“The greatest test of courage on earth is to bear defeat without losing heart.”

Robert G. Ingersoll

Prolonged Sitting Affects Glucose Metabolism

New research published in the journal Diabetes Care has concluded that after meals, regular short bouts of light or moderate walking lower glucose and insulin levels. The subjects were asked to walk around for 2 mins every 20 mins. The effects of these short bouts of walking assist glucose metabolism and may reduce cardiovascular risk.

This adds to the mounting evidence regarding the health risks associated with prolonged sitting.

Metal On Metal Total Hip Replacements Unsafe?

A BBC Newsnight and British Medical Journal investigation has prompted a lot of discussion regarding metal on metal total hip replacements. Lately, a study has found that the metal components rub against each other causing small particles to break away into surrounding tissues. This leads to elevated blood levels of metal ions such as cobalt and chromium. The clinical significance of this is still unknown. The Medicines and Healthcare products Regulatory Agency (MHRA) have stated that annual blood tests should be conducted to check levels of cobalt and chromium. If levels are high, an MRI scan should be carried out to see if the prosthesis requires revision.

A recent technology overview conducted by the American Academy of Orthopaedic Surgeons (AAOS) has concluded that metal on metal implants are at greater risk of revision than replacements with different bearing surface combinations. This has come as a bit of a surprise as it was hoped that sturdy metal on metal implants would outlast metal on plastic implants. It was also noted that larger femoral head components are at higher risk than smaller ones and older patients also incur a greater likelihood of requiring another operation.

A previous technology review had found that hip resurfacing is more likely to need revising than total hip arthroplasties (THA). The size of the head is inversely related to the risk of revision. However, the Australian registry has suggested that younger men have less risk of revision with resurfacing than they do with THAs. This is interesting because research published in this month’s The Journal of Bone & Joint Surgery (British Volume) shows that the 10 year survival rate for a Birmingham hip resurfacing (BHR) is 89.1% for women and 97.5% for men. Mr AJ Shimmin et al. conclude that “BHR provides good functional outcome and durability for men, at a mean follow-up of ten years. We are now reluctant to undertake hip resurfacing in women with this implant”.

All this definitely provides food for thought and it’s well worth doing some research and having a long chat with your surgeon before deciding what sort of hip prosthesis to have.

Meditation Increases Blood Flow To The Brain

Recent research has shown that mantra-based meditation increases cerebral blood flow. An improvement in attention, emotional state and memory was also noted. Therefore, it’s likely that people with cognitive impairments or memory loss will benefit from meditation.

Acupuncture Awareness Week

This week the British Acupuncture Council is launching the very first Acupuncture Awareness Week and their website is full of useful information. Of all the treatments I use, acupuncture is by far the one that most clients are curious about. Acupuncture has been used in China for over 2000 years. Fine needles are inserted into the skin to stimulate the body. Obviously, the needles are sterile and disposed of after use. Acupuncture can help with all sorts of muscle or joint pains like back pain for instance. The most common question is; how does it work? Let’s use back pain as an example (the following information was provided by the British Acupuncture Council).

“Acupuncture can help back pain by:

• Providing pain relief – by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors and changes the processing of pain in the brain and spinal cord (Pomeranz 1987; Zhao 2008).
• Reducing inflammation – by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007;Zijlstra 2003).
• Improving muscle stiffness and joint mobility – by increasing local microcirculation (Komori 2009), which aids dispersal of swelling and bruising.
• Reducing the use of medication for back complaints (Thomas 2006).
• Providing a more cost-effective treatment over a longer period of time (Radcliffe 2006;Witt 2006).
• Improving the outcome when added to conventional treatments such as rehabilitation exercises (Ammendolia 2008; Yuan 2008).”
• Releasing tight bands in muscles

Following research into the effects of acupuncture on low back pain, the National Institute for Health and Clinical Excellence (NICE) now recommend that GPs offer a course of 10 sessions of acupuncture as a first line treatment for persistent, non-specific low back pain.

“Every patient carries her or his own doctor inside”.

Albert Schweitzer

Low Back Pain: When To See Your Doctor?

The BBC News-Health webpage currently links to the BBC Health site. The title of the link is “Back-pain danger signs, Symptoms to take straight to your doctor”. I followed it, read through the information and found it incomplete. In my opinion, a few things could be added to the list, but before adding anything…it’s important to bear in mind that the vast majority of low back pain is trivial and usually disappears after a couple of days or weeks. In a very small minority of cases the low back pain is a sign of something more serious. You should make an appointment to see your doctor if your back pain is associated with:

• Significant trauma (such as RTA or a fall)
• Osteoporosis
• Prolonged use of corticosteroids
• History of cancer
• Unexplained weight loss
• Fevers
• History or high risk of decreased immune response (AIDS or HIV, recreational drug use, steroid or immunosuppressant use)
• Unremitting pain (even when lying down)
• Neurological symptoms (urinary incontinence or retention, fecal incontinence, loss of sensation in the genital region, weakness or loss of sensation in the lower limbs)

Please note that the signs and symptoms listed above don’t automatically mean that something sinister is at hand but simply that further questioning and examination is required. Lastly, remember that the overwhelming majority of low back pain is insignificant…apart from the inconveniencing pain obviously!

“To ensure good health: eat lightly, breathe deeply, live moderately, cultivate cheerfulness, and maintain an interest in life.”

William Londen

Should You Run After A Hip Resurfacing?

Osteoarthritis is the gradual degradation of a joint. It can lead to pain, stiffness and swelling. One of the most common joints to be affected is the hip. In 1940 Dr Austin Moore performed the first total hip replacement (THR) and the technique was later refined by Dr John Charnley. Modern replacements consist of a metal stem and head that is inserted into the top of the femur. It fits into a plastic cup which is cemented into the pelvis. Post surgery, patients usually experience less pain and enjoy greater range of motion. However, several studies have shown that the prosthesis wears and loosens prematurely if excessive running and impact activities are undertaken. This can lead to another operation to revise the THR with the associated risk of complications.

More recently, hip resurfacing was developed by Dr Derek McMinn as an alternative to THRs. It requires less of the femur to be removed. A metal cap is placed over the head of the femur and a metal cup is placed in the socket. The advantages of a hip resurfacing compared to a THR are numerous: bone preservation, less chance of dislocation, less leg length inequality, better lower limb alignment and easier revision to a THR if necessary.

A recent article in Reuters has quoted work done by Dr Julien Girard in France. Hip resurfacings were performed on 40 physically active patients. Their average age was 51 years. After surgery, 90% of the patients returned to running. Three years later 33 out of 40 were still running albeit they had decreased their mileage from 24 miles per week to 16 miles per week. The study didn’t look at the long-term effects of running on the implant.

An article in today’s Medical News Today summarises research presented at the 2012 Annual Meeting of the Academy of Orthopaedic Surgeons.  Over 10 years, 445 patients (average age of 49 years) who had undergone a hip resurfacing were monitored. A correlation between higher activity scores and revision of surgery was found and it was concluded that impact activities such as running and tennis were harmful to long-term success.

In conclusion, although a return to running and impact sports is possible after a hip resurfacing…even to high level competitive sport…it does bear risks…such as the untimely wear and deterioration of the prosthesis. This would require further surgery…and possibly a total hip replacement. With that in mind, my advice for anyone with a hip resurfacing, wondering how much they can or can’t do…would be to stick to non-impact exercise such as cycling, rowing, cross-training, etc. That doesn’t mean that you shouldn’t run at all…I wouldn’t want you to miss that train…but it should remain occasional.

Tai Chi Improves Balance In People With Parkinson’s

Parkinson’s disease is a degenerative disorder that affects dopamine-generating cells in the central nervous system. The physical symptoms are the classic triad: shaking, rigidity and slowness of movement. Posture, walking and balance are also impaired. Dr Fuzhong Li and colleagues studied the effects of Tai Chi on patient’s with Parkinson’s. Amongst other benefits, they found that Tai Chi improved posture, walking ability and decreased the number of falls.

Previous research has already found that Tai Chi reduces falls among the elderly. In fact it’s slow, fluid movements over a firm, balanced stance seem like an ideal form of exercise for aging populations.