News Category: General

Walking is one of the easiest ways to exercise. Walking requires no gym membership or fancy equipment. And almost anyone can walk–you don’t need to be an athlete to enjoy a daily stroll through the neighborhood.

So how many Americans are regular walkers? These researchers did a national telephone survey to find out. They made sure to include people who live in low-income areas. People were put into three groups. The first group walked five times a week, 30 minutes at a time. The second group walked for exercise, but not that often. The third group never walked for exercise.

The researchers found some interesting results. Many of the findings were no surprise:

Overall, American kids are getting less and less exercise. Nationally, more than 60 percent of kids don’t get enough physical activity. This means kids are getting fatter. They are also developing the health problems that go along with being a couch potato. Girls are even less likely to be physically active than boys. What can moms and dads do to get their daughters moving?

This study looked at the kinds of things parents do that help young girls be active. They questioned 180 nine-year-old girls and their parents about activities, health, and exercise. In addition to the questions, the researchers tested the girls’ fitness and checked their height and weight. All the families were part of a larger study on girls’ health. All the girls were white and lived with two parents. In general, the parents were well educated and had good incomes.

The researchers were especially interested in the ways moms and dads were different in their support of physical activity. Moms were more likely to sign the girls up for sports, get them there, and cheer them on. Dads were more likely to plan physical family outings or play active games.

It didn’t seem to matter which kind of support the girls got. As long as at least one parent supported exercise, girls were more likely to be active. It also didn’t make any difference if the supportive parent was the mother or the father. In families where one parent was supportive, 56 percent of girls were active. When two parents were supportive, 70 percent of the girls were had high activity levels. These families tended to be good fitness role models, too. When neither parent was supportive, only 32 percent of the girls were physically active. It was no surprise that these girls tended to be
heavier, too.

The researchers note that physical activity levels do a nose-dive when kids reach adolescence. They suggest future research to see how parents’ roles affect girls during this important time. They also suggest that future research study different kinds of families–minority, lower income, or single-parent.

Everyone seems to be dealing with information overload these days — even orthopedic surgeons. The field of orthopedics is constantly changing. New techniques, products, and medicines are available every year. Orthopedic surgeons keep up in many ways, including conferences, books, and medical journals. Many companies place ads in medical journals to advertise their products. Can doctors rely on these ads for information about products that they might use in surgery?

These authors wanted to answer that question. They randomly chose 50 statements of fact from ads in major medical journals. The companies were asked to provide the research that supported the statements. Three orthopedic surgeons then rated the statements and research.

The final tally showed that only 36 percent of the claims were made based on published data; 24 percent of the data had been presented at a conference; another 24 percent was from data on file at the company; and eight percent was not based on a scientific study. (The remaining eight percent did not respond.) In the final ratings, only seven statements (14 percent) were judged to be well supported, while 22 statements (44 percent) were considered to be unsupported.

Obviously, the authors recommend that orthopedic surgeons should be careful of getting information from ads in medical journals. Even ads with citations were likely to present unsupported information. When almost half of the ads make unsupported statements as if they were fact, it is clear that orthopedic surgeons need to take the information with a grain of salt.

People with low back problems often do sit-ups as part of their exercise programs. Stronger abdominal muscles give more support to the lower back. Doctors and therapists know how sit-ups affect the muscles and the spine. But they don’t always know how sit-ups affect blood pressure. This could be important for low back patients who are out of shape or who have heart problems.

These researchers studied the way partial sit-ups (also called crunches) affected blood pressure and heart rate in 14 healthy people under 40 years of age. Blood pressure was measured before, during, and after doing crunches. The subjects did regular crunches and oblique crunches, which involve twisting to each side to work the oblique abdominal muscles. The subjects also used a common type of home exercise machine that works the abdominals. People with back pain are more likely to use machines to do sit-ups because the machines are thought to take some of pressure off the neck.

Subjects did five of each type of crunch. All crunches were done with the arms folded over the chest and were held for three seconds. The researchers made sure the crunches were done with correct breathing–exhaling while sitting up, and inhaling while relaxing down. Heart rate and blood pressure went up for all three types of sit-ups, but especially for the oblique crunches. All subjects returned to their resting blood pressure and heart rate within two minutes. They all reported that the sit-ups were easy to do.

The subjects were also tested doing crunches while they held their breath. Breath holding while doing sit-ups is a common mistake made by exercisers. In these tests, blood pressure went up twice as much as while breathing correctly, although heart rates were about the same.

Because this study was done with young, healthy subjects, there was probably much less increase in heart rate and blood pressure than would be seen among out-of-shape patients or patients with heart problems. The authors recommend that patients who do sit-ups should be monitored to be sure they are breathing correctly. They also suggest that doctors and therapists should be careful about assigning sit-ups (especially oblique sit-ups) to patients with heart problems or high blood pressure. Future research could help define how sit-ups affect the blood pressure and heart rates of patients who are not as fit as the subjects in this study.

Patients in England have some rare challenges. Waiting for a new hip or knee joint replacement can take 12 to 18 months. That’s a lot of time to spend thinking about the operation. What the doctor told the patient may be forgotten or distorted during the long wait.

But many worries never come to pass. The authors of this study think counseling before the operation may be a good idea. Not everyone needs the same advice. In their study, they found that different patients have different concerns.

For example, patients who had a total joint before were more concerned about the nursing care and hospital food. They were less worried about the outcome. Women were more likely to worry about joint stiffness, joint dislocation, using stairs, and falling. Younger patients listed their primary concerns as no change in pain, whether the joint would wear out, and if one leg would end up being longer than the other. The biggest worry for everyone was cancellation of the operation. Other areas of general concern included the risk of dying, infection, sleeping while in the hospital, going back to work, and driving.

With this information, doctors and staff at hospitals or clinics can give patients the right kind of comfort before a joint replacement operation. The kind of health care given in England may create different concerns than patients have in other countries with different healthcare systems.

You’ve probably heard products advertised on radio or TV that as reliable. People have come to count on reliability. It tells us we can trust that product. We can depend on it.

In the health care world, doctors and physical therapists need reliable ways to measure muscle tone, strength, and stiffness. A new device is ready to help them. It’s called a myotonometer®.

This device is quick and easy to use. It can be test muscles at rest and during contraction in a variety of patients. Therapists can measure before and after treatment to see if the treatment is effective. The effects of long-term bed rest can be measured. Even athletes can benefit from this kind of testing.

The myotonometer® is a handheld, electronic device developed by a physical therapist, Chuck Leonard. It has been tested before with several medical conditions such as headache and spasticity. In this study, two muscle groups are tested: the calf and biceps muscles.

The authors report that the device was reliable for testing the muscle tone and stiffness of these two muscles. This was true for relaxed and contracted muscles. It was also true when different people used it to take the measurements. And it was reliable each time the same therapist used it.

This study confirms the benefits of using a myotonometer®. The test doesn’t depend on the tester’s strength. The patient doesn’t have to move a muscle or joint through a range of motion. This can be especially useful when the patient has pain or doesn’t have full motion.

Athletic trainers work for high school and college teams, with professional athletes, and in clinics. They treat all kinds of injuries, mostly using the basic tools of ice, heat, electrical stimulation, and special exercises.

These authors wanted to know what kinds of complications athletes have from these common treatments. So they asked the experts. They sent out questionnaires to certified athletic trainers and got more than 900 answers. Twenty-six percent of the trainers reported complications, including burns, frostbite, allergic reactions, fainting, and irregular heartbeats. Ice treatments accounted for most of the problems, followed by electrical stimulation, heat, and special exercises.

Not surprisingly, the treatments used most often by a trainer were the ones for which he or she reported the most complications. The authors also note that experience seemed to matter. Head athletic trainers reported the lowest rate of complications, while assistant athletic trainers reported the highest rate.

The complications reported in this study were quite different than the complications written up in medical research. A survey of the research showed mostly problems with whirlpools.

The authors aren’t sure why there are such major differences between their questionnaire and the research. They suggest it is possible that athletic trainers don’t actually use whirlpools that often, or that they learned from the medical literature how to use whirlpools without complications. It is also possible that most complications are not reported for some reason. The authors recommend that future research focus on which trainers in which settings have the most complications.

Extracorporeal shock wave therapy (ESWT) has been used to break up kidney stones for the past 15 years. It was then used to help bones heal. Recently doctors have begun using it to treat a painful condition of the heel called plantar fasciitis. This article reviews the medical literature to give an overview of the way EWST is used in orthopedic clinics.

The article details the three different types of machines used to apply the shock waves. In all three machines, a mechanical head delivers shock waves as it is rubbed on the sore area. ESWT pushes the shock waves further into the body than similar treatments. Shock waves can penetrate up to 2.5 inches under the skin. The depth can be adjusted for the individual patient and the injury site. Patients often feel a sharp pain while getting ESWT. Other than that, there are few side effects. But the authors warn that EWST must be used with care around sensitive organs and tissues to avoid damage.

Medical research has shown that EWST can be effective in relieving pain. But there has been little research on how or why it works. These authors suggest a few possibilities:

Much research shows that exercise helps women build bone mineral density (BMD), before and after menopause. But the studies have been mostly short term and have tested a wide range of exercises on women of a wide range of ages. So what type of exercise is best, and does it really help over the long term? This three-year study in Germany is designed to help answer those questions.

This article reports on the first 14 months of the study. The authors are following two groups of women, all of whom are within eight years of menopause. The authors chose this age range because women lose much of their BMD in the years right after menopause. All the women in the study were diagnosed with osteopenia. Osteopenia is low BMD but not as low as in osteoporosis.

All the women in the study are taking calcium and vitamin D. However, only one group of women is doing a prescribed exercise routine. The exercise group does two one-hour group exercise sessions each week and two shorter sessions at home. The sessions built up gradually over the months to help avoid injuries. The exercise sessions include endurance, jumping, and stretching, with a special focus on strength training.

After 14 months, the authors compared the two groups’ endurance, strength, and BMD. BMD was checked in the lower spine, the pelvis, and the neck of the femur (the part of the thighbone that is right by the ball of the hip joint). These are common fracture sites in women with osteoporosis. Results showed that BMD increased in the spine and hip of the women who exercised. The researchers expect to see some improvement in the femur over the following two years of the study. The exercise group also had significantly better endurance and strength levels, which also play a role in preventing fractures.

The authors note that this study will not fully answer the questions of what type and how much exercise is best. But they feel confident that the exercise routine they designed is easy to adapt to “real life,” and that most women tend to stick with the program over time.

Golf is becoming more and more popular, but there is limited data about golf injuries. These authors surveyed 703 golfers in Germany about how much they golf and what kind of golf injuries they had over two seasons. The surveys provided some interesting information:

Men tend to have higher rates of back injury, while women report more neck injuries. Are there other gender-related differences in the work world? Will men or women get better faster? Who’s more likely to go back to work first?

The answers can be found in a study from Texas. Researchers from the Productive Rehabilitation Institute of Dallas for Ergonomics (PRIDE) teamed up with doctors from the University of Texas Southwestern Medical Center in Dallas. They did a large study comparing the results of treatment of chronic musculoskeletal disorders for men versus women.

All the patients had failed other treatment. Some even had surgery without relief of symptoms. Severe pain lasting at least four months was part of each patient’s history. Treatment given in this study was to restore function through many different methods. Each patient had an exercise program with a physical or occupational therapist. They moved to a fitness maintenance program at the end of treatment. Each patient received counseling, group therapy, and a stress management program.

The researchers found that men went back to work and kept their jobs more often than women. They aren’t sure if this is a gender issue or the fact that women may have had a different injury site. The authors suggest that men may be more single-minded about work, while women may focus more on family or childcare concerns.

Women also sought more healthcare than men. Again, this may be caused by something other than gender. Men and women went through the treatment program in the same amount of time. Women tended to be more depressed, but it’s not clear if this affected the final outcome of treatment.

The authors conclude that the differences between men and women are fairly small. Sometimes statistics seem important, but they may not help find risk factors for treatment failure.

The research shows us the what: there is a difference between men and women. How we differ in response to treatment remains unknown. More studies are needed to clear up the how.

Researchers call it the “female athlete triad:” the relationship between disordered eating, irregular periods, and osteoporosis in young women athletes. Some studies suggest that as many as two-thirds of these young women eat in ways that aren’t quite an eating disorder but are still harmful to their bodies. Very few studies have looked at all three parts of this triad at once.

These authors looked into this three-way relationship. They studied 91 competitive women distance runners between 18 and 26 years old. (All the runners were part of a larger study on the relationship between oral contraceptives and running.) All the young women competed in races, and they ran at least 40 miles a week during their peak training times. They filled out questionnaires about their eating habits and attitudes, their training schedule, and their menstrual history. They also went through tests of bone mineral density (BMD).

The data about running and menstruation supports other research:

Older women often suffer foot and ankle fractures. Doctors usually assume that these fractures are caused by osteoporosis. However, there has been little research into the cause of foot and ankle fractures. These injuries can cause a lot of pain and a loss of independence for older women, so it is important for doctors to understand them better.

As part of a larger study, these authors studied foot or ankle fractures in about 600 older, caucasian women. As expected, the foot fractures seemed to be caused most often by osteoporosis. Foot fractures most often happened in the fifth metatarsal (the main bone that forms the small toe), although the researchers didn’t know why this was true. Women with foot fractures were also more likely to have had a fracture earlier in life.

Ankle fractures, however, did not seem to be related to osteoporosis. Ankle fractures were most often in the fibula bone (the thin bone that runs from the knee to the ankle next to the shin bone). This fracture tended to happen in younger, more active, and heavier women. The authors suggest that obesity may give extra force to accidental ankle twists. Also, the women who broke their ankles reported problems of falling more often. The authors note that increased weight may make falls more likely.

The authors also considered other factors. Diabetes can cause fractures from osteoporosis. This study showed only a slight relationship between diabetes and fractures. Also, a class of anti-anxiety and sleep medications called benzodiazepines seemed to be related to foot fractures, although the authors don’t know why.

Future research from this osteoporosis study will focus on the kind of falls that cause foot and ankle fractures. This study may yet answer some of the questions about why and how older women break the bones of the foot and ankle.

When are bits of bone and pieces of sand alike? When scientists test them for strength. The same methods, formulas, and principles used in the science lab for measuring the strength of sand are also used for bone.

Sand that is used in building must be strong enough to withstand many kinds of forces. Bone, when used in bone grafts, must also hold up against similar forces. Studies to improve bone graft strength use mechanical properties of sand as a basis for research.

For example, there are math formulas to measure how far particles of sand will slide against each other. The formulas also hold true for measuring the strength of particles that lock together to form a bond. Scientists in Scotland used these concepts to improve bone graft material.

They found that bone dust particles of varied sizes and shapes are stronger than bone graft that is all one size. Uniform particle size means lower shear strength. Shape is also important. Round particles have lower shear strength compared to spike-shaped particles of bone graft.

The authors of this article show that washing bone graft before using it increases the interlocking of small pieces. Washed graft has greater shear strength. This is probably caused by the removal of fat and marrow from the graft. The graft can fit together more tightly without these other parts.

This research shows that washing bone graft is the best way to improve strength for any graft material. Removing fat and marrow tissue in the process also reduces the risk of the patient’s body rejecting donor bone graft. These discoveries will especially benefit people who require bone grafting during revision hip surgery.

Neck pain is very common and has many causes. Pain anywhere between the base of the skull and the upper back is considered “neck pain.” The most common causes of neck pain are sprains, arthritis, and aging.

This report describes 34 patients with neck pain coming from the shoulder. This is called referred pain. Inflammation or pinching of soft tissues in the shoulder can refer pain to the neck. The pinching condition is called shoulder impingement.

Referred pain is caused by nerve fibers that overlap. Some of the nerves for the neck also go to the upper back and shoulder. The nerves can start at the same place and cross over or overlap one another. Pain messages for the shoulder are sent to the neck instead.

Three-fourths of the patients in this study had a history of a car accident. Forces from the collision may transfer from the hand on the steering wheel up the arm to the shoulder. Other forces from the seat belt across the shoulder can also cause shoulder injury.

Doctors found a successful way to treat this problem. Each patient received a steroid injection into the shoulder to see if it eased the neck pain. If so, it was considered a positive test. Patients would then be shown how to change their sleeping position. Sleeping with the arm overhead or with the hand under the pillow contributes to shoulder impingement. Placing the arm against the body inside a nightshirt or in a special sling reduces neck pain in the morning.

The authors conclude that chronic neck pain from the shoulder may be prevented. Patients with neck pain after a car accident may benefit from preventive shoulder therapy. Rehab starts with proper posture and positioning. In patients with neck pain during arm movements, up to two additional steroid injections into the shoulder may be used.

When most people think of squat exercises, they picture muscle-bound guys hefting huge weights. But squats are also useful in general fitness plans and physical therapy. Squats involve all the joints of the leg–the hip, knee, and ankle. And they can be done in different ways to focus on specific muscles.

This study looked at using squats for older adults. Strong and steady leg joints can help older people avoid falls and maintain their independence. Squats are especially useful because they involve the same motions as sitting and rising from a chair, a task that can become difficult with age. But the squat exercises have to be safe for aging joints and practical for older people to do.

These authors studied the “chair squat.” In a chair squat, the exerciser lowers down toward a chair or bench, as if sitting, before slowly standing up straight again. The motion is similar in a regular squat, except that there is no chair to aid the exerciser in a regular squat. The chair adds an element of safety in case the exerciser loses balance or becomes tired.

Study participants were healthy adults between 70 and 80 years old. They were not regular exercisers. They did the squats at a speed they selected, without using any weights. After at least a week of practicing squats, their leg joint movements were measured doing regular squats and chair squats. The results showed that chair squats worked the hip muscles specifically, while the regular squats worked the knees and ankles.

This information can be used to help develop exercise and rehabilitation programs for older adults. The authors recommend studying how squats affect the muscles when done with weights, at higher speeds, and with increased repetition.

Total hip replacement and total knee replacement have become common orthopedic surgeries. As with all surgeries, there are risks, including death. These authors looked at the number of deaths in all patients who had hip and knee replacement surgery. The same doctor in a medium-volume university hospital did all the surgeries over a period of 17 years. All patients were included, even those with serious health problems such as heart disease, kidney failure, and cancer.

Results showed:

Strong muscles and good overall conditioning help prevent joint injuries during sports and exercise. But there is a “sixth sense” that is also crucial in helping prevent injuries. This sixth sense is the system of nerves and muscles that controls our posture and balance and keeps our joints in proper alignment–the neuromuscular system. The neuromuscular system needs to be kept in good working order, too.

This article outlines the way the neuromuscular system works. Nerve sensors in the muscles, skin, ligaments, and tendons constantly send messages to the brain about the way a joint is aligned. The nerve messages give us a sense of proprioception, which is a joint’s sensation of movement and position. This sense allows us to keep our balance with our eyes shut, detect when our joints move, and copy a position or a movement.

The author outlines the way proprioception and neuromuscular exercises are used in physical therapy and sports medicine. The exercises were first used in rehabilitating injured joints. They are now also used for preventing joint injuries. Proprioception exercises work on balance, reflexes, and posture. Some repetitive exercises are used to “reprogram” the way athletes do certain movements so that they are less prone to injury. Plyometric exercises combine quickly stretching and contracting the muscles to help with joint stability, speed, and power. The author also outlines the way neuromuscular exercises are developed for the knee, ankle, and shoulder.

The bottom line is that neuromuscular and proprioception exercises are clearly an important part of any training program. The author also suggests that these exercises could be helpful to aging adults to help them prevent falls.

Long ago, Benjamin Franklin told us to use “moderation in all things.” Exercise is one of those things. Weekend warriors, especially the ones who aren’t in shape, can get into trouble with too much exercise too quickly.

Military physical therapists report a case of acute exertional rhabdomyolysis (AER) in a soldier with a desk job. A 20-year old soldier who’d completed basic training seven months earlier came to the clinic with shoulder pain and weakness after doing “hundreds of push ups.” The exercise session took place 36 hours before the symptoms started.

AER results from breakdown of skeletal muscles. With overuse, the muscle can start to break down and dump the contents of overworked cells into the bloodstream. This is most likely to happen after doing squat exercises, sit-ups and crunches, push-ups, and heavy weight lifting.

Several problems can occur, the worst of which is kidney failure. The kidneys can get plugged up from trying to filter the cells from the muscle breakdown. AER with kidney failure can result in death.

Physical therapists are trained to recognize all kinds of problems. Early signs and symptoms of AER include muscle soreness, brown or tea-colored urine, and a history of recent overuse activity. Anyone suspected of having rhabdomyolysis must be sent to a doctor or to the emergency room right away. Early treatment can save the patient’s life.

People at risk for AER are often in poor physical condition. Exercising in hot, humid areas without enough fluids adds to this risk. Exercising gradually over a period of time can prevent conditions like this one. A single, intense workout puts people at risk of AER, not to mention problems of tendonitis, muscle tears, or bone stress fractures.

You’ve heard the old saying, “If it isn’t broken, don’t fix it.” But what if it’s not working at all? Take for example the way work-related back and arm pain is managed. Some think that getting treatment right away isn’t any better than standard treatment for these problems.

Even standard treatment is coming under fire. Care and costs for work-related injuries have gone up and up without a decrease in disability. Authors of a study on this subject in 1997 claimed that “new treatments treat too many, too soon, for too long.”

It has been suggested that we work on injury prevention and emotional support to return workers quickly back to the job. These may have a better result at a much lower cost. Researchers in Canada studied this proposal. The program included simple exercises, encouragement to get back on the job, and assurances of a good prognosis.

The authors of the study report that workers who had early treatment had the greatest costs and most time loss. For example, those who were sent to physical therapy and work hardening programs didn’t get back to work for six to 10 weeks. This increased the costs greatly.

It may be that an early referral for work-related injuries isn’t always the best option. The authors think that many workers would have recovered faster without treatment. They are quick to add that early treatment may still be a useful tool. The key is to find those patients who have a better result with early intervention.

In the meantime, reassurance and social support, along with exercises and encouragement after injury may be all that are needed. Combined with a quick return to work, these methods may result in lower costs and fewer days of work lost.