Friday, November 19, 2010

Time & Temperature

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Thursday, November 18, 2010

HISTORY OF MANUAL THERAPY (B .W. Atkinson. A.P.A.)

In recent years, there has been an upsurge of interest in mobilisation and manipulation of the peripheral
and spinal joints .
There have been a multitude of articles andbooks written by doctors, physiotherspists, lay manipulators
and anyone who has, or thinks he has, a knowledge of the subject.
Manipulation, for many years, was shunned by the medical profession and anyone who even attempted to
manipulate, whether it be to the peripheral or spinal joint, was immediately branded as a quack.
Why this was so is mystifying, because, if the history of manipulation is studied, it will be found it has its
roots as far back as 400 BC, where orthodox medicine, as we know it had its beginning.
The first known description of manipulation was given by Hippocrates whose ideas were the basis of
modern medicine.
Hippocrates advocated that the patient be given a steam bath and then placed prone, bound to a board, and
traction applied by assistants, pulling on head and feet . While this was being done, the physician would
press sharply on the affected area, or sit on the back and bounce up and down or even stand on the back .
However, the procedure most favoured was, while the patient was prone and still in traction, to put a board
in a cleft in the wall to act as a lever and then place it across the patients spine and press downwards . These
maneuvers were performed on a couch more primitive than those used today, but certainly similar .
Hippocrates influence was still evident in 200 AD when Galen described a method of manipulation for
dislocated discs while the patient was in traction .
In the early years of the 10th century, an Arab physician Abu'All ibn Sina, wrote a treatise on traction, illustraing
the Hippocrates method .
This treatment was still being used centuries later . Spinal traction was described by a Spanish-Arabian
physician in the early 14th century, and by a Turkish physician later in the same century.
In the 16th century, an Italian doctor known as Vidius Vidio, also followed Hippocrates, and indeed
organised the medical faculty of the day using the earlier illustrations. His methods were more refined but
were essentially that of the great master .
Ambroise Pare, recognised as the greatest surgeon of renaissance times, included a chapter on vertebral
dislocation in his works. He also described traction and pressure as advocated by Hippocrates .
Volume 2, 1978-79
33
After the mid 17th century, when Johan Schultes recommended similar treatment, little more was written
of manipulation for two hundred years'until the bone setters became known for their remedies .
Through the centuries, people practised cures on each other because physicians were not commonly
available . Some developed special skills . In places as far apart as Central Europe, Mexico and Japan,
Gypsies, Indians and Jiu-jitsu exponents respectively, used a form of manipulation to relieve back injuries .
The most primitive method was stamping on the back, and it was thought that certain women had special
gifts. An Emeror's physician in 400 AD wrote:
"A woman who has given birth to twins shall stamp on the painful kidneys and
that person shall be cured".
In 1211, a further refinement was reported, the twins had to be boys!
In 1662, in Norway, during a lawsuit about witchcraft, a woman gave evidence on the method she had been
using to cure back ache. Since she was three she had trodden on sufferers from rheumatism, and when
she grew up she found she could treat effectively with her hands.
People in different countries had their own particular beliefs . In Norway, the operator must be a first-born
child, and in Ireland a seventh child . In Scotland those born feet first possessed remarkable healing powers .
The first published description of the bone setter craft was made by a Dr . Wharton Hood in the late 1800's.
He was taught by a bone setter who owed his father a debt of gratitude. Dr. Hood said that the knowledge
gained was very important in preventative and curative treatment .
These people were named "bone setters" because they believed they were putting small bones back into
place . They were mainly farmers and blacksmiths and, being very jealous of their art, would not freely
discuss it . Their knowledge was, therefore, passed from father to son only.
One of the first practitioners documented was very small, ugly lass called Sarah Mapp. She was quite fat,
very bad tempered, but quite a competent manipulator, and royalty of the day used her services . She
acquired fame in the 1730's but was much criticized by the medical profession of the times . She lost her
supporters and died a pauper.
Perhaps the best known bone setter in modern times was Sir Albert Baker who learnt his art from his
cousin, John Atkinson (no relative of mine). For years, he offered to demonstrate and teach doctors
manipulation but they refused until 1916 when they finally agreed to publish his work in the Medical
Journal, and his skill was recognised openly by eminent members of the profession .
In 1922, he was knighted, much to the upset of many doctors throughout England .
Andrew Still (late 19th century), an American, was responsible for the introduction of Osteopathy. He
believed that the body had within itself the power to control all diseases . He also considered that anatomical
lesions caused physiological malfunction . e .g . Dislocation of the hips is a frequent cause of diabetes .
The Journal of the Hong Kong Physiotherapy Association
34
All this on todays standards seems very primitive, but when we consider the doctors of that day used bark
and opium for diabetes, and vinegar for smallpox, we realise the limitations of their knowledge .
In 1892, still joined an Edinborough doctor named William Smith to form the first school of osteopathy
and in 1900, the first Osteopaths were granted a full licence to practice medicine in some states in America .
Since this time, of course, the standard has improved until today, the Ostoepaths and doctors in U .S .A . have
equal standing .
During the same period, Chiropractics developed . At first they were "magnetisers" . A man called Daniel
Palmer in Iowa in the United States was convinced that he had powers of magnetism and started a business
which lasted ten years . He gained some knowledge of manipulation and replaced subluxated vertebrae .
Palmer's first patient was a negro who, for seventeen years, had been completely deaf after an injury to his
neck, Palmer found a "subluxation" which he adjusted and the patient recovered .
He opened his first Chiropractic school with a solicitor called Carver in 1897. Palmer not only manipulated
the spine but also the limbs. Carver later took over the school and taught the Carver method of Chiropractic
. These chiropractors were known as "mixers" .
Palmer's son then started his own school but only manipulated the spine . This was the "Palmer Method of
Chiropractic" and its exponents were called "straights" . The terms "mixers" and "straights' . are still used
to this day.
Chiropractors have gained a lot of recognition in America but with differing stateslaws, the situation is
confused .
A little known branch of Chiropractic is Naprapathy and was started in Chicago in 1903. These
practitioners believed that the ligaments become contracted and pull the vertebrate together, causing
diseases like gallstones, for example, by restricting nerves and blood vessels .
During the 19th century, the medical profession began to look at manipulation as a means of curing backache
and other discomforts of the spine and limbs .
Oscillatory tecniques were first recommended by Recamier in 1838 for treatment of Torticollis . Manual
vibration was intensively employed by Kellgreen, a Swedish physiotherapist working in London at the turn
of the century . These techniques have been adopted and improved on by modern therapists such as
Maitland and Grieves .
Since the turn of the century, there have been many men who have put respectability into the fine art of
manipulation . John Mennell practised in London as did Drs . Edgar and James Cyriax, father and son, and
Dr. Main in France, to name a few.
Volume 2, 1978-79
35
About 1950, Freddy Kaltenborn became interested in manipulation and after graduating as a physiotherapist,
went to U.K . to study under Mennell, Cyriax and Stoddart, and also attended .the school of
Osteopathy in London . After this, he returned to Norway to teach his new found art to his colleagues.
Cyriax followed to conduct the first examination in manipulation in Norway.
In 1970, Dr . Cyriax, Freddy Kaltenborn and sixteen physiotherapists from seven countries met on 20th
April with the intention of forming a special interest group which was the beginning of the International
Federation Of Manipulative Therapists . (I .F .O .M .T .)
In 1973, the first seminar and congress of I .F .O.M .T . was held in the Canary Islands. Here the first examination
and assessment of standards were held . The second seminar was also in Gran Canary and 1977 saw
the third seminar of I .F .O .M .T . in Vail in Colorado, and anyone who has read the proceedings of the
scientific week will realise the high standards achieved .
This has been a resume of the history of manipulation from Hippocrates to the present date .


References : Manipulation : Past and Present.
Eiler H. Schiotz.
James Cyriax .
The Journal of the Hong Kong Physiotherapy Association
36

Thursday, November 11, 2010

ENGINES OF LIFE

The more scientists study human muscles, the more amazed they are- at what muscles can do, and how new exercise techniques are helping to develop them faster than ever before. The results of this research have changed training methods, and have established that focused Strength Training Exercises are the best preventive medicine.


Muscles are truly marvellous. In the human body these powerhouses weigh as much as one's Blood, Bones, Brain & Liver put together. 2000 genes contribute to their development and functioning, and they produce 2,900 different proteins. In fact, some scientists have lately begun to regard muscles as the most complex organ of the body after the brain. Many researchers now studying the muscles often based on mice, ironincally given that it was mice who gave muscles their names. In the mind of ancient man, the movement of the arm's biceps resembled the scurrying of a little mouse, so the Romans called it “musculus” and muscles continued to referred to as “little mice” until well into the 18th century.






And it was through mice that Se-Jin Lee, a microbiologist at Johns Hopkins University in Baltimore, USA, discovered that the growth of muscles is dependent on the concentration of a protein called myostatin: the less there is of this protein, the more muscles there are. By removing the myostatin gene in some mice, he succeeded in producing animals that looked like miniature body builders. Lee's research has changed the science of muscles; it has transformed them from uninteresting organs into mysterious biological systems.


How can one increase muscle mass in an efficient and healthy way? This is a question that has long vexed doctors as as sports scientists. The classic doctrine preaches that regular and controlled training leads to success; patience and endurance- as many training sessions as possible- are considered to be the critical factors.


There are two types of skeletal muscles (1. Red muscles which contracts slowly and are good for endurance or stamina type of exercises; 2. White muscles  which contracts rapidly and are good for sprinters/ weight lifters for short burst activities)

All of us have a mix of these 2 types and 80 % of this mixture ins genetically determined. But recent studies prove that a certain portion of our muscles can be converted to “mixed” fibres. So anyone, even an average athlete who does short and crisp training can increase not only strength but, simultaneously, endurance as well.

The opinion that Strength Training and Endurance are mutually conflicting is based on misconceptions. However, one cannot be randomly substituted by the other- especially not from the point of view of health, which believes in a systematic build- up muscles. That's why it is not enough to focus only on endurance by jogging, for example.

Strength training protects the body. Accumulating muscle mass also increases the “Messengers” circulating in your blood stream- the hormones. They pulsate through the body 24 hrs a day regulating one's metabolism. A powerful musculature therefore also ensures, for instance,  that sugar and fat are broken down efficiently even when you are doing nothing more than lounging about on a sofa.




Besides our muscles shrink as we grow older- especially if we do nothing with them. The rule of thumb is that muscle strength reduces by 10 % with every decade. A terrifying phenomenon associated with this development is called SARCOPENIA., which literally means “Poverty of Flesh”. Those who suffer from this condition frequent falls and injuries associated with them. More than Alzheimer's or Cardio- vascular problems. Muscle loss is the creeping horror of old age, and makes invalids out of those whose don't exercise. Just 3 weeks of bed-rest can weaken a body more than 2 decades of aging.

Muscles are the efficient “Economic Stimulus Package” of our body against diabetes, obesity, and many other problems. And it does not take as much time to increase muscle mass as was once believed. High- intensity training (HIT) is the systematic and focused implementation of this knowledge. The priniciple: flat-out effort, as far as possible, a few times in succession. This gets the muscles of the entire system going. The heart pumps what it can. The legs build up fibres that are good for both strength and endurance. And for the professional, it is wonderful to get both the “huffing and puffing”, as well as the strength training for the back and upper body, over and done with one quick go.

Sports scientists say HIT is ideal for running, sports cycling, swimming, or playing football- in all of which endurance and the dynamic development of strength play a major role.


The foundations of high-intensity training were laid in the 1970s and 80s by 2 American: Arthur Jones, the sports- goods manufacturer, and Mike Mentzer, the body-builder. Their ideas spread throughout the body-building world, and found receptive ears in other fields as well: internationally, throughout the arena of professional sports, HIT is now regarded as the most effective training. Doctors too are now recomending the programme: for heart patients, for those suffering from lung diseases and for elderly people in general.

Norwegian Researchers have discovered that patients with coronary heart problems who do a HIT running work-out three times a week, for a period of 10 weeks, increase their Oxygen intake for more than those following only a moderate intensity exercise routine. The lesson learned from the research has always been the same: Use them or lose them.

By exerting your muscles to the maximum, you are doing your health the greatest good.

According to Billy Sperlich of the German Sports University, Koln, “HIT is the best thing for recreational sportsmen and women”. But not everyone can stretch themselves to this extent. “A stress test under medical supervision must be done first to check the heart”, says Sperlich.

Ten minutes should be spend each time to get the heart and circulation on track, both before and after the exercises. Prior to pumping iron, one must 1st go through all exercises with half- weights, to warm up the muscles. And because HIT strains the body to a greater extent than the classic volume training routine, intervals between sessions have to be longer. “It is important to have a break of 2-3 days after each training session”, says Sperlich.

“It is difficult to beat this method,” says Jurgen Giessing of the University of Koblenz- Landau in Germany. “Good results are achieved with moderate effort”. And it is not just sports scientists who have realised this – salmon breeders have, too.


Fish farms in Norway are now using HIT to keep young salmon in shape. The fish are made to swim vigorously upstream and their heart- rate and oxygen consumption are measured, after which they are released into their breeding cages in salt water. Initial results indicated that the mortality rate among juvenile fish dropped by more than 10 % within a period of 6 weeks.

Athletes, Heart patient, And now Salmon ! All living beings can exercise according to the same flatout, full stretch principle. Our muscular system is indeed a gift of Evoultion.



Courtesy : GEO Magazine Feb 2010

Tuesday, November 9, 2010

Physical Therapy Logo


There are a couple things you should keep in mind when designing your physical therapy. By following these considerations, you should be able to develop a physical therapy or medical logo which stands out among your competition and speaks to your target audience.


  • Choose the color of your physical therapy logo wisely- Most medical logos, including physical therapy logos, seem to use the same typical color schemes associated with the medical industry. While, these color schemes seem appropriate for medical industry and your physical therapy logo design, they don't make sense because they are overused and may have a negative impact on emotion. Personally, when I see a medical logo use the typical blue and green hues, it does not give off a warm feeling. Instead, it reminds me of the inside of a medical facility such as a hospital. When designing your physical therapy logo, one way to stand out and make a statement, is to focus on warmer color tones such as oranges and reds. Nobody said you had to stick with the color of a hospital gown for your physical therapy logo design. By adding a warmer color scheme, you can give off a more positive message without even saying anything.


  • No more than two colors in your medical logo design- When designing your physical therapy logo, keep the the number of colors used to a minimum. The main reason for this is to keep costs low. The more colors you have in your physical therapy logo, the more it will cost to print forms of communication such as your physical therapy business card, letterhead, physical therapy brochure, etc. Imagine if you run out of your physical therapy business cards several times a year and have to pay an extra amount of money just to print you 3-4 color physical therapy logo. There are many successful and dynamic logo designs which only use 1 or 2 colors.


  • Design your physical therapy logo with unique symbols and type- It is an all too common practice to use typical and common symbols when designing medical logos as well as physical therapy logos. When designing your physical therapy logo, try and come up with a symbol which is unique to physical therapy - or a symbol which is universal which can be applied to physical therapy. For example, you could use a shield to symbolise "protection." By using a symbol typical or common with physical therapy, you are basically telling your target audience that you are a "typical" therapy office. Wouldn't you rather stand out among your competition and give your target market a fresh and new perspective? You do not need a symbol for your physical therapy or medical logo design. Instead, you can just focus on the design of the type. By designing a unique type face for your physical therapy logo, you can make even a bigger impact than you can by designing a symbol which is unique.


  • Make sure your logo is a successful black and white logo - You will be surprised how many graphic designers still mess this one up. It is very important that your physical therapy logo design work as well in black and white as it does in color. There will be many times you will need to use a black and white version of your PT logo. For example, when you fax a document or make a black and white copy on a copier machine. If your physical therapy logo is not designed correctly, it may be easy to read when it's in color but more difficult to read in black and white if not unreadable.


  • By following these four considerations of logo design, you can avoid some of the pitfalls of logo design and help create yourself an unique and dynamic physical therapy logo.
     
     
     
    Physical Therapy Logos
     
    It is highly recommended to hire a professional graphic designer for your physical therapy logo and other forms of communication such as physical therapy business card, stationary, physical therapy brochure, signage, etc. Even if your budget does not allow for a high paying logo designer, you can still find quite a few good logo designers at a fraction of the cost. If you do insist on designing your own physical therapy logo, here are a few tips to help you out.

    Make sure any physical therapy logos that you create, are designed using a vector based program such as Adbobe Illustrator. Any physical therapy logos designed with this program can be resized to any size without losing quality. Physical therapy logos designed with a bitmap based program such as Adobe Photshop will lose quality if it is resized at the size it was created at.

    When designing physical therapy logos, take your time and sketch ideas. Many people will sketch a few ideas for their physical therapy logo and think they have created the most unique concept since sliced bread. Spend some time with the concepts for your physical therapy logo. You will see that the more you sketch, the more creative and interesting your ideas will become. When concepting for physical therapy logos, chances are, the 100th sketch will be the one and not the first.

    Keep physical therapy logos simple. It's too easy to get carried away with a logo and combining too many graphics, symbols, words and colors. If there is anything you should remember, keep your physical therapy logo simple. This will make your logo easier to read and stand out better.

    While it is recommended that you hire a logo designer for any physical therapy logos, by following these couple of steps, you can help you design your own pt logo

    Therapy websites

    There are many considerations to make when designing therapy websites. These decisions can have an big impact on the look and usability of the final therapy website design. These following tips and suggestions should help you with your therapy website design.

    One of the first considerations to make when designing your therapy website is the domain name. You want your domain name of your therapy website to be easy to remember. Therefore, the shorter the domain name, the better. If you have a long physical therapy business name, you should try and shorten it. If it is difficult to shorten, you can always come up with a domain name with the words "I Love Therapists" instead of "Johnson and Richards Physcical Therapy Clinic." Easier to remember and to the point.

    Once you have the domain name for your physical therapist website, you can decide if you want a animated flash website or a static html website. A flash website may wow visitors but may also take longer to load. Keep in mind that a flash website is not search engine friendly and users may have trouble finding your therapy website in a search engine. An html website should load faster and is search engine friendly.

    The domain name and the type of website should get you started. Other questions you way want to ask which should help you during the therapy website design process are: What content do I want on my website? How may pages do I want on my therapy website? Do I need any forms? Will these forms contain patient information? If so, do these forms need to be secured? Do I need an image gallery on my site or will my therapy site be mostly text?

    Following are some of the best schools offering physical therapy programs:

    University of Delaware
    - Rated 4th in the nation for Graduate PT Programs by US News (2009).
    - The UD Physical Therapy Curriculum is offered as a 2.5 year program.
    - It was ranked 14th among 100 best values in public colleges in Kiplinger's Personal Finance magazine.

    US Army-Baylor University
    - Baylor University is accredited through the Southern Association of Colleges and Schools (SACS).
    - The Army-Baylor Doctoral Program in Physical Therapy is accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE).

    University of Iowa
    - The University of Iowa Physical Therapy Graduate Program is ranked 3rd among public institutions (USNWR 2009).
    - Satisfactory completion of the Doctor of Physical Therapy (DPT) curriculum qualifies the candidates to take a state-administered national licensing examination.

    University of Miami
    - The Department of Physical Therapy offers a three year, entry level clinical doctoral degree the Doctor of Physical Therapy (DPT) and an academic doctoral degree, ( PhD) in Physical Therapy.
    - The Department of Physical Therapy is accredited by both the Commission on Accreditation in Physical Therapy Education (CAPTE) and the Southern Association of Schools and Colleges (SACS) Accrediting Commission for Senior Colleges and Universities.
    - It has been consistently ranked as one of the top 10 physical therapy programs in the United States.

    University of Florida
    - The Department of Physical Therapy has been ranked fourth in the nation for AAU Public Universities by U.S. News and World Report.
    - The DPT is the degree endorsed by the American Physical Therapy Association.

    Ranking of Best Physical Therapy Schools (Top 40 list):
    1. University of Southern California
    2. University of Pittsburgh
    2. Washington University in St. Louis
    4. University of Delaware
    5. US Army-Baylor University
    5. University of Iowa
    7. Arcadia University
    7. MGH Institute of Health Professions
    7. Northwestern University
    7. University of Miami
    11. Emory University
    11. University of North Carolina–Chapel Hill
    13. Duke University
    13. University of California–San Francisco/San Francisco State University
    15. New York University
    15. University of Florida
    15. University of Illinois–Chicago
    15. University of Maryland–Baltimore
    19. Creighton University
    19. Marquette University
    19. Ohio State University
    19. University of Minnesota–Twin Cities
    19. University of Utah
    24. Boston University
    24. Texas Woman’s University
    24. Univ of Kansas Medical Center
    24. Univ of Texas Medical Branch–Galveston
    24. Virginia Commonwealth Univ
    29. Northern Arizona Univ
    29. Regis Univ
    29. Univ of Alabama–Birmingham
    29. Univ of Washington
    33. Columbia Univ
    33. Mayo School of Health Related Sciences
    33. Univ of Colorado–Denver
    33. Univ of Nebraska Medical Center
    33. Univ of Wisconsin–Madison
    38. Univ of Kentucky
    38. Univ of Oklahoma Health Sciences Center
    38. Univ of Wisconsin–La Crosse

    Source: U.S. News & World Report (2009)
     


    Top universities offering online Physical Therapy programs:

    Arcadia University
    - The Physical Therapy program is rated 7th in the nation among more than 200 graduate PT programs (USNWR 2009).
    - Arcadia offers both the entry-level and transitional Doctor of Physical Therapy degrees. The transitional program is offered fully online.
    - The D.P.T. program is accredited by the Commission on Accreditation in Physical Therapy Education.
    - The 2008 Open Doors report ranks Arcadia University 1st in the nation in the percentage of undergraduate students studying abroad.

    The College of St. Scholastica
    - It offers the transitional Doctor of Physical Therapy Degree. The CSS tDPT program is a distance learning education program designed for the working clinician.
    - Ranked in the Top Tier of regional universities in the Midwest (US News "America's Best Colleges" 2008).

    Boston University
    - It offers an Online Transitional Doctor of Physical Therapy degree. This program is available to all qualified physical therapy graduates of accredited programs who are licensed physical therapists in the US.
    - Online students will learn the same material and receive the same degree as on-campus students.
    - Boston University, including Boston University College of Health and Rehabilitation Sciences: Sargent College is accredited by the New England Association of Schools and Colleges, Inc.

    University of South Dakota
    - USD offers state’s first online physical therapy doctoral degree.
    - It is fully accredited by the Commission of Accreditation of Physical Therapy Education and the North Central Agency for University Accreditation.

    Northeastern University
    - The Transitional Doctor of Physical Therapy (DPT) is an online program. It is for applicants who hold a baccalaureate or master's degree in Physical Therapy.
    - DPT Specializations include: Nutrition ,Leadership, Orthopaedics, Education, Geriatrics, Pediatrics, Women’s Health, Urban Health, Independent Track.
    - This program is designed for the working professional, using online course offerings to provide flexibility and convenience.

    Sunday, November 7, 2010

    The Myofascial Pain Syndrome and Trigger Point Therapy


    HISTORY

    DR. JANET TRAVELL

    Dr. travell was born in 1901, and followed in her father's footsteps to become a doctor. she initially specialized in cardiology but soon became interested in pain relief, as had her father. she joined her father's practice, taught at cornell university medical college, and pioneered and researched new pain treatments, including trigger point injections. in her private practice, she began treating senator john f. kennedy, who at the time was using crutches due to crippling back pain, and almost unable to walk down three stairs. this was at a time when television was bringing images of politicians into the nation's living rooms, and it had become important for presidential candidates to appear physically fit. being on crutches probably would have cost president john f. kennedy the election. dr. travell became the first female white house physician, and after president kennedy died, she stayed on to treat president johnson. she resigned a year and a half later to return to her passion for teaching, lecturing, and writing about chronic myofascial pain. she continued to work into her 90's, and died at the age of 95 on august 1, 1997.

    DR. DAVID G. SIMONS

    Dr. simons started out his career as an aerospace physician, and met dr. travell when she lectured at the school of aerospace medicine at brooks air force base in texas in the 1960's. he quickly teamed up with dr. travell. dr. simons began researching the international literature for any references to the treatment of pain, and discovered there were a few others out there who were also discovering trigger points, but using different terminology. he studied and documented the physiology of trigger points in both the laboratory and the clinic, and tried to find scientific explanations for trigger points. together, doctors travell and simons produced a comprehensive two-volume text written for physicians on the causes and treatment of trigger points.


    The Myofascial Pain Syndrome and Trigger Point Therapy


    The myofascial pain syndrome, MPS is one of the most common overlooked diagnoses in chronic pain. Up to 85% of patients with chronic pain have an underlying MPS. The terms MPS, myofascial trigger point, taut band, local twitch response and their definitions were first published in the fifties by Dr. Janet Travell. In 1983, together with Dr. David Simons, Travell published  the groundbreaking Trigger Point Manuals which are now in their second edition and have been translated into 12 different languages. Today Travell and Simons can be considered as true medical pioneers.

    The Foundations of Trigger Point Therapy

    The goals of successful trigger point therapy are releasing local sarcomere contractions, increasing local blood flow as well as inhibiting local inflammatory processes. The more precisely trigger points are treated the better the results achieved. There is a worldwide consensus among specialists that the combination of manual trigger point therapy and dry needling are the most effective approaches in the treatment of trigger points.

    Diagnosis

    The hallmark of the MPS are myofascial trigger points. Imaging techniques to diagnose trigger points and taut bands exist. However they have little value in clinical practice. The characteristic features of trigger points can be manually identified by palpation. The accepted diagnostic criteria are:
    • taut band
    • local tenderness within the taut band
    • referred pain
    • local twitch response
    Many studies have shown a high interrater reliability among trained clinicians for the diagnostic criteria of trigger points. The MPS can be local or widespread. It can affect one, two or more quadrants. This is one of the reasons why the MPS is often mistaken for fibromyalgia. Trigger Points have characteristic referred pain patterns.

    Pathophysiology of Myofascial Trigger Points


    Integrated Hypothesis

    Expanded Integrated Hypothesis, hand drawn by David G. Simons
    Muscle lesions (e.g. trauma, RSI) can cause ruptures of the sarcoplasmatic reticulum which leads to an uncontroled release of calcium ions from the sarcoplasmatic reticulum. This in turn causes persistent sarcomere contractions. Many contracted sarcomeres and muscle fibres cause the taut band. Taut bands are palpable and can be visualized by ultrasound and MRI. On the one hand prolonged contractions have an increased energy demand and on the other hand they compress vessels, which leads to a decreased energy supply. The result is an energy crisis. Due to the lack of ATP there is also a decreased reuptake of calcium ions into the sarcoplasmatic reticulum which perpetuates contractions. As a result there is a local release of bradykinin and CGRP which lower the threshold of nociceptive endings. Many studies confirm the energy crisis theory. The integrated hypothesis is an expansion of the energy crisis theory and is the most accepted model for the explanation of trigger points. It postulates that the energy crisis process takes place in the vicinity of motor endplates. This leads to an incresed release of acetylcholine and therefore perpetuates the vicious circle of prolonged contraction.

    Thursday, November 4, 2010

    A VERY INTERESTING CONVERSATION


    An Atheist Professor of Philosophy was speaking to his Class on the
    Problem Science has with GOD, the ALMIGHTY.  He asked one of his
    New Christian Students to stand and................


    Professor :   You are a Christian, aren't you, son ?

    Student    :   Yes, sir.

    Professor :    So, you Believe in GOD ?

    Student    :   Absolutely, sir.

    Professor :    Is GOD Good ?

    Student    :    Sure.

    Professor :    Is GOD ALL - POWERFUL ?

    Student    :    Yes.

    Professor :    My Brother died of Cancer even though he Prayed to  GOD
    to Heal him. Most of us would attempt to help others who are ill.. But
    GOD didn't. How is this GOD good then? Hmm?

    (Student was silent )

    Professor :   You can't answer, can you ?  Let's start again, Young Fellow.

                      Is GOD Good?

    Student    :   Yes.

    Professor :   Is Satan good ?

    Student    :   No.

    Professor :   Where does Satan come from ?

    Student    :   From . . . GOD . . .

    Professor :   That's right.  Tell me son, is there evil in this World?

    Student    :   Yes.

    Professor :    Evil is everywhere, isn't it ? And GOD did make
                        everything. Correct?

    Student    :   Yes.

    Professor :   So who created evil ?

    (Student did not answer)

    Professor :   Is there Sickness? Immorality? Hatred? Ugliness?

                       All these terrible things exist in the World, don't they?

    Student    :  Yes, sir.

    Professor :   So, who Created them ?

    (Student had no answer)

    Professor : Science says you have 5 Senses you use to Identify and
    Observe the World around you. Tell me, son . . . Have you ever seen
    GOD?

    Student    : No, sir.

    Professor   : Tell us if you have ever Heard your GOD?

    Student    :  No , sir.

    Professor :   Have you ever Felt your GOD , Tasted your GOD , Smelt
    your GOD ? Have you ever had any Sensory Perception of GOD for that
    matter?

    Student    :   No, sir. I'm afraid I haven't.

    Professor :   Yet you still Believe in HIM?

    Student    :  Yes.

    Professor :   According to Empirical, Testable, Demonstrable Protocol,
    Science says your GOD doesn't exist.  What do you say to that, son?

    Student    :  Nothing.  I only have my Faith.

    Professor :  Yes, Faith.  And that is the Problem Science has.

    Student    :   Professor, is there such a thing as Heat?

    Professor :   Yes.

    Student    :   And is there such a thing as Cold?

    Professor :   Yes.

    Student   :   No, sir. There isn't..



    (The class became very quiet with this turn of events )

    Student    :   Sir, you can have Lots of Heat, even More Heat,
    Superheat, Mega Heat, White Heat, a Little Heat or No Heat.
    But we don't have anything called Cold. We can hit 458 Degrees
    below Zero which is No Heat, but we can't go any further after that.
    There is no such thing as Cold. cold is only a Word we use to
    describe the Absence of Heat. We cannot Measure Cold.
    Heat is Energy. Cold is Not the Opposite of Heat, sir, just the
    Absence of it.

    (There was Pin-Drop Silence in the Lecture Hall )


    Student    :  What about Darkness, Professor? Is there such a thing as Darkness?

    Professor :  Yes. What is Night if there isn't Darkness?

    Student    :  You're wrong again, sir.   Darkness is the Absence of
    Something. Yu can have Low Light,   Normal Light, Bright Light,
    Flashing Light . But if you have No Light constantly,
    you have nothing and its called Darkness, isn't it?  In reality,
    Darkness isn't. If it is, were you would be able to make Darkness
    Darker, wouldn't you?

    Professor :   So what is the point you are making, Young Man ?

    Student   :   Sir, my point is your Philosophical Premise is flawed.

    Professor :   Flawed ? Can you explain how?

    Student    :   Sir, you are working on the Premise of Duality. You
    argue there is Life and then there is Death, a Good GOD and a Bad GOD.
    You are viewing the Concept of GOD as something finite, something we
    can measure. Sir, Science can't even explain a Thought.  It uses
    Electricity and Magnetism, but has never seen, much less fully
    understood either one. To view Death as the Opposite of Life is to be
    ignorant of the fact that Death cannot exist as a Substantive Thing.
    Death is Not the Opposite of Life: just the Absence of it. Now tell me
    Professor, do you teach your Students that they evolved from a Monkey?

    Professor :   If you are referring to the Natural Evolutionary
    Process, yes, of course, I do.

    Student    :   Have you ever observed Evolution with your own eyes, sir?



    (The Professor shook his head with a Smile, beginning to realize where
    the Argument was going )

    Student    :   Since no one has ever observed the Process of Evolution
    at work and Cannot even prove that this Process is an On-Going
    Endeavor, Are you not teaching your Opinion, sir?
    Are you not a Scientist but a Preacher?

    (The Class was in Uproar )


    Student    :  Is there anyone in the Class who has ever seen the
    Professor's Brain?

    (The Class broke out into Laughter )

    Student    :  Is there anyone here who has ever heard the Professor's
    Brain, Felt it, touched or Smelt it? . .. . No one appears to have
    done so. So, according to the Established Rules of Empirical, Stable,
    Demonstrable Protocol, Science says that You have No Brain, sir.  With
    all due respect, sir, how do we then Trust your Lectures, sir?

    (The Room was Silent. The Professor stared at the Student, his face
    unfathomable)


    Professor :   I guess you'll have to take them on Faith, son.

    Student    :  That is it, sir . .. .  Exactly !

    The Link between Man & GOD is FAITH.

    That is all that Keeps Things Alive and Moving.


    ( That student was Albert Einstein ! )
    This was a mail send by Dr Rajan Narayanan, 
    Senior Orthopaedic Surgeon, My beloved professor..