Tuesday, August 25, 2009

TIME Magazine VS. Exercise

John Cloud has written an article that will be considered blasphemy by many in the fitness arena, including many in my own profession of physical therapy. The article appears in the August 17, 2009 TIME magazine and is titled "Why Exercise Won't Make You Thin." Quite a provocative title, eh?

There have been some good reviews recently of what science actually has to say about weight loss and these reviews are consistent with the overall theme of Clouds article. This one is excellent.

Does this mean that you should stop exercising because it is a waste of time? Of course not. Exercise has an excellent track record in quality research for having many many health benefits, and the TIME article is sure to make this point.

Many will take this information as disheartening. But, there is no need for this. As with all good information it adds to our understanding. How would the information in this article change your approach to weight loss?

Friday, August 7, 2009

Scrutinizing claims

One of the toughest yet most important thing to do as a consumer of health care is to know the quality of information that you're being given. How do you know if someone is giving you good information? After all, there is contradictory info out there for pretty much everything! Well, luckily for us not all information is created equally and there are ways to scrutinize claims to help gain some insight into how much weight, if any, they carry.

It may appear that I've grown infatuated with Dr. Val lately, as I'm about to link to another of her blog posts. I find her writing style and topics to be the best suited for the lay person out of all of the great authors at Science Based Medicine. This week she posted an intro on this very topic and it's excellent. Here it is.

I consider these to be vital skills. Otherwise it is easy to be fooled and easy to spend a lot of money on something that has no real value. The media in its various forms is a perfect place for poor information to take a foot hold and spread. Just look at my previous post on Oprah for an example. I mean she's Oprah. She only gives out good advice, right? How about Good Morning America? Charlie Gibson? The local news paper?

Turns out there is a website that critiques the quality of evidence behind some of the stories in the media. It's pretty interesting to read through. Here it is. Can you find any stories you recognize? Any surprises in the reports?

Wednesday, July 29, 2009

David Butler, of NOI group in Australia, has put out a video explaining Graded Motor Imagery. This treatment, offered here at Forward Motion, includes mirror therapy and continues to gain research support as a support for various pain and movement conditions.

Here is the video in its entirety.


Sunday, July 12, 2009

Health Care Reform

Health care reform is upon us and many, including myself, are watching anxiously to see what we'll end up with. Several terms are becoming more and more commonplace in the news, including "socialized medicine", "single payer system" and "public option." Much debate exists as to the utility of these approaches and I won't claim to have the answers.

Depending on your view point of the role of government, it seems, the Canadian system is pointed to as both a successful model to follow and an example of how this type of system can't work.

Dr. Val has a recent blog post taking a look at the Canadian system and some of the issues fueling both sides of the debate. She's also provided some links that also are informative.

Friday, June 5, 2009

Do You Get Your Medical Advice on Oprah?

Dare I speak against Oprah, who can turn a book into a best seller by simply mentioning that she's read it? Could someone who is richer than everyone I know combined and multiplied by 10 possibly not have all the answers?

I'll just give a general rule:

Being a celebrity does not make you an expert on anything other than being a celebrity.

Oprah's entertainment media is wildly popular and she is gifted at eliciting and portraying stories of empowerment. What she is not gifted at, apparently, is detecting or preventing the spread of bad medical/health advice. In fact, the opposite seems to be the case.

This recent newsweek article sums it up nicely. Now, please lower your tomatoes until you've read the article.

Friday, May 1, 2009

Forward Motion is a Zero Carbon Business!

Forward Motion Physical Therapy is proud to announce that we are now a carbon free business!

We have partnered with carbonfund.org to purchase a carbon offset, thereby making us a "Carbon-free partner" and a carbon neutral business. (Actually, we contributed at a level that should more than offset our carbon contribution thus making us a carbon reducing business!)

This is an interesting process. Carbonfund.org uses the money to support carbon reducing projects such as reforestation and wind farms and recieves a carbon credit through the "cap and trade" system for doing so. The credit is never traded, however, which effectively removes the carbon from the market. For a much more thorough description see this review.

In a time when the phrase "going green" is becoming increasingly more meaningless and prone to exploitation as it grows in popularity, this is an action that provides real results to a real problem.

Forward Motion is proud to be carbon-free!

Forward Motion is a Zero Carbon Business

Forward Motion Physical Therapy has become a "Carbon-free partner" with carbonfund.org.

This means that we have purchased a carbon offset to account for the amount of carbon that is generated by our business for the year. The process by which this occurs is pretty interesting. Carbonfund.org uses the money to support carbon reducing projects (like reforestation, or wind energy projects) which generates a carbon credit from the "cap and trade" system, but then never trades the credit. This effectively removes the carbon from the market. For a more thorough discussion of the process see this review.

In a time when "going green" is becoming an increasingly meaningless and exploitative term as it becomes more trendy, I feel that this approach provides real results for a real problem.

Forward Motion is proud to be carbon free!

Monday, March 2, 2009

Plantar Fasciitis

I see people with this diagnosis fairly frequently and it is a common source of frustration. It can be quite disabling at times and is notoriously stubborn to going away. Also, like many painful conditions, there is a lot of bad information running around about it and how to treat it. So, in this post I’ll try to provide some information regarding the condition, research, misconceptions, treatment, and return to activity.

What is it?

Plantar fasciitis is a diagnosis literally meaning “inflammation of the plantar fascia.” The plantar fascia is a tissue structure in your foot that runs from the front of the heel bone (calcaneous) to the end of the pre-toe bones (Metatarsal heads). It provides some (but not much) of the passive support of the arch of the foot. It is similar to a ligament (which runs from bone to bone) but is also continuous with some of the muscles/tendons of the extensor mechanism of the foot which includes the calf muscles, Achilles tendon, and the toe flexors.

How does one know if they have Plantar Fasciitis?

Plantar fasciitis is diagnosed through what are called clinical testing (as opposed to a laboratory test in which a sample is taken and tested. Ouch!) and by symptom description. Plantar Fasciitis is typically diagnosed by a few key findings:

1) Pain that is worst with the first steps in the morning or after prolonged periods of being off the feet. The pain typically improves after taking a few steps
2) Pain which worsens with activation of the extensor mechanism (through stretching back the big toe or bending back the ankle, for example)
3) Pain to pressure over the plantar fascia, especially where it attaches to the heel bone (calcaneous).

How is Plantar Fasciitis usually treated?

The following are treatments which are in the typical regimen for a patient with plantar fasciitis that have some research support behind them:

Manual therapy, progressions of stretching, use of over the counter or custom shoe orthotics, steroid injections, night splints (if the problem is chronic), taping (in the first couple of weeks only), iontophoresis (in the first couple of weeks only)

Common misconceptions:

First, this is a fairly non-specific problem with a very specific name. In other words, there are many instances (if not a majority) of foot and heel pain that have this same or very similar presentations which have nothing to do with the plantar fascia other than being in the same part of the body. Commonly any pain in the arch gets called “Plantar Fasciitis.”

A common misconception is that pain means that inflammation is present. This is not true. Signs of inflammation (red appearance, hot to touch, visible swelling) are often absent making the diagnosis of fasciitis (inflamed fascia) problematic in such cases. The physiology of tissue repair is such that when the process is continually restarted, inflammation (which is the first stage of the healing process) eventually stops initiating and the soft tissues become degenerative (a state of breaking down) and become infiltrated with new growth of blood vessels (called neovascularization) and nerve endings. This is exactly what has been found in several research studies looking at the state of tissues that had been diagnosed as inflamed. The current thinking is that many presentations that have typically been called Plantar Fasciitis are actually Plantar Fasciosis (degenerative tissue).

What to do about degenerative tissue?

First off, the most important thing to know is that degeneration does not hurt. This is heresy, I know, but it is what the research/science supports. You have to consider the nervous system whenever pain is involved. So, if you have pain and a degenerative state tissue you’ll have to handle the nervous system too, but I’ll get to that in a minute. Changing the environment of the tissue to one of building instead of breaking down is what is required. There are multiple ways to accomplish this and one specific form of exercise called eccentric loading has research to support it.

More misconceptions:

What is an often overlooked component to foot pain, especially when the pain won’t seem to go away or stay away, is the nervous system. The plantar nerves reside in the same area and are a more logical culprit for these symptoms much of the time. Nervous system can become sensitive in absence of inflammation. Think about a time when you’ve been outside in the cold without gloves and then went directly to take a hot shower. The water feels 10 times as hot on your hands as it does on the rest of your body. This is an example of nervous system sensitivity of the temperature sensing nerves. You wouldn’t think that your hands are inflamed when this happens, would you? This same phenomenon happens in the nerves that sense movement through stretch or pressure.

Nervous system gets sensitive for an almost infinite number of reasons and is a very complex process. The easiest way to think of it is like a moody friend (click on the first link when the page opens).

So, what do you do for nervous system sensitivity?

The good news is that when the problem is sensitive nervous system there is nothing “wrong” with your foot. Sensitivity is a normal function of your nervous system and all testing and imaging would come back negative. But, if you treat the foot as if it is inflamed, (rest, ice, compression, and elevation) you’ll be treating a problem that isn’t there and often times the pain returns as soon as you resume your normal activities. You treat a nervous system that is sensitive to movement…..with movement. Only not just any old movement will do. You’ll want to move in a way that does not cause the moody friend to show its teeth. Then you’ll gradually want to move more and more, exposing the nervous system to ever increasing movement and activity. My friend and colleague, Jason Silvernail, wrote an excellent essay called “watering the grass” (click on the 2nd link on the page that opens) that helps clarify this concept.

Friday, January 9, 2009

The Healthy Woman

As I have mentioned in the past, it is difficult to find information that can be trusted. This is very true when it comes to the health promotion industry that markets to women. Think of all the celebrity endorsements and talk show "experts" and you've got yourself a lot of confusion in the people just looking for some good information.

Dr. Val Jones has just reviewed a new book called "The Healthy Woman" on her blog, Better Health. Dr. Jones has a history of not being swayed by fad, having an understanding of what constitutes credible scientific research, and having a skeptical viewpoint. All of these qualities are quite beneficial when looking for information that you can trust.

Also, be sure to check out her resource center of trusted sources.

Keep up the good work, Dr. Val!