It was a very interesting editorial and I must congratulate the authors for that.
In my humble opinion, even if the studies quoted are right, the title of the editorial is simply wrong. Even though the author tries to be politically correct in the concluding paragraph, most readers wouldn't
make it there and would have made up their minds. Does that mean even the guys doing moderate brisk walk...
It was a very interesting editorial and I must congratulate the authors for that.
In my humble opinion, even if the studies quoted are right, the title of the editorial is simply wrong. Even though the author tries to be politically correct in the concluding paragraph, most readers wouldn't
make it there and would have made up their minds. Does that mean even the guys doing moderate brisk walks for 30min a day for 30 yrs will have heart damage? That's not covered in this editorial, so why have such a general title!
How about 'life-long TV remote exercise better for the heart than physical exercise' as a title? Shouldn't we leave sensationalizing of news
to the Murdochs and not introduce it in Medical Journals of such good repute as BJSM?
All I'm saying is, let's please be a little more responsible in the way we communicate. Most folks who are reading this, yes, even the sports medicine doctors, aren't very physically active. Let's please not give
them an excuse to be even more sedentary.
Keep miling & smiling.
Rajat
...
Dr Rajat Chauhan
Sports-Exercise Medicine & Musculoskeletal Medicine Physician.
'Wealth of a nation should be measured by health & fitness of its
youngsters, not by pieces of gold & silver.'
- inspired from Mahatma Gandhi.
Conflict of Interest:
I'm first a passionate ultra runner who does like to run fast. Only then am I a Sports Medicine doctor.
I am the founder of the Back 2 Fitness chain of clinic that focuses on getting people back to fitness by getting them physically active for life.
I believe students, employees and even housewives will be a lot more productive if they are fitter, and not only disease free, which is the only thing addressed by current healthcare industry globally.
Ratzlaff (1) outlines broad categories in assessing societal activity-levels: occupational and household. While the latter was traditionally the greater source of activity, particularly for men, the nature of work has become steadily more sedentary. However, the same may be less true for
household tasks. One conclusion it that women today, as the gender likely to undertake most household tasks, may well be more active than th...
Ratzlaff (1) outlines broad categories in assessing societal activity-levels: occupational and household. While the latter was traditionally the greater source of activity, particularly for men, the nature of work has become steadily more sedentary. However, the same may be less true for
household tasks. One conclusion it that women today, as the gender likely to undertake most household tasks, may well be more active than their male counterparts. The gender imbalance may only be partly diminished by the
fact that males are more likely - at least at younger ages - to obtain a third category of activity in the voluntary participation in energetic sports.
My concern here is with another category of exercise that entails both occupational and sports elements: the commute to the work-place.
Choices of commuting-mode are dependent on distance to be travelled. Short home-to-work distances may render walking predominant. Distances beyond a few kilometres may render powered transport - cars, buses and trains - compulsory, so the scope for exercise may seem limited. The steady
increase in the UK of park-and-ride facilities attempts to reduce traffic in major centres such as cities: commuters drive to a strategically located car-park away from the city-centre and continue by public transport. This would not of course alter the conclusion that long-distance commuting does not entail significant activity-levels.
However, multi-modal commuting can include substantial elements of walking, cycling or running; this particularly applies to journeys entailing public transport, where pick-up points for public transport (bus
-stops and railway stations) may be at some distance from home. As many would attest, the disadvantages of walking, cycling and running concern poor weather conditions and build-up of sweat, perhaps requiring change of clothing at the work-place. Probably of most importance for all commuters is the issue of conflicts and potential collision with motor traffic.
Despite these problems, the incorporation of exercise into commuting is receiving some official support in the UK. For example, at least one public-transport provider now promotes exercise as a valuable "add-on" to
travel by public transport (2) - far removed from the days when exercise-free travel was regarded as a major feature supporting the preference for the private car (3). Furthermore, there are also now governmental schemes
to provide grants for the purchase of bikes to access the work-place (4).
To pursue the issues, if the problems with petroleum price and availability continue towards the levels that characterised the 1970s, the private motorcar may come to have a more restricted presence on the road.
At that stage, walking, cycling and running could become generally prominent in commuting - in a way that has applied particularly to cycling
in the Netherlands for many years. However, for this scenario to continue
in the UK beyond the present age of economic downturn requires a societal
change in attitude that eschews a thoughtless dependence on the car. That
most certainly did not happen after the petroleum crises of the 1970s had
passed (5). Perhaps the lessons will be learned this time.
REFERENCES
1. Ratzlaff CR, Good news, bad news: sports matter but occupational
and household activity really matter - sport and recreation unlikely to be
a panacea for public health. Br J Sports Med 2012 (10.1136/bjsports-2011-
090800).
2. www.translink.co.uk (accessed 25/4/12).
3. www.bike2workscheme (accessed 25/4/12).
4. Wolmar C. Fire and steam: a new history of the railways in
Britain. London: Atlantic.
5. Transport statistics Great Britain. 2001. London: Department for
Transport.
Nitrates boost blood supply and recovery to muscle groups via the
iNOS pathway, but only if converted to nitrites via salivary bacteria. The
use of mouthwash, a common practice in those consuming diets high in
refined carbohydrate, completely negate this possible conversion (1)
That the authors overlooked the potential risk of nitrosamine
formation from the combination of nitrite-precursor nitrates with dietary...
Nitrates boost blood supply and recovery to muscle groups via the
iNOS pathway, but only if converted to nitrites via salivary bacteria. The
use of mouthwash, a common practice in those consuming diets high in
refined carbohydrate, completely negate this possible conversion (1)
That the authors overlooked the potential risk of nitrosamine
formation from the combination of nitrite-precursor nitrates with dietary
protein (2), especially given the ubiquitous nature of protein
supplementation at all levels of sport - is a major oversight.
In animal experiments 85% of the 209 identified nitrosamines have
been shown to be carcinogenic across 40 species of mammals. It is
inconsistent to assume our mammalian tissue is somehow unique in avoiding
this risk - a viewpoint is shared by EU and others (2,3,4).
May I suggest that researchers in this area perform a simple study to
measure urinary excretion of nitrosamine as defining evidence as to the
overall long term safety of nitrate rich supplements at all levels of
sport.
(1) Van Maanen JM et al (1998). Formation of nitrosamines during
consumption of nitrate- and amine-rich foods, and the influence of the use
of mouthwashes. Cancer Detect Prev 22:204-212
(2)Vermeer ITM et al (1998). Volatile N-Nitrosamine Formation after
Intake of Nitrate at the ADI Level in Combination with an Amine-rich Diet.
Environ Health Perspect 106:459-463.
(3) Santamaria P (2005). Review. Nitrate in vegetables: toxicity,
content, intake and EC regulation. J Sci Food Agric 86:10-17
(4) Jakszyn P, Gonzalez CA (2006). Nitrosamine and related food
intake and gastric and oesophageal cancer risk: A systematic review of
the epidemiological evidence. World J Gastroenterol 12:4296-4303
Osteoarthritis is the most common form of joint disease, sparing no
age, race, or geographic area. Symptomatic disease also increases with
age. This arthropathy is characterized by degeneration of cartilage and by
hypertrophy of bone at the articular margins. Inflammation is usually
minimal. Hereditary and mechanical factors may be variably involved in the
pathogenesis.
Osteoarthritis is the most common form of joint disease, sparing no
age, race, or geographic area. Symptomatic disease also increases with
age. This arthropathy is characterized by degeneration of cartilage and by
hypertrophy of bone at the articular margins. Inflammation is usually
minimal. Hereditary and mechanical factors may be variably involved in the
pathogenesis.
Degenerative joint disease is traditionally divided into two types:
(1) primary, which most commonly affects some or all of the following: the
terminal interphalangeal joints and less commonly the proximal
interphalangeal joints, the metacarpophalangeal and carpometacarpal joints
of the thumb, the hip, the knee, metatarsophalangeal joint of the big toe,
and the cervical and lumbar spine; and secondary, which may occur in any
joint as a sequela to articular injury resulting from either intra-
articular or extra-articular causes. The injury may be acute, as in a
fracture: chronic, that due to occupational overuse of a joint, metabolic
disease or neurologic disorders. Obesity is a risk factor for knee
osteoarthritis and probably for the hip as well. Recreational running does
not increase the incidence of osteoarthritis, but participation in
competitive contact sports does. Jobs requiring frequent bending and
carrying increase the risk of knee osteoarthritis.
 Pathologically, the articular cartilage is first roughened and finally
worn away, and spur formation and lipping occur at the edge of the joint
surface. The synovial membrane becomes thickened and does not form
adhesions. Inflammation is prominent only in occasional patients. The
onset of the disease is insidious. Initially there is articular stiffness,
seldom lasting more than 15 minutes; this develops later into pain on
motion of the affected joint and is made worse by activity or weight
bearing and relieved by rest. There is no ankylosis, but limitation of
motion of the affected joint or joints is common. Joint effusion and other
articular signs of inflammation are mild.
As preventive measure, weight reduction has been shown in women to reduce
the risk of developing symptomatic knee osteoarthritis. Several
epidemiologic studies suggest that estrogen replacement therapy reduces
the risk of knee and hip osteoarthritis. For patients with mild to
moderate osteoarthritis of weight-bearing joints, a supervised walking
program may result in clinical improvement of functional status without
aggravating the joint pain. For many patients, acetaminophen in doses of
2.6-4 g/d is as effective as and less toxic than other NSAIDS. Patients
who fail to improve with acetaminophen and non-pharmacologic therapies
described above can be treated with salycilates or other NSAIDs.
Bougault and Boulet write that there is a high incidence of viral
respiratory infections in elite swimmers, in particular during heavy
training programmes. However, Bougault and Boulet do not mention the
evidence indicating that vitamin C may protect against respiratory
infections of athletes.
In five placebo-controlled trials with participants under heavy acute
physical stress, vitamin C supplementation halved...
Bougault and Boulet write that there is a high incidence of viral
respiratory infections in elite swimmers, in particular during heavy
training programmes. However, Bougault and Boulet do not mention the
evidence indicating that vitamin C may protect against respiratory
infections of athletes.
In five placebo-controlled trials with participants under heavy acute
physical stress, vitamin C supplementation halved the incidence of common
cold infections (95%CI: -65% to -36%). Three of the trials were with
marathon runners, one with Canadian soldiers in a northern training
exercise, and one with schoolchildren in a skiing camp in the Swiss Alps
[1,2]. Since elite swimmer also have high level physical stress, it is
possible that they too might benefit of vitamin C. A recent study on
adolescent competitive swimmers in Israel found that vitamin C halved
common cold duration in male swimmer (95%CI: -80% to -14%), but no benefit
was seen in females [3]. Sex-modification of vitamin C effect on the
common cold was previously found in two trials that had been carried out
in the UK [4].
Thus, more research is warranted on the effects of vitamin C on
competitive swimmers. Nevertheless, given the consistent benefit of
vitamin C for people under heavy acute physical stress, and the low cost
and safety, it may be worthwhile for swimmers to test vitamin C on an
individual basis if they suffer from repeated respiratory infections.
References
1. Hemila H (1996) Vitamin C and common cold incidence: a review of
studies with subjects under heavy physical stress. Int J Sports Med 17:379
-383
2. Hemila H, Chalker EB, Douglas RM (2010) Vitamin C for preventing
and treating the common cold. Cochrane Database Syst Rev CD000980
3. Constantini NW, Dubnov-Raz G, Eyal BB, Berry EM, Cohen AH, Hemila
H (2011) The effect of vitamin C on upper respiratory infections in
adolescent swimmers: a randomized trial. Eur J Pediatrics 170:59-63
4. Hemila H (2008) Vitamin C and sex differences in respiratory tract
infections. Resp Med 102:625-626
I commend the authors for their efforts in conducting a prospective
clinical trial on this therapeutically challenging condition [1]. They
developed nice reproducible intervention protocols, and appeared to have
access to a good flow of appropriate subjects that could be followed-up
relatively easily.
Reading beyond the abstract, however, there is ample evidence that
the headline result...
I commend the authors for their efforts in conducting a prospective
clinical trial on this therapeutically challenging condition [1]. They
developed nice reproducible intervention protocols, and appeared to have
access to a good flow of appropriate subjects that could be followed-up
relatively easily.
Reading beyond the abstract, however, there is ample evidence that
the headline result flatters to deceive. Furthermore, I can't help but
feel that the authors have missed an opportunity here to perform a more
rigorous level I study.
The biggest limitation to this study is the highly disparate study
arms, in terms of gender, age, severity and chronicity of symptoms. Would
it have been too great a step to randomise the subjects and overcome this
issue? And could the acknowledged possibility of the results being
attributable to the Hawthorne effect not have been avoided by considering
a placebo treatment for shockwave therapy? [2]
The authors claim that, other than shockwave treatment, only gender
differences between the groups could have explained the difference in
recovery time between the groups when univariate ANOVA analysis is used.
This confounder is then not accounted for when the final statistical
outcome (p = 0.008) is calculated and emphasized in the conclusion. How
large was the impact on the overall outcome of having twice as many males
in the shockwave group compared with the control group? Would the overall
result remain statistically significant if the effect of gender is
adjusted for? We know that sex differences exist for MTSS [3, 4], and it
could be argued that the real conclusion here is that recovery is more
protracted in females.
The authors appear to justify omitting the gender confounder by the
fact that the multivariate ANOVA analysis within groups did not reveal
correlation between gender differences and recovery. This is unsurprising
given the very small sample sizes that would have been compared between
the two study groups when divided into gender (7 vs. 14 males, and 13 vs.
8 females). This analysis only serves to corroborate that an inadequately
powered study has a small chance of uncovering a true statistically
significant difference in outcomes.
The results are presented in such a way that the effect size of
adding shockwave is not easily discernable. The absolute means in time to
recovery of the two groups with their standard deviations are given, but
not the mean difference between groups with the 95% confidence intervals.
How significant is the real difference when utilising shockwave?
The authors have not mentioned the use of any non-parametric tests,
which would be required for analyzing the non-Gaussian distributed 'days
with symptoms' as a potential confounder. With such wide variation in this
(189.3 days, SD 339.8 in the shockwave group, and 629.2 days, SD 761.1 in
the control group), the use of an inappropriate test may mask symptom
chronicity as a potential confounder in this study. A Mann-Whitney test is
likely to be a better option here.
This paper provides a reminder that as clinicians and readers of
medical literature, it is critical to maintain our knowledge of medical
statistics. Giving a statistician authorship responsibility could be
alternative way of overcoming statistical discrepancies [5], helping to
avoid a paper providing more questions than answers.
I hope the authors are able to pursue their own suggestion for
further studies, addressing the limitations in study design. To my mind
the benefits of using shockwave in MTSS remain to be proven. Drawbacks
such as the pain of treatment and potential for promoting further stress
in already abnormal bone must be considered [6].
References:
1. Moen MH, Rayer S, Schipper M, et al. Shockwave treatment for
medial tibial stress syndrome in athletes: a prospective controlled study.
BJSM 2012; 46: 253-257
2. Gerdesmeyer L, Frey C, Vester J, et al. Radial extracorporeal
shock wave therapy is safe and effective in the treatment of chronic
recalcitrant plantar fasciitis: results of a confirmatory randomized
placebo-controlled multicenter study. AJSM 2008; 36(11): 2100-2109
3. Yates B, White S. The incidence and risk factors in the
development of medial tibial stress syndrome among naval recruits. AJSM
2004; 32(3): 772-780.
4. Burne SG, Khan KM, Boudville PB, et al. Risk factors associated
with exertional tibial pain: a twelve months prospective clinical study.
BJSM 2004; 38(4): 441-445
5. Mullee FA, Lampe FC, Pickering RM, et al. Criteria for authorship.
Statisticians should be co-authors. BMJ 1995; 310(6983): 869.
6. Delius M, Draenert K, Al Diek Y, et al. Biological effects of
shock waves: in vivo effect of high energy pulses on rabbit bone.
Ultrasound Med Biol 1995; 21(9): 1219-1225.
I read with interest the editorial of O'Connor et al on screening for
the presence of sickle cell trait (SCT) in student athletes (1). Although
some aspects are indeed agreeable, such as the need of continued research
to strengthen the rationale for either continuing or revoking SCT
mandatory testing in student athletes, there is however a drawback in
their analysis that must be clearly emphasized. The cost-effectiveness...
I read with interest the editorial of O'Connor et al on screening for
the presence of sickle cell trait (SCT) in student athletes (1). Although
some aspects are indeed agreeable, such as the need of continued research
to strengthen the rationale for either continuing or revoking SCT
mandatory testing in student athletes, there is however a drawback in
their analysis that must be clearly emphasized. The cost-effectiveness
analysis was in fact based on the sickle cell solubility test, which is
indeed inappropriate for routine screening of SCT wherein most clinical
laboratories worldwide are now equipped with fully-automated thin-layer
isoelectric focusing (IEF) or high performance liquid chromatography
(HPLC). Clear recommendations against the use of sickle cell solubility
test as a primary screening tool have been recently endorsed by the
British Committee for Standards in Haematology. Both HPLC and IEF are
instead recommended by the U.S. Preventive Services Task Force (USPSTF)
and the British Committee for Standards in Haematology, since they carry
100% sensitivity and specificity for detecting hemoglobin variants,
including hemoglobin S, with a cost comparable to that of a solubility
test. As such, the following analysis of O'Connor et al about the 22
hypothetical "false negatives" cases using the sickle cell solubility
test, as well as the debate on discrimination of SCT from sickle cell
disease (SCD), are seemingly pleonastic. Although we would all agree that
it is still unclear as to whether SCT screening in student athletes is
really cost-effective, further analyses of cost and effectiveness must
entail the correct and most appropriate methodology. Why using a coach for
travelling from Paris to Rome, when we can use an airplane?
References.
1. O'Connor FG, Deuster P, Thompson A. Sickle cell trait: what's a sports
medicine clinician to think? Br J Sports Med. 2012 May 19. [Epub ahead of
print]
2. Ryan K, Bain BJ, Worthington D, James J, Plews D, Mason A, Roper D,
Rees DC, de la Salle B, Streetly A; British Committee for Standards in
Haematology. Significant haemoglobinopathies: guidelines for screening and
diagnosis. Br J Haematol 2010;149:35-49.
3. Lin KW. Screening for sickle cell disease in newborns. Am Fam Physician
2009;79:507-8.
I am just a concerned father of a 13 year old girl who has been
playing competitive soccer for four years now.At what age do girls become
more at risk to acl injuries and can anyone suggest what exercises she can
do to minimize the chances of this happening.
Webborn's [1] articulation of the different injury prevention needs
across an athlete' sporting lifetime emphasises that a "one-size-fits all"
does not apply for sport safety and that researchers and practitioners
will need to be creative in developing solutions to the varying injury
problems for different age-groups of athletes. His recognition that
addressing these life-course stage injury risks will require the input o...
Webborn's [1] articulation of the different injury prevention needs
across an athlete' sporting lifetime emphasises that a "one-size-fits all"
does not apply for sport safety and that researchers and practitioners
will need to be creative in developing solutions to the varying injury
problems for different age-groups of athletes. His recognition that
addressing these life-course stage injury risks will require the input of
a range of professionals from both the health and sporting sector is
particularly welcome.
Whilst the model has largely been developed for professional
athletes, it can easily be extended to more recreational sports
participants and others involved in physical activity of an organised,
unorganised, informal, casual and incidental nature. In fact, the major
mechanisms of most injury morbidity (as represented by the International
Classification of Diseases [ICD] external cause codes) also vary across
the lifespan, and correlate highly with physical activity patterns at each
stage.[2] Accordingly, there has been a call to include consideration of
changes in lifespan injury risk more globally in injury prevention
research agenda.[3]
So how is injury across the lifespan related to changing physical
activity? It is well recognized that the major external causes of
injuries in childhood (through the early years to late adolescence) are
closely related to their increased mobility and development of physical
activity habits [4]:
0-1 year olds are beginning their movement patterns and exploration of
their surroundings and injuries are commonly associated with a lack of
supervision in particularly hazardous environments (e.g. around water);
1-4 year olds start to develop gross motor skills and the ability to
crawl, walk and climb and hazards become within their reach; falls are
their major injury mechanism;
5-9 year olds further develop their gross motor skills during active play
and immature bone development increases their risk of fractures; falls are
the major cause of injury, particularly from playground equipment and
trampolines;
10-14 year olds commence participation in formal sport either
recreationally or at school and their gross motor skills development and
activity often involves use of wheeled recreational devices and other
"movement toys" that move at speed; sport and active recreational injuries
are common as are those sustained during active transportation such as
bicycling, inline skating and skate boarding;
15-19 years olds start to participate in more competitive forms of sport,
including at higher levels of play and with increased duration/frequency.
They use more active transportation devices including those used at faster
speeds, and have increased exposure to more hazardous environments such as
riding/skating/blading on roads. Talented children can often play more
than one sport and train/play for increasingly more hours leading to
tissue overload. Common injuries in this age group are related to sport
and recreational injuries and most forms of active transportation such as
bicycling, inline skating and skate boarding.
But age-related injury patterns linked to common physical activities
do not just apply to children. At the broad population level, 20-39 year
olds also commonly experience sports/active recreational injuries, but are
at increased of road trauma due to being vehicle drivers or when engaging
in active transportation on roadways. This group is also at highest risk
of workplace injury, particularly associated with physical occupations.
People aged 40-59 years spend more time in their home settings and can
become more involved in home repairs and maintenance, such as gardening;
there is a significant increase in injury risk in the home in this group
associated with more leisure and incidental physical in this setting. In
older people, physical functionality and balance decline and this can
manifest in an increased risk of falls and associated fractures,
particularly as aspects of their mobility declines.
It is well known that there is a strong link between injury risk and
physical activity,[5] but less recognition of how these links change with
age. If physical activity strategies aimed at different population age-
groups, do not also address the changing nature of the injury risks for
those age-groups, there is a strong likelihood that they will not be
sustainable and lead to lifelong health gains for all.
As exercise medicine researchers and professionals, we need to take
Webborn's [1] call for establishing a lifetime model of injury occurrence
for both professional and amateur levels of sport and extend that to
encompass all forms of health-achieving physical activity, irrespective of
the context in which it occurs.
References
1. Webborn N. Lifetime injury prevention: the sport profile model. Br
J Sports Med. 2012;46:193-7.
2. National Public Health Partnership (NPHP). The National Injury
Prevention and Safety Promotion Plan: 2004-2014. Canberra: NPHP:
Commonwealth of Australia2004.
3. Villaveces A, Christiansen A, Hargarten S. Developing a global research
agenda on violence and injury prevention: a modest proposal. Inj Prev.
2010;16:190-3.
4. Finch C, Twomey D. Chapter 10. The biomechanical basis of injury during
childhood. In: de Ste Croix M, Korff T, editors. Paediatric biomechanics
and motor control Theory and application: Routledge Research in Sport and
Exercise Science; 2012. 209-32.
5. Finch CF, Owen N. Injury prevention and the promotion of physical
activity: What is the nexus? J Sci Med Sport. 2001;4:77-87.
Caroline Finch is an injury prevention researcher from the Australian
Centre for Research into Injury in Sport and its Prevention (ACRISP)
within the Monash Injury Research Institute (MIRI), Monash University,
Australia. She specialises in implementation and dissemination science
applications for sports injury prevention. She is the Senior Associate
Editor for Implementation & Dissemination for the British Journal of
Sports Medicine and a member of the Editorial Board of Injury Prevention;
both journals are published by the BMJ Group. Caroline can be followed on
Twitter @CarolineFinch
The dorsal horns are not merely passive transmission stations but
sites at which dynamic activities (inhibition, excitation and modulation)
occur. [18]
Via a series of filters and amplifiers, the nociceptive message is
integrated and analysed in the cerebral cortex, with interconnections with
various areas. [1]
The processing of pain takes place in an integrated matrix throughout...
The dorsal horns are not merely passive transmission stations but
sites at which dynamic activities (inhibition, excitation and modulation)
occur. [18]
Via a series of filters and amplifiers, the nociceptive message is
integrated and analysed in the cerebral cortex, with interconnections with
various areas. [1]
The processing of pain takes place in an integrated matrix throughout
the neuroaxis and occurs on at least three levels, at peripheral, spinal,
and supraspinal sites. [9]
Knowledge of the modalities of pain control is essential to correctly
adapt treatment strategies (drugs, neurostimulation, psycho-behavioural
therapy, etc.).
Dysfunction of pain control systems causes neuropathic pain. [1]
Spinal Cord Stimulation modalities evolved from the gate-control
theory postulating a spinal modulation of noxious inflow. [16] [2] [7]
[11] [12] [15] [17] [20] [22] [23] [24] [25] [26]
It has been demonstrated in multiple studies that dorsal horn
neuronal activity caused by peripheral noxious stimuli could be inhibited
by concomitant stimulation of the dorsal columns. [8]
Pain relief was more prominent at pain ascending through C fibers
than pain ascending through Adelta fibers. [21]
Many theories on the mechanism of action of Spinal Cord Stimulation
have been suggested, including activation of gate control mechanisms,
conductance blockade of the spinothalamic tracts, activation of
supraspinal mechanisms, blockade of supraspinal sympathetic mechanisms,
and activation or release of putative neuromodulators. [14]
At present, Spinal Cord Stimulation is a well established form of
treatment for failed back surgery syndrome, complex regional pain
syndromes (CRPS), low back pain with radiculopathy and refractory pain due
to ischemia. [4] [3] [8] [13]
Stimulation produced analgesia can provide a level of analgesia and
efficacy that is unattainable by other treatment modalities. [19]
Spinal Cord Stimulation for the treatment of chronic pain is cost-
effective when used in the context of a pain treatment continuum. [14]
Precise subcutaneous field stimulation is targeted to specific areas
of neuropathic pain. [6]
We aim at attenuation or blockade of pain through intervention at the
periphery, by activation of inhibitory processes that gate pain at the
spinal cord and brain. [9]
Segmental noxious stimulation produces a stronger analgesic effect
than segmental innocuous stimulation. [10]
That is exactly what intradermal sterile water injections do!
This therapeutic approach should not be limited only to elite
athletes.
It can work for every patient with back pain.
References
[1] Prog Urol. 2010 Nov;20(12):843-52. Epub 2010 Oct 20.
Anatomy and physiology of chronic pelvic and perineal pain.
Labat JJ, Robert R, Delavierre D, Sibert L, Rigaud J.
Centre federatif de pelviperineologie, clinique urologique, CHU Hotel-
Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France.
http://www.ncbi.nlm.nih.gov/pubmed/21056357
[2] Int J Rehabil Res. 2010 Sep;33(3):211-7.
Effect of transcutaneous electrical nerve stimulation on sensation
thresholds in patients with painful diabetic neuropathy: an observational
study.
Moharic M, Burger H.
Department of Physical and Rehabilitation Medicine, Linhartova 51, SI-1000
Ljubljana, Slovenia.
http://www.ncbi.nlm.nih.gov/pubmed/20042866
[3] Conf Proc IEEE Eng Med Biol Soc. 2009;2009:2033-6.
Spinal cord stimulation for complex regional pain syndrome.
Shrivastav M, Musley S.
Medtronic Neuromodulation, 7000 Central Ave NE, Minneapolis, Minnesota,
55432 USA.
http://www.ncbi.nlm.nih.gov/pubmed/19964771
[4] J Clin Monit Comput. 2009 Oct;23(5):333-9.
Spinal cord stimulation: principles of past, present and future practice:
a review.
Kunnumpurath S, Srinivasagopalan R, Vadivelu N.
St George's School of Anaesthesia, Tooting, London, UK.
http://www.ncbi.nlm.nih.gov/pubmed/19728120
[5] Brain Res Rev. 2009 Apr;60(1):149-70. Epub 2008 Dec 31.
Chloride regulation in the pain pathway.
Price TJ, Cervero F, Gold MS, Hammond DL, Prescott SA.
University of Arizona, Department of Pharmacology, USA.
[6] Curr Pain Headache Rep. 2008 Jan;12(1):28-31.
Peripheral nerve stimulation for chronic pain.
Henderson JM.
Stereotactic and Functional Neurosurgery, Stanford University School of
Medicine, 300 Pasteur Drive, Edwards Building/R-227, Stanford, CA 94305,
USA.
http://www.ncbi.nlm.nih.gov/pubmed/18417020
[7] Schmerz. 2007 Aug;21(4):307-10, 312-7.
From Descartes to fMRI. Pain theories and pain concepts.
Handwerker HO.
Institut fur Physiologie und Pathophysiologie, Universitat
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Dear editor,
It was a very interesting editorial and I must congratulate the authors for that.
In my humble opinion, even if the studies quoted are right, the title of the editorial is simply wrong. Even though the author tries to be politically correct in the concluding paragraph, most readers wouldn't make it there and would have made up their minds. Does that mean even the guys doing moderate brisk walk...
Ratzlaff (1) outlines broad categories in assessing societal activity-levels: occupational and household. While the latter was traditionally the greater source of activity, particularly for men, the nature of work has become steadily more sedentary. However, the same may be less true for household tasks. One conclusion it that women today, as the gender likely to undertake most household tasks, may well be more active than th...
Nitrates boost blood supply and recovery to muscle groups via the iNOS pathway, but only if converted to nitrites via salivary bacteria. The use of mouthwash, a common practice in those consuming diets high in refined carbohydrate, completely negate this possible conversion (1)
That the authors overlooked the potential risk of nitrosamine formation from the combination of nitrite-precursor nitrates with dietary...
Osteoarthritis is the most common form of joint disease, sparing no age, race, or geographic area. Symptomatic disease also increases with age. This arthropathy is characterized by degeneration of cartilage and by hypertrophy of bone at the articular margins. Inflammation is usually minimal. Hereditary and mechanical factors may be variably involved in the pathogenesis.
Degenerative joint disease is traditionall...
Bougault and Boulet write that there is a high incidence of viral respiratory infections in elite swimmers, in particular during heavy training programmes. However, Bougault and Boulet do not mention the evidence indicating that vitamin C may protect against respiratory infections of athletes.
In five placebo-controlled trials with participants under heavy acute physical stress, vitamin C supplementation halved...
Dear Editor,
I commend the authors for their efforts in conducting a prospective clinical trial on this therapeutically challenging condition [1]. They developed nice reproducible intervention protocols, and appeared to have access to a good flow of appropriate subjects that could be followed-up relatively easily.
Reading beyond the abstract, however, there is ample evidence that the headline result...
I read with interest the editorial of O'Connor et al on screening for the presence of sickle cell trait (SCT) in student athletes (1). Although some aspects are indeed agreeable, such as the need of continued research to strengthen the rationale for either continuing or revoking SCT mandatory testing in student athletes, there is however a drawback in their analysis that must be clearly emphasized. The cost-effectiveness...
I am just a concerned father of a 13 year old girl who has been playing competitive soccer for four years now.At what age do girls become more at risk to acl injuries and can anyone suggest what exercises she can do to minimize the chances of this happening.
Conflict of Interest:
None declared
Webborn's [1] articulation of the different injury prevention needs across an athlete' sporting lifetime emphasises that a "one-size-fits all" does not apply for sport safety and that researchers and practitioners will need to be creative in developing solutions to the varying injury problems for different age-groups of athletes. His recognition that addressing these life-course stage injury risks will require the input o...
Dear Editors,
The dorsal horns are not merely passive transmission stations but sites at which dynamic activities (inhibition, excitation and modulation) occur. [18]
Via a series of filters and amplifiers, the nociceptive message is integrated and analysed in the cerebral cortex, with interconnections with various areas. [1]
The processing of pain takes place in an integrated matrix throughout...
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