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We got interesting research report this month: Research recommending massage as the best treatment for neck pain, the Mystery of muscle cramp, Yoga easing menopause symptoms, ACL tears in Seniors, Research in Aromatherapy, Father of Applied Kinesiology Dies, and 7 Bad Names.

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We Spend More to Treat Spine Woes

A report in The Journal of the American Medical Association, found that Americans are spending more money than ever to treat spine problems, but their backs are not getting any better. The spending on spine treatments in the United States totaled nearly $86 billion in 2005, a rise of 65 percent from 1997, after adjusting for inflation. Even so, the proportion of people with impaired function because of spine problems increased during the period, even after controlling for an aging population.

The report is the latest to suggest that the nation is losing its battle against back pain, and that many popular treatments may be ineffective or overused. Researchers have produced conflicting data about the effectiveness of spinal surgery for back pain, although one major clinical trial, known by the acronym Sport, showed that spinal surgery patients did better than patients receiving more conservative care, which included medications or physical therapy. However, some doctors have questioned whether surgeries, injections and narcotic pain medications are being used appropriately.

“I think the truth is we have perhaps oversold what we have to offer,” said Dr. Richard A. Deyo, a physician at the Oregon Health and Science University in Portland and a co-author of the report. “All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients. But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.”

To study spending trends on spinal care, the researchers examined annual household survey data from the Agency for Healthcare Research and Quality, which was collected from about 23,000 people a year from 1997 to 2005. It includes pharmacy and medical record data, and was used to estimate national spending and treatment practices. The researchers found that people with spine problems spent about $6,096 each on medical care in 2005, compared with $3,516 in medical spending by those without spine problems.

The biggest surge in spending has been for drugs. In 2005, Americans spent an estimated $20 billion on drug treatments for back and neck problems, an increase of 171 percent from 1997. The biggest jump was for narcotic pain relievers, like OxyContin and other drugs, which increased more than 400 percent.

Outpatient treatment for back and neck problems increased 74 percent to about $31 billion during the period, while spending related to emergency room visits grew by 46 percent to $2.6 billion. Spending for surgical procedures and other inpatient costs grew by 25 percent to about $24 billion.

Despite the growth in treatment of back problems, the data show that the percentage of people with serious spine problems has not declined; it appears to have increased.

Based on the sample, the researchers estimated that in 1997, about 21 percent of the adult population suffered from back or neck problems that limited their function. By 2005, that number grew to about 26 percent, after adjusting the numbers for an aging population.

http://www.nytimes.com/2008/02/13/health/research/13spine.html?_r=1&ref=health&oref=slogin

The Mystery of Common Cramp

IT can happen for no reason, it seems, taking you completely by surprise. And it can be excruciating. Suddenly, a muscle contracts violently, as if it had been prodded with a jolt of electricity. And it remains balled in a tight knot as painful second after painful second drags on. Cramps afflict 39 percent of marathon runners, 79 percent of triathletes, and 60 percent of cyclists at one time or another, said Dr. Martin P. Schwellnus, a professor of sports medicine at the University of Cape Town.

Cramps can occur during exercise, immediately after, or he said, as long as six hours later. Yet common as they are and terrible as they can be, no one really understands cramps. They are a medical mystery. “I would say, bottom line, there is no really convincing biological explanation for muscle cramps,” said Dr. Andrew Marks, a muscle researcher and chairman of the department of physiology and cellular biophysics at Columbia University College of Physicians and Surgeons. Medical textbooks skirt the topic, he added, often avoiding any explanation. And few scientists have studied cramps. But as anyone who has ever complained of cramps will attest, lots of advice is circulating on how to avoid them and lots of people — friends, coaches, doctors — think they have a solution.

Take a multivitamin pill to get zinc and magnesium. Massage the muscles. Drink plenty of water. Be sure to get enough electrolytes like sodium and potassium. Stretch before you start to exercise. No, stretch as soon as you finish. See a nutritionist to correct imbalances in your diet. See a trainer to be sure you are moving correctly.

Of course, Dr. Marks said, medical conditions can lead to cramps, including narrowed blood vessels, usually from atherosclerosis, or compression of a nerve, as happens in spinal stenosis. Cramps also can arise from hypothyroidism. And they can be a side effect of medications like diuretics, used to lower blood pressure, which can lead to a potassium deficiency that can cause cramps.

But, he and others said, those conditions do not explain the vast majority of cramps. “You are left with the fact that cramping usually occurs in healthy people without any underlying disease,” Dr. Marks said. There are three leading hypotheses about how to treat cramps and how to prevent them.

There’s the dehydration proposal: you just need more fluid. But, Dr. Schwellnus said, he studied athletes who cramped and found that they were no more dehydrated before or after a race than those who did not have cramps.

Then there’s the electrolyte hypothesis: what you really need is sodium and potassium. Michael F. Bergeron, who directs the environmental physiology laboratory at the Medical College of Georgia, said the electrolyte hypothesis applies to a specific type of cramp that is related to excessive sweating. It occurs, he said, when the fluid that bathes the connection between muscle and nerve is depleted of sodium and potassium, which was lost through sweat. The nerve then becomes hypersensitive, Dr. Bergeron said. “Usually you feel little twitches first,” he explained. “They last for 20 to 30 minutes and if you don’t do anything you can be in full-blown cramps.” Those cramps, he continued can move from place to place on your body, from one leg to the next, to your arms, stomach, even your fingers or your face. The solution, Dr. Bergeron said, is to drink salty fluids like Gatorade (the company sponsors his research). He said he had prevented cramps in tennis players this way. But asked whether there are any rigorous studies to confirm this hypothesis, he said no. “We haven’t done the study yet,” he said. “We’re at the point of kind of connecting the dots.”

The third hypothesis is advanced by Dr. Schwellnus. He questions the electrolyte hypothesis because his studies of Ironman-distance triathletes as well as other studies of endurance athletes found no difference in electrolyte levels between those who suffered cramps and those who did not. DR. SCHWELLNUS proposes that the real cause of cramping is an imbalance between nerve signals that excite a muscle and those that inhibit its contractions. And that imbalance, he said, occurs when a muscle is growing fatigued. His solutions for cramps are to exercise less intensely and for shorter times, to be sure you had enough carbohydrates to fuel your muscles, to train sufficiently and to regularly stretch the muscles that give you problems. These recommendations are based on his recent study of Ironman triathletes, Dr. Schwellnus said. But while he advocates those practices, he said, they have not been proved in a rigorous study. In the meantime, some doctors have resorted to experimenting on themselves, devising their own explanations and cures.

Dr. Charles van der Horst, an AIDS researcher at the University of North Carolina, said he was stunned when his calf started to cramp without warning when he was running. The pain was almost unbearable, he said, and even when the muscle finally relaxed, it cramped again when he resumed running. “I started carrying a cellphone with me on long runs,” Dr. van der Horst said. When a cramp struck, he called his wife to ask her to drive out and get him. “I think I was getting calcium deposits or something,” Dr. van der Horst said. His solution was to massage his calves at all hours, pushing deep into the muscle. This seems to work, he said, explaining that it’s been a year now since he had a cramp.

Dr. Stephen Liggett, a professor of medicine and physiology at the University of Maryland, has a different solution. He got terrible cramps in his calf during yoga. The culprit, he decided, was the drugs he takes for asthma, which can diminish the body’s supply of potassium. He knew that potassium is sold over the counter. But because high levels of potassium can be dangerous, store-bought potassium supplements are not very strong.

Dr. Liggett’s solution is not one anyone who is not a doctor should try at home. Before he does yoga, he measures the potassium levels in his blood before and after taking what he describes as a hefty dose of over-the-counter supplement. Then he calculates how much additional potassium he thinks he needs, securing it from concentrated potassium tablets from his research lab — how much he declined to say. “I didn’t want to drink two gallons of Gatorade,” Dr. Liggett explained. He hasn’t had cramps since he began “preloading,” as he calls it, with potassium. But, he said, “I haven’t done a controlled trial.” Dr. Marks, for one, is not convinced by the evidence for any of the hypotheses, nor by any of the proposed remedies. What causes cramps? “I would say the answer to that question is still open to investigation,” he said. And, he added, he hopes someone takes it up.

Many patients still experience pain following major surgery despite the availability of pain-relieving medications, according to background information in the article. Pain may be under-treated because patients fear becoming dependent on medications, are concerned about side effects, believe that they should endure pain without complaining or worry about bothering nurses. Physicians and nurses may administer ineffective doses of pain relievers because of personal biases, cultural attitudes or a lack of knowledge.

Allison R. Mitchinson, M.P.H., N.C.T.M.B., of the Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, Mich., and colleagues conducted a randomized controlled trial involving 605 veterans (average age 64) undergoing major surgery (chest or abdominal operations) between 2003 and 2005. Patients were randomly assigned to one of three groups for the five days following surgery: 203 received routine care; 200 received a daily 20-minute back massage; and 202 received 20 minutes of individual attention each day from a massage therapist, but no massage.
"The purpose of this group was to assess the effect of emotional support independent of massage," the authors write. Patients were asked daily to rate the intensity and unpleasantness of their pain, plus their level of anxiety, on scales of one to 10.

"Compared with the control group, patients in the massage group experienced short-term (preintervention vs. postintervention) decreases in pain intensity, pain unpleasantness and anxiety," the authors write. "In addition, patients in the massage group experienced a faster rate of decrease in pain intensity and unpleasantness during the first four postoperative days compared with the control group." There were no differences in long-term anxiety, length of hospital stay or the amount of pain-relieving medications used among the three groups.

"The effectiveness of massage in reducing both the intensity and unpleasantness of pain suggests that it may act through more than one mechanism," the authors write. "Massage may ameliorate suffering by helping to relieve the anxiety that so effectively synergizes with pain to create distress." It could also generate mood-boosting endorphins or create a competing sensation that blocks pain, they note.

"Historically, massage was a common experience for postsurgical patients," the authors write. "As health care systems have become more complex and administrative demands on nursing time have increased, the tradition of nurse-administered massage has been largely lost. With the recent emphasis on assessing pain as the fifth vital sign tempered by renewed concerns for patient safety, it is time to reintegrate the use of effective and less dangerous approaches to relieve patient distress."

Yoga Eases Menopause Symptoms in Breast Cancer Survivors

Yoga helps ease hot flashes and other menopausal symptoms in breast cancer survivors, a U.S. study says.

Some of the 37 women who'd had early stage breast cancer took part in an eight-week "Yoga of Awareness" program, while others were assigned to a control group. All the women self-reported their menopausal symptoms before, immediately after, and three months after the program. The yoga program used in this study is specifically designed to address menopausal symptoms through gentle stretching postures, breathing exercises, meditation techniques, group discussions and study of yoga principles.

"This program is not what you'd find at your local fitness center," study co-author Laura Porter, an assistant professor of psychiatry and behavioral sciences at Duke University Medical Center, said in a prepared statement. " 'Yoga of Awareness' is based on traditional yoga techniques that go beyond the teaching of specific postures to incorporate practices aimed at reducing stress and creating a heightened sense of awareness and acceptance about one's physical and mental state."

Women who took part in the yoga program showed significant reductions in the frequency and severity of their hot flashes, along with decrease in fatigue, joint pain, sleep disturbance, and symptom-related distress. They also reported increased vigor. These improvements were still evident three months after the end of the yoga program.

The study was to be presented Saturday at the International Association of Yoga Therapists Symposium for Yoga Therapy and Research, in Los Angeles. The researchers noted that breast cancer survivors often have more severe menopausal symptoms than other women but have limited treatment options. For example, they can't have hormone replacement therapy that may increase their risk of cancer recurrence. In addition, drugs used to prevent cancer recurrence tend to induce or exacerbate menopausal symptoms.

"While this is a specific pilot program, women seeking similar results could consult with an experienced yoga instructor to learn some of the same techniques," Porter said. "In addition to the traditional yoga postures, a well-trained yoga instructor or other mind-body practitioner may be able to provide instruction in breathing and meditation techniques to help manage stress and alleviate bothersome menopausal symptoms."

ACL Tears Worth Fixing in Seniors

A new, but small, study found that men and women in their 50s and 60s did well after undergoing reconstruction of injured tissues in their knees, the anterior cruciate ligaments (ACL).

A couple decades ago, surgeons wouldn't have bothered to fix these injuries in people over 50, or even 40. Now, "you're never too old to have your ACL reconstructed," said Dr. Diane Dahm, an assistant professor of orthopedic surgery at the Mayo Clinic in Rochester, Minn.She presented the research Wednesday at the American Academy of Orthopaedic Surgeons' annual meeting, in San Francisco.

The ACL is a kind of anchor that holds the knee together and can become injured when someone is playing sports and tries to turn and pivot, said Dr. Robert Gotlin, director of orthopedic and sports rehabilitation at Beth Israel Medical Center in New York City. Athletes who play sports like football, lacrosse, basketball and soccer are especially prone to the injury, he noted.

Tearing and extreme stretching hurt the ACL. According to Dahm, an injury could come while landing after a rebound on the basketball court. Injuries are also possible off the field, perhaps while changing direction quickly while getting out of a car. Still, she said, most of the injuries are related to sports.

In decades past, surgeons were reluctant to perform procedures on people who had injuries after the age of 40, because it was assumed that "your athletic life is done," Gotlin said. "You don't fix the ACL, because you don't really need it."Times, and attitudes, have changed. As a result, older patients are going under the knife so they can stay active. Gotlin said he's performed surgeries on patients in their 80s who returned to the ski slopes, although rehabilitation can take months.

In the new study, researchers looked at the records of 34 patients who underwent ACL reconstruction surgery between 1990 and 2002 at the Mayo Clinic. All were between the ages of 50 and 66. The surgery reconstructs the ACL with other tissue, sometimes from the patient's own body. Eighty-three percent of the patients were considered to have returned to a normal or near-normal state after the surgery, and 83 percent returned to playing sports. However, five of the 34 patients required more knee surgery. "Some people have felt that it's possible that reconstructing the ACL in these older patients might lead to an increased risk of complications like stiffness in the knee, but our complication rate was very low," Dahm said. The message, she said, is that the surgery works: "They were able to return to a fairly high level of activity."

Does Aromatherapy Work?

Researchers are reporting that two of the most commonly used scents in aromatherapy do nothing to heal wounds, relieve pain or enhance immune status, although one did briefly improve mood. In fact, in some cases, distilled water showed more of a salutary effect, the study found.

The study results are published online in the April issue of the journal Psychoneuroendocrinology.

Used for thousands of years in countries such as India and Egypt, aromatherapy has many adherents who say the concentrated oils extracted from flowers improve health and emotional well-being, according to the Cleveland Clinic. Despite its widespread use, there's little scientific data on the effectiveness of the therapy, the study authors stated.

"This is by far the largest and most comprehensive study of actual physiological outcomes," Kiecolt-Glaser said. "There are different perspectives on why odors should work in terms of changing physiology, if they do. A lot of aromatherapy literature thinks of it as a drug-specific mechanism." In other words, that scents work much like drugs work, with very specific effects.

Using this point of view as a starting point, Kiecolt-Glaser and her colleagues, who included husband Dr. Ronald Glaser, looked at the two odors that have been most researched: lemon, which is purported to be stimulating and a mood enhancer, and lavender, which is supposed to be relaxing and is used as a sleep aid. Distilled water was used as a control.

Potential study participants were first screened to see if they had an adequate sense of smell. Fifty-six people were then admitted into the study. During three half-day sessions, half the group was handed an envelope that explained the scent they were about to smell and what to expect. The other participants were simply told they'd be smelling a variety of fruit and floral odors.

Then the researchers taped cotton balls laced with either lemon oil, lavender oil or distilled water below the volunteers' noses for the duration of the tests. The participants were monitored for blood pressure and heart rate, and the researchers took regular blood samples from each volunteer. The samples were analyzed for changes in different biochemical markers, including Interleukin-6 and Interleukin10, as well as the stress hormones cortisol and norepinephrine.

The researchers then tested the volunteers' ability to heal by using a standard test in which tape is applied and removed repeatedly on a specific site on the skin. The scientists also tested the volunteers' reaction to pain by placing their feet in 32-degree water. Finally, the participants filled out three standard psychological tests to assess mood and stress during each session.While lemon oil showed a clear mood enhancement, lavender oil did not, the researchers said. Neither smell had any positive impact on any of the biochemical markers for stress, pain control or wound healing.

Still, research in the field is limited, and it's doubtful these findings will prove anything.

The "Father" of Applied Kinesiology, George J. Goodheart, DC 1918 - 2008 died on March 5, 2008 at his home at the age of 90.

He was the Founder and Developer of Applied Kinesiology. Through his remarkable observation skills and analytical mind, Dr Goodheart found that normal and abnormal body function could be evaluated using muscle tests.

A 1939 graduate of National College of Chiropractic, Dr. Goodheart was in active practice for over 60 years in Detroit and Grosse Pointe, Michigan. He has authored numerous articles and books on Chiropractic Technique for greater than four decades. His distinguished career includes such highlights as Director of the National Chiropractic Mutual Insurance Company, Research Director for the ICAK-USA., and being the first doctor of chiropractic appointed to the U.S. Olympic Sports Medicine Committee for the 1980 Lake Placid Games.

A second generation Doctor of Chiropractic, Dr. Goodheart has lectured and taught at each of the Chiropractic colleges in the United States, as well as colleges in Canada, Japan, Australia and Europe. Dr. Goodheart discussed the influence of his father and his early days of practice prior to the discovery of muscle testing as the diagnostic entity we know of today. He also covered a potpourri of clinical observations from throughout his career including his experiences in the obstetric and orthopedic surgical theaters.

According to the Planet Chiropractic website, 7 of the most common name (to avoid) for Chiro practice. they are

So we are wondering what's the most common name (probably to avoid) in massage therapy practice. We think the candidates are:

The Mystery of Common Cramp

Yoga Eases Menopause Symptoms in Breast Cancer Survivors

ACL Tears Worth Fixing in Seniors

Does Aromatherapy Work?

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