PHYSIOTHERAPY

Golfer's elbow

2008-01-25T18:59:00.000-08:00

Introduction:

You step onto the fairway, swing your iron and take a divot — hard. The poor shot may do more than hurt your score. It may injure your elbow, too.

Golfer's elbow — also known as medial epicondylitis — is pain and inflammation on the inner side of the elbow, where the tendons of the forearm muscles attach to the bony bump on the inside of the elbow (medial epicondyle). The pain may spread into your for earm and wrist.

Golfer's elbow is similar to tennis elbow. But it occurs on the inside — rather than the outside — of the elbow. And it's not limited to golfers. Tennis players and others who repeatedly use their wrists or clench their fingers can develop golfer's elbow.

The pain of golfer's elbow doesn't have to keep you off the course or away from your favorite activities. With rest and appropriate treatment, you can get back into the swing of things.

Signs and symptoms:

Golfer's elbow is characterized by pain and tenderness on the inner side of the elbow. Sometimes the pain extends along the inner side of the forearm. Your elbo w may feel stiff, and it may hurt to make a fist. You may have weakness in your hands and wrists.

The pain of golfer's elbow may appear suddenly or gradually. The pain may get worse when you:

Swing a golf club or racket
Squeeze or pitch a ball
Shake hands
Turn a doorknob
Pick up something with your palm down
Flex your wrist toward your forearm

Causes:

Golfer's elbow is caused by damage to the muscles and tendons that control the wrist and fingers. The damage is typically related to excess or repetitive stress — especially forceful wrist and finger motions. Sometimes golfer's elbow begins after a sudden force to the elbow or wrist.

Many activities can lead to golfer's elbow, including:

Golf. Gripping or swinging the clubs incorrectly can take a toll on your muscles and tendons.
Racket sports. Excessive topspin can hurt your elbow. Using a racket that's too small, heavy or tightly strung also can lead to injury.
Throwing sports. Improper pitching technique in baseball or softball can be another culprit.
Other activities. Painting, raking, hammering, chopping wood, typing and other repetitive wrist, hand or arm movements can result in golfer's elbow as well.

Risk factors:

Golfer's elbow is most common in men ages 20 to 49 — but the condition can affect anyone who repetitively stresses the wrists or fingers.

When to seek medical advice:

Consult your doctor if rest, ice and over-the-counter pain relievers don't ease your elbow pain and tenderness. Seek immediate care if:

Your elbow is hot and inflamed, and you have a fever
You can't bend your elbow
Your elbow looks deformed
You suspect you've broken a bone

Screening and diagnosis:

Golfer's elbow is usually diagnosed based on your medical history and a physical exam. To evaluate pain and stiffness, the doctor may apply pressure to the affected area or ask you to move your elbow, wrist and fingers in various ways.

An X-ray can help the doctor rule out other possible causes of elbow pain, such as a fracture or arthritis. Rarely, more comprehensive imaging studies — such as magnetic resonance imagining (MRI) — are done.

Complications:

Left untreated, golfer's elbow can cause persistent elbow pain

Treatment:

The sooner you begin treatment, the sooner you'll be able to return to your usual activities.

Rest. Put your golf game or other repetitive activities on hold until the pain is gone. If you return to the links too soon, you may only make it worse.
Ice the affected area. Apply ice packs to your elbow for 15 to 20 minutes at a time, four times a day for several days. To protect your skin, wrap the ice packs in a thin towel. It also may help to massage the inner elbow with ice for five minutes at a time, two to three times a day.
Reduce the load on your elbow. Wrap your elbow with an elastic bandage or use a forearm strap.
Take an over-the-counter pain reliever. Try ibuprofen (Advil, Motrin, others), naproxen (Aleve), acetaminophen (Tylenol, others) or aspirin.
Consider other medications. If over-the-counter pain relievers aren't effective, your doctor may recommend a cortisone injection to reduce pain and swelling.
Stretch and strengthen the affected area. Your doctor may suggest specific stretching and strengthening exercises. Physical or occupational therapy can be helpful, too.
Gradually return to your usual activities. When you're no longer in pain, practice the arm motions of your sport or activity. Review your golf or tennis swing with an instructor and make adjustments if needed.
Ask your doctor when surgery is appropriate. Surgery is seldom necessary. But if your signs and symptoms don't respond to conservative treatment, surgery may be an option.

Depending on the severity of your condition, the pain may linger for several months — even if you take it easy and follow instructions to exercise your arm. Sometimes the pain returns or becomes chronic. While you're recovering, remember the importance of rest. Sneaking in a round of golf before your elbow heals won't help you feel better. It will only prolong your recovery.

Prevention:

Occasional divots may be unavoidable, but you can take steps to prevent golfer's elbow.

Strengthen your forearm muscles. Use light weights or squeeze a tennis ball. Even simple exercises can help your muscles better absorb the energy of sudden physical stress.
Stretch before your activity. Walk or jog for a few minutes to warm up your muscles. Then take time for gentle stretching before you begin your game.
Fix your form. If you golf, ask an instructor to check your grip and swing technique. Swinging the club more slowly or gripping the club with less pressure may decrease the amount of shock in your arm when you hit the ball. A club with a flexible shaft may help, too.

If you play tennis, ask an instructor to check your technique for hitting a forehand. You may need to decrease your topspin. The racket size and tension of the strings are important, too.
Lift smartly. When lifting anything — including free weights — keep your wrist rigid and stable to reduce the force transmitted to your elbow.

It's also important to know when to rest. At the first sign of elbow pain, take a break. In addition to self-care measures, time off is often needed to promote healing.

Neck pain 2

2008-01-25T18:42:00.000-08:00

Signs and symptoms:

Your neck contains bones, joints, tendons, ligaments, muscles and nerves, any of which can hurt. Neck pain also may come from regions near your neck, such as your jaw, head and shoulders. Conversely, problems in your neck can make other parts of your body hurt, such as your upper back, shoulders or arms.

If your nerves are involved in your neck pain, you may also feel numbness, tingling or weakness in your arms or legs.

Causes:

Muscle strains. Overuse, such as too many hours hunched over a steering wheel, often triggers muscle strains. Neck muscles, particularly those in the back of your neck, become fatigued and eventually strained. When you overuse your neck muscles repeatedly, chronic pain can develop. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.
Arthritis. Just like all the other joints in your body, your neck joints tend to deteriorate with age.
Disk disorders. As you age, the cushioning disks between your vertebrae become dry, narrowing the spaces in your spinal column where the nerves come out. The disks in your neck also can herniate. This means the inner gelatinous material of a disk protrudes through the disk's tough covering. Nearby nerves can be irritated. Other tissues and bony growths also can press on your nerves as they exit your spinal cord, causing pain.
Injury. Rear-end collisions often result in whiplash injuries, which occur when the head is jerked forward and back, stretching the soft tissues of the neck beyond their limits.

When to seek medical advice:

Muscle irritations are usually easy to self-diagnose. They typically come on after excessive activity, a period of overuse or prolonged postures that put excessive strain on your neck muscles. But they usually get better on their own within a few days to a couple of weeks. If the pain doesn't let up within a week or two, see your doctor.

Also see your doctor if the following signs and symptoms occur in conjunction with neck pain:
Severe pain from an injury. After head or neck trauma, such as whiplash or a blow to your head, see your doctor immediately. Severe pain over a bone might indicate a fracture or an injury to a ligament.
Shooting pain. Pain radiating to your shoulder, through your shoulder blades or down your arm, or numbness or tingling in your fingers, may indicate nerve irritation. Neck pain from nerve irritation can last from three to six months or longer. Because serious problems may occur after continued nerve irritation, see your doctor.
Loss of strength. Weakness in an arm or a leg, walking with a stiff leg, or shuffling your feet indicates the need for immediate evaluation.
Change in bladder or bowel habits. Any significant change, especially a sudden onset of incontinence, could indicate a neurological problem.

Screening and diagnosis:

Your doctor often will be able to diagnose the cause of your neck pain and recommend treatment just by asking questions about the type, location and onset of your pain.

In less clear-cut cases, your doctor may use imaging techniques such as X-rays, magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These tests may show compression of nerve roots, narrowing of nerve root outlets, spinal cord problems and disk problems.

Electromyography (EMG), a test that evaluates the electrical activity in nerve and muscle, may help determine if there's nerve damage. And myelography, or X-ray imaging of the spinal cord after injection of a dye beneath its tough outer membrane, may be helpful in determining if a disk, bone or other growth is crowding the nerves or spinal cord.

Treatment:

Most neck pain responds well to home care. Neck injuries or strains often result in painful inflammation. You may want to try over-the-counter pain relievers that also combat inflammation, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). Acetaminophen relieves pain but not inflammation.

Ice is another good way to reduce inflammation. Heat can help relax sore muscles, but it sometimes aggravates inflammation, so use it with caution. Apply heat or ice for 15 to 20 minutes, with a 40-minute rest between applications.

For pain that doesn't get better with simple home-care measures, your doctor may recommend:

Physical therapy. Heat, ice or similar treatments combined with an appropriate stretching and muscle strengthening program may enhance the structures that support your cervical spine. Such treatments are often all you need for neck pain.
Pain medications. Your doctor may prescribe stronger pain medicine than what you can get over-the-counter. Opioid analgesics are sometimes used briefly to treat acute neck pain. Muscle relaxants or tricyclic antidepressant medications also may be prescribed.
Traction. This therapy, under supervision of a medical professional and physical therapist, may provide relatively fast relief of some neck pain, especially pain related to nerve root irritation. Relief may last for hours or even days.
Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on your skin near the painful areas deliver tiny electrical impulses that may relieve pain.
Corticosteroid medication. Although there is some evidence that corticosteroids are useful, research is inconclusive. These drugs may be administered orally or via injection into the space around the nerve roots.
Short-term immobilization. A soft cervical collar that supports your neck without taxing your muscles may help.

Surgery. Surgery is rarely needed for neck pain. It is used to relieve nerve root or spinal cord compression.

Prevention:

Most neck pain is associated with poor posture. The goal is to keep your head centered over your spine, so gravity works with your neck instead of against it. Some simple changes in your daily routine may help.

Take frequent breaks if you drive long distances or work long hours at your computer. Keep your head back, over your spine, to reduce neck strain. Try to avoid gritting your teeth.
Adjust your desk, chair and computer so the monitor is at eye level. Knees should be slightly lower than hips. Use your chair's armrests.
Avoid tucking the phone between your ear and shoulder when you talk. If you use the phone a lot, get a headset.
Stretch frequently if you work at a desk. Shrug your shoulders up and down. Pull your shoulder blades together and then relax. Pull your shoulders down while leaning your head to each side to stretch your neck muscles.
Balance your base. Stretching the front chest wall muscles and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced base of support for the neck.
Avoid sleeping on your stomach. This position puts stress on your neck. Choose a pillow that supports the natural curve of your neck.

Stress Management

2008-01-25T18:41:00.000-08:00

What happens when you are stressed?

Stress is what you feel when you have to handle more than you are used to. When you are stressed, your body responds as though you are in danger. It makes hormones that speed up your heart, make you breathe faster, and give you a burst of energy. This is called the fight-or-flight stress response.

Some stress is normal and even useful. It can help if you need to work hard or react quickly. For example, it can help you win a race or finish an important job on time.

But if stress happens too often or lasts too long, it can have bad effects. It can be linked to headaches, an upset stomach, back pain, or trouble sleeping. It can weaken your immune system, making it harder to fight off disease. If you already have a health problem, stress may make it worse. It can make you moody, tense, or depressed. Your relationships may suffer, and you may not do well at work or school.

What can you do about stress?

The good news is that you can learn ways to manage stress. To get stress under control:

Find out what is causing stress in your life.
Look for ways to reduce the amount of stress in your life.
Learn healthy ways to relieve stress.

How do you figure out your stress level?

Sometimes it is clear where stress is coming from. You can count on stress during a major life change such as the death of a loved one, getting married, or having a baby. But other times it may not be so clear why you feel stressed.

It may help to keep a stress journal. Get a notebook and write down when something makes you feel stressed. Then write how you reacted and what you did to deal with the stress. Keeping a stress journal can help you find out what is causing your stress and how much stress you feel. Then you can take steps to reduce the stress or handle it better.

To find out how stressed you are right now, use this Interactive Tool: What Is Your Stress Level?

How can you reduce your stress?

Stress is a fact of life for most people. You may not be able to get rid of stress, but you can look for ways to lower it.

Try some of these ideas:

Learn better ways to manage your time. You may get more done with less stress if you make a schedule. Think about which things are most important, and do those first.
Find better ways to cope. Look at how you have been dealing with stress. Be honest about what works and what does not. Think about other things that might work better.
Take good care of yourself. Get plenty of rest. Eat well. Do not smoke. Limit how much alcohol you drink.
Try out new ways of thinking. When you find yourself starting to worry, try to stop the thoughts. Work on letting go of things you cannot change. Learn to say “no.”
Ask for help. People who have a strong network of family and friends manage stress better.

Sometimes stress is just too much to handle alone. It can help to talk to a friend or family member, but you may also want to see a counsellor.

How can you relieve stress?

You will feel better if you can find ways to get stress out of your system. The best ways to relieve stress are different for each person. Try some of these ideas to see which ones work for you:

Exercise. Regular exercise is one of the best ways to manage stress. Walking is a great way to get started.
Write. It can help to write about the things that are bothering you.
Let your feelings out. Talk, laugh, cry, and express anger when you need to.
Do something you enjoy. A hobby can help you relax. Volunteer work or work that helps others can be a great stress reliever.
Learn ways to relax your body. This can include breathing exercises, muscle relaxation exercises, massage, aromatherapy, yoga, or relaxing exercises like tai chi and qi gong.
Focus on the present. Try meditation, imagery exercises, or self-hypnosis. Listen to relaxing music. Try to look for the humour in life. Laughter really can be the best medicine.

Neck Pain

2008-01-25T18:40:00.000-08:00

What is neck pain?

Neck pain can occur anywhere in your neck, from the bottom of your head to the top of your shoulders. It can spread to your upper back or arms. It may limit how much you can move your head and neck.

Neck pain is common, especially in people older than 50.

What causes neck pain?

Most neck pain is caused by activities that strain the neck. Slouching, painting a ceiling, or sleeping with your neck twisted are some things that can cause neck pain. These kinds of activities can lead to neck strain, a spasm of the neck muscles, or swelling of the neck joints.

Neck pain can also be caused by an injury. A fall from a ladder or whiplash from a car accident can cause neck pain. Some less common medical problems can also lead to neck pain, such as:

An infection in the neck.
Narrowing of the spinal canal in the neck (cervical spinal stenosis).
Rheumatoid arthritis.

What are the symptoms?

You may feel a knot, stiffness, or severe pain in your neck. The pain may spread to your shoulders, upper back, or arms. You may get a headache. You may not be able to move or turn your head and neck easily. If there is pressure on a spinal nerve root, you might have pain that shoots down your arm. You may also have numbness, tingling, or weakness in your arm.

If your neck pain is long-lasting (chronic), you may have trouble coping with daily life. Common side effects of chronic pain include fatigue, depression, and anxiety.

How is neck pain diagnosed?

Your doctor will ask questions about your symptoms and do a physical examination. He or she may also ask about any injuries, illnesses, or activities that may be causing your neck pain.

During the physical examination, your doctor will check how well you can move your neck. He or she will also look for tenderness or numbness, tingling, or weakness in your arms or hands.

If your pain started after an injury, or if it doesn't improve after a few weeks, your doctor may want to do more tests. Imaging tests such as an X-ray, an MRI scan, or a CT scan can show the neck muscles and tissues. These tests may be done to check the neck bones, spinal discs, spinal nerve roots, and spinal cord .

How is it treated?

The type of treatment you need will depend on whether your neck pain is caused by activities, an injury, or another medical condition. Most neck pain caused by activities can be treated at home.

For neck pain that occurs suddenly:

Reduce pain by putting an ice pack on the sore area and taking ASA, ibuprofen, or another anti-inflammatory medicine. Acetaminophen (such as Tylenol) can also help relieve pain.
Avoid more injury to your neck by changing activities and habits, such as how you sit or sleep.
Try exercises or physiotherapy to help you move your head and neck more easily.

To treat chronic neck pain, your doctor may prescribe medicine to relax your neck muscles. Or you may get medicines to relieve pain and help you sleep. You might also try massage or yoga to relieve neck stress.

Surgery is rarely done to treat neck pain. But it may be done if your pain is caused by a medical problem, such as pressure on the spinal nerve roots, a tumour, or narrowing of the spinal canal.

Can you prevent neck pain?

You can avoid neck pain caused by stress or muscle strain with some new habits. Avoid spending a lot of time in positions that stress your neck. This can include sitting at a computer for a long time.

If your neck pain is worse at the end of the day, think about how you sit during the day. Sit straight in your chair with your feet flat on the floor. Take short breaks several times an hour.

If your neck pain is worse in the morning, check your pillow and the position you sleep in. Use a pillow that keeps your neck straight. Avoid sleeping on your stomach with your neck twisted or bent.

Learning about neck pain:	What is neck pain? What causes it? Can I prevent it? What are the symptoms? What happens with neck pain? What increases my risk of getting it?
Being diagnosed:	Who can diagnose neck pain? How is it diagnosed?
Getting treatment:	How is neck pain treated? What other treatments are there? What medicine will I need? Will I need surgery?
Living with neck pain:	What can I do to treat neck pain at home? How often will I need to see my doctor? When should I call my doctor? What exercises can prevent and treat neck pain?

Massage Therapy

2008-01-25T18:39:00.000-08:00

What is massage?

Massage is rubbing the soft tissues of the body, such as the muscles. Massage may be helpful in reducing tension and pain, improving blood flow, and encouraging relaxation. Massage therapists usually apply pressure with their hands, but they can also use their forearms, elbows, or feet. There are at least 80 different types of massage. Some are gentle, and some are very active and intense.

For example, Swedish massage is very gentle and is often used to promote relaxation, improve blood flow, and relieve muscle tension. The therapist uses long, gliding strokes and kneading and tapping techniques on the top layer of muscles in the direction of blood flow to the heart. This may also include moving the joints gently to improve range of motion.

Deep tissue massage is more active and intense. It is used to treat long-lasting muscle tension. The therapist applies slow strokes (with the fingers, thumbs, and elbows) using intense pressure to reach deeper layers of the muscles than those reached with a Swedish massage technique.

You can use self-massage to unwind after work or school, or to energize yourself in the morning. You can easily massage your feet, hands, or neck while doing other tasks or while relaxing. Self-massage works best if you are in comfortable clothes and are sitting or lying in a comfortable position. Use oil or lotion to massage bare skin.

Trigger point massage is less gentle and can sometimes be uncomfortable. The therapist applies firm pressure to knots or tight, tense muscles that have been overused or injured, continuing until the muscles relax. Let your massage therapist know if you feel any discomfort during the massage.

Some people feel that massage works because the touch is healing. Touch also communicates a sense of caring.

What is massage used for?

People use massage to promote relaxation and relieve pain. It can also relieve muscle tension and may improve blood flow, relieve pressure on nerves, and restore normal joint movement.

Most studies on massage show that massage reduces anxiety and may improve blood flow and decrease muscle tension.¹ However, there is little reliable evidence that massage reduces pain, improves movement, or improves athletic performance.¹

Is massage safe?

When done properly, massage is considered safe. Choosing a massage therapist who has received provincial certification ensures that your massage therapist has a certain level of training and uses certain practise guidelines. Keep in mind that massage requires a time commitment and may be expensive. The cost of massage therapy is generally not covered by provincial health plans but may be covered by private health insurance.

Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.

Golfer's elbow

2008-01-25T18:09:00.000-08:00

Golfer's elbow, or medial epicondylitis, is an inflammatory condition of the elbow which in some ways is similar to tennis elbow.

The flexor muscles of the forearm, the muscles responsible for bending the fingers and thumb, clenching the fist and supinating the hand excluding biceps brachialis, come together in a common tendon which is inserted in to the medial epicondyle of the humerus at the elbow joint. In response to minor injury, or sometimes for no obvious reason at all, the point of insertion becomes inflamed.

Causes:

The condition is called Golfer's elbow because in making a golf swing this tendon is stressed; many people, however, who develop the condition have never handled a golf club. It is also sometimes called Pitcher's elbow^[1] due to the same tendon being stressed by the throwing of objects such as a baseball, but this usage is much less frequent.

Symptoms:

The predominant symptom is pain on the medial aspect of the elbow joint, which is made much worse if the flexor muscles of the forearm are under tension but may occur at rest. On examination the medial epicondyle of the humerus is exquisitely tender. There may be some weakness of flexor function, caused by pain-mediated reflex inhibition of function of the flexor muscles.

Treatment:

Simple analgesic medication has a place, as does more specific treatment with oral anti-inflammatory medications. The definitive treatment is, however, the injection into and around the inflamed and tender area of a long-acting glucocorticoid (steroid) agent. After causing an initial exacerbation of symptoms lasting 24 to 48 hours, this will produce a resolution of the condition in some five to seven days.

The ulnar nerve runs in the groove between the medial humeral epicondyle and the olecranon process of the ulna. It is most important that this nerve should not be damaged accidentally in the process of injecting a Golfer's elbow.

Exercise and physiotherapy for tennis elbow

2008-01-25T18:02:00.000-08:00

Treatment Overview As part of a tennis elbow rehabilitation program, exercise and physiotherapy may promote tendon healing, restore normal range of motion, and build muscle strength and endurance.

Your doctor or physiotherapist can develop a home program that will help restore your elbow movement and prevent further injury. He or she will explain each exercise, including the correct technique and number of times you should repeat each movement.

Exercise

Exercises to build or maintain good fitness are important for your recovery. Walking, cycling, water aerobics, jogging, and other aerobic exercises can increase your heart and lung fitness and increase general strength and endurance, without making your injury worse. These activities also increase blood circulation; increased circulation supplies the injured tendon with more oxygen and may promote healing.

Appropriate exercises for stretching, strengthening, and increasing your endurance are vital to your recovery. Your doctor or physiotherapist can recommend the best stretching and strengthening exercises for your condition.

Physiotherapy

There are several different types of physiotherapy. Some examples include:

Learning new techniques and using different equipment for activities to help prevent further injury
Ultrasound applied over the tender area is commonly recommended, although there is little evidence to support its use. The theory is that this deep heat increases blood flow and tissue flexibility, and may decrease pain and muscle spasms. (Therapists don't often use ultrasound therapy on children.)
Electrical stimulation, or transcutaneous electrical nerve stimulation (TENS), which involves a mild electrical current that travels through electrodes placed at nerve trigger points. The objective is to mask pain signals sent by the brain to the body. Its effectiveness has not been proven.
Massage over an inflamed area, which may reduce the formation of scar tissue and help new blood vessels grow in the damaged tissue. Massage is done by making small, firm circles over the injured area. It should not be painful and may be helpful before and after exercises.
Manual therapy (sometimes called body work) uses just the hands to cause relaxation, lessen pain, and increase flexibility. Besides massage, manual therapy includes manipulation to position joints and bones. Mobilization is another form of manual therapy. The therapist uses slow, careful movements to twist, pull, or push bones and joints into position.

What To Expect After Treatment

Tennis elbow recovery time varies with each person and may take several weeks to several months. Recovery may be faster and more successful when you follow a rehabilitation program that includes exercise and physiotherapy.

Why It Is Done

Exercise and physiotherapy are helpful for treating elbow pain and soreness.

Exercise and physiotherapy after elbow surgery are an important part of your recovery and may promote healing and restore strength and flexibility.

How Well It Works

Most people can improve their elbow flexibility and strength with exercise and physiotherapy. Without a good rehabilitative exercise program, it is likely that tennis elbow injuries will not get better.

Risks

If exercises or physiotherapy are not done correctly, there is a chance of further injury to the elbow.

If your pain increases, stop the exercises or physiotherapy and seek help and instruction from your physiotherapist or other health professional.

What To Think About

Exercise and physiotherapy can help to restore flexibility and strength in an injured elbow.

It's important to improve or change techniques and equipment that may have caused tennis elbow. You can consult:

An occupational therapist, who can help you find new ways to do everyday things that cause pain or trouble.
A sports trainer, who can help with sporting activities and equipment.
An ergonomic specialist, who can design your equipment and train you in techniques that improve your workplace comfort and efficiency.

Tennis elbow

2008-01-25T17:44:00.000-08:00

Tennis elbow is a condition where the outer part of the elbow becomes painful and tender, usually as a result of a specific strain or overuse. Although it is called "tennis elbow", it should be noted that it is not restricted to tennis players. If one hyperextends an elbow in any sport, this may be classified as tennis elbow. Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to tennis elbow. The condition was first described in 1883.^[1]. The medical term is lateral epicondylitis.

Etiology

With tennis elbow, the extensor carpi radialis brevis tendon has been identified as the primary site of pathological change. There have also been pathological changes found at the extensor digitorum communis, longus and ulnaris tendons. The extensor carpi radialis brevis has a small origin and does transmit large forces through its tendon during repetitive grasping. It has also been implicated as being vulnerable during shearing stresses during all movements of the forearm. There is no evidence relating mode of onset to pathology although it is generally acknowledged that tennis elbow is caused by repetitive microtrauma/overuse. Inflammatory changes have been noted in the acute stages of the condition but have been found to be absent if symptoms become chronic (3 months +). This may explain why approaches such as corticosteroid injections have little impact in the chronic stages of the condition. Although the name suggests otherwise, tennis elbow can affect anyone - not just racquet sport players. However, there are numerous studies that have implicated racquet sports as a cause or contributing factor for tennis elbow. The peak incidence is between 34 to 54 years of age. No difference in incidence between men and women or association between tennis elbow and the dominant hand has been demonstrated. A weak association has been found between work and tennis elbow development. Risk factors for this condition vary from taking up tennis later in life, unaccustomed strenuous activity, decreased reaction times and speed and repetitive eccentric muscle contractions (controlled lengthening of a muscle group).

Symptoms

Pain on the outer part of elbow (lateral epicondyle).
Gripping and movements of the wrist hurt, especially wrist extension and lifting movements.
Tenderness to touch, and elbow pain on simple actions such as lifting up a cup of coffee or throwing a baseball.
Pain usually subsides overnight.
If no treatment given, can become chronic and more difficult to eradicate.

Exams and Tests

The diagnosis is made by clinical signs and symptoms, since x-rays are usually normal. Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow.

There is also pain near the elbow when the wrist is extended (bent backwards, like revving a motorcycle engine) against resistance. ^[2]

Treatment

The goal of treatment is to relieve pain and swelling. Treatment may include:

Nonsteroidal anti-inflammatory medications (such as ibuprofen, naproxen or aspirin)
Local injection of cortisone and an numbing medicine
Using a splint to keep the forearm and elbow still for 2 to 3 weeks
Heat therapy
Physical therapy
Pulsed ultrasound to break up scar tissue, promote healing, and increase blood flow in the area

To prevent the injury from happening again, a splint may be worn during aggravating activities. Or, you may need to limit certain activities. If the pain persists despite non-surgical treatments, surgery may be necessary. ^[3]

Although not founded in clinical research^[4] , the tennis player's treatment of choice is frequent icing and compression (Cold compression therapy) for inflammation, and taking anti-inflammatory pain-killers, such as ibuprofen. In general the evidence base for intervention measures is poor.^[5] A brace might also be recommended by a doctor to reduce the range of movement in the elbow and thus reduce the use and pain. Also, ergonomic considerations are important to help with the successful relief of lateral elbow pain.

Initial measures

Rest, ice, and compression are the treatments of choice. There are many excellent cold compression therapy products available. Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain and inflammation.

Exercises and stretches

Stretches and progressive strengthening exercises are essential to prevent re-irritation of the tendon^[6]. Progressive strengthening for this condition involves using weights or elastic theraband to increase pain free grip strength and forearm strength. Racquet sport players also are commonly advised to strengthen their shoulder rotator cuff, scapulothoracic and abdominal muscles by Physiotherapists to help reduce any overcompensation in the wrist extensors during gross shoulder and arm movements. Soft Tissue Release or simply Massage can help reduce the muscular tightness and reduce the tension on the tendons. Strapping of the forearm can help realign the muscle fibers and redistribute the load.

Physiotherapy

With physiotherapy, ultrasound can be used to reduce the inflammation and promote collagen production although the current evidence for its efficacy is inconclusive. Manual therapy (a form of physiotherapy) is an important part of the treatment; and can take the form of elbow joint mobilisations/manipulations and/or extensor muscle tissue mobilisations. Nerve mobilisation can also be helpful if the Physiotherapist finds a positive nerve tension test in their assessment. The most common upper limb nerve found to be sensitive is the radial nerve for this condition. Elbow clasps are also found to give temporary relief of symptoms.

Local steroid injections

Intra-articular glucocorticoid steroid injections can resolve episodes for several months, but there is a risk of later recurrence. Following an injection, the patient normally experiences increased pain over the subsequent day before the steroid starts to settle the condition over the next few days^[7] . As with any steroid injection, there is a small risk of local infection and tendon rupture. Most doctors will restrict giving further courses after two injections, as there is less likelihood of effectiveness but increased risk of side-effects.

As opposed to short-term effect^[8] , the longterm benefits of local steroid injection are less clearly established.^[9]

Surgical intervention

If conservative measures fail, release of the common extensor origin may be helpful. It may be undertaken under general anaesthesia or regional block.

Alternative treatments

Laser Therapy

The Use of Laser Therapy (Low Power or Low Intensity Laser Therapy) is a currently used treatment. The approach was spun off of research on how light affects cells. The findings, that light stimulates and accelerates normal healing, sparked the creation of several devices. The dosage often determines the extent of the success with this treatment, so it is generally recommended that experienced clinicians apply the therapy with a device that can be 'customized.' Professional athletes have used the therapy and it has gained attention in the media lately, on shows like the Canadian health program "Balance" on CTV. However, studies evaluating the efficacy of laser therapy for tennis elbow are currently contradictory.

One study has alleged that electrical stimulation combined with Acupuncture is beneficial but evaluation studies are inconclusive.^[10]

Prognosis

Most people improve with non-surgical treatment. The majority of those that do have surgery show an improvement in symptoms. ^[11]

Possible Complications

Recurrence of the injury with overuse
Rupture of the tendon with repeated steroid injections
Failure to improve with nonoperative or operative treatment; these may be due to nerve entrapment in the forearm

References

http://www.nlm.nih.gov/medlineplus/ency/article/000449.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000449.htm
Bisset L, Paungmali A, Vicenzino B, Beller E (2005). "A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia". Br J Sports Med 39 (7): 411-22; discussion 411-22. PMID 15976161
abstract.
^ Stasinopoulos D, Stasinopoulou K, Johnson MI (2005). "An exercise programme for the management of lateral elbow tendinopathy". Br J Sports Med 39 (12): 944-7. PMID 16306504 abstract.
^ Lewis M, Hay EM, Paterson SM, Croft P (2005). "Local steroid injections for tennis

Scleroderma - Information for Clinicians

2008-01-24T17:40:00.000-08:00

Scleroderma - Information for Clinicians

Scleroderma is one of a group of chronic autoimmune diseases including systemic lupus erythematosis and Sjogren's syndrome. These diseases form a spectrum, and feature various combinations of the same set of symptoms. Skin thickening is the hallmark of the disease. Traditionally, the term "scleroderma" has encompassed two groups: "localised scleroderma", where problems are confined to the skin, and "systemic sclerosis", where internal organs and vessels are involved as well as the skin.

Localised Scleroderma

Localised scleroderma includes a heterogeneous group of conditions characterised by circumscribed, patchy, or linear scleroderma without the typical serological and visceral manifestations of systemic sclerosis (see below). This condition should not be confused with limited cutaneous scleroderma (CREST), which is a systemic variety of scleroderma. Localised scleroderma primarily affects children and young adults, especially females.

Morphoea

Localised scleroderma is characterised by one or more erythematous or violaceous areas of the skin which evolve to become sclerotic and waxy. Plaques may grow during the active phase up to several centimetres in diameter with violaceous inflammatory borders, before spontaneously softening after several months to a few years.

Linear Scleroderma

In linear scleroderma, sclerotic lesions appear as linear streaks or bands, usually on the upper or lower extremities and less commonly on the trunk or forehead. If the fronto-parietal scalp is involved ("en coup de sabre"), disfiguring facial asymmetry and hemiatrophy may occur, while joint contractures and neurovascular involvement may occur if linear scleroderma crosses a joint.

Lesional histology in both of these conditions reveals excessive dermal collagen and cellular infiltration with lymphocytes, plasma cells and histiocytes. Inflammation and fibrosis may extend to the deep fascia, muscle, and rarely, underlying bone. During the active phase of disease, investigations may reveal a modest peripheral eosinophilia, antinuclear antibodies (especially anti-single-stranded DNA) and positive rheumatoid factor.

No treatment has been uniformly successful for these conditions. Transition from the localised variety to systemic sclerosis is very rare, as is co-existence of the two diseases.

Systemic Sclerosis

Systemic sclerosis is a global disease with an incidence of 1-2 in 100,000 predominantly affecting women (female:male = 4:1) between the ages of 30 and 60 years. Patients and their relatives have detectable antinuclear antibodies, implying a genetic susceptibility that is probably related to HLA haplotypes. However, environmental factors are also
important, as evidenced by the identification of certain chemical agents which cause scleroderma (Table 1). Augmentation mammoplasty was linked with scleroderma on the basis of early anecdotal reports, but several large trials have recently argued against a strong link between the two entities.

Table 1: Chemical agents implicated in the development of scleroderma

Organic chemicals

aliphatic hydrocarbons (e.g. vinyl chloride, trichloroethylene)
aromatic hydrocarbons (e.g. benzene, toluene)

Epoxy resins
Toxic oil (aniline-treated rapeseed oil)
Silica, in stone masons, coal miners, gold miners
Foam insulation (urea-formaldehyde)
Drugs (e.g. L-tryptophan, bleomycin, cocaine, pentazocine, appetite-suppressants)

Differential Diagnosis

It is important to consider many different conditions in the differential diagnosis of scleroderma which may cause similar clinical features (Table 2).

Table 2: Scleroderma-Like Syndromes
Immunological/Inflammatory	Chronic graft-versus-host disease Eosinophilic fascitis Overlap syndromes (eg with rheumatoid arthritis and SLE) Undifferentiated connective tissue disease
Metabolic	Scleroderma of Buschke with or without Scleromyxoedema paraproteinaemia Insulin-dependent diabetes mellitus (digital sclerosis) Carcinoid syndrome Amyloidosis Acromegaly Lichen sclerosis et atrophicus Acrodermatitis chronica atrophicans
Inherited	Phenylketonuria Porphyrias Premature aging syndromes (eg progeria, Werner’s syndrome)
Localised	Idiopathic pulmonary fibrosis Amyloidosis Sarcoidosis Infiltrating carcnomas Infitrating cardiomyopathy Oesophageal and intestinal hypomotility syndromes Lichen sclerosis et atrophicus Acrodermatitis chronica atrophicans

Clinical Presentation

Typically, patients present with tight skin, Raynaud's phenomenon, and painful joints. Swallowing difficulties and gastro-oesophageal reflux may also occur early in the disease. The duration of symptoms and signs help to place the patient into one of the two major subsets, the relatively benign limited form or the aggressive diffuse form of systemic sclerosis (Table 3). A subgroup of patients present without skin changes and sometimes without Raynaud's, but with features associated with scleroderma and positive autoantibodies. These people with "scleroderma sine scleroderma" may present with oesophagitis, malabsorption, pseudo-obstruction, renal failure, cardiac arrhythmias, and interstitial lung disease. A minority of patients present with primary Raynaud's phenomenon associated with positive autoantibodies and abnormal nailfold capillaries. These "pre-scleroderma" patients may be developing more classical systemic sclerosis.

Table 3: Spectrum of Disease in Systemic Sclerosis
Diffuse cutaneous systemic sclerosis	Onset of skin changes (puffy or hidebound) within 1 year of onset of Raynaud's phenomenon Truncal and acral skin involvement Tendon friction rubs Early and significant incidence of interstitial lung disease, oliguric renal failure, diffuse gastrointestinal disease, and myocardial involvement Nailfold capillary dilatation and capillary drop-out Anti-topoisomerase I (Scl-70) antibodies in 30% Limited cutaneous systemic sclerosis (CREST) Raynaud's phenomenon for years (occasionally decades) Skin involvement limited to hands, face, feet, and forearms (acral) or absent Significant late incidence (10-15 years) of pulmonary hypertension, with or without interstitial lung disease, skin calcifications, telangiectasia, and gastrointestinal involvement High incidence of anti-centromere antibody (ACA) (70-80%) Dilated nailfold capillary loops, usually without capillary drop-out
Scleroderma sine scleroderma	Raynaud's phenomenon (may or may not be present) No skin involvement Presentation with pulmonary fibrosis, scleroderma renal crisis, cardiac disease, gastrointestinal disease Antinuclear antibodies may be present (Scl-70, ACA, nucleolar)
Pre-scleroderma	Raynaud's phenomenon plus nailfold capillary changes. Circulating autoantibodies (Scl-70, ACA, nucleolar)

Limited Cutaneous Systemic Sclerosis

Limited cutaneous systemic sclerosis is also known as CREST syndrome, an acronym referring to the combination of Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. Isolated Raynaud's may be present for years to decades before the insidious development of mild skin thickening limited to the distal extremities and face. Although the behaviour of CREST is generally far more benign than that of the diffuse variety, two important complications may occur after 10 to 15 years of disease: small bowel involvement producing malabsorption, and primary pulmonary hypertension. This occurs in about 10% of such patients and is not secondary to pulmonary fibrosis, which is rare in this patient subset. Mean survival after the detection of pulmonary hypertension is two years, with no effective therapy yet available.

Diffuse Cutaneous Scleroderma

Whereas skin involvement in CREST is mild and gradual, diffuse scleroderma is characterised by rapid progression of significant skin thickening, especially over the first 1 to 3 years, after which progression slowly plateaus. This is accompanied by restriction of mobility in tendons, joints, and muscles, with contractures and ulceration, as well as impaired eye closure, mouth opening, and even respiration, through chest-wall involvement. Tendon friction rubs are an ominous sign which may antedate rapid skin thickening or visceral involvement. Gastrointestinal involvement can cause dry mouth (sicca), oesophageal dysmotility with reflux, gastroparesis and bowel hypomotility with malabsorption. 70% of patients develop some degree of pulmonary fibrosis, which is the commonest cause of death directly related to scleroderma. The pulmonary hypertension occurring secondary to interstitial lung disease is generally milder than the primary form seen in CREST. 15-20% of patients with diffuse disease develop scleroderma renal crisis, which tends to occur in the first five years of disease and is usually (but not always) heralded by the abrupt onset of malignant hypertension associated with microangiopathic haemolysis. Angiotensin-converting-enzyme (ACE) inhibitors play a vital role in the management of this complication. Less commonly, pericarditis, biventricular failure and arrhythmias can complicate the illness.

Prognosis

After 5 years of illness (the "late" stage of diffuse disease), skin and musculoskeletal problems plateau and there is a reduced risk of new organ involvement, but existing visceral disease may still slowly progress. The five-year cumulative survival rate is about 70%, but this figure rises or falls depending on whether renal, lung, or heart disease co-exists.

Pathophysiology

The exact cause of disease is unknown, but it is believed to be due to an interplay between immunological, vascular, and connective tissue abnormalities occurring in genetically predisposed individuals.

Immunological: Over 80% of patients have detectable autoantibodies (Table 4). 50% of patients have dermal infiltration by T and B cells and macrophages.
Vascular: Primary capillary abnormalities may induce platelet activation, thrombus formation, and vasculitis. There is capillary intimal proliferation and serological evidence of endothelial damage (e.g. raised levels of endothelin-I and Von Willebrands Factor). In scleroderma renal crisis, renal vessels display fibrinoid necrosis ("onion-skinning"). Nailfold capillaroscopy reveals capillary drop-out and dilatation.
Connective-Tissue: Fibroblasts from these patients make excessive amounts of collagen in tissue culture. This may be related to cytokine imbalances, such as excesses of IL-1 and IL-2.
Genetic: HLA associations exist (e.g. anti-centromere antibodies and HLA-DR1) but are relatively weak. The tightskin mouse, an animal model of scleroderma, has a mutation of chromosome 2.

The Role of the Immunology Laboratory

In practical terms, anti-nuclear antibody (ANA), extractable nuclear antigens (ENA), and double-stranded DNA (dsDNA) antibodies should be requested. The ANA screen will be positive in over 80% of scleroderma patients. The detection of the extractable nuclear antigens RNP, Scl-70, and Pm-Scl will increase diagnostic specificity and provide prognostic information. For example, Scl-70 predicts an increased likelihood of pulmonary interstitial involvement. Antibody testing for dsDNA should be performed to exclude systemic lupus erythematosis, which may present with any of the above clinical features. The major types of autoantibodies and their associations are listed in Table 4.

Table 4: Major Autoantibodies in Scleroderma

ANA Pattern

Antigen

Associations

Organ Involvement

Centromere (ACA)

Centromere
(kinetochore)

CREST: 60% sensitive
98% specific

Pulmonary hypertension

Nucleolar

-speckled

-homogeneous

-clumpy

Scl-70
(topoisomerase-I)

Pm-Scl
(nucleolin)

Fibrillarin
(U3RNP)

Diffuse:38% sensitive 100% specific

Overlap with myositis

Overlap with myositis

Pulmonary fibrosis

Myositis

Pulmonary hypertension Myositis

Speckled

U1RNP

Mixed Connective
Tissue Disease

Raynaud's, myositis, serositis, arthritis

Disease Management

The chronicity of this disease makes a holistic approach important. Problems in coping with the diagnosis and living with the fatigue and other inconveniences the disease brings should be anticipated. Patient support groups are often valuable for encouragement as well as education.

Raynaud's may be controlled by maintaining warmth, especially of the central body, as well as avoiding smoking, Â¸-blockers, and other exacerbating factors. Sometimes calcium blockade, topical nitrates, and even parenteral vasodilators are required. Sympathectomy offers temporary relief in many cases. Scrupulous skin care and moisturisation is essential. ACE inhibitors play a major role in the management of scleroderma-related hypertension.

A number of agents have been shown to modulate disease in uncontrolled trials, including penicillamine, cyclosporin, methotrexate and colchicine. However, none of these agents are of proven efficacy, and all of them have significant potential side effects.

References

1. The Oxford Textbook of Medicine. Weatherall DJ, Ledingham JGG, Warrell DA. Oxford University Press 1996. Volume 3, p.3027 2. Primer on the Rheumatic Diseases, 9th Edition. Arthritis Foundation, Atlanta, Georgia, 1988.p.111

Written By: Glenn Reeves
Hunter Immunology Uni

Scleroderma, Lupus

2008-01-24T17:35:00.000-08:00

Muscles and Joints - Scleroderma

Connective Tissues

The body is comprised of millions of cells and these cells are held together by connective tissue. Early in evolution nature had to solve the problem of how cells could be held together to create a multi-cellular organism. A major solution was the building of extra-cellular (outside the cell) collagen fibrils and fibres. Collagen fibrils have the same tensile strength as steel wires and they act to hold together the cells of various tissues. There are several types of collagen and different forms are found in different parts of the body. Collagen is produced by cells called fibroblasts.

Connective tissue is also comprised of a related fibrous protein called elastin, which has elastic properties. Elastin is important in tissues that expand such as the lung and arterial wall. The other major components of connective tissue are the proteoglycans, which are sugar-rich substances that also have elastic properties and can expand and resist compression. Large amounts of proteoglycans are found in cartilage.

The fibrosis (tightening)of the skin and internal organs that occurs in scleroderma is the result of too much collagen being produced by the fibroblasts. The cause of this is unknown. The type of collagen produced, however, is normal.

Bone and Joint Involvement

Several types of joint involvement can occur in scleroderma.

1. Mild joint pain and stiffness involving the fingers, wrists, knees and ankles may occur early in scleroderma. This may be associated with generalised (overall) swelling of the fingers, the joints may be a little swollen and examination of joint fluid shows only mild inflammation. On biopsy excess collagen is found in the lining of the joint (the synovium). Sometimes calcification (calcinosis) can also occur in and around the joint. Joint erosions do not usually occur. Later flexion contractures (bowed fingers) can occur. These are caused by tight tendons, skin and fibrosis of connective tissues around the joint with increased amounts of collagen being present in these structures.

2. Occasionally a more severe joint swelling and inflammation can occur resembling rheumatoid arthritis, but this is very uncommon.

3. Because of lack of movement of the joints involved as a result of the stiffness, osteoporosis can occur but this does not usually cause symptoms.

4. The end bones of the fingers (distal phalanges) may partly become resorbed and disappear leaving shortened fingers. This is called osteolysis. This may occur in later stages of severe disease.

The joint involvement of scleroderma usually settles with physiotherapy and anti-inflammatory drugs.

Muscle Involvement

Muscle involvement is common in scleroderma.

1. The weakness and wasting of muscle commonly found in scleroderma is a result of disuse owing to joint contractures as a result of the skin involvement.

2. About 20% of patients with scleroderma develop a bland non-progressive muscle disorder (myopathy). Weakness is not usually noticed by the patient, but it can be detected on physical examination by the physician and the tests of muscle inflammation are either normal or only minimally elevated. The muscle biopsy shows areas of replacement of muscle fibres with collagen tissue without evidence of inflammation. This muscle involvement does not usually require treatment.

3. A very small minority of patients develop acute inflammation of their muscles with severe muscle pain and weakness especially around the shoulders and hips causing problems in arising from chairs and elevating the arms. This may occur in patients who have an overlap syndrome with features of scleroderma, polymyositis and S.L.E. (Mixed connective tissue disease). This form of muscle inflammation requires high dose Prednisone (Cortisone) for control.

Tendon Involvement

1. Some patients become aware of creaking noises on movement of their fingers or wrists, knees or ankles. They note a peculiar type of coarse leathery grating that may be felt over these areas during movement. The noise is due to fibrous deposits on the surface of tendon sheaths (the lining of tendons) and this often indicates a more severe form of scleroderma.

2. Symptoms of carpal tunnel compression may occur early in the disease with tingling and numbness in the hands at night or aching in the hands at night. This is caused by swelling of the tendons in the wrists causing pressure on the median nerve in the wrist. This may need treatment with a resting splint worn at night or a local steroid injection if necessary into the carpal tunnel, or surgical decompression.

Written By: Dr J. Glass
Visiting Medical Officer, Department of Rheumatology,

Royal Newcastle Hospital

Posture, Pain Relief and Exercise

2008-01-24T17:34:00.000-08:00

Posture

Posture refers to how we hold our bodies. If your body is not in correct alignment, your muscles and other body parts are subject to extra stresses for which they are not designed. The following additional factors further increase the stress on your body:

Poor footwear
Being physically unfit
Fatigue
Emotional stress
Being overweight
Maintaining one position for too long.

Outlined below is a guide for good posture:

Sitting:	Place your bottom back in the seat, with hips and knees bent to 90 degrees and your feet flat on the floor (use a stool or book if your feet do not reach the floor). Avoid low, saggy chairs which are hard to get out of and provide poor support. Adjust your work chair correctly, considering seat tilt and heights of the chair and back support . When in a chair at home or in the car, use a lumbar roll (or roll up a towel) to support the curve in your lower back. Ensure your desk height is at elbow level.
Standing:	Keep your chin tucked in (not poked forward), shoulders relaxed (not hunched forward or backward) and knees a little relaxed (not forced backward). Vary your position by placing one foot on a stool and keep your work height at elbow level.
Lying:	A firm mattress will provide good support. It is better to rest your joints in a flat rather than a flexed position. Do not place a pillow under your knees and only place enough under your neck so it is not bent up or down.
Lifting:	Hold object close to your body and never bend or twist your spine.

Pain Relief

Heat or cold may be used to relieve your symptoms and help you cope with pain. These can provide temporary relief but do not affect the disease process itself. It is very important that you have adequate sensation in the area to which you are applying the heat or cold. When receiving a heat/cold treatment all you should feel is a mild or comfortable warmth/cold sensation, though not so hot or cold that it is painful. If you feel more than this, or the heat/cold concentrates in any particular spot you must remove the heat/cold, otherwise you may be in danger of being burned.

You should also check with your doctor or physiotherapist first before applying heat or cold if you have any of the following conditions:

Poor circulation
Open wounds
Acute areas of inflammation and infection
Skin disorders, eg eczema, dermatitis
Areas of increased fluid tension
Conditions where you bleed easily
Severe heart or kidney disease

Heat Therapy

Heat can relieve pain, stiffness and muscle spasm and should be applied for 20 to 30 minutes. Ways of applying heat include:

Hot shower or bath
Hot water bottle
Heat wheat pack
Gel pack
Hot towel
Electric blanket
Lambskin

Coat hands in baby oil, apply gloves and place hands in warm water (this is also a good time to do your hand exercises) .

Cold Therapy

Cold can be effective for the relief of pain, muscle spasm and swelling and should be applied for 15 to 20 minutes. It should not be used if you have Raynaudâ€™s Phenomenon. Could can be applied using:

Crushed ice in a wet towel
A packet of frozen peas
Gel pack

Exercise

Exercise has many physical, social and psychological benefits. Regular exercise can help to improve your:

Muscle and joint mobility and flexibility
Muscle strength
Heart and lung fitness

These guidelines will help to make your exercise routine effective and safe:

1. Exercise on â€˜goodâ€™ days and rest on â€˜badâ€™ days

It is important to find a good balance between exercise and rest. When you are less comfortable, it may be possible to maintain some form of exercise by modifying the position in which you exercise (eg lying or sitting rather than standing) or decreasing the number of exercises. Performing some relaxation (breathing exercises, meditation or muscle relaxation) may help to enhance periods of exercise and rest. You do not have to do all your exercises at once.

2. Respect pain

You may push into a little bit of stiffness but never force joints into pain.

3. Do not substitute activities of daily living for exercise

Vacuuming or sweeping do not have the same value as exercise.

4. Exercise at the right time

You will exercise more effectively if you are not in pain. Use heat therapy and medications prior to exercise.

5. Start exercise slowly and increase gradually

Individual joint exercises should start at 2 repetitions and increase one daily until you reach six. Start you walking program at 10 minutes and gradually increase.

6. If you have any medical problems, check with your doctor before starting a new exercise program.

7. Exercise safely and make it fun

Make realistic goals
Keep your fluids up
Wear correct clothing and footwear
Keep a diary
Warm up and cool down
Exercise with a friend or take your dog for a walk to the shops
Do not hold your breath when you exercise. You should be able to carry on a normal conversation when you exercise.

The following forms of exercise may be suitable for you:

Walking
Badminton
Swimming
Line Dancing
Aquarobics
Ballroom Dancing
Tennis
Table Tennis
Cycling
Tai Chi
Golf Yoga
Bowls
Stretch and Tone Classes
Croquet
Individual joint range of movement exercises at home or in a pool

If you have any particular concerns, please see your doctor for a referral to see a physiotherapist for advice on posture, pain relief and an individualised exercise program.

Maintain Your Posture

2008-01-24T16:47:00.000-08:00

The best way to improve or maintain your posture is to always practice good posture, when sitting, standing, or moving. Practicing good posture is not always as easy as it sounds, especially for some of us who have forgotten what good posture feels like. The following two exercises can help bring back that good posture feeling.

Tips for maintaining good posture while sitting:

Sit with back firmly against chair; chair should be low enough to allow placement of both feet on the floor with knees slightly higher than hips.
Keep your head up and avoid leaning forward. If you work long hours at a desk or typewriter,keep your chair close-in to the desk top to help maintain your upright position.
If you feel your low back arching forward while sitting, cross your legs or put your feet up on a stool.
Other Exercises You Can Do:
O nly after a complete postural evaluation as provided by a physical therapist can you identify your particular postural problems. At that time you may be given specific exercises to correct them. One problem common to most people with poor posture is weakness of the lower abdominal muscles. If your lower abdomen sags and bulges, you can be sure the muscles there are weak. The best way to strengthen these muscles is to participate in an exercise that isolates and actively uses them. Contrary to popular belief, sit-ups do not always accomplish this goal. In fact, sit-ups, when done improperly, often cause unnecessary strain on back muscles and may cause additional complications. The following exercise, although not as vigorous as a sit-up, is perfect for tightening the lower abdominal muscles.

Good Posture For Life
Changes occur naturally in your body as you grow older. These changes can influence your posture and make it more difficult to maintain a good posture or correct a poor posture.
Some of the physical changes that occur:
The disks between the spinal segments become less resilient and give in more readily to external forces, such as gravity and body weight.
Muscles become less flexible.

Compression and deterioration of the spine, commonly seen in individuals with osteoporosis, cause an increased flexed, or bent forward, posture.
Lifestyles usually become more sedentary. Sitting for long periods of time shortens various
muscles, which results in the body being pulled into poor postural positions, and stretches and weakens other muscles, which allows the body to slump. Despite the changes that occur naturally with aging, good posture can be maintained and, for many, poor posture improved. In individuals with severe postural problems, such as poor alignments that have existed so long that structural changes have occurred, the poor posture can be kept from getting progressively worse. In any case, all of us must consciously work at achieving and maintaining good posture as we grow older.

Tips for Maintaining Good

Posture Throughout Your Life

Throughout each day, concentrate on keeping your three natural back curves in balanced alignment.
Keep your weight down; excess weight exerts a constant forward pull on the back muscles and stretches and weakens muscles in the abdomen.
M Avoid staying in one position for long periods of time; inactivity causes muscle tension and weakness.
Sleep on a firm mattress & use a pillow under your head just big enough to maintain the
normal cervical-neck-curve. Avoid use of oversized or several pillows.
Exercise regularly; exercise promotes strong and flexible muscles that keep you upright in a proper postural position.
Protect your back by using good body mechanics;bend your knees when picking something up or putting it down; carry a heavy object by using two hands and keeping the load close to your waist.
Wear comfortable and well-supported shoes. Avoid continuous use of high-heeled or platform shoes, which distort the normal shape of the foot and throw the back’s natural curves out of alignment.
Walk with good posture; keep head erect with chin parallel to the ground, allow arms to swing naturally, and keep feet pointed in the direction you are going.

Good Posture

2008-01-24T09:57:00.000-08:00

T o have good posture, it is essential that your back, muscles, and joints be in tip-top shape.

Your Back. A healthy back has three natural curves: a slight forward curve in the neck (cervical curve), a slight backward curve in the upper back (thoracic curve), and a slight forward curve in the low back (lumbar curve). Good posture actually means keeping these three curves in balanced alignment.
Your Muscles. Strong and flexible muscles also are essential to good posture. Abdominal, hip, and leg muscles that are weak and inflexible cannot support your back’s natural curves.
Your Joints. Hip, knee, and ankle joints balance your back’s natural curves when you move, making it possible to maintain good posture in any position.A View of Good Posture;

Good posture—when you are standing—is straight vertical alignment of your body from the top of your head, through your body’s center, to the bottom of your feet. From a side view, good posture can be seen as an imaginary vertical line through the ear, shoulder, hip, knee, and ankle. In addition, the three natural curves in your back can be seen. From a back view, the spine and head are straight, not curved to the right or left. The front view of good posture shows equal heights of shoulders, hips, and knees. The head is held straight, not tilted or turned to one side

Poor Posture
P oor posture distorts the body’s proper vertical alignment and the back’s natural curves.
Good posture only has one appearance, but poor posture comes in many unattractive styles.

Check Your Posture
T he best way to check your posture is to receive a thorough postural evaluation from a physical therapist. Physical therapists have special skills to evaluate and treat postural problems.
To determine if a professional evaluation may be necessary, you can evaluate your own posture to some degree. For this you need a wall and a fulllength mirror.
To check for normal curves of the spine:
Stand with your back to a wall, heels about three inches from the wall. Place one hand behind your neck, with the back of the hand against the wall, and the other hand behind your low back with the palm against the wall. If there is excessive space between your back and the wall, such that you can easily move your hands forward and back more than one inch, some adjustment in your posture may be necessary to restore the normal curves of your spine.

GOUTY ARTHRITIS

2008-01-16T06:27:00.000-08:00

WHAT IS GOUTY ARTHRITIS?The nature of Gouty Arthritis is most easily understood and controlled, as it stems from a partially known set of causes. It is a defect in the ability to rid oneself of uric acid, thus causing uric acid crystals to lodge in the collagen tissue matrices throughout portions of the body, especially near and around the joints. It also causes kidney stones, high blood pressure and other health problems in some folks, but it rarely afflicts women or children. As Osteoporosis is predominately a woman’s disease, gout is predominantely a man’s disease, the ratio being about 19 men for 1 women. Ninety-five percent of gout victims, therefore, are men. The few women who have gout show signs and symptoms after menopause, so there must surely be a hormonal component to gout. Children are almost never affected. Up until the 1960’s gout was a terrible disease without much help from the medical profession. One had attacks of fever, chills
and excruciating needle-like pains. The gout victim suffered for weeks at a time. Eventually the attacks of gout became more frequent and eventually disabling, with kidney disease, heart
disease and many other complications setting in5.

WHAT CAUSES GOUTY ARTHRITIS?Those who suffer from gout have a condition known as Hyperuricemia, which simply means too much uric acid in the blood serum. If you placed some of the patient’s blood on a string and let it dry, there would form linked crystals of uric acid. These when deposited in the wrong places in the body create joint inflammation, kidney blockage and lumps called “tophi5.”Uric acid does not easily dissolve in water, and blood is composed mainly of water. One gram of salt will dissolve in about one-half teaspoon of water; one gram of sugar in about one-tenth teaspoon of water. To dissolve the same amount of uric acid takes at least two quarts of water! We can easily produce uric acid, and our bodies are geared to conserving it, instead of excreting it freely through our kidneys with other waste products. The kidneys remove it from the blood, and hen restore most of it back to the bloodstream so that it can go on to other organs for use. It may also be that many gout victims are more efficient in doing this filtering/restoring, but that is only speculation. The extra uric acid must lodge someplace, and that’s where the pain comes in, when the body decides to deposit the small uric acid crystals in a collagen matrix, especially near a moving joint. Research by German scientists have pointed to mycoplasms as a source of gout. The mycoplasms produce a substance called ubiquiton, which causes the precipitation of uric acid. Interestingly, mycoplasms have also been indicted as a source of Rheumatoid Disease by Thomas McPherson Brown, M.D.

HOW CAN GOUTY ARTHRITIS BE PREVENTED AND/OR TREATED?

Very little is known about what starts and stops gout attacks. Emotional upset or stress can surely bring on an attack. Without question, diet can control attacks, causing it to be greater or lesser depending upon what is eaten. Perhaps weather changes or drugs may precipitate an attack. There are no general rules that apply to everyone5. Besides the diet — and probably related to the diet — is the fact of tissue acidity/alkalinity balances. It is also important that sufficient thyroid be produced or available to the metabolism. Not enough is known about the metabolic defects that bring about gout and so, other than inheriting a healthy metabolism, and
maintaining other healthy conditions, such as diet and relief of stress, appropriate physicial exercise and so on, few recommendations can be given for preventing the condition known as Gouty Arthritis. At least one person -- and probably more than one -- has restored this bodily functions to a healthy condition and found that his gout had disappeared.
If you do find yourself with Gouty Arthritis, there is a wellknown and accepted diet and medications that can be used to control the affliction. However, according to Warren Levin, M.D., "One of the well-recognized triggers for attacks of gout is a weight-reduction
program emphasizing low carbohydrate. This results in the patient going into ketosis as the body burns fatty-acid residues for energy. [Ketosis is a condition of too many ketones in the body, any compound containing the carbonyl group, CO.] These are ordinarily harmless 'clinkers' from the body's energy furnaces, although in excess they cause ketoacidosis as, for instance, severe diabetes where the body is unable to burn carbohydrates as well. The normal mechanism of excretion of ketone bodies is through the kidney and, hence, Dr. Robert Atkins' use of KetoStixTM to prove the compliance of his patients on the rigorous carbohydrate restriction. This same excretory pathway, however, is utilized by the body in excreting
uric acid. When there is a high level of ketoacid, it's like competition for a revolving door, everything slows down. The result is sometimes a dramatic increase in serum levels of uric acid, which can precipitate either kidney stones or a gouty attack."

Physical Therapy

Physical therapy and/or heat is often given a major role in the treatment or management of arthritis. Certainly it is important to exercise sufficiently to keep the joints working, but a word of caution: In the case of Gouty Arthritis, such physical activity is not only extremely painful, but may also help to rapidly erode joint bearing surfaces by the action of uric acid crystals gouging into the surfaces. If Rheumatoid Arthritis is caused by a genetic susceptibility
to the protein products or toxins of an unknown organism29, then extended exercise and heat will cause that organism to be spread further and faster, probably resulting in what is known as "galloping arthritis1." The Rheumatoid Disease Foundation takes the position that one should first halt the progress of the disease, and then conduct more strenuous exercises.

HOW CAN RHEUMATOID ARTHRITIS BE TREATED

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Rheumatoid Arthritis is known as “the great crippler,” and as such, this condition frightens a great many. Established medical doctrine does not admit to any solution or knowledge on how to
make one so afflicted well. According to Clinics in Rheumatic Diseases11, a peer-reviewed summary of peer-reviewed research literature, established treatments are statistically no more effective than if the afflicted were left alone, or about one out of three would spontaneously remit — at least for the moment — if left alone. Actually the statistics are somewhat worse when one realizes that traditional immuno-modulating drugs such as methotrexate, gold, penicillamine and long-term cortico-steroids are not only not effective but also further damage the immunological system. It is hardly recommended, therefore, that any kind of traditional treatments including the above damaging drugs be accepted by the patient. First and foremost for those found to be afflicted with Rheumatoid Disease is the searching out and removal of (or removal from) causation of stress2. Secondly, nutritional guidance and vitamin and mineral and
essential fatty acid supplements must be sought. A whole life-style change may be involved in accepting the two recommendations above, and so the question the afflicted must ask is this: Do I want to be well or will I continue to raise barriers against wellness? Third, a holistically minded physician will begin to rule out other conditions that the body uses to mimic Rheumatoid Arthritis. These may include, but not be limited to, external allergies from various pollutants and known allergens, internal allergies such as from food, air or drink, Candidiasis, bacterial pathogens (from ticks: Lyme Disease, for example), and from the inability to properly bring nourishment through the blood stream because of atherosclerosis. In this latter condition, of course, would be recommended Chelation Therapy. Fourth, a holistically minded physician may also want to determine if the hormonal system is in balance and, if replacement hormones are suggested, to so provide them to the patient

Allergies
Of all the conditions that create symptoms perceivable as "arthritic" certain ones seem to be most prominent. Candidiasis and others will be discussed briefly.The yeast/fungus Candidas albicans, is an ever-present microorganism. C. Orian Truss, M.D. first identified the characteristics and symptomatic patterns that deduced whether or not an individual
was being overwhelmed by this organism. Candidas albicans invades various parts of bodily tissues, resulting in the appearance of localized infections. Common sites of infection are the mouth as in infant Thrush, gastrointestinal tract, vagina, urinary tract, prostate gland, skin, fingernails and toenails. Under normal conditions your body is able to resist this invasion, as it does other germs. Whenever various substances weaken the immunological system,
the yeast/fungus begins to spread, and creates havoc throughout body parts and systems. It may cripple the immune system so that it can no longer repel invaders. It can create allergies to chemicals and foods. It is believed that it invades the intestinal wall where toxins from microorganisms and protein molecules from food enter the blood stream directly from the intestinal tract. Once inside the bloodstream these foreign proteins are recognized as foreign antigens and the body manufactures antibodies to it. This is the start of additional food allergies which progresses with the progress of Rheumatoid Disease. is the subject of treatment for Candidiasis is covered elsewhere, we shall not go further with the subject here. However, it has
a clear relationship to bringing about wellness in the Rheumatoid Disease patient as well as having a strong contribution to the general subject of allergies.

Other Allergies
Allergies are often described as being extrinsic (to the body) or intrinsic. Examples of extrinsic allergies are pollen, chemicals, fabrics, and so on. Examples of intrinsic allergies are: (1) foreign
invaders protozoa, bacteria, mycoplasma, yeast/fungus, virus or toxins produced by these microrganisms; and (2) residual chemicals or derivatives of chemicals that are stored in lipids (fatty parts) in the cells. Intolerance to foods may be genetically derived or might very well be from weakened intestinal lining from such agents as Candidiasis. As any of the above allergies can (1) produce symptoms that mimic various arthritic symptoms and (2) contribute to free radical pathology that enforces the arthritic condition, serious attention should be paid to either avoidance of the allergenic substances or treatments that cure the underlying allergenic response.

Treatments for Extrinisic and
Intrinsic Allergies
There are various alternative treatments reported to have affect on the course of otherwise intransigent allergies. These are Ozone Therapy32, 35 Photopheresis, Hydrogen Peroxide (IV) Therapy. Carnivora Pitcher Plant (Venus Fly Trap) Therapy44, Live Cell Therapy85, and Bee Pollen30, 45, 46, 55, 81. No one is entirely sure how all of these treatments function, but they obviously have an underlying ability to strengthen the immunological system, provide proper nourishment and/or enzymes, or help in the repair of crucial organs. J.O. Hunter found that food intolerance has been implicated in many conditions, and exclusion diets were found to be effective when treating "migraine, Crohn's disease, eczema, hyperactivity and rheumatoid arthritis80." Additional treatments include Bio-Detoxification and Clinical Ecological Treatment.

PREVENTION OF RHEUMATOID ARTHRITIS

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There are several primary keys known to effectively prevent Rheumatoid Arthritis with most people, although it is also true that embryos and newly born children can be affected by unknown mechanisms or by means of circumstances beyond their control. Among these primary keys, of course, are the dual mechanisms of insuring proper diet62, 63 and vitamin64, mineral and essential fatty acid supplements, and relief from stressful living conditions1, 2. Nutritional factors are again those common to health, which means, according to Gus J. Prosch, Jr., M.D.95, use of unpolluted fresh vegetables and fruits, whole grains and nuts, cold water fish (non-farmed) (for essential fatty acids), and so on. As researched and demonstrated by Carl J. Reich, M.D. of Canada, the object is to insure that bodily tissues are sustained as an alkaline, as opposed to an acidic condition, and this can be tested easily by a simple litmus paper test on saliva that is free from food and drinks momentarily. A litmus paper test of small children, then older children, and so on upwards toward older adults, will demonstrate that litmused saliva tends to be very dark purplish with the younger and then slowly fade out as an acid condition takes over from inappropriate nourishment as we age1, 2. Nutrition must take into consideration possible food allergies for each individual. Robert Bingham, M.D.20 has reported that about 1/3 of the arthritics are sensitive to solanines (nightshades), which should be eliminated from the diet. Solanines (nightshades) are potatoes, peppers, eggplant, tomatoes and tobacco. As with the treatment of Osteoarthritis, joint conditions can be greatly improved through the usage of William Kaufman's Ph.D., M.D. regimen of niacinamide, the dosage dependent upon the degree of joint inflexibility as measured by a special easy-to-use
scale89, 90, 91. Eating the proper essential fatty acids, and avoiding the wrong
kind of fats, is very important with most degenerative diseases, including Rheumatoid Arthritis, according to Gus J. Prosch, Jr.,M.D.21, 95.
Stress Management is absolutely essential for the Rheumatoid Arthritic. The reason is this: When we are under stress, adrenalin is produced which turns on cortisone in the form of a
substance called “cortisol.” Cortisol, to provide us with quick energy during emergencies, causes small proteins in the immunological system to be utilized as a quick energy source. When we are under stress continuually, this process goes on continually. The utilization of portions of the immunological system as quick energy causes the natural balance of cells responsible for defending us from invaders to be upset, and that, in effect, creates a kind of weakening of the immunological system. The weakening of the immunological system permits organisms of
opportunity (such as Candidas albicans) to spread throughout the body, which further creates problems.

Other Treatments of arthritis

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Photopheresis
Photopheresis is a new form of treatment that exposes portions of the blood mixed with a light-sensitive chemical to ultra-violet radiation. Its object is to "immunize" the body against malignant T cells found in the immunological system. It has so far shown promise for the treatment of various Rheumatoid Diseases (Scleroderma, Lupus Erythematosus, Rheumatoid Arthritis), autoimmune diabetes mellitus, organ transplant rejection and AIDS related complex25. William Campbell Douglass, M.D. of Georgia reports excellent success with many otherwise intransigent disease conditions, using photopheresis, and especially against AIDS26.
Cryogenic Exposure and Exercise Treatment Japanese scientists first studied the effect of cryogenic exposure on degenerative disease. Tonis Pai27, M.D. of Tallin, Estonia continues this work reporting improvement among patients with various joint diseases, including Rheumatoid Arthritis and Osteoarthritis. Patients enter a chamber (cooled cryogenically by liquid nitrogen) for repeated visits for a duration of 1-3 minutes. They then exercise strenuously. Dr.Pai has reported improvement in various arthritic conditions.
Ge132: Bis-Beta-carboxyethyl
Germanium Sesquioxide
Dr. K. Asai of Japan designed Bis-Beta-carboxyethyl Germanium Sesquioxide (Ge132), finding thereafter many interesting and useful properties. Ge132 is a substance that does not easily enter into bodily tissues, and therefore has been found to be non-dangerous. It performs several valuable functions, among which is the ability to take up excess electrons from the cell's mitochondria, and flush them from the body. This function is analogous to increasing basal metabolism in that excess electrons can create free-radicals which
may lead to pain and inflammation. Ge132 also decreases pain by increasing endorphins in the brain. "In both humans and animals Ge132 has been shown to increase gamma interferon in the blood, activate macrophages and natural killer cells, bring blood hemoglobin levels up and white cell counts down, stimulate immunomodulation activity in the B cell system and demonstrate antitumor and antiviral activities. This substance, therefore, may be an excellent adjuvant (aids the operation) of immunochemotherapeutic agents. The effects of Ge132 on various immune parameters are almost identical to that of known gamma interferon immunomodulating activity. In addition, studies on immune-suppressed animals and on patients with malignancies or rheumatoid arthritis suggest that Ge132 normalized the function of T cells, B lymphocytes, anti-bodydependent cellular cytotoxicity, natural killer cell activity and numbers of antibody-forming cells. Obviously organic germanium has a `normalizing' influence on the immune system57,58,59," and it can be effectively used either sub-lingually or as an injectable. Caution: do not take Germanium Oxide, which can be damaging, even poisonous.

Live-Cell Therapy

According to Lester Winter, Ph.D.12, 85, 93, European Live-Cell Therapy has been available to the rich and famous since 1915. This replacment therapy now is available at a reasonable cost outside of the United States in Europe, Bahamas, Mexico and other countries. Briefly, either calf or piglet embryonic tissue is injected (or placed) in the body. For a period of one to four years, depending upon nutrition, metabolism and life-style, these foreign tissues supply hormones and other vital chemicals which the body uses as its own. In particular, according to Dr. med. Gerhard Shettler94, intraarticular cellular therapy is often effective in replacing joint cartilage.Live-cell therapy is well worth exploring for various health reasons, not just Osteoarthritis and Rheumatoid Diseases.

Homeopathy

Homeopathy is several centuries old, and was once a widely practiced healing discipline, until the dominance of allopathic medicine in many parts of the world. According to the Arizona Revised Statutes 32-2901, "Homeopathy means a system of medicine employing substances of animal, vegetable or mineral origin which are given in microdosage, prepared according to homeopathic pharmacology, in accordance with the principle that a substance which produces symptoms in a healthy person can cure those symptoms in an ill person. The practice of homeopathy [in Arizona] includes acupuncture, neuromuscular integration, orthomolecular therapy, nutrition, chelation therapy, pharamaceutical medicine and minor surgery66." As some practitioners of Homeopathy do not subscribe to the total practice as described herein, we will discuss only the first part of the above definition. Dr. Samuel Hahneman (one of Napoleon Bonaparte's physicians66, 69), Kent66, and others founded and defined the basic outlines of Homeopathy. On Napoleon's route to conquer most of Europe, Napoleon used "Dr. Hahneman to keep his troops free of typhoid fever. Hahneman created a totally new concept of medicine, which he called `Homeopathy,' derived from the Greek words, `homeos,' which means `similar,' and, `pathos' or `disease'. Hahneman's basic law was, `Let's cure a disease with the disease itself, or like cures like69.' Hahneman and other physicians observed and reported that an extremely minute dosage of a substance that could reproduce some of the symptoms of a known disease could somehow teach the body how to heal itself. Substances, therefore, are diluted to such an extreme dilution that scoffing scientists will describe the dosages as being the "essence of residual vibrations of a ghostly spirit passing quickly through the room one time." Carefully selected substances are sequentially diluted (and struck: percussed) to concentrations such as 0.9 X 10-61. The more diluted is the substance chosen, the more "powerful" its effect -- a phenomenon which stretches normal imagination beyond training of allopathic physicians.
Hydrogen Peroxide Therapy and
Ozone Therapy
Hydrogen Peroxide has been in medical use for several centuries34,37,39, and there are thousands of scientific studies on its use. What is not well known is that Hydrogen Peroxide is also used by many both internally37 and externally for many different disease conditions, including Rheumatoid Disease. Ozone Therapy35 is somewhat newer on the medical scene. These two are often referred to as "Oxygen Therapies," which is somewhat of a misnomer. One can take a breath of air and receive more oxygen than one can receive from Hydrogen Peroxide Therapy, and the use of Ozone Therapy32, although not entirely understood, is clearly not that of supplying additional oxygen. Like Photopheresis, a certain supply of blood is removed, treated with Ozone, and then replaced in the patient. In desperation for relief -- any kind of relief -- arthritics will gradually increase their oral intake of food-grade hydrogen peroxide, many reporting relief of their symptoms, and sometimes their degenerative conditions. Other physicians, including Charles H. Farr, M.D., Ph.D.31, have shown that the intravenous usage of hydrogen peroxide has a beneficial effect on many disease states. They have also shown that the good effects of intravenous hydrogen peroxide usage stem principally from its ability to activate oxidation enzymes. Osteoarthritis and Rheumatoid Arthritis have been historically
viewed by established medical practitioners as two far-ranging "unsolved" disease conditions. As established medicine admits to no answer despite a multitude of modern scientific tests and categorizations of phenomena, it is not surprising to find that trial and error medicine by those concerned and those afflicted have brought about some practical answers. What is surprising is that many of these answers have no clear or clearly known underlying basis. For example, among various proferred solutions to either the inflammatory conditions, or to the underlying unknown physiological mechanisms are Diet, Extreme Cold Therapy, Hydrotherapy, Poultices and Topical Treatments, Homeopathy, modern methods based on Professor Dr. Guenther Enderlein's work68, Biomagnetics, Colon Therapy, Sound Therapy, Color Therapy, Aromatherapy, Mental Healing, Ayurveda, Dental Involvement (replacing poisonous mercury amalgams), Live Cell Therapy, Hydrogen Peroxide Therapy, Acupuncture, Acupressure, Rolfing, Oxygen and Ozone Therapy, Photopheresis, Yoga, Chelation Therapy98 and many specialized organic substances from either the land61 or sea36. Obviously not all of these treatments work for 100% of the afflicted or there would be no reason for this chapter. The Rheumatoid Disease Foundation takes the position that -- since established medicine admits to no answers -- each person must search out the medical answer for him/herself, and that search may require openmindedly trying one recommendation after another. After all, to the afflicted, it is not the correct theory that is important, but whether or not desirable results are achieved.

TREATMENT OF OSTEOARTHRITIS

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TREATMENT OF OSTEOARTHRITIS;
Treatment for Osteoarthritis can be divided into four components: Treatment for the
(1) pain,
(2) defective skeletal structure,
(3) faulty nutrition,
(4) hormonal imbalances.
As treatment for faulty nutrition and hormonal imbalances have already been mentioned, and as they both require individualized attention by holistically minded physicians, we shall further discuss only treatment for pain and defective skeletal structure, with the exception of repeated emphasis of the use of niacinamide as per William Kaufman's Ph.D. M.D. early and lengthy research work89, 90, 91.
Pain
Professor Roger Wyburn-Mason M.D, Ph.D. more than thirty years ago was able to demonstrate that the source of pain in both Osteoarthritis and Rheumatoid Disease is not in the joints — where most modern-day treatment lies — but in certain key nerve ganglia leading to the joint. These nerve ganglia are found in uninsulated nerves usually lying close to the skin’s surface, known as "C fibers."
Intra-neural Injections
Using Roger Wyburn-Mason's theory, Dr. Paul Pybus7 found that a combination of Depot Medrol with a very dilute solution of Triamcinolone Hexacetonide (LederspanR or AristospanR) not only immediately halted the pain appearing in remote joints, but also permitted the nerve cell lesions to heal, probably by stabilizing nerve cell membranes. Pybus stated that these nerve lesions triggered off two signals, one set following the nerve path to the brain, the other following
a reflex arc to the spinal column and back. The signal to the brain came back to represent pain at the joint. The reflex signal to the spinal column came back to the joint to produce the following
easily recognizable phenomena: heated joints (pyrexia), swollen joints (edema) and tension or clamping of muscles at the joints. It is the tension or clamping of muscles at the joints which creates degeneration of cartilage at the joint which results in the pain of Osteoarthritis (or the pain of Rheumatoid Arthritis), and this was explained by Pybus by knowledge of Charnley clamps used on knee joints which, while producing a forcible compression of joints, also resulted in destruction of cartilage in the joints.

Acupuncture:

Most of the traditional acupuncture points are exactly the same as the trigger or key nerve ganglia used in Intra-neural Injections, and the physics of explanation is identical for both, as the developer of Intra-neural Injections, Dr. Paul Pybus, was first an acupuncturist and surgeon. He said, "Acupuncture . . . shows no great permanency in the relief afforded just by one treatment, as when the needle is removed the membrane is still destabilized and the condition reverts
to the status quo ante." This seems to be confirmed by the experience of Arabinda Das, M.D. who says, "acupuncture may help localized pain of rheumatoid arthritis but chronic generalized rheumatoid arthritis is not amenable to acupuncture as [is true with] many chronic infectious conditions79." When Pybus combined acupuncture with a substance that stabilized the nerve cell membrane, he began to see long-term improvement in both Osteoarthritis and the pain of Rheumatoid Arthritis. Undoubtedly others who were familiar with Acupuncture discovered this same phenomenon, as there is now practised "Pharamaceutical Acupuncture." In addition to good effects on pain, Acupuncture is said to strengthen the immune system69.

Arithritis

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Introduction:There are many kinds of arthitides determined by observation of symptoms, each named uniquely. The three most prominent are Osteoarthritis, Rheumatoid Arthritis and Gouty Arthritis. Tens of millions of Americans suffer from either Osteoarthritis or Gouty Arthritis. At least thirteen million Americans suffer from so-called incurable Rheumatoid Disease, a
name given to a broad cluster of diseases, perhaps 100 in number that, while appearing to be different diseases because they are differently named, are all related by the fact that collagen tissue is somehow affected. An estimated forty million people have Osteoarthritis, six million have Rheumatoid Arthritis and about one million Americans have Gouty Arthritis1, 2, 3, 4, 5. Most people know “arthritis” as a joint disease: painful, swollen, or heated joints. Most treatments, therefore, are aimed at relieving pain at the joints without in any way attending to thesystemic nature of the diseases.
It has been stated by some practicing physicians that at least 50% of us will have Osteoarthritis (Osteo) if we live long enough, and therefore Osteoarthritis is often said to be a “degenerative” or “aging” disease. It is characterized by swelling that is bony with irregular spurs and occasional soft cysts, whereas Rheumatoid Arthritis (RA) is characterized by synovial, capsular soft tissue
that is bony only in late stages3.Tenderness is normal for RA, but is usually absent with Osteo, except during occasional acute flare-ups and particularly at the onset. The distal interphalangeal
joint (closest to the nails) is usually not involved with RA (except thumb) but quite characteristic with Osteo. The proximal interphalangeal joint (middle) is usually involved with RA, and is
frequently involved with Osteo. The metacarpophalangeal joint (knuckles) is usually involved with RA, but never with Osteo, except for the thumb. Wrist involvement is normal for RA but
never involved with Osteo, except for the base of the thumb3. Osteo is characterized by degenerative loss of joint cartilage, deadening of bone beneath the cartilage, and cartilage and bone proliferation at the joint margins with subsequent bony outgrowths. Impaired joint function and synovial inflammation is common3. Osteoarthritis is said to be “inflammation of the bones and joints” according to a medical dictionary. While Osteo is painful, and leads to progressively less usage of joints, it is not the great crippler that characterizes Rheumatoid
Arthritis. Rheumatoid Arthritis usually is known by a cluster of easily observed symptoms distinguishing it from Osteo: Joints are swollen, heated, and an increasing number of them become affected over time. Night sweats, depression and lethargy accompany this disease1.
Gouty Arthritis, on the other hand, is characterized by sharp painful joints, as if a needle were probing the internal structure of the joints. One can have attacks of fever, chills and, of course, the described excruciating needle-like pains. Gout victims will suffer for weeks at a time often with loss of mobility; and, as these attacks become more frequent, they will eventually be disabling. Kidney disease, heart disease, and many other complications can set in5.
OSTEOARTHRITIS
WHAT CAUSES OSTEOARTHRITIS?
Osteoarthritis appears to be caused by a combination of factors. Hormonal deficiencies certainly play their part, as one-third more women suffer from Osteoarthritis after menopause than
do men. Faulty nutrition and stress may also play their fair share, as probably do genetic predisposing factors1, 2, 3, 4. Prevailing general medical theory suggests that Osteoarthritis
may be divided into two categories, primary and secondary17. "In primary osteoarthritis, the degenerative 'wear-and-tear' process occurs after the fifth and sixth decades, with no apparent predisposing abnormalities. The cumulative effects of decades of use leads to the degenerative changes by stressing the collagen matrix of the cartilage. Damage to the cartilage results in the release of enzymes that destroy collagen components. With aging, the ability to restore
and synthesize normal collagen structures is decreased. "Secondary osteoarthritis is associated with some predisposing factor which is responsible for the degenerative changes. Predisposing factors in secondary osteoarthritis include: congenital abnormalities in joint structure or function (e.g., hypermobility and abnormally shaped joint surfaces); trauma (obesity, fractures along
joint surfaces, surgery, etc.); crystal deposition; presence of abnormal cartilage; and previous inflammatory disease of joint (rheumatoid arthritis, gout, septic arthritis, etc.)3, 4"
PREVENTION OF OSTEOARTHRITIS
There are, apparently, three major aspects to the prevention of Osteoarthritis: restore proper nutrition, relieve stress and replace hormones3, 4. Nutrition must be designed to fit each individual, of course, but there are always good broad outlines that are safe and helpful
or each of us. According to Gus J. Prosch, Jr,, M.D.95 in principle,the closer we can eat to the “caveman diet,” the better the nutritional values received. Our human bodies evolved through a
varying diet of grains, nuts, berries, fish, meats and other food substances. Known as the “caveman diet” it is generally described by recommendations of fresh fruits and vegetables, whole grains, nuts, cold water fish (non-farmed) and other sources of essential fatty acids. One mineral apparently of great importance to the prevention of Osteoarthritis is boron. Dr. Rex E. Newnham, Ph.D., D.O., N.D. of Leeds, England demonstrated demographic and clinical evidence for the usefulness of Boron in preventing and treating Osteoarthritis and some forms of Rheumatoid Disease3,4. Dietary supplements often used are: Niacinamide89, 90, 91 (under
close medical supervision), Methionine, Glycosaminoglycans, Superoxide Dismutase, Vitamins A, E, Pyridoxine, Pantothenic Acid and minerals Zinc and Copper18. Linus Pauling Ph.D.64 and Robert F. Cathcart, III M.D.2 both recommend large quantities of Vitamin C, either orally or as an injectable. Many of the above supplements are either anti-oxidants, anti-inflammatories, synergistic with other substances, hormonal replacements or blockages, or intended to
encourage the maintenance of, or faster re-growth of, connective tissue.
Various herbs60 have been historically useful for the same purposes, especially in treating inflammation without the serious side-affects attributed to aspirin and other Non-Steroidal Anti- Inflammatories (NSAIDS). These are Glycyrrhiza glabra, Medicago sativa, Harpagophytum procumbens, and the Proanthocyanidins, Cherries, Hawthorn Berries and Blueberries17, 19. Wayne Martin, B.S., who synthesizes and writes about a great deal of medical
treatment possibilities suggests daily use of ginger mixed in milk, tea, coffee, or cold drinks.55
Stress69 is a factor that is perhaps most often overlooked by the normal medical practitioner. Often there is one or more persons in the close work or home enviroment who are suppressive to another, such suppression expressing itself in a way that constantly invalidates a person’s actions, thoughts or emotions. It is a negative stimulus that depresses our beingness, our will to wantto engage in friendly exchange of ideas or activities. A person who is so related to another will often suppress his/her emotions and behavior in ways that express outwardly in the form of hormonal changes and accompanying clinical sicknesses. The medical terminology is “psychosomatic,” indicating that the person’s mind governs his emotions and bodily condition. This is true to the extent that a person permits suppressive conditions and “suppressive”
people to influence his/her mind/body. As few physicians have training in recognizing the causative patterns, and would probably be resisted by their patients if they mentioned them, stress sources are often ignored in treatment, although they may be the largest component of all diseases, acute or chronic2.

Treating Rheumatoid Arthritis&Diet

2008-01-16T05:18:00.000-08:00

Supportive Measures in Treating Rheumatoid Arthritis:
To achieve the best results in treating any chronic degenerative disease it is important to remember that simply giving a drug to kill a disease causing germ is not enough. In the first place, these patients have been ill for many months to years and their entire body chemistry,
digestion, nutrition, and immune system has been continually stressed and damaged over this period of time. The next slide will list the supporting facets of treatment which first not be overlooked if a physician wants to give his patients the very best opportunities to achieve the most successful improvement. Supportive Evaluations for Better Results in Treating Any Chronic Degenerative Disease
1. Diet and proper nutrition.
2. Correction of any Nutritional Deficiency or imbalance.
3. Correction of any digestive malfunctions.
4. Elimination of contributing factors that may be suppressing the patient’s immune system:
a. Food, inhalant, and chemical allergies.
b. Concomitant infections such as yeast, virus, foci of infections.
c. Exposure to toxins such as heavy metals and petrochemicals.
5. Exercise.
6. Rest and relaxation.
7. Removal of physical or mental stress factors.
8. Instill hope and positive mental attitude in patients.
9. Intraneural injections for arthritis patients.

Intraneural Injections

Most patients with Rheumatoid and Osteoarthritis have developed inflammation in various nerves that go to the joints. These areas of inflammation in the nerves may be caused by calcium deposits in the nerve areas, trauma or injury to the nerves or even invasion of the nerves by germs like the amoebae or Candida-yeast infections. Our Foundation’s Medical Director, Dr. Paul K. Pybus, has been working with this problem for several years and has developed various techniques of intra-neural injections that have caused remarkable improvement in many patients. I will be speaking tomorrow concerning these injections and will go into detail to explain the theories involved, the preparation of solutions for injection and the actual techniques of injection, but I just wanted to mention here that this is a supportive measure I use in treating all arthritic patients. I would now like to go into a little more detail on a couple of the other very important supportive measures.

Diet:

There are more incidents of the chronic degenerative diseases in our land today than has ever been known in the history of mankind. These diseases include all the forms of arthritis and auto-immune diseases but also obesity, diabetes, and cardiovascular diseases which include heart disease, arteriosclerosis, and peripherial vascular disease. Today, with the processing of most our foods, many important vitamins, minerals, amino acids, and fatty acids are removed so the foods will last longer on the shelves. Many soils which are used to grow our foods are becoming depleted of essential nutrient substances, especially minerals. Also thousands of chemicals are added to soils in the growing process and also preservatives and other chemicals are added to our processed foods. Because of all of this, we are finding that our entire society is suffering from a diet that is plagued with over-consumption and under-nutrition and the incidence of chronic degenerative diseases can only increase in severity. Most Americans are now conditioned to follow this “S.A.D.” or Standard American Diet and our diet plays a very important factor in treating all arthritic patients. It can spell the difference in getting poor, fair, good, or excellent results in the treatment of our arthritic patients.

Summary of Diet for Rheumatoid Disease Patients Avoid These Foods:

1. Processed foods (foods in box or can).
2. Alcohol, caffeine, nicotine.
3. Processed cereals, white rice, and corn products.
4. Four vegetables — Irish potatoes [white potatoes], tomatoes, eggplant, and peppers.
5. All forms of pork.
6. Peanuts, walnuts.
7. Skim milk or low fat milk.
8. Any known allergenic foods.
9. All sweets, deserts, sugars, candy, soft drinks, ice cream, pies, cakes, pastries, etc.
10. All white flour such as white breads, crackers, biscuits, spaghetti, macaroni, pasta.
11. All “hydrogenated” or “hardened” cooking oils or fats, and especially margarine.
12. Excessive diet drinks (2 per day permitted).

Eat These Foods:

1. Fish, fowl, eggs, cheeses, lamb, and beef (up to 3 times weekly), yogurt, venison, shrimp.
2. All vegetables, preferably raw or “wok” cooked, (avoid potatoes, tomatoes, eggplant, and
peppers).
3. All vegetable juices except tomato.
4. All salad vegetables.
5. Whole wheat or whole grain breads (if 100%).
6. Whole grain cereals — non-processed.
7. All nuts except peanuts and walnuts.
8. Home canned foods without sugar added.
9. All fruits and juices including dried fruits. (The whole fruits are preferable to the juices.)
10. Decaffeinated coffee, herbal teas, whole milk, buttermilk, spring or mineral water, juices.
11. Butter, olive oil, cooking oils that are “cold-pressed.”
12. Adequate vitamin, mineral supplements with cod liver oil.

Rheumatoid Diseases an Infection

2008-01-16T05:06:00.000-08:00

Are Rheumatoid Diseases an Infection:

In the past few years, it appears that most researchers now believe that the Rheumatoid Diseases are due to an infectious etiology, or they are caused by some type of germ. Dr. Wyburn-Mason in his book clearly summarizes the medical literature with his ex of investigators only serve to confirm his own findings. Dr. Wyburn- Mason discusses, compares, explains and analyzes many answers to numerous unanswered questions relating to the Rheumatoid Diseases. He presents documented evidence which demonstrates significant improvement and in many cases, complete remission when treated by anti-amoebic drugs of all the Rheumatoid Diseases. He lists in his book comparison after comparison proving that the Rheumatoid Diseases are infective in their cause or that they are caused by an invading germ organism. Time does not permit a detailed discussion of these events; but in a very short summary, let me list some comparing factors he demonstrated to prove this infection etiology
or cause. The following symptoms and signs are very often seen in infections of one type or another as well as the various Rheumatoid Diseases: Fever, loss of appetite, weight loss, increased sedimentation rate in blood, enlarged lymph glands, increased gammaglobulin in
blood, enlarged spleen, granulomas, anemias, increase or decrease of white blood cells, increased plasmocytes, decrease of blood platelets, increased paraproteins, increased cryoglobulins in blood, evidence of amyloidosis, increased eosinophils in blood, allergic reactions, Jarisch Herxheimer reaction, atrophy of stomach and small intestine lining, presence of rheumatoid and antinuclear factor in blood, return to normal of most of preceding abnormalities following treatment with anti-amoebic drugs.
Treatment does not correct any damage that has already been done by the amoebae to the tissues, but the progress of the disease is usually arrested. Therefore, any arthritic deformities remain but the pain, swelling, stiffness and redness all gradually go away. Some patients may become reinfected and depending upon the severity, they may have to return for re-treatment. Dr. Blount advises patients that one way to prevent re-infection is to make certain all water pipes in one’s house are copper, since copper kills the amoebae very effectively. Also, since chlorine doesn’t kill amoebae [efficiently] and they grow rapidly in swimming pools, especially in warm water, he advises placing plates of copper in the pool itself. [Further research has shown that the more effective treatment is the use of a copper algaecide, as suggested by William E. Catterall, Sc.D. Bio-GuardTM MSA Algicide (Bio-Lab, Decatur, Georgia) contains 7% copper in
the form of a soluble triethanolamine complex. Recommended treatment is 4oz./5000 gal, or 0.4 ppm copper added. Ed.]

Anti-amoebic Treatment of Rheumatoid Disease

We have found that the majority of patients with Rheumatoid Arthritis respond well to treatment by using Metronidazole and Allopurinol. The Allopurinol, according to Dr. Wyburn-Mason interferes with the enzyme systems of the amoebae and this is the reason
for its effectiveness. The Metronidazole itself or its metabolites seem to actually kill the amoebae and are primarily responsible for causing the Herxheimer reaction if given in the proper dosage. I usually routinely begin treatment of my Rheumatoid Arthritis patients
by giving 3 primary medications.
1. One cc of Depot Medrol is given on the day the patient comes to my office. This is a cortisone-like medication that prevents a severe Herxheimer reaction. As more amoebae are killed at first, the “flu-like” symptoms can be quite severe and the Depot Medrol lasts about 7-10 days. Because of this, many patients notice fairly severe
flu-symptoms the second and third week of treatment after the Depot Medrol has worn off. I don’t like to use cortisone-like medications for any condition normally, but I find it very appropriate in this treatment.
2. Secondly, I give a prescription for Allopurinol or ZyloprimTM, 300 mg. tablets. The patient takes 1 tablet 3 times daily for 1 week then stops this medication.
3. I also give a prescription for Metronidazole, 250 mg. tablets, to be taken in divided doses, two days in a row each week for 6 weeks. For a patient who weighs around 200 pounds, I recommend 2000 mg. daily or 2 tablets with meals and 2 at bedtime two at bedtime two days in a row, each week for six weeks. For a 150 pound patient, I give 1,500 mg. daily or 2 tablets with each meal and none at bedtime. For a person who weighs over 225 pounds, I prescribe 3 tablets with each meal or 2,360 mg. daily. I have the patient begin both medications the next day after the Depot Medrol injection. In addition to the above medications, I prescribe a special diet and various supplements that I will mention later. Also, I check each involved joint to determine if any of the nerves are inflamed and inject the affected nerves when appropriate. I will also go into detail tomorrow concerning the techniques and theory involved with intra neural injections. I have the patient make an appointment to return for evaluation in 6 or 7 weeks.
When the patient returns for the second or follow-up visit, I usually see one of three things that have happened:
1. The patient has no more arthritic pains and the involved joints are not inflamed anymore even though the patient may have had no Herxheimer reaction, or a moderate or a severe reaction. I do not give any further medication to these patients but advise continuing the diet along with continuing the supplements for another 2-3 months.
2. Some patients returning may be no better at all and have had no Herxheimer reaction at all. With these patients, I re-evaluate the previous diagnosis and if the original diagnosis was wrong, I change the treatment accordingly. With this situation, one of two things has happened: The diagnosis is wrong and the patient doesn’t have Rheumatoid Arthritis or the patient’s particular amoebae are not sensitive or responsive to the medication given and with these patients I
will usually change to another anti-amoebic medication.
3. The third thing I may see on the second return visit is a patient who has had a mild, moderate or severe Herxheimer reaction and usually is somewhat to greatly improved but still has arthritic pains and symptoms and some evidence of inflammation in the involved joints. Should they seem to be reacting to medication, I may prescribe an additional 4 weeks of Metronidazole. If they have had only a mild Herxheimer reaction, I may change the medication to a different anti-amoebic drug. It really depends on the particular patient response

Rheumatoid Disease

2008-01-16T04:56:00.000-08:00

Introduction:

Good morning, to all you visitors, friends and supporters of The Rheumatoid Disease Foundation. I’m honored to have been asked by The Rheumatoid Disease Foundation to speak to you and share with you some of the exciting new developments and advances that are being made concerning the treatment of Rheumatoid Arthritis and other Rheumatoid Diseases. I would like to personally thank each and every one of you who have supported The Rheumatoid
Disease Foundation and want you to know that if it had not been for the personal help and financial support of many of you and thousands of other supporters across the entire United States, our progress would have been very minimal, but thanks to you and all our supporters,
our knowledge and research is moving and progressing at a very rapid rate. I was asked to speak on the anti-amoebic treatment of Rheumatoid Disease and this is a very broad subject. I know that there are some people here who are not familiar with our work so I will give a rapid background review of our work, what has been done, and then go into the actual treatments and support methods being recommended at the present time.

Rheumatoid Diseases;

Now you have heard me refer to the term Rheumatoid Diseases and let me clarify this term. Dr. Wyburn-Mason was able to isolate and identify heavy concentrations of free-living amoebae which he called the Limax Amoebae in the involved tissues of most of the socalled auto-immune or collagen diseases as well as several types of cancers that primarily involved the lymphatic system as lymphomas. Auto-immune diseases are those in which the white blood cells are
tying to fight some agent (such as a germ or chemical) in the tissues and they are not able to tell the difference between the agent and normal tisssues so they attack normal tissues as well as the agent and this results in severe tissue destruction in the tissues involved. Dr. Wyburn-Mason found the amoebae in all these tissues and learned that the amoebae can attack any tissue in the body. Rheumatoid Disease is not simply a disease of the joints but a generalized condition and every tissue of the body at some time has been reported to be affected. The same tissue changes seen under a microscope as are found in the joint tissues can be seen in other body tissues and consist of invasion by certain white blood cells as lymphocytes and plasmacytes along with inflamed small arteries. If they attack the joints, the disease is called Rheumatoid Arthritis. If they attack the colon, the condition is called Ulcerative Colitis. Small intestine, Crohn’s Disease; arteries: Periarteritis Nodosum; blood: [hemolytic disease]; [connective tissue, skin, organs]: Lupus Erythematosis; thyroid: Hasimoto’s Thyroiditis; nerves: Multiple Sclerosis; salivary glands: Sjorgrens Syndrome; muscle: Dermatomyositis; skin: Psoriasis or Scleroderma.
These are just a few of the various diseases that Dr. Wyburn- Mason has been able to isolate the amoebae from. He therefore calls these diseases where the limax amoebae are found “the Rheumatoid Diseases” and many of these diseases have gone into remission after being treated by anti-amoebic medications. As examples, I have had about 2 out 3 Psoriasis and Lupus Erythematosis patients go into remission after trying the anti-amoebic treatment. I’ve had about 50% of Ulcerative Colitis or Crohn’s Disease patients go into remission. Of the Rheumatoid Arthritis patients treated with various antiamoebic medications, I have found about 80%, 8 out of 10 patients are very significantly relieved or they go into remission. Dr. Robert Bingham of Desert Hot Springs, California, has treated hundreds of Rheumatoid Arthritis patients and his results are very close to my own. Dr. Paul Pybus, The Foundation’s Chief Medical Advisor,
also has had results that fairly closely parallel those of my own. Some physicians have gotten even better results and some have even reported poor results. We haven’t determined as yet why this is so, but we are working on those factors that play a part in influencing treatment medications.
1. Methods of administering the anti-amoebic medications.
2. The diet followed by the patients and nutritional supplements provided.
3. The amounts and types of exercise recommended.
4. The mental attitude and hope instilled into the patients by various physicians.
5. The geographic areas of the country involved.
6. Possibly other types of germs that may be involved or different species of the amoebae that may be resistant to the present available medications.
7. The presence of allergies or co-existing infections that play a part in weakening the immune system.
8. Digestive disturbances and faulty absorption of necessary nutrients, foods and supplements. Candida albicans. Anyhow, several physicians are working on these factors, and we believe with time that we will be able to solve to a great extent the unanswered questions that remain. We are tremendously excited and enthused about our progress so far and are anxiously awaiting the
results of presently on-going studies that have been made possible because of the loyal support of the thousands of concerned members of the Rheumatoid Disease Foundation that are helping us.

Activity Ideas

2008-01-16T04:18:00.000-08:00

Activity Ideas :

Including hands on, visual, fun and meaningful activities in your programming can help participants to better remember and implement the ideas you present. Here are a couple of
ideas that may help:

Postural Pitfalls

Objective:

To understand the importance of and practice good posture. As participants enter, have large pieces of butcher paper on the floor or taped against the wall. Pair participants and have one participant lie on or stand against the paper while the other draws an outline of the body. Keep in mind with adults, some people may already be experiencing back pain, so be sensitive to individual needs if possible. You may want to just ask for one volunteer and draw his/her outline among adults, while kids will almost always enjoy having their outlines drawn. Blow up balloons and tape them to the body outline. Tell participants the balloons represent their vital organs (e.g., stomach, liver, heart, etc.). Place the outline in a chair behind a desk or table if possible. Make sure the chair and desk or table are turned sideways so all can see. Now bend the body outline and balloons over in a slouching position - this will put pressure on the balloons. Ask participants to tell what is happening (there isn’t much room for the body organs, blood can’t flow as easily to the body organs, the person probably does not look or feel good, either).Discuss the postural tips when sitting, standing, and sleeping, as well as the body mechanics for lifting from this newsletter. Explain that strong muscles help to keep the body in correct posture. Practice sitting with feet flat on the floor (or on a book or stool, if needed). Have participants place their hands palms down next to their hips and count to six - then relax. Participants will now be sitting with correct posture. This exercise makes muscles used for correct sitting posture strong. Try some of the other back strengthening exercises in this issue of HealthHints or see the suggested websites.Be sensitive to participant limitations or needs such as disability, current back pain, or pregnancy. Be prepared with varied ideas so you can adapt with your audience.

Back Pack Basics

Objective:
To understand how to wear a back pack safely to prevent injury. Note: This activity would be particularly good for safety camps for kids or at health fairs. Explain that overloading back packs has recently received alot of attention in schools among parents and school administrators. “More than 13,260 injuries related to back packs were treated at hospital emergency rooms, doctor’s offices, and clinics in the year 2000 (American Academy of Orthopaedic Surgeons, 2001a).” Purchase or borrow a few backpacks that have the correct components (e.g., hip straps, and padded straps and back) for safety as well as some that don’t have these features to use as examples. Then, present the following tips, allowing articipants to try the back packs on, tighten them, pack them appropriately (provide a few books of different sizes and weights, or other items that might be carried), etc.

Back pack tips to prevent injury:

• Use a hip strap for heavier weights.
• Use a back pack with padded, wide straps and a padded back.
• Use both shoulder straps, firmly tightened, to hold the back pack two inches above the waist.
• Use correct lifting techniques, bending both knees, keeping the back straight, and lifting with the legs when picking up a heavy back pack.
• Neatly pack the back pack, placing the heaviest items close to your back - try to keep items in place. (Consider features that help keep items organized and in place when purchasing a pack.)
• For kids in school, try to make frequent trips to your locker between classes to replace books.
• Consider purchasing a back pack with wheels.
• If possible borrow or purchase a second set of books for home to avoid carrying heavy loads between home and school each day.
• Engage in exercises that strengthen and condition the back muscles.
(Note:Provide participants ideas for exercises from this issue of HealthHints, or suggest
they consult a doctor, orthopaedicsurgeon, or physical therapist for advice).

Treat Back Pain

2008-01-16T04:02:00.000-08:00

How to Treat Back Pain at Home:

When back pain develops or injury occurs that does not warrant a doctor’s care, successful home treatment can be your avenue to more rapid relief. Here are some steps that can help you treat back pain at home:
Apply cold, then heat: Immediately after back injury, apply ice for 15-20 minutes three to four times a day for the first three days. Place ice in a plastic bag and wrap with a cloth or towel to keep a thin barrier between the ice and your skin. After spasms or acute pain subside, you can apply a heating pad to help loosen tight muscles. Limit heat applications to 20 minutes.
Get in a comfortable position: Do not sit up in bed or on soft couches. Avoid positions that worsen symptoms, such as sitting for long periods of time or in a position that requires your back to be twisted.
Rest only for short periods: Short periods of rest, lying flat on your back with knees bent, can help relieve back pain. Long periods of bed rest, however, are not recommended since it may weaken the muscles and delay recovery. More than three days of bed rest is not recommended and could actually delay healing.
Use over-the-counter pain relievers: Non-prescription pain relievers, such as acetaminophen may help control pain. Nonsteroidal antiinflammatory drugs, such as ibuprophen can also reduce inflammation that affects muscles and joints.
Perform light exercise: Take a short walk (3-5 minutes) on a level surface every three hours. Walk only distances you can manage without pain. Try pelvic tilts (i.e., lie on back with knees bent and slowly tighten stomach pressing the lower back against the floor, hold for 10 seconds and relax) to gently move the spine and stretch the lower back.

If You are Pregnant...

During pregnancy the body goes through many changes; some may cause discomfort - that’s normal. Back pain is one of the most common complaints among pregnant women. By following a few tips (see below), and doing exercises to strengthen your muscles, you can ease some of the
discomfort. Tips for easing back pain during pregnancy:
• Consult with your doctor, especially if back pain is accompanied by fever,
burning during urination, or vaginal bleeding.
• Exercise for a healthy back. Consult with your doctor, and see the following website for exercises ideas http://medem.com/search/article_display_for_printer.cfm?path=n:&mstr=/
ZZZIVT1487C.html&soc=ACOG&srch_typ=NAV_SERCH.
• Wear low-healed (but not flat) shoes with good arch support.
• Ask for help when lifting heavy objects.
• If your bed is too soft, have someone help you place a board between the mattress and box spring.
• Don’t bend over from the waist to pick something or someone up - squat down, bend your knees, keep your back straight, and use your legs to lift.
• Sit in chairs with good back support, or use a pillow behind the lower part of your back.
• Try to sleep on your side with one or two pillows between your legs for support.
• Apply cold, followed by heat (if needed) to the painful area or massage it.
If back pain continues, your doctor may suggest you wear a maternity girdle, special elastic sling, or back brace.

Back Pain Part 5

2008-01-16T03:37:00.000-08:00

When Back Pain Strikes:
When back pain strikes the first line of defense is to decide whether it can be treated at home or needs a doctor’s care. Here are some guidelines for when to consult a doctor, what to expect during diagnosis, and when/how to treat back pain at home. When to Consult a Doctor It is important to consult a doctor if you experience any of the following:
• Severe pain that makes it difficult to move.
• Fever and/or vomiting with back pain.
• Loss of bowel or bladder control.
Constipation and frequent or urgent urination are common in some people with low back pain, but any new problems with bowel or bladder should be discussed with a doctor.
• New numbness in the genital or rectal area.
• Pain, numbness, or tingling in another part of the body.
• Leg weakness that is not solely due to pain. Significant leg weakness should be evaluated, especially if you are unable to bend your foot upward, get up out of a chair, or climb stairs.
• Weakness in another part of the body.
• New or increased back pain with unexplained fever, painful urination, or other signs of urinary tract infection (e.g., burning with urination, itching or pain in urethra, lower abdominal discomfort,urge to urinate without passing much urine).
• Dramatic increase in chronic back pain, especially when unrelated to any change in physical activity.
• A history of cancer of HIV infection with the development of new or increased back pain.
• New back pain that does not improve after one week of home treatment.

What to Expect During Diagnosis:

It can be difficult to diagnose back pain, since there can be so many possible causes. For this reason, your family doctor or general practitioner may suggest you see an orthopaedist, rheumatologist, neurosurgeon, neurologist, physical therapist, chiropractor or other medical
specialist for diagnosis (Kemper,University of Washington Department of Orthopaedics 2002).
Regardless of the type of doctor you see, there are some things you can expect in common from any type of doctor.

Medical History:

Most doctors will ask questions about your medical history as well as past and current symptoms. These questions may include the following:
• What are your symptoms?
• Where is the pain?
• Where is the pain most severe?
• When did the pain begin, and how long have you had it?
• Did something specific cause your back pain (e.g. accident or injury)?
• What home treatments have you tried?
• Were you under any additional stress when the pain began?
• What type of work do you do?
• In what types of recreational activities have you participated?
Think through the answers to these questions prior to any doctor’s visit if possible. You may also want to prepare a list of your own questions. As you think of questions you’d like to ask, jot them down and take them to your appointment. After the discussion of your medical history, the doctor will most likely perform a physical examination, including some or all of the following:
• observing your muscles and joints,
• asking you to sit or lie down,
• asking you to move your back in different positions,
• observing and feeling the areas of most pain,
• checking to see if other areas of the body are tender or in pain (e.g., kidneys, intestines, or other organs).

Diagnostic Testing:

Your doctor may need to run some diagnostic tests if more information is needed to help diagnose the problem. These tests may include one or several of the following:
X-ray - X-ray pictures may help determine if pain is due to injury to back
bones, tumor, deformity in spine, or ankylosing spondylitis.
CT or CAT (computerized axial tomography) Scan - A CT scan takes an x-ray that is turned into a 3- dimensional image.
MRI (magnetic resonance imaging) - MRI provides pictures of soft tissues such as muscles, cartilage, ligaments, tendons, and blood vessels, in addition to bone structure.
Myleogram - A myleogram uses a dye injected into the spinal column to detect spinal stenosis, spinal tumors, or other neurological problems. This is often used by neurologists prior to back surgery.
Bone Scan - In a bone scan, a small amount of radioactive liquid is injected into a vein. A radioactive machine scans the area of concern creating a picture to look for damage or tumors in the bones themselves. (Note: Back pain is rarely related to diseases of the bones.)
Electrodiagnostic Studies - There are two types of electrodiagnostic tests; one that uses electrical stimulation to measure the speed of nerve impulses as related to possible nerve compression; the other is a needle test (electromyogram [EMG]) to study the effect of nerve compression on the muscle.
Blood Tests - Blood tests may be ordered, in which a laboratory technician will draw a small amount of blood from your arm. Blood tests may be used to look at a number of things, including a chemical profile, hemoglobin and hematocrit, white blood cell count, etc., which could help the doctor to better determine the cause of your back pain. (Adapted from University of Washington Department of Orthopaedics and Sports Medicine, 2002.)

Doctor recommendations:

In addition to diagnosing back pain, your doctor may recommend ~
• an individualized exercise and home care plan or modified work plan if needed
• prescribed muscle relaxants antiinflammatory drugs, or pain relievers
• physical therapy
• back surgery (Kemper, 1997, pp 99).

Note: Be sure to always inquire what medications are for, how they might affect you, and for how long you will need to use them (University of Washington Department of Orthopaedics and Sports Medicine, 2002). If surgery is recommended, consider all the factors, including second opinions. The most common back surgeries are to remove herniated discs or fuse the lumbar spine. Be sure to discuss the long-term outcome of any surgery with your doctor

Back Pain Part 4

2008-01-16T03:04:00.000-08:00

Pregnancy:Back pain is among the most common discomforts during pregnancy. Back pain during pregnancy can be due to a number of factors, usually resulting in strain on the back muscles:
• In mid-pregnancy the uterus becomes heavier, changing the woman’s center of gravity, resulting in postural and movement changes. Most women begin to lean backwards in later pregnancy, causing the back muscles to work harder.
• Weakness of abdominal muscles can also contribute to back pain during pregnancy. The abdominal muscles usually support the spine, playing an important role in keeping
the back in good health.
• Additionally, the hormones of pregnancy cause the muscles to relax and become loose, which may cause some back pain and can contribute to making one more injury prone during physical activity (American College of Obstetricians and Gynecologists, 1997).
Bad Posture
Bad posture in any circumstance - while standing or sitting for long periods,
or while lifting, exercising, or doing any other type of activity - can contribute to
back pain and problems.
Lifestyle
Lifestyle factors, such as stress and smoking are thought to play a part in some cases of back pain. The mechanisms for this association, however, have not yet been proven

Prevention, diagnosis, treatment -

chronologically, this is the best way to treat back pain:
1 Try to prevent it.
2 Know when to see a doctor for diagnosis.
3 Understand and implement treatment options.
Preventing back pain. The first strategy for dealing with back pain is to try to prevent it. There are three primary areas one can focus on to keep a healthy back:
1 Exercise
2 Posture
3 Diet.

Exercise:
“Regular exercise is the most potent weapon against back problems (Mayo Clinic, 1997).” Exercise has the potential to strengthen the back, increase aerobic capacity, improve
overall fitness, reduce stress, and help shed excess pounds that put more pressure on the
back (Mayo Clinic, 1997). By increasing strength and flexibility of back muscles, weight is better distributed, and less force is placed on the spine (Cluett, 2001). Strengthening of back muscles is also one of the most important steps in treating most causes of back pain (Cluett, 2001).

The following are a few examples of back exercises:

Partial sit-up
Lie down on your back with bent knees. Slowly raise head and shoulders off the floor, and hold for 3 minutes. Knee-to-chest raise Lie down on your back. Slowly pull knees to chest, relaxing neck and back. Hold for 10 seconds; repeat 10 times.

Press-up
Lie down on your stomach. Place hands near shoulders and keep pelvis on floor. Press up painlessly. Hold for 10 seconds; repeat 10 times (National Library of Medicine, 2001). It is recommended that these exercises be done 2-3 times a week (National Library of Medicine, 2001). Be sure to always stretch before doing any type of exercise (Pace, 2000), and always consult your doctor before beginning any new exercise activity.
For more exercise ideas, see the following
websites:
• About back pain (UW) at: http://www.orthop.washington.edu/arthritis/
types/backpain.
• Back pain exercises (AAOS) at: http://orthoinfo.aaos.org/fact/
thr_report.cfm?thread_ID=17&
topcategory=Spine.
• Low back exercises (AAOS) at: http://orthoinfo.aaos.org/booklet/
thr_report.cfm?thread_id=18&
topcategory=spine.

Posture:

Maintaining good posture can keep the back healthy. Postural techniques can also help relieve back pain. Here are some tips to follow for good posture:
When sitting
• Sit in a firm chair with armrests.
• Keep the back straight and shoulders relaxed.
• Keep the stomach pulled in, and maintain the proper curve in the back - this can be done by tightening the stomach and buttocks.
• If it is more comfortable, place the back of the chair at a 15-20 degree angle. A small cushion behind the lower back to maintain the natural curve of the back can also be helpful.
• Keep the knees slightly higher than the hips - use a footstool or book under the feet if necessary.
• Keep your feet flat on the floor, stool, or book.
• Do not sit for long periods of time. Stand up occasionally to stretch tight muscles and give them a chance to relax.

When standing:

• Stand with weight equal on both feet.
• Avoid locking your knees.
• Place one foot on a footstool to ease tension in your back.
• Wear flat or low-heeled shoes if you must stand for long periods of time.
• Keep your back straight by tightening your stomach muscles and buttocks.

When sleeping:

• Use a firm mattress.
• Lie on your side with your knees bent.
• Place a pillow between your knees if it is more comfortable.
• If you sleep on your back, consult your doctor to find out if placing a pillow under your knees would help or worsen lower back pain for you.
(Adapted from University of Washington Department of Orthopaedics and Sports Medicine, 2002).

Back Pain Part 3

2008-01-16T01:06:00.000-08:00

OsteoarthritisOverloading, injury, and aging can slowly deteriorate cartilage, the soft, elastic material that covers the surface of vertebral joints and other joints in the body (Mayo Clinic, 1997; University of Washington Department of Orthopaedics and Sports Medicine, 2002). Discs between vertebrae may become worn,narrowing the space between vertebrae, leading to a gradual stiffening of the back and loss of flexibility. Joints may also rub together, compress, and become irregular. When the cartilage becomes worn, pain may result. This wear and pain is known as osteoarthritis. Lower back pain may become worse if osteoarthritis affects the hips or knees.
Osteoarthritis can also directly affect the spine, causing muscles, tendons, or ligaments to become strained, leading to back and/or neck pain (Mayo Clinic, 1997; University of Washington Department of Orthopaedics and Sports Medicine, 2002).

Osteoporosis (compression fractures)

Osteoporosis is a disease that causes bones to become more porous due to calcium loss, which gradually makes them weaker and more brittle. Healthy bone is dense and strong, able to withstand a great deal of pressure. With osteoporosis, bones become fragile and can break more easily. In particular, osteoporosis contributes to compression fractures, or spinal fractures where the vertebrae become flattened (University
of Washington Department of Orthopaedics and Sports Medicine, 2002). One in three women older than 50 is
affected by compression fractures as a result of osteoporosis. Progressive compression of the vertebrae often
leads to gradual loss of height, and sometimes structural changes to the spinal column that cause one to have a stooped posture or a dowager’s hump (Mayo Clinic, 1997).

Injuries and Accidents
Many back injuries are caused by an unexpected twist or sudden motion (University of Washington Department of Orthopaedics and Sports Medicine, 2002), most often resulting in muscle strain and spasms. Muscle spasms are a common response to injury, and are designed to immobilize the painful area and
prevent further damage (Mayo Clinic, 2000). With injury or accident, severe muscle spasms usually last 48-72 hours, followed by days or weeks of less severe pain, and 2-4 weeks for complete recovery from mild
back injury. For more severe injury, involving strained ligaments, it could take 6-12 weeks for recovery. Severe back injury involving a fall or other accident may require hospitalization and a longer recovery period
(University of Washington Department of Orthopaedics and Sports Medicine, 2002).

Fibromyalgia
Fibromyalgia is a syndrome characterized by achy pain, tenderness, and stiffness in muscles and areas where tendons insert into bones, especially in the upper back and neck. Pain often worsens with inactivity and
can be improved with movement (Mayo Clinic, 1997; University of Washington Department of Orthopaedics and Sports Medicine, 2002).

Ankylosing Spondylitis
Ankylosing Spondylitis is a form of arthritis initially causing pain and stiffness in the joints of the spine, followed by a fusing together (growing together) of these joints, limiting back movement (University of Washington Department of Orthopaedics and Sports Medicine, 2002). This is an uncommon type
of back problem that typically affects young men ( Mayo Clinic, 1997)

Spinal Stenosis
Spinal stenosis involves a narrowing of the spinal canal, which can develop because of a congenital defect or from osteoarthritis. As discs are worn and vertebrae and soft tissue are pushed into the spinal canal,
nerves are compressed (Mayo Clinic, 1997). This nerve compression causes back pain, and can also cause numbness, pain, and weakness in the legs. The most common sign of spinal stenosis is pain that worsens
when walking and subsides when sitting down (University of Washington Department of Orthopaedics and Sports Medicine, 2002).

Rheumatoid disorders
Rheumatic disorders that create acute and chronic inflammation, muscle soreness and stiffness, and pain in the joints and associated structures (Tabers, 1997), such as rheumatoid arthritis and Polymyalgia
Rheumatica (PMR) commonly cause back and neck pain problems.

Back Pain Part 2

2008-01-16T00:53:00.000-08:00

Causes of Back PainAnything that puts pressure on the back muscles or nerves can cause pain; and any illness or damage to the spine can also cause pain. Though back pain is one of the most common health problems in America, its cause is often unidentified. The majority of acute back pain problems, however, are most likely due to minor strains, sprains, spasms and overuse (National Library of Medicine, 2001; University of Washington Department of Orthopaedics and Sports Medicine, 2002), and can be exacerbated by emotional stress, which slows the rate of recovery (University of Washington Department of Orthopaedics and Sports Medicine, 2002).

Muscle Spasms and Strains

Muscle strains and spasms are thought to be the most common causes of back pain (Cluett, 2001; National Library of Medicine, 2001). An awkward movement of the back (even when sneezing, coughing, bending to
tie a shoe, or incorrectly lifting a heavy object) can cause a muscle spasm. A muscle spasm causes the back to lock up and can cause severe pain. Muscle spasms tend to get better over time; severe cases can be treated with physical therapy and medication (National Library of Medicine, 2001). Strained muscles, tendons, or ligaments or inflamed joints may cause pain along the spine (Mayo Clinic, 2000). If the back is strained, soreness or stiffness may develop over time or immediate pain may be felt (Mayo Clinic, 1997).

Herniated Disc

A herniated disc, also called a ruptured invertebral disc or slipped disc, is among the most painful back problems, but is also one of the easiest to identify. Though vertebral discs don’t actually slip, normal
wear and tear or strain can cause a disc to bulge or rupture (herniate) into the spinal canal, pressing on the nerve roots. A herniated disc can cause back pain and muscle spasms, but more often causes sciatic pain - severe pain spreading down one leg and often into the foot (Mayo Clinic, 1997; University of Washington Department of Orthopaedics and Sports Medicine, 2002). A herniated disc can usually be detected with
physical examination alone, but sometimes may require the use of computerized axial tomography (CAT)
scan or magnetic resonance imaging (MRI) to confirm diagnosis (see What to Expect During Diagnosis section for more information) (University of Washington Department of Orthopaedics and Sports Medicine, 2002).

Sciatica

Compression or inflammation of nerves in the lower back or buttocks can cause sciatica, named after the sciatic nerve that extends down the leg from the hip to the heel. About 10 in 100 people with back pain will experience sciatica. Sciatica may cause pain radiating from the back down through the buttock to the
lower leg. Tingling, numbness, or muscle weakness may also accompany nerve compression. Any activity that exerts pain on the spine can worsen sciatica, including sneezing and coughing, but pain usually resolves on its own. Severe nerve compression, however, can cause progressive muscle weakness (Mayo Clinic, 1997).

Back Pain Part 1

2008-01-16T00:35:00.000-08:00

Back PainBack pain is one of the most common medical problems in America (National Library of Medicine, 2001). Eight out of ten people will experience back pain at some point in their life (American Academy of
Orthopaedic Surgeons, 2001b). Back pain is ranked second only to headaches as the most frequent location of pain (Mayo Clinic, 2000).
Approximately 12 million visits are made to physicians’ offices each year for back pain problems (American Academy of Orthopaedic Surgeons, 2001); mostly for lower back problems, since this part of the
back bears the most weight and stress (Mayo Clinic, 2000). Fortunately, nine out of ten acute back
injuries will heal on their own within 8 to 12 weeks (Kemper, 1997). If not taken seriously, however, back pain can last for a long time, and can become disabling (National Library of Medicine, 2001). Though back pain is rarely life-threatening, estimates of its total cost to society range from $20-60 billion annually in the United
States (Mayo Clinic, 1997; University of Washington Department of Orthopaedics and Sports Medicine, 2002; ). With such numbers in mind, it may be surprising that with exercise, weight management, and a few simple postural techniques, you can ward off back pain. Even if you’ve injured your back before, you can learn techniques to help avoid re-injury
In this issue of HealthHints we will look at:
• some common causes of back pain, and
• techniques for preventing and treating back pain.

Your Back

The back has three primary parts, the:
1 backbone or spine (also referred to as the spinal column or vertebral column),
2 back muscles, and
3 nerves or spinal cord.
Backbone
The backbone is actually not one long bone, but 24 separate bones called vertebrae as well as the sacrum and
coccyx (also called the tailbone). The vertebrae are stacked one on top of the other to form the backbone or spine. The points where two vertebrae or bones fit together are called joints (University of Washington, Department of Orthopaedics and Sports Medicine, 2002). The joints make it possible for the spine to move and turn in different directions. Soft discs (made of fibrous, elastic cartilage) separate each vertebrae, allowing the spine to bend and flex, and act as shock absorbers, cushioning the hard vertebrae as we move (Mayo Clinic, 1997). The spine is joined to the pelvis, or hip, by the sacroiliac joints, which unlike most joints,
are fixed and do not move (National Library of Medicine, 2001).
Back Muscles
The muscles of the back are attached to the spine (National Library of Medicine, 2001). There are 40 muscles and numerous connecting tendons (fastening muscles to the vertebrae) and ligaments (tough fibrous bands holding the vertebrae together) running from the base of the skull to the tailbone (Mayo Clinic, 1997).
Nerves
In addition to bones and muscles, there are 31 pairs of nerves in the back ((Mayo Clinic, 1997), which make up the spinal cord. These nerves connect the brain to the rest of the body. The vertebrae protect the nerves of the spinal cord. The nerves branch off from the spinal cord carrying instructions to the organs, muscles, and limbs. They also carry sensations, such as pain from different parts of the body to the brain (National
Library of Medicine, 2001).

Respiratory Therapy

2008-01-14T03:49:00.000-08:00

Respiratory Therapy

For most people, breathing is as easy and natural as blinking. But for
thousands of Canadians, breathing is a struggle. They might be accident victims, premature babies with immature lungs, heart attack and stroke patients, or people who live with asthma and emphysema. When it comes to their care, a respiratory therapist will likely play a
vital role on the healthcare team.
Is Respiratory Therapy the right choice for you?
Are you strong in math and sciences?
Do you have an interest in health and wellness?
Does a hands-on role as a front line health care professional sound
exciting and challenging?
What do Respiratory Therapists do?

• Maintain an open airway for trauma, intensive care, and surgery
patients
• Assisting in cardiopulmonary resuscitation and support
• Providing life support for patients who can’t breath on their own
• Assisting in high risk births
• Stabilizing high-risk patients being moved by air or ground
ambulance
• Administering inhaled drugs and medical gases such as asthma
medication and oxygen
• Conducting tests to measure lung function
• Teaching people to mange their asthma or to quit smoking
Where do Respiratory Therapists work?
Most Respiratory Therapists work in hospitals. Respiratory Therapists
also work in the community bringing their expertise to:
• Home care
• Asthma, emphysema, cystic fibrosis and other clinics
• Teaching
• Research
• Rehabilitation
• Diagnostic clinics and sleep disorder labs
• Medical equipment sales and services
Career Prospects
While the number of Respiratory Therapists in Ontario continues to
grow, the demand for Respiratory Therapists is also expected to
increase as our population ages. Salary ranges from approximately
$47, 000 to $66,000 per year.
Schools that have Respiratory Therapy programs in Ontario
• Algonquin College, Nepean, ON www.algonquincollge.com
• Canadore Collge, North Bay, ON www.canadorc.on.ca
• Conestoga College, Kitchener, ON www.conestogac.on.ca
• Fanshawe College, London, ON www.fanshawec.on.ca
• La Cite Collegial, Ottawa, ON www.lacitec.on.ca
• The Michener Institute of Applied www.michener.ca

Health Sciences, Toronto, ON
For more information contact:
Vince Ruberto, Charge Therapist
Cardio-Respiratory Department
Thunder Bay Regional Health Sciences Centre
Rubertov@tbh.net
References: CRTO crto@crto.on.ca
RTSO office@rtso.org

Massage

2008-01-12T06:40:00.000-08:00

Massage

Massage therapy is the manipulation of the soft tissue of the body to increase blood flow, overall
circulation and lymph movement. Individual benefits range from sedentary and recreational applications to
all levels in the competitive environment. It is applied for aesthetic, hygienic and therapeutic benefits. In
competitive applications, massage improves the quality of an athlete’s recovery after vigorous training
activities, relieves muscular tension and reduces overall muscular dysfunction.

Movements of massage:

Massage can be categorized in five different movements. Two are primarily associated with the intensity of
the pressure applied with the other three are more directly associated with the technique with which the
manipulation is applied.
The five movements are:
· Stroking
· Rubbing
· Kneading
· Tapping
· Vibrating

Stroking:

Of the five movements, this is the softest and most delicate. It provides for a gradual relaxation of muscle
masses. Stroking alone has no significant therapeutic effect however it is considered indispensable in
serving as a foundation to successful subsequent movements.
Stroking, applied in a broad radius with circular movement, is executed using the palm of the hand without
any discernable pressure and directed towards the heart from the lower to the upper extremities.

Rubbing:

Rubbing is practiced with the same general sense as stroking but with greater pressure. It is the basic
movement of therapeutic massage and because it causes a displacement of underlying layers of the skin it
mobilizes adherent tissue. Its secondary benefit favours the elimination of the toxic products which, can
accumulate in muscle. Rubbing is executed rhythmically, applying direct pressure with the palm of the
hand and directed towards the heart from the lower to the upper extremities. On completion of a stroke, the
hand should be raised and brought back to the initial point of departure to begin the subsequent stroke
Enduro Training Systems Inc.
www.endurotraining.com
Distinguished by the application of intensity of pressure
Distinguished by the different technique of manipulation
of the muscle

Kneading:

Kneading is used in areas of the body where large muscle masses are present as can be found in the lower
limbs (hamstrings and quadriceps), in the hip and buttocks, and the deltoid/upper arm region.
The hands are placed transversally to the direction of the muscle fibre and the movement applied in a
rhythmic, kneading action. The action is similar to that produced by rubbing but produces a significantly
more effective result by speeding up blood and lymphatic flow than can be achieved by rubbing. Kneading
promotes increased toning and contractability in muscle fibres, as would be beneficial to preparatory
massage and the detoxification action as would be desirable in de-fatiguing massage. This benefit that
kneading massage brings to post exercise massage make is essential to recovery protocols than can be
derived from rest alone.

Tapping:

Tapping is carried out on regions of large muscle masses. Its intent is to cause muscular
constriction
followed by a reactive dilation of it. It is executed by apply a series of taps of intense pressure in rapid
succession. Taps can be applied with the ulnar side of a closed fist or open hand, with the distal phalanx of
one or more fingers or with the palm of the hand (slapping).

Vibrating:
A little used movement, difficult to execute which has now been replaced with electric vibrators.

Types of massage:
Massages are categorized under three headings. They are:
· Hygienic massage
· Sports massage
· Preparatory
· De-fatiguing
· Therapeutic massage

Hygienic Massage:

Hygienic massage constitutes stroking and to a minor extent, rubbing. It is used in a restoratory application
to increase circulation and relieves tense and tired muscles especially in sedentary individuals after a
continuous physical effort (e.g. yard work, home work project, a tiring journey, etc.). It could also to used
as a preparatory means toward moderate physical effort in a non-competitive sense.

The Sports Massage – Preparatory
The preparatory massage (competitive) should always begin with stroking followed by rubbing. The intent
would be to prepare the muscle for warm the muscle, increase blood flow in preparation for a competitive
effort and to increase their elasticity and their subsequent strength.

The Sports Massage - De-fatiguing
The de-fatiguing massage is carried out at the conclusion of competition. It should be done after the athlete
has a warm bath (with Epsom) or hot shower. De-fatiguing will utilize varying degrees of stroking as the
basis, then rubbing and kneading. The intent of this massage will be to increase tone and contractability,
minimize adherence and improve detoxification.

Therapeutic Massage:
Therapeutic massage is used in cases of traumatological and non-traumatological situations. The former
includes conditions of scarred muscular contractions, muscle sprains, after effects of dislocations, fractures,
and surgical procedures, tendon sprains, etc.) The latter includes rheumatological problems. Discussion of

MASSAGE THERAPY

2007-12-18T20:41:00.001-08:00

Massage Therapy Helps Shoulder Pain:

-- By Susan Jackson Grubb NCMT, CNMT

Each year, around four million people in the United States seek medical care for
pain related to shoulder sprains, strains, dislocations, or other problems, according to the
National Institute of Arthritis and Musculoskeletal and Skin Diseases.

The most frequently heard medical explanations for shoulder pain include arthritis,
degenerative disease, under-use, over-use, aging, bursitis, tendonitis, rotator cuff injury,
adhesive capsulitis, and loss of joint cartilage. X-rays, CAT scans, MRI‟s and other tests often
seem to substantiate such diagnoses. As a result, exploratory surgery, forced mobilization, and
even replacement surgery for shoulder joints are commonplace.

An Opposing View:

In opposition to conventional medical practices, doctors Janet Travell and David Simons in their widely acclaimed medical textbook,
Myofascial Pain and Dysfunction: The Trigger Point Manual, state that myofascial trigger points (tiny knots of contraction) in overworked or traumatized muscles are actually the most frequent cause of pain and loss of mobility in the shoulder.
Travell and Simons believe that even when a shoulder joint has suffered an actual injury, trigger points always contribute a major part of the pain. Pain referred from trigger
points can be every bit as intense and debilitating as pain from a damaged joint, they stress.

Frozen Shoulder:

The most frequent causes of shoulder pain are trigger points in the four rotator cuff muscles that cover the front and back of the shoulder blade and cause the shoulder to rotate (Subscapularis, Teres Minor, Infraspinatus, and Supraspinatus). Unlike the
knee, a joint that only moves forward and back, the ball and socket joint of the
shoulder is constructed to move in many directions. Certain types of movements can
cause these muscles to become particularly tense.

There are up to twenty muscles are involved in operating the shoulder and all of them
are vulnerable to strain. When a shoulder muscle is made dysfunctional by trigger
points, other muscles have to compensate. Under the extra burden, each muscle
acquires trigger points in turn, until every muscle in the region is in trouble. It often
also involves pain on that side in the neck, chest, upper arm, and back. This can lead
to progressively limited movement of the arm, ending in a frozen shoulder.

Stiff Muscles:

Travell and Simons quote other researchers who believe that trigger points may actually be the root cause of true osteoarthritis and other kinds of joint deterioration. This is because muscles afflicted with trigger points become shortened and stiff. When this happens, even normal movement puts undue strain on muscle
attachments at the joints,
which can eventually result in damage to connective tissue and distortion of the
joints themselves. Popping in a shoulder joint is evidence that muscles afflicted with
trigger points are straining and partially disarticulating the joint.

Trigger Point Therapy:

Following the first 48 hours or as soon as pain permits, ischemic pressure may be applied to the trigger points in this area. Pressure on the trigger point stops blood from flowing into the affected area making it ischemic (deprived of oxygen).
The person should feel a „comfortable pain‟ as if pressure is being released. After 8 to 20 seconds the pressure is released and the circulation of blood, oxygen and nutrients to the area increases. In addition, it is important to apply general massage to the surrounding muscles of the shoulder. This helps keep the shoulder functioning correctly and speeds up the rehabilitation process. Cold therapy or ice following treatment is recommended.

Cross Fiber Friction:

As the injury becomes less painful, ischemic pressure can progress to cross fiber friction. This technique helps encourage the body to lay down connective tissue in the same direction as the originally damaged tissue. The proper alignment causes smaller amounts of connective tissue to be needed and allows for a fuller range of motion upon recovery.

People can take steps to reduce shoulder pain, such as using good posture and
ensuring that repetitive, job-related tasks do not lead to injuries. However, exercising
and stretching a bad shoulder can also make trigger points worse and, in turn, worse the pain. Trigger points are designed to protect stressed muscles from further abuse, which has often occurred in the form or overstretching in the first place. With shoulder muscles in particular, stretching and exercising should not be done until all trigger points have been deactivated.

Research:

Soft-tissue massage improved range of motion, reduced pain and improved function in people with shoulder pain, according to a research study conducted by the staff at Auburn Hospital and Concord Repatriation General Hospital in Sydney, Australia.
Twenty-nine subjects who had been referred to the Concord hospital for management of shoulder pain participated in the study. Their medical diagnoses varied, but impingement, rotator cuff tear, and unspecified shoulder pain were the most common diagnoses.
About half of the participants received no treatment for two weeks. The other half were randomly assigned to the massage group, where they received six 15 – 20 minute sessions of soft-tissue massage around the shoulder for two weeks.
Active range of motion was evaluated for flexion, abduction and hand-behind-back movements before and after the study. Pain was assessed on the Short Form McGill Pain Questionnaire, and functional ability was assessed with the Patient Specific Functional Disability Measure, both before and after the study period.
Subjects in the control group showed no significant improvements from the beginning to the end of the two-week period. Subjects in the massage group showed significant improvements in all measures, with a mean improvement of 22.6 degrees in flexion; 42.2 degrees in abduction; and the ability to reach a mean of 11 centimeters further up the back. Subjects in the massage group also reported decreased pain and improved function.
“The fact that these patients improved with such a wide range of diagnoses points to the potential generalisability of the effects of this massage in patients with shoulder pain of local mechanical origin” wrote the authors.

Self Treatment:

Treatment for shoulder pain varies according to the type and severity of the injury.
If shoulder pain is minor, home-based treatments, such as icing, over-the-counter medications or stretching exercises are beneficial.
Self-massage can also help. Just feel around the shoulder area until you feel a “knot” or area of pain. Hold it with moderate pressure for 10 seconds, and then gently massage the area in a circular pattern. Clair Davies in his book The Trigger Point Therapy Workbook has simplified Travell and Simon‟s extensive research on myofascial pain and made it understandable to the layman. His innovative methods of self-applied trigger point massage will relieve shoulder pain and frozen shoulder when trigger points are the cause.

About the Author:

Susan Jackson Grubb, President of Center for Neuromuscular Massage Therapy, Inc. in the Cherry Creek area of Denver is a graduate of the Boulder College of Massage Therapy and has been a massage therapist since 1984. All nine therapists at the center are graduates of massage therapy schools -- each with twice the state requirement for training, are nationally certified, are licensed with the City and County of Denver, and are members of the American Massage Therapy Association. For more information visit www.cnmtmassage.com

manual therapy

2007-12-17T10:44:00.000-08:00

INTRODUCTION

What is manual therapy?

The clinical Master in Manual therapy is a public postgraduate education for physiotherapists in examination and treatment of problems in the nerve-, muscle- and skeletal system. The postgraduate education shall enable the physiotherapist in analyses and evaluation of the neuromuscular-and biomechanical function in the locomotor system. Through general, local and specific examination, the joints of the body with related structures are assessed regarding mobility,stability and pain. Manual therapy includes specific and general treatment methods in order to improve or maintain function, or delay progressive functional deficiency. The treatment can include manipulative techniques on joints, that is, high velocity manual trust techniques in order to improve local function.

The manual therapists’ evaluation is based on a perspective that dysfunctions in the muscular-skeletal system may also be due to psychological and social conditions, and manipulative physiotherapy is put in the context of total patient management.

Aims for the Clinical Master in Manual Therapy for physiotherapists (MMT) The MMT is an education that shall enable the student to become a specialist in examination and treatment of patients with disorders in the musculoskeletal system. The student shall further develop his or her ability to critically evaluate the validity and efficacy of a wide range of musculoskeletal and manipulative physiotherapy assessment and treatment options. The MMT programme, targets physiotherapists who already have some clinical experience, and want to further develop their formal and clinical competence by enhanced theoretical knowledge, expanded practical skills, and by learning how to use scientifically based knowledge as basis for clinical practice.

The Clinical Master in Manual Therapy gives competency in manual therapy by:

- Being an advanced study in examination and treatment of disorders in the musculoskeletal
system

- Qualifying for advanced academic and evidence based clinical work in the area of
musculoskeletal and manipulative physiotherapy

- Qualifying for teaching and supervision

- Giving formal competence resulting in a Master of Philosophy in Health Science degree, which is the starting point for further research and PhD-studies, nationally as well as internationally.

PHYSIOTHERAPY

Golfer's elbow

Neck pain 2

Treatment:

Stress Management

What happens when you are stressed?

What can you do about stress?

How do you figure out your stress level?

How can you reduce your stress?

How can you relieve stress?

Neck Pain

What is neck pain?

What causes neck pain?

What are the symptoms?

How is neck pain diagnosed?

How is it treated?

Can you prevent neck pain?

Massage Therapy

What is massage?

What is massage used for?

Is massage safe?

Golfer's elbow

Symptoms:

Treatment:

Exercise and physiotherapy for tennis elbow

Exercise

Physiotherapy

What To Expect After Treatment

Why It Is Done

How Well It Works

Risks

What To Think About

Tennis elbow

Etiology

Symptoms

Exams and Tests

Treatment

Initial measures

Exercises and stretches

Physiotherapy

Local steroid injections

Surgical intervention

Alternative treatments

Prognosis

Possible Complications

References

See also

Scleroderma - Information for Clinicians

Scleroderma - Information for Clinicians

Localised Scleroderma

Morphoea

Linear Scleroderma

Systemic Sclerosis

Differential Diagnosis

Clinical Presentation

Limited Cutaneous Systemic Sclerosis

Diffuse Cutaneous Scleroderma

Prognosis

Pathophysiology

The Role of the Immunology Laboratory

Disease Management

References

Scleroderma, Lupus

Muscles and Joints - Scleroderma

Connective Tissues

Bone and Joint Involvement

Muscle Involvement

Tendon Involvement

Posture, Pain Relief and Exercise

Posture

Pain Relief

Heat Therapy

Cold Therapy

Exercise

Maintain Your Posture

Good Posture

GOUTY ARTHRITIS

HOW CAN RHEUMATOID ARTHRITIS BE TREATED

PREVENTION OF RHEUMATOID ARTHRITIS

Other Treatments of arthritis