Terra Rosa

Australian Government provides $5m grant for alternative therapies research

Complementary and alternative medicines and therapies – a category that spans herbal, traditional and homeopathic medicines, vitamins, supplements, acupuncture, aromatherapy, naturopathy, and therapies that involve massage and manipulation – are hugely popular in Australia. More than half of us use some form of complementary medicine in any given year, and collectively spend more than $1.8 billion out of our own pockets on them.

As in the case of slippery elm, research into complementary and alternative medicine has often been less extensive and less rigorous than research into pharmaceutical medicines. The reasons are varied, ranging from greater difficulty in getting anyone to bankroll such research, to challenges in setting up the clinical trials themselves. The result has been that many doctors have been sceptical and reluctant to recommend alternative therapies, and often don't discuss them either. A study published in the Medical Journal of Australia last year found more than 53 per cent of South Australians who were taking complementary medicines were doing it without the knowledge of their doctor (MJA 2006;184:27-31).

Meanwhile, natural therapies that may be as effective as pharmaceutical medications – and have fewer side effects – are never fully explored. And therapies that do have significant evidence backing them up are rarely researched for cost effectiveness or quality assurance, or compared to mainstream treatments for efficacy and safety.

But things are beginning to change. In November the National Health and Medical Research Council, the federal government's peak funding body for medical research, allotted $5 million to investigate the use and effectiveness of complementary and alternative medicines (CAM). Applications from research groups seeking a share of the money for specific projects close at the end of this month.

But that $5 million is still dwarfed by funding by some other countries. Only about a third of Americans use complementary medicines, compared to 52 per cent of Australians, but the US has committed more than $US120 million annually for the National Center for Complementary and Alternative Medicine alone. Still, the $5 million grant is the first allocation of significant Australian taxpayer funds for CAM research. The NHMRC has also put CAM on its three-year strategic plan.

That's particularly significant because the private pharmaceutical companies that fund the bulk of research into new drug development often see little profit in alternative medicine, says Marc Cohen, professor of complementary medicine at RMIT and president of the Australasian Integrative Medicine Association, a non-profit organisation that promotes integrating complementary medicine into mainstream medical practice.

"With complementary medicine, very often there's no product at the end, or there's a common plant that is not able to be patented, or it's a lifestyle intervention such as yoga – so there's no incentive for them (to fund research)." Designing clinical trials for complementary medicines can also pose difficulties, as procedures that are often taken as a given – such as comparing treatments with an alternative therapy or a placebo – are challenging and sometimes impossible, Cohen says. It's difficult to devise a "placebo massage" – something that patients think might be massage, but isn't.

Scepticism aside, there's no doubt some of the early research into complementary medicines is promising. Systematic reviews of acupuncture show it can be very effective for treating nausea, vomiting and pain – and it's already being used in emergency departments at two Melbourne hospitals, though as yet there has been no research on its cost-effectiveness.

And at least 15 complementary herbs and natural supplements have "a high level of evidence" that they are as safe and effective as the equivalent pharmaceutical medicine, Cohen says. The Therapeutic Goods Administration classes evidence as high when there has been either a systematic review of all the relevant randomised controlled trials, or one properly designed trial where the subjects have been randomly allocated to treatment and control groups, and "blinded" so neither patients nor their treating doctors know who is receiving the substance under investigation and which the placebo or comparator product.

Some natural therapies are already receiving quite a bit of attention. Glucosamine is entering widespread use for osteoarthritis, particularly in the wake of safety concerns over Vioxx and the Cox-2 family of anti-arthritis drugs drugs. Ginkgo biloba has been investigated for a role in reducing risk of dementia, fish oils for preventing cardiovascular disease and even depression, and the list goes on. Doctors themselves are also starting to change their perceptions.

Source: The Australian 24 March 2007 http://www.theaustralian.news.com.au/story/0,20867,21434077-23289,00.html

Gel could treat back pain

A hi-tech gel could be used instead of major surgery to treat chronic lower back pain, according to a study. The gel contains tiny particles which swell and stiffen when injected into a damaged area. Tests on animals, reported in the journal Soft Matter, showed it was able to repair the discs that provide a cushion between the bones of the spine. See the article: http://www.rsc.org/publishing/journals/SM/article.asp?doi=b613943d

Our approach has the advantage of restoring spinal mobility whereas spinal fusion surgery results in a significant loss of mobility at the fused and adjacent discs Professor Tony Freemont University of Manchester. It offers a potential alternative to spinal fusion surgery, a technique in which the bones of the spine - the vertebrae - are fused together to reduce pain by eliminating motion in the affected area.

The micro gel particles the research team have developed are like "smart sponges" when dispersed in water. The material is a fluid with a low pH - indicating a high level of acidity - and can be injected through a syringe. However, at the higher pH found in the body it changes to a stiff gel because of the absorption of water. In tests, the researchers injected the gel into a damaged disc taken from a pig, and increased pH to levels similar to those found in the body by injecting alkaline solution.

Researcher Professor Tony Freemont said there was a pressing need to develop a non-surgical method for repairing intervertebral discs. He said: "Our approach has the advantage of restoring spinal mobility whereas spinal fusion surgery results in a significant loss of mobility at the fused and adjacent discs."

However, his colleague Dr Brian Saunders said: "Although we are encouraged by our findings, much work lies ahead to develop a viable non-surgical repair technology to replace spinal fusion as the standard surgical treatment for chronic lower back pain."

Source

http://news.bbc.co.uk/2/hi/health/6466827.stm

http://www.manchester.ac.uk/aboutus/news/display/index.htm?id=107437

Soft Matter Journal. A study of pH-responsive microgel dispersions: from fluid-to-gel transitions to mechanical property restoration for load-bearing tissue http://www.rsc.org/publishing/journals/SM/article.asp?doi=b613943d

Increase in massage use by men

National consumer research released today by Associated Bodywork & Massage Professionals (ABMP) in the US shows the increasing popularity of massage among American adults, continuing a 20-year climb in massage use and acceptance. There was a remarkable jump in the number of men reporting massage use, an increase of 5.3 million men from 2004 to 2006, or growth from 8 percent of male adults to 13 percent. The research was conducted by Boulder, Colo.-based Harstad Strategic Research in January. Telephone survey conducted among a cross-section of 1,008 adults age 21-plus from Jan. 4-11, 2007. A full 33.6 million American adults aged 21 or older received at least one massage in 2006, up nearly 9 million from the 2004 level. That represents growth from 12 percent in 2004 to 16 percent in 2006.

There are three primary reasons people seek massage, each representing about a third of all massages delivered. Most seek relaxation and restoration (30 percent), need relief from pain or muscle soreness (29 percent), or have a massage because they received it as a gift (28 percent). Recommendations by medical professionals and receiving gift certificates are primary factors in consumers choosing to get a massage.

http://www.businessportal24.com/en/JUMP_IN_MASSAGE_USE_BY_119656.html

Easing Chronic Neck Pain

Canadian researchers reported that sleeping with a neck support pillow and doing neck exercises can help ease chronic neck pain. Dr Hugh A. Smythe at the University of Toronto, Ontario, and colleagues concluded that patients with chronic neck pain should be treated by health professionals trained to teach both exercises and the appropriate use of a neck support pillow during sleep; either strategy alone will not give the desired clinical benefit. Neck pain is fairly common and usually gets better on its own, but cases that last longer than two months can become chronic, the researchers note in the Journal of Rheumatology. Little scientific information is available on which treatment approaches are most effective.

Using a factorial design in a clinical trial, participants were equally allocated at random to 4 treatment groups in the study: (1) placebo control, of hot or cold packs and massage; (2) sleeping neck support pillow and placebo; (3) active neck exercises and placebo; and (4) combined exercise and sleeping neck support pillow and placebo. Participants were treated by physical (physio) therapists over a 6 week period and assessed by masked independent assessors at 0, 3, 6, 12, 24 weeks, and 12 months, with the 12 week assessment being the primary decision time. The primary outcome measure was the Northwick Park Neck Pain Questionnaire (NPQ).

The results showed that the main effects of Exercise (p = 0.146) and Pillow (p = 0.443) were not statistically significant; but the interaction of Exercise plus Pillow (p = 0.029) was statistically significant and clinically meaningful. They concluded that treatment to teach both exercises and the use of a neck support pillow achieved the most favorable benefit for participants with chronic neck pain; either strategy alone was not more effective than a control regimen. Time was an important cofactor.

Source:

http://www.iol.co.za/index.php?set_id=14&click_id=117&art_id=qw1170795422212B243

http://www.jrheum.com/abstracts/abstracts07/151.html

Researchers found that the pain in Fibromyalgia is for Real

Recent genetic findings showed that fibromyalgia and related chronic pain conditions are real, but their clinical management leaves much to be desired. That is the conclusion of two researchers from the University of Michigan Richard E. Harris, PhD, and Daniel J. Clauw, MD, who have studied fibromyalgia for several years. Because there has been no obvious physiological cause for the pain disorder, doctors still routinely dismiss fibromyalgia as being "in a patient's head." But after reviewing the research, they wrote that it is increasingly clear that fibromyalgia is a central nervous system disorder and that patients experience hypersensitivity to pain.

They suggest that specific gene mutations may predispose individuals to develop fibromyalgia. In addition, neurobiological studies indicate that fibromyalgia patients have abnormalities within central brain structures that normally encode pain sensations in healthy pain-free controls.

"It is time for us to move past the rhetoric about whether these conditions are real, and take these patients seriously as we endeavor to learn more about the causes and most effective treatments for these disorders," Harris and Clauw write in the December issue of the journal Current Pain and Headache Reports.

Brain imaging studies conducted at the University of Michigan and other research centers in recent years show clear differences in responses to pain stimulation among people with and without fibromyalgia. Compared to people without the disorder, fibromyalgia patients showed increased brain activity in response to pain. These studies indicate that fibromyalgia patients have abnormalities within their central brain structures. “In people without pain, these structures encode pain sensations normally. In people with fibromyalgia, the neural activity increased”. Research also suggests that fibromyalgia patients don't process the body's natural pain relievers as efficiently as people without the disorder.

"This is a new paradigm for medical professionals to understand," she says. "It isn't a virus, or bacteria or inflammation. It isn't a tumor or something else that you can see. It is a problem within the pain-processing center of the central nervous system."

While the recent research has done much to improve the understanding of fibromyalgia and related chronic pain conditions, few advances have been made in the treatment of these disorders, Harris says. The use of medications such as antidepressants can help some patients with fibromyalgia. And regular exercise seems to help many patients. Acupuncture has been shown to reduce pain in some studies, but not others, he adds. Matallana says several drug companies are in the later stages of testing several new drugs designed specifically for the treatment of fibromyalgia, which target the central nervous system.

Source

Harris RE, Clauw DJ. How do we know that the pain in fibromyalgia is "real"? Current Pain & Headache Reports 2006 Dec ;10(6):403-407

http://www.medicinenet.com/script/main/art.asp?articlekey=77863

http://www.med.umich.edu/opm/newspage/2006/fibromyalgia.htm

Massage eases pain of knee osteoarthritis

A study conducted by a team of Medical doctors in the US found that people who suffer from oesteoarthritis (OA) of the knee appear to gain lasting relief from Swedish massage. The findings suggest that doctors may want to advise arthritis patients to add massage to the treatments they are already using, like anti-inflammatory drugs. Massage may even be able to take the place of drugs for people who have mild arthritis or whose health does not allow them to take the medications. The researchers said it was not clear how massage, which generally focuses on the muscles, helps people with a disease that affects joint tissues and bones. The authors are now embarking on larger studies to confirm the findings and see if massage is a viable alternative or adjunct to drugs and other existing treatments.

The study, led by Dr. Adam J. Perlman of the University of Medicine and Dentistry of New Jersey, reported in the December issue of Archives of Internal Medicine. “We’re really thinking there are a couple of things going on,” said the senior author of the study, Dr. David L. Katz of the Yale University School of Medicine. Part of the benefit may come from attracting more blood to the knee, Dr. Katz said. Massage may also reduce pain in the same way rubbing injured areas often does, by sending out sensory stimuli that compete with the pain stimuli. Massage also seems to make arthritic knees more limber, encouraging patients to walk more, in itself a treatment for the disease.

"The very significant therapeutic response over eight weeks of therapy persisted eight weeks later," Katz said. "Two months after the last massage, they were still significantly better than baseline and significantly better than the control group. That exceeded our expectations." There are two possible explanations for the improvements. In the immediate time frame, Katz explained, "sensory input [the massage] competes with pain input in the spinal cord, travels faster and blocks pain symptoms." Massage may also enhance blood flow to the region affected by osteoarthritis. "Since the acute pain of osteoarthritis is related to inflammation, increased perfusion brings an influx of cells to clean out the debris and facilitates, to whatever extent possible, bone and cartilage remodeling". More studies are needed before doctors, patients and insurance companies can be persuaded to accept this as common practice, he said. "The end game would be that this would be something people with osteoarthritis would be able to access routinely," Katz said. "We ultimately want to change the standard of practice, but we don't do that with one study."

Conventional treatments include pain medication, exercise, hot and cold therapy, corticosteroid injections and, possibly, surgery. The medications used for osteoarthritis, however, are problematic. Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, can cause serious gastrointestinal side effects. The cox-2 inhibitors such as Vioxx that were developed to bypass those side effects are now known to cause cardiovascular problems, and some, including Vioxx, have been taken off the market. "Primarily therapy is NSAIDs, but the target population is the very group that is least tolerant of those drugs," Katz said. "The cox-2s were developed as alternatives to NSAIDs to offer less toxicity, and look at how that turned out. We've kind of left folks high and dry." While massage has been shown to relieve chronic lower back pain and musculoskeletal disorders, there has been no research on massage to help osteoarthritis sufferers. At least until now.

The study involved 68 patients with knee OA assigned either to treatment (twice-weekly sessions of standard Swedish massage in weeks 1-4 and once-weekly sessions in weeks 5-8) or to control (delayed intervention). Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and functional scores and the visual analog scale of pain assessment. After eight weeks, the group receiving massage therapy demonstrated significant improvements in the WOMAC global scores, pain, stiffness ,and physical function domains and in the visual analog scale of pain assessment, range of motion, and time to walk.

Source:

Adam I. Perlman, MD, MPH; Alyse Sabina, MD; Anna-Leila Williams, PA-C, MPH; Valentine Yanchou Njike, MD; David L. Katz, MD, MPH. 2006. Massage Therapy for Osteoarthritis of the Knee, A Randomized Controlled Trial. Archives of Internal Medicien 2006;166:2533-2538. http://archinte.ama-assn.org/cgi/content/abstract/166/22/2533

http://www.forbes.com/forbeslife/health/feeds/hscout/2006/12/11/hscout536528.html

http://www.nytimes.com/2006/12/12/health/12ther.html?em&ex=1166158800&en=3968962f6613bd7e&ei=5087%0A

Best Treatment for Tennis Elbow

The researchers at Physiotherapy School of the University Queensland investigated what therapy is best for this condition. The studies involved three ways of treating tennis elbow. The study involves 198 participants aged 18 to 65 years with a clinicaldiagnosis of tennis elbow of a minimum six weeks' duration,who had not received any other active treatment by a healthpractitioner in the previous six months. The three treatments are: Eight sessions of physiotherapy; corticosteroidinjections; wait and see. Physio treatment involves a specific elbow manipulation with a gentle mobilisation with movement. The outcome measures are global improvement, grip force, and assessor'srating of severity measured at baseline, six weeks, and 52 weeks.The results showed that the steroid injection is superior in the first three to six weeks but not after that, and that there's a significantly greater recurrence rate - somewhere around 72% of people said they were good at six weeks were no good in the remaining time out to twelve months. The physiotherapy group was as good as the injection at six weeks and far better than doing nothing or the wait and see group and was much better after three months than the corticosteroid injection group. But the wait and see group catches up with the physio group out at around about three months and on, so three to six months physiotherapy is no more superior than wait and see. The recovery rate of the "wait and see" at twelve months is about 70% to 80%.

The advice to people from Dr. Bill Vincenzino is "rest it, see how it goes in three months, if it hasn't resolved by then you're probably one of those in the category where you could be that 20% to 30% that are not going to get better. Well then, I would recommend they have some physiotherapy at that stage and I don't think there's much evidence for steroid injections until a really good attempt has been made at the wait and see approach plus sensible physiotherapy. And if that's failed well then you're looking at some quite drastic invasive measures like injections and possibly surgery."

Source:

http://www.abc.net.au/rn/healthreport/stories/2006/1804339.htm

Bisset L et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. British Medical Journal, 4 November, 2006;333:939-941.

Predicting the Outcome of Whiplash Injury

Researchers at the Whiplash Research Unit at the University of Queensland have looked at predictors of outcome for whiplash patients and are also investigating treatments. Dr Michelle Sterling is co Director of the Neck Pain and Whiplash Research Unit at UQ. Whiplash is defined as neck pain as a result of a motor vehicle crash. Most commonly it's a rear end collision but people can get symptoms following a side impact or a front end. And the mechanism is more than just a head flipping backwards and forwards - there's compression and translation throughout the vertebrae in the neck and the upper back.

Using data from studies in Queensland and also in NSW, Dr. Sterling fund out about a third of person will recover from whiplash injury, about another third or so will have lower levels of pain and disability and then there's another third that go on to have more moderate to severe levels. And these are the people that it's a real problem for them, they have difficulty sometimes returning to work and their life is quite disrupted, and can have long term problems.

Higher initial levels of pain and disability, older age, cold hyperalgesia, impaired sympathetic vasoconstriction and moderate post-traumatic stress symptoms have been shown to be associated with poor outcome 6 months following whiplash injury.

Source:

http://www.abc.net.au/rn/healthreport/stories/2006/1787908.htm#transcript

Sterling M et al. Physical and psychological factors maintain long-term predictive capacity post-whiplash injury. Pain, 2006;122:102-108

Treatment for Plantar Fasciitis

Proximal plantar fasciitis is the most common cause of heel pain. Researchers in the U.S. led by Dr. Ben DiGiovanni suggest that a plantar fascia-specific stretching exercise is proving quite effective to help treat and potentially cure plantar fasciitis.

Eighty-two patientswith chronic proximal plantar fasciitis for a duration of morethan ten months completed a randomized, prospective clinicaltrial. The patients received instructions for either a plantar fascia-stretching protocol or an Achilles tendon-stretching protocol and were evaluated after eight weeks. The results showed substantial differencesin favor of the group managed with the plantar fascia-stretchingprogram.

The stretch is as follows:

The stretch requires patients to sit with one leg crossed over the other, so if it's your right foot you put the right foot and ankle over your left knee. Using your right hand, pull up on your toes - grab just the toes, not the ball of the foot, pull it up towards your shin and towards your knee. Using the other hand, feel the mid arch of the foot (like guitar strings). After a count of 10 let go of the stretch, pull the toes again and feel the stretch. This exercise is repeated 10 times, and performed at least three times a day, with main acivity before taking the first step in the morning and before standing after a prolonged period of sitting or any time you've been less active.

The study was continued with atwo-year follow-up, results showed marked improvement for allpatients after implementation of the plantar fascia-stretching exercises, with an especially high rate of improvement for thosein the original group treated with the Achilles tendon-stretchingprogram. In contrast to the eight-week results, the two-yearresults showed no significant differences between the groupswith regard to the worst pain or pain with first steps in themorning. Descriptive analysis of the data showed that 92% (sixty-one)of the sixty-six patients reported total satisfaction or satisfactionwith minor reservations.

Source:

DiGiovanni BF et al. Plantar Fascia-Specific Stretching Exercise Improves Outcomes in Patients with Chronic Plantar Fasciitis. The Journal of Bone and Joint Surgery, 2006;88(8):1775-1781

DiGiovanni BF et al. Tissue-Specific Plantar Fascia Stretching Exercise Enhances Outcomes in Patients with Chronic Heel Pain. The Journal of Bone and Joint Surgery, 2003;85(7):1270-1277

http://www.abc.net.au/rn/healthreport/stories/2006/1784908.htm#transcript

http://www.urmc.rochester.edu/pr/news/story.cfm?id=1275

'Blind massage' law in South Korea

In South Korea, the law says that only the blind can give a massage. In South Korea some jobs have, by historical precedent or even legislation, been the preserve of those with disabilities.

The law giving only the legally blind the right to become registered massage workers was introduced under Japanese occupation in 1913 and reaffirmed by South Korea 50 years later. In the absence of a welfare system, the arrangement was designed to give blind people a protected way of earning a living. But that aim now has collided with South Korea's constitutional guarantees against discrimination. Massage workers who aren't blind and want to offer sports therapy or facial and foot massages have long complained that the law is biased.

The courts in May 2006, have ruled that restricting massage licences to the blind discriminates against sighted people who want to pursue the same trade. This overturned an earlier ruling three years ago, which had found in favour of the existing rules. The court's verdict has ignited fierce protests by the blind, who say they are being stripped of the only work available to them. One masseur died after throwing himself from a high-rise building, apparently in protest, while others jumped onto the tracks of a Seoul subway station to highlight their plight. More than 6,500 visually-impaired people are licensed to work as masseurs in South Korea, according to the Korean Masseurs Association (KMA). It now fears a flood of entrants into the sector that will drive out its members. The ruling opens the way for licensing massage parlours employing the sighted: until now, these have operated illegally.

Some people argue that the continued association of the business of massage with the blind demeans those in the profession, implicitly labelling them as restricted to this kind of work. Ideally, people with disabilities, including the blind, would have access to a wider range of job opportunities. But, says the KMA, the established tradition has served its members well. Prejudice, and a lack of official support, continues to restrict the choice of work for the blind, hence their fierce defence of their exclusive right to the trade.

Pressured by the emotional protests, the South Korean government bent. In August, the National Assembly passed a regulation under the state medical code restoring to the blind the exclusive right to give massages. Some sighted massage workers have responded with another lawsuit, asking the Constitutional Court to again rule against the restriction. The conflicting demands for equality have left even human-rights advocates uncertain about whether a law that favors the blind is leveling the occupational playing field or condemning them to an occupational ghetto-- while discriminating against others in the process. The estimated 6,000 blind South Koreans with certificates allowing them to provide massages earn enough money to live more independent lives; virtually all the others are dependent on state assistance.

Blind massage workers are discreet. Seoul's airport terminals, for example, don't have massage clinics at the gates, unlike many Asian airports. Instead, the blind work mostly out of their homes or at hotels, where the front desk will arrange for a traditional muscle-relief massage the Koreans call an anma.

Source:

The Chicago Tribune http://www.chicagotribune.com/news/nationworld/chi-0611230249nov23,1,1326781.story?coll=chi-newsnationworld-hed&ctrack=1&cset=true

http://www.economist.com/displayStory.cfm?story_id=7090275

Why woodpeckers don't get headaches

Dr. Ivan Schwab from University of California, Davis, studied the anatomy of the woodpecker's skull to find out why it does not suffer from headaches after banging its head against a tree trunk 12,000 times a day. This research has won the 2006 "Ig-Nobel" in ornithology (the scientific study of bird life). The Ig Nobel is an alternative Nobel prize, honors achievements that first make people laugh, and then make them think. The prizes are intended to celebrate the unusual, honor the imaginative -- and spur people's interest in science, medicine, and technology.

Dr. Schwab is interested in woodpeckers because the birds do not experience retinal detachments, brain damage and spinal cord injuries, damage that one would expect as a result from the birds' repeated hammering. In his study, Schwab noted that North America's largest woodpecker may strike a tree at the rate of 20 times a second and up to 12,000 times a day, with forces as high as 1,200 g's with each impact. That is equivalent to striking a wall at 26 km an hour — face first — each time.

Dr. Schwab in his article in British Journal of Ophthalmology explained:

evolution has provided the woodpecker with a thick bony skull with relatively spongy bone, especially at the occiput, and cartilage at the base of the mandible to partially cushion the incessant blows. Inside the skull, there is almost no cerebrospinal fluid in a very small subarachnoid space. The mandibles are attached to the skull by powerful muscles that contract a millisecond before strike, creating a tight, but cushioned structure at the moment of impact and distributing the force of the impact to the base and posterior aspects of the skull, thus bypassing the brain.

The neurological mechanisms must be superb since these birds strike in a perfect perpendicular stroke to eliminate the torsional shear force that would otherwise tear the meninges or cause concussions. Although not studied, this mechanism probably also protects against intraretinal haemorrhages and retinal detachment. Additionally, the woodpecker is protected, at least to some extent, by its size. Its brain is relatively small, resulting in a small ratio of brain weight to brain surface area. Any impact force would be spread out over a relatively large area making its brain somewhat more resistant to concussion than a human’s brain. Nevertheless, the woodpecker will use the leverage of its entire body weight to increase the force of impact of its bill, and it becomes a full body hammer.

High speed photography has revealed that in that millisecond before strikethe thickened nictitans closes over the eye. This would protectthe eye from flying debris and chips, but would also act asa "seat belt" to restrain the eyes from quite literally "poppingout of its head." Woodpeckers enjoy a cushioned choroid withan as yet unknown mucopolysaccharide filling the interstices.The pecten probably also has a role in maintaining an effectivecushion as the pecten can fill with blood to briefly elevateintraocular pressure thus maintaining firm pressure on the lensand retina to prevent damage.

The woodpecker has other unique adaptations that deserve recognitionand may contribute to the protection from intracranial injuries.The tongue is most unusual as it originates on the dorsum ofthe maxilla, passes through the right nostril, between the eyes,divides into two, arches over the superior portion of the skulland around the occiput passing on either side of the neck, comingforward through the lower mandible, and uniting into a singletongue in the oropharyngeal cavity. The muscles encase the bonyhyoid throughout this muscular course into the oropharynx andare additionally secured in the floor of the mouth creatingan apparatus that allows for extraordinary protrusion of thetongue of up to 4 inches beyond the tip of the bill! These musculotendinousbands create a curious sling-like structure that probably functionsas an isometric shock absorber if contracted before each strike.This sling would also serve to distribute the potential shearingforces. Such length isuseful for penetrating insect nests beneath the bark of trees.The sharp tongue (literally) is coated with sticky saliva forsmaller insects such as ants and has backward pointing barbsthat are useful in impaling larger insects and grubs. For addedemphasis, the tongue is equipped with excellent tactile abilitiesto allow for recognition of smaller insects, such as ants. Thechisel tipped mandibles are constructed of individual fusedplates of keratin called rhamphotheca, and the longitudinaltrabeculae are reinforced with calcium.

Reference:

"Cure for a Headache," Ivan R Schwab, British Journal of Ophthalmology, vol. 86, 2002, p. 843.
"Woodpeckers and Head Injury," Philip R.A. May, Joaquin M. Fuster, Paul Newman and Ada Hirschman, Lancet, vol. 307, no. 7957, February 28, 1976, pp. 454-5.
"Woodpeckers and Head Injury," Philip R.A. May, Joaquin M. Fuster, Paul Newman and Ada Hirschman, Lancet, vol. 307, no. 7973, June 19, 1976, pp. 1347-8.

See:

http://www.pbs.org/wgbh/evolution/library/01/1/image_pop/l_011_04.html

http://www.ucdmc.ucdavis.edu/welcome/features/20061011_ig_nobel_schwab/index.html

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