LLLT for Degenerative Foot Conditions

From Meditech International’s Winter 2015 Newsletter, on the subject of degenerative changes in the foot: “(LLLT) can increase angiogenesis, which is the formation of small collateral arteries, arterioles and capillaries resulting in increased arterial perfusion.  These physiological activities will increase the blood supply to the foot.  In turn, this has the potential to counter some of the secondary effects that occur in the ageing process and accelerate the regenerative process.  Laser Therapy can offer a myoprotective effect, preventing the apoptosis of myonuclei.  As such, prolonged course of Laser Therapy directly and positively impacts the majority of the problems of the ageing foot.”

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Elite Athletes + Interoception, Resilience + Chronic Pain

….elite athletes are very good at interpreting their own body signals in order to maintain their activity level within both biomechanical and metabolic limits. Ultimately, this ability enables them to cope with highly stressful situations without getting hurt. As often happens, the relation of causality between body awareness and being an athlete[*] is not clear, but nonetheless a link does exist

Given the close link existing between interoception and resilience  [1], and that chronic pain patients have indeed a poor representation of their affected part (see, for example [6]), low interoception/low resilience might have a crucial role in the development and maintenance of chronic pain. In other words, perhaps it is possible that when generally low interoceptive/low resilient individuals experience a stressful situation (e.g. a sprained ankle), they are unable to efficiently deal with the corresponding interoceptive signals….

Massage and Fitness Magazine

Quoted from Massage and Fitness Magazine by Nick Ng:

“Massage treatments don’t need to hurt or cause any discomfort. To be effective, massage needs only to provide novel stimuli for the nervous system.

Giving the patient the dramatic sensation of what is truly needed to make a change will produce therapeutic results. That may mean lingering on a sore spot to take the patient to the edge of discomfort – delivering the good pain.” ~ Bruce Martell, RMT

Food or Exercise for Fat Loss?

A new systematic review and meta-analysis has shown that dietary factors are indeed more important than exercise in terms of reducing body fat.  However, exercise is better at reducing visceral fat, the type of fat that is a primary risk factor for multiple chronic diseases!  Bottom line, is that both diet and exercise are important […]

Pain Science Gems

Taken from Lars Avemarie – PT and pain aficianado:

What we have learned about what “pain” is, (from pain research):

“Pain is not simply the end product of a linear sensory transmission system; it is a dynamic process that involves continuous interactions among complex ascending and descending systems. The neuromatrix theory guides us away from the Cartesian concept of pain as a sensation produced by injury, inflammation, or other tissue pathology and toward the concept of pain as a multidimensional experience produced by multiple influences”

Ref:.
Melzack R., Katz J. (2013), Pain. WIREs Cogn Sci, 4: 1–15.

“There is not an isomorphic relationship between pain and nociception, nor between pain and tissue damage“

“The evidence that tissue pathology does not explain chronic pain is overwhelming (e.g., in back pain [11], neck pain [12] and knee osteoarthritis [13]). 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.”

Ref.:
G Lorimer Moseley. Teaching people about pain: why do we keep beating around the bush? Pain Manage. (2012) 2(1), 1–3.

“The biology of pain is never really straightforward, even when it appears to be. It is proposed that understanding what is currently known about the biology of pain requires a reconceptualisation of what pain actually is, and how it serves our livelihood. There are four key points:

(i) that pain does not provide a measure of the state of the tissues;
(ii) that pain is modulated by many factors from across somatic, psychological and social domains;
(iii) that the relationship between pain and the state of the tissues becomes less predictable as pain
persists; and
(iv) that pain can be conceptualised as a conscious correlate of the implicit perception that tissue is in danger.”

Ref.:
Moseley, G. Lorimer. Reconceptualising pain according to modern pain science. Physical Therapy Reviews 2007; 12: 169–178.

“Pain catastrophizing has been associated with heightened pain severity, emotional distress and pain-related disability, even when controlling for medical status variables [2,4]. Pain catastrophizing has also been shown to compromise the effectiveness of pharmacological and psychological pain management interventions. Several studies have shown that reduction in pain catastrophizing is the single best predictor of successful rehabilitation for pain-related conditions [5,6].”

Ref.:
Sullivan M L. What is the clinical value of assessing pain-related psychosocial risk factors?. Pain Manage. (2013) 3(6), 413–416

“Psychosocial factors are important in the development of low back pain and disability.7,8 Depression, passive coping strategies, fear avoidance beliefs (the avoidance of movement or activity resulting from fear of pain or injury), and low expectations of recovery are independently associated with poor outcome.9,10 A clinical guide to assessing psychosocial warning signs (yellow flags) developed in New Zealand has been adopted internationally.11 Patients’ beliefs need to be better understood to improve management of low back pain.”

Ref.:
Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med. 2013 Nov-Dec;11(6):527-34.

“Clinicians should not utilize patient education and counseling strategies that either directly or indirectly increase the perceived threat or fear associated with low back pain, such as education and counseling strategies that

(1) promote extended bed-rest or
(2) provide in-depth, pathoanatomical explanations for the specific cause of the patient’s low back pain. ”

Ref.:
Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, Denninger TR, Godges JJ. Low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):A1-57. Epub 2012 Mar 30.

Effects of Manual Therapy

A fantastic article detailing the current scientific understanding of manual therapy and its limitations: http://www.truemovement.net/manual-therapies-make-space/

“I like to conceptualize the effects of hands on care as “making space.” People who seek massage or other manual therapies are typically having some kind of unpleasant experience they would like to distance themselves from, overcome, or adapt to. Because the application of skilled touch can provide short term pain relief, improvements in mood, reduced muscular tension, and improved range of motion, manual therapies can often create a sort of buffer from some of the factors that influence these experiences.

A great deal of common aches, injuries, stiffness, and other stressors will get better over time without intervention. While the nature of different conditions certainly influences the recovery period of these events, even some rather complicated disorders improve at about the same rate with or without treatment. The goal of manual therapy here is not to alter healing, but to make the natural process feel easier and more comfortable.”

Light Therapy Research @ Harvard and McGill

Some remarkable research coming out of Harvard and McGill with regards to light therapy. Very briefly, researchers have shown the potential for green light to reduce headache symptoms (while showing that blue light worsens symptoms) (Harvard), and for yellow light to reduce chronic pain (McGill).  This news comes at a time of burgeoning use of LLLT (low-level laser therapy) for musculoskeletal injuries/pain, a technology that uses red light (and infrared light) to speed musculoskeletal healing.  

Links to articles re. this research:

McGill/yellow light/research

Harvard/green light/research