“We’re genetically programmed to respond favourably to movement and exercise,

there’s healing in motion.”

G

Tender Tendons

Tendon problems can affect many areas of the body such as the elbows (tennis elbow and golfer’s elbow), hips, knees (runner’s knee), ankles (Achilles tendon) and feet (policeman’s heel). In the past these problems went by the name of tendonitis. The suffix “itis” was used because it was thought that inflammation was present. Imaging techniques like ultrasound and MRI scans have revealed that there is in fact very little inflammation (except possibly in the very early stages) but instead degenerative changes were found. This led to the replacement of tendonitis by tendinosis. The suffix “osis” means degeneration. Recently however, studies have found that the imaging findings are not directly related to symptoms:

• some people are symptom-free even though they have structural tendon pathology
• as symptoms improve, structural pathology doesn’t change
• structural pathology is not necessarily a good predictor of recovery

This has led to a yet another word being used…tendinopathy. The “pathy” simple means problem…something is wrong but we’re not exactly sure what it is! It’s thought that past experience, emotion and adverse pain beliefs could lead to a hypersensitive nervous system.

That being said, it’s believed that tendon overload plays a crucial role, whereby the rate of wear is greater than the rate of repair. Therefore, inciting factors tend to fall under 2 categories.

1) Factors that increase the rate of tear:

• repetitive impact activities
• tendon compression
• sudden increase in training volume, intensity or frequency
• muscle weakness
• faulty biomechanics
• obesity

2) Factors that decrease the rate of repair:

• menopause
• age
• rheumatoid arthritis
• type II diabetes
• high cholesterol
• statins
• smoking

After a thorough clinical assessment the probable causative factors should be addressed when possible. The aim of treatment is to decrease pain, promote healing and improve function. There are several different treatments that are used. The choice usually depends on the site, severity of symptoms and the stage of presentation. In the early stages when there is possibly some inflammation present, NSAIDs, rest, ice, wedges, taping or splinting can be used. Obviously, physiotherapy and acupuncture are useful and corticosteroid injections are helpful (especially when performed around the tendon rather than in it). Surgery is a last resort and results can sometimes be disappointing. Some of the best evidence is for the use of extracorporeal shock-wave therapy or a progressive exercise programme. In fact, a progressive exercise programme should be part of all treatment packages particularly alongside treatments that are successful at decreasing pain but that don’t improve healing or function. A graduated exercise programme can ensure the long-term success of treatment.

Sleep Quality Linked to Rumination

Jacob Nota and Meredith Coles from the Department of Psychology at Binghamton University in the US have made some interesting discoveries regarding sleep duration and timing. Their research confirmed what others had already noticed, that rumination (repetitive negative thinking) was associated with reduced sleep duration. In addition to this, they found that the timing of sleep was also important. Individuals that reported later sleep and activity times also reported more repetitive negative thinking.

People that ruminate tend to suffer more from anxiety, depression, post-traumatic stress disorder and obsessive-compulsive disorders. For those that sleep too few hours, increasing sleep has already been found to decrease symptoms of psychopathology. Further efforts to get to bed earlier may provide even more benefit.

These recent findings highlight the importance of sleep on health.

“The art of living is neither careless drifting on the one hand nor fearful clinging on the other. It consists in being sensitive to each moment, in regarding it as utterly unique, in having the mind open and wholly receptive.”

Alan Watts

“Failure is the key to success;

Each mistake teaches us something.”

Morihei Ueshiba

Diabetes Linked To Shoulder & Hand Pain and Disability

A recent study by Shah et al. found that about two-thirds of patients attending a diabetes outpatient clinic reported shoulder pain and/or disability. They had significant restrictions in shoulder movement, decreased shoulder strength and hand grip strength. In addition to this, they had a greater likelihood of decreased sensation and limited mobility of the hand. Further research is needed to understand the underlying mechanisms and to find preventative measures.

The 5 Habits of Highly Healthy People

Since 1979 Professor Peter Elwood and his team of researchers from Cardiff University School of Medicine have tracked the lifestyle habits of 2500 men aged 45-59 (at the start of the study). They found that men that followed 5 habits had 70% less chance of developing diabetes, 60% reduced incidents of heart attacks and strokes, 40% fewer cancers, and a reduction of 60% in cases of dementia. Incidentally, less than 1% of the study group followed all 5 habits! These 5 habits have the potential to reduce illness and chronic disease and so promote longevity…what are they?

The 5 habits of highly healthy people are:

• regular exercise
• no smoking
• a healthy bodyweight
• a healthy diet
• a low alcohol intake

Not rocket science by any means…and definitely within everyone’s grasp!

Side Planking Reduces Scoliosis

Dr Loren Fishman et al. studied a group of 25 patients with scoliosis. They taught the patients how to perform the side plank, which is a static exercise performed in Yoga and Pilates. The patients were then asked to perform the exercise once a day for as long as possible. They were instructed to only perform it on one side, with the scoliotic convexity downwards. The theory being that it would strengthen the weaker side of the spine and help address the muscle imbalance.

Measurements and x-rays were taken pre and post treatment. On average, patients reported practising the pose for 90 seconds a day, 6 days a week, for just under 7 months. A significant improvement of 32% was found in the Cobb angle of the primary scoliotic curve. The improvement rose to above 40% among the 19 most compliant patients.

This is an amazing result given the minor time investment!

Low Level Physical Activity Benefits Knee Osteoarthritis

It’s well known that increasing the time spent doing moderate intensity physical activities has wide ranging benefits on health. Guidelines recommend 150 minutes a week of moderate to vigorous physical activity. What about those unable to engage in moderate or vigorous physical activities due to health issues? Could light physical activity work too?

A study by professor Dunlop et al. looked at the effects of physical activity in people with knee osteoarthritis or risk factors for knee osteoarthritis. As well as finding benefits to moderate activity, they found that spending more time doing light intensity physical activities reduced the risk of onset and progression of disability due to osteoarthritis. They concluded that “an increase in daily physical activity time may reduce the risk of disability, even if the intensity of that additional activity is not increased.”

Breathing Exercises Help Treat PTSD

A study by Seppala et al, published in last month’s issue of the Journal of Traumatic Stress, looked into the effects of yogic breathing on war veterans with post traumatic stress disorders (PTSD). They found that after the course of controlled breathing exercises the test subjects had reductions in PTSD scores, anxiety symptoms, respiration rate, startle signs and other hyperarousal symptoms. The benefits were still present 1 year later. It’s thought that the breathing exercises help balance the autonomic nervous system.