder or knee pain.

Physical Therapy as Effective as Surgery for Meniscal Tear

Patients with knee osteoarthritis and a meniscal tear who received physical therapy without surgery had good functional improvement 6 months later, and outcomes did not differ significantly from patients who underwent arthroscopic partial meniscectomy, a new trial shows.

Patients with a meniscal tear and osteoarthritis pose a treatment challenge because it is not clear which condition is causing their symptoms.

Currently, millions of people are being exposed to potential risks associated with a surgical treatment that may or may not offer specific benefit, and the costs are substantial.

The physical therapy in both regimens  involved 1 or 2 sessions a week for about 6 weeks and home exercises. The average number of physical therapy visits was 7 in the surgery group and 8 in the non-surgery group.

 Mean Improvement in Osteoarthritis Index at 6 Months

Treatment Group	Mean Improvement (Points)	95% Confidence Interval
Surgery+ physical therapy	20.9	17.9–23.9
Physical therapy	18.5	15.6–21.5

The 12-month results were similar to the 6-month results. 

 John Mays, MD, an orthopaedic surgeon practicing in  Louisiana, USA, who was asked to comment on the findings, said most patients don't choose physical therapy. "In the real world, most people want a quick fix" and choose surgery, he noted.

Dr. Mays said he would have liked to have seen a group of patients who underwent surgery but did not receive postoperative physical therapy. He explained that his patients with osteoarthritis and meniscal tear rarely get physical therapy after arthroscopic meniscectomy; they most often do home-based exercises.

He added that "most insurance plans have limits on the number of physical therapy sessions they allow."

N Engl J Med. Published online March 19, 2013. Abstract, Editorial

Being active increases survival rates from colorectal cancer

The more you walk the more likely you are to survive after being diagnosed with colorectal cancer. 

In a study of 2293 patients who developed colorectal cancer it was shown the more you walked and were active, the more likely you were to survive from this disease. The less activity you did the more likely you were to die from it. "Get out of that chair" was the message from this study.

This data further strengthen current recommendations to participate in at least 2.5 hours of walking per week for colorectal cancer survivors. 

Campbell PT, Patel AV, Newton CC, Jacobs EJ, Gapstur SM

J Clin Oncol. 2013;31:876-885

Widely Used Diclofenac Associated With Increased Risk for Cardiovascular Events

The nonsteroidal anti-inflammatory drug (NSAID) diclofenac, a drug that is frequently used for the treatment of pain and inflammation caused by arthritis, is associated with a significantly increased risk of cardiovascular complications and should be removed from essential-medicines lists (EML), according to a newreview [1].

Diclofenac, which is listed on the EML of 74 countries, increased the risk of cardiovascular events between 38% and 63% in different studies. The increased risk with diclofenac was similar to the COX-2 inhibitor rofecoxib (Vioxx, Merck), a drug withdrawn from worldwide markets because of cardiovascular toxicity.

"We could find no-risk doses with some of the other drugs, like ibuprofen, naproxen, and celecoxib [Celebrex, Pfizer],"

Fitness Linked to Lower Dementia Risk

We need to do about  75  minutes of vigorous activity a week or 150 minutes of moderate activity.

Higher fitness levels in midlife are associated with a lower risk for dementia in later life, a new study suggests.

"We already know exercise has cardiovascular and many other benefits, but this may give people more incentive to get moving," lead author, Laura F. DeFina, MD,  "Dementia is the second most feared disease after cancer, and our research suggests you can lower your risk by keeping fit."

The study is published in the February 5 issue of the Annals of Internal Medicine.

The study included 19,458 individuals participating in the Cooper Clinic Longitudinal Study at the Cooper Institute, a preventive medicine clinic. All underwent standardized fitness testing in midlife (median age, 49.8 years) and were then followed for an average of 25 years. 

There were 1659 cases of all-cause dementia reported. After multivariable adjustment, participants with the highest fitness level  at midlife had a 36% reduction in risk of developing dementia from any cause during follow-up than those in the lowest fitness category 

Dr. DeFina also pointed out that the reduction in dementia was consistent in patients who had had a stroke and in those who hadn't, suggesting that the mechanism does not just involve vascular disease. "Exercise is known to reduce cardiovascular disease, which we would expect to be translated into benefit on stroke, but because we also saw a similar reduction in dementia with improved fitness in patients who hadn't had a stroke, this suggests that other mechanisms are also involved."

She added that animal studies have suggested that increased fitness and activity correlates with a reduction in brain atrophy and loss of cognition, and changes in amyloid have been seen with regular activity.

Although this was a study of fitness, rather than actual physical activity undertaken, Dr. DeFina said the results were consistent with US physical activity guidelines that recommend 150 minutes of moderate exercise or 75 minutes of vigorous activity per week for health benefits.

Tennis Elbow: No Long-Term Benefit From PT, Corticosteroids

What is  best practice for treatment of tennis elbow is a knotty issue. Studies continue to try to unravel this. A recent piece of research published showed little long term benefits of physio but it was stated that they:

 "... believe strongly in physical therapy for tennis elbow, both to help the patient through the acute phase of the injury and to provide the patient with exercises/knowledge to prevent reinjury down the line".  "In many cases, patients will benefit considerably just from knowledge gained in physical therapy. If they apply this knowledge consistently, they may achieve better long-term outcomes,"

Below is an abstract of this work:

A steroid injection and 2 months of physical therapy may not be the solution for lateral epicondylalgia, commonly known as tennis elbow, suggest research findings published in the February 5 issue of JAMA.

Brooke K. Coombes, PhD, from the University of Queensland, St. Lucia, Australia, and colleagues found that patients treated with a single corticosteroid injection had a 14% greater chance of poor outcome and a 77% increased risk for reinjury at 1 year relative to placebo.

Eight weeks of physical therapy appeared to have no long-term benefit with the exception of decreased analgesic use. However, the physical therapy did improve short-term pain and disability outcomes at 1 month, although those benefits were lost when steroid injection was added to the treatment.

JAMA. 2013;309:461-469. 

Skin, Joint, and Back Problems Prompt Most Physician Visits

FYI

Most patients without acute conditions see their physicians not because of diabetes, heart disease, or cancer but because of skin problems, joint disorders, and back pain, according to an article published in the January 2013 issue of Mayo Clinic Proceedings.

Jennifer L. St. Sauver, PhD, MPH, from the Division of Epidemiology, Mayo Clinic Center for the Science of Health Care Delivery, Rochester, Minnesota, and colleagues analyzed the medical records of residents of Olmstead County, Minnesota, as of April 1, 2009

They say, "Finding that skin and back problems are major drivers of health care utilization affirms the importance of moving beyond the commonly recognized health care priorities such as diabetes, heart disease, or cancer," the researchers conclude. "Our findings highlight opportunities to improve health care and decrease costs related to common non-acute conditions as we move forward through the changing health care landscape."

Using my Blackberry makes my thumbs hurt

Some of you might of experienced this but I thought is was worth passing on. We have all heard of RSI; well this an RSI of the the nerve that you find in the thumb. This information is being passed on by neuro orthopaedic institute or NOI. Have a read....

I have self-diagnosed myself with ‘blackberry thumb’ (BT)! Bear with me and my personal minor health story. This is quite exciting as I have never owned a blackberry but I admit to being a recent convert to texting, perhaps tripling the amount of texting that I do in the last month. Blackberry thumb is basically pain in the thumb from excessive texting.  You imagine a bruised black thumb and you kind of want to lick it and I much prefer the label to others suggested such as ‘teen texting tendonitis’ ‘wii-tis’ and ‘playstation thumb’. I thought it was quite exotic until I read that 1 in 6 British teens complain of hand pain while texting. With iPhone sales alone around 120 million a year and even more androids, there will be more aches and pains. It is predicted that there will be 2 billion smartphones in use by 2015. Blackberrys were invented before iPhones otherwise it might have been called iPhone thumb which sounds weird.  What is it? If you read the various case studies in the literature, most refer to a thumb tendonitis or a joint arthritis. Maybe I am biased but my Blackberry thumb is a nerve irritation (an abnormal impulse generating site) in the dorsal nerve of the radial nerve (on the radial side). I think this is the first description of neurogenic blackberry thumb. I suspect (as in many other parts of the body) that peripheral neuropathic problems are often missed. Check out the image of my thumb in Figure 1. The spotted part is where the thumb is slightly numb. I know numb is numb, but this area is slightly numbish. If I press the spot where the arrow is, the numbness increases and it can zing into the base of my nail – more of a thudding feeling than a pain. Of course I tried out an active radial nerve neurodynamic test – reaching down with an internally rotated shoulder and with my thumb flexed. This gives a real thudding feeling into the nail and I was wondering if it could neurogenically inflame the nail bed. However, it doesn’t do it always when I try and finds the thudding position again. This made me a bit frustrated at first and then I remembered that peripheral nerve problems often present with this unpredictability. The thumb looks exactly like the other thumb i.e. no swelling or colour changes. Figure 1 Did my fat thumbs cause it? I think it is from texting with a firmly flexed thumb interphalangeal joint with ulnar deviation pressure. Because my thumbs are bigger and fatter than most, I flex, ulnar deviate and almost rotate the distal phalange to get a more angular edge of the thumb, ie near the nail to hit the right key. Check out my texting style in Figure 2. I think it will take a while for our thumbs to evolve to handle texting and by then there will be sure to be a better way of communication. Such flexion will give quite a local stretch of the nerve and it is the repeated unusual tweaking of the nerve that I think has caused this. Older peripheral nerve entrapment books mention that compressive forces such as scissor use could cause a similar neuropathy, but this is more a repetitive traction injury which has not been mentioned before in regard to blackberry thumb. Figure 2 Peeking inside I would love to peek inside the thumb, take a look at the nerve and then peek inside the nerve. Tiny nerves, especially in the extremities are very mobile – they have to be so we can move so much. Look at the dorsal side (back) of your thumb. Flex it and imagine how much the nerves just under the skin have to glide and stretch. I think I overdid this a little and I may have stretched a bit of myelin, maybe peeled some of the Nodes of Ranvier in outerlying fibres apart, there must be a little bit of intraneural inflammation and perhaps a bit of ion channel upregulation. So what? The main issue here is that peripheral nerves and their injuries and problems are missed ‘out there’. The brain is now so trendy – peripheral nerve research or even clinical consideration, is rare these days. Many people still think a peripheral nerve is like the cord on the television set, i.e. if you cut it, it stops working. Yet peripheral nerves are reactive, adapting, mobile parts of our bodies which deserve to be included in a wider view of the neuromatrix. Does my BT need treating? Some of these minor problems can go onto chronic problems. I think as long as you know about it, and don’t panic that you have some rare neurological disease this should be OK. I have adapted my texting techniques, in particular to using my index fingers which are more designed for dextrous work. I am trying some active radial nerve mobilising techniques which include the thumb and I am expecting that it will slowly go away in a month or so. Or you could take on texting with a sausage – an adaptation that has spread throughout South Korea and Russia to stop frostbite in the winter time. Light blackberry relief Ronnie Corbett also has an issue with a Blackberry – check it out :)

Soldier Who Lost All Limbs Gets Two Arm Transplants

The things that are happening these days...! It will of course take months to years for recover but peripheral nerves to regrow; 1mm a day. You are not going to transplant arms unless you know that there is a chance of success for the individual. The physical and physiological stresses are immense. Have a read about this pioneering work that is going on in Baltimore USA.

A retired U.S. Army sergeant who underwent a double arm transplant after losing both arms and both legs in Iraq was discharged from The Johns Hopkins Hospital, Baltimore USA saying he was anxious to get back to an active life.

Sgt. Brendan Marrocco, 26, of Staten Island, New York, had the successful bilateral arm transplant six weeks ago at the renowned Baltimore hospital.

"I feel like I'm getting a second chance to start over," Marrocco said at a news conference announcing his discharge. "I'm just looking forward to everything I would have wanted to do over the last four years."

A roadside bomb attack in Iraq in 2009 cost him all four limbs.

"I hated having no arms," Marrocco said. "I was alright with having no legs."

It will be a few years before Marrocco's nerves regenerate and he regains significant use of his arms but Marrocco wheeled himself into the news conference, during which he pushed his hair back several times with his left arm. He said his right arm and both hands have little or no feeling or movement.

Marrocco will spend up to six hours a day in physical therapy.

The rare surgery took 13 hours and involved 16 doctors who volunteered from plastic surgery, orthopedics and other disciplines, the hospital said.

Eating whole grain and diabetes

Eating whole cereal grains is linked to lower prediabetes risk and keeps you healthier

Eating whole grains is associated with a decreased risk of impaired glucose

tolerance.  Swedish residents who ate food containing more than 59 g of

whole grains per day were 27% less likely to become prediabetic compared

with residents who ate 30 g less, according to research

The American Diabetes Association estimates that one in four Americans older than 20 have prediabetes, and nearly one in four of those will eventually develop full-blown diabetes.

Previous research has linked whole grain rich diets with a decreased risk of diabetes, but the new study online December 12th in the American Journal of Clinical Nutrition makes the connection to the earlier condition.

The association between whole grain intake and prediabetes risk was stronger for men. Those with an increased genetic risk for developing diabetes did not see a difference, researchers found.

 A similar study found losing weight was the most important factor for people with prediabetes to revert back to normal blood sugar level.

It is worth noting that prediabetes is a reversible state so eat whole grain to stay healthier

SOURCE: http://bit.ly/UQTSpK  Am J Clin Nutr 2012.

Low Vitamin D levels Linked to Headache

Low Vitamin D Linked to Headache

 

Marie Kjaergaard, MD, University Hospital of North Norway, and colleagues

found that the incidence of non-migrainous headache was 20% higher in

participants who had the lowest levels of vitamin D than in those with the

highest levels. Physical exercise, alcohol consumption, education level, and

some chronic diseases also influence vitamin D levels.

Headache. 2012;52:1499-1505. Abstract