Want A New Knee?

total knee replacementWant a new knee?

Last Saturday morning I attended a study morning, dedicated to the topic of knee replacements, hosted by the New Zealand Orthopaedic Nurses Association. I learned a lot!

 

Prof Gary Hooper, Orthopaedic Surgeon, spoke about the history of knee replacements and the complex functional problems which arise when the alignment of the prosthetic parts is faulty. He also stated that the incidence of joint replacements is increasing in New Zealand, and is expected to reach epidemic proportions due to:

  • Our aging population
  • The increasing numbers of healthy retired people
  • The greater expectation of the population to access free health funded procedures

He also reported that statistics for the USA predict that by 2030

  • Total hip replacements will increase by 157%
  • Total knee replacements will increase by 673%.

New Zealand statistics show that we model similar trends.

The NZ Orthopaedic Association has established a NZ Joint Registry which collates information about joint arthroplasty outcomes. Using data gathered between the years 1999-2012:

  • The incidence of Total Knee Replacements has increased by 157%
  • The incidence of Total Knee Replacements is 57% higher than Total Hip Replacements

These statistics are attributed to the physically orientated population, high levels of obesity, ethnicity, and favour females between the ages of 70-79 years of age.

By 2018, it is predicted that the number of Total Knee Replacements will exceed the number of Total Hip Replacements.

The Survival Rate of the prosthesis has been found to be 95%, for a period of approximately 14 years – after which a revision of the procedure may be necessary. This is the main reason why people under the age of 55 years are discouraged from having the surgery as their chances for requiring a revision are greater.

Reasons for requiring revision can include:

  • Prosthesis in the Tibia loosening
  • Patellar problems
  • Deep infection
  • Pain

Prof Hooper was very clear in stating that any person who has had any form of joint replacement could be at risk of deep tissue infection for the rest of their lives. Any haematological infection (carried in the blood) such as a respiratory tract or urinary tract infection, could cause a “seed to plant” in the replacement area. Any such infection must be treated by prophylactic antibiotics.

By far the commonest cause for revision is PAIN. Even after revision, which is usually cementless, the person will probably still experience PAIN.

With my background in Pain Management, this is not at all surprising, as numerous people return to surgery to “investigate the source of pain” after “failed” procedures, leaving the person worse off than before, as the pain pathways have yet again been excited / assaulted.

According to Chris Scott, Physiotherapist, scar tissue management to reduce pain is one of the vital postoperative goals in order to return to full functional activities. This was covered in a later presentation.

Take Home Message:

  • The incidence of joint replacement is reaching epidemic proportions
  • Be Proactive – ensure that you remain physically healthy and active
  • Do not depend on the public health system to automatically be able to cater to your health needs

Have you received a joint replacement?

How has it influenced your life?

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The Heart in Two Forms – Treating the Real Heart

Quote

The Real HeartHow much do we really connect with the people in our worlds?

As a physiotherapist I have been taught to observe, palpate, analyse, correct. In some instances, manual therapy has been obliterated totally and the therapist is required to only observe, record and comment.

There is little satisfaction gained when, intrinsically, you ache to get to the root of an issue and manually massage it out or provide a gentle reassuring technique to feed your patient’s need for ‘something to make me feel better’.

John Mandrola wrote an article posted in Medscape recently, about treating the Real Heart. Although I am not a Cardiologist, I related so much to what was being expressed. He was discussing a plenary session presented by Dr Abraham Verghese (Stanford University, CA) during the American College of Cardiology 2015 Scientific Sessions.

Dr Verghese spoke of the heart in two forms:

 

The hearts that we examine physically that are easy to see and

The Spiritual Heart, the organ that connects us as people.

 

He wanted to know what makes that connection, how do we treat the Real Heart of our patient?

Firstly, we need to harness the power of words, as words are the glue that makes the meeting between us happen.

Then, another way to carry the hearts of our patients requires that we notice the ritual that happens during the encounter between the clinician and patient. The place beyond words is the encounter between clinician and patient – the actual ritual. “They trust us with their secrets, they allow us to touch them”.

Dr Verghese went on to say that when we recognise our own sense of self and of the patient’s being, something profound and magical happens.

But, if we shorten this ritual, when we don’t hear or touch our patient, we miss the transformation.

If we connect with the Real Heart of our patient we approach the magic of poetry – a place where the mind and the heart say the same thing.

Have you recently experienced this magic?

It can happen during any encounter during our day, not just between clinician and patient. When did you last greet someone warmly and sincerely, and hug them? Smile a greeting and hold out a hand? Listen to a child’s lament and wipe their tears? You have experienced this magic!

We have the opportunity to truly connect with each others Real Hearts multiple times in our daily interactions, if we could just remember it.

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Balneotherapy helps Fibromyalgia?

Head to your nearest thermal mineral water spa !

 

selfmanagechronicpain with balneotherapy

Enjoying the Therapeutic effects of Balneotherapy and Hydrotherapy

Therapeutic Effect of Balneotherapy and Hydrotherapy in the Management of Fibromyalgia Syndrome

Fibromyalgia syndrome (FMS) is a debilitating condition of almost unknown etiology and pathogenesis that is characterised by widespread musculoskeletal pain and tenderness, as well as secondary symptoms like fatigue, depression, irritable bowel syndrome and sleep disturbances.

A standard therapy regimen is lacking. Patient-tailored approaches are emphasised recommending non-pharmacological and pharmacological interventions according to individual symptoms. Self-management strategies involving active patient participation should be an integral component of the therapeutic plan.

Balneotherapy (thermal mineral water spas) and Hydrotherapy are commonly used interventions.

A qualitative systematic review and meta-analysis of randomised controlled trials showed that:

For Hydrotherapy with exercise, at the end of treatment, there was:

  • Moderate-to-strong evidence for a small reduction in pain
  • Moderate-to-strong evidence for a small improvement in health related quality of life (HRQOL)
  • No effect seen for depressive symptoms and Tender Point Count (TPC).
  • Follow-up data provided moderate evidence for maintenance of improvement with regard to pain.
  • No group difference was found when comparing water-based exercise to land-based exercise.

For Balneotharapy in mineral / thermal water, at end of treatment, there was:

  • Moderate evidence for medium-to-large size reduction in pain and TPC
  • Moderate evidence given for a medium improvement of HRQOL
  • No significant effect was found for depressive symptoms.
  • Moderate evidence for maintenance of improvements was found at follow-up, with smaller effects.

Pain may be relieved by the hydrostatic pressure of the water and the effects of the temperature on the nerve endings, as well as by muscle relaxation. It has been shown that thermal mud baths increase plasma levels of beta-endorphin, which explains their analgesic and anti-spastic effect.

The beneficial effects of water treatments are probably the result of a combination of specific (for example, buoyancy, aquatic resistance, heat) and unspecific effects (for example, change of environment, spa-scenery).

Source:

Therapeutic Benefit of Balneotherapy and Hydrotherapy in the Management of Fibromyalgia Syndrome: Johannes Naumann, Catharina Sadaghiani

Arthritis Res Ther. 2014; 16(R141) © 2014 BioMed Central, Ltd. http://medscape.com

 

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A New Name for Chronic Fatigue Syndrome

 

Managing Systemic Exertion Intolerance Disease (SEID)

A New Name for Chronic Fatigue Syndrome.

An article in Medscape caught my eye last week. If you suffer from Chronic Fatigue Syndrome, you may find it interesting too.

 

problems with movement?

do you experience fatigue, perhaps sleep difficulties, and brain fog?

Dr Paul Auwaerter is based at the Johns Hopkins Division of Infectious Diseases, Johns Hopkins University in Baltimore, Maryland. He reports that some of his most challenging outpatient visits are with patients who describe long-standing problems that include fatigue, perhaps sleep difficulties, and brain fog.

 Often they may not be functioning well, perhaps experiencing problems in school or at work. Most of these patients are quite bright; they are analytical and sophisticated. They are hoping that something can be found to explain their fatigue and symptoms.

He explains that patients want to embrace something that makes sense. In fact, science has determined that the human brain likes distinct answers, and that uncertainty seems to amplify problems.

The term “chronic fatigue syndrome” or “myalgic encephalomyelitis” was developed and the defining criteria included:

  • more than 6 months of symptoms
  • an inability to perform customary activities.

The term resulted in a fair amount of controversy and sometimes even stigma because many clinicians believe this could be a psychosomatic illness; while others believe it is quite real. There is also symptom overlap with other syndromic problems, including fibromyalgia and irritable bowel syndrome.

“Within this context, the Institute of Medicine (IOM) was charged by several federal agencies to come up with a new name, some subcategories, and other aspects. In sum, the IOM committee decided that it would be important to rename chronic fatigue syndrome something that captures the nature of this. They have called it “systemic exertion intolerance disease,” or SEID.”

The criteria for SEID include:

  • substantial decline in functional activities for at least 6 months
  • post-exertional fatigue
  • non-restorative sleep.

And then at least one of the following:

  • cognitive impairment or orthostatic intolerance
  • gastrointestinal issues
  • pain
  • stimuli hypersensitivity
  • lymphadenopathy
  • sore throat

Some patients may develop SEID / chronic fatigue syndrome after having an authentic infection from which they never seem to recuperate and for others, there seems to be no precipitating factor. The condition afflicts a large number of people, children and young adults included, and the best treatment strategies -compiled by Simon Wessely and colleagues, (who did a fair amount of work on chronic fatigue syndrome and Gulf War syndrome), and others include:

  • graded exercises
  • conditioning to build up tolerance
  • cognitive-behavioral therapy.

Once again, a graduated approach to increasing physical activity is one of the most beneficial interventions.

What are your thoughts about these recommendations?

 

Reference:

Dr Paul Auwaerter

Medscape Infectious Diseases © 2015  WebMD, LLC

Cite this article: Managing Systemic Exertion Intolerance Disease (SEID). Medscape. Mar 03, 2015.

 

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Immense Relief as Migraine Headache Aborted!

Have you ever had a migraine headache that seems to split your head in two, with sharp searing knife-like stabbing? Just the memory of it makes one shudder!

The migraine has distinct phases – that sinking feeling when you feel it building up. Oh no. Not again. Why now? The progression seems inevitable unless you can nip it in the bud with heavy duty analgesics. Sometimes, you just don’t get to avert it.

Then you have to endure the aching body muscles, the nausea, the floating through no-man’s land while the wretched thing takes on a life of its own. Hunker down, keeping quiet and still, hoping ‘it’ will somehow not take too much notice of you curled like an embryo waiting for the labour contractions to end – to deliver you from this awful state of existance.

The post-drome is equally tiresome. Feeling like you have lost your capacity to think or reason – mind foggy and brain fatigued. Muscles aching as if you had run a marathon, then a triathalon, back to back. This can take a couple of days to pass.

Does this sound familiar?

Imagine my delirious delight when I managed to ABORT a migraine last week, in a completely unexpected way!

Natural Pain Relief

PowerStrips – a patented fusion of Modern Energy and Ancient Herbs

This is my ‘selfie’ of the PowerStrip I placed over my greatest tension area, before I took two regular panadol tablets and went to lie down. After an hour I woke – and the migraine was GONE! No residual headache, no residual muscle tension or brain fog and fatigue. I had to believe it – because I experienced it first hand. I kept the PowerStrip in place for the recommended 48 hours, and felt its comforting warmth as it worked wonders.

If you, or anyone close to you, would benefit from knowing more about the natural pain relief and energy giving properties of PowerStrips (FDA listed Class 1Medical Device), please leave me a comment below with your email address.

comment here

for more information ask us here

 

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What Is The Most Effective Weapon For Fibromyalgia?

Aerobic Exercise !

aerobic exercise is the most effective ‘weapon’ that we have

People with fibromyalgia benefit from continuous physical exercise.

 

A recent article in www.medscape.com by Alice Goodman summarised an overview of research on fibromyalgia treatment that was presented at the Paris 2014 European League Against Rheumatism Congress.

Winfried Häuser MD, from Technische Universität Munchen is an expert in the field of fibromyalgia. He believes that treatment for people with fibromyalgia should be individualised and include non pharmacalogical approaches, as these are often more effective than drugs. He explained that aerobic exercise is the most effective ‘weapon’ that we have and both healthy people and people with fibromyalgia benefit from continuous physical exercise.

He and his colleagues recently published a network meta-analysis which was an indirect comparison of all available therapies for fibromyalgia. They were unable to find any significant differences in effectiveness between drug and non-drug therapies. While the effects of drugs are lost once the patient stops taking them, the effects of aerobic exercise and multicomponent therapy are sustained but declining at 1 or 2 years.

Dr Häuser advocates a graduated approach to treating fibromyalgia.

Mild fibromyalgia: can be managed with reassurance from the doctor and encouragement to engage in regular physical and mental activities.

Moderate fibromyalgia: should be managed with aerobic exercise and the temporary limited use of drugs.

Severe fibromyalgia: can be managed with aerobic exercise, drugs and the psychological and/or psychopharmalogic treatment of mental comorbidities.

Dr Mary-Ann Fitzcharles, a rheumatologist at McGill University in Montreal who treats people with fibromyalgia, agreed with the patient-tailored approach outlined by Dr Häuser. She cautioned about overmedicating people, and keeping them on continued medications which have side effects. Non Pharmalocological therapies have no risks, she explained.

Dr Fitzcharles went on to say that non pharmacologic therapies are probably the most important ones for people with fibromyalgia. In her experience, every person with fibromyalgia should be managed with exercise, promotion of an internal locus of control and education.

Activity pacing is the key, in order to not overdo or avoid exercise.

Non Pharmacological therapies include:

  • Aerobic exercise
  • Acupuncture
  • Psychotherapy

Pharmacologic / drug therapies include:

  • GABA analogues
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants
  • Serotonin-specific reuptake inhibitors (SSRIs)

References:

  1. Aerobic Exercise ‘Most effective weapon’ for Fibromyalgia. Medscape. June19, 2014. Annals of the Rheumatic Diseasesard.bmj.com
  1. Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis

          Eveline Nüesch, Winfried Häuser, Kathrin Bernardy, Jürgen Barth, Peter Jüni

               Ann Rheum Dis 2013;72:955-962 doi:10.1136/annrheumdis-2011-201249

 

 

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Positioned for Success – Poor Posture Influences Movement and Chronic Pain

functional posture

Our posture helps to position us for success and prevent chronic fatigue and pain

Are You Positioned For Success?

Health professionals are trained to objectively analyse presenting signs and symptoms, in order to offer possible solutions to all manner of ‘conditions’. Today I have been exploring Posture, and the role it generally plays in our daily functional activities, and specifically, in chronic pain presentations.

Why is this interesting?

Because we need to be Positioned For Success!

The way we habitually hold ourselves influences all our movements and ultimately affects how we go about accomplishing our everyday activities – whether we are working, playing sport or a musical instrument, relaxing or sleeping.

I did a bit of research around the topic of being positioned for success by being Cognitively/Mindfully and Behaviourally aware of our posture, and the influences we could pay more attention to.

It has been observed that poor posture is widespread in the general population. It appears to be an adaptive, self- perpetuating trait that most people lack the cognitive ability or desire to correct by themselves. (2)

Studies have shown that people in occupations that include prolonged periods of sitting may experience a high incidence of Low Back Pain. (1)

Commonly adopted relaxed postures are often passive in nature with a predisposition to “sway” standing and slumped sitting which can exacerbate pain. (4)

Increased pain does not leave us positioned for success.

Recent studies conclude that

  • Forward head posture is the most common form of poor posture related to a multitude of myofascial pain disorders and cervical dysfunction. (2) This posture requires the person to flex the lower part of the neck forward and bend the upper portion of the neck backwards.
  • Adopting passive postures such as sway standing and slump sitting can exacerbate pain in individuals with low back pain. Lumbopelvic stabilising musculature is active in maintaining optimally aligned erect postures, and are less active during adoption of passive postures. The muscles of the lumbopelvic region become deactivated and deconditioned, which increases the load on the lumbar discs and ligaments which in turn could leave the lumbopelvic region vulnerable to strain, instability or injury. (4)
  • Back pain intensity and referred leg pain could be significantly reduced after sitting with a lordotic posture, demonstrating that a change in posture could have a positive effect on pain location. Centralisation (a change in distribution of referred symptoms from distal to a more central location) was brought about by certain lumbar movements and positioning. (1)
  • Erect postural alignment in weight bearing positively facilitated the stabilising muscles of the lumbopelvic region. (4) Immediately we are better positioned for success in performing our daily activities.
We are not Positioned For Success when we adopt postures that are not energy efficient and structurally sustainable.

We are not Positioned For Success when we adopt postures that are not energy efficient and structurally sustainable.

Postural Training (being Positioned for Success) works on the assumption that an optimally aligned skeletal system reduces stress in its structures.  It is recommended as one of the Interdisciplinary treatment components of Cognitive Behavioural Therapy (CBT) for chronic pain.

  • It usually involves exercises performed repetitively to stretch structures that poor posture tends to shorten
  • Strengthens structures that poor posture tends to weaken
  • Creates awareness of desirable posture (2)

 

Cognitive Behavioural treatment methods have been applied to the most common chronic pain conditions. Posture correction in daily life, by its very nature, is considered Behavioural Therapy as the individual is required to continually monitor his / her improved conditioned posture for success. (2, 3)

These CBT Programmes usually involve multiple components, including

  • Information to increase knowledge and awareness of the factors influencing the nature and typical course of chronic pain conditions
  • Basics of pain physiology with the emphasis on chronic pain
  • Biomedical and bio-behavioural management of the condition
  • How to self-monitor the signs and symptoms of the condition
  • Cognitive and behavioural therapies aimed at increasing physical and functional activities and adaptive responses to pain
  • Skill training such as the use of relaxation, biofeedback, hypnosis and other self-control strategies to modify the perception of pain and related body sensations
  • Information on the relationship between muscle fatigue, muscle tension and the psycho-physiologic aspect of stress
  • Introduction to cognitive and behavioural pain and stress-coping strategies (3)

 

Instructions for Posture Correction to be positioned for success may include

Sitting

  • Don’t slouch when sitting on a chair
  • Don’t sit with legs crossed
  • Don’t rest chin on hand
  • If sitting on the floor, sit upright by sitting on folded legs
My sitting posture may prevent me from being Positioned For Success

My sitting posture may prevent me from being Positioned For Success

 

My sitting posture may prevent me from being Positioned For Success

 Standing

  • Rest weight on both feet evenly
  • Don’t lean against a wall

 Sleeping

  • Sleep on a firm mattress
  • Sleep on your back
  • Keep your neck straight by supporting on a low pillow or flattened towel

 Eating

  • Bring food to mouth without tilting head forward
  • Chew looking straight ahead, not downward

 Walking

  • Walk with long even strides while swinging your arms

 Others

  • Don’t carry a heavy package with one hand
  • Don’t thrust head forward

Ref (3)

With this information in mind, we could be more mindful to ensure we are better Positioned For Success, without compromising our Postural efficiency.

 

References

1. A comparison of the effects of two sitting postures on back and referred pain     M M Williams, J A Hawley, R A McKenzie, P M van Wijmen Spine Vol 16, No 10,  Oct 1991; 1185-1191

2. Usefulness of posture training for patients with temporomandibular disorders  E F Wright, M A Domenech, J R Fischer Jr  J Am Dent Assoc 2000; 131; 202-210

3. Posture correction as part of behavioural therapy in treatment of myofascial pain with limited opening  O Komiyana, M Kawara, M Arai, T Asano,  K Kobayashi J Oral Rehab May 1999; Vol 26; No 5;428-435

4. The effect of different standing and sitting postures on trunk muscle activity in a pain-free population  P B O’Sullivan, K M Grahamslaw, M Kendell, S C Lapenskie, N E Moller, K V Richards Spine 2002; Vol 27; No 11; 1238-1244

 Which strategies do you employ to ensure you are Positioned For Success?

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