Benefits and risks of exercise

Week after week, studies come out about the benefits of exercise. And while online resources can inspire you in countess ways to get moving, you likely won’t learn the correct way to squat or dead lift via YouTube.

The monkey see, monkey do mentality could, in fact, be a recipe for disaster.

“If you don’t have enough mobility at each joint to perform an exercise safely, then really any part of the body is at risk for injury,” says Alison McGinnis, DPT, FAFS. She’s a physical therapist at Finish Line Physical Therapy in New York City.

Related: The 25 craziest workout excuses trainers have ever heard

But that isn’t stopping people from pumping iron. Even with an onlooking trainer or coach, gym go-ers, racers and athletes alike still get injured. Yes, this is the exact business that keeps physical therapists busy and employed, but the rehab bills and time can really start to add up if you’re the victim of improper training.

Wondering which types of exercises might make you the most vulnerable?

While any exercise performed with poor technique could put you in harm’s way, some moves are more commonly botched than others. We called on six leading physical therapists to share, which exercises could land you in rehab if done incorrectly. Don’t say you weren’t warned.

1. Bicycle crunches


Pump ’em out as fast as you can, right? Wrong!

“As exercisers drop in and out of abdominal flexion, losing their muscle tension in the midsection, the low back gets wrenched in and out of extension with little support,” says Alycea Ungaro, PT. She’s the owner of Real Pilates in New York City.

She explains that twisting at high speeds is a recipe for herniated discs and muscle spasms.

“In addition, many people clutch the back of their heads and crane their necks back and forth subjecting their cervical spine to injuries as well.”

Your better bet: Slow the crunch down drastically if you feel you have to perform it.

Related: Hate crunches? 6 better core exercises for beginners

2. Lat pull-downs (behind the head)

If you don’t realize vulnerable positions you’re placing your body in, you won’t be able to help prevent injury.

“The lat pull-down places a lot of stress on the anterior joint capsule of the shoulder and can eventually lead to impingement or even rotator cuff tears,” says Jessica Malpelli, DPT. She’s a therapist at the Florida Orthopedic Institute.

If something in your shoulder doesn’t feel right, stop and find another exercise. Even doing the lat pull-down in front of your head can be a safer approach.

3. The kettlebell swing

03.kettlebell swing

Yes, it’s one of the best strengthening exercises around. The catch: It requires impeccable technique.

While many people think this movement is all arms, it’s actually powered from your lower body, specifically the posterior chain including the glutes and hamstrings. It’s important to learn the correct way to move the weight before you start swinging it.

“Because of the speed and the force of the swinging motion of the kettlebell, the shoulder is at significant risk for injury,” says John Gallucci Jr., MS, ATC, PT, DPT. He’s the president of JAG Physical Therapy.

“If performed incorrectly, the repetitive swinging motion could result in rotator cuff injury and/or inflammation of other structures in the shoulder.”

To avoid landing on the examination table, make sure the power is generated from glutes and hamstrings.

4. Bent over rows


“Rows can be great for shoulder and upper back,” says Malpelli, “but often patients perform them bent over at the waist. Being in that much lumbar spine flexion can cause a disc to displace posteriorly, potentially hitting a nerve.” Hinging from the waist also causes your shoulders to roll forward, which can contribute to poor posture (and is counterproductive to the row exercise in general).

If you’re going to do row, try performing them lying face down on a Swiss ball or bench.

5. The Romanian dead lift


If performed correctly, it’s a great exercise for the back and hips. However, dead lifts are one of the easiest ways to hurt your back if you don’t know what you’re doing. Why?

“Most commonly a person will fall into hyperextension through the low back while lowering and lifting weight, which could result in lumbar disc injury or muscular spasm,” says Gallucci.

Translation: Many lifters will round their back when picking up or putting down the bar — and often they may not even realize it.

“Also, if the weight isn’t distributed through the feet properly and is shifted too far forward, then the glutes and hamstrings won’t fire and the lumbar extensors are overworking, which again could result in a low back spasm,” explains Gallucci. If you’re a newbie to this lift, we recommend asking a trainer for help.

6. The overhead squat


Lifting anything overhead is challenging to your body, and even more so to the nervous system. Add a squat to that and form can quickly go out the window.

“An overhead squat is a full-body exercise, so for example, a person who doesn’t have enough mobility in their hips, knees and ankles will have trouble getting into a deep squat even without the overhead press,” says McGinnis. “The actual overhead motion adds strain to shoulder, cervical, thoracic and lumbar regions.”

If you insist on attempting this move, make sure you cease going down as soon as your form is compromised.

“Stop when your low back starts to arch excessively, your knees drive forward past your toes or your arms move forward,” says McGinnis. “Whatever depth that is, that is the bottom of your squat.”

Related: Detoxing for beach season? Here’s your 5-day plan

7. Backward medicine ball rotation tosses (against a wall)


It may look functional and maybe even fun, but it’s never a good idea to forcefully rotate your spine backward. There are so many small and delicate discs in the back that can herniate with the slightest wrong movement, so anything bending you backward should be done slowly and with serious caution, says Jason D’Amelio, MS, ATC-L, ART-C. He’s the owner of Total Athletic Performance Training in New York City.

“The reason that I dislike this exercise is because there is no movement in sports that requires you to aggressively rotate backwards,” he says. In most athletic rotation and swinging movements (think: swinging a baseball bat or golf club), the most powerful part of the movement is when the body rotates forward, not backward.

The backward rotation does nothing for the client from an athletic standpoint, D’Amelio says. He recommends opting for medicine ball throws for rotary power, but only laterally and throwing the ball forward.

8. Seated leg extension


Maybe it’s time to rethink using this piece of equipment just because everyone else is. It may actually be doing more harm than good.

“Using a leg extension machine isn’t functional — there is no natural movement in life were you sit and straighten your knee with a 100-pound load against it,” says Joe Tatta, DPT. He’s a physical therapist at Premier Physical Therapy & Wellness in New York City.

When you isolate any muscle and put an intense amount of weight on it, you run the chance of creating muscle imbalances. Plus, many people flex their toes when performing this exercise, overworking already tight muscles such as the hip flexors.

“It also places undue stress across your knee joint affecting the delicate cartilage under the patella,” says Tatta. Need another option? Try squats instead.

9. The pull-up


Can’t pump out 20 straight? That may not be such a bad thing, especially if your alignment isn’t quite there yet. This exercise targets the lats, which is one of the most underused muscles in the body, especially for women. To get the benefits of a pull-up, the lats must be activated.

“You need to have your chest up with your abs engaged, and lead the pull with your elbows,” says Sulyn Silbar, orthopedic massage therapist and owner of Body + Mind NYC. “Most people cannot do them properly, as their lats aren’t working or aren’t strong enough, and therefore the body compensates by using the upper traps and chest to do the movement.” This can lead to short, tight pecs, or worse, shoulder issues.

Learn the pull-up using a band and checking your form in the mirror or with a certified trainer before you start knocking them out.

10. The preacher curl


It’s time for a separation of church and exercise. While the setup for a preacher curl is to, in fact, activate the bicep muscle, the position makes the rest of your body vulnerable.

“It puts the muscle in an active insufficiency, which means the muscle is already shortened, and puts your shoulders in an anterior tilted position and in abduction, which means they are farther apart,” says David Reavy, PT, OCT. He’s a therapist at React Physical Therapy in Chicago.

“There is no stabilization of your core or lats because your shoulder blades are out of place and you are in a forward posture. You are strengthening in a bad position.”

Instead, Reavy recommends bicep curls be done in a half-kneeling position.

While there may not be any “bad” exercises, there can be poor executions of those movements. When in doubt, seek out expert advice to make sure your programming and exercise technique are sound.

 From CNN Health

Shift from Acetaminophen to exercising for low back pain and osteoarthritis

Doubts About Acetaminophen for LBP, OA Lead to Discussion of Effectiveness of Exercise
A new study that questions the effectiveness of acetaminophen for low back pain (LBP) and hip or knee osteoarthritis (OA) has also sparked a discussion about what does work: namely, movement and exercise.
The study itself, published in the March 31 British Medical Journal (BMJ), analyzed results from 13 randomized clinical trials that evaluated short-term pain and disability outcomes for a total of 5,366 patients who received either acetaminophen or a placebo for LBP (1,825 patients) or OA (3,541 patients).
Researchers concluded that evidence was strong that acetaminophen is “ineffective” for reducing pain intensity or improving quality of life in the short term for people with LBP, and provides “minimal short-term benefit” for individuals with hip or knee OA.
“Overall, our research is based in ‘high quality’ evidence … and therefore further research is unlikely to change this evidence,” authors write. “This systematic review should inform clinical practice and policy with regard to first line care of these patients.”
The study was accompanied by an editorial in BMJ titled “Physical treatments are the way forward.” In that editorial, authors cite the UK’s National Institute for Health Care and Excellence (NICE) recommendation that all patients with OA receive information on exercise and weight management (if appropriate) and write that “the effectiveness of exercise for both osteoarthritis and spinal pain is established.”
The editorial names physical therapists as “key professionals to offer expert advice and support in this regard,” and calls for a shift in treatment away from drugs.
“Changing behavior of doctors and their patients is notoriously difficult, but the findings [of the study] emphasize that the time has come to shift our attention away from tablets as the default option for managing chronic musculoskeletal pain,” editorial authors write. “Non-pharmacological treatments work, are safe, and have benefits that reach beyond the musculoskeletal system.”
The BMJ study was reported in the media, including on websites for the Today show and US News and World Report, which posted a report on the study first published in HealthDay. Both reports mentioned physical therapy as an effective treatment.
The HealthDay article also included a response to the study from Allyson Shrikhande, MD, a physiatrist in New York City. Like the BMJ editorial authors, Shrikhande cited the efficacy of nondrug approaches. “Strengthening exercises have been shown to decrease pain in knee osteoarthritis,” Shrikhande is quoted as saying in the HealthDay article. “Physicians often prescribe [acetaminophen] or other oral medications as first-line treatment, but perhaps an individually tailored physical therapy program should be tried prior to the use of [acetaminophen] or other oral pain medications.”
The BMJ study authors themselves also acknowledge the benefits of an approach based on movement.
“Recent evidence on lower limb [OA] shows that exercises (such as strengthening exercise) compared with no exercise control result in large treatment effects for pain reduction,” authors write. “[Acetaminophen] alone therefore might not be sufficient to treat hip or knee OA and might need to be accompanied by other management strategies, such as exercises or advice/education.”
The Health Center for Low Back Pain at, APTA’s official consumer information website, includes numerous resources about the benefits of physical therapist treatment.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association’s PTNow website.
Posted by News Now Staff at 11:21 AM Labels: Health Care Headlines

How your body feels when you stop working out for some time

How fast will you fall out of shape?
You worked hard to get fit, whether by logging regular runs or striving for new personal bests in your bench press. When your workouts fall by the wayside, how fast you fall out of shape depends on more than just how much time you spent away from the gym. Your overall fitness and the type of workout you’re missing will also impact your losses, says Dr. James Ting, a board-certified sports medicine physician with the Hoag Orthopedic Institute in Irvine, California.

As a general rule, the fitter you are, the longer it will take your muscles to turn to flab, he says. Your physique doesn’t like change; it’s constantly trying to achieve homeostasis. So the longer you have been exercising (and the fitter you are), the more time it will take for your body to say, “Well, I guess we don’t need to build muscle any more.”

If it’s only been a week since you broke a sweat, don’t stress. Whatever your workout history, it’ll take more than seven days for your body to soften. But two weeks? You might not get away with that as easily. One study in the Journal of Applied Physiology suggests that easing up on your workouts for just 14 days can significantly reduce your cardiovascular fitness, lean muscle mass and insulin sensitivity. Meanwhile, it can take two months or longer to see complete losses of your fitness gains, according to Ting.

Endurance vs. strength: Which will you lose?
Your body will react differently depending on whether you’re skipping endurance exercise versus strength training, says exercise physiologist and trainer Marta Montenegro.

That’s because your muscles contain both type I (slow-twitch) and type II (fast-twitch) muscle fibers. Type I fibers contribute to endurance performance. Type II fibers are more powerful, and their “fast-twitch” capabilities help you power through high-intensity exercise or strength training.

Related: What 25 grams of protein looks like

During your day-to-day activities (like walking, talking, sitting at a desk, etc.), your type I fibers are contributing to the bulk of your efforts. But you really have to work to get your type II fibers to switch into gear. So when you take a break from exercise, your type I fibers are likely still being used, helping to prevent them from breaking down. But some of your type II, fast-twitch fibers may be rarely, if ever, used if you aren’t working out, Montenegro says.

That may explain why type II fibers tend to atrophy more quickly than type I fibers, she says. In other words, your max bench press will suffer before your 10K time does when you’re slacking. If you’re taking a break from strength work or high-intensity intervals, you’ll notice a huge difference when you finally do go back to the gym.

Endurance athletes aren’t entirely out of the woods, though. When you perform regular cardio, your type II muscle fibers gradually change from type IIx to type IIa, Montenegro explains. Type IIa fibers are key to endurance performance: They are powerful, but don’t tucker out as quickly as IIx ones, meaning they can help power your long runs. When you take a break from your long runs and rides, this essentially reverses, and your percentage of type IIa fibers decreases, while your IIx fibers increase, she says. So prepare to tire out way faster.

Breaks aren’t all bad
Before we terrify you into heading to the gym right now, know that it’s actually good for you to skip workouts from time to time. In fact, if you train hard, taking a break can actually help improve your strength, muscle development and aerobic fitness, says certified strength and conditioning specialist Brad Schoenfeld, assistant editor-in-chief of the Strength and Conditioning Journal.

Days off can also improve your mental fitness. “Your body and mind both need time to recover for overall health and in order to achieve optimal performance,” says Ting. “Failing to recognize this and training too hard can lead to fatigue and, ironically, underperformance, the so-called overtraining syndrome.”

If you’re sore more than 72 hours after a workout, you’re feeling ill, or your fitness progress is stalling, it may be time to back off. How long should your break last? “There’s no hard and fast rule for how long a ‘break’ from exercise should be,” Ting says. “It may be as short as a few days, but it’s important to realize as well that it can also be up to one to two weeks without any significant detriment or loss in previous fitness gains.”

Just remember that taking a break from exercise doesn’t (and shouldn’t) equate to gluing your butt to the couch and Netflix-binging. “Taking up some light activity that isn’t part of your typical training regimen, such as yoga or even a long walk or leisurely bike ride, can all constitute a ‘break,'” Ting says.

Related: Are you crazy for working out while sick?

How to jump back into your workouts
Depending on how long you took off — and how lazy you were — you might not want to jump back into your workouts, but rather ease into them. If you’ve taken more than a couple of weeks off, you’ll probably notice some differences. After a month or more, you’ll definitely want to get started with a less intense version of your regular workout, Ting says.

“The most important thing is to back off a little for the first week,” Schoenfeld says. “Choose a weight where you will be able to stop several reps short of failure on your sets. The following week you should be able to train at your previous level, assuming the reason for stopping wasn’t an illness or injury.” Meanwhile, if you’re getting back into running, start at a pace at which you can run comfortably and are able to speak in short sentences. After a week, try turning up the speed.

It can be frustrating to exercise at anything less than your max effort, sure, but gradual is the way to go to prevent injury. The last thing you want is to walk into the gym after a month off, try to squat your usual load, and throw out your back. (Hello, another month off.)

Luckily, when it comes to getting back into your pre-break shape, you do have muscle memory working for you, Schoenfeld says. There are two aspects to muscle memory. One involves your ability to carry out movements in a coordinated fashion. Wonder why your first rep on the bench press looked so sloppy? It’s because your body was learning which muscle fibers it needed to recruit, and which ones it didn’t, to properly perform the exercise.

Then second component of muscle memory involves your cells. “Muscles have satellite cells — basically muscle stem cells — that help to drive protein synthesis. Resistance training increases satellite cells and these changes remain for years,” he explains. “So even if muscle is lost from taking time away for many years, a person can regain the lost muscle much more quickly after an extended layoff.” Score.

Exactly how long it takes will vary from person to person, but by and large, you can expect to be back in fighting shape in a few weeks.

By K. Aleisha Fetters

Hip and knee replacement costs vary


Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are among the most common procedures patients in the United States undergo while hospitalized.[1] In 2011, US surgeons performed approximately 645,000 TKAs and 306,000 THAs, excluding revisions.[2] Data suggest that in 2015, they will perform more than 925,000 TKAs and 378,000 THAs.[3]

As the US population ages, experts anticipate that the need for TKA and THA will increase dramatically.[3] By 2020, the number of primary TKAs performed in the United States is predicted to reach almost 1.4 million and the number of THAs is expected to top 510,000.[3]

Concerned about the rapidly growing economic burden of TKAs and THAs, Blue Cross Blue Shield (BCBS) and its independent licensee Blue Health Intelligence (BHI) analyzed BCBS claims data to compare regional costs for both types of joint replacement surgery.[4]

Study Summary

Researchers for BCBS and BHI analyzed three consecutive years of claims data for BCBS health insurance subscribers 18 to 65 years of age who underwent a typical TKA or a typical hip replacement. Eligible claims were those incurred in the 36 months ending July 2013 and paid through September 2013. Claims for individuals who had concurrent Medicare coverage or who had a serious comorbidity, such as cancer or HIV, were excluded from the analysis.

The study determined the average cost of a typical total hip or knee replacement for each of 64 BCBS markets, which encompassed nearly every state in the United States. The estimated cost of each procedure included all claims stemming from the primary surgery and any claims related to presurgical and postsurgical care. In addition, BCBS-BHI analyzed differences in cost between markets and within a market.

The average price of a typical TKA was $31,124, and the average price of a THA was $30,124. However, costs varied substantially between regional markets. Claims incurred for a TKA ranged from $11,317 in Montgomery, Alabama, to $69,654 in New York; claims incurred for a THA ranged from $11,327 in Birmingham, Alabama, to $73,987 in Boston, Massachusetts.

On average, the most expensive market for a patient to undergo either joint replacement procedure was New York, where the mean cost of a TKA was $61,266 and the mean cost of a THA was $59,448. The least expensive market for both procedures was Montgomery, Alabama, where the cost of a TKA averaged $16,097 and the cost of a THA averaged $16,399.

The study showed that costs often varied greatly within a single market. For example, data reflected a 267% difference in price between the least and most expensive TKA in the Dallas, Texas, market; and a 313% difference in price between the least and most expensive THA in the Boston-Worcester, Massachusetts, market.

Conversely, some markets had relatively consistent costs between facilities. The difference between the least and most expensive TKA was only .3% in the Fort Collins-Loveland, Colorado, market; and the difference between the least and most expensive THA was only 1.7% in the Wilmington-Newark, Delaware, market.

The report proposed that the “lack of cost variation within a market can negatively impact consumers when prices are consistently high.”

The study did not analyze reasons for the regional variations in cost or whether certain aspects of the joint Viewpoint

Thomas C. Barber, MD, chair of the American Academy of Orthopaedic Surgeons (AAOS) Council on Advocacy and an orthopedic surgeon in Oakland, California, who specializes in total joint replacement, offered his perspective on the study:

“Most importantly, we have to all understand the concept of ‘cost.’ Blue Cross is measuring the cost to them, not the cost of doing the procedure in the hospital. This is an important distinction, because most of what they are measuring is the effectiveness of their contracting for hospital and physician services, not true cost. The contract for physician services may vary by 30%, depending on the market power and contracting skill of the medical group. Hospital services are even more variable in terms of contracting based on the hospital’s participation in a larger hospital organization or its location in an area where few competitors exist. Many hospital contracts from insurers are in a per-diem format, so a day in the hospital for a psychiatric illness can be paid the same as a day for a total hip replacement. This leads to difficulty in estimating cost, because clearly the resource use in surgery for a total hip is far greater than the resource use for psychiatric care.”

Previous preplacement procedure (eg, price of the implant, facility costs, or surgical fees) were more likely to drive the cost differences observed. The report also did not explore whether any relationship existed between cost and quality.

Article from Medscape, written by Christin L. Melton, February 26, 2015.

Ten things you want to know about knee arthritis

From CNN:

1. Knee osteoarthritis is “wear and tear” of the knee.

Knee arthritis occurs when the cartilage of the knee joint gradually erodes. Cartilage is a rubbery, slippery tissue at the ends of bones.  Without the gliding, cushioning effect of cartilage, the bones of the knee joint rub together. The knee can’t move easily and becomes stiff, swollen, and painful.

2. Symptoms usually develop gradually.

Early symptoms of knee arthritis may be aching joints after physical activity or stiffness first thing in the morning. With time, symptoms may occur more often. It becomes harder to walk, climb stairs, and get in and out of chairs.

3. Knee arthritis can affect your whole life.

Although most people have mild knee arthritis, it can become severe. Knee arthritis can interfere with daily tasks and your ability to take part in family and work activities. Living with this painful condition can contribute to chronic mood disorders such as depression and anxiety.

4. There is no cure, but treatment can help.

To relieve pain and stay active, you may need a multipronged approach. Weight loss, exercise, medication, alternative therapies, and surgery are some of the options.

5. Trim your weight to ease knee stress.

If you’re overweight, losing just 5 percent of your current weight can improve your arthritis symptoms.  Every pound lost takes 4 pounds of stress off your knees. Shedding pounds isn’t easy, but a healthy weight will go a long way toward keeping you active.

6. Exercise is one of the best treatments.

Low-impact aerobic exercise, such as walking, swimming, water aerobics, and cycling, relieves arthritis pain. Stretching and strengthening your leg muscles helps, too. Adding just a little activity to your day several times a week can make a difference in your symptoms.

7. Medication combats pain and inflammation.

Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and topical creams and sprays are common therapies. Mild narcotic painkillers and injections of drugs that tame inflammation or improve joint lubrication are sometimes used. Which medication is best for you depends on the severity of your pain, your other health problems, and the other medicines you take.

8. Non-drug and alternative therapies may be worth trying.

Physical therapy can improve joint function, while occupational therapy teaches you how to move smarter to minimize pain. Acupuncture, massage, and electrical stimulation of the nerves (transcutaneous electrical nerve stimulation, or TENS) improve symptoms for some people.

9. Self-care means less ouch.

Pay attention to your body’s signals so you know when it’s time to slow down or rest. A good night’s sleep and a healthy diet will help you cope better with your arthritis. When flare-ups occur, apply hot or cold packs or warm towels to your knee, or take a warm bath. Cold lessens inflammation, while heat boosts circulation and eases pain and stiffness.

10. There are several surgical options.

In knee replacement surgery, the entire knee or part of the knee is replaced with metal or plastic parts. This major surgical procedure can decrease pain and swelling and improve movement when the knee is very damaged.  Removal of loose pieces of cartilage, smoothing of the knee’s bony surfaces, and realignment of the bones are other surgical procedures that can reduce pain and disability.

Medically Reviewed By: Williams, Robert, MD | Last Review Date: Jan 30, 2012

Need sleep?

(CNN) — Can a lack of sleep affect the size of your brain? It’s possible, a recent study published in an online issue of Neurology suggests.

European researchers looked at 147 adults between the ages of 20 and 84. With two MRI scans, they examined the link between sleep problems like insomnia and the study participants’ brain volume. The first scan was taken before patients completed a questionnaire pertaining to their sleep habits. The second scan was done approximately 3½ years later.

The questionnaire showed that 35% of those in the study met the criteria for poor sleep health. Investigators found that those with sleep problems had a more rapid decline in brain volume or size over the course of the study than those who slept well.

The results were even more significant in participants over the age of 60.

Sleep tips for more zzzzzs!

Trouble sleeping? Put the iPhone down

Sleep & Health

Numerous studies have showed the importance of sleep and the effect sleep deprivation can have on our brains. It is well-known that poor sleep patterns can contribute to such brain disorders as Alzheimer’s and dementia.

So it stands to reason that, if a lack of sleep can lead to memory loss, the size of the brain would also be affected.

“We know that a lack of sleep can lead to all kinds of problems,” explained Dr. Neal Maru, a neurologist and sleep specialist with Integrated Sleep Services in Alexandria, Virginia, who is not associated with the study. “Poor sleep can affect our immune systems, our cardiovascular health, weight and, of course, memories. But we still don’t know why.

“Studies have shown poor sleep can cause protein buildup in the brain that attacks brain cells. So we’re still trying to put the puzzle together.”

The study authors agree.

“It is not yet known whether poor sleep quality is a cause or consequence of changes in brain structure,” said author Claire Sexton of the University of Oxford in the United Kingdom.

“There are effective treatments for sleep problems, so future research needs to test whether improving people’s quality of sleep could slow the rate of brain volume loss. If that is the case, improving people’s sleep habits could be an important way to improve brain health.”

“The problem is, we really don’t know what comes first,” Maru agreed. “Is it a sleep problem that causes the atrophy (wasting away of a body part), or is it the atrophy that causes the sleep problems? That’s a question we need to sort out.”

Shoulder pain

Best Treatment for Shoulder Pain?
Pauline Anderson
August 06, 2014

Both manual physical therapy (MPT) and corticosteroid injections (CSI) significantly improve symptoms in patients with shoulder impingement syndrome (SIS), but physical therapy may be less costly to the healthcare system, according to a new study.

Physicians might consider physical therapy for patients with SIS — a sort of “catch all” diagnosis encompassing shoulder pain resulting from rotator cuff tendinosis and bursitis in the shoulder area — who don’t want injections, said lead study author, Daniel Rhon, PT, DPT, DSc, who at the time of the study was director, research, Department of Physical Medicine, Madigan Army Medical Center, Tacoma, Washington.

“The number one reason patients didn’t want to participate in this study was that they didn’t want to get an injection, indicating that there is clearly a subset of patents who are averse to injections.” For these patients, said Dr. Rhon, physical therapy “would be a great thing to keep top of mind in terms of other treatment options.”

The study, which Dr. Rhon believes is the first to compare MPT with CSI “head to head” long term, was published onlineAugust 5 in Annals of Internal Medicine.
Dr. Daniel Rhon
Pain and Disability

Researchers randomly assigned consecutive patients aged 18 to 65 years with unilateral shoulder pain to receive CSI or MPT. Patients were referred from family practice and orthopedic clinics. None had had physical therapy or corticosteroid injections within the previous 3 months.

The CSI group received up to 3 injections of 40 mg triamcinolone acetonide 1 month apart. The injections were administered by a family practice physician with sports medicine fellowship training.

Matched to individual impairment, the MPT intervention consisted of a combination of joint and soft-tissue mobilizations, manual stretches, contract-relax techniques, and reinforcing exercises directed to the shoulder girdle or thoracic or cervical spine. Patients were treated twice weekly over a 3-week period and prescribed home exercises.

Ten CSI patients crossed over to receive physical therapy, and 9 in the MPT group crossed over to receive injections.

After 1 year, both the CSI group (n = 52) and the MPT group (n = 46) had a greater than 50% improvement in the Shoulder Pain and Disability Index (SPADI), with neither group being superior. The between-group difference in the SPADI, a 13-item, self-administered questionnaire that includes pain and disability subscales, was 1.55% (95% confidence interval [CI], –6.3% to 9.4%; P = .70). The minimal clinically important difference for the SPADI is a change between 8 and 13 points (6% to 10%).

Ratings on the Global Rating of Change (GRC) scale improved by 3 points (95% CI, 2 – 4) for each group. The GRC measures overall perceived changes in quality of life, with a score of 3 or more points being clinically meaningful.

Self-reported pain intensity as measured by the 11-point Numeric Pain Rating Scale significantly improved from baseline (P < .05) in both groups, but neither intervention was superior (between-group difference 0.4 (95% CI, –0.5 to 1.2; P = .42).

More Smokers

The researchers also looked at related healthcare use. The study showed that 37% of the MPT and 60% of the CSI groups had at least 1 additional healthcare visit to their primary care physician for shoulder pain.

MPT patients had fewer corticosteroid injections than the CSI group (20% vs 38%) after the end of the treatment portion of the study. Even though physical therapy can be costly, Dr. Rhon wondered whether starting patients on injections is “putting them on a path” to needing additional healthcare.

“Is this going to end up taking more time and costing more money in the long run than maybe starting with something like physical therapy at the beginning,” said Dr. Rhon.

He said he hopes to compare the costs of the 2 interventions in the future.

As for adverse effects, 10.7% of the CSI group experienced transient pain and 4%, skin pigmentation. There were no reports of adverse effects of MPT.

Sleep quality and obesity can affect shoulder pain prognosis. However, in this study, both groups reported similar effects of pain on their sleep quality, and their baseline weight was similar (mean body mass index, 28.65 kg/m2 for CSI and 28.34 kg/m2 for MPT).

There were, however, twice as many smokers in the MPT group. It’s possible, said Dr. Rhon, that the therapy group would have done even better had there been fewer smokers. He and his fellow researchers are now doing a secondary analysis looking at the effect of smoking.

On the other hand, the CSI group had more than twice the number of retired military personnel. However, Dr. Rhon doesn’t believe this affected the outcome because the mean age of the 2 groups was almost identical (42 years for CSI and 40 years for MPT).

He pointed out that someone can enter the military at age 18 years and retire before age 40.

Patients and clinicians weren’t blinded to the intervention, and the study included only patients referred for physical therapy. Other limitations were lack of standardized diagnostic criteria for SIS and of patients with a full-thickness rotator cuff tear.

Interpret With Caution

Commenting on the study for Medscape Medical News, Richard Radnovich, DO, Injury Care Medical Center, Boise, Idaho, and clinical instructor, University of Washington School of Medicine, Seattle, said that the study was “well thought out and executed” and had “appropriately limited focus” and that the results suggest certain types of manipulation are as effective as injections in treating SIS.

However, said Dr. Radnovich, the study had some drawbacks. For one thing, it looked at MPT techniques provided at a single military hospital with no copayments or other financial impediments to care and didn’t compare the cost of this treatment to injections.

“It remains to be seen if patients would get similar results in a fee-for-service environment, or if access was an issue,” said Dr. Radnovich.

He pointed out that the therapists in the study may have been “particularly skilled or even gifted” in this area of physical therapy and that physicians providing injections “may not have been particularly skilled.”

The data may also have been “skewed” by the fact that the injection group had more than twice the number of retired military than the manipulation group. Military personnel, said Dr. Radnovich, may acquire more “wear and tear” injuries than, for example, dependents.

“Because of these and other limitations, we cannot overly generalize or extrapolate,” said Dr. Radnovich. “However, if a patient prefers to avoid injections, and has the time, resources and a skilled manual therapist, trying a course of manipulation for SIS may be a reasonable option.”

Dr. Rhon and Dr. Radnovich have disclosed no relevant financial relationships.

Ann Intern Med. 2014;161:161-169. Abstract

Running for your life

By Dennis Thompson

HealthDay Reporter

MONDAY, July 28, 2014 (HealthDay News) — Runners may live an average three years longer than people who don’t run, according to new research.

But, the best news from this study is that it appears that you can reap this benefit even if you run at slow speeds for mere minutes every day, the 15-year study suggests.

“People may not need to run a lot to get health benefits,” said lead author Duck-chul Lee, an assistant professor of kinesiology at Iowa State University. “I hope this study can motivate more people to start running and to continue running as an attainable health goal.”

It’s not clear from the study whether the longer lifespan is directly caused by running. The researchers were only able to prove a strong link between running and living longer. There could be other reasons that runners live longer. It could be that healthy people are the ones who choose to run, noted the study’s authors. The investigators did try to control the data to account for such factors though.

Current U.S. guidelines for physical activity call for a minimum of 75 minutes per week of running or other vigorous-intensity aerobic activity, or 30 minutes of moderate-intensity exercise most days of the week.

But people who exercised less than that still received significant health benefits, according to the new research.

Running modest amounts each week — less than 51 minutes, fewer than 6 miles, slower than 6 miles per hour, or only one to two times — was still associated with solid health benefits compared to no running, the researchers reported in the Aug. 5 issue of the Journal of the American College of Cardiology.

The study also suggested that you can have too much of a good thing. People who regularly ran less than an hour per week reduced their risk of death just as much as runners who logged three hours or more weekly.

The study involved more than 55,000 adults aged 18 to 100, who were followed during a 15-year period to determine whether there is a relationship between running and longevity. About one quarter of this group were runners.

Participants were asked to complete a questionnaire about their running habits, and researchers kept track of those who died during the study period.

The researchers discovered that people who didn’t run had a life expectancy three years less than that of runners. Running was linked to a 30 percent lower risk of death from any cause and a 45 percent lower risk of death from heart disease or stroke, compared to no running.

Even less-avid runners received significant benefits. Running a minimum 30 minutes to 59 minutes each week — which equates to just 5 to 10 minutes a day — was associated with a 28 percent lower overall risk of death and a 58 percent reduced risk of death from heart disease, compared with no running.

“The mortality [death] benefits in runners were similar across running time, distance, frequency, amount and speed,” Lee said. The benefits held firm even after the researchers took into account for factors such as weight, smoking, drinking or health problems.

However, runners need to keep at it. Persistent runners — those who had been running regularly for an average of six years — had the greatest benefit, the study authors found.

Improved heart and lung function appears to be key to running’s health benefits, Lee said. Runners in the study had 30 percent better fitness than nonrunners, and their fitness increased with the amount of time they spent running.

Dr. Michael Scott Emery, co-chair of the American College of Cardiology’s Sports and Exercise Cardiology Council, found it “a little surprising that 5 or 10 minutes of running had such an impact on health.”

Emery, a cardiologist in Greenville, S.C., said, “This shows your biggest bang for the buck is just getting up and doing something, even if it doesn’t meet current guidelines. Even a little bit is better than zero.”

But, he noted that running does have more potential for injury than walking, including joint problems, ankle sprains, shin splints, back pain and muscle pulls.

People might gain similar benefits from walking the same distance for a longer period of time, he suggested.

“Running has more potential for injury, but walking takes longer,” Emery said. “You have to find your own mix, your balance.”

Lee agreed that people interested in running should start out slow and build up over time.

“Running is a vigorous-intensity activity, thus it is recommended that inactive people can start walking to reduce injury risk before they start running,” he said.

More information

For more about exercise and physical fitness, visit the U.S. National Library of Medicine.



5 Things People Don’t Tell You About Acupuncture
July 30, 2014 | By Camille Chatterjee and Ellen Seidman
Photo: Getty Images

Does acupuncture really work? What’s it like to have a bunch of needles stuck in you? Health magazine editors Camille Chatterjee and Ellen Seidman recently started getting treatments to alleviate pain. Camille has gotten a couple of sessions for tendinitis in her elbow, and Ellen has an achy left shoulder that’s simultaneously being treated by a physical therapist. The two of them share their experiences going under the needle.

Yeah, you feel it
Camille: I was surprised to feel a little twinge or tingle in some places where a needle was placed. The first time I got acupuncture, the practitioner actually hooked the needles up to a little machine that purposely stimulated them—and, by association, certain trigger points.

Ellen: Hey, I’m going to ask about that little machine! Like Camille, I thought the process would be painless. The insertion of needles doesn’t usually hurt—but on occasion, I’ve felt it go in. And at times, when I’ve felt a serious ache in muscles, the practitioner has adjusted the needle so it doesn’t hurt.

And it’s a little weird
Ellen: I decided to take a selfie while I was lying on the table with a needle in my forehead—I thought it would look cool. As it turns out, it falls under “Stuff I wish I hadn’t done” because it made me cringe to see a needle smack in the middle of the forehead.

Camille: I once had the practitioner take a pic of my needles too—guess there’s a reason we’re health editors! I am not afraid of needles, at all, but I have to admit that I don’t like staring at a bunch of them in my skin. So I just look away. I’ve had some bruising in my arm afterward; nothing alarming, since I tend to bruise easily, but I had to deal with a week of people asking, “What’s that?”

The needles aren’t the ones you’re thinking of
Ellen: These are not those long needles you’re used to for doctor office shots. They’re more similar to needles used for sewing, but without the heads, and they’re skinnier. They come tucked inside plastic tubes; the practitioner places them on key spots and taps them into your skin.

Camille: My first acupuncturist used slightly thicker “sewing needles.” I prefer the skinnier!

Those needles don’t go where you’d imagine
Ellen: I thought the needles would be inserted into my left shoulder, where it hurts. While that is a possibility down the road, the practitioner ended up focusing on my right ankle and calf.

Camille: Acupuncture is based on the idea that your body has various lines of energy that connect to points related to a particular organ. Stimulating points on one side of the body can help heal points on the other side—explaining Ellen’s right ankle and calf, and why I got needles in my right forearm to relieve pain on my left side.

The relief can be immediate…or not
Camille: I’ll admit that the treatments for my elbow didn’t help as far as I could tell—the practitioner did tell me that I may need a bunch of sessions to see progress, and I decided to stick with the physical therapy I’d already been doing. But just one appointment was enough to loosen a knot in my shoulder and increase my range of motion.

Ellen: On my first session, he put a couple of needles in my ears for stress relief, even though that wasn’t the reason I was there. Within a few minutes, I genuinely felt like I’d been lulled into a pleasant stupor. That treatment did nothing for my shoulder pain. The next time around, though, he inserted needles in other areas and my ache subsided. I actually said the words “Wow, this works!” And it was the same for the next session. So, I’m an acupuncture convert. It’s not a cure-all but for me, it is a pain reliever.

Camille Chatterjee is the Deputy Editor of Health; Ellen Seidman is the Contributing Features Editor.


Shiatsu to help patients with chronic pain sleep

Researchers explore shiatsu to help people with chronic pain fall asleep
Published on June 18, 2014.
There was a time, back in Nancy Cheyne’s youth, when she combined the poise and grace of a ballerina with the daring and grit of a barrel racer. When she wasn’t pursuing either of those pastimes, she bred sheepdogs, often spending hours on her feet grooming her furry friends at dog shows.

All that seems like a lifetime ago. After 15 years of living with chronic lower-back pain, Cheyne, 64, can’t walk from the disabled parking stall to the elevator at work without stopping for a rest. She eats mostly junk food because it hurts too much to stand over the stove and spends most of her spare time in a recliner with a heating pad.

Despite pain patches and opiates, Cheyne often lies awake at night in the same recliner-sleeping in a bed is like torture-after waking every couple of hours in excruciating pain.

“Pain affects everything I do,” says Cheyne. “The chronic ongoing lower-back pain, it’s all the time.”

Researchers at the University of Alberta are exploring the traditional Japanese massage practice called shiatsu as a potential treatment to help Cheyne and others like her find slumber-and stay asleep. A small pilot study followed nine people living with chronic pain as they self-administered shiatsu pressure techniques on their hands at bedtime.

“We know that sleep involves both physiology and learning. You don’t just flip a switch and go to sleep,” says Cary Brown, an associate professor of occupational therapy in the Faculty of Rehabilitation Medicine. “What we saw with this pilot is that it appears self-shiatsu may help your body to prepare for sleep and help you stay asleep for longer periods.”

For the study, occupational therapy and physical therapy students were taught the basic shiatsu techniques and in turn trained participants, who reported falling asleep faster-sometimes even while administering treatment-and slept longer after two weeks and eight weeks of treatment, compared with a baseline measurement.

Cheyne spent about 10 to 15 minutes every night performing the treatments and found that instead of waking up every 45 or 60 minutes, she could stay asleep for 1.5 to two hours. Given she hasn’t felt well rested in more than a decade, every minute counts and she still keeps up her treatments months after the pilot concluded.

“Usually within a few minutes of doing the pressure treatments, I’m gone-asleep,” she says. “Sometimes I can’t even finish, I just go out.”

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Results promising, but more study required

Brown cautions it’s impossible to draw strong conclusions about the pilot given the small sample size, self-reported nature of the data and limitations in gender; however, she believes the results are promising enough to warrant further study.

Brown also notes there’s a difference between people with pain passively going to a therapist versus taking control of their sleep problem in the form of self-administering hand shiatsu, which requires more mental effort-a theory of cognitive attention that she would like to explore further. Hand shiatsu, when self-administered, takes some concentration because our minds cannot focus on two demands at one time, she says, making it less likely that negative thoughts would interfere with sleep.

“One of the barriers to falling asleep for people who have pain is they worry about what’s going to happen and while you’re laying there you’re thinking about all these negative things, it occupies your attention,” Brown says. “This relates to research on attention in cognitive theory.”

The pilot was an attempt to explore low-cost, unintimidating alternatives to drugs to help people with chronic pain fall asleep, noting medication is seldom recommended for long-term use. Brown collaborated on the project with shiatsu therapist Leisa Bellmore of the Artists’ Health Centre at Toronto Western Hospital and U of A colleague Geoff Bostick.

For patients suffering from chronic pain due to low-back and other musculoskeletal injuries, the only thing that matters is finding results that work, Brown says. Not only does sleep deprivation lower a person’s pain threshold, it also affects their health, from increased risk of obesity, diabetes, cardiovascular disease and traffic accidents.

More research is needed in foundational areas to break the cycle, she adds.

“If you have insomnia, you face a higher risk of experiencing chronic pain. If you have chronic pain, you’re not going to get as much sleep.”

University of Alberta