Hamstring injury rehab is an inexact science at best, says new study

Hamstring injuries are a huge part of sports, and with that so is the rehab. Every therapist has his or her own protocols that have worked for them and their patients. Here is an article that shows the limitations in the number and types of studies that have been done on Hamstring rehab. I know what I do works for me and my patients. Do the research, read the studies. Stay informed and know what works for you. 

Hamstring injury rehab is an inexact science at best, says new study

Posted on December 15, 2012 by Stone Hearth News

Cochrane Database Syst Rev. 2012 Dec 12;12:CD004575. doi: 10.1002/14651858.CD004575.pub3.

Rehabilitation for hamstring injuries.

Mason DL, Dickens VA, Vail A.

Source

Physiotherapy Directorate, Salford University, Allerton Annexe, Frederick Road Campus, Salford, Manchester, UK, M6 6PU.

Abstract

BACKGROUND:

Hamstring injuries are a common musculoskeletal disorder, particularly amongst athletes. Many factors have been associated with these injuries, including motor control and strength, soft tissue length and postural alignment. Well-established rehabilitation protocols are commonly used in the treatment of this condition, but their effectiveness remains questionable. This is an update of a Cochrane review first published in 2007.

OBJECTIVES:

To evaluate the effectiveness of all rehabilitation strategies employed to promote the return to full strength, range of movement and function of those individuals presenting with all forms of hamstring injury, regardless of site, severity, onset or level of chronicity.

SEARCH METHODS:

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to September 2011), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2011 Issue 3), MEDLINE (including in-process & other non-indexed citations: 1966 to August 2011), EMBASE (1980 to September 2011), PEDro (2006 to June 2012), CINAHL (1937 to September 2011), AMED (1985 to September 2011), SPORTDiscus (1859 to February 2006), and the World Health Organisation International Clinical Trials Registry platform (April 2012).

SELECTION CRITERIA:

Randomised clinical trials investigating the effect of at least one rehabilitation strategy, in isolation or combination with another, compared with another strategy or control, performed on individuals presenting with hamstring injuries.

DATA COLLECTION AND ANALYSIS:

Two review authors performed study selection. All review authors performed data extraction and assessed risk of bias. Any disagreement was resolved by discussion.

MAIN RESULTS:

Two trials were included in the review, totaling 104 participants. One trial assessed additional (four times a day) versus once daily stretching and the other assessed exercise for movement dysfunction versus stretching and strengthening. The first trial, involving 80 elite athletes, suggested additional stretching could reduce time to return to full activity (mean difference (MD) -1.8 days, 95% confidence interval (CI) -2.1 to -1.5, P < 0.001). The second trial, involving 24 participants from a diverse sporting background, did not find conclusive evidence of a difference (MD -14.5 days, 95% CI -30.64 to 1.64, P = 0.08). It did, however, report reduced re-injury rates using exercise for movement dysfunction of 8% versus 64% (odds ratio (OR) 0.05, 95% CI 0.00 to 0.52, P = 0.01). No other outcomes relevant to this review were reported by either study: most notably pain and participant satisfaction.

AUTHORS’ CONCLUSIONS:

Most proposed physiotherapy techniques for rehabilitation of hamstring injuries have not been assessed using randomised trials. Those that have only have single studies with a limited range of participants and outcomes. There is limited evidence to suggest that time to recovery for elite athletes can be reduced with an increased daily frequency of hamstring stretching exercises. There is preliminary evidence from another small study of mixed ability athletes to suggest that exercise to correct movement dysfunction could reduce time to return to full activity and the risk of re-injury. Further studies are required to check these findings. Until further evidence is available, current practice and widely published rehabilitation protocols cannot either be supported or refuted.

PMID:
23235611
[PubMed - in process]

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Source

Long-term aerobic exercise is associated with greater muscle strength throughout the life span

Posted on December 9, 2012 by Stone Hearth News

J Gerontol A Biol Sci Med Sci. 2012 Dec 3. [Epub ahead of print]

Long-term Aerobic Exercise Is Associated With Greater Muscle Strength Throughout the Life Span

Crane JD, Macneil LG, Tarnopolsky MA.

Source

Department of Pediatrics, McMaster University, 1200 Main St. West, HSC-2H26, Hamilton, Ontario, Canada, L8N 3Z5. tarnopol@mcmaster.ca.

Abstract

Aging is associated with a progressive decline in muscle strength, muscle mass, and aerobic capacity, which reduces mobility and impairs quality of life in elderly adults.

Exercise is commonly employed to improve muscle function in individuals of all ages; however, chronic aerobic exercise is believed to largely impact cardiovascular function and oxidative metabolism, with minimal effects on muscle mass and strength.

To study the effects of long-term aerobic exercise on muscle strength, we recruited 74 sedentary (SED) or highly aerobically active (ACT) men and women from within three distinct age groups (young: 20-39 years, middle: 40-64 years, and older: 65-86 years) and tested their aerobic capacity, isometric grip and knee extensor strength, and dynamic 1 repetition maximum knee extension.

As expected, ACT subjects had greater maximal oxygen uptake and peak aerobic power output compared with SED subjects (p < .05).

Grip strength relative to body weight declined with age (p < .05) and was greater in ACT compared with SED subjects in both hands (p < .05).

Similarly, relative maximal isometric knee extension torque declined with age (p < .05) and was higher in ACT versus SED individuals in both legs (p < .05).

Absolute and relative 1 repetition maximum knee extension declined with age (p < .05) and were greater in ACT versus SED groups (p < .05).

Knee extensor strength was associated with a greater amount of leg lean mass in the ACT subjects (p < .05). In summary, long-term aerobic exercise appears to attenuate age-related reductions in muscle strength in addition to its cardiorespiratory and metabolic benefits.

PMID:
23213030
[PubMed - as supplied by publisher]

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Source

Creative Yoga for Children

Posted on December 9, 2012 by Stone Hearth News

Creative Yoga for Children: Inspiring the Whole Child through Yoga, Songs, Literature, and Games offers a simple, ready-to-teach Montessori-based yoga program for children age twelve and under. Following age-appropriate classroom themes, the book’s forty detailed, one-hour lessons are designed to supplement any learning environment and are accessible to parents and teachers alike–no special training is required. In a recent study by California State University, Los Angeles, yoga was found to improve students’ behavior, physical health, academic performance, and attitudes toward themselves. Research also shows that the benefits of yoga are particularly strong among children with special needs. This book demonstrates how yoga can become a fun daily practice inside or outside the school classroom.

Enhanced with over 100 black and white photos, the book’s themes, or lessons, are divided by age range (ages four to six, seven to nine, and ten to twelve) and explore topics based on the child’s developmental level. For four- to six-year-olds there are twenty hour-long lessons on subjects ranging from colors and the holiday seasons to sounds and words. Ten hour-long lessons for seven- to nine-year-olds introduce such topics as the body, countries of the world, botany, zoology, and the universe. For ten- to twelve-year-olds, ten hour-long lessons cover the environment, geometry, the Earth, fractions, the food chain, and more.

Following the structure of a classroom lesson plan, each lesson incorporates elements of yoga including poses, breath work, meditation, and mindfulness. A discussion of the theme and intention of the lesson is followed by a warm-up of yoga poses. The children then engage in a cooperative “connecting” activity designed to bring them together, and a fun and lively theme-oriented activity that involves movement and awareness. The class winds down with breath work, a craft, and often a story. Finally, there is relaxation time and a guided meditation. With this preset structure, the children feel safe while being challenged and inspired.

Derived from the educational philosophy of Dr. Maria Montessori and the author’s own experience in the classroom and yoga studio,Creative Yoga for Children: Inspiring the Whole Child through Yoga, Songs, Literature, and Games allows children to move at their own pace and to be free to learn and grow within a non-competitive, nurturing setting. An essential resource for the 4,000 certified Montessori schools in the U.S., this book will appeal to yoga teachers, classroom teachers, parents, and anyone who works with children.

Read the first few pages of Creative Yoga for Children: Inspiring the Whole Child through Yoga, Songs, Literature, and Games

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Back pain more common among smokers

Back pain more common among smokers: new study

Posted on December 6, 2012 by Stone Hearth News

A University of Rochester Medical Center analysis of more than 5,300 patients followed for eight months during treatment of spinal disorders showed that cigarette smokers reported far more pain than never-smokers or those who had quit.

Smoking cessation either prior to treatment or during the course of care was related to significant improvements in pain – a result that underlines the need for structured stop-smoking programs among the legions of patients who experience back pain due to degenerative disease, deformity, or musculoskeletal problems, said Caleb Behrend, M.D., chief resident in the Department of Orthopaedics and Rehabilitation at URMC.

Glenn R. Rechtine, M.D., a nationally recognized spinal surgeon and adjunct faculty at URMC, led the study, which was published in the Journal of Bone and Joint Surgery.

“We found that people who stopped smoking had meaningful benefit by reduction of their pain,” said Behrend. “The pain improvement is in addition to all the other benefits you gain from quitting.”

The relationship between pain and smoking is complex and full of contradictions. Nicotine has analgesic properties, for example, and yet clinical evidence shows that smokers are at higher risk for developing back pain and other chronic pain disorders, according to the American Society of Anesthesiologists.

Scientists already know that nicotine interacts with a family of proteins (nAChR), which have a key role in the central, and peripheral nervous system, and control anxiety and pain. Prolonged exposure to cigarettes upsets the function of these cells and eventually changes the way pain is processed, as well as impairing oxygen delivery to tissues, predisposing a person to bone and joint disorders such as osteoporosis, and inducing inflammation and depression. Smokers with spinal conditions also tend to have persistently more intense pain and more long-term disability.

The URMC study noted a daunting fact: Nearly all people will experience back pain at some point in their lives and many will seek medical care. And because the socioeconomic impact of spinal disorders (cost of care and lost productivity for patients) is so great, researchers wanted to find out if improvements in pain could be achieved with a cost-effective intervention such as smoking cessation.

Researchers reviewed a prospectively maintained database of 5,333 patients, who completed questionnaires about pain at the initial doctors’ visit and at the time of discharge from care. Patients were treated with surgery, or with physical therapy, injections, over-the-counter medications, and home exercise programs. Physicians counseled all smokers to quit, and patients were referred to a smoking cessation hotline.

Of the 5,333 people, those who had never smoked or had quit some time ago reported less pain than smokers or those who had just quit. By the end of the follow-up period, the people who had recently quit or who quit during treatment showed significant improvements in pain. People who continued to smoke during treatment had no improvement in pain on all scales.

Behrend noted that younger people tended to comprise the group of current smokers and those who only decided to quit during treatment; this is consistent with other studies showing that smoking is associated with degenerative spine disease at a younger age. Older patients tended to comprise the group who had never smoked or quit long ago.

The rate of smoking cessation was 22 percent, and research shows that up to 36 percent of patients with painful spinal disorders are able to quit with help from a structured program. A grant from the Southwestern Medical Foundation was used to create and maintain the patient database.

How calorie restriction affects longevity

How calorie restriction affects longevity: some science

Posted on December 6, 2012 by Stone Hearth News

Scientists at the Gladstone Institutes have identified a novel mechanism by which a type of low-carb, low-calorie diet—called a “ketogenic diet”—could delay the effects of aging. This fundamental discovery reveals how such a diet could slow the aging process and may one day allow scientists to better treat or prevent age-related diseases, including heart disease, Alzheimer’s disease and many forms of cancer.

As the aging population continues to grow, age-related illnesses have become increasingly common. Already in the United States, nearly one in six people are over the age of 65. Heart disease continues to be the nation’s number one killer, with cancer and Alzheimer’s close behind. Such diseases place tremendous strain on patients, families and our healthcare system. But today, researchers in the laboratory of Gladstone Senior Investigator Eric Verdin, MD, have identified the role that a chemical compound in the human body plays in the aging process—and which may be key to new therapies for treating or preventing a variety of age-related diseases.

In the latest issue of the journal Science, available online today, Dr. Verdin and his team examined the role of the compound β-hydroxybutyrate (βOHB), a so-called “ketone body” that is produced during a prolonged low-calorie or ketogenic diet. While ketone bodies such as βOHB can be toxic when present at very high concentrations in people with diseases such as Type I diabetes, Dr. Verdin and colleagues found that at lower concentrations, βOHB helps protect cells from “oxidative stress”—which occurs as certain molecules build to toxic levels in the body and contributes to the aging process.

“Over the years, studies have found that restricting calories slows aging and increases longevity—however the mechanism of this effect has remained elusive” Dr. Verdin said. Dr. Verdin, the paper’s senior author, directs the Center for HIV & Aging at Gladstone and is also a professor at the University of California, San Francisco, with which Gladstone is affiliated. “Here, we find that βOHB—the body’s major source of energy during exercise or fasting—blocks a class of enzymes that would otherwise promote oxidative stress, thus protecting cells from aging.”

Oxidative stress occurs as cells use oxygen to produce energy, but this activity also releases other potentially toxic molecules, known as free radicals. As cells age, they become less effective in clearing these free radicals—leading to cell damage, oxidative stress and the effects of aging.

However, Dr. Verdin and his team found that βOHB might actually help delay this process. In a series of laboratory experiments—first in human cells in a dish and then in tissues taken from mice—the team monitored the biochemical changes that occur when βOHB is administered during a chronic calorie-restricted diet. The researchers found that calorie restriction spurs βOHB production, which blocked the activity of a class of enzymes called histone deacetylases, or HDACs.

Normally HDACs keep a pair of genes, called Foxo3a and Mt2, switched off. But increased levels of βOHB block the HDACs from doing so, which by default activates the two genes. Once activated, these genes kick-start a process that helps cells resist oxidative stress. This discovery not only identifies a novel signaling role for βOHB, but it could also represent a way to slow the detrimental effects of aging in all cells of the body.

“This breakthrough also greatly advances our understanding of the underlying mechanism behind HDACs, which had already been known to be involved in aging and neurological disease,” said Gladstone Investigator Katerina Akassoglou, PhD, an expert in neurological diseases and one of the paper’s co-authors. “The findings could be relevant for a wide range of neurological conditions, such as Alzheimer’s, Parkinson’s, autism and traumatic brain injury—diseases that afflict millions and for which there are few treatment options.”

“Identifying βOHB as a link between caloric restriction and protection from oxidative stress opens up a variety of new avenues to researchers for combating disease,” said Tadahiro Shimazu, a Gladstone postdoctoral fellow and the paper’s lead author. “In the future, we will continue to explore the role of βOHB—especially how it affects the body’s other organs, such as the heart or brain—to confirm whether the compound’s protective effects can be applied throughout the body.”

###

Matthew Hirschey, PhD; John Newman, MD, PhD; Wenjuan He, PhD; Kotaro Shirakawa, PhD; Natacha Le Moan, PhD; Carrie Grueter, PhD; Hyungwook Lim, PhD; Laura Saunders, PhD; Robert V. Farese, Jr., MD; and Katerina Akassoglou, PhD, also participated in this research at Gladstone. This research was supported by the Gladstone Institutes.

About the Gladstone Institutes

Gladstone is an independent and nonprofit biomedical-research organization dedicated to accelerating the pace of scientific discovery and innovation to prevent, treat and cure cardiovascular, viral and neurological diseases. Gladstone is affiliated with the University of California, San Francisco.