Keep Moving! It's Good for You're Brain Too!

COURTESY OF HELATH.COM

Regular physical activity—even walking—may be key to maintaining a sharp mind as we get older, two new studies suggest.

While that's not a new discovery, the studies plug critical gaps in the scientific literature and corroborate previous reports linking exercise to reduced rates of mental impairment in older adults.

The message is now clearer than ever: "If you stay physically active, you're buying protection for your brain," says Eric B. Larson, M.D., the vice president for research at Group Health Cooperative, a nonprofit health-care system based in Seattle.

The studies appear in the July 25 print edition of the Archives of Internal Medicine and were published online today to coincide with the International Conference on Alzheimer's Disease, taking place this week in Paris.

One of the studies included 2,809 women over the age of 65 who had a history of heart disease or stroke, or at least three risk factors for those conditions. That's noteworthy because most previous studies on exercise and dementia have focused on healthy people, according to Dr. Larson, who wrote a commentary accompanying the new research.

Exercise may be particularly important for these women, since unhealthy cholesterol levels, high blood pressure, and other conditions that affect blood-vessel health have been linked to the memory and language problems known as cognitive decline, which often precedes Alzheimer's disease and other forms of dementia.

Researchers in Paris and at the Harvard School of Public Health, in Boston, reanalyzed data from a study originally designed to examine the role of antioxidant vitamins in heart health. Beginning in 1995, the women answered biennial surveys on how often they engaged in various types of exercise (such as jogging, swimming, walking, and climbing stairs). Several years later, the researchers then gave them a series of telephone-based cognitive and memory tests on four separate occasions spread out over a four- to six-year period.

The more active the women were, the better their performance on the test. And they didn't have to be marathoners: The most active women, who were getting the equivalent of 30 minutes or more of brisk walking every day, experienced much slower cognitive decline than those who got little or no exercise. According to the researchers, the difference amounted to being 5 to 7 years younger, cognitively speaking.

The strong link between activity and a lower risk of cognitive decline was all the more notable given the "very crude" telephone tests used by the researchers, Dr. Larson says.

A second, smaller study addressed a common weakness of the existing research on exercise and dementia: the reliance on the participants' own description of their exercise habits, which can be unreliable.

In addition to using surveys, researchers used various laboratory tests to gauge the total amount of energy expended by 197 men and women in their 70s over a two-week period. The tests involve drinking chemically altered water and measuring, via blood and urine samples, how quickly the body breaks down the chemicals.

Compared with more sedentary individuals, the people who expended the most energy over the two weeks had 90% lower odds of developing cognitive decline over the five- to seven-year follow-up period—a "really strong" reduction in risk, says the lead researcher, Laura E. Middleton, Ph.D., an assistant professor of kinesiology at the University of Waterloo, in Ontario.

What's more, the participants' lab-tested energy expenditure was more closely linked with cognitive health than their subjective accounts of how much exercise they typically get, which suggests that everyday activity, and not just exercise, may help maintain brain health.

"It's not only that type of purposeful physical activity that's important; it's also the less intense work...stuff like just standing up more often and walking more often," Middleton says.
"It's bad news for those of us, including myself, who sit at a desk all day," she adds. "It means that we really need to find some way to get up and move."


Read more: http://healthland.time.com/2011/07/19/more-evidence-that-exercise-is-key-to-brain-health/#ixzz1TJMs7RHk

Barefoot Running: Theory Behind It and Practical Advice

Barefoot running is a hot topic among runners and fitness enthusiasts these days. Here is a Q+A with a physical therapist, who also happens to be a long-time runner. He offers some good thoughts about barefoot running, briefly discusses the theory and research, and offers some good, practical advice if you're considering trying barefoot running.

Running with a minimal-support shoe such as Vibrams, Merrels, Nike Free, and some others, can also be a very good option for some. Click below to read more......

http://www.postcrescent.com/article/20110717/APC0212/110714049/Look-no-shoes-Experienced-runner-talks-about-transition-barefoot-running

Staying Fit as We Age: Some Practical Advice and Thoughts

Nice video below from Move Forward PT discussing the importance of "keeping moving" as we get older.

Spinal Fusion: More Evidence (And it's Not Good)

Redirecting Our Enthusiasm

COURTESY OF EVIDENCE IN MOTION

The use of spinal fusion surgery for chronic low back pain has increased dramatically in recent years-despite a lack of consistent evidence that it improves patient outcomes.  During the last several weeks more damning evidence has come out for the Lobotomy of Our Time.

It began with the paper by Trang and colleagues in Spine who compared 725 patients who had spinal fusion surgery with 725 patients who chose other methods to treat their low back pain (such as physical therapy, exercise, etc).  The researchers assessed the final treatment outcomes-including return to work, disability, and use of opioid medications (i.e. oxycontin and the like)-at two years' follow-up.

Almost all categories of outcomes were worse for patients undergoing spinal fusion. Just over one-fourth of spinal fusion patients had returned to work, compared to two-thirds of those treated without surgery. Twenty-seven percent of patients in the spinal fusion group had repeat surgery, while 36 percent experienced some type of complication. 
Eleven percent of the spinal fusion patients had permanent disability, compared with two percent of patients treated without surgery. Most spinal fusion patients continued using opioid drugs after their surgery, with many taking higher doses.

Let me rephrase that "If we do this surgery you have a 1 in 4 chance of a repeat surgery, a 1 in 3 chance of a complication, and 3 in 4 chance of never working again." There were also more deaths in the spinal fusion group.

The geographical variability of this procedure has been repeatedly highlighted in the literature.  How can a high cost, high risk procedure with questionable value continue to be used at increasing frequency?

Bederman et al. just published a paper which explored the concept of what is driving this unacceptable variability. The authors used a cross-sectional population-based study which surveyed orthopedic surgeons, neurosurgeons, family physicians and patients in Ontario, Canada in attempt to determine the influence of the enthusiasm of patients, family physicians, and surgeons for surgery on the regional variation in surgical rates for degenerative diseases of the lumbar spine (spinal stenosis and degenerative spondylolisthesis). Although patients and Family Physicians had variable enthusiasm for surgery, surgeon enthusiasm was the dominant factor influencing surgical rates. Prevalence of disease and community resources were not related to surgical rates. Surgeon enthusiasm for surgery rather than that of referring physicians or patients was the dominant determinant of surgical rates.

As a PT, my enthusiasm is not in the power of my manipulation procedures, exercise programs, or counseling techniques, rather my enthusiasm is in the power of our patients to improve upon their current status.   From the beginnings of our profession we were in the empowerment and change business.  As physical therapists we relish not in the skill of our hands but in the power of our patients to overcome adversity.   When it comes to patient education it is time that we speak loudly against elective procedures that have failed to show benefit and place our patients at risk of significant harm and even death.

Does This Story Sound Familiar to Anyone?

 Lenny Bernstein

Physical therapists can help injuries heal, even when the cause is unclear

COURTESY OF THE WASHINGTON POST

My newest hero has vanished, as heroes are wont to do, perhaps down the dark streets of Gotham City or off to the Fortress of Solitude. Okay, she’s in Cumberland, Md. But before she moved on to her new job, Carla Colella, my physical therapist, revived my exercise program by figuring out what to do about an injury that just wouldn’t go away.

And that’s no small thing. As I whined in a column in January, losing the ability to exercise when you’re accustomed to regular physical activity can be life-changing. Getting it back is just as earth-shaking.

Like my doctors, Colella never determined precisely what caused the ache in my right groin and hip whenever I went running, though she suspects I injured my abdominal fascia while working out with a trainer last year, then created more problems by continuing to run. But as experts in movement issues, physical therapists get right to work helping patients like me by teaching us strengthening, stabilizing and stretching exercises even as they look for the problem.

“Sometimes we have to get to that very root of it,” says Mary Ann Wilmarth, chief of physical therapy for Harvard University. “But we can always give the person something immediately to start with that can help them.”

No offense to my physicians. The care I’ve received over the past several months has been superb. Suspecting a hernia, I went to see a doctor at my HMO, Kaiser Permanente. He examined me and referred me to a surgeon, Brian M. Cantor.

Cantor is an earnest, amiable guy who had me lie on his exam table while he checked me out. We chatted casually about the Redskins until he sank his fingers deep enough in my groin to examine my tonsils. Even that was not enough to find my problem for sure, so he sent me for an ultrasound exam.

There, three women — two technicians and a physician — peered intently at a screen while one of them rolled the device over my exposed hip and groin, and I tried to pretend there was more between me and them than the flimsy “drape” I had tucked into the top of my drooping boxers. I think of “drapes” as long, flowing lengths of fabric used to cover windows. This one was the size of a couple of sheets of paper towel.
Just to make sure, Cantor also sent me for an MRI. It seems as if I read about athletes having these every day, but the sports pages never mention the quart of thick, nauseating barium I had to drink before the test to ensure that my insides would show up on the computer screen.  And when it was done, I was back where I started: unable to run, with no clue what was wrong.

So I asked Cantor to refer me to a physical therapist.

The Kaiser office where I met Colella is in a nondescript building not far off Connecticut Avenue in Kensington, in a neighborhood of commercial structures. Colella, 28, is one of the 180,000 physical therapists in the United States and one of the 20 percent who hold doctor of physical therapy degrees, which she earned at George Washington University. Like a small percentage of her peers, she is a contract worker, and she is taking advantage of the severe shortage of physical therapists in the United States to move from city to city before deciding where to settle down.

(Note to college students: The shortage will continue, and physical therapists earn a median salary of as much as $90,000, depending on where they work. Earning a degree can be expensive, though.)
Colella knows the benefits of physical therapy from personal experience. “Similar to you, I did not have a major medical diagnosis,” she told me in a recent e-mail. In high school, “I caught an elbow to the back going up for a layup and a few months later decided to attempt to throw (shot & discus) in addition to sprint. The combination did a number on my thoracic (mid-back) area. I went though the typical medical management routine with no relief. I then went through physical therapy and after many months . . . I was able to compete in all recreational activities pain free. I thought it seemed like a good career — helping people, decent pay, tennis shoes & no cubicle, where do I sign up?”

On my first visit, Colella outlined a series of exercises, even drawing stick figure diagrams to make sure I did them correctly. After months of pain, I began to feel a difference in just a week or two. At two subsequent visits, she did deep tissue mobilization, or massage, on my hip.

Colella wanted to see me twice a week for three weeks, but with so many people seeking physical therapy at Kaiser, I was able to get only four appointments in four weeks (the last of which I missed).
In the end, it didn’t seem to matter. Colella’s treatment has put me back on the road and the treadmill. Although some pain and stiffness remain, I’m slowly overcoming a winter of sluggishness and weight gain. If all goes well, I’ll resume marathon training in a few weeks.

So thanks, Carla. And although I can’t flash a distress call against the night sky the next time I get hurt, I know where that Kaiser physical therapy center is now.


Do you need a physical therapist? In many cases, you can make an appointment without a doctor’s referral. Find one at at the American Physical Therapy Association’s site. The organization also hosts a Q and A at Ask a PT.

ALWAYS BELIEVE

 

Great video below about Eric Lagrande, a Rutgers University football player who was paralyzed, and his determination to never give up. If you have 7 minutes, check this video out.

 

http://espn.go.com/new-york/ncf/story/_/id/6766456/paralyzed-rutgers-scarlet-knights-football-player-eric-legrand-stands-therapy&ex_cid=espn-twttr

Rolfing: What is it? Can it be helpful for back pain? Read on......

We've had a number of people ask us about Rolfing recently. This article gives a nice explaination of what Rolfing is, and what it is thought to do. The most current research shows that 1)Rolfing should not be the first line of defense in treating or managing muscular and joint pain, and 2) it may provide some benefit as an adjunct treatment for some people (it shouldn't be the main treatment you are doing).

A good point was made in the article that muscle and joint problems are multi-factorial, meaning that there are often a number of reasons why problems are occuring. That is likely one reason why the research behind Rolfing is weak. On the other hand, an abundance of research supports the benefits of physical therapy in improving pain and function. Having pain or a problem? See a good physical therapist!

COURTESY OF NPR

Rolfing Back In Vogue, But With Shaky Evidence

 

James Gritz/iStockphoto.com Rolfing was named after its founder, an American biochemist named Ida Rolf. Her own health problems led her to believe that deep tension could be relieved by pressing into fascia tissue.

As I open the door to a somewhat antiseptic-looking medical office in downtown San Francisco, I'm quite certain I will not be getting a lavender-candles-and-wind-chimes kind of a massage — the kind that will leave me facedown in my own drool. I expect this to be painful. That's what I've been told anyway.

Greg Brynelson, a certified Rolfer and registered nurse with a loyal following, tells me to lie on my back. Rolfing Structural Integration is a type of deep — really deep — massage that was last popular when Nixon was president. Well, Rolfing has become a favorite again — this time among the yoga-Pilates-acupuncture crowd.

"Through here, it feels like I'm coming up against a wall," he says. "There's not a lot of give."
Brynelson has kind eyes and strong hands. Or thumbs. I think that's what's pressing into my neck.
Rolfing was named after its founder, an American biochemist named Ida Rolf. Her own health problems led her to believe that deep tension — even mild physical deformities in children, like pigeon toes — could be relieved by pressing into a type of tissue called fascia. Fascia fuses skin to muscle and muscle to bone, and it kind of keeps everything in place, like a snug pair of pantyhose.

A.D.A.M. Inc. via U.S. National Library of Medicine, National Institutes of Health Inflammation of the plantar fascia in the foot causes heel pain.

Slouching over a computer and schlepping around kids can tighten and shorten your muscles, and with them, the fascia cinches down, like one of those vacuum-sealed beef jerky bags. Rolfers, like Brynelson, believe stretching out the fascia — getting it to be more soft and pliable — can improve posture and strength, and over time, reduce aches and pain.

A Closer Look
Since I had just had my fascia flattened, I wanted to see what it looks like. So I head to the cadaver lab in the basement of Stanford University.
Sakti Srivastava, a physician at Stanford's division of clinical anatomy, and I are looking at the fascia on a partially dissected human leg.
"This is what fascia looks like," he says. It almost looks like the thin layer of white film you have after you debone a chicken and pull the skin off of it. If this person had bad posture or a chronic injury, Rolfers say the fascia would tighten, throwing off the person's gait and possibly leading to lower back pain or other aches.

Beyond Fascia
It's a theory that is largely taken on faith, many researchers say. Wolf Mehling is a manual medicine physician at the University of California, San Francisco who treats patients with Rolfing as well as other kinds of massage. Still, he says, it's hard to say if Rolfing can lead to long-term structural changes in the body.

Becoming A Rolfer

Rolfing isn't just for achy adults: babies, the elderly and even horses can all receive it. But to be a real Rolfer, practitioners must be trained and certified by the Rolf Institute of Structural Integration.


Rolfers "come from all walks of life," says Susan Winter, a spokeswoman for the institute. Some are massage therapists or nurses, while others are totally new to bodywork.


The certification program takes a year to 18 months to complete. Students learn about anatomy and ethics, and they receive instruction in the institute's special brand of therapeutic touch.


The institute offers three types of certification: At the basic level, students become Certified Rolfers. Then there are Certified Advanced Rolfers, who have at least three years of experience and completed the 24-day Advanced Rolfing Training course. Rolf Movement Practitioners complete an additional two-phase course that lasts 18 days.


To find a Rolfer who has received the official training, visit the institute's website.
— Whitney Blair Wyckoff

"To my knowledge, there has been no randomized, controlled trials comparing Rolfing with other types of massage or bodywork," he says.

According to Mehling and other researchers, the few studies that have been done are too limited or flawed to draw any conclusions about Rolfing's effectiveness. Rob Landel, head of physical therapy at the University of Southern California, says the philosophy of Rolfing makes sense — if you can loosen up and improve your posture, your overall body movement improves, too.

Indeed, physical therapists are trained to work on soft tissue, like fascia. It's just that they work on other things, too — joints and muscles and ligaments. And that, says Landel, is why Rolfing probably couldn't stand up in a clinical trial.

"I doubt if it will end up being, 'Oh this is The Thing,' because our musculoskeletal problems end up being multifactorial," he says. "So, it's doubtful that any single approach is going to fix everybody."
More likely, Landel says, is that Rolfing could be shown to work for certain problems like low back pain, when combined with strengthening exercises and better posture.

Back To The Back
Which brings us back to my back. After pressing deeply into my right shoulder and neck, my Rolfer Greg Brynelson asks me to stand up and look in the mirror.
"Do you see how the left side is still grabbing?" Brynelson asks. "There's just more softness through here. Do you feel a little more movement?"
"It feels more relaxed, more fluid," I say.
And it's true: One shoulder has an easy, graceful slope. The other is hunched up, like it often is. As I put my shoes back on — a pair of very unorthotic heels — and sling my oversized, overloaded purse onto my shoulder, Brynelson looks at me with pity and resignation. Me and my fascia, it seems — we're a work in progress.

Smart Packing for Work, School, or Travel

Nice tips for students or parents/adults alike......in this video a PT shows how you can pack smartly to make the load you're carrying easier on your back. This applies to shoolbags, briefcases, or even when you travel or go hiking.

Main points to remember:
1. Pack the heaviest items closest to your body, and as high as possible in the bag.
2. Adjust the straps so that the bag isn't "sagging down" on your back. Get it up high.
3. If carrying a laptop bag or duffel bag, sling the strap across your body if possible to distribute the load more evenly (this should feel better/lighter).

Spinal Stenosis: Surgery or Physical Therapy?

Below are two good pieces - one is an article reviewing the research on surgery, specifically spinal fusions, in the treatment of spinal stenosis. The second is a slideshow demonstrating treatment techniques we often employ here for stenosis. Research shows these are extremely beneficial for many patients. Another good thing is they are non-invasive and much less costly!

Press Releases

FOR IMMEDIATE RELEASE

CHOOSE BACK SURGERY AT YOUR OWN RISK

Fusion surgeries found to have increased risk of death; patients should choose safer alternatives.Tallahassee, Florida, April 7, 2010 — Patients with low back pain from spinal stenosis are increasingly being exposed to dangerous surgeries. The Journal of the American Medical Association (JAMA) has just reported an alarming increase in complex spinal surgery for lumbar spinal stenosis. In just five years, from 2002 to 2007, the number of complex fusion surgeries to treat lumbar (low back) spinal stenosis soared from a rate of 1.3 per 100,000 to 19.9 per 100,000. The study showed that life-threatening complications occurred in 5.6% of patients having complex spinal fusions. Patients who had complex fusions had longer hospitalizations, higher rates of re-hospitalization, and three times the rate of serious complications such as heart attack and stroke. These surgeries continue despite little medical consensus on whether or not these procedures are helpful or should even be used in the management of lumbar spinal stenosis.
 
"This study supports what we have been seeing in our clinics for years," said Dr. Bob Rowe, President of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). "Older adults are seeking care from physical therapists following significant back surgeries and they frequently have problems that weren't there prior to surgery and yet they still have back and leg pain. We hope this finally sounds the alarm and stops the madness that is going on in surgical spine care." Dr. Rowe cautions that patients should be aware that these surgeries are extremely risky and put your life in danger and that you may not be any better off after the procedure."
 
Fortunately there is good news for healthcare consumers as a previous randomized clinical trial demonstrated that patients with Lumbar Spinal Stenosis report significant improvement after physical therapy, with the greatest gains occurring in patients who received manual physical therapy, exercise, and a progressive body-weight supported treadmill walking program. Rowe noted that, "it just make sense to try physical therapy first, which is a low cost, low risk, and most importantly effective treatment for chronic low back pain due to lumbar spinal stenosis." Consumers should actively seek care from a qualified physical therapist for their low back complaints.

SLIDESHOW: CLICK LINK BELOW (VERY GOOD INFO!)
http://tinyurl.com/stenosisRCT

It's Hot - Stay Hydrated!

Especially if you're working outside in this heat, don't forget to drink plenty of water. We recommend you drink at least half of your body weight in ounces each day - more if you are active/exercising. For example, if you weigh 200lbs., you would want to drink at least 100oz. of water daily. So carry that water bottle with you, and get out and have fun.

Good, short article below about heat injury and how to prevent it.

http://www.stopsportsinjuries.org/heat-illness.aspx

Cortisone (Steroid) Shots: What Do They Do?

Nice article explaining how cortisone (steroid) injections work, and what recent research shows about them. This may or may not surprise you. Good read.

http://well.blogs.nytimes.com/2010/10/27/do-cortisone-shots-actually-make-things-worse/