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Category Archives: Journal Articles

Do you feel Born to Run, but Walk instead to save your Knees?

As long as your joints are healthy to begin with, it may be safe to pick up the pace.

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If you’ve been reluctant to make running one of your New Year’s resolutions, fear no more. A common misconception is that running puts tremendous wear and tear on the knees and can even bring on osteoarthritis. But a new study of almost 75,000 runners shows just the opposite: There was no association between running and osteoarthritis. In fact, runners were less likely to develop arthritis than people with lower activity levels. Running isn’t necessarily a higher-impact exercise, biomechanically speaking. While runners do apply more force with each step, that force is distributed over fewer steps (since their strides are longer). Walkers apply less force but take more strides. The bottom line: The impact of running or walking on your knees may be the same.

But keep this in mind: If you’re a woman over 55 or a man over 45, the American College of Sports Medicine recommends that you get your doctor’s okay before beginning an exercise program. While running may be easier on our joints than previously thought, it is still considered moderate to strenuous cardiovascular exercise, so it’s smart to make sure your heart and lungs are up to the challenge.

 

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Physical Therapy is Conservative Care

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As an adult, you have most likely experienced back pain at some point in your life. Given its frequency, one might assume the health care system adheres to the most current guidelines that call to treat the condition conservatively, with over the counter pain medication and physical therapy. But a recent study from the Journal of the American Medical Association (JAMA) suggests that back pain is often being over-treated with referrals to specialists, orders for expensive imaging, and prescriptions for pain medication. In our most recent episode of Move Forward Radio, we discuss the findings of this study and provide tips for avoiding back pain. http://bit.ly/1gy4V0p

 

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New Research says, “Some Brains May be Hard Wired for Chronic Pain”

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Structural differences in the brain may be one reason why one person recovers from pain while another develops chronic agony, a new study suggests. Researchers scanned brains of 46 people who had lower back pain for about three months, and then evaluated their pain four times over the following year. About 50% of the patients recovered during the year; the other half continued to have persistent pain throughout the study.

Looking back at the brain scans, researchers found structural differences in the brains of people who recovered compared with people who developed chronic pain. The differences were found in the brain’s white matter, which consists mostly of long connections between neurons and brain regions. Specifically, the differences lay in the connections between brains regions thought to be involved in pain perception, the researchers said.

“We may have found an anatomical marker for chronic pain in the brain,” study researcher Vania Apkarian, professor of physiology at Northwestern University Feinberg School of Medicine in Chicago, said in a statement. Such structural differences most likely exist independent from the incident that triggers back pain, and may mean that some people are more susceptible to developing chronic pain, the researchers said in the study, which will be published in the October issue of the journal, Pain.

Most people who suffer pain after an injury eventually return to a healthy state. However, some continue to suffer long after the injury has healed. It is not clear what mechanisms drive the transition from acute pain to chronic pain, which may persist for years. In the study, the researchers used a brain imaging technique called diffusion tensor imaging (DTI), which measures the integrity of the brain’s white matter. The results were further confirmed when the researchers compared the study participants with additional groups of people. They found that the white matter of patients with persistent pain looked similar to a third group of people who also suffered from chronic pain. In contrast, the white matter of patients whose pain did not persist looked similar to the white matter of healthy people.

To test the strength of the relationship between brain’s structure and chronic pain, the researchers looked at whether the brain differences shown in the initial brain scans could predict whether patients would recover or continue to experience pain. They found that the early brain scans predicted whose pain would resolve and whose pain would persist one year later.

“We were surprised how robust the results were and amazed at how well the brain scans predicted persistence of low back pain,” Apkarian said. “Prediction is the name of the game for treating chronic pain.”
The findings suggest that brain’s structural properties are involved in chronic pain, and more extensive studies are needed to understand the role of white matter integrity in chronic pain, the researchers said.

 
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Posted by on September 18, 2013 in Did You Know..., Journal Articles

 

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Top 5 Things You Need to Know About a Superior Labral Tear

Understanding how a SLAP lesion occurs and what exactly is happening pathologically is extremely important to diagnose and treat these shoulder injuries appropriately.

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Classification of SLAP Lesions
There are several variations of injuries that can occur to the superior labrum where the biceps anchor attaches (see the above figure to view the biceps attaching into the labrum). Following a retrospective review of 700 shoulder arthroscopies, Snyder et al: Arthroscopy ’90 identified 4 types of superior labrum lesions involving the biceps anchor. Collectively they termed these SLAP lesions, in reference to their anatomic location: Superior Labrum extending from Anterior to Posterior. This was the original definition but as we continue to learn more about SLAP tears, they certainly do not always extend from anterior to posterior. But, the most important concept to know is that a SLAP lesion is an injury to the superior labrum near the attachment of the biceps anchor.

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Type I-IV SLAP lesions from left to right

•Type I SLAP lesions were described as being indicative of isolated fraying of the superior labrum with a firm attachment of the labrum to the glenoid. These lesions are typically degenerative in nature. At this time, it is currently believed that the majority of the active population may have a Type I SLAP lesion and this is often not even considered pathological by many surgeons.

•Type II SLAP lesions are characterized by a detachment of the superior labrum and the origin of the tendon of the long head of the biceps brachii from the glenoid resulting in instability of the biceps-labral anchor. These is the most common type of SLAP tear. When we receive a script from a surgeon to treat a “SLAP repair” he or she is more than likely talking about a Type II SLAP and surgery to re-attach the labrum and biceps anchor. Three distinct sub-categories of type II SLAP lesions have been further identified by Morgan et al: Arthroscopy ’90. They reported that in a series of 102 patients undergoing arthroscopic evaluation 37% presented with an anterosuperior lesion, 31% with a posterosuperior lesion, and 31% exhibited a combined anterior and superior lesion. (33) These findings are consistent with my clinical observations of patients. Different types of patients and mechanisms of injuries will result in slightly different Type II lesions. For example, the majority of overhead athletes present with posterosuperior lesions while individuals who have traumatic SLAP lesions typically present with anterosuperior lesions. These variations are important when selecting which special tests to perform based on the patient’s history and mechanism of injury. We’ll get to this in a future post on all the different clinical tests for SLAP tears.

•Type III SLAP lesions are characterized by a bucket-handle tear of the labrum with an intact biceps insertion. The labrum tears and flips into the joint similar to a meniscus. The important concept here is that the biceps anchor is attached, unlike a Type II.

•Type IV SLAP lesions have a bucket-handle tear of the labrum that extends into the biceps tendon. In this lesion, instability of the biceps-labrum anchor is also present, similar to that seen in the type II SLAP lesion. This is basically a combination of a Type II and III lesion.

What is complicated about this classification system is the fact that the Type I-IV scale is not progressively more severe. For example a Type III SLAP lesion is not bigger, or more severe, or indicative to more pathology than a Type II SLAP lesion.

To further complicate things, Maffet et al: AJSM ’95 noted that 38% of the SLAP lesions identified in their retrospective review of 712 arthroscopies were not classifiable using the I-IV terminology previously defined by Snyder et al (49). They suggested expanding the classification scale for SLAP lesions to a total of 7 categories, adding descriptions for types V-VII. (29)

•Type V SLAP lesions are characterized by the presence of a Bankart lesion of the anterior capsule that extends into the anterior superior labrum.
•Type VI SLAP lesion involve a disruption of the biceps tendon anchor with an anterior or posterior superior labral flap tear.
•Type VII SLAP lesions are described as the extension of a SLAP lesion anteriorly to involve the area inferior to the middle glenohumeral ligament.

These 3 types typically involve a concomitant pathology in conjunction with a SLAP lesion. Although they provided further classification, this terminology has not caught on and is not frequqntly used. For example, most people will refer to a Type V SLAP as a Type II SLAP with a concomitant Bankart lesion. Since then there have been even more classification types described in the literatue, up to at least 10 that I know of, but don’t worry, nobody really uses them.

Top 5 things you need to know about classifying SLAP lesions

1.Just worry about Type I-IV SLAP lesions and realize that any classification system above Type IV just means that there was a concomitant injury in addition to the SLAP tear.
2.You can break down and group Type I and Type III lesions together. Both involved degeneration of the labrum but the biceps anchor is attached. Thus, these are not unstable SLAP lesions are not surgically repaired. This makes surgery (just a simple debridement) and physical therapy easier.
3.You can also break down and group Type II and Type IV lesions togther. Both involve a detached biceps anchor and require surgery to stabilize the biceps anchor. Type IV SLAP tears are much more uncommon and will involve the repair and a debridement of the bucket handle tear.
4.Type II lesions are by far the most common that you will see in the clinic and are almost always what a surgeon is referring to when speaking of a “SLAP repair.”
5.We all may have a Type I lesion, it is basically just fraying and degeneration of the labrum.

source: MikeReinhold.com
Image via Wikipedia

 

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10 Ways to Start Exercise: Part 1 of 2

Walking, strength training, running, swimming, biking, yoga, tai chi — the possibilities for exercise are endless. The good news is that it doesn’t matter which one you choose — it just matters that you do some form of exercise.

“If you have a choice between not moving and moving — move,” says Heather Nettle, MA, coordinator of exercise physiology services for the Cleveland Clinic Sports Health and Orthopaedic Rehabilitation Center. “Ultimately it will help with overall health and well-being.” So go ahead, find an activity you love and get moving with these 10 do’s and don’ts for starting an exercise routine.

1. Do Anything — It’s Better Than Nothing
Experts are quite clear on this point: Get 30 to 60 minutes of exercise three to five days a week for improved energy, as well as to help prevent heart disease, diabetes and certain types of cancer. If you can’t dedicate that amount of time, any exercise, any movement for any amount of time is better than nothing.

2. Keep Track
Tracking your steps with a pedometer is one key to success if you like to walk, says Michael F. Roizen, MD, chief wellness officer at the Cleveland Clinic. Another is recording some basic health information before starting a new routine. “Keeping track of how your body changes inside and out over the weeks and months gives you proof of the healthy changes you’re making,” he says. A few ways to do it:
• Before your first workout, check your blood pressure at your local pharmacy. Then recheck once a month.
• Time yourself at a track or on a treadmill. See how many minutes it takes you to walk or run one mile. Retest yourself after one month of consistent exercise.
• Measure your waist circumference and your weight. Take these measurements once a week.
• Schedule a visit with your physician and request these tests: lipid panel, vitamin D and C-reactive protein. Check these levels again after six months of consistent exercise.

3. Weight-Train
There’s no question: You’ll shed pounds faster if you lift weights. That’s because strength training builds muscle, and the more muscle you have, the faster your metabolism will be. And women, hear this: You will not bulk up! What you’re doing by lifting weights is preventing muscle loss. Strength training also improves overall body composition, giving you more lean muscle tissue in relation to fat, so you look toned and trim. To experience the most benefit, lift more weight than you think you can. Dashing through your repetitions doesn’t take as much effort because it allows your muscles to rely on momentum. Instead, focus on your form by practicing slow and steady movements on both the contraction and the release. This will help you strengthen every muscle fiber.

4. Head for the Hills
Do you follow the same flat path day in and day out when you go for your walk or run? Look for hills along your route that you can slip into your routine. If it’s too much for you to tackle all at once, start by going only halfway up. Walking or running up inclines boosts the intensity of your workout: It burns more calories and helps build muscle strength and cardiovascular endurance. Switching between flat surfaces and hills is a form of interval training, a type of workout that involves short bursts of high-intensity exercise in between moderate activity. This kind of exercise, practiced by elite athletes, can supercharge your workout. It can also help keep boredom at bay. If you have joint problems, go easy on the downhill — slow your pace and shorten your stride.

5. Think Outside the Box
Even if you can’t engage in rigorous, high-intensity sweat sessions, there are plenty of other ways to improve your physical health. According to a review in the American Journal of Health Promotion, mind-body practices like tai chi and qigong may help promote bone health, cardiorespiratory fitness, physical function, balance, quality of life, fall prevention and emotional well-being. Described as “meditation in motion,” tai chi and qigong involve a series of flowing, gentle movements — similar to but much slower than yoga. Interested? Get the Gaiam tai chi for beginners DVD in our clevelandclinicwellness.com wellness store.

Check back in tomorrow for the remaining 5 ways to get started on exercise!

 

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