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PrintHigher Risk of Low Back Pain for Competitive Youths
A recent study published in the American Journal of Sports Medicine by researchers from the Institute of Clinical Medicine, University of Tsukuba in Japan found that excessive exposure to competitive sports activities during youth was associated with low back pain and symptoms in the lower extremities, with the severity varying with the sport.
The researchers suggested that to reduce low back pain in youth, factors that may be causing low back pain, such as sport-specific postures and motions, thought these suggestions need to be investigated.
Reference:
- Relationship between low back pain and competitive sports activities during youth., Am J Sports Med. 2010 Apr;38(4):791-6. Epub 2010 Jan 5.
The Mechanics of Barefoot Running
Dr William Roberts, "The Sports Doc" over at Runner's World recently wrote about barefoot running and the mechanics of it. Read his whole article here, "The Mechanics of Barefoot Running"
It complements our two articles, Running Economy and Professor Daniel Lieberman's video (The Barefoot Professor: by Nature Video)
Stability Walking Shoes Not Necessarily Good for Arthritic Knees
In a recent report of a study published in the journal Arthritis Care & Research, found flip-flops and sneakers with flexible soles are easier on the knees than clogs or even special (stability) walking shoes,
"Traditionally, footwear has been engineered to provide maximum support and comfort for the foot, with little attention paid to the biomechanical effects on the rest of the leg," said Dr. Najia Shakoor, a rheumatologist at Rush and the primary author of the study. "But the shoes we wear have a substantial impact on the load on the knee joints, particularly when we walk."
Source: Flickr Fuschia Foot
And this bio-mechanical chain sometimes make treatment or support choices difficult. Shakoor cautioned that knee loading is not the only consideration in any clinical recommendations based on her study. "For the elderly and infirm individuals, flip-flops could contribute to falls because of their loose-fitting design. Factors like these need to be taken into account," Shakoor said.
Journal Reference:
1. Najia Shakoor, Mondira Sengupta, Kharma C. Foucher, Markus A. Wimmer, Louis F. Fogg, Joel A. Block. The effects of common footwear on joint loading in osteoarthritis of the knee. Arthritis Care & Research, 2010; DOI: 10.1002/acr.20165
Predicting Running Related Injuries in Male and Female Novice Runners
In a study of 532 novice runners (226 men, 306 women) preparing for a recreational 4-mile (6.7-km) running event. After completing a baseline questionnaire and undergoing an orthopaedic examination, they were followed during the training period of 13 weeks. Running Related Injuries (RRI) was defined as any self-reported running-related musculoskeletal pain of the lower extremity or back causing a restriction of running for at least 1 week.
Twenty-one percent of the novice runners had at least one RRI during follow-up. Male and female novice runners have different risk profiles
The model for male participants showed that body mass index (BMI) , previous injury in the past year , and previous participation in sports without axial load were associated with RRI.
In female participants, only navicular drop remained a significant predictor for RRI. Type A behavior and range of motion (ROM) of the hip and ankle did not affect risk.
Source:Am J Sports Med February 2010 38:273-280; doi:10.1177/0363546509347985
Who needs bone-building drugs?
Osteoporosis is a common debilitating condition that contributes to increase risk of fractures. To prevent possible risk of fractures, bone building drugs are available to improve bone density. However, they can have side effects and are only 50 percent effective in preventing fractures. Therefore, World Health Organisation has come up with a tool to find out who will benefit from bone building drugs.
FRAX is an online risk calculator which helps the doctors and patients to determine the possibility of potential fracture and determine whether the drug therapy might prevent fractures. The list consists of questions looking at risk factors of osteoporosis. The factors analyze the lifestyle, conditions, diseases and medications that can contribute to the risk of osteoporosis and fractures.
The formula is applicable to both men and women. It can be used independently without a person’s bone density score but having a bone density score can further enhance the accuracy of the prediction.
References
TENS – Not effective for Chronic Low Back Pain according to latest guidelines
The American Academy of Neurology (AAN) recently published an evidence-based guidelines on the use of TENS ( transcutaneous electric nerve stimulation) is not recommended for the treatment of chronic low-back pain due to lack of proven efficacy. This supports our views at Core Concepts as a large number of chronic back pain cases is mechanical in nature.
"The strongest evidence showed that there is no benefit for people using TENS for chronic low-back pain," said guideline author Richard M. Dubinsky, MD, MPH, of Kansas University Medical Center in Kansas City and a Fellow of the American Academy of Neurology. "Doctors should use clinical judgment regarding TENS use for chronic low-back pain. People who are currently using TENS for their low-back pain should discuss these findings with their doctors."
TENS however, continues to be recommended for TENS can be effective in treating diabetic nerve pain.
Reference:
- Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
- American Academy of Neurology (2009, December 31). Widely used device for pain therapy not recommended for chronic low back pain. ScienceDaily. Retrieved January 1, 2010, from http://www.sciencedaily.com­ /releases/2009/12/091230174120.htm
Newly Discovered Sensory System in the Skin May Explain Fibromyalgia
A newly discovered sensory system hidden in a network located throughout our blood vessels and sweat glands, separate from the usual nerves that gives us the ability to touch and feel, may explain difficult to treat pain conditions like Fibromyalgia (more…)
Elderly Balance Better After Foot Massages
Researchers found that elderly people were able to balance on their feet better with foot massages.
Jacques Valiant and his group of fellow researchers from Grenoble, France and Geneve, Switzerland found that a session of plantar massage and joint mobilisation of the feet and ankles with clinical balance performance tests in elderly people.
Dividing 28 subjects, aged between 65-95 years, into two groups:
1. An intervention group had a 20 minute session of massage and mobilisation to the feet and ankle,
2. A placebo group that was given an application of three demagnetized magnets in the region of the fifth metatarsal for 20 minutes.
The subjects were tested on their One Leg Balance (OLB), Timed Up and Go (TUG) and Lateral Reach performance. Results were compared between the two groups before and after the massage and application of the magnets.
The group who had massages and mobilisations showed significant improvements in performance of OLB and TUG after one session of intervention.
Reference:
Massage and mobilisation of the feet and ankles in elderly adults: Effect on clinical balance performance, J Vaillant et al., Manual Therapy 2009;14:661-664
Tai Chi Reduces Knee Osteoarthritis Pain in the Elderly
Researchers from Tufts University School of Medicine have found that patients over 55 years old with knee osteoarthritis have lesser knee pain and better improvement in their physical functions with Tai Chi.
http://www.flickr.com/photos/edwinylee
Tai Chi is an ancient Chinese exercise that encompasses mind and body approach to enhance muscle function, balance, flexibility and reduce pain, depression and anxiety may be a good approach to treat knee osteoarthritis.
In the research, Dr Jordan and his team randomly divided 40 participants of age 55 and above, suffering with osteoarthritis knee pain for most of the days in the past months into two groups – the Tai Chi group and Control group. All participants had to attend 60 minutes of either intervention two times weekly for 12 weeks.
A range of measuring tools that mainly measure pain, physical function, balance tests, self efficacy and depression were taken at the first week, 12 weeks, 24 weeks and 48 weeks of the interventions.
The Tai Chi group was taught 10 modified forms of exercise from the classical Yang style. Each session included 10 minutes of self massage and a review of Tai chi principles; 30 minutes of Tai Chi movements; 10 minutes of breathing technique; and 10 minutes of relaxation.
The control group on the other hand was taught stretching for 10 minutes and attended 40 minutes wellness education including osteoarthritis as a disease, diet and nutrition, therapies to treat osteoarthritis, or physical and mental health education.
The results showed that participants who continued Tai Chi after 12 weeks had more long-lasting benefits with lesser knee pain and better physical functions compared with the control group.
The researchers suggested that Tai Chi is an effective exercise to treat pain and physical impairment for patients with severe osteoarthritis knee but notes the need to carry out more research to further understand the mechanism of Tai Chi in osteoarthritis knee.
Reference:
Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial, C C Wang, C H Schmid, P L Hibberd, R Kalish, R Roubenoff, R Rones and T McAlindon, Osteoarthritis and Cartilage 2008;16:S32-33
Different Compensation Strategies During Jogging by Low Back Pain Sufferers
I am sure all athletes have experienced the effects of muscle fatigue. You will use your body differently, trying to compensate by moving your limbs in a more comfortable way. Try going down stairs right after a marathon and you get the picture.
An interesting question is, do everyone compensate using the same strategy? Apparently not. A recent study¹ shows people with recurrent low back pain jogs with a different compensation strategy compared to healthy individuals after a set of fatiguing lower back muscle endurance exercise.
The exercise was to hold the lower back in an extended position until their muscles shows signs of fatigue on surface electromyography (EMG).
The low back pain group was found to jog with a more extended or arched lower back and had more hip movements whereas the normal healthy group runs with a more forward flexed trunk. This may be why it is a common for people with chronic low back pain to complain of hip muscle soreness and fatigue after endurance exercises.
It is a known fact that chronic low back pain sufferers have poor core muscle function. This adaptation of running with an extended back may be a strategy to stabilise the lower back without the need to use core muscles and yet able to continue running. On the other hand, healthy individuals are able to use their core muscles as a natural trunk stabiliser and prevent unnecessary movements.
Parallels can be drawn with long hours of sitting where the body requires muscle endurance to sustain in a single position. When fatigue sets in, the body may adopt a different strategy to try to protect the back and inadvertently creates a wrong movement pattern or mal-adaptation. Therefore, correcting wrong movement patterns and strengthening of the core muscles are important aspects of treating chonic low back pain.
Reference:
1. Hart JM, Kerrigan DC, Fritz JM, Ingersoll CD. Jogging Kinematics After Lumbar Paraspinal Muscle Fatigue Journal of Athletic Training. 2009; 44(5):475–481
Picture: www.amercianrunning.org
