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Friday, 24 August 2012

Blocking Newly Identified Molecule May Improve And Speed Recovery From Stroke

Blocking Newly Identified Molecule May Improve And Speed Recovery From Stroke

Researchers at UCLA have identified a novel molecule in the brain that, after stroke, blocks the formation of new connections between neurons. As a result, it limits the brain's recovery. In a mouse model, the researchers showed that blocking this molecule - called ephrin-A5 - induces axonal sprouting, that is, the growth of new connections between the brain's neurons, or cells, and as a result promotes functional recovery.

If duplicated in humans, the identification of this molecule could pave the way for a more rapid recovery from stroke and may allow a synergy with existing treatments, such as physical therapy.

Stroke is the leading cause of adult disability because of the brain's limited capacity for repair. An important process in recovery after stroke may be in the formation of new connections, termed axonal sprouting. The adult brain inhibits axonal sprouting and the formation of these connections. In previous work the researchers found, paradoxically, that the brain sends mixed signals after a stroke - activating molecules that both stimulate and inhibit axonal sprouting. In this present work, the researchers have identified the effect of one molecule that inhibits axonal sprouting and determined the new connections in the brain that are necessary to form for recovery.

The researchers also developed a new tissue bioengineering approach for delivering drugs to the brain after stroke. This approach uses a biopolymer hydrogel, or a gel of naturally occurring brain proteins, to release neural repair molecules directly to the target region for recovery in stroke - the tissue adjacent to the center of the stroke.

Last, the paper also shows that the more behavioral activity after stroke, such as the amount an impaired limb is used, the more new connections are directly stimulated to form in the injured brain. This direct link between movement patterns, like those that occur in neurorehabilitation, and the formation of new brain connections, provides a biological mechanism for the effects of some forms of physical therapy after stroke.

Friday, 10 August 2012

Iron Bracelets - Do They Work?

Recently we came across this question and decided it would be best to post some more information regarding this. This is what we were asked.

I recently came across a new kind of sports enhancement bracelet. Apparently it emits positive ions that are good for you. The bracelet is also a watch. There are credible scientific studies on positive ion therapy and apparently positive ions are good for you. They are used to treat seasonal affective disorder (although the result of the study does go on to cast doubt about its findings).
The question is whether it is possible for positive ions to affect your good health and if so whether a bracelet can deliver enough positive ions to have any effect at all. It would also be beneficial if you have any links to medical studies on these devices.

So here is the answer we provided with a little more information.


The only FDA approved study that has any claims for the benefits of ions is for the use of air filters. Any other claims are beyond the scope of any studies, and rely on the gullibility of customers. The fact that "Lithium Ion" batteries exist may add confusion for the consumers, but is a totally different thing. There are no credible studies on these bracelets, so you will not find any links backing up their claims. And see the bolded quote below. The Web MD article that the company used as a "reference" again refers to machines that actually expend electricity to generate negative ions in the air. And as the article itself sates, in relation to relieving depression, or having added benefits against allergies:

It's too early to tell for sure

But again, keep in mind that machines are required for this process, not a plastic bracelet with a hologram on it.
This is an excellent opportunity to practise grass roots scepticism. Ask yourself: By what mechanism is this supposed to work? How does the proposed mechanism align with what we know about science, biology, physics, etc.? Also, you may be interested to know that in some countries, Power Balance must state that they have no actual scientific backing for their claims. The Placebo band is just as effective, and much cheaper.
What sort of demo was done at the expo? Was it Applied Kinesiology by any chance? That is a well known bit of deliberate deception.
A quote from the first link:
Power Balance bracelets promise to improve balance, strength and flexibility and feature some lofty endorsers: Shaquille O’Neal, Drew Bree's and Nicole Branagh, an Olympian from the University of Minnesota. Yet the maker of the $30 bracelets admitted this week that there’s no scientific evidence that the things actually work.
The producers of Power Balance bracelets have sold them by the millions around the globe. They adorn the celebrity wrists of Robert de Niro and Kate Middleton, among others. The hologram-embedded rubbery bracelets “work with your body’s natural energy field” in ways similar to “concepts behind many Eastern philosophies,” the Power Balance website explains.
These claims got the attention of the Australian Competition and Consumer Commission, which compelled Power Balance to issue a letter that was published in various media outlets Down Under.
“We admit that there is no credible scientific evidence that supports our claims,” the company wrote. “Therefore we engaged in misleading conduct.”
Also, while not a strict debunking of the exact device you link to, I found this interesting write up at JREF. I think the quackwatch link may provide you with additional information.
Written by Brandon Peterson Wednesday, 17 March 2010 10:32
I recently had the opportunity to attend The Amaz!ng Adventure 5. While at Grand Turks, our final port, I was wandering through the duty-free shop looking for deals on liquor (Jack Daniel’s Single Barrel for $39!) when I happened upon a tableful of woo. Seeing as I was a medical student on a skeptical cruise, I had to stop and have my wife help make this video.
In my off-the-cuff video, I didn’t have the opportunity to mention the lack of scientific evidence for their claims. Even if the magnetic field did penetrate the skin, it still would not stimulate blood flow because the amount of iron in blood is far too small. If blood did have a strong magnetic attraction, your body would explode in an MRI (which would be cool, I admit).
I also didn’t have time to discuss the clinical trials that have been performed to evaluate efficacy. As usual with CAM research, earlier poor quality studies were weakly positive (1,2), while more recent high quality studies and meta-analyses are definitively negative (3,4,5).
I also forgot to mention the numerous court rulings in the late ‘90s and early ‘00s against companies making false claims about these products. This issue is discussed extensively on Quackwatch for those interested (6). In a nutshell, companies that fraudulently claimed to treat specific illnesses (arthritis, diabetic neuropathy, migraines, etc.) were sued. Now, they use nebulous phrases such as “support the healing process” or “restore natural energy.” You know, phrases that have not been evaluated by the Federal Drug Administration and are not designed to diagnose, treat or blah blah blah.
In short, magnet therapy is a great case study of CAM. The lack of scientific plausibility, the progression of the medical literature, and the FDA Miranda Rights statement are all characteristic of CAM. And if a lowly medical student can debunk it is less than a minute, how good can it really be?
1. Harlow T, Greaves C, White A, et al. Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee. BMJ 2004; 329:1450-1454
2. Vallbona C, Hazelwood CF, Jurida G. Response of pain to static magnetic fields in postpolio patients: A double-blind pilot study. Archives of Physical and Rehabilitative Medicine 1997; 78:1200-1203.
3. Winemiller MH and others. Effect of magnetic vs sham-magnetic insoles on plantar heel pain: a randomized controlled trial. JAMA2003; 290:1474-1478.
4. Pittler MH. Static magnets for reducing pain: systematic review and meta-analysis of randomized trials. CMAJ 2007; 177(7): 736-42.
5. Cepeda MS, Carr DB, Sarquis T, et al. Static magnetic therapy does not decrease pain or opioid requirements: a randomized double blind trial. Anesth Analg 2007; 104. 290-294.
6. Barrett S. Magnet therapy: a skeptical view. Accessed March 15, 2010. Available at
I will note that there are things that electromagnetic fields can do to the human body. In particular the neural effects if placed about the head (see God Helmet). However, the main thing to do when dealing with claims like this is to ask yourself: By what mechanism is this device claiming to work? How does this align with what we know about biology, chemistry, physics, etc.? Does the claimant use language that would be high on the crankpot index?
If you are starting to see a trend here, that is because there is one. There is no known mechanism for these things to work, and their claims are well beyond what the science would indicate.

Wednesday, 8 August 2012

Biomechanics of joint manipulation

Manipulation can be distinguished from other manual therapy interventions such as joint mobilisation by its bio mechanics, both kinetics and kinematics.

Until recently, force-time histories measured during spinal manipulation were described as consisting of three distinct phases: the preload (or prethrust) phase, the thrust phase, and the resolution phase. Evans and Breen added a fourth ‘orientation’ phase to describe the period during which the patient is oriented into the appropriate position in preparation for the prethrust phase.
When individual peripheral synovial joints are manipulated, the distinct force-time phases that occur during spinal manipulation are not as evident. In particular, the rapid rate of change of force that occurs during the thrust phase when spinal joints are manipulated is not always necessary. Most studies to have measured forces used to manipulate peripheral joints, such as the metacarpophalangeal (MCP) joints, show no more than gradually increasing load. This is probably because there are many more tissues restraining a spinal motion segment than an independent MCP joint.

The kinematics of a complete spinal motion segment when one of its constituent spinal joints are manipulated are much more complex than the kinematics that occur during manipulation of an independent peripheral synovial joint. Even so, the motion that occurs between the articular surfaces of any individual synovial joint during manipulation should be very similar and is described below.
Early models describing the kinematics of an individual target joint during the various phases of manipulation (notably Sandoz 1976) were based on studies that investigated joint cracking in MCP joints. The cracking was elicited by pulling the proximal phalanx away from the metacarpal bone (to separate, or 'gap' the articular surfaces of the MCP joint) with gradually increasing force until a sharp resistance, caused by the cohesive properties of synovial fluid, was met and then broken. These studies were therefore never designed to form models of therapeutic manipulation, and the models formed were erroneous in that they described the target joint as being configured at the end range of a rotation movement, during the orientation phase. The model then predicted that this end range position was maintained during the prethrust phase until the thrust phase where it was moved beyond the 'physiologic barrier' created by synovial fluid resistance; conveniently within the limits of anatomical integrity provided by restraining tissues such as the joint capsule and ligaments. This model still dominates the literature. However, after re-examining the original studies on which the kinematic models of joint manipulation were based, Evans and Breen[2] argued that the optimal prethrust position is actually the equivalent of the neutral zone of the individual joint, which is the motion region of the joint where the passive osteoligamentous stability mechanisms exert little or no influence. This new model predicted that the physiologic barrier is only confronted when the articular surfaces of the joint are separated (gapped, rather than the rolling or sliding that usually occurs during physiological motion), and that it is more mechanically efficient to do this when the joint is near to its neutral configuration.

Cracking joints

Main article: Cracking joints
Joint manipulation is characteristically associated with the production of an audible 'clicking' or 'popping' sound. This sound is believed to be the result of a phenomenon known as cavitation occurring within the synovial fluid of the joint. When a manipulation is performed, the applied force separates the articular surfaces of a fully encapsulated synovial joint. This deforms the joint capsule and intra-articular tissues, which in turn creates a reduction in pressure within the joint cavity. In this low pressure environment, some of the gases that are dissolved in the synovial fluid (which are naturally found in all bodily fluids) leave solution creating a bubble or cavity, which rapidly collapses upon itself, resulting in a 'clicking' sound. The contents of this gas bubble are thought to be mainly carbon dioxide. The effects of this process will remain for a period of time termed the 'refractory period', which can range from a few minutes to more than an hour, while it is slowly reabsorbed back into the synovial fluid. There is some evidence that ligament laxity around the target joint is associated with an increased probability of cavitation.

Clinical effects and mechanisms of action
The clinical effects of joint manipulation have been shown to include:
   Temporary relief of musculoskeletal pain.
   Shortened time to recover from acute back sprains (Rand).
   Temporary increase in passive range of motion (ROM).
   Physiological effects upon the central nervous system.
   No alteration of the position of the sacroiliac joint.
Common side effects of spinal manipulative therapy (SMT) are characterised as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort.
Shekelle (1994) summarised the published theories for mechanism(s) of action for how joint manipulation may exert its clinical effects as the following:
   Release of entrapped synovial folds or plica
   Relaxation of hypertonic muscle
   Disruption of articular or particular adhesion
Unbuckling of motion segments that have undergone disproportionate displacement

Monday, 23 July 2012

Manual therapy

From Wikipedia, the free encyclopedia


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See also: Bodywork (alternative medicine)


Manual therapy, manipulative therapy, or manual & manipulative therapy is a physical treatment primarily used by physiotherapists, massage therapists, chiropractors, and osteopaths to treat musculoskeletal pain and disability; it most commonly includes kneading and manipulation of muscles, joint mobilization and joint manipulation.[1]



Manual therapy may be defined differently (according to the profession describing it for legal purposes) to state what is permitted within a practitioners scope of practice. Within the physical therapy profession, manual therapy is defined as a clinical approach utilizing skilled, specific hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.

A consensus study of US chiropractors [2] defined manual therapy as "Procedures by which the hands directly contact the body to treat the articulations and/or soft tissues."

Alternatively, Korr (1978) described manual therapy as the "Application of an accurately determined and specifically directed manual force to the body, in order to improve mobility in areas that are restricted; in joints, in connective tissues or in skeletal muscles."


In Western Europe, North America and Australasia, manual therapy is usually practiced by members of specific health care professions (e.g. Chiropractors, Osteopaths, Osteopathic Physicians, Physiotherapists/Physical Therapists, and Physiatrists).[1] However, some lay practitioners (not members of a structured profession), such as bonesetters also provide some forms of manual therapy.

A survey released in May 2004 by the National Center for Complementary and Alternative Medicine focused on who used complementary and alternative medicine (CAM), what was used, and why it was used in the United States by adults age 18 years and over during 2002. According to this recent survey, manipulative therapy was the 3rd most commonly used NCCAM classification of CAM categories (10.9%) in the United States during 2002 ([1] table 4 on page 10) when all use of prayer was excluded. Consistent with previous studies, this study found that the majority of individuals (i.e., 54.9%) used CAM in conjunction with conventional medicine (page 6)


A number of professional peer-reviewed journals specialize in the dissemination of information associated with manual therapy. The Journal of Manual and Manipulative Therapy, Manual Therapy, and the Journal of Manipulative and Physiological Therapeutics are PubMed indexed journals that have provided readers with useful research on manual therapy for over 15 years. Peer reviewed information has improved the quality of information that is provided to practicing clinicians and has dispelled a number of myths commonly associated with manual therapy.


Styles of manual therapy

There are many different styles of manual therapy. It is a fundamental feature of ayurvedic medicine, traditional Chinese medicine and some forms of New Age alternative medicine as well as being used by mainstream medical practitioners. In one form or another it is probably as old as human culture itself and is a feature to some degree of therapeutic interactions in traditional cultures around the world.


Wednesday, 13 June 2012

What Is WAD? An Introduction to Whiplash Associated Disorders

What is WAD? An Introduction to Whiplash Associated Disorders
Whiplash is a term that is used fairly loosely to refer to a type of injury where a person’s neck is subjected to a sudden force causing it to rapidly accelerate and then decelerate. This motion often leads to various associated injuries ranging from minor strains and bruising to severe neurological damage and permanent impairment.
‘Whiplash’ is most common in motor vehicle accidents (MVAs) and many professionals such as insurers, solicitors and employers working with third party claimants should be familiar with the complaint.
In fact, due to the prevalence and notoriety of MVAs and journey claims, anybody working in any capacity within worker’s compensation will, therefore, often come across the term ‘Whiplash Associated Disorder’.
Because so many of our clients will come into contact with someone suffering from a whiplash associated disorder, in a very brief form, the current context of recommendation in relation to whiplash injuries is seen below to assist with understanding what a whiplash associated disorder actually is and, most importantly, what it implies.
Quebec Task Force
In 1991 the Canadian car insurance industry raised concern regarding the frequent use of the term “whiplash” for any neck injury relating to a motor vehicle accident and the inconsistent treatments which were being recommended and implemented.
The Canadian car industry decided to set up a task force of experts to investigate the following in relation to whiplash injuries:
   Risk and occurrence
   prognosis, and
   treatment recommendations.
A total of over 10,000 publications were reviewed and recommendations were made based on the evidence identified by these experts.
The result was a document entitled the Quebec Task Force Guidelines for Whiplash Associated Disorders.
Among the recommendations was a classification of the types of whiplash injuries;
   WAD O – No complaint about the neck. No physical sign(s).
   WAD I – Neck complaint of pain, stiffness or tenderness only /  No physical sign(s).
   WAD II – Neck complaint AND musculoskeletal sign(s). / Musculoskeletal signs include decreased range of motion and point tenderness.
   WADIII – Neck complaint AND neurological sign(s). / Neurological signs include decreased or absent deep tendon reflexes, weakness and sensory deficits.
   WAD IV     Neck complaint AND fracture or dislocation.
This classification system allows for consistency in research and also in supporting prognosis and treatment. Once diagnosis is provided and the classification of WAD is given, the next task is to identify standard recommendations to address the level of injury.
In our next post some of the criticism which has been applied to the Quebec Task Force will be discussed and we will outline what the WAD recommends in terms of prognosis and treatment.
We will also begin to look at how the industry has evolved internationally in response to the WAD classification and what it means within Insurance, Legal and Rehab settings.

This information was taken form Overland Health Website, you can visit their page for more information on

Friday, 8 June 2012

what is whiplash?

What Is Whiplash?


Web definitions
   an injury to the neck (the cervical vertebrae) resulting from rapid acceleration or deceleration (as in an automobile accident)

Whiplash is a term that describes injury to the neck that occurs as a result of a motor vehicle or car accident. The most common type of car accident is the rear impact, and most typically, the occupant in the vehicle that gets "rear-ended" (hit from behind) is at the greatest risk of injury, including whiplash.

What Is Now Known about Whiplash

Until recently, the reason for the extent of whiplash injuries was poorly understood. In addition, due to the legal and insurance issues, the veracity of complaints of neck pain and other symptoms by people who suffer from whiplash is commonly viewed as suspect.
However, recent research has helped clarify why occupants struck from behind experience more extensive whiplash injuries than those in other types of crashes. This new information is important for the physician treating whiplash pain, as it impacts the physician’s case management strategy.

Related Whiplash Symptoms/Conditions

Whiplash injuries can be quite complex and may include a variety of related problems, such as:
Joint dysfunction. As a result of the whiplash, one of the joints in the spine or limbs may lose its normal resiliency and shock absorption (referred to as the joint play), possibly leading to restricted range of movement and pain.

Disc herniation. A whiplash accident may injure the discs between the vertebrae, lead to small tears and cause the inner core of the disc to extrude through its outer core. If the disc's inner core comes in contact with and irritates a nearby spinal nerve root, a herniated disc occurs, with symptoms possibly including sharp, shooting pain down the arm and even neurological symptoms like numbness, tingling and muscle weakness.
Faulty movement patterns. It is believed that the nervous system may change the way in which it controls the coordinated function of muscles as a result of a barrage of intense pain signals from the whiplash injury.

Chronic pain. While often resulting in minor muscle sprains and strains that heal with time, more severe whiplash injuries may produce neck pain and other symptoms that are persistent and long lasting (chronic).

Cognitive and higher center dysfunction. In some instances, whiplash may affect the patient's mental functioning, possibly leading to difficulties concentrating, as just one example.