News Category: General

Employers can save money if workers don’t use sick leave. One way to prevent health care and sick leave use is to reduce risk factors for their use. This study shows that low back pain, older age, and living alone are important risk factors for sick leave use. So are high job strain and being female.

Work-related neck, back, and arm pain often comes back after the first episode. In this study at least one-third of all workers with a musculoskeletal problem took sick leave or got further medical care three to six months after the first episode of pain.

Reducing sick leave use more than trying to prevent back pain may be the best way to save money in health care costs. While employers can’t change some of the risk factors, programs to reduce work-related risk factors might help. Symptoms are linked to high job strain and lack of support from the supervisor. High job strain was defined as high job demands and low job control.

The results of this study showed when looking for ways to reduce sick leave, employers may need to look at a different set of risk factors. Reducing both work-related physical and work-related psychosocial factors might save money more than trying to prevent recurrence of musculoskeletal pain and symptoms.

There’s a simple way to decrease body fat during midlife: exercise and activity. These are the results of a study of Chinese and white peri- and post-menopausal women ages 47 to 57.

The increase in body fat around the middle is common with aging, not just with menopause. In this study lean mass, body fat, and central fat distribution were measured. Women in the SWAN study (Study of Women’s Health Across the Nation) were included.

They found that in general, Chinese women had less lean mass, less fat mass, and smaller waists. They also exercised less than other ethnic groups. Body fat decreased with activity in both groups. In fact, the higher the level of activity, the less body fat was present. Waist size goes down in white women with activity at any level.

Increased body fat occurs in menopause at a time when women tend to be less active. The authors found that loss of lean mass occurs with aging. Menopause also occurs with aging so the overall body changes are greater during this phase of life. Increased central body fat and decreased lean body mass puts these women at increased risk for disability and death.

Future studies to find ways to help midlife women keep a balance of body fat and lean mass are needed. This study shows that physical activity, especially vigorous and intense exercise can help.

Physical therapists (PTs) learn about thrust joint manipulation (TJM) in class. How often do they practice during clinical internships? That’s the question studied in this report. TJM is defined as a “high-velocity, low force movement of the joint at the end range of motion.”

Clinical instructors and coordinators were polled using a survey to find out if PT students receive such training. Results showed that most (85 percent) didn’t know. They don’t ask whether TJM training is given at various educational clinic sites. Reasons for this lack of training were listed as:

This is a review article for physical therapists. It’s about nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are the most common drugs given to physical therapy patients. In fact, 73 million prescriptions are written every year for NSAIDs. Many patients are also taking over-the-counter NSAIDs. These include drugs such as aspirin, ibuprofen, Aleve, Advil, Motrin, and others.

NSAIDs are used to reduce pain and inflammation and reduce body temperature. They are used most often by patients with pain from gout, arthritis, and soft tissue injuries. They also decrease blood clotting. Some NSAIDS are used in small amounts to prevent strokes and heart attacks.

The benefits of NSAIDs are sometimes outweighed by the adverse effects. Besides stomach problems, these drugs can cause skin, kidney, and nervous system disorders. Stomach ulcers, poor wound healing, and dizziness are just a few of the more common side effects.

The author of this report reviews the different categories of NSAIDs. The report tells how the various NSAIDs work. It explains how NSAIDs produce their effects (good and bad). How and why drugs work is called pharmacodynamics and pharmacokinetics.

Knowing about NSAIDs is important in a physical therapy practice. Since so many physical therapy patients are taking NSAIDs, therapists must know what to watch for as possible toxic side effects. The effects of these drugs can slow or even prevent patients from recovering in rehab.

How risky is a joint replacement at age 80 (or older)? That’s the topic of this study from the Institute of Clinical Evaluative Sciences in Toronto, Canada.

Octogenarian refers to anyone 80 years old or older. Results for a group of octogenarians after total hip or total knee joint replacements were compared to results for the same operations in patients aged 65 to 79.

Only serious problems were counted. These included death, heart attack, pneumonia, and urinary tract infections. The study showed octogenarians were 3.4 times more likely to die after total joint replacement compared to younger patients.

They were also 3.5 times more likely to get pneumonia. Twice as many octogenarians had heart attacks after a hip or knee replacement compared to the 65 to 79 age group. Men were more likely than women to have a heart attack or pneumonia.

The authors report that patients with health problems were more likely to die than those in good health. This was equally true for men and women. Problems such as diabetes, hip fracture, and cancer increase the risk of death after joint replacement.

Even with the increased risk of serious problems the overall rate of complications is low. Total joint replacement is still a good option for the octogenarian. They must be prepared to face some increased risks when thinking about having a hip or knee replaced.

Tai Chi has been tested in the laboratory and found effective. Do these same health benefits occur when Tai Chi is done in a community setting with a group of people? The answer is “yes” according to this study. Grip strength, heart rate, and lung function all improved.

The study was divided into two phases. During phase one 60 adults with no experience in Tai Chi were instructed by a Tai Chi master. The master and four assistants taught a beginners’ level with moderate intensity. The assistants were also Tai Chi masters.

Everyone met each morning for 90 minutes to practice. The group did Tai Chi three times a week for three months. Various measures of function were taken before and after the program. For example, blood pressure, lung function, range of motion, and balance were measured. Grip strength and flexibility were also tested.

During phase two an experienced group of Tai Chi practitioners was compared to the beginner group. The authors report the experienced group had greater flexibility than the novice group. They also had a lower resting heart rate. Only the diastolic blood pressure was higher.

This study showed that the health benefits of Tai Chi are present whether done one-on-one in a lab or with a large group. The researchers suggest public health programs may want to offer group Tai Chi. Such programs may help people of all ages to exercise more, eat healthier, lose weight, and relax.

In this study physical activity, fitness, and strength are measured before and after pregnancy. Changes in each area were compared with changes in body weight during pregnancy. Fitness and strength are normally linked together. Does this relationship hold true during pregnancy?

Healthy, adult women were put in three groups based on body weight. The three groups were low, normal, and high according to body mass index (BMI). Besides height and weight, body composition and bone mineral content were measured. Physical activity, fitness, and strength were also measured. All measurements were taken before pregnancy and again at six and 27 weeks after delivery.

The results showed that physical activity was higher in the group with low BMI. Fitness and strength decreased in all groups during pregnancy. Leg strength decreased even more than arm strength. This last finding surprised the researchers because the women were more active using their legs during home and walking activities.

Physical fitness and strength improved by week 27 but didn’t return to normal. It isn’t clear from this study how long it takes women to recover strength fully after pregnancy.

Low fitness levels can be a problem in military boot camp. The Armed Forces are interested in finding ways to predict who can complete the first month of training without injury.

In this study 1,583 Marine Corps recruits answered a few questions about their physical fitness and exercise before boot camp. A four-question survey was used to self-assess fitness and exercise. Everyone filled out the survey within three days of arrival at the Marine Corps training camp.

A month later they took a physical fitness test and compared the results. African Americans had the highest score. The white group had the lowest score. Pull-ups were the best predictor of fitness.

The authors report that self-assessed upper body strength is a good way to predict who will pass or fail boot camp. Recruiters can use this information to help incoming recruits prepare for boot camp. Preventing training injuries is a second benefit of this tool.

In this review article, doctors take the time to report on many studies using injectable corticosteroids for painful, inflamed joints. They discuss how steroids work inside the joint, their local effects, and side effects.

Some injections can be used for both joints and soft-tissues. The authors present a table of the common corticosteroids, how quickly they work, and how long they last. Most of the time corticosteroid are used for painful, swollen arthritic joints. They can be used for other problems like carpal tunnel syndrome, tennis elbow, and gout.

In looking over all the data collected, here’s what we know from this review:

This study reports results after the first three years in a five-year trial. The study was on exercise in early postmenopausal women. It’s called the Erlangen Fitness Osteoporosis Prevention Study (EFOPS). EFOPS is sponsored by the Institute of Medical Physics and Institute of Sciences in Erlangen, Germany.

Two groups of postmenopausal women were included. Group one (the exercise group) did a twice-weekly program of group exercises. They also did a home training program two times a week. The exercises included warm ups, jumping, strength training, endurance, and stretching.

The second (control) group was a nontraining group. They just followed their normal lifestyle. There were no changes in their activity level. All women in both groups took vitamin D and calcium.

Each woman was tested for bone mineral density (BMD), body fat, and cholesterol levels. In addition, everyone kept track of any menopausal symptoms. Here’s what the results showed after the first three years:

Exercise is proven to be effective to prevent many health problems, including arthritis. But the exercise must be done for years, not just months. Many people don’t make it that long. This study looks at the use of arthritis medication as a predictor of drop out status in an exercise study.

Exercise was structured and supervised by a fitness trainer. Everyone worked out three times a week for 30 minutes. Warm ups, resistance training, and flexibility were built in to the program. The study was carried out for two full years. Anyone who was not exercising at the end of 24 months was counted as a “dropout.”

They found that patients using arthritis medication were four times more likely to drop out than those who didn’t use pain relievers or anti-inflammatories. Age, gender, and body weight didn’t make a difference. Severity of symptoms did.

The authors say it may be that the use of arthritis medication is a sign of poor overall health status. Or perhaps people taking arthritis medication are looking for a “quick fix” for their symptoms. When exercise doesn’t change their symptoms quickly, they drop out.

Researchers will be able to use this drop out rate when planning long-term exercise studies. If they know half the group will drop out, then they can double the number who are part of the study in the first place. Knowing what factors predict drop out can help physical therapists plan ways to keep people in the program.

Osteoarthritis (OA) is a common problem in older adults. Your risk of developing OA increases as you age and/or gain weight. Joint injury and deformity also increase the rate of OA. More and more studies are showing a genetic link. The findings of this study add to the evidence that genetics may be a primary cause in OA of the hip.

Patients included in this study came from one of 49 families. Each family had at least two sisters with OA. Their children were examined for signs of hip arthritis. X-rays were used to grade the disease severity.

Here’s what they found:

What makes a patient satisfied with his or her physical therapy care? Is it the interaction with the therapist? Or how they are treated in the clinic? Physical therapists at six clinics in Pennsylvania and New York offer some insights.

They used the MedRisk Instrument for measuring satisfaction with physical therapy care. Over 1,000 patients filled out the survey. Questions were asked about the process of registering in the office, the receptionist, and the therapist.

The goal was to find out what makes for a satisfied customer. The therapists want a survey that answers this question specifically. For example, is satisfaction based on internal factors like time spent with the therapist? Or external things like the waiting room or cost of care?

The researchers found among this group of patients patient satisfaction was most closely linked to interaction with the therapist. Patients were more satisfied when the therapist took the time to answer questions and treated the patient with respect.

The authors conclude the MedRisk Instrument is a valid tool for measuring patient satisfaction in a physical therapy clinic. It is inexpensive and easy to use. And it measures internal versus external factors separately. For therapists who want to improve their services, this kind of information is very helpful.

The editors of The Journal of Bone and Joint Surgery wrote this review of the drug Vioxx, which was recently pulled off the market. Vioxx is a fairly new class of nonsteroidal anti-inflammatory drugs (NSAIDs) called Cox-2 inhibitors (coxibs). Coxib drugs are used to treat the painful symptoms of arthritis.

The benefit of the Coxibs is their ability to prevent stomach (GI) problems. They have the added advantage of reducing platelets in the blood. Fewer platelets means less bleeding. This is important during and after any surgery.

Vioxx was withdrawn from use because long-term use can lead to an increased risk of heart attack and stroke. The heart attacks don’t happen right away, but they were observed to occur 18 months or more after taking this drug.

There are two other coxibs still available for use: Celebrex and Bextra. Based on studies done so far, it’s likely these drugs carry a similar risk. Patients who have Stevens-Johnson syndrome or who have had a coronary artery bypass graft are also at increased risk of heart problems.

What advice do the editors offer doctors? Tylenol should be used as the first choice for chronic muscle or joint pain. Coxibs should be saved for older patients (65 and older) or who already have a history of GI bleeding. Anyone with high blood pressure or a history of heart problems should avoid coxibs.

In this study researchers at the University of Pittsburgh used mice to show the effects of Suramin on scar tissue formation. Suramin is an anti-tumor drug. It prevents scar tissue from forming by binding to the receptors for growth factor (GF). Without GF, fibroblasts needed to fill in the damaged area are limited.

There were three groups of mice based on when Suramin was injected into the muscle. The main difference between groups was based on when the injection took place (zero, seven, or 14 days after muscle injury). A control group received a sham injection of saline.

Muscles were examined two weeks after the injection. The scientists looked at how much tissue healing and scarring were present in the muscle. They found very little change in scarring when Suramin was used 14 days after the injury. This is about the time when fibrosis begins to form. Higher doses of Suramin worked better than low doses. Muscle strength was also greater in the Suramin-treated muscles.

The results of this study may direct future treatment for muscle injuries. This could be very helpful for athletes with sports injuries. Improving muscle healing by blocking muscle fibrosis may get athletes back in play sooner.

Severe pain from Complex Regional Pain Syndrome (CRPS) can be difficult to treat even with medication or surgery. In this study, doctors report the results of using a sphenopalatine block in two cases of CRPS.

CRPS is a poorly understood pain condition. It occurs most often in the arms or legs after an injury. Any part of the body can be affected. In these two case studies, one woman had chronic leg pain with CRPS after falling down a flight of stairs. In the other case, a woman had a car crash and traumatic brain injury with CRPS of the leg later.

In both cases the sphenopalatine ganglion (SPG) was blocked with a local anesthetic (tetracaine). The tetracaine was applied directly to the ganglion. A ganglion is a group of nerve cells outside the nervous system. The sphenopalatine ganglion can be reached through the nose at the back of the nasal passages.

Both patients got partial relief from pain but enough to improve function. The SPG can be blocked as often as needed. In one case the patient did this treatment to herself.

The authors conclude SPG blocks have been used for many years to manage pain from a variety of problems. Pain from CRPS can also be reduced in some patients with this treatment.

Climbing stairs, getting out of a chair, or even making the bed can be hard tasks to perform as we age. Almost half of all adults 85 or older need help with daily activities. Does it have to be this way, or can exercise help reverse the decline in function as we age?

Researchers used two groups of women ages 70 to 91 to compare the effects of two different exercise programs on daily function. Both groups exercised one hour three times a week for 12 weeks. The first group carried out a functional tasks exercise group. This program consisted of walking, climbing stairs, or getting out of bed while doing something else.

For example sometimes the women walked through an obstacle course carrying objects or lifting and carrying weights. Other exercises included picking up sandbags from the floor and putting them in a bucket. Stair climbing while lifting or carrying light to heavy objects was also part of the program. All activities mimicked tasks done everyday.

The second group did a resistance exercise program. They used hand held weights and elastic tubing to resist movement. Wrist, elbow, shoulder, ankle, knee, hip, and trunk exercises were done. In both groups exercises were made harder when the women were ready for more. The functional group increased the weight carried or distance walked. The resistance group added weights or shortened up the elastic tubing.

Researchers measured satisfaction with the exercise program and change in physical function. Surveys of opinion, muscle strength, and specific tests of function were given to each woman. When the two groups were compared, here’s what the authors found:

Hormone replacement therapy (HRT): does it hurt or harm women? Doctors at Boston University Medical Center bring us up-to-date on the topic in this review article. Millions of American women were using HRT for menopausal symptoms until the late 1990s. Studies of nurses found that it increased the risk of cancer. Studies were halted, and many women stopped taking the hormones.

The authors review studies reported on HRT from that time to the present. Here is what they report:

Dr. Felson offers us a new paradigm to understand what goes wrong to cause osteoarthritis (OA). A paradigm is a pattern or model for something. A paradigm shift occurs when traditional thinking changes about something like OA.

The new way to look at OA is through risk factors that affect joint protectors. Joint protectors include the cartilage, muscles, tendons, and mechanoreceptors. Mechanoreceptors are nerves that tell the muscles, tendons, ligaments, and capsule to get ready for the load or movement. All the soft tissues assume a position of protection. They keep the joint from moving too far, and they spread out the load.

Aging, muscle weakness, and genetics play a role in causing joint protectors to fail. Alignment problems and joint deformities are also risk factors. Also important are factors that affect the load on the joint, such as obesity and some physical activities.

Injury to the joint puts it at risk for OA. Anything that can cause failure of joint protectors can be a problem. Increased load or overload added to this kind of failure can lead to OA. In this article, the author discusses each of the risk factors and brings us up to date about each one.

Ultrasound (US) has been thought to delay wound healing in fractures. But new studies show that US may, in fact, help broken bones heal faster. The key is the intensity of the sound wave. Low-intensity ultrasound speeds up healing time in animals and humans. Are doctors and physical therapists aware of this? They see more patients with fractures than anyone else.

In this study, doctors and therapists were asked three sets of questions: