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PrintThe Right Tool for a Specific Occassion
When we came across this article in the New York Times (How Yoga Can Wreck Your Body) last week, we knew exactly what article was all about. Don’t get us wrong, we think that yoga is fine. But rather people tend to forgot that everything has its place and time, and often in the proper amounts.
“Yoga is for people in good physical condition. ” – Glenn Black
If you have been a regular reader of our articles, you will know that we strongly advocate understanding the situation first – what’s causing what, then only do we ‘treat’. And that treatment choices will change over time as we progress along the pain management pathways. One treatment technique that worked for you at the acute or painful stage of pain may not be very appropriate or even wrong when the pain has lessened to a more dull and persistent nature.
Two common mistakes – not moving along and jumping the queue
A common mistake made here is not progressing along the treatment pathways. An example is when someone continually seeks relief for a persistent problem instead of working to resolve the underlying problem. Popping pill is one such activity or repeated seeking massages for a recurrent muscle ache.
The second common mistake is skipping the next step in the treatment pathways, or sometimes, several steps. Some with persistent back problems may suddenly start doing yoga because they heard that it was good for the back muscles without a) understanding their underlying problem and b) they may not be in the best shape for the strain that yoga places. It is not unheard of for people to get worse after yoga or pilates.
In healthcare, beware the practitioner that has the “right” tool for every occassion.
MRI’s overused in Sports Injuries?
In a previous article, we highlighted the issue of MRIs scan leading to un-necessary back surgeries (Does more MRI scanners do more good or harm?). The issue now seems to be spreading to the sporting arena.
MRI-shoulder
A sports medicine orthopedist, Dr. James Andrews, wanted to test his suspicion that M.R.I. scans given to almost every injured athlete or casual exerciser, might be a bit misleading. He MRI-ed 31 pitchers who were perfectly healthy, and had no problems with pain, discomfort, or performance in their pitching arm. As suspected, the MRI picked up problems in the rotator cuff and shoulder cartilage of nearly 90 percent of these asymptomatic pitchers. For more about this story, read “Sports Medicine Said to Overuse M.R.I.’s“
This is a disturbing trend in medicine where we develop and build ever increasingly more accurate or more precise machines but our diagnostic ability to interpret the results is not always developing at the same pace. This phenomenon is known as “false precision” in science and engineering fields where data is presented in a manner that implies better precision than is actually the case; since precision is a limit to accuracy, this often leads to overconfidence in the accuracy as well.
Treatment Options for Chronic Pain- What Does the Research say?
As discussed in the previous article, chronic pain can manifest through very complex thought processes, as result of a wide variety of factors stemming from physical, psychological and cultural influences.
For this reason, there is not one single fix for chronic pain, but its treatment is very much defendant on a combined approach.
This article will focus on the conservative management of chronic back pain whilst not negating the importance of appropriate pharmaceutical and other interventions.
So what does the research say?
- Exercise therapy -the first line treatment
The current evidence suggests exercise is more effective than “GP care” for the reduction of pain, disability and return to work . No one form of exercise (e.g. Aerobic, Mckenzie, conditioning exercise) appears to be superior to the other, although an supervised and individualised exercise programme is recommended over general exercise conducted individually. This is something that can be discussed and provided by a qualified physiotherapist following a thorough assessment of your back.
Studies comparing the effect of pilates based exercises and usual back care, has shown pilates to significantly reduce low back symptoms and disability over long term basis.
There is strong evidence showing that exercise therapy alone is not more effective than conventional physiotherapeutic techniques (e.g joint mobilisations) and therefore exercise therapy must be prescribed along side other treatment adjuncts.
- Cognitive behavioral therapy
This form of psychosocial therapy assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and “negative” emotions (Maladaptive behavior is behavior that is counter – productive or interferes with everyday living).This treatment focuses on changing an individual's thoughts (cognitive patterns) in order to change his or her behavior and emotional state, allowing them to partake in exercise and all activities of daily living.
- Manual therapy
Joint mobilizations should be considered as treatment in the short term management for chronic pain sufferers to increase function and decrease pain.
The research shows that joint mobilizations carried out in physiotherapy treatments is of equal effectiveness to analgesia, normal "GP care" and physiotherapy exercises in reducing symptoms.
- Massage
Massage is not considered as an effective treatment option for chronic pain sufferers, but may be useful to treat the symptoms of muscle tightness post exercise.
- Education
This is vital in in helping people understand that beliefs can alter and affect their recovery from pain. Pain should not been taken for granted, and a person should seek medical advice to decrease the amount of pain as soon as possible.
Education regarding pain, and understanding that pain is an unpleasant but subjective emotional experience, and therefore should not be used as a tool to measure the amount of tissue damage is vital.
Having less fear and anxiety will make a person more willing to return to functional activities and exercise allowing for recovery.
References:
O. Airaksinen, J. I. Brox, C. Cedraschi, J. Hildebrandt, J. Klaber-Moffett, F. Kovacs, A. F. Mannion, S. Reis, J. B. Staal and H. Ursin, et al (2006) European guidelines for the management of chronic nonspecific low back pain, European spine journal, vol 15: 193-300
Rydeard,R., Legar, A., Smith, D (2006) Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability : A randomized controlled trial, The Journal of orthopaedic and sports physical therapy, vol 36:474-484
Human Exoskeletons
Eythor Bender of Berkeley Bionics brings onstage two amazing exoskeletons, HULC and eLEGS — robotic add-ons that could one day allow a human to carry 200 pounds without tiring, or allow a wheelchair user to stand and walk. It's a powerful onstage demo, with implications for human potential of all kinds.
Surgeon’s Skill over Implant Design
A recent study release by the Henry Ford Hospital finds the success of total knee replacement surgery still is dependent on the surgeon's skill. Researchers found that utilizing a series of common but nuanced surgical techniques is far more important to customizing the fit of a patient's implant than the implant's design.
“Customized knee implants will not replace the need for precise, methodical surgical skill,” says Jason Davis, M.D., a Henry Ford joint replacement surgeon and the study’s lead author. “While improving outcomes will continue to evolve, getting back to the basics of surgery is still paramount to successful knee replacement.”
The study was presented recently at the annual meeting of the American Academy of Orthopaedic Surgeons.
Reference:
- "Surgeon's Skill, Not Implant Design Key to Knee Replacement", Feb. 16, 2011
Plantar Fasciitis? Stretching seems to do the trick
Last year, we wrote about some Simple Exercises For Plantar Fasciitis Sufferers which included some stretched. Recently the American Academy of Orthopaedic Surgeons announced the results of a new study from the Journal of Bone and Joint Surgery, that patients with acute plantar fasciitis who perform manual plantar fasciitis stretching exercises, as opposed to shockwave therapy, had superior results and higher patient satisfaction.
According the Dr. Judy Baumhauer, president-elect of the American Orthopaedic Foot and Ankle Society (AOFAS), who was not involved in this study, has been counseling patients on the plantar fascia stretch for 15 years. “I am a firm believer in this type of stretch and nearly 80 percent of my patients have shown improvement in just eight weeks of stretching therapy.”
For the full press release, click here.
Why get manipulated in the first place?
A few months ago in April, we wrote about the risk of VBI when getting your neck cracked, "If you like getting your neck ‘cracked’ or thinking about it, you should know about VBI", a group of researchers from the University of Sydney in collaboration with University of Queensland found that that neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.
Project leader, Dr. Andrew Leaver from the Faculty of Health Science, University of Sydney said, "It makes us question why patients or practitioners would favour a treatment which possibly carries risk of catastrophic outcome over an equally effective one with very few reported complications despite widespread use."
So why do then patients seem lured towards neck manipulation?
While over the longer-term results from the mobilisation and manipulation approach is identical, the short-term relief that manipulation provides can be a mis-leading siren song. Patient generally immediately feel better after a crack compared to the more gentler mobilisation. But the VBI risk doesn't seem to be worth it as little is done to improve the underlying functional problem. In fact, it opens a door towards excessive frequent weekly 'cracking' session to sustain the pain relief.
Reference:
- Controversial study suggests neck manipulation not worth the risk, University of Sydney, 9 September 2010
- A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain, Archives of Physical Medicine and Rehabilitation – Volume 91, Issue 9, Pages 1313-1318 (September 2010)
Is the Outcome of ACL Surgery really better than Conservative Management?
If you have sustained an ACL ( Anterior Cruciate Ligament of the knee) tear and is considering an ACL surgery, you would find it useful to know more about the latest research discussion on ACL surgery versus Physical therapy management.
Why high-heel wearers hurt walking flat foot?
If you know of women who wear high-heels most of the time, you will notice that they often stand and walk tip-toe even when barefooted. This is because the women complain that it hurts to walk flat footed. This feeling of pain has been often theorized to be the result of a shrunken calf muscle. So Marco Narici from Manchester Metropolitan University, UK and Robert Csapo, from the University of Vienna, Austria sought to test the theory.
Source: Flickr lanier67
Turning to the achilles tendon, the tendon attachment the calf muscles to the heel. What Csapo and Narici found were thicker and stiffer tendon in women who wore high-heels. While the tendon was not stretched longer than the other group, the thicker-stiffer tendon helped compensate for the shorter calf muscle.
It is this thicker and stiffer tendon that causes the discomfort when walking flat-footed as it cannot stretch enough.
References
Csapo, R., Maganaris, C. N., Seynnes, O. R. and Narici, M. V. (2010). On muscle, tendon and high heels. J. Exp. Biol. 213, 2582-2588.[Abstract/Full Text]
