Measurements in Medicine

Excellent article in the New York Times delineating the issues with the phenomenon of over-measuring in both education and healthcare.  Sometimes measurement is good, and sometimes it can be wasteful and counterproductive.

From the article: In medicine, for example, measuring the rates of certain hospital-acquired infections, has led to a greater emphasis on prevention and has most likely saved lives.  On the other hand, measuring whether doctors had documented that they provided discharge instructions to heart failure or asthma patients at the end of their hospital stay sounds good, but turns out to be an exercise in futile box-checking, and should be jettisoned.

 

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Learned Associations Help with Chronic Pain

Chronic pain = pain lasting 12+weeks

“A 2014 study conducted by a multidisciplinary team of researchers that included University of Luxembourg psychological scientist Fernand Anton provided converging evidence for the role of conditioning in pain experiences. Participants experienced a painful electric pulse to one foot while they simultaneously put one hand in a bucket of ice water, the bracing sensation of the ice water actively mitigating the pain of the shock. The researchers found that participants who heard a telephone ringtone while engaging in this active pain reduction strategy came to associate the ringtone with pain reduction; they subsequently reported significantly lower pain from the pulse when exposed only to the ringtone. The finding reinforces how learned associations can help people regulate pain.”

http://www.psychologicalscience.org/index.php/publications/observer/2015/november-15/relief.html

Tendinitis vs. Tendinosis

Tendinitis is the inflammation of the tendon and results from microtears occuring when the musculotendinous unit is acutely overloaded with a tensile force that supercedes the capacity of the tendon.  Tendinitis is a very common diagnosis, although was is thought to be tendinitis is most likely usually tendinosis.

Tendinosis is what occurs with frequent/unaddressed tendinitis.  It is a degeneration of the tendon’s collagen in response to chronic overuse without proper healing of the tendon.

Dancing increases BDNF

It has been known for some time that exercise modulates BDNF (brain-derived neurotrophic factor), losses of which are implicated in cognitive diseases i.e. dementia + Alzheimer’s .  Makes sense that dance does the same doesn’t it.  An article eloquently exploring the concept: Article

Wikipedia also has a fantastic article on BDNF if you’d like to learn more:

https://en.wikipedia.org/wiki/Brain-derived_neurotrophic_factor

A problem with Google-searching Health Issues, and Curriculums

One issue with formal education programs is that a curriculum can take many years to be changed despite evidence suggesting that information within the curriculum is outdated. Many students, at this moment in 2016, are being taught that an anterior pelvic tilt is strongly correlated with low back pain, when the latest scientific evidence suggests otherwise.  In addition, a Google search might lead the general public in that direction as well.

A more nuanced and up-to-date thinking approach can be found however, if one looks in the right places.  The following being one of them, an article from Better Movement:

http://www.bettermovement.org/blog/2012/does-anterior-pelvic-tilt-cause-low-back-pain

Lorimer Moseley – Rockstar of Pain Science

The TED Talk shown above is both excellent and entertaining, especially for a topic that can be “painfully” dry.  Here are some other notable Moseley quotes:

-Thinking that we have a slipped disc has the potential to increase back pain. But what if this piece of knowledge we have stored is inaccurate, just like our notion of a slipped disc? A disc is so firmly attached to its vertebrae that it can never, ever slip. Despite this, we have the language, and the pictures to go with it, and both strongly suggest it can.

-When the brain is using this inaccurate information to evaluate how much danger one’s back is in, we can predict with confidence that, if all other things were equal, thinking you have a slipped disc and picturing one of those horrible clinical models of a slipped disc will increase your back pain.

-The evidence that tissue pathology does not explain chronic pain is overwhelming, in back pain, neck pain, and knee osteoarthritis for example.

-Yet we continue to avoid the truth that tissue damage, nociception and pain are distinct. I would go so far as to suggest that even the use of these erroneous terms – pain receptors, pain fibers and pain pathways – leaves the patient with chronic pain feeling illegitimate and betrayed, and leaves the rehabilitation team lacking credibility when they look beyond the tissues for a way to change pain.

Greg Lehman – “No Ideal Posture/Positions”

Greg Lehnman is a physiotherapist and chiropractor, and has a popular blog.  He denounces the poor science of “text-neck” in this article, hinting that there isn’t really an “ideal posture”:

http://www.greglehman.ca/2014/11/22/text-neck-is-bad-science-and-fear-mongering/

This is also a good article, in which he questions the validity of the perhaps outdated “lower-crossed syndrome”.

http://www.greglehman.ca/2016/01/11/jandas-lower-crossed-syndrome-has-not-been-validated/