NEWS

Hip Surgery Has a Positive Side Benefit?
Patients seeking treatment for severe hip pain due to osteoarthritis experienced lasting pain relief and improved function in their hips, after undergoing total hip arthropathy. Interestingly this had a substantially positive secondary effect on their spine.

According to results of a prospective study conducted by investigators in Houston and Israel, 25 consecutive patients who presented with hip problems were diagnosed with hip-spine syndrome, a condition involving debilitating hip osteoarthritis (OA) that is also associated with low back pain (LBP).

Although it has been scientifically shown that the effects of many spinal treatments deteriorate over time, at 2 years after THA “they maintained their positive effect and even furthered it,” Ben-Galim told Orthopedics Today. Ben-Galim and his co-investigators theorized that if THA surgery resolved the patient’s hip pain and helped them regain function and walking ability, then it should positively affect their LBP, as well. “And, that’s exactly what we saw,” he said. In these cases, “we can conclude that hip arthroplasty may be a means to alleviate low back pain and improve spinal function,” Ben-Galim said.

By Susan M. Rapp ORTHOPEDICS TODAY 2007; 27:78.

Physicists challenge notion of electric nerve impulses; say sound more likely
*(From ScienceBlog.com - http://digbig.com/4rswp) Wed, 2007-03-07 07:27 – BJS

Danish scientists challenge the accepted scientific views of how nerves function and of how anesthetics work. Their research suggests that action of nerves is based on sound pulses and that anesthetics inhibit their transmission.

Every medical and biological textbook says that nerves function by sending electrical impulses along their length. “But for us as physicists, this cannot be the explanation. The physical laws of thermodynamics tell us that electrical impulses must produce heat as they travel along the nerve, but experiments find that no such heat is produced,” says associate professor. Thomas Heimburg is an expert in biophysics.

But the curious turned out to be simple. If a nerve is to be able to transport sound pulses and send signals along the nerve, its membrane must have the property that its melting point is sufficiently close to body temperature and responds appropriately to changes in pressure. The effect of anesthetics is simply to change the melting point - and when the melting point has been changed, sound pulses cannot propagate. The nerve is put on stand-by, and neither nerve pulses nor sensations are transmitted. The patient is anesthetized and feels nothing.

FCER Funds Study on Maintenance Care
Thanks to generous support from the National Board of Chiropractic Examiners (NBCE), the Foundation for Chiropractic Education and Research has announced the funding of one of the first studies on the effectiveness of chiropractic care for the prevention of chronic cervical pain. It is titled “Preventive Care of Chronic Cervical Pain and Disabilities: Comparison of Spinal Manipulative Therapy and Individualized Home Exercise Programs”. The principal investigator is Martin Descarreaux, D.C., Ph.D. and it will be conducted at the Universite du Quebec a Trois-Rivieres

Although tertiary preventive (maintenance) care is commonly practiced by chiropractors with 95% of American chiropractors believing that such care will minimize the recurrence or exacerbation of pain and symptoms, there is at present very little research to directly support this assertion. This proposal seeks to address this problem by determining whether a preventive regime of spinal manipulation, or a home exercise program, a combination of approaches, or doing nothing following a period of intensive chiropractic care is the more efficient approach to reduce pain and increase functional capacity, quality of life, and the general health condition of patients initially complaining of chronic cervical pain.

This study will involve 105 patients who first receive 15 chiropractic adjustments using the diversified technique over a 5-week period. They are then passed into a second phase of the program which lasts 45 weeks by being randomly allocated into (i) a no-treatment group, (ii) a group receiving 15 additional chiropractic manipulations 3 weeks apart; and (iii) manipulation plus home exercise group of 10-15 minutes on a daily basis. Time spent with all 3 experimental groups will be equalized to eliminate attention bias as a possible confounding factor of results. Outcomes to be monitored will include pain (visual analog scale), disability (neck disability index), quality of life (SF-36), postural analysis, and various psychological measures (Beck Anxiety Inventory, Beck Depression Inventory, Yale-Brown Obsessive-compulsive scale, Trail Making Test, Stroop Test), in addition to maximal strength in extension, flexion and lateral flexion, active range of motion in 3 planes, and a kinematic analysis of head movement. All readings are to be conducted at baseline, second, and final evaluation. Exercises will include submaximal isometric and one dynamic contraction of the neck muscles with given rest periods between contractions.

For more information on FCER, please visit www.fcer.org.

Medics Cough Up $150m
More than $150 million was paid out last financial year to patients and their families who sued their doctors for malpractice following injury or death.

An Australian Competition and Consumer Commission (ACCC) report on medical indemnity insurance, released yesterday, found that about 2500 claims were made against doctors in 2005-06. The figure equates to about 10 claims for each 100,000 services performed under Medicare. The average payout was $60,000. Claims totalled $99 million in 1997-1998 and $169 million in 2000-2001. The Federal Government had asked the ACCC to investigate whether premiums charged by the six medical indemnity insurers in Australia were justified. The report found premiums, which had fallen about 6 per cent since the last annual report to an average $5537, were justified. Doctors paid a total of $315 million to the insurance companies in the year ending June 2006.

(Melbourne Sun Herald 13^th March 2007)

The rate of NSAID-induced endoscopic ulcers increases linearly but not exponentially with age
The risk of major ulcer complications on treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is known to increase exponentially with age. However, in a pooled analysis of 12 trial arms, the incidence of endoscopic ulcers on treatment with NSAID was found to increase with age in a roughly linear fashion. Thus, it is concluded that increasing age is associated with both more frequent and more serious NSAID gastropathy.

Maarten Boers et al, Annals of the Rheumatic Diseases 2007;66:417-418

Everything You Knew About Good Abs May Be Wrong
Today, the advice to draw your navel to your spine is ubiquitous and has little to do with vanity. Drawing in (as the move is called) is supposed to engage a deep abdominal muscle called the transverse abdominus. Fire the transverse abdominus, the thinking goes, and the torso temporarily acts like a muscular corset, protecting the lower back. Practice firing that muscle enough, and over time not only will you get a strong midsection, but the transverse abdominus will eventually fire on its own.

Physical therapists instruct back-pain patients to draw in during sessions and as all-purpose advice before lifting groceries. Personal trainers instruct clients to perform the move during mat exercises and on stability balls; some even say you should be drawn in while running or cycling. And Pilates relies on some form of drawing in, although it also addresses a whole range of muscles related to core strength.

But new questions are being raised about whether drawing in is an appropriate technique for all kinds of exercisers. Critics, including personal trainers and specialists in the spine and biomechanics, are now saying that drawing in may not make sense while, say, lifting weights or performing a crunch or running a race. In fact, some say, drawing in may even be counterproductive.

“If you hollow in, you bring the muscles closer to the spine, and you reduce the stability of the spine,” said Stuart McGill, a professor of spine biomechanics in the department of kinesiology at the University of Waterloo in Ontario. Try rising from a chair with a hollowed out stomach; not only are you “weak,” he said, but “it’s very difficult.” His findings dispute not only the validity of drawing in, but also the very notion that the transverse abdominus plays a pivotal role in stability. All abdominal and back muscles are important, not just this one, Dr. McGill said.

“I don’t know of a study that shows that drawing in becomes a subconscious reflex,” said Shirley Sahrmann, a professor of physical therapy at the Washington University School of Medicine in St. Louis. “I would rather facilitate the motion that turns the muscle on all by itself,” said Gary Gray, a physical therapist in Michigan who has been trying to re-educate other therapists to abandon the drawing-in technique. “Motion is the thing that turns on muscles, not the mind.” Dr. McGill said there is a better way than drawing in to protect the spine and build the core. For those about to lift something heavy or, say, leap for a rebound, he recommends bracing all the abdominal muscles - something he said the body does more naturally during exertion. “Bracing is stiffening the abdominal wall,” he said, explaining the difference. It’s a neutral position. “It’s not sucking in and it’s not pushing your belly out,” he said. The easiest way to teach it: “Pretend you are going to get whacked in the belly,” he said. The body’s natural response is bracing.

But some are saying that this approach is perhaps too widely respected and that some discretion should be used about when to teach it. Even Carolyn Richardson, one of the original Australian researchers, said that when she helped write the 1998 manual that popularized the technique, she never dreamed that personal trainers and coaches across the globe would make it as much a part of their regimen as stretching.

“We only wrote the book about treating back pain,” she said, referring to her three co-authors. “I’ve found that for the fitness industry, it’s quite a poor instruction.”

By PAUL SCOTT, Published: February 22, 2007 New York Times

Survivors of Chiropractic Abuse to Testify
Westville, CT (PRWEB) March 4, 2007

The reality of chiropractic abuse will take centre stage Monday at the Connecticut General Assembly as the leaders of a grassroots movement testify about their life-changing injures caused by chiropractors.

Janet Levy, President of Victims of Chiropractic Abuse, Inc. and Britt Hawre, Founder of the Chiropractic Victims Awareness Group, will tell their surprising and heart-wrenching stories to lawmakers. Both women suffered damaged arteries during chiropractic treatment that resulted in strokes. They represent hundreds of other people who have had similar experiences. “Chiropractors advertise that their procedures are ‘safe’ and ‘natural’ so the public assumes there are no risks and this is simply not true,” Levy said. “We want it to be mandatory that chiropractors inform patients about any and all risks of chiropractic procedures because it should be the public’s right to know.”

Levy and Hawre will testify in support of SB-1252 which would require informed consent for chiropractic procedures. The General Assembly’s Public Heath Committee is scheduled to hold the public hearing on the bill Monday March 5, 2007 beginning at 10 a.m. in Room 1D of the Legislative Office Building in Hartford. SB-1252 will be the 14th bill to be heard out of a total of 18 bills.

About Victims of Chiropractic Abuse, Inc: Victims of Chiropractic Abuse, Inc. (VOCA) was incorporated in May of 2005 to promote awareness of chiropractic risks through advocacy and legislation. VOCA seeks to require chiropractors to obtain informed consent from patients prior to treatment and believes malpractice claims against chiropractic physicians should be made public, just as they are for medical physicians.

For more Information Victims of Chiropractic Abuse, www.vocact.com.

Is there a relationship between limb length inequality and hip and knee osteoarthritis?
A recent study published in Osteoarthritis Cartilage (predominately aimed at orthopaedic specialists) sought to answer this question by examining the relationship of limb length inequality (LLI) with radiographic hip and knee osteoarthritis (OA) in a large, community-based sample. The total study group comprised 926 participants with radiographic knee OA, 796 with radiographic hip OA, and 210 (6.6%) with LLI >/=2cm. The presence of radiographic OA was defined as Kellgren/Lawrence (K/L) grade >/=2. Statistically they examined the relationship of LLI with hip and knee OA, while controlling for age, gender, race, body mass index, and history of hip or knee problems (joint injury, fracture, surgery, or congenital anomalies). They found that participants with LLI were more likely than those without LLI to have radiographic knee OA and radiographic hip OA. In multiple logistic regression models, knee OA was significantly associated with presence of LLI, but there was no significant relationship between hip OA and LLI. Among participants with LLI, right hip OA was more common when the contralateral limb was longer than when the ipsilateral limb was longer. They concluded that LLI was associated with radiographic knee OA, controlling for other important variables. They also suggested that future research should examine the relationship of LLI with hip or knee OA incidence, progression, and symptom severity, as well as the efficacy for LLI corrective treatments in OA. Anybody interested in a Ph D topic?

Relationship of limb length inequality with radiographic knee and hip osteoarthritis Golightly YM et al. Osteoarthritis Cartilage. 2007 Feb 21.