Deborah Carroll's Blog, page 16
November 9, 2013
Deconditioning – 7 Articles
Aging does not cause you to lose muscles. Loss of muscle is caused by lack of exercise. You can preserve both muscle size and strength by continuing to exercise as long as you live. Here are MRIs of the legs of 40- and 70-year-old triathletes, and a 70-year-old non-exerciser:
http://www.drmirkin.com/public/ezine030412.html
The dark spots are muscle, the light spots are fat. Which legs would you like to have?
Forty competitive athletes, aged 40-81, who trained four to five times a week, had the same size muscles, the same absence of fat around their muscles, and close to the same strength as much younger athletes (The Physician and Sportsmedicine, September 2011).
Many of the diseases and debilitating conditions associated with aging are caused by lack of exercise. “Exercise decreases body fat and obesity, increases muscle strength, improves balance, gait, and mobility, decreases likelihood of falling, improves psychological health, reduces arthritis pain, and heart
attacks, osteoporosis, cancer, and diabetes.”
After age 40, the average person loses more than eight percent of muscle size per decade. This loss increases to 15 percent per decade after age 75 years. Older people who lose muscles are four times more likely be disabled, have difficulty walking, and need walkers and other mechanical devices to help
them walk (Am J Epidemiol, 1998; 147(8):755-763).
From Deb:
This post was taken from Dr. Mirkin’s eZine on health and fitness.The primary benefit my practice brings to animals, human or otherwise, is the knowledge of how to develop and encourage the right types of movement to improve health. In short. 
The primary attribute that YOU bring is follow-through, compliance. Thank you.
Which Nutritional Factors Help Preserve Muscle Mass, Strength and Performance in Seniors?
Jan. 18, 2013 — New review by International Osteoporosis Foundation (IOF) Nutrition Working Group examines role of nutrition in sarcopenia, with focus on protein, vitamins D and B, and acid-based diet.
Sarcopenia, or the gradual loss of muscle mass, is a common consequence of aging, and poses a significant risk factor for disability in older adults. As muscle strength plays an important role in the tendency to fall, sarcopenia leads to an increased risk of fractures and other injuries.
The International Osteoporosis Foundation (IOF) Nutrition Working Group has published a new review which identifies nutritional factors that contribute to loss of muscle mass, or conversely, are beneficial to the maintenance of muscle mass. The Group reviewed evidence from worldwide studies on the role of nutrition in sarcopenia, specifically looking at protein, acid-base balance, vitamin D/calcium, and other minor nutrients like B vitamins.
“The most obvious intervention against sarcopenia is exercise in the form of resistance training,” said Professor Jean-Philippe Bonjour, co-author and Professor of Medicine at the Service of Bone Diseases, University of Geneva. “However, adequate nutritional intake and an optimal dietary acid-base balance are also very important elements of any strategy to preserve muscle mass and strength during aging.”
The review discusses and identifies the following important nutritional factors that have been shown to be beneficial to the maintenance of muscle mass and the treatment and prevention of sarcopenia:
Protein: Protein intake plays an integral part in muscle health. The authors propose an intake of 1.0-1.2 g/kg of body weight per day as optimal for skeletal muscle and bone health in elderly people without severely impaired renal function.
Vitamin D: As many studies indicate a role for vitamin D in the development and preservation of muscle mass and function, adequate vitamin D should be ensured through exposure to sunlight and/or supplementation if required. Vitamin D supplementation in seniors, and especially in institutionalized elderly, is recommended for optimal musculoskeletal health.
Avoiding dietary acid loads: Excess intake of acid-producing nutrients (meat and cereal grains) in combination with low intake of alkalizing fruits and vegetables may have negative effects on musculoskeletal health. Modifying the diet to include more fruits and vegetables is likely to benefit both bones and muscles.
Emerging evidence also suggests that vitamin B12 and/or folic acid play a role in improving muscle function and strength.
As well, the Review discusses non-nutritional interventions such as hormones, and calls for more studies to identify the potential of antioxidants and anti-inflammatory compounds in the prevention of sarcopenia.
Dr. Ambrish Mithal, co-author and Chair and Head of Endocrinology and Diabetes division at Medanta, New Delhi underlined the need for further research in the field. “Strategies to reduce the numbers of falls and fractures within our aging populations must include measures to prevent sarcopenia. At present, the available evidence suggests that combining resistance training with optimal nutritional status has a synergistic affect in preventing and treating sarcopenia, ” said Mithal.
“We hope that further studies will shed light on other effective ways of preventing and treating this condition.”
From ScienceDaily.com
Resistance Training and the Older Adult
From the American College of Sports Medicine
Comments and Position Statements
(and, yes, most of the ideas outlined here may be adapted, and have been by me, for functional animal rehab–RehabDeb)
“The health benefits of appropriately prescribed long-term (more than 12 weeks) resistance training in older adults–ages 65 and older–are well known. They include improvements in muscle strength and endurance; other possible health benefits include increase in muscle mass, which translates into improvements in functional capacity. In addition, increased weight bearing with resistance training is considered beneficial in improving bone density and combating the effects of osteoporosis.
Achieving appropriate levels of function is very important for older adults so they are able to carry out most of the daily living skills necessary to lead independent lives. Due to the fact that muscle wasting (sarcopenia) and weakness, exacerbated by physical inactivity, is prevalent in the aging population, more emphasis has been placed on developing resistance-training programs for older adults. When developing resistance-training programs for this group, important components to consider are the various training-related variables: frequency, duration, exercises, sets, intensity, repetitions, and progression.
Older adults often have orthopedic issues that contraindicate resistance training of the affected joint(s). Older adults are also at a higher risk of cardiovascular disease, and in many cases have even been diagnosed with it. Therefore, it is critical that the older adult receive prior approval from their physician before participating in resistance training. It should be noted that proper supervision of the individual’s resistance-training program, including any testing procedures, by an appropriately trained exercise professional, is highly recommended. It should also be noted that performing maximum strength testing in many older adults is not recommended. Therefore, when strength testing is appropriate, sub-maximum testing protocols for estimating maximum strength are recommended.
Frequency refers to the number of exercise sessions per week. The traditional recommendation for frequency is to engage in three training sessions per week for individuals primarily seeking improvement in their overall health and fitness capacity. Even though some individuals may be motivated to train more frequently, resistance-training studies with the elderly have indicated a range of two to four days per week to be effective and adequate in improving strength. So the recommendation is that the older individual train at least two days per week but no more than four, suggesting an average training frequency of three days per week. Also, the frequency of exercise should be structured so that there is at least 48 hours between training sessions. An individual could satisfy this requirement with a “total body” routine, meaning that they would exercise all of the chosen muscle groups during each training session two or three days per week. Another approach could be a “split” routine where some of the chosen muscle groups are exercised on one or two days a week while the remaining are exercised on a separate one or two days. This “split” routine approach may not be appropriate for those older individuals who are just beginning their program.
Duration describes the length of each training session. In reference to training duration, longer training sessions are not necessarily more effective. If one has an appropriately designed program based on sound training variables, lengthy training sessions are not necessary. In fact, older adults should avoid lengthy training sessions, because they may increase the risk of injury, manifested by extreme fatigue. Present guidelines for resistance training in older adults recommend a range of approximately 20-45 minutes per session. In other words, one should attempt to train for at least 20 but no longer than 45 minutes. This range suggests an approximate average duration of 30 minutes per session.
Exercise may be categorized as either multi-joint, meaning more than one joint is dynamically involved to perform the exercise (e.g., bench press, shoulder press, leg press), or uni-joint, meaning only one joint is dynamically involved (e.g., bicep curls, triceps extensions, leg extensions). In the older adult, the resistance-training program should focus primarily on multi-joint exercises. Uni-joint exercises are not discouraged entirely but should not make up the majority of exercises within the training program.
Additionally, machines are recommended over free weights (i.e., barbells and dumbbells) due to skill-related and safety factors. As the individual progresses, they can use free-weight exercises appropriate for their level of skill, training status and functional capacity.
Traditionally, muscle groups are classified as the following: 1) chest, 2) shoulders, 3) arms, 4) back, 5) abdomen, and 6) legs. Specifically, the chest group contains the pectoral muscles, the shoulder group contains the deltoid, rotator cuff, scapular stabilizers and trapezius muscles, the arm group contains the biceps, triceps, and forearm muscles, the back group contains the latissimus dorsi of the upper back and the erector muscles of the lower back, the abdomen group contains the rectus abdominis, oblique, and intercostals muscles, and the leg group contains the hip (gluteals), thigh (quadriceps), and hamstring muscles. In the older adult, it is important to attempt to incorporate all six of these muscle groups into the comprehensive resistance-training program.
It has been recommended that one to two exercises per muscle group is normally adequate. Noteworthy here is to understand that by employing primarily multi-joint exercises in the resistance training program one may actually exercise more than one muscle group or specific muscle per exercise. For example, in performing the leg press exercise the quadriceps, hamstrings, and gluteal muscles are all involved and, in many cases, this could eliminate the need to perform any uni-joint exercises for those particular muscles.
If a person is performing both multi-joint and uni-joint exercises for a particular muscle group, it is recommended that the multi-joint exercise(s) be performed before the uni-joint exercise. Additionally, within each resistance-training workout, larger muscle groups (i.e., legs, back, and chest) should be worked before smaller muscle groups (i.e., arms and shoulders).
Studies have shown improvements in muscle strength employing ranges of one to three sets of each exercise during the training program. Based on current guidelines, it would be recommended that the individual start with one set of each exercise and, depending on individual need, possibly progress up to no more than three sets when the fitness professional deems it appropriate. It should be noted, however, that an average of two sets of each exercise would be beneficial for most individuals. To avoid excess fatigue, a two-to-three minute rest period between sets and exercises is recommended.
Intensity refers to the amount of weight being lifted, and is a critical component of the resistance-training program, considered by many fitness professionals to be the most important training-related variable for inducing improvements in muscle strength and function. In other words, the more weight lifted, the more strength gained. Even though this may not always be the case, the importance of intensity in facilitating strength improvements is well documented. Intensity is often expressed as a percentage of the maximum amount of weight that can be lifted for a given exercise (1RM). For example, if someone who has a maximum effort of 100 pounds on the bench press exercise performs a set with 80 pounds, they would be training at 1RM of 80%. Studies have suggested that older individuals are able to tolerate higher intensities of exercise, up to 85%.
However, research has also shown intensities ranging from 65%-75% of maximum to significantly increase muscle strength. Therefore, in order to increase strength while simultaneously decreasing the risk of musculoskeletal injury that often accompanies higher intensities of resistance training, a low-intensity to moderate-intensity range of 65%-75% is recommended.
Repetitions (reps) refer to the number of times an individual performs a complete movement of a given exercise. There is an inverse relationship between intensity and repetitions, indicating that as the intensity increases the repetitions should decrease. Based on previous research, a rep continuum has been established that demonstrates the number of repetitions possible at a given relative intensity. For example, an intensity of 60% relates to 16-20 reps, 65% = 14-15 reps, 70% = 12-13 reps, 75% = 10-11 reps, 80% = 8-9 reps, 85% = 6-7 reps, 90% = 4-5 reps, 95% = 2-3 reps, and 100% = 1 rep. In view of the previously mentioned recommendations for an intensity of 65%-75% of maximum, this would suggest that for each training exercise the individual perform an adequate amount of weight that would allow for 10-15 reps. In the event that no initial strength testing was performed, simply through trial-and-error an individual could determine appropriate training loads that would allow them to perform only 10-15 reps. They could then be sure of training at 65%-75% of maximum effort.
In order to continually enjoy improvements in strength and functional capacity, it is important to consistently incorporate progression and variation into the resistance-training program. Progressing and varying one’s program commonly involves incorporating the overload principle. The overload principle involves making adjustments to the training variables of the resistance-training program such as frequency, duration, exercises for each muscle group, number of exercise for each muscle group, sets and repetitions. In terms of adjustment, normally the overload principle involves making increases to these variables. For example, making progressive increases in intensity has been shown to be important in increasing muscle strength. In terms of the rate of progression, one should consider attempting to progress their resistance-training program on a monthly basis. However, it should be noted that increasing the intensity in some older adults may be contraindicated due to orthopedic and/or other medical limitations. As a result, making adjustments in other training variables would be recommended.”
Written for the American College of Sports Medicine by Darryn S. Willoughby, Ph.D., CSCS, FACSM
Fighting Foot Drop
From Advance Journal for Human Physical Therapy
My (RehabDeb) Comment:
“Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.”
Employing these techniques in animal-other-than-human rehab is what I do and is highly successful here, as well–proprioceptive training that can also build nerve strength For dogs and cats, I utilize Orthovet footbed splints and Thera-Paws Dorsi-Flex Assist boots on a case-by-case basis.
The Foot Drop Fight
Early treatment and compliance with a home exercise program are essential.
By Rebecca Mayer Knutsen
Posted on: December 20, 2012
Foot drop, a general term for difficulty lifting the front part of the foot, can be a temporary or permanent condition. The condition signals an underlying neurological, muscular or anatomical problem.
A patient with foot drop due to weakness or paralysis may exhibit behavior such as scuffing her toes along the ground. Or she may develop a high-stepping gait so her foot does not catch on the floor as she walks.
Beyond the obvious frustrations and limitations that accompany this condition, these patients are at greater risk for falls. According to physical therapists, early treatment and patient commitment to a prescribed home exercise program is often the best approach for patients with this gait abnormality.
Gaining Control
The source of foot drop is most commonly a central neurological impairment such as stroke, multiple sclerosis or traumatic brain injury or a peripheral injury such as nerve damage stemming from knee replacement surgery.
“Controlling foot drop through strengthening, orthotics or a functional electrical stimulation foot drop system may address the instability of the ankle, limit the possibility of catching the toe during gait and increase safety and stability to decrease the potential of falls,” said Gregory A. Thomas, PT, physical therapy supervisor, Rehabilitation Center at Eastern Idaho Regional Medical Center in Idaho Falls, ID.
Therapists must conduct a thorough PT evaluation that includes a complete patient history and an assessment of range of motion, strength, sensation, spasticity, reflexes and mobility. Treatment varies depending upon the cause and presentation of the foot drop. Treatment options range from therapeutic exercises including ROM, stretching and/or strengthening to electrical stimulation and gait training.
“The first thing I do with a patient is determine if the dysfunction is central or peripheral,” explained Douglas O. Brown, PT, CSCS, manager of Raub Rehabilitation, Sailfish Point Rehabilitation and Riverside Physical Therapy, all part of Martin Health System in Stuart, FL. “Is it a brain injury such as stroke or MS?” Brown asked. “Or is it a pinched nerve in back or leg or damage from a hip surgery?”
Once the origin of the foot drop has been determined, Brown must determine if the patient is flaccid with no movement whatsoever. “If so, then the outcome /prognosis will not be as good as someone who exhibits some movement,” he shared.
According to Thomas, PT exercises for this patient population include range of motion exercises for knees and ankles and strengthening leg muscles with resistance exercises. And, stretching exercises are particularly important to prevent the development of stiffness in the heel.
“There are no exercises that are off limits to these patients as long as the ankle is stable during the exercise,” Thomas explained. “The exercises can be closed chained or open depending on the level of stability.”
“We have to focus on restoring normal movement patterns but also on stability,” Brown said. “Can the patient stand on one leg without swaying back and forth? It’s important that we remember the static part because these patients function on different surfaces in real life.”
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Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.
“If my patient’s goal is to be able to walk the beach in her bare feet, then we need to work on uneven surfaces,” Brown said.
The therapists need to understand a patient’s case 100 percent and treat each one as an individual. These patients need to be assessed on their own merits, according to Brown. “If I have a patient with a traumatic ankle injury from being run over by a car, then I may stay away from certain load bearing exercises,” he shared.
Enter the AFO
If a patient does not have functional use of his muscles, then an ankle foot orthosis (AFO) can be used to keep the ankle at 90 degrees and prevent the foot from dropping toward the ground, thereby creating a more even and normal gait.
The type of AFO used depends on each patient’s specific needs. Some of the types most commonly used include solid ankle, articulated ankle and posterior leaf spring and are most typically made of polypropylene. Articulated ankles allow for some ankle motion, dorsiflexion assist and partial push-off during gait and solid ankle AFOs are rigid and more appropriate if the ankle and/or knee are unstable. Patients typically need to wear a larger shoe size to accommodate these types of AFOs.
“As a physical therapist, I need to realistically fulfill the goal of a patient, which in the case of foot drop, is most typically to stop using an AFO,” Brown explained. “But there are other issues to consider aside from the annoyance of the device. I may need to worry about comorbidities such as diabetes and how the AFO may be causing skin breakdown.”
Brown aims to improve his patients’ optimum function and quality of life while decreasing the fall risk. “Once a patient tells me his goals, I need to determine if they are realistic,” he told ADVANCE.
The goal of physical therapy with these patients is to use the least restrictive device, according to Thomas. “If there is active movement at the ankle and we can strengthen it back to normal, then a temporary brace can be used for support and to increase safety,” he stated. “If the foot drop is more long standing, a custom fitted AFO may be needed.”
In the last 10 years or so, AFOs have improved in quality and function, according to Brown. In fact, he says, some AFOs are made of carbon fiber and elicit a dynamic action instead of keeping the foot rigid while going through the swing phase of gait.
Another option is a foot drop system that applies electrical stimulation in a precise sequence, which then activates the muscles and nerves to lift the foot and bend or extend the knee. This type of device assists with a more natural gait, reeducates muscles, reduces muscle loss, maintains or improves range of motion and increases local blood circulation.
The foot drop device allows a flexible ankle during gait to obtain a more normal walking pattern. A good alternative to bracing, the device’s gait sensor adapts to changes in walking speed and terrain, allowing the patient to walk easily on stairs, grass and carpet.
Brown recently treated a 37-year-old woman with early stages of MS. He put the FES foot drop system on her and it helped her walk normally for the first time in years, bringing tears to her eyes.
“FES can help patients develop great gait patterns and fire muscles,” Brown observed. “FES shows the potential for improvement and the patient can rent the device themselves to wear all day instead of an AFO. The technology is helpful but the device isn’t for everyone. There is a better response with central foot drop as opposed to peripheral lesions.”
The device works well when the peripheral nerve is intact. Patients with a peripheral nerve injury-from diabetes or trauma-who have no palpable muscle contractions may not see improvements. “If the damage is peripheral nerve, then a FES foot drop system will not work in correcting foot drop and a passive AFO system will have to be used,” Thomas shared.
If the patient’s spinal cord has been interrupted in any way, then retraining the muscles would be a very difficult-and maybe even impossible-endeavor.
An AFO remains the appropriate solution for patients with lower-extremity edema, unstable ankle stance or cognitive impairments that interfere with operation of a foot drop system.
Complying at Home
For this condition, patients typically go to therapy for about 45 minutes, two times a week, according to Thomas. “If a patient is going to make gains, however, it’s imperative that there is good compliance with a home exercise program,” he shared. “The patients who have the greatest success are the ones with a solid work ethic outside the clinic.”
Brown’s approach to ensure compliance with a home program begins with the patient’s first evaluation. “I tell them how important the home program is and that participation is crucial,” he shared. “I put them on the spot and I go through the exercises the first day and then send them home with illustrations. I say I will quiz them during the beginning of the next session and will ask them to demonstrate the exercises I assigned.”
With this approach, Brown knows whether or not they’ve followed through based on their familiarity with the exercises. “I give additional exercises and instruction during each session,” he said. “And that’s how I make sure that they are compliant. It usually works because patients come prepared because they don’t want to fail.”
When it comes to foot drop-and really any PT-related injury or diagnosis-Brown stresses the importance of seeking care with a physical therapist as soon as possible. “I don’t want to see someone with foot drop after 6 months,” he stated. “Once a patient is medically stable and safe to treat, they need to be sent to PT.”
Brown recalls seeing a patient with foot drop after having a stroke one and a half years earlier. “There was a lot less I could do for her compared with what I could have done right after her stroke,” he said. “It’s crucial to treat these patients as soon as possible with exercise, stretching and weight bearing.”
Rebecca Mayer Knutsen is senior regional editor of ADVANCE and can be reached atrmayer@advanceweb.com.
Bone Strength – From MedlinePlus
Exercise, lifestyle, and your bones
Osteoporosis is a disease that causes bones to become brittle and more likely to fracture (break). With osteoporosis, the bones lose density. Bone density is the amount of bone tissue that is in your bone.
Exercise plays a key role in preserving bone density as you age.
Why Exercise?
Make exercise a regular part of your life. It will help keep your bones strong and lower your risk of osteoporosis and fractures as you get older.
Before you begin an exercise program, talk with your doctor if you are older, have not been active for a while, have diabetes, heart disease, lung disease, or any other health condition.
How Much and What Type of Exercise?
To build up bone density, the exercise must make your muscles pull on your bones. These are called weight-bearing exercises. Some of them are:
Brisk walks, jogging, playing tennis, dancing, or other weight-bearing activities such as aerobics and other sports
Careful weight training, using weight machines or free weights
Weight bearing exercises also:
Increase bone density even in young people
Help preserve bone density in women who are approaching menopause
To protect your bones, do weight bearing exercises 3 or more days a week for a total of over 90 minutes a week.
If you are older, do not do high-impact aerobics, such as step aerobics. This type of exercise may increase your risk of fractures.
Low-impact exercises like yoga and tai chi do not help your bone density very much. But they can improve your balance and lower your risk of falling and breaking a bone. And, even though they are good for your heart, swimming and biking do not increase bone density.
Other Lifestyle Changes to Help Your Bones
If you smoke, quit. Also limit how much alcohol you drink. Too much alcohol can damage your bones and raise your risk of falling and breaking a bone.
If you do not get enough calcium, or if your body does not absorb enough calcium from the foods you eat,your body may not make enough new bone. Talk with your health care provider about calcium and your bones.
Vitamin D helps your body absorb enough calcium.
Ask your health care provider if you should take a vitamin D supplement.
You may need more vitamin D during the winter or if you need to avoid sun exposure to prevent skin cancer.
Ask your health care provider about how much sun is safe for you.
Alternate Names
Osteoporosis – exercise; Low bone density – exercise
References
Lewiecki EM. In the clinic. Osteoporosis. Ann Intern Med. 2011 Jul 5;155(1):ITC1-1-15; quiz ITC1-16.
National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington,DC: National Osteoporosis Foundation; 2010.
Update Date: 5/17/2012
Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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Quality of Life of Obese Dogs Improves When They Lose Weight
This is actually recent research that was done in the UK, where they estimate 1/3 of the dog population is obese. Study conducted by Waltham/Royal Canin. I wouldn’t think we needed research to prompt us on this, however human nature proves we do! For those of you who need research to tell you that your dog will have a longer, happier life (same goes for humans…) if they drop the extra fat, here it is! Wheeeeeee!
The results showed that the quality of life improved in the dogs that had successfully lost weight, in particular vitality scores increased and the score for emotional disturbance and pain decreased. Moreover, the more body fat that the dog lost, the greater the improvement in vitality.
…and, interestingly, the study notes this: “The research also found that dogs that failed to complete their weight loss programme had worse quality of life at the outset than those successfully losing weight, most notably worse vitality and greater emotional disturbance.” …sort of as if the dogs failed the program and not that the owners were part and parcel. lol…the dogs didn’t fail to complete the program. And their finding here denotes the close connection and issues to be explored within the human/animal psychology bond; it works both ways-to the positive and to negative effect. The failed dogs notably had ‘worse quality of life at the outset” than the ones who ended up succeeding, and most compromised were their vitality and emotional status. We definitely pass our moods, demeanor, and worry onto our animals. Breathe peacefully with your pets
The “HOW TO” is up to me to help you accomplish, usually in conjunction with your vet.
I have over 30 years experience in program design and nutrition, so I am well qualified to help with lifestyle changes and subtle or great control measures. People are usually able to follow my plans because I work with them to determine how they operate best, whether with large changes or baby steps or in-between. Blessings-Feb. 21, 2012 — Researchers at the University of Liverpool have found that overweight dogs that lose weight have an improved quality of life compared to those that don’t.
A study of 50 overweight dogs, comprising a mix of breeds and genders was undertaken by scientists at the University in collaboration with the University of Glasgow, Royal Canin and the WALTHAM Centre for Pet Nutrition.
Owners completed a questionnaire to determine the health-related quality of life of their dog prior to weight loss. A follow-up questionnaire was completed by the owners of 30 dogs that successfully completed the weight loss programme, enabling changes in quality of life to be assessed. A range of life quality factors were scored, including vitality, emotional disturbance and pain. The quality of life of dogs which succeeded with their weight loss programme was also compared with those dogs that failed to lose weight successfully.
The results showed that the quality of life improved in the dogs that had successfully lost weight, in particular vitality scores increased and the score for emotional disturbance and pain decreased. Moreover, the more body fat that the dog lost, the greater the improvement in vitality.
The research also found that dogs that failed to complete their weight loss programme had worse quality of life at the outset than those successfully losing weight, most notably worse vitality and greater emotional disturbance.
Dr Alex German, Director of the Royal Canin Weight Management Clinic at the University, said: “Obesity is a risk for many dogs, affecting not only their health but also their quality of life. This research indicates that weight loss can play an important role in keeping your dog both healthy and happy.”
Dr Penelope Morris, from the WALTHAM Centre for Pet Nutrition, added: “Strategies for combating obesity and keeping dogs fit and healthy include portion control, increased exercise and diets specifically formulated for overweight pets.”
Established in 2004, the Royal Canin Weight Management Clinic at the University’s Small Animal Hospital UK’s is the world’s first animal weight management referral clinic and was set up to help tackle and prevent weight problems in animals such as dogs and cats.
Veterinary surgeons from any general practice in the UK can refer overweight animals to the clinic. The patients receive a thorough medical examination, and are then given a specific dietary plan and exercise regime to follow over several weeks.
Taken from ScienceDaily
Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial.
Winters-Stone KM, Dobek J, Nail L, Bennett JA, Leo MC, Naik A, Schwartz A.
Source
School of Nursing, Oregon Health & Science University, Portland, OR 97239, USA. wintersk@ohsu.edu
Erratum in
Breast Cancer Res Treat. 2011 Jun;127(2):457.
Abstract
Targeted exercise training could reduce risk factors for fracture and obesity-related diseases that increase from breast cancer treatment, but has not been sufficiently tested. We hypothesized that progressive, moderate-intensity resistance + impact training would increase or maintain hip and spine bone mass, lean mass and fat mass and reduce bone turnover compared to controls who participated in a low-intensity, non-weight bearing stretching program. We conducted a randomized, controlled trial in 106 women with early stage breast cancer who were >1 year post-radiation and/or chemotherapy, ≥ 50 years of age at diagnosis and postmenopausal, free from osteoporosis and medications for bone loss, resistance and impact exercise naïve, and cleared to exercise by a physician. Women were randomly assigned to participate in 1 year of thrice-weekly progressive, moderate-intensity resistance + impact (jump) exercise or in a similar frequency and length control program of progressive, low-intensity stretching. Primary endpoints were bone mineral density (BMD; g/cm²) of the hip and spine and whole body bone-free lean and fat mass (kg) determined by DXA and biomarkers of bone turnover-serum osteocalcin (ng/ml) and urinary deoxypyrodiniline cross-links (nmol/mmolCr). Women in the resistance + impact training program preserved BMD at the lumbar spine (0.47 vs. -2.13%; P = 0.001) compared to controls. The resistance + impact group had a smaller increase in osteocalcin (7.0 vs. 27%, P = 0.03) and a larger decrease in deoxypyrodinoline (-49.9 vs. -32.6%, P = 0.06) than controls. Increases in lean mass from resistance + impact training were greatest among women currently taking aromatase inhibitors compared to controls not on this therapy (P = 0.01). Our combined program of resistance + impact exercise reduced risk factors for fracture among postmenopausal breast cancer survivors (BCS) and may be particularly relevant for BCS on aromatase inhibitors (AIs) because of the additional benefit of exercise on muscle mass that could reduce falls.”
A comment from me, Deborah: I know of medical doctors, specialists, oncologists…who are ceasing to prescribe the pharmaceuticals that were developed to be used for osteoporosis and osteopenia yet have turned out to be destructive in the long run, and instead they are recommending weight-bearing exercise to improve bone density. Specific exercise under controlled circumstances is proved to be beneficial for healing of bone after surgery as well.
Filed under: RESEARCH CITATIONS (NOT EXHAUSTIVE)
Deconditioning – 5 Articles
Jan. 18, 2013 — New review by International Osteoporosis Foundation (IOF) Nutrition Working Group examines role of nutrition in sarcopenia, with focus on protein, vitamins D and B, and acid-based diet.
Sarcopenia, or the gradual loss of muscle mass, is a common consequence of aging, and poses a significant risk factor for disability in older adults. As muscle strength plays an important role in the tendency to fall, sarcopenia leads to an increased risk of fractures and other injuries.
The International Osteoporosis Foundation (IOF) Nutrition Working Group has published a new review which identifies nutritional factors that contribute to loss of muscle mass, or conversely, are beneficial to the maintenance of muscle mass. The Group reviewed evidence from worldwide studies on the role of nutrition in sarcopenia, specifically looking at protein, acid-base balance, vitamin D/calcium, and other minor nutrients like B vitamins.
“The most obvious intervention against sarcopenia is exercise in the form of resistance training,” said Professor Jean-Philippe Bonjour, co-author and Professor of Medicine at the Service of Bone Diseases, University of Geneva. “However, adequate nutritional intake and an optimal dietary acid-base balance are also very important elements of any strategy to preserve muscle mass and strength during aging.”
The review discusses and identifies the following important nutritional factors that have been shown to be beneficial to the maintenance of muscle mass and the treatment and prevention of sarcopenia:
Protein: Protein intake plays an integral part in muscle health. The authors propose an intake of 1.0-1.2 g/kg of body weight per day as optimal for skeletal muscle and bone health in elderly people without severely impaired renal function.
Vitamin D: As many studies indicate a role for vitamin D in the development and preservation of muscle mass and function, adequate vitamin D should be ensured through exposure to sunlight and/or supplementation if required. Vitamin D supplementation in seniors, and especially in institutionalized elderly, is recommended for optimal musculoskeletal health.
Avoiding dietary acid loads: Excess intake of acid-producing nutrients (meat and cereal grains) in combination with low intake of alkalizing fruits and vegetables may have negative effects on musculoskeletal health. Modifying the diet to include more fruits and vegetables is likely to benefit both bones and muscles.
Emerging evidence also suggests that vitamin B12 and/or folic acid play a role in improving muscle function and strength.
As well, the Review discusses non-nutritional interventions such as hormones, and calls for more studies to identify the potential of antioxidants and anti-inflammatory compounds in the prevention of sarcopenia.
Dr. Ambrish Mithal, co-author and Chair and Head of Endocrinology and Diabetes division at Medanta, New Delhi underlined the need for further research in the field. “Strategies to reduce the numbers of falls and fractures within our aging populations must include measures to prevent sarcopenia. At present, the available evidence suggests that combining resistance training with optimal nutritional status has a synergistic affect in preventing and treating sarcopenia, ” said Mithal.
“We hope that further studies will shed light on other effective ways of preventing and treating this condition.”
From ScienceDaily.com
Resistance Training and the Older Adult
From the American College of Sports Medicine
Comments and Position Statements
(and, yes, most of the ideas outlined here may be adapted, and have been by me, for functional animal rehab–RehabDeb)
“The health benefits of appropriately prescribed long-term (more than 12 weeks) resistance training in older adults–ages 65 and older–are well known. They include improvements in muscle strength and endurance; other possible health benefits include increase in muscle mass, which translates into improvements in functional capacity. In addition, increased weight bearing with resistance training is considered beneficial in improving bone density and combating the effects of osteoporosis.
Achieving appropriate levels of function is very important for older adults so they are able to carry out most of the daily living skills necessary to lead independent lives. Due to the fact that muscle wasting (sarcopenia) and weakness, exacerbated by physical inactivity, is prevalent in the aging population, more emphasis has been placed on developing resistance-training programs for older adults. When developing resistance-training programs for this group, important components to consider are the various training-related variables: frequency, duration, exercises, sets, intensity, repetitions, and progression.
Older adults often have orthopedic issues that contraindicate resistance training of the affected joint(s). Older adults are also at a higher risk of cardiovascular disease, and in many cases have even been diagnosed with it. Therefore, it is critical that the older adult receive prior approval from their physician before participating in resistance training. It should be noted that proper supervision of the individual’s resistance-training program, including any testing procedures, by an appropriately trained exercise professional, is highly recommended. It should also be noted that performing maximum strength testing in many older adults is not recommended. Therefore, when strength testing is appropriate, sub-maximum testing protocols for estimating maximum strength are recommended.
Frequency refers to the number of exercise sessions per week. The traditional recommendation for frequency is to engage in three training sessions per week for individuals primarily seeking improvement in their overall health and fitness capacity. Even though some individuals may be motivated to train more frequently, resistance-training studies with the elderly have indicated a range of two to four days per week to be effective and adequate in improving strength. So the recommendation is that the older individual train at least two days per week but no more than four, suggesting an average training frequency of three days per week. Also, the frequency of exercise should be structured so that there is at least 48 hours between training sessions. An individual could satisfy this requirement with a “total body” routine, meaning that they would exercise all of the chosen muscle groups during each training session two or three days per week. Another approach could be a “split” routine where some of the chosen muscle groups are exercised on one or two days a week while the remaining are exercised on a separate one or two days. This “split” routine approach may not be appropriate for those older individuals who are just beginning their program.
Duration describes the length of each training session. In reference to training duration, longer training sessions are not necessarily more effective. If one has an appropriately designed program based on sound training variables, lengthy training sessions are not necessary. In fact, older adults should avoid lengthy training sessions, because they may increase the risk of injury, manifested by extreme fatigue. Present guidelines for resistance training in older adults recommend a range of approximately 20-45 minutes per session. In other words, one should attempt to train for at least 20 but no longer than 45 minutes. This range suggests an approximate average duration of 30 minutes per session.
Exercise may be categorized as either multi-joint, meaning more than one joint is dynamically involved to perform the exercise (e.g., bench press, shoulder press, leg press), or uni-joint, meaning only one joint is dynamically involved (e.g., bicep curls, triceps extensions, leg extensions). In the older adult, the resistance-training program should focus primarily on multi-joint exercises. Uni-joint exercises are not discouraged entirely but should not make up the majority of exercises within the training program.
Additionally, machines are recommended over free weights (i.e., barbells and dumbbells) due to skill-related and safety factors. As the individual progresses, they can use free-weight exercises appropriate for their level of skill, training status and functional capacity.
Traditionally, muscle groups are classified as the following: 1) chest, 2) shoulders, 3) arms, 4) back, 5) abdomen, and 6) legs. Specifically, the chest group contains the pectoral muscles, the shoulder group contains the deltoid, rotator cuff, scapular stabilizers and trapezius muscles, the arm group contains the biceps, triceps, and forearm muscles, the back group contains the latissimus dorsi of the upper back and the erector muscles of the lower back, the abdomen group contains the rectus abdominis, oblique, and intercostals muscles, and the leg group contains the hip (gluteals), thigh (quadriceps), and hamstring muscles. In the older adult, it is important to attempt to incorporate all six of these muscle groups into the comprehensive resistance-training program.
It has been recommended that one to two exercises per muscle group is normally adequate. Noteworthy here is to understand that by employing primarily multi-joint exercises in the resistance training program one may actually exercise more than one muscle group or specific muscle per exercise. For example, in performing the leg press exercise the quadriceps, hamstrings, and gluteal muscles are all involved and, in many cases, this could eliminate the need to perform any uni-joint exercises for those particular muscles.
If a person is performing both multi-joint and uni-joint exercises for a particular muscle group, it is recommended that the multi-joint exercise(s) be performed before the uni-joint exercise. Additionally, within each resistance-training workout, larger muscle groups (i.e., legs, back, and chest) should be worked before smaller muscle groups (i.e., arms and shoulders).
Studies have shown improvements in muscle strength employing ranges of one to three sets of each exercise during the training program. Based on current guidelines, it would be recommended that the individual start with one set of each exercise and, depending on individual need, possibly progress up to no more than three sets when the fitness professional deems it appropriate. It should be noted, however, that an average of two sets of each exercise would be beneficial for most individuals. To avoid excess fatigue, a two-to-three minute rest period between sets and exercises is recommended.
Intensity refers to the amount of weight being lifted, and is a critical component of the resistance-training program, considered by many fitness professionals to be the most important training-related variable for inducing improvements in muscle strength and function. In other words, the more weight lifted, the more strength gained. Even though this may not always be the case, the importance of intensity in facilitating strength improvements is well documented. Intensity is often expressed as a percentage of the maximum amount of weight that can be lifted for a given exercise (1RM). For example, if someone who has a maximum effort of 100 pounds on the bench press exercise performs a set with 80 pounds, they would be training at 1RM of 80%. Studies have suggested that older individuals are able to tolerate higher intensities of exercise, up to 85%.
However, research has also shown intensities ranging from 65%-75% of maximum to significantly increase muscle strength. Therefore, in order to increase strength while simultaneously decreasing the risk of musculoskeletal injury that often accompanies higher intensities of resistance training, a low-intensity to moderate-intensity range of 65%-75% is recommended.
Repetitions (reps) refer to the number of times an individual performs a complete movement of a given exercise. There is an inverse relationship between intensity and repetitions, indicating that as the intensity increases the repetitions should decrease. Based on previous research, a rep continuum has been established that demonstrates the number of repetitions possible at a given relative intensity. For example, an intensity of 60% relates to 16-20 reps, 65% = 14-15 reps, 70% = 12-13 reps, 75% = 10-11 reps, 80% = 8-9 reps, 85% = 6-7 reps, 90% = 4-5 reps, 95% = 2-3 reps, and 100% = 1 rep. In view of the previously mentioned recommendations for an intensity of 65%-75% of maximum, this would suggest that for each training exercise the individual perform an adequate amount of weight that would allow for 10-15 reps. In the event that no initial strength testing was performed, simply through trial-and-error an individual could determine appropriate training loads that would allow them to perform only 10-15 reps. They could then be sure of training at 65%-75% of maximum effort.
In order to continually enjoy improvements in strength and functional capacity, it is important to consistently incorporate progression and variation into the resistance-training program. Progressing and varying one’s program commonly involves incorporating the overload principle. The overload principle involves making adjustments to the training variables of the resistance-training program such as frequency, duration, exercises for each muscle group, number of exercise for each muscle group, sets and repetitions. In terms of adjustment, normally the overload principle involves making increases to these variables. For example, making progressive increases in intensity has been shown to be important in increasing muscle strength. In terms of the rate of progression, one should consider attempting to progress their resistance-training program on a monthly basis. However, it should be noted that increasing the intensity in some older adults may be contraindicated due to orthopedic and/or other medical limitations. As a result, making adjustments in other training variables would be recommended.”
Written for the American College of Sports Medicine by Darryn S. Willoughby, Ph.D., CSCS, FACSM
Fighting Foot Drop
From Advance Journal for Human Physical Therapy
My (RehabDeb) Comment:
“Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.”
Employing these techniques in animal-other-than-human rehab is what I do and is highly successful here, as well–proprioceptive training that can also build nerve strength For dogs and cats, I utilize Orthovet footbed splints and Thera-Paws Dorsi-Flex Assist boots on a case-by-case basis.
The Foot Drop Fight
Early treatment and compliance with a home exercise program are essential.
By Rebecca Mayer Knutsen
Posted on: December 20, 2012
Foot drop, a general term for difficulty lifting the front part of the foot, can be a temporary or permanent condition. The condition signals an underlying neurological, muscular or anatomical problem.
A patient with foot drop due to weakness or paralysis may exhibit behavior such as scuffing her toes along the ground. Or she may develop a high-stepping gait so her foot does not catch on the floor as she walks.
Beyond the obvious frustrations and limitations that accompany this condition, these patients are at greater risk for falls. According to physical therapists, early treatment and patient commitment to a prescribed home exercise program is often the best approach for patients with this gait abnormality.
Gaining Control
The source of foot drop is most commonly a central neurological impairment such as stroke, multiple sclerosis or traumatic brain injury or a peripheral injury such as nerve damage stemming from knee replacement surgery.
“Controlling foot drop through strengthening, orthotics or a functional electrical stimulation foot drop system may address the instability of the ankle, limit the possibility of catching the toe during gait and increase safety and stability to decrease the potential of falls,” said Gregory A. Thomas, PT, physical therapy supervisor, Rehabilitation Center at Eastern Idaho Regional Medical Center in Idaho Falls, ID.
Therapists must conduct a thorough PT evaluation that includes a complete patient history and an assessment of range of motion, strength, sensation, spasticity, reflexes and mobility. Treatment varies depending upon the cause and presentation of the foot drop. Treatment options range from therapeutic exercises including ROM, stretching and/or strengthening to electrical stimulation and gait training.
“The first thing I do with a patient is determine if the dysfunction is central or peripheral,” explained Douglas O. Brown, PT, CSCS, manager of Raub Rehabilitation, Sailfish Point Rehabilitation and Riverside Physical Therapy, all part of Martin Health System in Stuart, FL. “Is it a brain injury such as stroke or MS?” Brown asked. “Or is it a pinched nerve in back or leg or damage from a hip surgery?”
Once the origin of the foot drop has been determined, Brown must determine if the patient is flaccid with no movement whatsoever. “If so, then the outcome /prognosis will not be as good as someone who exhibits some movement,” he shared.
According to Thomas, PT exercises for this patient population include range of motion exercises for knees and ankles and strengthening leg muscles with resistance exercises. And, stretching exercises are particularly important to prevent the development of stiffness in the heel.
“There are no exercises that are off limits to these patients as long as the ankle is stable during the exercise,” Thomas explained. “The exercises can be closed chained or open depending on the level of stability.”
“We have to focus on restoring normal movement patterns but also on stability,” Brown said. “Can the patient stand on one leg without swaying back and forth? It’s important that we remember the static part because these patients function on different surfaces in real life.”
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Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.
“If my patient’s goal is to be able to walk the beach in her bare feet, then we need to work on uneven surfaces,” Brown said.
The therapists need to understand a patient’s case 100 percent and treat each one as an individual. These patients need to be assessed on their own merits, according to Brown. “If I have a patient with a traumatic ankle injury from being run over by a car, then I may stay away from certain load bearing exercises,” he shared.
Enter the AFO
If a patient does not have functional use of his muscles, then an ankle foot orthosis (AFO) can be used to keep the ankle at 90 degrees and prevent the foot from dropping toward the ground, thereby creating a more even and normal gait.
The type of AFO used depends on each patient’s specific needs. Some of the types most commonly used include solid ankle, articulated ankle and posterior leaf spring and are most typically made of polypropylene. Articulated ankles allow for some ankle motion, dorsiflexion assist and partial push-off during gait and solid ankle AFOs are rigid and more appropriate if the ankle and/or knee are unstable. Patients typically need to wear a larger shoe size to accommodate these types of AFOs.
“As a physical therapist, I need to realistically fulfill the goal of a patient, which in the case of foot drop, is most typically to stop using an AFO,” Brown explained. “But there are other issues to consider aside from the annoyance of the device. I may need to worry about comorbidities such as diabetes and how the AFO may be causing skin breakdown.”
Brown aims to improve his patients’ optimum function and quality of life while decreasing the fall risk. “Once a patient tells me his goals, I need to determine if they are realistic,” he told ADVANCE.
The goal of physical therapy with these patients is to use the least restrictive device, according to Thomas. “If there is active movement at the ankle and we can strengthen it back to normal, then a temporary brace can be used for support and to increase safety,” he stated. “If the foot drop is more long standing, a custom fitted AFO may be needed.”
In the last 10 years or so, AFOs have improved in quality and function, according to Brown. In fact, he says, some AFOs are made of carbon fiber and elicit a dynamic action instead of keeping the foot rigid while going through the swing phase of gait.
Another option is a foot drop system that applies electrical stimulation in a precise sequence, which then activates the muscles and nerves to lift the foot and bend or extend the knee. This type of device assists with a more natural gait, reeducates muscles, reduces muscle loss, maintains or improves range of motion and increases local blood circulation.
The foot drop device allows a flexible ankle during gait to obtain a more normal walking pattern. A good alternative to bracing, the device’s gait sensor adapts to changes in walking speed and terrain, allowing the patient to walk easily on stairs, grass and carpet.
Brown recently treated a 37-year-old woman with early stages of MS. He put the FES foot drop system on her and it helped her walk normally for the first time in years, bringing tears to her eyes.
“FES can help patients develop great gait patterns and fire muscles,” Brown observed. “FES shows the potential for improvement and the patient can rent the device themselves to wear all day instead of an AFO. The technology is helpful but the device isn’t for everyone. There is a better response with central foot drop as opposed to peripheral lesions.”
The device works well when the peripheral nerve is intact. Patients with a peripheral nerve injury-from diabetes or trauma-who have no palpable muscle contractions may not see improvements. “If the damage is peripheral nerve, then a FES foot drop system will not work in correcting foot drop and a passive AFO system will have to be used,” Thomas shared.
If the patient’s spinal cord has been interrupted in any way, then retraining the muscles would be a very difficult-and maybe even impossible-endeavor.
An AFO remains the appropriate solution for patients with lower-extremity edema, unstable ankle stance or cognitive impairments that interfere with operation of a foot drop system.
Complying at Home
For this condition, patients typically go to therapy for about 45 minutes, two times a week, according to Thomas. “If a patient is going to make gains, however, it’s imperative that there is good compliance with a home exercise program,” he shared. “The patients who have the greatest success are the ones with a solid work ethic outside the clinic.”
Brown’s approach to ensure compliance with a home program begins with the patient’s first evaluation. “I tell them how important the home program is and that participation is crucial,” he shared. “I put them on the spot and I go through the exercises the first day and then send them home with illustrations. I say I will quiz them during the beginning of the next session and will ask them to demonstrate the exercises I assigned.”
With this approach, Brown knows whether or not they’ve followed through based on their familiarity with the exercises. “I give additional exercises and instruction during each session,” he said. “And that’s how I make sure that they are compliant. It usually works because patients come prepared because they don’t want to fail.”
When it comes to foot drop-and really any PT-related injury or diagnosis-Brown stresses the importance of seeking care with a physical therapist as soon as possible. “I don’t want to see someone with foot drop after 6 months,” he stated. “Once a patient is medically stable and safe to treat, they need to be sent to PT.”
Brown recalls seeing a patient with foot drop after having a stroke one and a half years earlier. “There was a lot less I could do for her compared with what I could have done right after her stroke,” he said. “It’s crucial to treat these patients as soon as possible with exercise, stretching and weight bearing.”
Rebecca Mayer Knutsen is senior regional editor of ADVANCE and can be reached atrmayer@advanceweb.com.
Bone Strength – From MedlinePlus
Exercise, lifestyle, and your bones
Osteoporosis is a disease that causes bones to become brittle and more likely to fracture (break). With osteoporosis, the bones lose density. Bone density is the amount of bone tissue that is in your bone.
Exercise plays a key role in preserving bone density as you age.
Why Exercise?
Make exercise a regular part of your life. It will help keep your bones strong and lower your risk of osteoporosis and fractures as you get older.
Before you begin an exercise program, talk with your doctor if you are older, have not been active for a while, have diabetes, heart disease, lung disease, or any other health condition.
How Much and What Type of Exercise?
To build up bone density, the exercise must make your muscles pull on your bones. These are called weight-bearing exercises. Some of them are:
Brisk walks, jogging, playing tennis, dancing, or other weight-bearing activities such as aerobics and other sports
Careful weight training, using weight machines or free weights
Weight bearing exercises also:
Increase bone density even in young people
Help preserve bone density in women who are approaching menopause
To protect your bones, do weight bearing exercises 3 or more days a week for a total of over 90 minutes a week.
If you are older, do not do high-impact aerobics, such as step aerobics. This type of exercise may increase your risk of fractures.
Low-impact exercises like yoga and tai chi do not help your bone density very much. But they can improve your balance and lower your risk of falling and breaking a bone. And, even though they are good for your heart, swimming and biking do not increase bone density.
Other Lifestyle Changes to Help Your Bones
If you smoke, quit. Also limit how much alcohol you drink. Too much alcohol can damage your bones and raise your risk of falling and breaking a bone.
If you do not get enough calcium, or if your body does not absorb enough calcium from the foods you eat,your body may not make enough new bone. Talk with your health care provider about calcium and your bones.
Vitamin D helps your body absorb enough calcium.
Ask your health care provider if you should take a vitamin D supplement.
You may need more vitamin D during the winter or if you need to avoid sun exposure to prevent skin cancer.
Ask your health care provider about how much sun is safe for you.
Alternate Names
Osteoporosis – exercise; Low bone density – exercise
References
Lewiecki EM. In the clinic. Osteoporosis. Ann Intern Med. 2011 Jul 5;155(1):ITC1-1-15; quiz ITC1-16.
National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington,DC: National Osteoporosis Foundation; 2010.
Update Date: 5/17/2012
Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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Quality of Life of Obese Dogs Improves When They Lose Weight
This is actually recent research that was done in the UK, where they estimate 1/3 of the dog population is obese. Study conducted by Waltham/Royal Canin. I wouldn’t think we needed research to prompt us on this, however human nature proves we do! For those of you who need research to tell you that your dog will have a longer, happier life (same goes for humans…) if they drop the extra fat, here it is! Wheeeeeee!
The results showed that the quality of life improved in the dogs that had successfully lost weight, in particular vitality scores increased and the score for emotional disturbance and pain decreased. Moreover, the more body fat that the dog lost, the greater the improvement in vitality.
…and, interestingly, the study notes this: “The research also found that dogs that failed to complete their weight loss programme had worse quality of life at the outset than those successfully losing weight, most notably worse vitality and greater emotional disturbance.” …sort of as if the dogs failed the program and not that the owners were part and parcel. lol…the dogs didn’t fail to complete the program. And their finding here denotes the close connection and issues to be explored within the human/animal psychology bond; it works both ways-to the positive and to negative effect. The failed dogs notably had ‘worse quality of life at the outset” than the ones who ended up succeeding, and most compromised were their vitality and emotional status. We definitely pass our moods, demeanor, and worry onto our animals. Breathe peacefully with your pets
The “HOW TO” is up to me to help you accomplish, usually in conjunction with your vet.
I have over 30 years experience in program design and nutrition, so I am well qualified to help with lifestyle changes and subtle or great control measures. People are usually able to follow my plans because I work with them to determine how they operate best, whether with large changes or baby steps or in-between. Blessings-Feb. 21, 2012 — Researchers at the University of Liverpool have found that overweight dogs that lose weight have an improved quality of life compared to those that don’t.
A study of 50 overweight dogs, comprising a mix of breeds and genders was undertaken by scientists at the University in collaboration with the University of Glasgow, Royal Canin and the WALTHAM Centre for Pet Nutrition.
Owners completed a questionnaire to determine the health-related quality of life of their dog prior to weight loss. A follow-up questionnaire was completed by the owners of 30 dogs that successfully completed the weight loss programme, enabling changes in quality of life to be assessed. A range of life quality factors were scored, including vitality, emotional disturbance and pain. The quality of life of dogs which succeeded with their weight loss programme was also compared with those dogs that failed to lose weight successfully.
The results showed that the quality of life improved in the dogs that had successfully lost weight, in particular vitality scores increased and the score for emotional disturbance and pain decreased. Moreover, the more body fat that the dog lost, the greater the improvement in vitality.
The research also found that dogs that failed to complete their weight loss programme had worse quality of life at the outset than those successfully losing weight, most notably worse vitality and greater emotional disturbance.
Dr Alex German, Director of the Royal Canin Weight Management Clinic at the University, said: “Obesity is a risk for many dogs, affecting not only their health but also their quality of life. This research indicates that weight loss can play an important role in keeping your dog both healthy and happy.”
Dr Penelope Morris, from the WALTHAM Centre for Pet Nutrition, added: “Strategies for combating obesity and keeping dogs fit and healthy include portion control, increased exercise and diets specifically formulated for overweight pets.”
Established in 2004, the Royal Canin Weight Management Clinic at the University’s Small Animal Hospital UK’s is the world’s first animal weight management referral clinic and was set up to help tackle and prevent weight problems in animals such as dogs and cats.
Veterinary surgeons from any general practice in the UK can refer overweight animals to the clinic. The patients receive a thorough medical examination, and are then given a specific dietary plan and exercise regime to follow over several weeks.
Taken from ScienceDaily
Filed under: RESEARCH CITATIONS (NOT EXHAUSTIVE :))
Atrophy and Muscle Recovery – 8 Articles
Rehab Deb’s Comments: One of the most important bits of this report is something I’ve been reading more and more research regarding, and that is that nsaids (non-steroidal anti-inflammatories) stifle the healing process. I have also read several reports regarding the same and ice. Nsaids in animal medicine include Previcox, Deramaxx, Rimadyl, Metacam, etc…and for humans include Advil, Ibuprofen, Motrin, Tylenol, Aspirin, Aleve (sodium naproxen), etc…Does this mean to cut them out altogether? NO…it means think about the application, and possibly combine smaller doses of several analgesics, depending on the issue, rather than higher and continuous doses of nsaids.
This is only one suggestion.
Ultimately this should be discussed with the medical practitioner who prescribed the meds in the first place. There are other reasons to minimize nsaids and use Tramadol and/or Gabapentin and/or other analgesics to alleviate pain for the short run while building muscle to support damaged joints. Many practitioners are aware of using these other drugs, and while they may not know about this more recent news regarding nsaids delaying healing and muscle growth, which came out of human sport science, vets seem to be interested in the information when it is presented to them.
Article from Dr. Gabe Mirkin’s Fitness and Health E-Zine
May 6, 2012
How to Recover from Muscle Soreness Caused by Intense Exercise
Muscle soreness should be part of every exercise program. If you don’t exercise intensely enough on one day to have sore muscles on the next, you will not gain maximum fitness and you are also losing out on many of the health benefits of exercise. The benefits of exercise are much greater with intense exercise than with casual exercising.
You must damage your muscles to make them grow and become stronger. When muscles heal, they are stronger than they were before you damaged them. All athletes train by “stressing and recovering”. On one day, they take a hard workout in which they feel their muscles burning. Eight to 24 hours after they finish this intense exercise, their muscles start to feel sore. This is called Delayed Onset Muscle Soreness (DOMS). Then they take easy workouts until the soreness is gone, which means that their muscles have healed.
DOMS IS CAUSED BY MUSCLE DAMAGE. Muscles are made up of fibers. The fibers are made up of a series of protein blocks called sarcomeres that are lined in a long chain. When you stretch a muscle, you stretch apart the sarcomeres in the chain. When sarcomeres are stretched too far, they tear. Your body
treats these tears in the same way that it treats all injuries, by a process called inflammation. Eight to 24 hours after an intense workout, you suffer swelling, stiffness and pain.
The most beneficial intense exercise program is:
* severe enough to cause muscle pain on the next day, and
* usually allows you to recover almost completely within 48 hours.
ACTIVE, NOT PASSIVE, RECOVERY: When athletes feel soreness in their muscles, they rarely take days off. Neither should you. Keeping sore muscles moving makes them more fibrous and tougher when they heal, so you can withstand greater forces and more intense workouts on your hard days. Plan to go at low intensity for as many days as it takes for the soreness to go away. Most athletes try to work out just hard enough so that they recover and are ready for their next hard workout in 48 hours.
TIMING MEALS TO RECOVER FASTER: You do not need to load extra food to recover faster. Taking in too much food fills your muscle cells with fat, and extra fat in cells blocks the cell’s ability to take in and use sugar. Sugar is the main source of energy for your muscles during intense exercise. Using sugar to drive your muscles helps them to move faster and with more strength. Timing of meals is more important than how much food you eat. Eating protein- and carbohydrate-containing foods helps you recover faster, and the best time to start eating is as soon as you finish a hard workout. At rest, muscles are inactive. Almost no sugar enters the resting muscle cell from the bloodstream (J. Clin. Invest. 1971;50: 2715-2725). Almost all cells in your body usually require insulin to drive sugar into their cells. However during exercise your muscles (and your brain) can take sugar into their cells without needing insulin. Exercising muscles are also incredibly sensitive to insulin and take up sugar into their cells at a rapid rate. This effect lasts maximally for up to an hour after you finish exercising and disappears almost completely in around 17 hours. The best time to eat for recovery is when your cells are maximally responsive to insulin, and that is within a short time after you finish exercising. Not only does insulin drive sugar into muscle cells, it also drives in protein building blocks, called amino acids. The sugar replaces the fuel for muscle cells. The protein hastens repair of damaged muscle. Waiting to eat for more than an hour after finishing an intense workout delays recovery.
WHAT TO EAT AFTER YOUR INTENSE WORKOUTS: Fatigue is caused by low levels of sugar, protein, water and salt. You can replace all of these with ordinary foods and drinks. If you are a vegetarian, you can replace your protein with combinations of grains and beans. You can replace carbohydrates by eating
virtually any fruits, vegetables, whole grains, beans, seeds and nuts. A recovery meal for a vegetarian could include corn, beans, water, bread, and fruits, nuts and vegetables. If you prefer animal tissue, you can get your protein from fish, poultry,or meat. Special sports drinks and sports supplements are made from ordinary foods and therefore offer no advantage whatever over regular foods.
BODY MASSAGE: Many older studies have shown that massage does not help you recover faster from DOMS. Recently, researchers at McMaster University in Hamilton, Ontario showed that deep massage after an intense workout causes muscles to enlarge and grow new mitochondria (Science Translational
Medicine, published online Feb, 2012). This is amazing. Enlarging and adding mitochondria can help you run faster, lift heavier weights, and even prevent heart attacks and certain cancers.
NSAIDS DELAY DOMS RECOVERY: Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may help relieve pain, but they also can block muscle repair and delay healing.
HOT BATHS: Most research shows that a hot bath is not much better than doing nothing in helping muscles recover from exercise (European Journal of Applied Physiology, March 2006)
COLD OR ICE BATHS: A recent review of 17 small trials, involving 366 participants, showed a minor decrease in DOMS with ice water baths. They found “little quality research” on the subject and “no consistent method of cold water immersion” (Cochrane Library, published online February 15, 2012). Cold
water immersion can reduce swelling associated with injury, but has not been proven to speed the healing of DOMS.
Resistance Training and the Older Adult
From the American College of Sports Medicine
Comments and Position Statements
(and, yes, most of the ideas outlined here may be adapted, and have been by me, for functional animal rehab–RehabDeb)
“The health benefits of appropriately prescribed long-term (more than 12 weeks) resistance training in older adults–ages 65 and older–are well known. They include improvements in muscle strength and endurance; other possible health benefits include increase in muscle mass, which translates into improvements in functional capacity. In addition, increased weight bearing with resistance training is considered beneficial in improving bone density and combating the effects of osteoporosis.
Achieving appropriate levels of function is very important for older adults so they are able to carry out most of the daily living skills necessary to lead independent lives. Due to the fact that muscle wasting (sarcopenia) and weakness, exacerbated by physical inactivity, is prevalent in the aging population, more emphasis has been placed on developing resistance-training programs for older adults. When developing resistance-training programs for this group, important components to consider are the various training-related variables: frequency, duration, exercises, sets, intensity, repetitions, and progression.
Older adults often have orthopedic issues that contraindicate resistance training of the affected joint(s). Older adults are also at a higher risk of cardiovascular disease, and in many cases have even been diagnosed with it. Therefore, it is critical that the older adult receive prior approval from their physician before participating in resistance training. It should be noted that proper supervision of the individual’s resistance-training program, including any testing procedures, by an appropriately trained exercise professional, is highly recommended. It should also be noted that performing maximum strength testing in many older adults is not recommended. Therefore, when strength testing is appropriate, sub-maximum testing protocols for estimating maximum strength are recommended.
Frequency refers to the number of exercise sessions per week. The traditional recommendation for frequency is to engage in three training sessions per week for individuals primarily seeking improvement in their overall health and fitness capacity. Even though some individuals may be motivated to train more frequently, resistance-training studies with the elderly have indicated a range of two to four days per week to be effective and adequate in improving strength. So the recommendation is that the older individual train at least two days per week but no more than four, suggesting an average training frequency of three days per week. Also, the frequency of exercise should be structured so that there is at least 48 hours between training sessions. An individual could satisfy this requirement with a “total body” routine, meaning that they would exercise all of the chosen muscle groups during each training session two or three days per week. Another approach could be a “split” routine where some of the chosen muscle groups are exercised on one or two days a week while the remaining are exercised on a separate one or two days. This “split” routine approach may not be appropriate for those older individuals who are just beginning their program.
Duration describes the length of each training session. In reference to training duration, longer training sessions are not necessarily more effective. If one has an appropriately designed program based on sound training variables, lengthy training sessions are not necessary. In fact, older adults should avoid lengthy training sessions, because they may increase the risk of injury, manifested by extreme fatigue. Present guidelines for resistance training in older adults recommend a range of approximately 20-45 minutes per session. In other words, one should attempt to train for at least 20 but no longer than 45 minutes. This range suggests an approximate average duration of 30 minutes per session.
Exercise may be categorized as either multi-joint, meaning more than one joint is dynamically involved to perform the exercise (e.g., bench press, shoulder press, leg press), or uni-joint, meaning only one joint is dynamically involved (e.g., bicep curls, triceps extensions, leg extensions). In the older adult, the resistance-training program should focus primarily on multi-joint exercises. Uni-joint exercises are not discouraged entirely but should not make up the majority of exercises within the training program.
Additionally, machines are recommended over free weights (i.e., barbells and dumbbells) due to skill-related and safety factors. As the individual progresses, they can use free-weight exercises appropriate for their level of skill, training status and functional capacity.
Traditionally, muscle groups are classified as the following: 1) chest, 2) shoulders, 3) arms, 4) back, 5) abdomen, and 6) legs. Specifically, the chest group contains the pectoral muscles, the shoulder group contains the deltoid, rotator cuff, scapular stabilizers and trapezius muscles, the arm group contains the biceps, triceps, and forearm muscles, the back group contains the latissimus dorsi of the upper back and the erector muscles of the lower back, the abdomen group contains the rectus abdominis, oblique, and intercostals muscles, and the leg group contains the hip (gluteals), thigh (quadriceps), and hamstring muscles. In the older adult, it is important to attempt to incorporate all six of these muscle groups into the comprehensive resistance-training program.
It has been recommended that one to two exercises per muscle group is normally adequate. Noteworthy here is to understand that by employing primarily multi-joint exercises in the resistance training program one may actually exercise more than one muscle group or specific muscle per exercise. For example, in performing the leg press exercise the quadriceps, hamstrings, and gluteal muscles are all involved and, in many cases, this could eliminate the need to perform any uni-joint exercises for those particular muscles.
If a person is performing both multi-joint and uni-joint exercises for a particular muscle group, it is recommended that the multi-joint exercise(s) be performed before the uni-joint exercise. Additionally, within each resistance-training workout, larger muscle groups (i.e., legs, back, and chest) should be worked before smaller muscle groups (i.e., arms and shoulders).
Studies have shown improvements in muscle strength employing ranges of one to three sets of each exercise during the training program. Based on current guidelines, it would be recommended that the individual start with one set of each exercise and, depending on individual need, possibly progress up to no more than three sets when the fitness professional deems it appropriate. It should be noted, however, that an average of two sets of each exercise would be beneficial for most individuals. To avoid excess fatigue, a two-to-three minute rest period between sets and exercises is recommended.
Intensity refers to the amount of weight being lifted, and is a critical component of the resistance-training program, considered by many fitness professionals to be the most important training-related variable for inducing improvements in muscle strength and function. In other words, the more weight lifted, the more strength gained. Even though this may not always be the case, the importance of intensity in facilitating strength improvements is well documented. Intensity is often expressed as a percentage of the maximum amount of weight that can be lifted for a given exercise (1RM). For example, if someone who has a maximum effort of 100 pounds on the bench press exercise performs a set with 80 pounds, they would be training at 1RM of 80%. Studies have suggested that older individuals are able to tolerate higher intensities of exercise, up to 85%.
However, research has also shown intensities ranging from 65%-75% of maximum to significantly increase muscle strength. Therefore, in order to increase strength while simultaneously decreasing the risk of musculoskeletal injury that often accompanies higher intensities of resistance training, a low-intensity to moderate-intensity range of 65%-75% is recommended.
Repetitions (reps) refer to the number of times an individual performs a complete movement of a given exercise. There is an inverse relationship between intensity and repetitions, indicating that as the intensity increases the repetitions should decrease. Based on previous research, a rep continuum has been established that demonstrates the number of repetitions possible at a given relative intensity. For example, an intensity of 60% relates to 16-20 reps, 65% = 14-15 reps, 70% = 12-13 reps, 75% = 10-11 reps, 80% = 8-9 reps, 85% = 6-7 reps, 90% = 4-5 reps, 95% = 2-3 reps, and 100% = 1 rep. In view of the previously mentioned recommendations for an intensity of 65%-75% of maximum, this would suggest that for each training exercise the individual perform an adequate amount of weight that would allow for 10-15 reps. In the event that no initial strength testing was performed, simply through trial-and-error an individual could determine appropriate training loads that would allow them to perform only 10-15 reps. They could then be sure of training at 65%-75% of maximum effort.
In order to continually enjoy improvements in strength and functional capacity, it is important to consistently incorporate progression and variation into the resistance-training program. Progressing and varying one’s program commonly involves incorporating the overload principle. The overload principle involves making adjustments to the training variables of the resistance-training program such as frequency, duration, exercises for each muscle group, number of exercise for each muscle group, sets and repetitions. In terms of adjustment, normally the overload principle involves making increases to these variables. For example, making progressive increases in intensity has been shown to be important in increasing muscle strength. In terms of the rate of progression, one should consider attempting to progress their resistance-training program on a monthly basis. However, it should be noted that increasing the intensity in some older adults may be contraindicated due to orthopedic and/or other medical limitations. As a result, making adjustments in other training variables would be recommended.”
Written for the American College of Sports Medicine by Darryn S. Willoughby, Ph.D., CSCS, FACSM
Which Nutritional Factors Help Preserve Muscle Mass, Strength and Performance in Seniors?
Jan. 18, 2013 — New review by International Osteoporosis Foundation (IOF) Nutrition Working Group examines role of nutrition in sarcopenia, with focus on protein, vitamins D and B, and acid-based diet.
Sarcopenia, or the gradual loss of muscle mass, is a common consequence of aging, and poses a significant risk factor for disability in older adults. As muscle strength plays an important role in the tendency to fall, sarcopenia leads to an increased risk of fractures and other injuries.
The International Osteoporosis Foundation (IOF) Nutrition Working Group has published a new review which identifies nutritional factors that contribute to loss of muscle mass, or conversely, are beneficial to the maintenance of muscle mass. The Group reviewed evidence from worldwide studies on the role of nutrition in sarcopenia, specifically looking at protein, acid-base balance, vitamin D/calcium, and other minor nutrients like B vitamins.
“The most obvious intervention against sarcopenia is exercise in the form of resistance training,” said Professor Jean-Philippe Bonjour, co-author and Professor of Medicine at the Service of Bone Diseases, University of Geneva. “However, adequate nutritional intake and an optimal dietary acid-base balance are also very important elements of any strategy to preserve muscle mass and strength during aging.”
The review discusses and identifies the following important nutritional factors that have been shown to be beneficial to the maintenance of muscle mass and the treatment and prevention of sarcopenia:
Protein: Protein intake plays an integral part in muscle health. The authors propose an intake of 1.0-1.2 g/kg of body weight per day as optimal for skeletal muscle and bone health in elderly people without severely impaired renal function.
Vitamin D: As many studies indicate a role for vitamin D in the development and preservation of muscle mass and function, adequate vitamin D should be ensured through exposure to sunlight and/or supplementation if required. Vitamin D supplementation in seniors, and especially in institutionalized elderly, is recommended for optimal musculoskeletal health.
Avoiding dietary acid loads: Excess intake of acid-producing nutrients (meat and cereal grains) in combination with low intake of alkalizing fruits and vegetables may have negative effects on musculoskeletal health. Modifying the diet to include more fruits and vegetables is likely to benefit both bones and muscles.
Emerging evidence also suggests that vitamin B12 and/or folic acid play a role in improving muscle function and strength.
As well, the Review discusses non-nutritional interventions such as hormones, and calls for more studies to identify the potential of antioxidants and anti-inflammatory compounds in the prevention of sarcopenia.
Dr. Ambrish Mithal, co-author and Chair and Head of Endocrinology and Diabetes division at Medanta, New Delhi underlined the need for further research in the field. “Strategies to reduce the numbers of falls and fractures within our aging populations must include measures to prevent sarcopenia. At present, the available evidence suggests that combining resistance training with optimal nutritional status has a synergistic affect in preventing and treating sarcopenia, ” said Mithal.
“We hope that further studies will shed light on other effective ways of preventing and treating this condition.”
From ScienceDaily.com
Intense Acupuncture Can Improve Muscle Recovery in Patients With Bell Palsy, Study Suggests
Feb. 25, 2013 — Patients with Bell palsy who received acupuncture that achieves de qi, a type of intense stimulation, had improved facial muscle recovery, reduced disability and better quality of life, according to a randomized controlled trial published in CMAJ (Canadian Medical Association Journal).
Bell palsy is sudden onset of facial paralysis that is usually temporary, resolving within weeks or months, although it can sometimes be permanent.
Acupuncture is used to treat a variety of conditions and is gaining acceptance worldwide. De qi is a combination of sensations stimulated by manipulation of acupuncture needles — soreness, tingling, coolness, warmth and others radiating at the insertion points — but has not been validated by randomized controlled trials.
“There is a long-held belief in the traditional theory and clinical practice of acupuncture that the intensity of the stimulus must reach a threshold to elicit de qi, which plays a pivotal role in achieving the best therapeutic effects,” writes Dr. Wei Wang, Department of Neurology, Key Laboratory of Neurological Diseases of Chinese Ministry of Education, Wuhan, Hubei, China, with coauthors.
In a randomized controlled trial with 338 patients, Chinese researchers sought to understand the efficacy of acupuncture with weak stimulation or strong (de qi) stimulation. The trial, conducted at 11 tertiary hospitals in China, involved 15 experienced acupuncturists who administered acupuncture to the de qi group (167 people), which received intense stimulation, and the control group (171 people), which received needles but no stimulation. Patients’ facial expressions, a marker of facial-nerve function, were rated on a 6-point scale and videotaped to ensure consistent findings across hospital sites.
Six months after randomization, facial-nerve function, disability and quality of life were better in patients in the de qi group than in the control group.
“We found evidence that acupuncture with de qi improved facial muscle recovery, disability and quality of life among patients with Bell palsy. Stronger intensity of de qi was associated with better therapeutic effects.”
“De qi and its related techniques should be properly appreciated in acupuncture practice and research, and should be considered for inclusion in clinical guidelines for acupuncture,” the authors conclude.
From ScienceDaily.com
Fighting Foot Drop
From Advance Journal for Human Physical Therapy
My (RehabDeb) Comment:
“Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.”
Employing these techniques in animal-other-than-human rehab is what I do and is highly successful here, as well–proprioceptive training that can also build nerve strength For dogs and cats, I utilize Orthovet footbed splints and Thera-Paws Dorsi-Flex Assist boots on a case-by-case basis.
The Foot Drop Fight
Early treatment and compliance with a home exercise program are essential.
By Rebecca Mayer Knutsen
Posted on: December 20, 2012
Foot drop, a general term for difficulty lifting the front part of the foot, can be a temporary or permanent condition. The condition signals an underlying neurological, muscular or anatomical problem.
A patient with foot drop due to weakness or paralysis may exhibit behavior such as scuffing her toes along the ground. Or she may develop a high-stepping gait so her foot does not catch on the floor as she walks.
Beyond the obvious frustrations and limitations that accompany this condition, these patients are at greater risk for falls. According to physical therapists, early treatment and patient commitment to a prescribed home exercise program is often the best approach for patients with this gait abnormality.
Gaining Control
The source of foot drop is most commonly a central neurological impairment such as stroke, multiple sclerosis or traumatic brain injury or a peripheral injury such as nerve damage stemming from knee replacement surgery.
“Controlling foot drop through strengthening, orthotics or a functional electrical stimulation foot drop system may address the instability of the ankle, limit the possibility of catching the toe during gait and increase safety and stability to decrease the potential of falls,” said Gregory A. Thomas, PT, physical therapy supervisor, Rehabilitation Center at Eastern Idaho Regional Medical Center in Idaho Falls, ID.
Therapists must conduct a thorough PT evaluation that includes a complete patient history and an assessment of range of motion, strength, sensation, spasticity, reflexes and mobility. Treatment varies depending upon the cause and presentation of the foot drop. Treatment options range from therapeutic exercises including ROM, stretching and/or strengthening to electrical stimulation and gait training.
“The first thing I do with a patient is determine if the dysfunction is central or peripheral,” explained Douglas O. Brown, PT, CSCS, manager of Raub Rehabilitation, Sailfish Point Rehabilitation and Riverside Physical Therapy, all part of Martin Health System in Stuart, FL. “Is it a brain injury such as stroke or MS?” Brown asked. “Or is it a pinched nerve in back or leg or damage from a hip surgery?”
Once the origin of the foot drop has been determined, Brown must determine if the patient is flaccid with no movement whatsoever. “If so, then the outcome /prognosis will not be as good as someone who exhibits some movement,” he shared.
According to Thomas, PT exercises for this patient population include range of motion exercises for knees and ankles and strengthening leg muscles with resistance exercises. And, stretching exercises are particularly important to prevent the development of stiffness in the heel.
“There are no exercises that are off limits to these patients as long as the ankle is stable during the exercise,” Thomas explained. “The exercises can be closed chained or open depending on the level of stability.”
“We have to focus on restoring normal movement patterns but also on stability,” Brown said. “Can the patient stand on one leg without swaying back and forth? It’s important that we remember the static part because these patients function on different surfaces in real life.”
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Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.
“If my patient’s goal is to be able to walk the beach in her bare feet, then we need to work on uneven surfaces,” Brown said.
The therapists need to understand a patient’s case 100 percent and treat each one as an individual. These patients need to be assessed on their own merits, according to Brown. “If I have a patient with a traumatic ankle injury from being run over by a car, then I may stay away from certain load bearing exercises,” he shared.
Enter the AFO
If a patient does not have functional use of his muscles, then an ankle foot orthosis (AFO) can be used to keep the ankle at 90 degrees and prevent the foot from dropping toward the ground, thereby creating a more even and normal gait.
The type of AFO used depends on each patient’s specific needs. Some of the types most commonly used include solid ankle, articulated ankle and posterior leaf spring and are most typically made of polypropylene. Articulated ankles allow for some ankle motion, dorsiflexion assist and partial push-off during gait and solid ankle AFOs are rigid and more appropriate if the ankle and/or knee are unstable. Patients typically need to wear a larger shoe size to accommodate these types of AFOs.
“As a physical therapist, I need to realistically fulfill the goal of a patient, which in the case of foot drop, is most typically to stop using an AFO,” Brown explained. “But there are other issues to consider aside from the annoyance of the device. I may need to worry about comorbidities such as diabetes and how the AFO may be causing skin breakdown.”
Brown aims to improve his patients’ optimum function and quality of life while decreasing the fall risk. “Once a patient tells me his goals, I need to determine if they are realistic,” he told ADVANCE.
The goal of physical therapy with these patients is to use the least restrictive device, according to Thomas. “If there is active movement at the ankle and we can strengthen it back to normal, then a temporary brace can be used for support and to increase safety,” he stated. “If the foot drop is more long standing, a custom fitted AFO may be needed.”
In the last 10 years or so, AFOs have improved in quality and function, according to Brown. In fact, he says, some AFOs are made of carbon fiber and elicit a dynamic action instead of keeping the foot rigid while going through the swing phase of gait.
Another option is a foot drop system that applies electrical stimulation in a precise sequence, which then activates the muscles and nerves to lift the foot and bend or extend the knee. This type of device assists with a more natural gait, reeducates muscles, reduces muscle loss, maintains or improves range of motion and increases local blood circulation.
The foot drop device allows a flexible ankle during gait to obtain a more normal walking pattern. A good alternative to bracing, the device’s gait sensor adapts to changes in walking speed and terrain, allowing the patient to walk easily on stairs, grass and carpet.
Brown recently treated a 37-year-old woman with early stages of MS. He put the FES foot drop system on her and it helped her walk normally for the first time in years, bringing tears to her eyes.
“FES can help patients develop great gait patterns and fire muscles,” Brown observed. “FES shows the potential for improvement and the patient can rent the device themselves to wear all day instead of an AFO. The technology is helpful but the device isn’t for everyone. There is a better response with central foot drop as opposed to peripheral lesions.”
The device works well when the peripheral nerve is intact. Patients with a peripheral nerve injury-from diabetes or trauma-who have no palpable muscle contractions may not see improvements. “If the damage is peripheral nerve, then a FES foot drop system will not work in correcting foot drop and a passive AFO system will have to be used,” Thomas shared.
If the patient’s spinal cord has been interrupted in any way, then retraining the muscles would be a very difficult-and maybe even impossible-endeavor.
An AFO remains the appropriate solution for patients with lower-extremity edema, unstable ankle stance or cognitive impairments that interfere with operation of a foot drop system.
Complying at Home
For this condition, patients typically go to therapy for about 45 minutes, two times a week, according to Thomas. “If a patient is going to make gains, however, it’s imperative that there is good compliance with a home exercise program,” he shared. “The patients who have the greatest success are the ones with a solid work ethic outside the clinic.”
Brown’s approach to ensure compliance with a home program begins with the patient’s first evaluation. “I tell them how important the home program is and that participation is crucial,” he shared. “I put them on the spot and I go through the exercises the first day and then send them home with illustrations. I say I will quiz them during the beginning of the next session and will ask them to demonstrate the exercises I assigned.”
With this approach, Brown knows whether or not they’ve followed through based on their familiarity with the exercises. “I give additional exercises and instruction during each session,” he said. “And that’s how I make sure that they are compliant. It usually works because patients come prepared because they don’t want to fail.”
When it comes to foot drop-and really any PT-related injury or diagnosis-Brown stresses the importance of seeking care with a physical therapist as soon as possible. “I don’t want to see someone with foot drop after 6 months,” he stated. “Once a patient is medically stable and safe to treat, they need to be sent to PT.”
Brown recalls seeing a patient with foot drop after having a stroke one and a half years earlier. “There was a lot less I could do for her compared with what I could have done right after her stroke,” he said. “It’s crucial to treat these patients as soon as possible with exercise, stretching and weight bearing.”
Rebecca Mayer Knutsen is senior regional editor of ADVANCE and can be reached atrmayer@advanceweb.com.
Endurance Execise and Protein Intake
(Metabolically many mammalian systems operate similarly…see what you may extrapolate from this solid report. Keep in mind that information regarding nutrition intake during complex exercise could also be valued for surgery and post-surgical recovery in some cases. Blessings-)
Dr. Gabe Mirkin’s Fitness and Health E-Zine
May 13, 2012
You Do Not Need Protein During Endurance Exercise
A study from California State University, Fullerton shows that taking protein during exercise does not help you race faster (Journal of Strength and Conditioning Research/National Strength & Conditioning Association, May 2012; 26(5):1361-5).
A study from Denmark shows that taking protein during endurance exercise does not increase muscle growth (Medicine and Science in Sports and Exercise, September 2011; 43(9):1635-42). On the other hand, taking protein after you finish exercising helps you recover faster so you can exercise again sooner.
MUSCLE TIREDNESS AND FATIGUE: Muscle tiredness and weakness during and after prolonged exercise are caused by lack of water, sugar, salt and calories. Your body stores very little sugar and an almost infinite amount of fat and protein. These studies confirm many other studies which show that you don’t need to take protein during exercise to improve performance or to hasten recovery. You will recover faster by taking sugar and protein within an hour after finishing your exhausting exercise. Here’s the recommended formula for taking food and drink during exercise:
* LASTING LESS THAN AN HOUR — fit athletes do not need to take any food or drink, except they may need water on the hottest days.
* LASTING MORE THAN AN HOUR AND A HALF — Take sugared drinks frequently.
* LASTING MORE THAN THREE HOURS — Take sugared drinks frequently, and eat the food of your choice (fruit or sugar-added foods such as whole grain bars, etc.), plus a source of salt. We use potato chips or peanuts. You cannot get enough salt in a drink because it would taste awful.
Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial.
Winters-Stone KM, Dobek J, Nail L, Bennett JA, Leo MC, Naik A, Schwartz A.
Source
School of Nursing, Oregon Health & Science University, Portland, OR 97239, USA. wintersk@ohsu.edu
Erratum in
Breast Cancer Res Treat. 2011 Jun;127(2):457.
Abstract
Targeted exercise training could reduce risk factors for fracture and obesity-related diseases that increase from breast cancer treatment, but has not been sufficiently tested. We hypothesized that progressive, moderate-intensity resistance + impact training would increase or maintain hip and spine bone mass, lean mass and fat mass and reduce bone turnover compared to controls who participated in a low-intensity, non-weight bearing stretching program. We conducted a randomized, controlled trial in 106 women with early stage breast cancer who were >1 year post-radiation and/or chemotherapy, ≥ 50 years of age at diagnosis and postmenopausal, free from osteoporosis and medications for bone loss, resistance and impact exercise naïve, and cleared to exercise by a physician. Women were randomly assigned to participate in 1 year of thrice-weekly progressive, moderate-intensity resistance + impact (jump) exercise or in a similar frequency and length control program of progressive, low-intensity stretching. Primary endpoints were bone mineral density (BMD; g/cm²) of the hip and spine and whole body bone-free lean and fat mass (kg) determined by DXA and biomarkers of bone turnover-serum osteocalcin (ng/ml) and urinary deoxypyrodiniline cross-links (nmol/mmolCr). Women in the resistance + impact training program preserved BMD at the lumbar spine (0.47 vs. -2.13%; P = 0.001) compared to controls. The resistance + impact group had a smaller increase in osteocalcin (7.0 vs. 27%, P = 0.03) and a larger decrease in deoxypyrodinoline (-49.9 vs. -32.6%, P = 0.06) than controls. Increases in lean mass from resistance + impact training were greatest among women currently taking aromatase inhibitors compared to controls not on this therapy (P = 0.01). Our combined program of resistance + impact exercise reduced risk factors for fracture among postmenopausal breast cancer survivors (BCS) and may be particularly relevant for BCS on aromatase inhibitors (AIs) because of the additional benefit of exercise on muscle mass that could reduce falls.”
A comment from me, Deborah: I know of medical doctors, specialists, oncologists…who are ceasing to prescribe the pharmaceuticals that were developed to be used for osteoporosis and osteopenia yet have turned out to be destructive in the long run, and instead they are recommending weight-bearing exercise to improve bone density. Specific exercise under controlled circumstances is proved to be beneficial for healing of bone after surgery as well.
Lack of Exercise, Not Aging, Causes Weakness and Loss of Muscle in Older People
Aging does not cause you to lose muscles. Loss of muscle is caused by lack of exercise. You can preserve both muscle size and strength by continuing to exercise as long as you live. Here are MRIs of the legs of 40- and 70-year-old triathletes, and a 70-year-old non-exerciser:
http://www.drmirkin.com/public/ezine030412.html
The dark spots are muscle, the light spots are fat. Which legs would you like to have?
Forty competitive athletes, aged 40-81, who trained four to five times a week, had the same size muscles, the same absence of fat around their muscles, and close to the same strength as much younger athletes (The Physician and Sportsmedicine, September 2011).
Many of the diseases and debilitating conditions associated with aging are caused by lack of exercise. “Exercise decreases body fat and obesity, increases muscle strength, improves balance, gait, and mobility, decreases likelihood of falling, improves psychological health, reduces arthritis pain, and heart
attacks, osteoporosis, cancer, and diabetes.”
After age 40, the average person loses more than eight percent of muscle size per decade. This loss increases to 15 percent per decade after age 75 years. Older people who lose muscles are four times more likely be disabled, have difficulty walking, and need walkers and other mechanical devices to help
them walk (Am J Epidemiol, 1998; 147(8):755-763).
From Deb:
This post was taken from Dr. Mirkin’s eZine on health and fitness.The primary benefit my practice brings to animals, human or otherwise, is the knowledge of how to develop and encourage the right types of movement to improve health. In short.
The primary attribute that YOU bring is follow-through, compliance. Thank you.
Filed under: RESEARCH CITATIONS (NOT EXHAUSTIVE)
Atrophy and Muscle Recovery – 6 Articles
Rehab Deb’s Comments: One of the most important bits of this report is something I’ve been reading more and more research regarding, and that is that nsaids (non-steroidal anti-inflammatories) stifle the healing process. I have also read several reports regarding the same and ice. Nsaids in animal medicine include Previcox, Deramaxx, Rimadyl, Metacam, etc…and for humans include Advil, Ibuprofen, Motrin, Tylenol, Aspirin, Aleve (sodium naproxen), etc…Does this mean to cut them out altogether? NO…it means think about the application, and possibly combine smaller doses of several analgesics, depending on the issue, rather than higher and continuous doses of nsaids.
This is only one suggestion.
Ultimately this should be discussed with the medical practitioner who prescribed the meds in the first place. There are other reasons to minimize nsaids and use Tramadol and/or Gabapentin and/or other analgesics to alleviate pain for the short run while building muscle to support damaged joints. Many practitioners are aware of using these other drugs, and while they may not know about this more recent news regarding nsaids delaying healing and muscle growth, which came out of human sport science, vets seem to be interested in the information when it is presented to them.
Article from Dr. Gabe Mirkin’s Fitness and Health E-Zine
May 6, 2012
How to Recover from Muscle Soreness Caused by Intense Exercise
Muscle soreness should be part of every exercise program. If you don’t exercise intensely enough on one day to have sore muscles on the next, you will not gain maximum fitness and you are also losing out on many of the health benefits of exercise. The benefits of exercise are much greater with intense exercise than with casual exercising.
You must damage your muscles to make them grow and become stronger. When muscles heal, they are stronger than they were before you damaged them. All athletes train by “stressing and recovering”. On one day, they take a hard workout in which they feel their muscles burning. Eight to 24 hours after they finish this intense exercise, their muscles start to feel sore. This is called Delayed Onset Muscle Soreness (DOMS). Then they take easy workouts until the soreness is gone, which means that their muscles have healed.
DOMS IS CAUSED BY MUSCLE DAMAGE. Muscles are made up of fibers. The fibers are made up of a series of protein blocks called sarcomeres that are lined in a long chain. When you stretch a muscle, you stretch apart the sarcomeres in the chain. When sarcomeres are stretched too far, they tear. Your body
treats these tears in the same way that it treats all injuries, by a process called inflammation. Eight to 24 hours after an intense workout, you suffer swelling, stiffness and pain.
The most beneficial intense exercise program is:
* severe enough to cause muscle pain on the next day, and
* usually allows you to recover almost completely within 48 hours.
ACTIVE, NOT PASSIVE, RECOVERY: When athletes feel soreness in their muscles, they rarely take days off. Neither should you. Keeping sore muscles moving makes them more fibrous and tougher when they heal, so you can withstand greater forces and more intense workouts on your hard days. Plan to go at low intensity for as many days as it takes for the soreness to go away. Most athletes try to work out just hard enough so that they recover and are ready for their next hard workout in 48 hours.
TIMING MEALS TO RECOVER FASTER: You do not need to load extra food to recover faster. Taking in too much food fills your muscle cells with fat, and extra fat in cells blocks the cell’s ability to take in and use sugar. Sugar is the main source of energy for your muscles during intense exercise. Using sugar to drive your muscles helps them to move faster and with more strength. Timing of meals is more important than how much food you eat. Eating protein- and carbohydrate-containing foods helps you recover faster, and the best time to start eating is as soon as you finish a hard workout. At rest, muscles are inactive. Almost no sugar enters the resting muscle cell from the bloodstream (J. Clin. Invest. 1971;50: 2715-2725). Almost all cells in your body usually require insulin to drive sugar into their cells. However during exercise your muscles (and your brain) can take sugar into their cells without needing insulin. Exercising muscles are also incredibly sensitive to insulin and take up sugar into their cells at a rapid rate. This effect lasts maximally for up to an hour after you finish exercising and disappears almost completely in around 17 hours. The best time to eat for recovery is when your cells are maximally responsive to insulin, and that is within a short time after you finish exercising. Not only does insulin drive sugar into muscle cells, it also drives in protein building blocks, called amino acids. The sugar replaces the fuel for muscle cells. The protein hastens repair of damaged muscle. Waiting to eat for more than an hour after finishing an intense workout delays recovery.
WHAT TO EAT AFTER YOUR INTENSE WORKOUTS: Fatigue is caused by low levels of sugar, protein, water and salt. You can replace all of these with ordinary foods and drinks. If you are a vegetarian, you can replace your protein with combinations of grains and beans. You can replace carbohydrates by eating
virtually any fruits, vegetables, whole grains, beans, seeds and nuts. A recovery meal for a vegetarian could include corn, beans, water, bread, and fruits, nuts and vegetables. If you prefer animal tissue, you can get your protein from fish, poultry,or meat. Special sports drinks and sports supplements are made from ordinary foods and therefore offer no advantage whatever over regular foods.
BODY MASSAGE: Many older studies have shown that massage does not help you recover faster from DOMS. Recently, researchers at McMaster University in Hamilton, Ontario showed that deep massage after an intense workout causes muscles to enlarge and grow new mitochondria (Science Translational
Medicine, published online Feb, 2012). This is amazing. Enlarging and adding mitochondria can help you run faster, lift heavier weights, and even prevent heart attacks and certain cancers.
NSAIDS DELAY DOMS RECOVERY: Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may help relieve pain, but they also can block muscle repair and delay healing.
HOT BATHS: Most research shows that a hot bath is not much better than doing nothing in helping muscles recover from exercise (European Journal of Applied Physiology, March 2006)
COLD OR ICE BATHS: A recent review of 17 small trials, involving 366 participants, showed a minor decrease in DOMS with ice water baths. They found “little quality research” on the subject and “no consistent method of cold water immersion” (Cochrane Library, published online February 15, 2012). Cold
water immersion can reduce swelling associated with injury, but has not been proven to speed the healing of DOMS.
Resistance Training and the Older Adult
From the American College of Sports Medicine
Comments and Position Statements
(and, yes, most of the ideas outlined here may be adapted, and have been by me, for functional animal rehab–RehabDeb)
“The health benefits of appropriately prescribed long-term (more than 12 weeks) resistance training in older adults–ages 65 and older–are well known. They include improvements in muscle strength and endurance; other possible health benefits include increase in muscle mass, which translates into improvements in functional capacity. In addition, increased weight bearing with resistance training is considered beneficial in improving bone density and combating the effects of osteoporosis.
Achieving appropriate levels of function is very important for older adults so they are able to carry out most of the daily living skills necessary to lead independent lives. Due to the fact that muscle wasting (sarcopenia) and weakness, exacerbated by physical inactivity, is prevalent in the aging population, more emphasis has been placed on developing resistance-training programs for older adults. When developing resistance-training programs for this group, important components to consider are the various training-related variables: frequency, duration, exercises, sets, intensity, repetitions, and progression.
Older adults often have orthopedic issues that contraindicate resistance training of the affected joint(s). Older adults are also at a higher risk of cardiovascular disease, and in many cases have even been diagnosed with it. Therefore, it is critical that the older adult receive prior approval from their physician before participating in resistance training. It should be noted that proper supervision of the individual’s resistance-training program, including any testing procedures, by an appropriately trained exercise professional, is highly recommended. It should also be noted that performing maximum strength testing in many older adults is not recommended. Therefore, when strength testing is appropriate, sub-maximum testing protocols for estimating maximum strength are recommended.
Frequency refers to the number of exercise sessions per week. The traditional recommendation for frequency is to engage in three training sessions per week for individuals primarily seeking improvement in their overall health and fitness capacity. Even though some individuals may be motivated to train more frequently, resistance-training studies with the elderly have indicated a range of two to four days per week to be effective and adequate in improving strength. So the recommendation is that the older individual train at least two days per week but no more than four, suggesting an average training frequency of three days per week. Also, the frequency of exercise should be structured so that there is at least 48 hours between training sessions. An individual could satisfy this requirement with a “total body” routine, meaning that they would exercise all of the chosen muscle groups during each training session two or three days per week. Another approach could be a “split” routine where some of the chosen muscle groups are exercised on one or two days a week while the remaining are exercised on a separate one or two days. This “split” routine approach may not be appropriate for those older individuals who are just beginning their program.
Duration describes the length of each training session. In reference to training duration, longer training sessions are not necessarily more effective. If one has an appropriately designed program based on sound training variables, lengthy training sessions are not necessary. In fact, older adults should avoid lengthy training sessions, because they may increase the risk of injury, manifested by extreme fatigue. Present guidelines for resistance training in older adults recommend a range of approximately 20-45 minutes per session. In other words, one should attempt to train for at least 20 but no longer than 45 minutes. This range suggests an approximate average duration of 30 minutes per session.
Exercise may be categorized as either multi-joint, meaning more than one joint is dynamically involved to perform the exercise (e.g., bench press, shoulder press, leg press), or uni-joint, meaning only one joint is dynamically involved (e.g., bicep curls, triceps extensions, leg extensions). In the older adult, the resistance-training program should focus primarily on multi-joint exercises. Uni-joint exercises are not discouraged entirely but should not make up the majority of exercises within the training program.
Additionally, machines are recommended over free weights (i.e., barbells and dumbbells) due to skill-related and safety factors. As the individual progresses, they can use free-weight exercises appropriate for their level of skill, training status and functional capacity.
Traditionally, muscle groups are classified as the following: 1) chest, 2) shoulders, 3) arms, 4) back, 5) abdomen, and 6) legs. Specifically, the chest group contains the pectoral muscles, the shoulder group contains the deltoid, rotator cuff, scapular stabilizers and trapezius muscles, the arm group contains the biceps, triceps, and forearm muscles, the back group contains the latissimus dorsi of the upper back and the erector muscles of the lower back, the abdomen group contains the rectus abdominis, oblique, and intercostals muscles, and the leg group contains the hip (gluteals), thigh (quadriceps), and hamstring muscles. In the older adult, it is important to attempt to incorporate all six of these muscle groups into the comprehensive resistance-training program.
It has been recommended that one to two exercises per muscle group is normally adequate. Noteworthy here is to understand that by employing primarily multi-joint exercises in the resistance training program one may actually exercise more than one muscle group or specific muscle per exercise. For example, in performing the leg press exercise the quadriceps, hamstrings, and gluteal muscles are all involved and, in many cases, this could eliminate the need to perform any uni-joint exercises for those particular muscles.
If a person is performing both multi-joint and uni-joint exercises for a particular muscle group, it is recommended that the multi-joint exercise(s) be performed before the uni-joint exercise. Additionally, within each resistance-training workout, larger muscle groups (i.e., legs, back, and chest) should be worked before smaller muscle groups (i.e., arms and shoulders).
Studies have shown improvements in muscle strength employing ranges of one to three sets of each exercise during the training program. Based on current guidelines, it would be recommended that the individual start with one set of each exercise and, depending on individual need, possibly progress up to no more than three sets when the fitness professional deems it appropriate. It should be noted, however, that an average of two sets of each exercise would be beneficial for most individuals. To avoid excess fatigue, a two-to-three minute rest period between sets and exercises is recommended.
Intensity refers to the amount of weight being lifted, and is a critical component of the resistance-training program, considered by many fitness professionals to be the most important training-related variable for inducing improvements in muscle strength and function. In other words, the more weight lifted, the more strength gained. Even though this may not always be the case, the importance of intensity in facilitating strength improvements is well documented. Intensity is often expressed as a percentage of the maximum amount of weight that can be lifted for a given exercise (1RM). For example, if someone who has a maximum effort of 100 pounds on the bench press exercise performs a set with 80 pounds, they would be training at 1RM of 80%. Studies have suggested that older individuals are able to tolerate higher intensities of exercise, up to 85%.
However, research has also shown intensities ranging from 65%-75% of maximum to significantly increase muscle strength. Therefore, in order to increase strength while simultaneously decreasing the risk of musculoskeletal injury that often accompanies higher intensities of resistance training, a low-intensity to moderate-intensity range of 65%-75% is recommended.
Repetitions (reps) refer to the number of times an individual performs a complete movement of a given exercise. There is an inverse relationship between intensity and repetitions, indicating that as the intensity increases the repetitions should decrease. Based on previous research, a rep continuum has been established that demonstrates the number of repetitions possible at a given relative intensity. For example, an intensity of 60% relates to 16-20 reps, 65% = 14-15 reps, 70% = 12-13 reps, 75% = 10-11 reps, 80% = 8-9 reps, 85% = 6-7 reps, 90% = 4-5 reps, 95% = 2-3 reps, and 100% = 1 rep. In view of the previously mentioned recommendations for an intensity of 65%-75% of maximum, this would suggest that for each training exercise the individual perform an adequate amount of weight that would allow for 10-15 reps. In the event that no initial strength testing was performed, simply through trial-and-error an individual could determine appropriate training loads that would allow them to perform only 10-15 reps. They could then be sure of training at 65%-75% of maximum effort.
In order to continually enjoy improvements in strength and functional capacity, it is important to consistently incorporate progression and variation into the resistance-training program. Progressing and varying one’s program commonly involves incorporating the overload principle. The overload principle involves making adjustments to the training variables of the resistance-training program such as frequency, duration, exercises for each muscle group, number of exercise for each muscle group, sets and repetitions. In terms of adjustment, normally the overload principle involves making increases to these variables. For example, making progressive increases in intensity has been shown to be important in increasing muscle strength. In terms of the rate of progression, one should consider attempting to progress their resistance-training program on a monthly basis. However, it should be noted that increasing the intensity in some older adults may be contraindicated due to orthopedic and/or other medical limitations. As a result, making adjustments in other training variables would be recommended.”
Written for the American College of Sports Medicine by Darryn S. Willoughby, Ph.D., CSCS, FACSM
Which Nutritional Factors Help Preserve Muscle Mass, Strength and Performance in Seniors?
Jan. 18, 2013 — New review by International Osteoporosis Foundation (IOF) Nutrition Working Group examines role of nutrition in sarcopenia, with focus on protein, vitamins D and B, and acid-based diet.
Sarcopenia, or the gradual loss of muscle mass, is a common consequence of aging, and poses a significant risk factor for disability in older adults. As muscle strength plays an important role in the tendency to fall, sarcopenia leads to an increased risk of fractures and other injuries.
The International Osteoporosis Foundation (IOF) Nutrition Working Group has published a new review which identifies nutritional factors that contribute to loss of muscle mass, or conversely, are beneficial to the maintenance of muscle mass. The Group reviewed evidence from worldwide studies on the role of nutrition in sarcopenia, specifically looking at protein, acid-base balance, vitamin D/calcium, and other minor nutrients like B vitamins.
“The most obvious intervention against sarcopenia is exercise in the form of resistance training,” said Professor Jean-Philippe Bonjour, co-author and Professor of Medicine at the Service of Bone Diseases, University of Geneva. “However, adequate nutritional intake and an optimal dietary acid-base balance are also very important elements of any strategy to preserve muscle mass and strength during aging.”
The review discusses and identifies the following important nutritional factors that have been shown to be beneficial to the maintenance of muscle mass and the treatment and prevention of sarcopenia:
Protein: Protein intake plays an integral part in muscle health. The authors propose an intake of 1.0-1.2 g/kg of body weight per day as optimal for skeletal muscle and bone health in elderly people without severely impaired renal function.
Vitamin D: As many studies indicate a role for vitamin D in the development and preservation of muscle mass and function, adequate vitamin D should be ensured through exposure to sunlight and/or supplementation if required. Vitamin D supplementation in seniors, and especially in institutionalized elderly, is recommended for optimal musculoskeletal health.
Avoiding dietary acid loads: Excess intake of acid-producing nutrients (meat and cereal grains) in combination with low intake of alkalizing fruits and vegetables may have negative effects on musculoskeletal health. Modifying the diet to include more fruits and vegetables is likely to benefit both bones and muscles.
Emerging evidence also suggests that vitamin B12 and/or folic acid play a role in improving muscle function and strength.
As well, the Review discusses non-nutritional interventions such as hormones, and calls for more studies to identify the potential of antioxidants and anti-inflammatory compounds in the prevention of sarcopenia.
Dr. Ambrish Mithal, co-author and Chair and Head of Endocrinology and Diabetes division at Medanta, New Delhi underlined the need for further research in the field. “Strategies to reduce the numbers of falls and fractures within our aging populations must include measures to prevent sarcopenia. At present, the available evidence suggests that combining resistance training with optimal nutritional status has a synergistic affect in preventing and treating sarcopenia, ” said Mithal.
“We hope that further studies will shed light on other effective ways of preventing and treating this condition.”
From ScienceDaily.com
Intense Acupuncture Can Improve Muscle Recovery in Patients With Bell Palsy, Study Suggests
Feb. 25, 2013 — Patients with Bell palsy who received acupuncture that achieves de qi, a type of intense stimulation, had improved facial muscle recovery, reduced disability and better quality of life, according to a randomized controlled trial published in CMAJ (Canadian Medical Association Journal).
Bell palsy is sudden onset of facial paralysis that is usually temporary, resolving within weeks or months, although it can sometimes be permanent.
Acupuncture is used to treat a variety of conditions and is gaining acceptance worldwide. De qi is a combination of sensations stimulated by manipulation of acupuncture needles — soreness, tingling, coolness, warmth and others radiating at the insertion points — but has not been validated by randomized controlled trials.
“There is a long-held belief in the traditional theory and clinical practice of acupuncture that the intensity of the stimulus must reach a threshold to elicit de qi, which plays a pivotal role in achieving the best therapeutic effects,” writes Dr. Wei Wang, Department of Neurology, Key Laboratory of Neurological Diseases of Chinese Ministry of Education, Wuhan, Hubei, China, with coauthors.
In a randomized controlled trial with 338 patients, Chinese researchers sought to understand the efficacy of acupuncture with weak stimulation or strong (de qi) stimulation. The trial, conducted at 11 tertiary hospitals in China, involved 15 experienced acupuncturists who administered acupuncture to the de qi group (167 people), which received intense stimulation, and the control group (171 people), which received needles but no stimulation. Patients’ facial expressions, a marker of facial-nerve function, were rated on a 6-point scale and videotaped to ensure consistent findings across hospital sites.
Six months after randomization, facial-nerve function, disability and quality of life were better in patients in the de qi group than in the control group.
“We found evidence that acupuncture with de qi improved facial muscle recovery, disability and quality of life among patients with Bell palsy. Stronger intensity of de qi was associated with better therapeutic effects.”
“De qi and its related techniques should be properly appreciated in acupuncture practice and research, and should be considered for inclusion in clinical guidelines for acupuncture,” the authors conclude.
From ScienceDaily.com
Fighting Foot Drop
From Advance Journal for Human Physical Therapy
My (RehabDeb) Comment:
“Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.”
Employing these techniques in animal-other-than-human rehab is what I do and is highly successful here, as well–proprioceptive training that can also build nerve strength For dogs and cats, I utilize Orthovet footbed splints and Thera-Paws Dorsi-Flex Assist boots on a case-by-case basis.
The Foot Drop Fight
Early treatment and compliance with a home exercise program are essential.
By Rebecca Mayer Knutsen
Posted on: December 20, 2012
Foot drop, a general term for difficulty lifting the front part of the foot, can be a temporary or permanent condition. The condition signals an underlying neurological, muscular or anatomical problem.
A patient with foot drop due to weakness or paralysis may exhibit behavior such as scuffing her toes along the ground. Or she may develop a high-stepping gait so her foot does not catch on the floor as she walks.
Beyond the obvious frustrations and limitations that accompany this condition, these patients are at greater risk for falls. According to physical therapists, early treatment and patient commitment to a prescribed home exercise program is often the best approach for patients with this gait abnormality.
Gaining Control
The source of foot drop is most commonly a central neurological impairment such as stroke, multiple sclerosis or traumatic brain injury or a peripheral injury such as nerve damage stemming from knee replacement surgery.
“Controlling foot drop through strengthening, orthotics or a functional electrical stimulation foot drop system may address the instability of the ankle, limit the possibility of catching the toe during gait and increase safety and stability to decrease the potential of falls,” said Gregory A. Thomas, PT, physical therapy supervisor, Rehabilitation Center at Eastern Idaho Regional Medical Center in Idaho Falls, ID.
Therapists must conduct a thorough PT evaluation that includes a complete patient history and an assessment of range of motion, strength, sensation, spasticity, reflexes and mobility. Treatment varies depending upon the cause and presentation of the foot drop. Treatment options range from therapeutic exercises including ROM, stretching and/or strengthening to electrical stimulation and gait training.
“The first thing I do with a patient is determine if the dysfunction is central or peripheral,” explained Douglas O. Brown, PT, CSCS, manager of Raub Rehabilitation, Sailfish Point Rehabilitation and Riverside Physical Therapy, all part of Martin Health System in Stuart, FL. “Is it a brain injury such as stroke or MS?” Brown asked. “Or is it a pinched nerve in back or leg or damage from a hip surgery?”
Once the origin of the foot drop has been determined, Brown must determine if the patient is flaccid with no movement whatsoever. “If so, then the outcome /prognosis will not be as good as someone who exhibits some movement,” he shared.
According to Thomas, PT exercises for this patient population include range of motion exercises for knees and ankles and strengthening leg muscles with resistance exercises. And, stretching exercises are particularly important to prevent the development of stiffness in the heel.
“There are no exercises that are off limits to these patients as long as the ankle is stable during the exercise,” Thomas explained. “The exercises can be closed chained or open depending on the level of stability.”
“We have to focus on restoring normal movement patterns but also on stability,” Brown said. “Can the patient stand on one leg without swaying back and forth? It’s important that we remember the static part because these patients function on different surfaces in real life.”
Archive ImageA
Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.
“If my patient’s goal is to be able to walk the beach in her bare feet, then we need to work on uneven surfaces,” Brown said.
The therapists need to understand a patient’s case 100 percent and treat each one as an individual. These patients need to be assessed on their own merits, according to Brown. “If I have a patient with a traumatic ankle injury from being run over by a car, then I may stay away from certain load bearing exercises,” he shared.
Enter the AFO
If a patient does not have functional use of his muscles, then an ankle foot orthosis (AFO) can be used to keep the ankle at 90 degrees and prevent the foot from dropping toward the ground, thereby creating a more even and normal gait.
The type of AFO used depends on each patient’s specific needs. Some of the types most commonly used include solid ankle, articulated ankle and posterior leaf spring and are most typically made of polypropylene. Articulated ankles allow for some ankle motion, dorsiflexion assist and partial push-off during gait and solid ankle AFOs are rigid and more appropriate if the ankle and/or knee are unstable. Patients typically need to wear a larger shoe size to accommodate these types of AFOs.
“As a physical therapist, I need to realistically fulfill the goal of a patient, which in the case of foot drop, is most typically to stop using an AFO,” Brown explained. “But there are other issues to consider aside from the annoyance of the device. I may need to worry about comorbidities such as diabetes and how the AFO may be causing skin breakdown.”
Brown aims to improve his patients’ optimum function and quality of life while decreasing the fall risk. “Once a patient tells me his goals, I need to determine if they are realistic,” he told ADVANCE.
The goal of physical therapy with these patients is to use the least restrictive device, according to Thomas. “If there is active movement at the ankle and we can strengthen it back to normal, then a temporary brace can be used for support and to increase safety,” he stated. “If the foot drop is more long standing, a custom fitted AFO may be needed.”
In the last 10 years or so, AFOs have improved in quality and function, according to Brown. In fact, he says, some AFOs are made of carbon fiber and elicit a dynamic action instead of keeping the foot rigid while going through the swing phase of gait.
Another option is a foot drop system that applies electrical stimulation in a precise sequence, which then activates the muscles and nerves to lift the foot and bend or extend the knee. This type of device assists with a more natural gait, reeducates muscles, reduces muscle loss, maintains or improves range of motion and increases local blood circulation.
The foot drop device allows a flexible ankle during gait to obtain a more normal walking pattern. A good alternative to bracing, the device’s gait sensor adapts to changes in walking speed and terrain, allowing the patient to walk easily on stairs, grass and carpet.
Brown recently treated a 37-year-old woman with early stages of MS. He put the FES foot drop system on her and it helped her walk normally for the first time in years, bringing tears to her eyes.
“FES can help patients develop great gait patterns and fire muscles,” Brown observed. “FES shows the potential for improvement and the patient can rent the device themselves to wear all day instead of an AFO. The technology is helpful but the device isn’t for everyone. There is a better response with central foot drop as opposed to peripheral lesions.”
The device works well when the peripheral nerve is intact. Patients with a peripheral nerve injury-from diabetes or trauma-who have no palpable muscle contractions may not see improvements. “If the damage is peripheral nerve, then a FES foot drop system will not work in correcting foot drop and a passive AFO system will have to be used,” Thomas shared.
If the patient’s spinal cord has been interrupted in any way, then retraining the muscles would be a very difficult-and maybe even impossible-endeavor.
An AFO remains the appropriate solution for patients with lower-extremity edema, unstable ankle stance or cognitive impairments that interfere with operation of a foot drop system.
Complying at Home
For this condition, patients typically go to therapy for about 45 minutes, two times a week, according to Thomas. “If a patient is going to make gains, however, it’s imperative that there is good compliance with a home exercise program,” he shared. “The patients who have the greatest success are the ones with a solid work ethic outside the clinic.”
Brown’s approach to ensure compliance with a home program begins with the patient’s first evaluation. “I tell them how important the home program is and that participation is crucial,” he shared. “I put them on the spot and I go through the exercises the first day and then send them home with illustrations. I say I will quiz them during the beginning of the next session and will ask them to demonstrate the exercises I assigned.”
With this approach, Brown knows whether or not they’ve followed through based on their familiarity with the exercises. “I give additional exercises and instruction during each session,” he said. “And that’s how I make sure that they are compliant. It usually works because patients come prepared because they don’t want to fail.”
When it comes to foot drop-and really any PT-related injury or diagnosis-Brown stresses the importance of seeking care with a physical therapist as soon as possible. “I don’t want to see someone with foot drop after 6 months,” he stated. “Once a patient is medically stable and safe to treat, they need to be sent to PT.”
Brown recalls seeing a patient with foot drop after having a stroke one and a half years earlier. “There was a lot less I could do for her compared with what I could have done right after her stroke,” he said. “It’s crucial to treat these patients as soon as possible with exercise, stretching and weight bearing.”
Rebecca Mayer Knutsen is senior regional editor of ADVANCE and can be reached atrmayer@advanceweb.com.
Endurance Execise and Protein Intake
(Metabolically many mammalian systems operate similarly…see what you may extrapolate from this solid report. Keep in mind that information regarding nutrition intake during complex exercise could also be valued for surgery and post-surgical recovery in some cases. Blessings-)
Dr. Gabe Mirkin’s Fitness and Health E-Zine
May 13, 2012
You Do Not Need Protein During Endurance Exercise
A study from California State University, Fullerton shows that taking protein during exercise does not help you race faster (Journal of Strength and Conditioning Research/National Strength & Conditioning Association, May 2012; 26(5):1361-5).
A study from Denmark shows that taking protein during endurance exercise does not increase muscle growth (Medicine and Science in Sports and Exercise, September 2011; 43(9):1635-42). On the other hand, taking protein after you finish exercising helps you recover faster so you can exercise again sooner.
MUSCLE TIREDNESS AND FATIGUE: Muscle tiredness and weakness during and after prolonged exercise are caused by lack of water, sugar, salt and calories. Your body stores very little sugar and an almost infinite amount of fat and protein. These studies confirm many other studies which show that you don’t need to take protein during exercise to improve performance or to hasten recovery. You will recover faster by taking sugar and protein within an hour after finishing your exhausting exercise. Here’s the recommended formula for taking food and drink during exercise:
* LASTING LESS THAN AN HOUR — fit athletes do not need to take any food or drink, except they may need water on the hottest days.
* LASTING MORE THAN AN HOUR AND A HALF — Take sugared drinks frequently.
* LASTING MORE THAN THREE HOURS — Take sugared drinks frequently, and eat the food of your choice (fruit or sugar-added foods such as whole grain bars, etc.), plus a source of salt. We use potato chips or peanuts. You cannot get enough salt in a drink because it would taste awful.
Filed under: RESEARCH CITATIONS (NOT EXHAUSTIVE :))
How to Use This Guide for Rehab After Dog Knee Injury-
HOW TO USE THIS HOMEWORK GUIDE
(taken from the booklet, found here:http://www.amazon.com/dp/B00F7VMJYW)
Read the Preface.
Read the Prologue.
Read the whole booklet before beginning the work.
Thank you! Now continue to read this chapter. The above three bullet point sentences were for people who really want bullet points. Both the Preface and the Prologue contain beneficial information, and I think the following contents will answer several questions you might not even know you have!
This homework covers guidelines that may be used after any invasive procedure performed for surgical repair of your pet’s knee after a torn ligament, whether any of the bones were cut or not. Right now it does not matter so much that you know exactly which surgery was performed; the restrictions and care are equally beneficial.
These guidelines are also very beneficial for recovery after surgery for torn meniscus and after surgical intervention for osteochondritis dissecans (OCD) (yes, really, but different from psych OCD) of the stifle (knee) joint. Whichever method of surgery was used, this homework is an excellent place to continue the healing journey!
As I stated earlier, written programs like this were not readily available, if at all, when I first began working officially in small animal veterinary medicine rehab in 2004. I knew from working with athletes and others, as well as from reading related research for several decades, that very slowly progressing, return-to-function programs were needed for our pets, as well.
In light of what I knew, I began using simple post-surgical protocol I developed. The larger discussion, continually, is among varieties of veterinarians who have come to believe in a particular method or methods of surgery to be used to stabilize the knee after ruptured cranial cruciate ligament. Regardless of method used, this intro protocol should be very beneficial toward accustoming the joint to greater amounts of use again, toward improving bone healing, and toward improving bone and muscle strength.
I don’t have the money to fund a large study or the time to ask for it at this point or in recent years. I do, however, have the validation of many veterinarians who have seen the progress of the pets whose caretakers have fastidiously followed my instruction for at least 8 weeks.
Often people see such notable improvement after only 4 weeks that they don’t understand the need to continue to follow through with progressive rehab. In well-established human rehabilitation protocol for ACL surgery, patients are progressed through criteria-based functional activities and evaluations for discharge from rehab are targeted between 4 and 6 months after surgery.*
Is this happening with your pet?
My preference is that people follow at least 12 weeks of rehab protocol for their pets in almost every case. The feedback from situations of which I am aware where this has occurred has been entirely positive. This homework is an excellent place to continue the healing journey, so take a deep breath and move forward confidently!
Also, as noted, my practice and protocol are based on using the home or a standard vet clinic environment to accomplish functional rehabilitation. I prefer land-based exercise because I find it very practical for most pets and their caretakers after this surgery. You may put your internet researching skills to good use by looking for research data which encourages the use of weight-bearing exercise, where possible, to bring about greatest changes toward healing, including bone strengthening and the strengthening of soft tissue, as well as muscle hypertrophy. The latter is often the reason animals are referred to me; people want to see the muscle rebuilt where it has diminished over time due to injury and subsequent lameness (muscle atrophy).
Some people will want to utilize a clinic and a water treadmill in addition to the instructions in this booklet, possibly because the clinic option is available and their veterinarian has recommended it. Most people do not have the option of a rehabilitation facility for their pet, and that’s okay, because it’s not necessary to have that in order for your pet to recover…so don’t fret!
Regardless, I find that people are really in need of instructions that outline steps they may take to assist the healing and improved return to function of their pet in the home environment. Caretakers usually just don’t know what to do that is proactive and practical at home after pet surgery (or injury!).
I also emphasize over and over that pain control is important to my rehab protocol. If you are not going to use enough pain control to help your pet bear weight on the injured leg, then you should consider using the water treadmill..
It is extremely important for pet caretakers to learn how to control and care for their companions at home after this surgery whether or not they also entrust this aftercare to a clinic for a few hours a week as well. Do collaborate with your vet clinic, yet also learn how to do your part, hopefully aided by the ideas in this booklet.
*You may find out more about the topic of clinic-based human rehabilitation from books like Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician, Hospital for Special Surgery, Department of Rehabilitation, Copyright 2006, Elsevier, Inc.
Filed under: Knees (Stifles, Patellas) Tagged: canine, cruciate ligament repair, does my dog need surgery?, dog ACL, instead of surgery for my dog, knee, rehab after surgery for torn ligament, rehab my dog after torn ligament, rehabilitation, ruptured CCL, stifle, torn ligament, water treadmill for my dog
October 28, 2013
Guidelines for Home Rehabilitation of Your Dog: Instead of Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition
Reblogged from rehabandconditioningforanimals:
Here is the link to the Amazon.com site for my booklet of instructions for you to follow after a diagnosis of torn CCL (cranial cruciate ligament, like ACL in people, in the knee) in your dog, whether you are decided to not pursue surgery for your dog or you are doing some rehab prior to surgery, "pre-hab". These instructions cover four weeks from when you begin to tackle the lameness and issues...doesn't have to be four weeks exactly after diagnosis :) I sometimes get to work with a dog that has been lame from injury for a year or more after injury.
October 12, 2013
Surgeons Report Two New Approaches to Lessen Postoperative Pain
Surgeons Report Two New Approaches to Lessen Postoperative Pain
(Taken from ScienceDaily.com, intended for human medicine audience, however the principles are good and some are interchangeable. Italics mine)
Oct. 8, 2013 — New combinations of postoperative pain treatment decreased both pain and the use of narcotic pain relievers according to two studies presented this week at the 2013 Clinical Congress of the American College of Surgeons. One pain treatment utilized the simple but nonstandard application of ice packs after major abdominal operations in patients, and the other treatment was a prolonged drug delivery method using nanotechnology in animals.
Past research has shown that postoperative pain is often under-treated The standard pain treatment after most major (human) operations is narcotics, also called opioids, such as morphine. However, these medicines have many possible side effects, including sleepiness, constipation, and — when used long term — the risk of drug dependence. (we don’t see this issue in veterinary medicine, not in the same way, so for now don’t worry about your pet becoming an addict!)
“A growing body of scientific evidence shows that narcotics may not be the best way to control pain,” said the principal investigator of the ice pack study, Viraj A. Master, MD, PhD, FACS, associate professor of urology at Emory University School of Medicine, Atlanta. “We now know that it is more effective to use combination treatments that reduce the amount of narcotics needed.“
New use for ice following open abdominal procedures
Multiple studies have found that cryotherapy — application of ice to the surgical wound — is safe and effective at reducing pain after some types of operations, such as orthopedic procedures. However, researchers have not studied the use of cryotherapy in patients undergoing major, “open” (large-incision) abdominal operations, Dr. Master explained.
For the Emory study, Dr. Master and his colleagues compared the effect on postoperative pain of applying soft ice packs to the incision area after open abdominal operations (27 patients), versus no ice application (28 patients).
Patients in the cryotherapy group applied ice packs to the wound at desired intervals for at least 24 hours. They also had the option of taking prescribed opioids, whereas the other group received only opioids for pain relief. Twice a day the patients rated their pain intensity on a line indicating a range from no pain (zero) to severe pain (100).
The results showed that patients who used ice packs reported significantly less pain than those who did not ice their surgical wounds. On average, the cryotherapy group had about 50 percent less pain on the first and third days after the operation compared with the no-ice control group, according to the investigators. In addition, on the first postoperative day, the cryotherapy group used 22.5 percent less opioid pain medication than controls, while some patients who iced reportedly used no narcotics.
According to Dr. Master, surgeons should recommend that their patients who have open abdominal operations intermittently apply ice packs to the surgical wound, removing the ice when it becomes too cold. “An ice pack,” he said, “is safe and inexpensive, gives the patient a sense of empowerment because it is self-care, and doesn’t require high-tech devices.”
Prolonged delivery of lidocaine effective in animals
The pain treatment utilized in the second study used a high-tech device — nanoparticles — to create a controlled-release delivery system for the nonopioid numbing medication lidocaine. Although the effects of lidocaine injections usually are short-lived, nanotechnology allowed researchers at Houston Methodist Research Institute to extend the drug’s delivery time so that pain relief lasted all seven days of the study.
Led by Jeffrey L. Van Eps, MD, a research associate at the institute and general surgery resident at Houston Methodist Hospital, the research team developed an injectable hydrogel containing lidocaine. The gel also held microscopic spheres of a biodegradable polymer called polylactic-co-glycolic acid (PLGA), which the U.S. Food and Drug Administration has approved for drug delivery. This polymer acts as an “envelope” for nanoparticles — molecular-sized structures — of the mineral silica, whose spongelike holes take up the lidocaine gel, Dr. Van Eps explained.
“Nanotechnology with PLGA makes an ideal drug delivery system because we can tailor the nanoparticles to allow prolonged delivery,” Dr. Van Eps said. He said that this method re-duces or avoids side effects.
After first testing their lidocaine delivery system in the laboratory, Dr. Van Eps’ team obtained results in an animal model of postoperative pain. In groups of rats under different experimental conditions, the investigators rated the animals’ pain by measuring their withdrawal response to mechanical force applied around the surgical wound.
Rats that received lidocaine gel through the novel delivery system needed twice the amount of force to elicit a pain response compared with control rats that received no pain medication after the incision, the researchers reported. Using this same technique of measuring the pain response, the investigators reported that the lidocaine gel also was superior to daily treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) alone.
The best study results were seen with combination therapy using lidocaine gel and daily NSAIDs. This combination therapy reportedly showed equivalent effect to daily opioid narcotic treatment by mechanical-force withdrawal testing and superior results by daily scoring of pain-related adaptive behaviors. This finding is important because it shows that the experimental drug delivery system is not inferior to standard opioid treatment of pain, according to Dr. Van Eps.
Studies in larger animals will take place before the research team can test this therapy in patients, he said. Yet he called the new technology an “exciting potential treatment of post-surgical pain, the largest barrier to successful postoperative care.”
The research team developed and is testing the drug delivery system in the Houston Methodist Research Institute’s Surgical Advanced Technology Lab, which was created to accelerate transition of new products to the clinic.
The above story is based on materials provided by American College of Surgeons, via EurekAlert!, a service of AAAS.
Filed under: Pain, Pain Tagged: cryotherapy, icing after surgery, surgery pain
September 16, 2013
Guidelines for Home Rehabilitation of Your Dog: Instead of Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition
Here is the link to the Amazon.com site for my booklet of instructions for you to follow after a diagnosis of torn CCL (cranial cruciate ligament, like ACL in people, in the knee) in your dog, whether you are decided to not pursue surgery for your dog or you are doing some rehab prior to surgery, “pre-hab”. These instructions cover four weeks from when you begin to tackle the lameness and issues…doesn’t have to be four weeks exactly after diagnosis I sometimes get to work with a dog that has been lame from injury for a year or more after injury.
http://www.amazon.com/dp/061590047X
Paperback is $7.99 USD and $4.99 for Kindle the Kindle version. If you purchase the Paperback, the Kindle version is only $2.49 USD for you to purchase and have electronically available. Both versions should also be available on worldwide Amazon sites, as well as other distribution sites, like Barnes & Noble.
On all other Amazon sites around the world, and on other distribution sites, please search this title and ISBN:
Guidelines for Home Rehabilitation of Your Dog: Instead of Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition
ISBN-13: 978-0615900476
Thank you-
Preface
Some of the information contained in this volume has been published previously by me on my websites beginning in January, 2007. Until this particular current publication, I have had available on my various sites (and on some sites that co-opted the material) a general outline for the first four weeks of post-surgical or post-injury rehab because the demand for this information has been so great.
The updated content of this volume is not available on any of my sites, nor has the full content been previously available, and most of the definitive information regarding exercise protocol that is contained in this volume has been removed from my websites and personal social media pages as of this publication.
When I first began publishing a simple home-based plan to the internet, it was only a four-week, progressive walking exercise plan, useful for a variety of rehab situations. A version of that is what is contained in this booklet. What has happened though over time is that I have encountered many situations wherein people have interpreted these basic instructions in contrary ways, often omitting bits they thought they could while still hoping for success and often in a way that has been detrimental to the pet.
Therefore, what this booklet also contains is a more thorough explanation of how to enact the plan well …and enact it simply. There is no “bullet point” version, because bullet points will not describe the details of functional rehab so that the animal receives more benefit while receiving less harm or discomfort. As it is, I continually want to add to or modify bits of this edition, and I have to stop somewhere!
This is the basic edition, the closest you may come to bullet points outside of my professional website.
There is also an expanded edition, which contains more in-depth looks at potential pitfalls and additional remedies, along with greater explanation as to why I believe some therapies are better than others, especially for wellness and healing complementary to a home environment.
Thank you, on behalf of your pet, for taking this time to learn more about the healing methods available for them.
Thanks!
Blessings-
Filed under: Knees (Stifles, Patellas) Tagged: canine stifle rehabilitation, dog tore ligament, I don't want surgery for my dog, rehabilitation for dog torn knee ligament, torn knee ligament
September 15, 2013
After Surgery for Torn Knee Ligament, The First Four Weeks, Basic Edition (Guidelines for Home Rehabilitation of Your Dog)
Preface
Some of the information contained in this volume has been published previously by me on my websites beginning in January, 2007. Until this particular current publication, I have had available on my various sites (and on some sites that co-opted the material) a general outline for the first four weeks of post-surgical or post-injury rehab because the demand for this information has been so great.
The updated content of this volume is not available on any of my sites, nor has the full content been previously available, and most of the definitive information regarding exercise protocol that is contained in this volume has been removed from my websites and personal social media pages as of this publication. This declaration means to say that the full content of this volume is not available anywhere else electronically except for via Kindle and Amazon.
When I first began publishing a simple home-based plan to the internet it was only a four-week, progressive walking exercise plan, useful for a variety of rehab situations. A version of that is what is contained in this booklet. What has happened though over time is that I have encountered many situations wherein people have interpreted these basic instructions in contrary ways, often omitting bits they thought they could and often in a way that has been detrimental to the pet.
Therefore, what this booklet also contains is a more thorough explanation of how to enact the plan well …and enact it simply. There is no “bullet point” version, because bullet points will not describe the details of functional rehab so that the animal receives more benefit while receiving less harm or discomfort. As it is, I continually want to add to or modify bits of this edition, and I have to stop somewhere!
This is the basic edition, the closest you may come to bullet points outside of my professional website. There is also an expanded edition, which contains more in-depth looks at potential pitfalls and additional remedies, along with greater explanation as to why I believe some therapies are better than others, especially for wellness and healing complementary to a home environment. Thank you, on behalf of your pet, for taking this time to learn more about the healing methods available for them.
Here are the links to find the book on Kindle (only online version available right now):
U.S.- http://www.amazon.com/dp/B00EY3D03S
U.K.- http://www.amazon.co.uk/dp/B00EY3D03S
Canada – http://www.amazon.ca/dp/B00EY3D03S/
Deutschland – http://www.amazon.de/dp/B00EY3D03S
France – http://www.amazon.fr/dp/B00EY3D03S/
España – http://www.amazon.es/dp/B00EY3D03S/
Italia – http://www.amazon.it/dp/B00EY3D03S/
日本国 – http://www.amazon.co.jp/dp/B00EY3D03S/
India – http://www.amazon.in/dp/B00EY3D03S/
Brasil – http://www.amazon.com.br/dp/B00EY3D03S/
Mexico – http://www.amazon.com.mx/dp/B00EY3D03S/
**These page notations are in no particular order. I went down the list that Amazon has and so that I could put this online fast, I went in the same order. Thank you-
Filed under: Knees (Stifles, Patellas) Tagged: dog knee injury, dog knee surgery, dog limping after surgery, rehab dog knee
