“Things without remedy should be without regard;

what is done, is done.”

William Shakespeare, Macbeth

I read an interesting article in BBC News Health a couple of weeks ago. It reviewed 2 recent studies on pain. The first was published in The Journal of Pain by Atsuo Yoshino et al. Subjects were shocked with an electric current whilst they were shown pictures of sad, happy or neutral faces. Photos of an emotional face usually provoke the same emotional response in the person viewing the picture. Although the electrical stimulation was the same in all cases, subjects felt more pain when looking at sad faces.

The second study was conducted by Marion Hofle et al. in Pain. The researchers asked the subjects to place one of their hands under a screen. On the screen, they played a video of a hand being pricked by a needle, poked by a cotton bud or just left alone. The subjects perceived the hand on the screen as their own.  A painful or non-painful stimuli was applied simultaneously to the video. Viewing the needle prick increased the unpleasantness ratings of the stimulus.

As these studies have shown, negative emotional states and negative expectation seem to increase pain and so the mind plays an important role in the experience of pain. As a physiotherapist, dealing with pain is a daily occurrence and I can remember qualifying as an acupuncturist over 10 years ago…I was desperately keen to use my new skill on anyone that was willing to try and worked hard at convincing anyone that was hesitant to try! With those that were initially hesistant…possibly due to a slight needle aversion, I quickly noticed their exaggerated responses to acupuncture. I can remember several occasions when I would gently touch them with a finger or with the plastic guide tube that surrounds the needle and they would jump and shout “ouch”…to which I would reply “relax, we haven’t started yet!” I’ve now learnt from those experiences and no longer feel the need to convince everyone to have acupuncture…no matter how great I think it is!

John Milton was right in Paradise Lost…“The mind is its own place, and in itself can make a heaven of hell, a hell of heaven.”

A study by Akiko Onda et al. published in Biochemical and Biophysical Research Communications has concluded that “acupuncture can partially prevent skeletal muscle atrophy”. It helps recover skeletal muscle mass and cross-sectional area possibly by increasing protein synthesis and decreasing protein degradation. Although the experiment was performed on mice, it was hypothesised that acupuncture could be used to prevent muscle wasting in the elderly and in patients with “severe conditions”.

Exciting new research by Burd and colleagues shatters currently held beliefs about the type of resistance training required for muscle growth. Their article entitled “Bigger weights may not beget bigger muscles: evidence from acute muscle protein synthetic responses after resistance exercise” has been published in the journal Applied Physiology, Nutrition, and Metabolism. They found that performing repetitions until fatigue (an average of 24 repetitions) with 30% of one repetition maximum (1RM) was just as effective at eliciting muscle protein synthesis (MPS) as 5 repetitions with 90% 1RM! In fact, exercise performed at 30% 1RM produced longer lasting MPS.

The authors believe that maximal muscle fibre recruitment is fundamental in inducing MPS and that lifting light weights to failure causes the fibre activation required. In addition, low-intensity resistance exercise allows for a higher total number of repetitions and greater total exercise volume, which is important in sustaining the MPS response over time.

Burd et al. note that “skeletal muscle mass is a large contributor to daily energy expenditure and will assist in weight management. Additionally, skeletal muscle, because of its overall size, is the primary site of blood glucose disposal and thus will likely play a role in reducing the risk for the development of type II diabetes”.

“Act when the idea is hot and the emotion is strong”

Jim Rohn

A recent randomised trial published in Annals of Internal Medicine by Cohen and his colleagues shows that steroid epidurals can help relieve sciatica. They found that “75% of patients treated with epidural steroids reported 50% or greater leg pain relief and a positive global perceived effect at 1 month”.  Of course, an epidural is an invasive treatment with associated risks and would probably not be the first choice of treatment. Conservative therapies such as physiotherapy, osteopathy, chiropractic, acupuncture, etc. should be the first port of call. In addition, your GP may prescribe anti-inflammatories and analgesia. Only in cases of severe sciatica when conservative treatment has not been effective should an epidural be envisaged.

Over time the healing process should help settle the sciatica, irrespective of whether or not a steroid epidural is performed, but an epidural can catalyse the process by decreasing pain, decreasing anxiety and stress, increasing mobility and allowing the participation in physiotherapy and rehabilitation.

An article in Medical News Today reviews a study in The Journal of Alternative and Complementary Medicine on the treatment of low back pain. A combined program of complementary and conventional therapies was found to be more helpful than the usual care provided by the primary care physician. The benefits of the program were a decrease in pain and an improvement in function. The complementary therapies provided included physiotherapy, acupuncture, massage, mind-body techniques, chiropractic and nutritional advice. Healing in Motion in St Albans aims to treat musculoskeletal disorders using a holistic, integrated approach.

It’s common knowledge that smoking is bad for health. In the UK, according to the NHS, 114,000 people die each year of smoking related illnesses. In the US, the figure is 443,000 and as reported by Centers for Disease Control and Prevention, smoking is the cause of one out of every five deaths. Smoking damages the lungs and causes conditions such as bronchitis, emphysema, pneumonia and 90% of lung cancers…in addition to several other types of cancer. It also damages the heart and circulatory system and increases the risk of getting coronary heart disease, heart attacks and strokes…but we know all that, what we’re less familiar with are the effects on the musculoskeletal system.

Lets take a closer look at some of the harmful constituents of cigarette smoke: nicotine, carbon monoxide and hydrogen cyanide. Nicotine causes a narrowing of blood vessels and thus decreases blood flow to tissues. Nicotine also increases the risk of blood clots by increasing platelet stickiness. Carbon monoxide and hydrogen cyanide both hinder oxygen metabolism and transport. In summary, smoking decreases the blood flow and transport of oxygen to tissues. The supply of nutrients, minerals and oxygen via blood flow is vital for the development and regeneration of cells.

Some of the numerous documented musculoskeletal risk factors associated with tobacco use are:

• poor wound healing and increased rates of postoperative complications such as infections, haematoma, tissue death and skin graft loss
• delayed or deficient ligament healing (in mice)
• shoulder rotator cuff disease
• the development of osteoporosis and osteoporosis related hip fractures
• an extensive body of evidence shows that smoking delays mineralization during the bone healing process, decreases the strength of regenerating bones and increases the incidence of non-union (failure to heal). In one study on wrist fractures, non-smokers took 4.1 months to heal whereas smokers took 7.1 months…almost twice as long! Smokers have been estimated as having 2.5 times more risk of ensuing complications.
• an increase in the incidence of rheumatoid arthritis
• a greater likelihood of developing systemic lupus erythematosus (an inflammatory autoimmune disease affecting connective tissue)

In order to enhance soft tissue healing and fracture healing, as well as for general musculoskeletal health, it’s definitely advisable to stop smoking!

“Everything can be taken from a man but one thing: the last of the human freedoms…

to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

Viktor Frankl

A study by Suezie Kim et al. published in The American Journal of Sports Medicine has shown that injury rates in snowboarders are slightly higher than injury rates in alpine skiers. Snowboarders more commonly injure their wrists, shoulders and ankles while skiers tend to injure their knees.

In skiers the knee accounts for a third of all injuries but female skiers are twice as likely to injure their knees as men and 3 times as likely to strain their anterior cruciate ligaments (ACL). Gerhard Ruedl et al. found that women “showed a 2-fold higher risk of suffering an ACL rupture of their non-dominant leg”. Men had an equal chance of injuring the right or left knee. Ruedl told Reuters Health that women showed greater discrepancies in strength and proprioception (sense of joint positioning)  between their dominant and non-dominant legs. Most female skiers injured their left (non-dominant) ACLs during right turns when the forces on the left (outside) leg were greatest.