Friday, April 30, 2010
Chiropractic Care for Low Back Pain
A new Cochrane systematic review of chiropractic treatment for low back pain was published this month (April 2010). The review reflects favorably for chiropractic care and states that “Combined chiropractic interventions slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP.” The review goes on to point out that there is a great need for future research including research that compares the relative efficacy of different interventions with chiropractic treatment.
Sacroiliac Joint May Play a Much Greater Role in Low Back Pain
It is well documented that low back pain is the most common presenting complaint in a chiropractic office. A growing body of evidence has elevated the importance of the sacroiliac joint in low back pain and suggested a reduction in the role of the lumbar spine as likely the most common cause. This April 2010 study was supported by the Arthritis Society and conducted at Canadian Memorial Chiropractic College. Radiographs of 315 patients ages 18-60 with chronic low back pain greater than 3 months duration were included in the study. Two radiologists read the films and categorized the SI joint as normal, degenerative or inflammatory. The authors found that “a significantly large proportion of the cohort (23.8%) had degenerative changes in the SI joint. Degenerative change in the SI joint has received little attention in prior investigations and is clinically under-recognized…it appears unrelated to concurrent OA in the lumbar spine.”
The Effect of Inspiratory Muscles Fatigue on Postural Control in People With and Without Recurrent Low Back Pain
After inspiratory muscles fatigue (IMF), control subjects use a rigid proprioceptive postural control strategy, rather than the normal “multisegmental” control, which is similar to people with low back pain (LBP). This results in decreased postural stability. These results suggest that IMF might be a factor in the high recurrence rate of LBP.
The Nordic back pain subpopulation program: Can low back pain patterns be predicted from the first consultation with a chiropractor?
It is widely believed that non–specific low back pain (LBP) consists of a number of subgroups which should be identified in order to improve treatment effects...The diagnostic classes were associated with the pain course patterns and number of LBP days. Patients with disc pain had the highest number of LBP days and patients with muscular pain reported the fewest. Men had better outcome than women and patients without leg pain tended to have fewer LBP days than those with leg pain. Duration of LBP at the first visit was not associated with outcome. The study indicated that there is a clinically meaningful relationship between diagnostic classes and the course of LBP. This should be evaluated in more depth.
Thursday, April 29, 2010
Take the SMARTER Approach
The SMARTER approach to achieving your goals is similar to cooking. First you need to know what you are cooking (Specific). Then you pull together the amounts (Measurable) of each ingredient (Attainable), and bake everything at a specific temperature for a determined (Reasonable) length of time (Timely). Then you taste (Evaluate) the food and finally decide how you will modify (Reorganize) your recipe to improve on your next attempt. Learning how to doing things SMARTER has never been so easy!
Specific: When putting your goals to paper, make sure they are straightforward and free of ambiguity. For example, instead of: "I want to lose weight," try: "I will lose 10 pounds over the next 10 weeks." Instead of: "I want to save more money," try: "I will increase my savings by $2,500 over the next 12 months."
Measurable: Reviewing your goals and documenting or measuring your progress daily will help you to make the choices that continually point you in the right direction. For example, documenting your workouts and the foods and drinks that pass through your lips, as well as using the same scale to weigh yourself, are ways to measure your progress toward your weight-loss goal.
Attainable: Is your goal realistically attainable? Using weight loss as the example again, if you are naturally stocky or big-boned, for example, setting a weight-loss goal that would be difficult for a supermodel to achieve isn't realistic and probably not attainable. In fact, setting unrealistic goals likely will result in burnout and failure.
Reasonable: Part of your action plan for losing weight might include getting some form of exercise every day, drinking more water and using smaller plates. Are these lifestyle changes reasonable and sustainable? If so, you are on your way to permanently achieving your goal. If not, you'll need to determine what steps are reasonable to you.
Timely: To successfully achieve your goals, you must set completion dates. Setting timelines for each task gives you clear targets and deadlines. Without completion dates, your goal will always be open ended and much more likely to remain unachieved. Set a realistic time frame for completion and move forward every day until your goal is reached.
Evaluate: Continually evaluating your progress will help reveal your weak points and identify the areas that need improving. This process also helps you evaluate if your time and efforts are being spent wisely.
Reorganize: Once you have determined what works and what doesn't, make the necessary adjustments to your approach to maintain focus and stay on track. Continue to regroup and reorganize your efforts until you know you are on a stable path toward success. If something isn't helping you achieve a particular goal, rethink the process and find a better way.
Specific: When putting your goals to paper, make sure they are straightforward and free of ambiguity. For example, instead of: "I want to lose weight," try: "I will lose 10 pounds over the next 10 weeks." Instead of: "I want to save more money," try: "I will increase my savings by $2,500 over the next 12 months."
Measurable: Reviewing your goals and documenting or measuring your progress daily will help you to make the choices that continually point you in the right direction. For example, documenting your workouts and the foods and drinks that pass through your lips, as well as using the same scale to weigh yourself, are ways to measure your progress toward your weight-loss goal.
Attainable: Is your goal realistically attainable? Using weight loss as the example again, if you are naturally stocky or big-boned, for example, setting a weight-loss goal that would be difficult for a supermodel to achieve isn't realistic and probably not attainable. In fact, setting unrealistic goals likely will result in burnout and failure.
Reasonable: Part of your action plan for losing weight might include getting some form of exercise every day, drinking more water and using smaller plates. Are these lifestyle changes reasonable and sustainable? If so, you are on your way to permanently achieving your goal. If not, you'll need to determine what steps are reasonable to you.
Timely: To successfully achieve your goals, you must set completion dates. Setting timelines for each task gives you clear targets and deadlines. Without completion dates, your goal will always be open ended and much more likely to remain unachieved. Set a realistic time frame for completion and move forward every day until your goal is reached.
Evaluate: Continually evaluating your progress will help reveal your weak points and identify the areas that need improving. This process also helps you evaluate if your time and efforts are being spent wisely.
Reorganize: Once you have determined what works and what doesn't, make the necessary adjustments to your approach to maintain focus and stay on track. Continue to regroup and reorganize your efforts until you know you are on a stable path toward success. If something isn't helping you achieve a particular goal, rethink the process and find a better way.
Steps to Better Health
Today, we know more than ever about how our bodies deteriorate over time and our vulnerability to diseases. Health practitioners are rapidly adapting this new knowledge to promote health and longevity. The "healthier you" is all about you at your physical, mental, and emotional best. Here are some of the steps you can take to help unleash better health.
Beat the Leading Cause of Death. Johanna Parker, from the University of Warwick (United Kingdom), and colleagues conducted a systematic literature review of studies examining vitamin D (specifically 25-hydroxy vitamin D [25OHD] as an indicator of vitamin D status) and cardiometabolic disorders. The studies revealed a significant association between high levels of vitamin D and a decreased risk of developing cardiovascular disease (33 percent lower risk compared to people with low levels of vitamin D), type 2 diabetes (55 percent risk reduction) and metabolic syndrome (51 percent risk reduction).
Excite the Brain. A large nationwide study by Brandeis University (Massachusetts) suggests that mental exercises aid cognitive skills. Margie Lachman and colleagues conducted the Midlife in the United States study, which assessed 3,343 men and women, ages 32 to 84 years, 40 percent of whom had at least a four-year college degree. Evaluating how the participants performed in two cognitive areas, verbal memory and executive function, the team found that those with higher education engaged in cognitive activities more often and performed better on the memory tests.
However, some subjects with lower education performed just as well; the researchers found that intellectual activities undertaken regularly made a difference. Specifically, among individuals with low education, those who engaged in reading, writing, attending lectures, and doing word games or puzzles once a week or more had memory scores similar to people with more education.
Engage the Body. In that physical activity is associated with reduced risks of chronic diseases and premature death, Qi Sun, from Harvard School of Public Health, and colleagues explored whether physical activity is also associated with improved overall health among those who survive to older ages. Analyzing data from 13,535 participants in the Nurses' Health Study, whereby the women reported their physical activity levels in 1986 (average age then: 60 years), the team found that women who survived to age 70 or older (10-plus years after the study began) were engaged in higher levels of physical activity at the beginning of the study and were less likely to have chronic diseases, heart surgery or any physical, cognitive or mental impairments.
Keep in mind, of course, that these aren't the only ways to maximize your health, but they're a great place to start. There's never a bad time to sit down and assess your current health and what you can do to improve it, especially when some simple behavior and lifestyle modifications can have a profound impact on your life span. Talk to your doctor for more information.
Beat the Leading Cause of Death. Johanna Parker, from the University of Warwick (United Kingdom), and colleagues conducted a systematic literature review of studies examining vitamin D (specifically 25-hydroxy vitamin D [25OHD] as an indicator of vitamin D status) and cardiometabolic disorders. The studies revealed a significant association between high levels of vitamin D and a decreased risk of developing cardiovascular disease (33 percent lower risk compared to people with low levels of vitamin D), type 2 diabetes (55 percent risk reduction) and metabolic syndrome (51 percent risk reduction).
Excite the Brain. A large nationwide study by Brandeis University (Massachusetts) suggests that mental exercises aid cognitive skills. Margie Lachman and colleagues conducted the Midlife in the United States study, which assessed 3,343 men and women, ages 32 to 84 years, 40 percent of whom had at least a four-year college degree. Evaluating how the participants performed in two cognitive areas, verbal memory and executive function, the team found that those with higher education engaged in cognitive activities more often and performed better on the memory tests.
However, some subjects with lower education performed just as well; the researchers found that intellectual activities undertaken regularly made a difference. Specifically, among individuals with low education, those who engaged in reading, writing, attending lectures, and doing word games or puzzles once a week or more had memory scores similar to people with more education.
Engage the Body. In that physical activity is associated with reduced risks of chronic diseases and premature death, Qi Sun, from Harvard School of Public Health, and colleagues explored whether physical activity is also associated with improved overall health among those who survive to older ages. Analyzing data from 13,535 participants in the Nurses' Health Study, whereby the women reported their physical activity levels in 1986 (average age then: 60 years), the team found that women who survived to age 70 or older (10-plus years after the study began) were engaged in higher levels of physical activity at the beginning of the study and were less likely to have chronic diseases, heart surgery or any physical, cognitive or mental impairments.
Keep in mind, of course, that these aren't the only ways to maximize your health, but they're a great place to start. There's never a bad time to sit down and assess your current health and what you can do to improve it, especially when some simple behavior and lifestyle modifications can have a profound impact on your life span. Talk to your doctor for more information.
Maximize Your Balance
The feet are very important in balance and posture because they are loaded with proprioceptive sensors. These sensors are constantly sending signals to the brain, which then sends signals back down the spinal column to the muscles telling them when to contract and when to relax. Every movement from standing to walking, running and jumping is controlled by this system.
Many chiropractors are specially trained to evaluate the structural integrity of the arches of the feet to see if they are a contributing factor to postural stress. Supporting the arches of the feet with a custom-made orthotic device (insert) that you wear in your shoes has been shown to block the abnormal foot motions that create a twisting stress in the knee, hip, pelvis and spine and that improves balance and posture. The messages sent from the feet to the brain are done so more efficiently when the arches are properly supported.
In addition to chiropractic adjustments and spinal pelvic stabilization with orthotic inserts, there are certain activities that promote balance and don't require any special equipment:
Begin by standing on one leg for 30 seconds and then shift to the other side. Practice this until you can consistently stand on each leg without losing your balance.
Stand on one leg with your arms crossed for 30 seconds and then do the same while standing on the other leg. Crossing the arms adds complexity to the amount of information going to the brain from the sensors in the muscles and joints.
Stand on one leg with your eyes closed for 30 seconds. (Be sure you are in an area where you can support yourself if needed. Stand next to a doorway or have a chair available to reach out to for support.) Repeat with the other side. Closing the eyes increases the difficulty of the exercise by removing one of the systems of balance.
Stand on one leg, close your eyes and cross your arms for 30 seconds. Repeat with the other side.
Talk to your doctor about the importance of balance and proper posture, and how the two of you can work together to help maintain both for a lifetime.
Many chiropractors are specially trained to evaluate the structural integrity of the arches of the feet to see if they are a contributing factor to postural stress. Supporting the arches of the feet with a custom-made orthotic device (insert) that you wear in your shoes has been shown to block the abnormal foot motions that create a twisting stress in the knee, hip, pelvis and spine and that improves balance and posture. The messages sent from the feet to the brain are done so more efficiently when the arches are properly supported.
In addition to chiropractic adjustments and spinal pelvic stabilization with orthotic inserts, there are certain activities that promote balance and don't require any special equipment:
Begin by standing on one leg for 30 seconds and then shift to the other side. Practice this until you can consistently stand on each leg without losing your balance.
Stand on one leg with your arms crossed for 30 seconds and then do the same while standing on the other leg. Crossing the arms adds complexity to the amount of information going to the brain from the sensors in the muscles and joints.
Stand on one leg with your eyes closed for 30 seconds. (Be sure you are in an area where you can support yourself if needed. Stand next to a doorway or have a chair available to reach out to for support.) Repeat with the other side. Closing the eyes increases the difficulty of the exercise by removing one of the systems of balance.
Stand on one leg, close your eyes and cross your arms for 30 seconds. Repeat with the other side.
Talk to your doctor about the importance of balance and proper posture, and how the two of you can work together to help maintain both for a lifetime.
Restoration of Normal Cervical Lordosis
Cervical pain is one of the most common symptoms in today’s society. Indeed, in our personal clinical experience, well over 90% of patients with headache have a cervical component easily observed with physical examination and which reveals abnormal cervical posture. Among other conventional treatments, axial linear traction (ALT) has been used with a variety of designs and weights of 20-25 lbs. This type of traction clearly straightens or even reverses the normal cervical curve and often results in temporomandibular joint pain. The current study was carried out to compare axial linear traction and Expanding Ellipsoidal Decompression (EED) via Posture Pump.
Normal cervical posture presents with a lordotic curve of approximately 43 degrees measured from C2 to C7. Without this normal lordosis, most often the balance of the weight of the head is tilted forward and thus creates increased wear and tear on the intervertebral discs and the vertebral bodies. This eventually leads to bony spurs and osteophytes. Such changes also lead to decreased mobility of the cervical spine and to cervical pain.
With axial linear traction, the cervical lordotic curve was flattened or even buckled posterior into kyphosis in 83% of subjects with a variety of variations in the degree of such change. On the other hand, when EED was applied via Posture Pump joints were decompressed and the lordotic curve was enhanced or restored. Cervical curves were actually compromised or made worse in 30 of 36 subjects during ALT. In contrast, the cervical curve during EED via the Posture Pump was improved in 26 of 36 subjects. None of the subjects had any significant discomfort during the procedure.
In all 36 subjects, the posture during EED was superior to that with axial linear traction. Despite the fact that the curvature was significantly worsened with axial linear traction, in only one subject was there a significant increase in posterior disc bulging and this was subsequently improved during the application of EED.
The current findings emphasize the additional benefit of EED via Posture Pump in improving cervical anatomy along with significant symptomatic improvement in cervicogenic pain.
Normal cervical posture presents with a lordotic curve of approximately 43 degrees measured from C2 to C7. Without this normal lordosis, most often the balance of the weight of the head is tilted forward and thus creates increased wear and tear on the intervertebral discs and the vertebral bodies. This eventually leads to bony spurs and osteophytes. Such changes also lead to decreased mobility of the cervical spine and to cervical pain.
With axial linear traction, the cervical lordotic curve was flattened or even buckled posterior into kyphosis in 83% of subjects with a variety of variations in the degree of such change. On the other hand, when EED was applied via Posture Pump joints were decompressed and the lordotic curve was enhanced or restored. Cervical curves were actually compromised or made worse in 30 of 36 subjects during ALT. In contrast, the cervical curve during EED via the Posture Pump was improved in 26 of 36 subjects. None of the subjects had any significant discomfort during the procedure.
In all 36 subjects, the posture during EED was superior to that with axial linear traction. Despite the fact that the curvature was significantly worsened with axial linear traction, in only one subject was there a significant increase in posterior disc bulging and this was subsequently improved during the application of EED.
The current findings emphasize the additional benefit of EED via Posture Pump in improving cervical anatomy along with significant symptomatic improvement in cervicogenic pain.
Wednesday, April 28, 2010
Rest Easy: How to Ensure a Good Night's Rest
Sleep problems are actually extremely common in our society, and they can have serious consequences. Sleep problems can lead to difficulty concentrating, memory lapses, loss of energy, fatigue and emotional instability, and in the longer term, can elevate your risk of serious health conditions including high blood pressure and heart attack. And poor sleeping can cause difficulties with learning, memory, thinking and feelings, which may lead to poor school and work performance. Furthermore, problem sleepiness can manifest as drowsy driving or workplace accidents and errors.
Aside from some of the more serious things that could be negatively affecting your sleep, there are some variables or situations that you can have more control over. Let's talk about how to change your sleeping conditions so you sleep easier and get the rest your body needs:
1. The Right Sleep Position: The position that is the least stressful on your body is on your back with a pillow under your neck and another under your knees so they are comfortably bent. Bent knees give the lower (lumbar) spine support. The pillow under the neck gives it support as well. However, not many people are able to stay in this position for an entire night. Also, people who snore tend to avoid sleeping on their back because their snoring becomes worse.
2. The Right Mattress: Try to have as firm and supportive of a mattress as you can for your body. Also find out about the warranty. Good mattress companies provide a warranty that pretty much guarantees your satisfaction. It may include a trial period (to see if the bed works) and a money-back guarantee if you don't like it.
Pillow tops are not necessarily a good thing. Much of the time, pillow tops soften up the surface of your bed too much, which means it will not support your body well. You need to see how it feels when you sleep on it. Memory foam mattresses and tops are very supportive, and they do mold to your body. The only drawback is that they can trap heat. If you run hot at night, this may not be the mattress for you.
3. The Right Pillow: In general, your pillow must support you in the sleep positions you are in at night. If you only sleep on your back, your pillow must support your neck accordingly. If you only sleep on your side, the pillow must be thick enough to support the entire part of the body from the neck to the shoulder at a 90 degree angle. If you sleep on both your back and your side, the pillow needs to support both positions.
Custom-made pillows are available that can provide you with the proper support for your body and sleep patterns. Your doctor can actually take measurements of your body so a pillow can be created to fit you perfectly.
To learn more about proper sleep position and what you can do to ensure a good night's rest, talk to your doctor.
Aside from some of the more serious things that could be negatively affecting your sleep, there are some variables or situations that you can have more control over. Let's talk about how to change your sleeping conditions so you sleep easier and get the rest your body needs:
1. The Right Sleep Position: The position that is the least stressful on your body is on your back with a pillow under your neck and another under your knees so they are comfortably bent. Bent knees give the lower (lumbar) spine support. The pillow under the neck gives it support as well. However, not many people are able to stay in this position for an entire night. Also, people who snore tend to avoid sleeping on their back because their snoring becomes worse.
2. The Right Mattress: Try to have as firm and supportive of a mattress as you can for your body. Also find out about the warranty. Good mattress companies provide a warranty that pretty much guarantees your satisfaction. It may include a trial period (to see if the bed works) and a money-back guarantee if you don't like it.
Pillow tops are not necessarily a good thing. Much of the time, pillow tops soften up the surface of your bed too much, which means it will not support your body well. You need to see how it feels when you sleep on it. Memory foam mattresses and tops are very supportive, and they do mold to your body. The only drawback is that they can trap heat. If you run hot at night, this may not be the mattress for you.
3. The Right Pillow: In general, your pillow must support you in the sleep positions you are in at night. If you only sleep on your back, your pillow must support your neck accordingly. If you only sleep on your side, the pillow must be thick enough to support the entire part of the body from the neck to the shoulder at a 90 degree angle. If you sleep on both your back and your side, the pillow needs to support both positions.
Custom-made pillows are available that can provide you with the proper support for your body and sleep patterns. Your doctor can actually take measurements of your body so a pillow can be created to fit you perfectly.
To learn more about proper sleep position and what you can do to ensure a good night's rest, talk to your doctor.
Androgen Responses to Sprint Exercise in Young Men
These results suggest that sprint training increases plasma total testosterone (TT) concentrations in response to sprint exercise in adolescent boys. Plasma adrenaline (A) and plasma lactate (La) concentrations increases in response to sprint exercise could be involved in this elevation of plasma TT concentrations.
Tuesday, April 27, 2010
Ginger Reduces Muscle Pain Caused by Eccentric Exercise
The purpose of this study was to examine the effects of 11 days of raw (study 1) and heat–treated (study 2) ginger supplementation on muscle pain. Study 1 and 2 were identical double–blind, placebo controlled, randomized experiments with 34 and 40 volunteers, respectively...This study demonstrates that daily consumption of raw and heat–treated ginger resulted in moderate–to–large reductions in muscle pain following exercise–induced muscle injury. These findings agree with those showing hypoalgesic effects of ginger in osteoarthritis patients and further demonstrate ginger's effectiveness as a pain reliever.
Thursday, April 22, 2010
Prolotherapy, Where Does It Stand Today?
Prolotherapy is a somewhat controversial intervention for a variety of musculoskeletal complaints. The treatment consists of a series of injections of an irritant, usually a dextrose based compound, into painful soft tissues. In theory the injection begins a controlled inflammatory response. This in turn causes connective tissue growth and collagen tissue formation resulting in a more stable, less painful joint or strengthened tendons or ligaments. Chronic low back pain, knee and hand osteoarthritis, lateral epicondylosis, Achilles tendonitis and plantar fasciitis, to name a few, have been reported in the scientific literature as conditions for which prolotherapy has been utilized.
Tuesday, April 20, 2010
Health insurers shifting costs ahead of law
Some of the largest U.S. health insurers are changing their accounting practices to book administration costs as medical costs in an attempt to circumvent new industry reforms, according to a U.S. Senate panel’s report released on Thursday.
Under the healthcare law passed in March, insurers must adjust their spending habits to meet new requirements. For example, large group plans must spend at least 85 cents of every premium dollar paid to them on actual medical care as opposed to administrative costs, while individual and small group plans must spend 80 cents.
Wall Street closely watches such spending levels, known as medical-loss ratios, or MLRs, as a sign of potential profits. Major health insurance stock indexes fell after the report.
“The insurance industry is beginning to consider the financial impact of the new federally required (medical) loss ratio requirements, including questionable changes in their accounting practices,” the Democratic-led Senate Committee on Commerce, Science and Transportation said in a statement.
For example, WellPoint Inc “has already ‘reclassified’ more than half a billion dollars of administrative expenses as medical expenses,” it said.
WellPoint spokeswoman Kristin Binns said the company would work with regulators to implement the MLR requirement, but did not comment on whether it had shifted any costs or changed its accounting practices.
A review of companies’ expenses for 2009 shows that in some markets, insurers are spending 74 cents per dollar on care on average, according to the report, which was released on the committee’s website link.reuters.com/bas87j.
Cigna spokesman Chris Curran said it was too early to say how the new MLR rules would affect the insurer, and that methods of calculating costs were still being developed ahead of the new rules. Other insurers did not respond to requests for comment.
2011 DEADLINE
Although the MLR rule does not kick in until Jan. 1, insurers so far are “still far below” what the law will require, said Senator John Rockefeller, the committee’s chairman.
“This new data makes clear that too many health insurance companies are still putting profits before people,” Rockefeller said, “and they have a lot of work to do to meet the consumer protection requirements of the health care reform law by the end of this year.”
Regulators at the Department of Health and Human Services, charged with implementing much of the new health reform law, are pushing to apply the MLR changes quickly.
Earlier this week, the agency called on a major health insurance organization — the National Association of Insurance Commissioners — to give its recommendations for specific MLR ratio regulations by June 1, six months earlier than the law’s Dec. 31 deadline.
“(The agency) is seeking to publish regulations as soon as possible to allow sufficient time for health insurance issuers to incorporate these changes,” U.S. Health Secretary Kathleen Sebelius wrote in a letter the group.
The S&P Managed Health Care Index closed down 0.9 percent on Thursday. The Morgan Stanley Healthcare Payor Index, which also fell after the report was released and was largely in negative territory all day, closed up 0.4 percent.
Under the healthcare law passed in March, insurers must adjust their spending habits to meet new requirements. For example, large group plans must spend at least 85 cents of every premium dollar paid to them on actual medical care as opposed to administrative costs, while individual and small group plans must spend 80 cents.
Wall Street closely watches such spending levels, known as medical-loss ratios, or MLRs, as a sign of potential profits. Major health insurance stock indexes fell after the report.
“The insurance industry is beginning to consider the financial impact of the new federally required (medical) loss ratio requirements, including questionable changes in their accounting practices,” the Democratic-led Senate Committee on Commerce, Science and Transportation said in a statement.
For example, WellPoint Inc “has already ‘reclassified’ more than half a billion dollars of administrative expenses as medical expenses,” it said.
WellPoint spokeswoman Kristin Binns said the company would work with regulators to implement the MLR requirement, but did not comment on whether it had shifted any costs or changed its accounting practices.
A review of companies’ expenses for 2009 shows that in some markets, insurers are spending 74 cents per dollar on care on average, according to the report, which was released on the committee’s website link.reuters.com/bas87j.
Cigna spokesman Chris Curran said it was too early to say how the new MLR rules would affect the insurer, and that methods of calculating costs were still being developed ahead of the new rules. Other insurers did not respond to requests for comment.
2011 DEADLINE
Although the MLR rule does not kick in until Jan. 1, insurers so far are “still far below” what the law will require, said Senator John Rockefeller, the committee’s chairman.
“This new data makes clear that too many health insurance companies are still putting profits before people,” Rockefeller said, “and they have a lot of work to do to meet the consumer protection requirements of the health care reform law by the end of this year.”
Regulators at the Department of Health and Human Services, charged with implementing much of the new health reform law, are pushing to apply the MLR changes quickly.
Earlier this week, the agency called on a major health insurance organization — the National Association of Insurance Commissioners — to give its recommendations for specific MLR ratio regulations by June 1, six months earlier than the law’s Dec. 31 deadline.
“(The agency) is seeking to publish regulations as soon as possible to allow sufficient time for health insurance issuers to incorporate these changes,” U.S. Health Secretary Kathleen Sebelius wrote in a letter the group.
The S&P Managed Health Care Index closed down 0.9 percent on Thursday. The Morgan Stanley Healthcare Payor Index, which also fell after the report was released and was largely in negative territory all day, closed up 0.4 percent.
Relationships between posterior shoulder muscle stiffness and rotation in patients with stiff shoulder
These findings support that muscle stiffness is related to shoulder range of motion. It is important to consider the posterior deltoid, infraspinatus, and teres minor muscles in the rehabilitation of patients with restricted internal rotation of the shoulder.
Journal of Rehabilitation Medicine, 03/17/10
Journal of Rehabilitation Medicine, 03/17/10
Monday, April 19, 2010
Chiropractic for the Treatment and Prevention of Sports Injuries
Thanks to ChiroAccess for access to these materials!
Chiropractors have a longstanding history of treating musculoskeletal sports injuries. There have been few research studies that document the value of chiropractic treatment for sports injuries and nearly no research that has looked at providing evidence that chiropractic care can play a role in preventing those injuries. The void and need for research supporting the role of chiropractic in sports injury prevention makes a randomized clinical trial (RCT) published last week (8 April, 2010) an important contribution to the literature. [1]
Hoskins and Pollard used two groups of male semi elite Australian Rules football athletes, matched them in several ways and randomly placed them in one of two arms of the study. All received the usual and customary management and medical care. Half also received chiropractic care which consisted of both soft tissue and high velocity spinal manipulation. There research evaluated several outcomes. When chiropractic care was added to conventional management, there was a significant reduction in lower limb strain injuries, time missed as a result of knee injuries, lower low back pain, and there was improvement in health status. “In addition, although not statistically significant, there was a trend towards prevention of hamstring and primary non-contact knee injuries and there were no reported adverse outcomes from the intervention.” The authors do acknowledge the several limitations to their work including the small sample size. The work is nonetheless an important piece and one of the few where the focus is prevention.
1. The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial
BMC Musculoskelet Disord. 2010 (Apr 8); 11 (1): 64.
Chiropractors have a longstanding history of treating musculoskeletal sports injuries. There have been few research studies that document the value of chiropractic treatment for sports injuries and nearly no research that has looked at providing evidence that chiropractic care can play a role in preventing those injuries. The void and need for research supporting the role of chiropractic in sports injury prevention makes a randomized clinical trial (RCT) published last week (8 April, 2010) an important contribution to the literature. [1]
Hoskins and Pollard used two groups of male semi elite Australian Rules football athletes, matched them in several ways and randomly placed them in one of two arms of the study. All received the usual and customary management and medical care. Half also received chiropractic care which consisted of both soft tissue and high velocity spinal manipulation. There research evaluated several outcomes. When chiropractic care was added to conventional management, there was a significant reduction in lower limb strain injuries, time missed as a result of knee injuries, lower low back pain, and there was improvement in health status. “In addition, although not statistically significant, there was a trend towards prevention of hamstring and primary non-contact knee injuries and there were no reported adverse outcomes from the intervention.” The authors do acknowledge the several limitations to their work including the small sample size. The work is nonetheless an important piece and one of the few where the focus is prevention.
1. The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial
BMC Musculoskelet Disord. 2010 (Apr 8); 11 (1): 64.
Scapular Muscle Activity in Overhead Athletes With Symptoms of Secondary Shoulder Impingement During Closed Chain Exercises
Archives of Physical Medicine and Rehabilitation, 04/19/10
These results suggest that the muscle activation of the middle trapezius differs in overhead athletes with a history of secondary shoulder impingement compared with those who lack this history during closed chain exercise, as well as within the 3 closed chain exercises. The levels of muscle activation of the serratus anterior and upper trapezius during these closed chain exercises were similar between the 2 groups. These results support the use of closed chain exercises in the rehabilitation process of overhead athletes with secondary shoulder impingement. However, clinicians should consider the muscle(s) of interest when selecting an exercise.
These results suggest that the muscle activation of the middle trapezius differs in overhead athletes with a history of secondary shoulder impingement compared with those who lack this history during closed chain exercise, as well as within the 3 closed chain exercises. The levels of muscle activation of the serratus anterior and upper trapezius during these closed chain exercises were similar between the 2 groups. These results support the use of closed chain exercises in the rehabilitation process of overhead athletes with secondary shoulder impingement. However, clinicians should consider the muscle(s) of interest when selecting an exercise.
Thursday, April 15, 2010
Three Steps to a Happier You
They say happiness is a state of mind, not a reflection of your circumstances, but we all know one can have a dramatic effect on the other. Here are three simple suggestions that can put a smile on your face and maximize your health and wellness while doing so:
1. Challenge Yourself: If you're stuck in the daily grind, wondering why every day seems to be "same old, same old," maybe it's because it is. Fortunately, you have the power. Whether it's changing up your workout routine, learning a new language, or finding creative ways to teach your kids new things, commit to continually challenging yourself and avoid stagnation.
2. Turn Bad Into Good: We all experience good and bad moments in life, but whether you crumble or climb is really just a matter of attitude. Negative breeds negative, which can have profound consequences. Next time you're hit with a negative, think about the up side (there always is one, even if it's not immediate) and turn that frown upside down. Before you know it, you'll be back on track.
3. Find Time to Relax: Life isn't a race, it's a journey filled with memorable moments; make sure you appreciate them, rather than rushing from one day to the next. It's all-too-easy to get caught up in daily routines and lose yourself. Schedule some you time every day, whether it's a sunset walk, a long bath, a good book, or even a nap - find time to relax and reap the physical and psychological benefits.
1. Challenge Yourself: If you're stuck in the daily grind, wondering why every day seems to be "same old, same old," maybe it's because it is. Fortunately, you have the power. Whether it's changing up your workout routine, learning a new language, or finding creative ways to teach your kids new things, commit to continually challenging yourself and avoid stagnation.
2. Turn Bad Into Good: We all experience good and bad moments in life, but whether you crumble or climb is really just a matter of attitude. Negative breeds negative, which can have profound consequences. Next time you're hit with a negative, think about the up side (there always is one, even if it's not immediate) and turn that frown upside down. Before you know it, you'll be back on track.
3. Find Time to Relax: Life isn't a race, it's a journey filled with memorable moments; make sure you appreciate them, rather than rushing from one day to the next. It's all-too-easy to get caught up in daily routines and lose yourself. Schedule some you time every day, whether it's a sunset walk, a long bath, a good book, or even a nap - find time to relax and reap the physical and psychological benefits.
Nutrition for Healthy Skin
Along with hair and nails, skin is the fastest growing and most superficial tissue in the body. As such, it has a high demand for nutrients in order to continuously replenish itself with rapidly developing immature skin cells from the layers below. Even a marginal deficiency of nutrients such as vitamin A, the carotenoids, vitamin D, vitamins B1 and B2, niacin, pantothenic acid, biotin, folic acid, vitamin B12, vitamin E, vitamin C or essential fatty acids can result in impaired development of skin cells, resulting in skin that is less smooth, prone to lesions, less elastic and more likely to suffer accelerated aging.
Here are some of the more common skin problems and the nutritional supplements that can help you get rid of them:
For sun- and chemical-induced free-radical damage that causes premature aging of the skin, wrinkling, cancerous conditions, other forms of skin damage, the appropriate supplement contains optimal levels of antioxidants to help protect your skin from the aging and damaging effects caused by the sun: Antioxidants vitamin C, vitamin E, beta-carotene, selenium and zinc intercept and neutralize free radicals and defend skin cells from these damaging effects. Antioxidants also protect skin from ultraviolet light damage.
For skin disorders such as dermatitis (skin inflammation problems), lack of smoothness, seborrhoea-like scaly lesions, irregular pigmentation, the appropriate supplement contains B vitamins at sufficient doses to ensure the healthy development of skin cells: B-vitamin supplementation corrects these skin problems and successfully treats a wide range of dermatitis problems. B vitamins also help to improve the smoothness and texture of the skin.
For unhealthy skin, acne and other conditions, the appropriate supplement provides adequate daily doses of zinc and selenium to enhance your skin's vitality and appearance: Zinc improves oil gland function, local skin hormone activation, wound healing, inflammation control within the skin and tissue regeneration of skin cells. Selenium plays a key role in antioxidant protection and in the prevention and management of various skin conditions.
Healthy skin is an important step toward a healthy, happy you, so what are you waiting for? Ask your doctor about how to give yourself an "inner facial" with the right nutrition.
Here are some of the more common skin problems and the nutritional supplements that can help you get rid of them:
For sun- and chemical-induced free-radical damage that causes premature aging of the skin, wrinkling, cancerous conditions, other forms of skin damage, the appropriate supplement contains optimal levels of antioxidants to help protect your skin from the aging and damaging effects caused by the sun: Antioxidants vitamin C, vitamin E, beta-carotene, selenium and zinc intercept and neutralize free radicals and defend skin cells from these damaging effects. Antioxidants also protect skin from ultraviolet light damage.
For skin disorders such as dermatitis (skin inflammation problems), lack of smoothness, seborrhoea-like scaly lesions, irregular pigmentation, the appropriate supplement contains B vitamins at sufficient doses to ensure the healthy development of skin cells: B-vitamin supplementation corrects these skin problems and successfully treats a wide range of dermatitis problems. B vitamins also help to improve the smoothness and texture of the skin.
For unhealthy skin, acne and other conditions, the appropriate supplement provides adequate daily doses of zinc and selenium to enhance your skin's vitality and appearance: Zinc improves oil gland function, local skin hormone activation, wound healing, inflammation control within the skin and tissue regeneration of skin cells. Selenium plays a key role in antioxidant protection and in the prevention and management of various skin conditions.
Healthy skin is an important step toward a healthy, happy you, so what are you waiting for? Ask your doctor about how to give yourself an "inner facial" with the right nutrition.
Feel the Runner's High
Running is one of the best forms of aerobic conditioning for your heart and lungs. It can significantly increase your metabolic rate and the amount of calories you burn, leading to loss of excess body fat. Running is also beneficial for slowing down the aging process. Those who run regularly are less likely to experience bone and muscle loss due to the body's positive response to additional physical demands.
Running can also have many psychological benefits. Most runners typically report being happier and feeling less stressed from the grind of daily life. Why? Because regular exercise has the ability to alter mood, attributable to a surge in hormones called endorphins. These hormones create a sense of euphoria often referred to as a "runner's high" and can result in an improvement in mood.
Here are some great tips, courtesy of running coach Chipper Robinson from Running on the Edge in Ramsey, N.J., on how to maximize your running experience:
Incorporate cross training into your running routines. Add weight-lifting, bicycling, yoga, elliptical training, or swimming. Why? They make you fitter and less prone to injury.
Exercise your abdominal muscles almost every day. A strong midsection (core) is a key component to running. In fact, it can often be the single most important factor for success in long-distance running.
Change your intensity levels by running faster or farther. Alternate which one you choose to implement in various workouts. It prevents your body from adapting to routines.
Pay attention to your shoes. Most shoes wear out after 300 to 500 miles. You often can't see the wear, but, your knees, hips, and back will feel it. Visit a running specialty store for quality shoes and talk to your doctor for suggestions on the best shoes to get. Not just any shoe will do.
Run on different surfaces. See how many different surfaces you can run on in a month: asphalt, gravel, trail, grass, track, treadmill, and beach. Each stresses your leg muscles in a slightly different way, helping to prevent overuse injuries. (If possible, avoid concrete, the hardest and most harmful surface for runners.)
Keep a training journal. A journal can be a great way to maintain motivation and consistency. Keep it filled with running times, routines, motivational quotes, and how your body reacts to various routines. You should have a documented road map for reaching your running goals.
Take some time off. You don't have to run every day, every week, or even every month (as long as you're performing other cardiovascular activities). For healthy, consistent training, your body needs regular recovery periods. Performance suffers with too much exercise. Start slow and work your way toward higher mileages and/or more frequency.
Introduce high-intensity interval training into your running routine. Alternate, pace, speed, tempo and rest periods during a single running session. For example, keep a steady pace for a mile and then sprint run for 30 seconds. Do this for several cycles and notice how your heart rate and muscle fatigue threshold increase.
Every great journey starts with a single step; now just put one foot in front of the other to see how far this new journey takes you. Welcome to the wonderful world of running. Talk to your doctor to learn more about the benefits of running.
Running can also have many psychological benefits. Most runners typically report being happier and feeling less stressed from the grind of daily life. Why? Because regular exercise has the ability to alter mood, attributable to a surge in hormones called endorphins. These hormones create a sense of euphoria often referred to as a "runner's high" and can result in an improvement in mood.
Here are some great tips, courtesy of running coach Chipper Robinson from Running on the Edge in Ramsey, N.J., on how to maximize your running experience:
Incorporate cross training into your running routines. Add weight-lifting, bicycling, yoga, elliptical training, or swimming. Why? They make you fitter and less prone to injury.
Exercise your abdominal muscles almost every day. A strong midsection (core) is a key component to running. In fact, it can often be the single most important factor for success in long-distance running.
Change your intensity levels by running faster or farther. Alternate which one you choose to implement in various workouts. It prevents your body from adapting to routines.
Pay attention to your shoes. Most shoes wear out after 300 to 500 miles. You often can't see the wear, but, your knees, hips, and back will feel it. Visit a running specialty store for quality shoes and talk to your doctor for suggestions on the best shoes to get. Not just any shoe will do.
Run on different surfaces. See how many different surfaces you can run on in a month: asphalt, gravel, trail, grass, track, treadmill, and beach. Each stresses your leg muscles in a slightly different way, helping to prevent overuse injuries. (If possible, avoid concrete, the hardest and most harmful surface for runners.)
Keep a training journal. A journal can be a great way to maintain motivation and consistency. Keep it filled with running times, routines, motivational quotes, and how your body reacts to various routines. You should have a documented road map for reaching your running goals.
Take some time off. You don't have to run every day, every week, or even every month (as long as you're performing other cardiovascular activities). For healthy, consistent training, your body needs regular recovery periods. Performance suffers with too much exercise. Start slow and work your way toward higher mileages and/or more frequency.
Introduce high-intensity interval training into your running routine. Alternate, pace, speed, tempo and rest periods during a single running session. For example, keep a steady pace for a mile and then sprint run for 30 seconds. Do this for several cycles and notice how your heart rate and muscle fatigue threshold increase.
Every great journey starts with a single step; now just put one foot in front of the other to see how far this new journey takes you. Welcome to the wonderful world of running. Talk to your doctor to learn more about the benefits of running.
Wednesday, April 14, 2010
Look how far Chiropractic has come.
Chiropractors are well known for adjusting the spine and restoring alignment to the body. While chiropractors are the spine authorities, they use other methods to treat the body, as well as treating disorders and ailments, which have nothing to do with the spine. Chiropractors seek to understand and treat the patient through a total wellness approach. In addition, recent discoveries in medicine are supporting chiropractic care as an avenue to treat multiple afflictions.
Diet and Nutritional Counseling
In the spirit of a total wellness approach; chiropractors are specifically trained in diet and nutritional counseling. It is no secret that a healthy diet and balanced nutrition are the foundation of good health. Chiropractors design nutritional programs that are specific to your needs. These programs are designed to improve overall health, encourage weight loss, and decrease the effects of chronic conditions, such as diabetes, cancer, heart disease, etc. Chiropractors take nutritional counseling a step further than dietitians do as they understand the effect that each nutrient has on the muscles, joints, and limbs.
Lifestyle Modification Counseling
"Health is a state of complete physical mental and social well-being, and not merely the absence of disease or infirmity."
~World Health Organization, 1948
Health is more than the absence of sickness. Health refers to a person’s total lifestyle, as lifestyle choices have a substantial impact on your short and long term health. Even small unhealthy lifestyle choices, such as smoking a few cigarettes each time you drink, can have long term effects on the heart and lungs; not to mention the affect of the alcohol on the liver! Excessive stress can also rob the body of sleep and deplete the body of nutrients. Your chiropractor offers lifestyle modification counseling to create a realistic plan of action that will enable you to kick the bad habits.
Therapeutic Exercise
Chiropractors utilize strengthening exercises as a total approach to treating back, neck, leg, arm, and shoulder problems. The exercises are designed to alleviate pain, strengthen the muscles and joints. Therapeutic exercise also aims to increase range of motion that may have been lost due to the injury and decrease the risk for new injuries. The chiropractor works one on one with the patient to ensure that they are performing the exercise correctly, and the patient then performs the exercises at home. Performing the injuries as prescribed, will decrease healing time dramatically.
Allergies
Allergies are successfully treated with chiropractic care. Hypersensitivity of the immune and/or respiratory system frequently causes allergy problems. Research has shown that the immune and respiratory systems require normal communication from the brain and spinal cord to regulate the systems successfully. If your neck is misaligned, your nervous system functioning will be imbalanced. The patient does not necessarily suffer with the misalignment, but rather with the byproduct of it. The scientific evidence is so specific in fact, that an examination can tell if your misaligned spine is potentially causing your allergies.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is one of the most prevalent occupational health problems today. Millions of people are afflicted per year with carpal tunnel syndrome. With 1 out of every 3 homes having a computer, the number of cases is expected to increase. Pressure on the median nerve, which is located just below the wrist, causes the condition. Activities such as typing and using a computer mouse, puts direct pressure on the nerve. A chiropractic adjustment to the affected area is an effective treatment option.
Colic
Colic primarily affects infants and it characterized by ongoing crying, for no apparent reason. It is typical for an infant with colic to pull in their arms and legs toward their bodies and scream as though they are in severe pain, when in fact they are not. Parents of children with colic deal with a tremendous amount of stress and they are never sure how to help their child, as nothing provides relief. Colic is usually gone by the time the child is 3 months old. Despite the brief time the child has colic, to a parent, it seems like an eternity.
While the cause of colic has not yet been established, there are several things that contribute to the condition. An irritated nervous system and spine are two of the contributing factors. As the child goes through the birth process, it is it is not uncommon for the baby to have subluxations in the neck and back that can irritate their delicate nervous system. Gentle, pediatric spinal adjustments will produce a rapid improvement in the condition. Diet also contributes to colic, with cow’s milk believed to be the main contributor. Spicy foods, alcohol, and other dairy products also contribute to colic. Again, your chiropractor is qualified to offer nutritional counseling to analyze the mother’s diet, which has a direct impact on a child who is breastfeeding.
TMJ
TMJ refers to the inflammation or the temporomandibular joint that connects the mandible to the skull. Temporomandibular joint dysfunction (TMJ) causes frequent and severe headaches. TMJ causes tightness in the neck muscles, low blood sugar, stress, and high blood pressure. TMJ causes tension, cluster, and migraine headaches. The disorder can be treated by a dentist, neurologist, or a chiropractor. Chiropractic is the least invasive and most effective treatment for TMJ. A series of chiropractic adjustments will realign the joint and reduce the inflammation.
These are only a sample of the services that chiropractic medicine treats. Many people are surprised to learn the total scope that chiropractic medicine covers. By the time this article is written, new chiropractic applications will be discovered. Chiropractic medicine has something to offer just about everyone, not just people with back pain.
Diet and Nutritional Counseling
In the spirit of a total wellness approach; chiropractors are specifically trained in diet and nutritional counseling. It is no secret that a healthy diet and balanced nutrition are the foundation of good health. Chiropractors design nutritional programs that are specific to your needs. These programs are designed to improve overall health, encourage weight loss, and decrease the effects of chronic conditions, such as diabetes, cancer, heart disease, etc. Chiropractors take nutritional counseling a step further than dietitians do as they understand the effect that each nutrient has on the muscles, joints, and limbs.
Lifestyle Modification Counseling
"Health is a state of complete physical mental and social well-being, and not merely the absence of disease or infirmity."
~World Health Organization, 1948
Health is more than the absence of sickness. Health refers to a person’s total lifestyle, as lifestyle choices have a substantial impact on your short and long term health. Even small unhealthy lifestyle choices, such as smoking a few cigarettes each time you drink, can have long term effects on the heart and lungs; not to mention the affect of the alcohol on the liver! Excessive stress can also rob the body of sleep and deplete the body of nutrients. Your chiropractor offers lifestyle modification counseling to create a realistic plan of action that will enable you to kick the bad habits.
Therapeutic Exercise
Chiropractors utilize strengthening exercises as a total approach to treating back, neck, leg, arm, and shoulder problems. The exercises are designed to alleviate pain, strengthen the muscles and joints. Therapeutic exercise also aims to increase range of motion that may have been lost due to the injury and decrease the risk for new injuries. The chiropractor works one on one with the patient to ensure that they are performing the exercise correctly, and the patient then performs the exercises at home. Performing the injuries as prescribed, will decrease healing time dramatically.
Allergies
Allergies are successfully treated with chiropractic care. Hypersensitivity of the immune and/or respiratory system frequently causes allergy problems. Research has shown that the immune and respiratory systems require normal communication from the brain and spinal cord to regulate the systems successfully. If your neck is misaligned, your nervous system functioning will be imbalanced. The patient does not necessarily suffer with the misalignment, but rather with the byproduct of it. The scientific evidence is so specific in fact, that an examination can tell if your misaligned spine is potentially causing your allergies.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is one of the most prevalent occupational health problems today. Millions of people are afflicted per year with carpal tunnel syndrome. With 1 out of every 3 homes having a computer, the number of cases is expected to increase. Pressure on the median nerve, which is located just below the wrist, causes the condition. Activities such as typing and using a computer mouse, puts direct pressure on the nerve. A chiropractic adjustment to the affected area is an effective treatment option.
Colic
Colic primarily affects infants and it characterized by ongoing crying, for no apparent reason. It is typical for an infant with colic to pull in their arms and legs toward their bodies and scream as though they are in severe pain, when in fact they are not. Parents of children with colic deal with a tremendous amount of stress and they are never sure how to help their child, as nothing provides relief. Colic is usually gone by the time the child is 3 months old. Despite the brief time the child has colic, to a parent, it seems like an eternity.
While the cause of colic has not yet been established, there are several things that contribute to the condition. An irritated nervous system and spine are two of the contributing factors. As the child goes through the birth process, it is it is not uncommon for the baby to have subluxations in the neck and back that can irritate their delicate nervous system. Gentle, pediatric spinal adjustments will produce a rapid improvement in the condition. Diet also contributes to colic, with cow’s milk believed to be the main contributor. Spicy foods, alcohol, and other dairy products also contribute to colic. Again, your chiropractor is qualified to offer nutritional counseling to analyze the mother’s diet, which has a direct impact on a child who is breastfeeding.
TMJ
TMJ refers to the inflammation or the temporomandibular joint that connects the mandible to the skull. Temporomandibular joint dysfunction (TMJ) causes frequent and severe headaches. TMJ causes tightness in the neck muscles, low blood sugar, stress, and high blood pressure. TMJ causes tension, cluster, and migraine headaches. The disorder can be treated by a dentist, neurologist, or a chiropractor. Chiropractic is the least invasive and most effective treatment for TMJ. A series of chiropractic adjustments will realign the joint and reduce the inflammation.
These are only a sample of the services that chiropractic medicine treats. Many people are surprised to learn the total scope that chiropractic medicine covers. By the time this article is written, new chiropractic applications will be discovered. Chiropractic medicine has something to offer just about everyone, not just people with back pain.
Salt Intake, Asthma, and Exercise-Induced Bronchoconstriction: A Review
This article reviews the studies conducted that have questioned whether reducing dietary salt intake potentially improves pulmonary function and airway hyper–responsiveness in asthmatics, as well as studies evaluating dietary salt intake on the severity of exercise–induced bronchoconstriction (EIB). The data presented supporting dietary salt restriction for reducing airway hyper–responsiveness in asthmatics is encouraging, though not clinically convincing. Studies conducted previously have been limited for a variety of reasons, including limitations related to the experiment and populations studied. However, in studies that evaluated the severity of EIB in asthmatic individuals and involved altered dietary salt intake, data have been more convincing. A low–sodium diet maintained for 1 to 2 weeks decreases bronchoconstriction in response to exercise in individuals with asthma. There are no data regarding the longer–term effects of a low–sodium diet on either the prevalence or severity of asthma or on EIB.
Treatment of Hypertension in Athletes: An Evidence-Based Review
Hypertension is the most common cardiovascular condition in adults. It is also very common in athletes. When lifestyle changes fail, medications may be needed for the treatment of hypertension. When choosing a drug for antihypertensive therapy, providers should choose an agent that has favorable effects on blood pressure and minimal detrimental hemodynamic change during exercise. Evidence supports that the medications with the most favorable effects are angiotensin–converting enzyme inhibitors, calcium channel blockers, alpha–blockers, and cardiac–selective beta–blockers. The effects of diuretics are less desirable, and nonselective beta–blockers should be a last choice for hypertensive patients who are physically active.
The Physician and Sportsmedicine, 04/14/10
The Physician and Sportsmedicine, 04/14/10
Mouth breathing can cause major health problems
When the winter snow melts and flowers bloom, pollen and other materials can wreak havoc on those suffering from seasonal allergies, usually causing a habit called "mouth breathing." The physical, medical and social problems associated with mouth breathing are not recognized by most health care professionals, according to a study published in the January/February 2010 issue of General Dentistry, the peer–reviewed clinical journal of the Academy of General Dentistry (AGD). Dentists typically request that their patients return every six months, which means that some people see their dentist more frequently than they see their physician. As a result, dentists may be the first to identify the symptoms of mouth breathing. And, because dentists understand the problems associated with mouth breathing, they can help prevent the adverse effects.
Tuesday, April 13, 2010
Money and Spinal Surgery: What Happened to the Patient?
There is a lack of evidence-based support for the efficacy of complex fusion surgeries over conservative surgical decompression for elderly stenosis patients. There is, however, a significant financial incentive to both hospitals and surgeons to perform the complex fusions. Spinal stenosis is the most frequent cause for spinal surgery in the elderly. There has been a slight decrease in these surgeries between 2002 and 2007. However, there has also been an overall 15 fold increase in the more complex spinal fusions (360 degree spine fusions). Deyo et. al. in yesterday’s issue (April 7, 2010) of the Journal of the American Medical Association concludes that “It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years. The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications…financial incentives to hospitals and surgeons for more complex procedures may play a role…” There is a significant difference in mean hospital costs for simple decompression versus complex surgical fusion. The cost of decompression is $23,724 compared to an average of $80,888 for complex fusion. Despite the much higher cost, there is no evidence of superior outcomes and there is greater morbidity associated with the complex fusion. The surgeon is typically reimbursed only $600 to $800 for simple decompression and approximately ten times more, $6,000 to $8,000 for the complex fusion.
In a JAMA editorial that accompanied this study and was written by Dr. Carragee of Stanford University School of Medicine, the following comment was made “In 2007, the final year of data reported in the study by Deyo et al, Consumer Reports rated spinal surgery as number 1 on its list of overused tests and treatments. This was a harsh rebuke given the benefit associated with many common spinal surgeries. However, the findings from the study by Deyo et al should not only remind patients, surgeons, and payors that the efficacy of basic spinal techniques must be assessed carefully against the plethora of unproven but financially attractive alternatives, but also should serve as an important reminder that as currently configured, financial incentives and market forces do not favor this careful assessment before technologies are widely adopted. When applied broadly across medical care in the United States, the result is a formidable economic and social problem.”
These studies reflect much of what is plaguing our broken health care system. Third party payors, including the government, fail to hold all health professionals to the same evidence-based standards. There is little or no accountability when significantly more expensive surgery, with no evidence of superior effectiveness, is routinely reimbursed. There is discrimination of health care providers and the needs and desires of the patient are secondary to matters of finance and politics.
In a JAMA editorial that accompanied this study and was written by Dr. Carragee of Stanford University School of Medicine, the following comment was made “In 2007, the final year of data reported in the study by Deyo et al, Consumer Reports rated spinal surgery as number 1 on its list of overused tests and treatments. This was a harsh rebuke given the benefit associated with many common spinal surgeries. However, the findings from the study by Deyo et al should not only remind patients, surgeons, and payors that the efficacy of basic spinal techniques must be assessed carefully against the plethora of unproven but financially attractive alternatives, but also should serve as an important reminder that as currently configured, financial incentives and market forces do not favor this careful assessment before technologies are widely adopted. When applied broadly across medical care in the United States, the result is a formidable economic and social problem.”
These studies reflect much of what is plaguing our broken health care system. Third party payors, including the government, fail to hold all health professionals to the same evidence-based standards. There is little or no accountability when significantly more expensive surgery, with no evidence of superior effectiveness, is routinely reimbursed. There is discrimination of health care providers and the needs and desires of the patient are secondary to matters of finance and politics.
Studies Recommend Conservative Care for Low Back Pain before Surgery
The current issue of The Spine Journal (March 2010) examines the cost of previous conservative care for patients that ultimately elect to have spine surgery. The study consisted of 30,709 patients. The average cost of conservative care in the 90 days period before surgery was $3,445 each. Magnetic resonance imaging and other diagnostic procedures represented a little over half of the total pre-surgery costs. Of the treatment costs, 16% were for injections, 5.7% physical therapy, and 1.2% chiropractic care. Despite the fact that these expenses were for failed back conservative care, the authors recognize the overall benefits of conservative care and recognize that many patients are able to avoid surgery. They conclude that “Although a large number of patients will ultimately require surgical intervention, given that many patients will improve with nonoperative therapy, a trial of conservative management is appropriate”.
Previous studies (see abstracts below) have examined conservative versus surgical treatment related to several common causes of low back pain. For spinal stenosis, “Among patients with lumbar spinal stenosis completing 8- to 10-year follow-up, low back pain relief, predominant symptom improvement, and satisfaction with the current state were similar in patients initially treated surgically or nonsurgically.” Another study of patients with disc herniation reported, “…with moderate or severe sciatica, surgical treatment was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased over time.”
Previous studies (see abstracts below) have examined conservative versus surgical treatment related to several common causes of low back pain. For spinal stenosis, “Among patients with lumbar spinal stenosis completing 8- to 10-year follow-up, low back pain relief, predominant symptom improvement, and satisfaction with the current state were similar in patients initially treated surgically or nonsurgically.” Another study of patients with disc herniation reported, “…with moderate or severe sciatica, surgical treatment was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased over time.”
Does hormone therapy cause dementia?
Q. The Women’s Health Initiative found that hormone therapy wasn’t helpful for avoiding dementia; there was some suggestion that it might even cause cognitive problems. Am I at risk for dementia by continuing hormone therapy?
A. You’re right about the results of the Women’s Health Initiative Memory Study (WHIMS), the largest clinical trial to date of the effects of hormone therapy (HT) on cognitive function and dementia. Women ages 65 to 79 took HT (estrogen alone or estrogen combined with a progestin) or a placebo. After four to five years, the researchers found that taking HT didn’t improve cognitive function. Moreover, the women who took combined estrogen and progestin were twice as likely as the placebo takers to develop dementia.
These findings don’t square with animal and laboratory studies suggesting a favorable effect of estrogen on cognitive function. And there’s strong biological evidence that estrogen is important for brain function in women. Estrogen receptors are found throughout the brain, and many interactions take place between the brain and the reproductive endocrine system. Some research suggests that ovary removal during hysterectomy increases the risk of cognitive problems, presumably due to the loss of estrogen.
So what accounts for the WHIMS results? Some researchers think the problem is in the timing; they suggest that HT is more likely to benefit the brain if it’s started in early menopause. A five-year clinical trial called the Kronos Early Estrogen Prevention Study (KEEPS) is now addressing this question. Results are expected in 2011.
Based on what we know right now, HT won’t improve your thinking or stave off dementia. But could it increase your risk for cognitive problems? Here the evidence is less compelling. We do know that taking HT increases the risk for several serious conditions, including blood clots, stroke, heart attack, and breast cancer (when estrogen is combined with a progestin). Unless you have burdensome hot flashes or vaginal atrophy that can’t be controlled any other way, I suggest that you taper off HT, which is recommended only for the short-term relief of such symptoms. There are several non-hormonal, risk-free strategies that may help your memory and thinking, including these: get regular exercise; keep learning — through work, hobbies, or pursuits such as reading; get enough sleep; and review your medications, to make sure you’re not taking anything that could interfere with your thinking.
A. You’re right about the results of the Women’s Health Initiative Memory Study (WHIMS), the largest clinical trial to date of the effects of hormone therapy (HT) on cognitive function and dementia. Women ages 65 to 79 took HT (estrogen alone or estrogen combined with a progestin) or a placebo. After four to five years, the researchers found that taking HT didn’t improve cognitive function. Moreover, the women who took combined estrogen and progestin were twice as likely as the placebo takers to develop dementia.
These findings don’t square with animal and laboratory studies suggesting a favorable effect of estrogen on cognitive function. And there’s strong biological evidence that estrogen is important for brain function in women. Estrogen receptors are found throughout the brain, and many interactions take place between the brain and the reproductive endocrine system. Some research suggests that ovary removal during hysterectomy increases the risk of cognitive problems, presumably due to the loss of estrogen.
So what accounts for the WHIMS results? Some researchers think the problem is in the timing; they suggest that HT is more likely to benefit the brain if it’s started in early menopause. A five-year clinical trial called the Kronos Early Estrogen Prevention Study (KEEPS) is now addressing this question. Results are expected in 2011.
Based on what we know right now, HT won’t improve your thinking or stave off dementia. But could it increase your risk for cognitive problems? Here the evidence is less compelling. We do know that taking HT increases the risk for several serious conditions, including blood clots, stroke, heart attack, and breast cancer (when estrogen is combined with a progestin). Unless you have burdensome hot flashes or vaginal atrophy that can’t be controlled any other way, I suggest that you taper off HT, which is recommended only for the short-term relief of such symptoms. There are several non-hormonal, risk-free strategies that may help your memory and thinking, including these: get regular exercise; keep learning — through work, hobbies, or pursuits such as reading; get enough sleep; and review your medications, to make sure you’re not taking anything that could interfere with your thinking.
The pros and cons of PSA screening
A prostate-specific antigen (PSA) blood test measures the level of a protein called prostate-specific antigen (PSA), which is made by cells in the prostate. Doctors use the test to detect prostate cancer. Since its introduction in the late 1980s, the prostate-specific antigen (PSA) test has been hailed as a way to detect prostate cancer in its earliest, most curable stage. It has been called one of the most important tests a man can have. So why are many experts now stepping back, and even discouraging the use of widespread PSA screening?
Concerns about PSA screening
The shift comes on the heels of a growing body of evidence that shows the benefits of PSA screening may not outweigh the potential harm of unnecessary treatment. PSA screening has always been somewhat controversial. That’s because PSA tests often alert doctors to the presence of cancer, but there is no precise way to determine, definitively, whether the cancers detected would have ever caused symptoms or harm during a man’s lifetime. One study estimated overdetection to rise with age, from 27% at age 55 to 56% by age 75.
Despite this, to be on the safe side, most men with elevated PSA levels will opt for treatment, frequently suffering side effects such as incontinence and impotence. Increasingly, there are questions about the effectiveness of PSA screening for prostate cancer. Just how many lives are actually being saved? And is the emotional and physical toll on the millions of men who are being overdiagnosed and overtreated worth it?
What the research says
Two long-awaited studies—one conducted in the United States and the other in Europe—were supposed to help settle the debate over the value of PSA testing. Instead, the trials, published in the New England Journal of Medicine in March 2009, seemed to come to opposite conclusions. The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial reported no survival benefit with PSA screening and digital rectal examination, but the European Randomized Study of Screening for Prostate Cancer (ERSPC) found a 20% reduction in prostate cancer deaths. The ERSPC study estimated that for every life saved, 48 men are treated and 1,068 men are screened.
Although experts are somewhat split on the value of PSA tests as a screening tool, there is widespread agreement on two major points: overdiagnosis and over treatment rates are far too high, and there is an urgent need to refine PSA testing to be a more effective screening tool. The principal investigator of the Prostate Cancer Prevention Trial and his colleagues wrote an editorial in The Journal of the American Medical Association in October 2009 that took a closer look at the issues. They pointed out that while the amount of prostate cancer diagnosed has risen dramatically since PSA testing began, there has not been a proportional decrease in the number of men with metastatic tumors. It appears screening may be detecting a disproportionate number of lower-risk cancers, while missing many of the most aggressive tumors, which may advance too rapidly to be found with periodic testing.
The debate over the effectiveness of PSA screening has quickly filtered into the offices of general practitioners and urologists. On a daily basis, confused men are asking their doctors: “Should I have a PSA test or not?”
What you should know about PSA screening
Screening doesn’t lower your risk of having prostate cancer; it increases the chance you’ll find out you have it.
PSA testing can detect early-stage cancers that a digital rectal examination (DRE) would miss.
A “normal” PSA level of 4 ng/ml or below doesn’t guarantee that you are cancer-free; in about 15% of men with a PSA below 4 ng/ml, a biopsy will reveal prostate cancer.
A high PSA level may prompt you to seek treatment, resulting in possible urinary and sexual side effects.
Conditions other than cancer—BPH and prostatitis, for example—can elevate your PSA level.
In the past few years, more and more men who undergo PSA screening and later learn that they have cancer have opted to pursue active surveillance. This strategy involves frequent monitoring of the disease through PSA tests and biopsies—and postponing treatment until the cancer shows signs of increasing its activity. In short, these men choose to live with prostate cancer until it advances, sometimes avoiding potentially life-altering side effects for several years.
PSA testing guidelines from the American Cancer Society emphasize discussing the pros and cons of prostate cancer screening with your doctor, including your individual level of prostate cancer risk, before having a PSA blood test.
Concerns about PSA screening
The shift comes on the heels of a growing body of evidence that shows the benefits of PSA screening may not outweigh the potential harm of unnecessary treatment. PSA screening has always been somewhat controversial. That’s because PSA tests often alert doctors to the presence of cancer, but there is no precise way to determine, definitively, whether the cancers detected would have ever caused symptoms or harm during a man’s lifetime. One study estimated overdetection to rise with age, from 27% at age 55 to 56% by age 75.
Despite this, to be on the safe side, most men with elevated PSA levels will opt for treatment, frequently suffering side effects such as incontinence and impotence. Increasingly, there are questions about the effectiveness of PSA screening for prostate cancer. Just how many lives are actually being saved? And is the emotional and physical toll on the millions of men who are being overdiagnosed and overtreated worth it?
What the research says
Two long-awaited studies—one conducted in the United States and the other in Europe—were supposed to help settle the debate over the value of PSA testing. Instead, the trials, published in the New England Journal of Medicine in March 2009, seemed to come to opposite conclusions. The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial reported no survival benefit with PSA screening and digital rectal examination, but the European Randomized Study of Screening for Prostate Cancer (ERSPC) found a 20% reduction in prostate cancer deaths. The ERSPC study estimated that for every life saved, 48 men are treated and 1,068 men are screened.
Although experts are somewhat split on the value of PSA tests as a screening tool, there is widespread agreement on two major points: overdiagnosis and over treatment rates are far too high, and there is an urgent need to refine PSA testing to be a more effective screening tool. The principal investigator of the Prostate Cancer Prevention Trial and his colleagues wrote an editorial in The Journal of the American Medical Association in October 2009 that took a closer look at the issues. They pointed out that while the amount of prostate cancer diagnosed has risen dramatically since PSA testing began, there has not been a proportional decrease in the number of men with metastatic tumors. It appears screening may be detecting a disproportionate number of lower-risk cancers, while missing many of the most aggressive tumors, which may advance too rapidly to be found with periodic testing.
The debate over the effectiveness of PSA screening has quickly filtered into the offices of general practitioners and urologists. On a daily basis, confused men are asking their doctors: “Should I have a PSA test or not?”
What you should know about PSA screening
Screening doesn’t lower your risk of having prostate cancer; it increases the chance you’ll find out you have it.
PSA testing can detect early-stage cancers that a digital rectal examination (DRE) would miss.
A “normal” PSA level of 4 ng/ml or below doesn’t guarantee that you are cancer-free; in about 15% of men with a PSA below 4 ng/ml, a biopsy will reveal prostate cancer.
A high PSA level may prompt you to seek treatment, resulting in possible urinary and sexual side effects.
Conditions other than cancer—BPH and prostatitis, for example—can elevate your PSA level.
In the past few years, more and more men who undergo PSA screening and later learn that they have cancer have opted to pursue active surveillance. This strategy involves frequent monitoring of the disease through PSA tests and biopsies—and postponing treatment until the cancer shows signs of increasing its activity. In short, these men choose to live with prostate cancer until it advances, sometimes avoiding potentially life-altering side effects for several years.
PSA testing guidelines from the American Cancer Society emphasize discussing the pros and cons of prostate cancer screening with your doctor, including your individual level of prostate cancer risk, before having a PSA blood test.
Why Do Spinal Surgery Rates Continue To Rise?
First, let’s review some history. In 1974, the Congressional Committee on Interstate and Foreign Commerce held hearings on unnecessary surgery. Their findings from the First Surgical Second Opinion Program found that 17.6% of recommendations for surgery were not confirmed. The House Subcommittee on Oversight and Investigations extrapolated these figures to estimate that, on a nationwide basis, there were 2.4 million unnecessary surgeries performed annually resulting in 11,900 deaths at an annual cost of $3.9 billion. [1]
With the total number of lower back surgeries having been estimated in 1995 to exceed 250,000 in the U.S., at a hospital cost of $11,000 per patient. [2] This would mean that the total number of unnecessary back surgeries each year in the U.S. could be 44,000, costing as much as $484 million. [3]
So, the first risk of spinal surgery is that it may not be necessary.
The next set of risks include:
a 2.1% chance of a serious adverse drug reaction. [4]
a 5-6% chance of acquiring a nosocomial infection [5]
a 4-36% chance of having an iatrogenic injury (medical error or adverse drug reactions). [6]
a 17% chance of a procedure error. [7]
As few as 3%, and no more than 20% of iatrogenic injuries are ever reported! Yipes! [8]
That takes all the fun out of being a statistic, doesn’t it?
This September 2006 article from the Journal of the American Academy of Orthopedic Surgeons says it all:
“Failed back surgery syndrome is a common problem with enormous costs to patients, insurers, and society. The etiology of failed back surgery can be poor patient selection, incorrect diagnosis, suboptimal selection of surgery, poor technique, failure to achieve surgical goals, and/or recurrent pathology.” [9]
That is right from the horse’s mouth.
Other testimony is equally disturbing:
A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of unnecessary medical and surgical procedures performed annually is 7.5 million. The number of people exposed to unnecessary hospitalization annually is 8.9 million. [8]
A 1987 JAMA study found the following significant levels of inappropriate surgery: 17% of cases for coronary angiography, 32% for carotid endarterectomy, and 17% for upper gastrointestinal tract endoscopy. Using the Healthcare Cost and Utilization Project (HCUP) statistics provided by the government for 2001, the number of people getting upper gastrointestinal endoscopy, which usually entails biopsy, was 697,675; the number getting endarterectomy was 142,401; and the number having coronary angiography was 719,949.13 Therefore, according to the JAMA study 17%, or 118,604 people had an unnecessary endoscopy procedure. Endarterectomy occurred in 142,401 patients; potentially 32% or 45,568 did not need this procedure. And 17% of 719,949, or 122,391 people receiving coronary angiography were subjected to this highly invasive procedure unnecessarily. These are all forms of medical iatrogenesis. [8]
The most recent controversy is reported in the the New York Times:
“Spinal-fusion surgery is one of the most lucrative areas of medicine. An estimated half-million Americans had the operation this year, generating billions of dollars for hospitals and doctors. But there have been serious questions about how much the surgery actually helps patients with back pain and whether surgeons’ generous fees might motivate them to overuse the procedure. Those concerns are now heightened by a growing trend among some surgeons to profit in yet another way — by investing in companies that make screws and other hardware they install.” [10]
Now, added to concerns about medicine’s low level of musculoskeletal training and these dangerous statistics, now we have to wonder if the orthopedist might be motivated to install 6 of those $1000 screws to your spine just because they are a stockholder of a lucrative medical device manufacturing company. [10]
The sanest and safest approach is to use conservative approaches like chiropractic care first. You can always resort to drugs or surgical approaches as a last-ditch resort, but the statistics suggest that most low back and neck pain can be successfully managed with lower costs and higher patient satisfaction by chiropractors.
You may want to explore research supporting chiropractic care for a wide variety of conditions in our Research section. There is also a significant body of work demonstrating the vastly superior Cost-Effectiveness of Chiropractic, as well as contrasting Patient Satisfaction With Chiropractic with standard Medical Care for the same conditions.
And Now Medicine Has Upped the Ante
Thanks to ChiroACCESS for the following commentary:
There is a lack of evidence-based support for the efficacy of complex fusion surgeries over conservative surgical decompression for elderly stenosis patients. There is, however, a significant financial incentive to both hospitals and surgeons to perform the complex fusions. Spinal stenosis is the most frequent cause for spinal surgery in the elderly. There has been a slight decrease in these surgeries between 2002 and 2007. However, there has also been an overall 15-fold increase in the more complex spinal fusions (360 degree spine fusions). [11]
Deyo et. al. in yesterday’s issue (April 7, 2010) of the Journal of the American Medical Association concludes that “It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years. The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications…financial incentives to hospitals and surgeons for more complex procedures may play a role…” There is a significant difference in mean hospital costs for simple decompression versus complex surgical fusion. The cost of decompression is $23,724 compared to an average of $80,888 for complex fusion. [11]
Despite the much higher cost, there is no evidence of superior outcomes, and there is greater morbidity associated with the complex fusion. The surgeon is typically reimbursed only $600 to $800 for simple decompression and approximately ten times more, $6,000 to $8,000 for the complex fusion. [11]
In a JAMA editorial that accompanied this study and was written by Dr. Carragee of Stanford University School of Medicine, the following comment was made:
“In 2007, the final year of data reported in the study by Deyo et al, Consumer Reports rated spinal surgery as number 1 on its list of overused tests and treatments. This was a harsh rebuke given the benefit associated with many common spinal surgeries. However, the findings from the study by Deyo et al should not only remind patients, surgeons, and payors that the efficacy of basic spinal techniques must be assessed carefully against the plethora of unproven but financially attractive alternatives, but also should serve as an important reminder that as currently configured, financial incentives and market forces do not favor this careful assessment before technologies are widely adopted. When applied broadly across medical care in the United States, the result is a formidable economic and social problem.” [11]
These studies reflect much of what is plaguing our broken health care system. Third party payors, including the government, fail to hold all health professionals to the same evidence-based standards. There is little or no accountability when significantly more expensive surgery, with no evidence of superior effectiveness, is routinely reimbursed. There is discrimination of health care providers and the needs and desires of the patient are secondary to matters of finance and politics. [11]
REFERENCES:
[1] US Congressional House Subcommittee Oversight Investigation
Cost and Quality of Health Care: Unnecessary Surgery.
Washington, DC: Government Printing Office, 1976
[2] Herman R. Back Surgery. Washington Post [Health Section], April 18, 1995
[3] Testimony to the Department of Veterans Affairs’ Chiropractic Advisory Committee
George B. McClelland, D.C., Foundation for Chiropractic Education and Research March 25, 2003
http://www.chiro.org/LINKS/ABSTRACTS/Testimony_to_the_Department_of_Veterans_Affairs.shtml
[4] Incidence of Adverse Drug Reactions in Hospitalized Patients: A Meta-analysis of Prospective Studies
JAMA 1998 (Apr 15); 279 (15): 1200-1205
[5] Nosocomial Infection Update
Emerg Infect Dis 1998 (Jul); 4 (3): 416-420
[6] Error in Medicine
JAMA 1994 (Dec 21); 272 (23): 1851-1857
[7] Medication errors in hospitalized cardiovascular patients
Arch Intern Med 2003 (Jun 23); 163 (12): 1461-1466
[8] Death by Medicine
Life Extension Foundation
http://www.chiro.org/LINKS/FULL/Death_By_Medicine.html
[9] Failed Back Surgery Syndrome: Diagnostic Evaluation
Journal of the American Academy of Orthopaedic Surgeons 2006 (Sep); 14 (9): 534-543
[10] The Spine as Profit Center
New York Times ~ December 30, 2006
[11] Money and Spinal Surgery: What Happened to the Patient?
ChiroACCESS April 8, 2010
With the total number of lower back surgeries having been estimated in 1995 to exceed 250,000 in the U.S., at a hospital cost of $11,000 per patient. [2] This would mean that the total number of unnecessary back surgeries each year in the U.S. could be 44,000, costing as much as $484 million. [3]
So, the first risk of spinal surgery is that it may not be necessary.
The next set of risks include:
a 2.1% chance of a serious adverse drug reaction. [4]
a 5-6% chance of acquiring a nosocomial infection [5]
a 4-36% chance of having an iatrogenic injury (medical error or adverse drug reactions). [6]
a 17% chance of a procedure error. [7]
As few as 3%, and no more than 20% of iatrogenic injuries are ever reported! Yipes! [8]
That takes all the fun out of being a statistic, doesn’t it?
This September 2006 article from the Journal of the American Academy of Orthopedic Surgeons says it all:
“Failed back surgery syndrome is a common problem with enormous costs to patients, insurers, and society. The etiology of failed back surgery can be poor patient selection, incorrect diagnosis, suboptimal selection of surgery, poor technique, failure to achieve surgical goals, and/or recurrent pathology.” [9]
That is right from the horse’s mouth.
Other testimony is equally disturbing:
A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of unnecessary medical and surgical procedures performed annually is 7.5 million. The number of people exposed to unnecessary hospitalization annually is 8.9 million. [8]
A 1987 JAMA study found the following significant levels of inappropriate surgery: 17% of cases for coronary angiography, 32% for carotid endarterectomy, and 17% for upper gastrointestinal tract endoscopy. Using the Healthcare Cost and Utilization Project (HCUP) statistics provided by the government for 2001, the number of people getting upper gastrointestinal endoscopy, which usually entails biopsy, was 697,675; the number getting endarterectomy was 142,401; and the number having coronary angiography was 719,949.13 Therefore, according to the JAMA study 17%, or 118,604 people had an unnecessary endoscopy procedure. Endarterectomy occurred in 142,401 patients; potentially 32% or 45,568 did not need this procedure. And 17% of 719,949, or 122,391 people receiving coronary angiography were subjected to this highly invasive procedure unnecessarily. These are all forms of medical iatrogenesis. [8]
The most recent controversy is reported in the the New York Times:
“Spinal-fusion surgery is one of the most lucrative areas of medicine. An estimated half-million Americans had the operation this year, generating billions of dollars for hospitals and doctors. But there have been serious questions about how much the surgery actually helps patients with back pain and whether surgeons’ generous fees might motivate them to overuse the procedure. Those concerns are now heightened by a growing trend among some surgeons to profit in yet another way — by investing in companies that make screws and other hardware they install.” [10]
Now, added to concerns about medicine’s low level of musculoskeletal training and these dangerous statistics, now we have to wonder if the orthopedist might be motivated to install 6 of those $1000 screws to your spine just because they are a stockholder of a lucrative medical device manufacturing company. [10]
The sanest and safest approach is to use conservative approaches like chiropractic care first. You can always resort to drugs or surgical approaches as a last-ditch resort, but the statistics suggest that most low back and neck pain can be successfully managed with lower costs and higher patient satisfaction by chiropractors.
You may want to explore research supporting chiropractic care for a wide variety of conditions in our Research section. There is also a significant body of work demonstrating the vastly superior Cost-Effectiveness of Chiropractic, as well as contrasting Patient Satisfaction With Chiropractic with standard Medical Care for the same conditions.
And Now Medicine Has Upped the Ante
Thanks to ChiroACCESS for the following commentary:
There is a lack of evidence-based support for the efficacy of complex fusion surgeries over conservative surgical decompression for elderly stenosis patients. There is, however, a significant financial incentive to both hospitals and surgeons to perform the complex fusions. Spinal stenosis is the most frequent cause for spinal surgery in the elderly. There has been a slight decrease in these surgeries between 2002 and 2007. However, there has also been an overall 15-fold increase in the more complex spinal fusions (360 degree spine fusions). [11]
Deyo et. al. in yesterday’s issue (April 7, 2010) of the Journal of the American Medical Association concludes that “It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years. The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications…financial incentives to hospitals and surgeons for more complex procedures may play a role…” There is a significant difference in mean hospital costs for simple decompression versus complex surgical fusion. The cost of decompression is $23,724 compared to an average of $80,888 for complex fusion. [11]
Despite the much higher cost, there is no evidence of superior outcomes, and there is greater morbidity associated with the complex fusion. The surgeon is typically reimbursed only $600 to $800 for simple decompression and approximately ten times more, $6,000 to $8,000 for the complex fusion. [11]
In a JAMA editorial that accompanied this study and was written by Dr. Carragee of Stanford University School of Medicine, the following comment was made:
“In 2007, the final year of data reported in the study by Deyo et al, Consumer Reports rated spinal surgery as number 1 on its list of overused tests and treatments. This was a harsh rebuke given the benefit associated with many common spinal surgeries. However, the findings from the study by Deyo et al should not only remind patients, surgeons, and payors that the efficacy of basic spinal techniques must be assessed carefully against the plethora of unproven but financially attractive alternatives, but also should serve as an important reminder that as currently configured, financial incentives and market forces do not favor this careful assessment before technologies are widely adopted. When applied broadly across medical care in the United States, the result is a formidable economic and social problem.” [11]
These studies reflect much of what is plaguing our broken health care system. Third party payors, including the government, fail to hold all health professionals to the same evidence-based standards. There is little or no accountability when significantly more expensive surgery, with no evidence of superior effectiveness, is routinely reimbursed. There is discrimination of health care providers and the needs and desires of the patient are secondary to matters of finance and politics. [11]
REFERENCES:
[1] US Congressional House Subcommittee Oversight Investigation
Cost and Quality of Health Care: Unnecessary Surgery.
Washington, DC: Government Printing Office, 1976
[2] Herman R. Back Surgery. Washington Post [Health Section], April 18, 1995
[3] Testimony to the Department of Veterans Affairs’ Chiropractic Advisory Committee
George B. McClelland, D.C., Foundation for Chiropractic Education and Research March 25, 2003
http://www.chiro.org/LINKS/ABSTRACTS/Testimony_to_the_Department_of_Veterans_Affairs.shtml
[4] Incidence of Adverse Drug Reactions in Hospitalized Patients: A Meta-analysis of Prospective Studies
JAMA 1998 (Apr 15); 279 (15): 1200-1205
[5] Nosocomial Infection Update
Emerg Infect Dis 1998 (Jul); 4 (3): 416-420
[6] Error in Medicine
JAMA 1994 (Dec 21); 272 (23): 1851-1857
[7] Medication errors in hospitalized cardiovascular patients
Arch Intern Med 2003 (Jun 23); 163 (12): 1461-1466
[8] Death by Medicine
Life Extension Foundation
http://www.chiro.org/LINKS/FULL/Death_By_Medicine.html
[9] Failed Back Surgery Syndrome: Diagnostic Evaluation
Journal of the American Academy of Orthopaedic Surgeons 2006 (Sep); 14 (9): 534-543
[10] The Spine as Profit Center
New York Times ~ December 30, 2006
[11] Money and Spinal Surgery: What Happened to the Patient?
ChiroACCESS April 8, 2010
Thursday, April 8, 2010
Intravenous versus Oral Rehydration in Athletes
Several studies have shown that rehydration is more rapid with IV fluid. However, the benefits are generally transient and only small differences to markers of hydration status are seen when comparing IV and oral rehydration. Furthermore, several studies have shown improvements in cardiovascular function and thermoregulation with IV fluid, while others have indicated that oral fluid is superior. Subsequent exercise performance has not been improved to a greater extent with one technique over the other. The paucity of definitive findings is probably related to the small number of studies investigating these variables and the vast differences in the designs of studies that have been conducted. The major limitation of IV rehydration is that it bypasses oropharyngeal stimulation, which has an influence on factors such as thirst sensation, antidiuretic hormone (arginine vasopressin) release, cutaneous vasodilation and mean arterial pressure. Further research is necessary to determine the relative benefits of oral and IV rehydration for athletes.
The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers
This study demonstrated a trend towards lower limb injury prevention with a significant reduction in primary lower limb muscle strains and weeks missed due to non–contact knee injuries through the addition of a sports chiropractic intervention to the current best practice management.
BMC Musculoskeletal Disorders, 04/08/10
BMC Musculoskeletal Disorders, 04/08/10
Tuesday, April 6, 2010
Effect of cupping therapy in treating chronic headache and chronic back pain at "Al heijamah" clinic HMC
The total number of the participants was eighty six, slightly more than half of them were male (51.2%). The majority were non Qatari (72.1%); thirty seven of them had headache and forty nine of them had back pain. Most of the participants were treated with wet cup therapy (98.8%) and only one of them was treated with dry cup. Fifty two of the participants had only one session of cupping while only five of them completed the four sessions. The pain score for patients with headache was decreased from eight to four after cupping therapy followed by intermittent periods of fluctuation of pain, scored from four to five for around five weeks, then it maintained constant at four score till the end of the follow up period. Meanwhile the pain scale for patients with low back pain decreased from seven to three after two weeks and stayed constant till the end of the twelve weeks. The effect of cupping therapy (Al heijamah) for chronic headache and back pain has been studied and the results revealed significant improvements in participants as a result of cupping therapy. Further studies with larger samples, for longer duration of follow up and use of a comparison group are recommended.
Relationship Between Low Back Pain and Competitive Sports Activities During Youth
Excessive exposure to competitive sports activities during youth was associated with low back pain and symptoms in the lower extremities, with the severity varying with the sport. To reduce low back pain in youth, factors that may be causing low back pain, such as sport–specific postures and motions, need to be investigated.
Four Ways to Keep Kids Moving
1. Lead by Example. When it comes to exercise, an adult couch potato effectively nurtures a child couch potato, who then becomes yet another adult couch potato years down the road - a vicious cycle of inactivity that increases disease risk. Fortunately, the opposite is also true, so get off the couch and show your kids the value of an active life filled with physical activity.
2. Unplug for Awhile. Hours on end of TV, video games, and even phone and computer "activities" like instant messaging, chat rooms and other pursuits leave very little time for exercise. While there's no easy solution, establishing a daily time limit on these activities is a great start.
3. Find the Time. When we're young, we spend hours in the yard or on school grounds playing our favorite games; then we slowly get more and more responsibilities and somehow, the time just seems to disappear. It happens quickly, right around the time daily homework comes along. What can you do about it? It's the same advice, whether young or old: Find the time. Pencil physical activity into your child's daily schedule and don't let "life" ever erase it.
4. Make It Fun. Too often, exercise becomes more of a chore than a pleasing activity, and this often begins at an early age, basically as soon as children get involved in the rigors of organized sports. Sure, it's never all fun and games, but exercise shouldn't be a dreaded activity, not if you do it right. Be creative and teach children that active is fun at any age.
2. Unplug for Awhile. Hours on end of TV, video games, and even phone and computer "activities" like instant messaging, chat rooms and other pursuits leave very little time for exercise. While there's no easy solution, establishing a daily time limit on these activities is a great start.
3. Find the Time. When we're young, we spend hours in the yard or on school grounds playing our favorite games; then we slowly get more and more responsibilities and somehow, the time just seems to disappear. It happens quickly, right around the time daily homework comes along. What can you do about it? It's the same advice, whether young or old: Find the time. Pencil physical activity into your child's daily schedule and don't let "life" ever erase it.
4. Make It Fun. Too often, exercise becomes more of a chore than a pleasing activity, and this often begins at an early age, basically as soon as children get involved in the rigors of organized sports. Sure, it's never all fun and games, but exercise shouldn't be a dreaded activity, not if you do it right. Be creative and teach children that active is fun at any age.
Show Me the Light: The Healing Power of Laser Therapy
An increasing number of doctors nationwide are offering laser therapy to their patients. With its increasing popularity and use, that means more and more people are probably wondering about lasers in general and some important specifics, including how they work, how safe they are and what it feels like to get treated. Here's a little Q & A on laser therapy.
Q: What is laser therapy?
A: Laser therapy is the application of low levels of laser light to areas of the body that have been injured or damaged. Contrasted with high-powered lasers used in health care that cut tissue, such as surgical or hair-removal lasers, therapy lasers produce beneficial photochemical and photobiological interactions that can help relieve pain and repair injured/damaged tissue.
Q: How does laser therapy work?
A: The photons of laser light penetrate through your skin and are absorbed by special components in your body's cells called chromophores. Just as photosynthesis creates energy for plants, the absorption of the photons by your cells causes increased production of cellular energy. In areas of injury or damage, this means there is more energy available to improve the rate and quality of healing.
Q: What does it feel like to get a treatment?
A: With very low-powered therapy lasers, you feel nothing at all. Higher-powered (Class IV) therapy lasers produce a mild, soothing, warm feeling. You may notice a tingling sensation in the treatment area as blood vessels dilate, or that muscle spasms are reducing in strength and duration. Laser therapy is a painless treatment.
Q: How do you know it not causing cancer or other tissue damage?
A: There are two ways that laser light can damage tissue; if it is very concentrated (high power density) or if the photons are very high energy. Therapy lasers use power densities that are far below the levels that cause tissue damage. Ultraviolet light has very high-energy photons capable of ionizing molecules, but therapy lasers use visible and near-infrared light, which only cause molecular vibrations. You could argue that therapy laser light is safer than sunlight.
Q: How can I get more information?
A: Ask your doctor! A steadily growing number of health care practitioners are offering laser therapy to their patients. Your doctor can determine if laser therapy is appropriate for your particular health situation.
Q: What is laser therapy?
A: Laser therapy is the application of low levels of laser light to areas of the body that have been injured or damaged. Contrasted with high-powered lasers used in health care that cut tissue, such as surgical or hair-removal lasers, therapy lasers produce beneficial photochemical and photobiological interactions that can help relieve pain and repair injured/damaged tissue.
Q: How does laser therapy work?
A: The photons of laser light penetrate through your skin and are absorbed by special components in your body's cells called chromophores. Just as photosynthesis creates energy for plants, the absorption of the photons by your cells causes increased production of cellular energy. In areas of injury or damage, this means there is more energy available to improve the rate and quality of healing.
Q: What does it feel like to get a treatment?
A: With very low-powered therapy lasers, you feel nothing at all. Higher-powered (Class IV) therapy lasers produce a mild, soothing, warm feeling. You may notice a tingling sensation in the treatment area as blood vessels dilate, or that muscle spasms are reducing in strength and duration. Laser therapy is a painless treatment.
Q: How do you know it not causing cancer or other tissue damage?
A: There are two ways that laser light can damage tissue; if it is very concentrated (high power density) or if the photons are very high energy. Therapy lasers use power densities that are far below the levels that cause tissue damage. Ultraviolet light has very high-energy photons capable of ionizing molecules, but therapy lasers use visible and near-infrared light, which only cause molecular vibrations. You could argue that therapy laser light is safer than sunlight.
Q: How can I get more information?
A: Ask your doctor! A steadily growing number of health care practitioners are offering laser therapy to their patients. Your doctor can determine if laser therapy is appropriate for your particular health situation.
Control Your Allergy Symptoms Naturally
When looking to control allergy symptoms without resorting to medications, the first step is to limit your exposure. Using an air filter, preferably one that ties into a central heating and air conditioning system, can drastically reduce the build-up of allergens in your home. It is also important to focus on areas where allergens can collect. Pet areas, carpets, rugs, and upholstered furniture should be cleansed regularly, and bedding should be washed at least once a week.
In addition to these simple steps, you may want to look to your diet as a means for controlling your allergy symptoms. A study of 35 patients conducted in the Journal of Asthma found a positive correlation between allergy relief and vegetarian or vegan diets. In a clinical observation, 92 percent of patients who followed a vegan diet for one year reported reduction in asthma symptoms.
Foods that have been closely linked to respiratory allergies include dairy products, chocolate, sugar, and gluten. There is also strong evidence indicating a connection between allergic rhinitis and intake of certain food additives, including artificial dyes and colorants, sulfites, and benzoates.
Omega-3 fatty acids have also been shown to support healthy airways and additionally favor the production of anti-inflammatory mediators. In a 2009 study reported in the International Archives of Allergy and Immunology, atopic asthma patients supplemented daily with omega-3 fatty acids improved airway responsiveness even when subjects were exposed to a known allergen. Dietary sources of omega-3 fatty acids include cold-water fish, flax seeds, chia seeds, and walnuts.
Increasing antioxidant intake is also essential to prevent the free radicals that are often elevated in allergies and asthma. Vitamin C is considered as one of the most important dietary antioxidants for the protection of the lungs, and low levels of blood vitamin C are considered an independent risk factor for allergic rhinitis. Other beneficial antioxidants may include vitamin E, selenium, the carotenoids, and the flavonoids, which all posses powerful free radical- quenching capabilities.
Why go through life suffering from allergies if you don't have to? With a few dietary and lifestyle changes, you can face allergy season without stockpiling allergy medications and Kleenex. Talk to your doctor for more information about allergies and natural solutions.
In addition to these simple steps, you may want to look to your diet as a means for controlling your allergy symptoms. A study of 35 patients conducted in the Journal of Asthma found a positive correlation between allergy relief and vegetarian or vegan diets. In a clinical observation, 92 percent of patients who followed a vegan diet for one year reported reduction in asthma symptoms.
Foods that have been closely linked to respiratory allergies include dairy products, chocolate, sugar, and gluten. There is also strong evidence indicating a connection between allergic rhinitis and intake of certain food additives, including artificial dyes and colorants, sulfites, and benzoates.
Omega-3 fatty acids have also been shown to support healthy airways and additionally favor the production of anti-inflammatory mediators. In a 2009 study reported in the International Archives of Allergy and Immunology, atopic asthma patients supplemented daily with omega-3 fatty acids improved airway responsiveness even when subjects were exposed to a known allergen. Dietary sources of omega-3 fatty acids include cold-water fish, flax seeds, chia seeds, and walnuts.
Increasing antioxidant intake is also essential to prevent the free radicals that are often elevated in allergies and asthma. Vitamin C is considered as one of the most important dietary antioxidants for the protection of the lungs, and low levels of blood vitamin C are considered an independent risk factor for allergic rhinitis. Other beneficial antioxidants may include vitamin E, selenium, the carotenoids, and the flavonoids, which all posses powerful free radical- quenching capabilities.
Why go through life suffering from allergies if you don't have to? With a few dietary and lifestyle changes, you can face allergy season without stockpiling allergy medications and Kleenex. Talk to your doctor for more information about allergies and natural solutions.
Thursday, April 1, 2010
How to Buy Athletic Shoe
Although the right pair of athletic shoes may not enhance sports performance, it might help you avoid discomfort or even injury. Here are tips about what to look for in your next pair.
How do I know when it's time to replace my old athletic shoes?
Place your old shoes on a table or other flat surface and look at them from the back. If they lean inward or outward or show signs of excessive wear like badly worn edges of the sole, it's probably time for a new pair. Even if they look like they're in good shape, if you've logged 500 or more miles in them, or if you start to notice pain in your feet, ankles, legs, or knees though you haven't changed your exercise routine, worn-out shoes may be a factor.
After you buy new shoes, go to the store and try on a new pair of that same model about every 4 to 6 months, depending on the extent of your activity. You may not realize how much your shoes have worn until you compare them with a new pair.
There are so many styles and brands—where do I start?
If your old shoes lean inward or if your feet are flat or tend to roll inward when you walk or run, you should look for shoes with added support under the arch. If your shoes lean outward or your arches are high, you need plenty of cushioning.
The shoe's material should be flexible and allow your foot to "breathe," as shoes that have mesh fabric do. Most people like the feel of a softer shoe, but with the pressure on shoes during exercise, a softer shoe may not last as long as a firmer one.
Think about protection from injuries. Shoes don't have to be very heavy to offer good support. Also, thin or flimsy shoes like canvas sneakers can worsen some problems such as calf or Achilles tendon pain. A shoe whose heel compresses too easily can overstretch your calf. In addition, soles that bend at the ball of the foot, not under the arch, offer better support.
Styles change about every 19 months, and you may not like the new version of your favorite model of shoe. If this happens, a knowledgeable salesperson should be able to help you find a style of athletic shoe comparable to your old favorite.
Regardless of the style, fit is the most important consideration. No matter how good you hear a shoe is, if it doesn't fit you or you're not comfortable with it, don't buy it. No one brand will fit everyone's needs.
How can I get the best fit?
No matter where you go to buy your shoes, try to find a knowledgeable salesperson who understands footwear and will take the time to guide you to the best style and size for you.
Try to shop at the end of the day or after a workout when your feet are generally at their largest. Wear the type of socks you usually wear during exercise, and if you use orthotic devices (orthoses) for your feet, make sure you wear them when you're trying on shoes.
Choose shoes for their fit, not by the size you've worn in the past. It's important to have both the length and width of your feet measured every time you shop for shoes, since foot size often changes with age.
There should be a thumbnail's width (about 1/2 inch) between the longest toe and the end of the shoe on your longer foot. Be sure to have the salesperson check the fit of both shoes for you when you are standing up. If you bend over to check it yourself, you will change the position of your foot in the shoe.
The widest part of your foot should be in the widest part of the shoe. The sides of your foot should not extend over the sole of the shoe, and your foot shouldn't move from side to side inside the shoe.
After you've found a pair that you think fits well, walk or run a little in the store—some stores even have a treadmill for that purpose. The shoes should feel comfortably snug—not tight or too loose—and you should not feel the stitching or seams on the inside of the shoes. Note also whether your toes slide forward or feel pinched together or your heel rises out of the shoe slightly.
Should I buy a shoe designed for my sport?
If you participate in a sport more than three times a week, you should consider a sport-specific shoe. Running shoes are primarily made to absorb shock as the heel strikes the ground. Tennis shoes, in contrast, provide more side-to-side stability. Walking shoes allow the foot to roll and push off naturally during walking. They usually have a fairly rigid arch, a well-cushioned sole, and a stiff heel support for stability.
How much should I pay for athletic shoes?
Most people don't need top-of-the-line models or shoes that cost more than $150. The best values are usually in the middle- to upper-middle price ranges. Beginning exercisers should buy high-quality shoes in this range because their bodies are less adapted to the stress of exercise.
How should I take care of my new shoes?
Let shoes air dry between uses. You can even alternate pairs to ensure thorough drying. Because the insoles in most shoes are made for immediate comfort, not extended use, they often break down quickly. When your original insoles wear through, extend the shoe's life by replacing them with off-the-shelf insoles.
Can my shoes affect my sports performance?
Although a high-quality, well-fitted athletic shoe might make your workout easier, it probably won't fix a mechanical problem with your feet or legs. If you have foot, ankle, or leg pain, a foot imbalance may be at fault, which may be corrected by wearing custom orthotics. Consult a doctor who specializes in athletic injuries.
How do I know when it's time to replace my old athletic shoes?
Place your old shoes on a table or other flat surface and look at them from the back. If they lean inward or outward or show signs of excessive wear like badly worn edges of the sole, it's probably time for a new pair. Even if they look like they're in good shape, if you've logged 500 or more miles in them, or if you start to notice pain in your feet, ankles, legs, or knees though you haven't changed your exercise routine, worn-out shoes may be a factor.
After you buy new shoes, go to the store and try on a new pair of that same model about every 4 to 6 months, depending on the extent of your activity. You may not realize how much your shoes have worn until you compare them with a new pair.
There are so many styles and brands—where do I start?
If your old shoes lean inward or if your feet are flat or tend to roll inward when you walk or run, you should look for shoes with added support under the arch. If your shoes lean outward or your arches are high, you need plenty of cushioning.
The shoe's material should be flexible and allow your foot to "breathe," as shoes that have mesh fabric do. Most people like the feel of a softer shoe, but with the pressure on shoes during exercise, a softer shoe may not last as long as a firmer one.
Think about protection from injuries. Shoes don't have to be very heavy to offer good support. Also, thin or flimsy shoes like canvas sneakers can worsen some problems such as calf or Achilles tendon pain. A shoe whose heel compresses too easily can overstretch your calf. In addition, soles that bend at the ball of the foot, not under the arch, offer better support.
Styles change about every 19 months, and you may not like the new version of your favorite model of shoe. If this happens, a knowledgeable salesperson should be able to help you find a style of athletic shoe comparable to your old favorite.
Regardless of the style, fit is the most important consideration. No matter how good you hear a shoe is, if it doesn't fit you or you're not comfortable with it, don't buy it. No one brand will fit everyone's needs.
How can I get the best fit?
No matter where you go to buy your shoes, try to find a knowledgeable salesperson who understands footwear and will take the time to guide you to the best style and size for you.
Try to shop at the end of the day or after a workout when your feet are generally at their largest. Wear the type of socks you usually wear during exercise, and if you use orthotic devices (orthoses) for your feet, make sure you wear them when you're trying on shoes.
Choose shoes for their fit, not by the size you've worn in the past. It's important to have both the length and width of your feet measured every time you shop for shoes, since foot size often changes with age.
There should be a thumbnail's width (about 1/2 inch) between the longest toe and the end of the shoe on your longer foot. Be sure to have the salesperson check the fit of both shoes for you when you are standing up. If you bend over to check it yourself, you will change the position of your foot in the shoe.
The widest part of your foot should be in the widest part of the shoe. The sides of your foot should not extend over the sole of the shoe, and your foot shouldn't move from side to side inside the shoe.
After you've found a pair that you think fits well, walk or run a little in the store—some stores even have a treadmill for that purpose. The shoes should feel comfortably snug—not tight or too loose—and you should not feel the stitching or seams on the inside of the shoes. Note also whether your toes slide forward or feel pinched together or your heel rises out of the shoe slightly.
Should I buy a shoe designed for my sport?
If you participate in a sport more than three times a week, you should consider a sport-specific shoe. Running shoes are primarily made to absorb shock as the heel strikes the ground. Tennis shoes, in contrast, provide more side-to-side stability. Walking shoes allow the foot to roll and push off naturally during walking. They usually have a fairly rigid arch, a well-cushioned sole, and a stiff heel support for stability.
How much should I pay for athletic shoes?
Most people don't need top-of-the-line models or shoes that cost more than $150. The best values are usually in the middle- to upper-middle price ranges. Beginning exercisers should buy high-quality shoes in this range because their bodies are less adapted to the stress of exercise.
How should I take care of my new shoes?
Let shoes air dry between uses. You can even alternate pairs to ensure thorough drying. Because the insoles in most shoes are made for immediate comfort, not extended use, they often break down quickly. When your original insoles wear through, extend the shoe's life by replacing them with off-the-shelf insoles.
Can my shoes affect my sports performance?
Although a high-quality, well-fitted athletic shoe might make your workout easier, it probably won't fix a mechanical problem with your feet or legs. If you have foot, ankle, or leg pain, a foot imbalance may be at fault, which may be corrected by wearing custom orthotics. Consult a doctor who specializes in athletic injuries.
Four Simple Tests to Assess Your Fitness for All Sports
To perform well in any sport your fitness is very important. Your fitness should be improved steadily throughout the year or season and can be monitored by fitness testing. However which fitness tests should you use and which fitness variables should be measured to monitor your fitness throughout the year.
By repeating tests throughout the year can give you a valid estimate of your progress. If you find your performance is not improving, changes can be made to your training to enhance your fitness. If your fitness is progressing you can gain confidence from knowing your training is successful.
To help you monitor your fitness throughout the year, four tests have been formulated which are easy to perform and can be carried out for a variety of different sports. It is however important that the tests are performed on relatively similar days.
For example running on a cool dry day may provide much different results to performing a test on a hot and humid day. Another example is your mood on a day. You will not produce as good a performance when you are feeling tired as you would on a day when you are feeling great.
At least one day of rest or very easy training should precede each fitness test, and you should always feel fresh and ready to perform at a high level on a fitness testing day.
The four simple tests to assess your fitness are shown below. Make sure you warm up thoroughly before undertaking all the tests:
1. The Six Minute Run
This is an endurance test, which involves running as far as possible in six minutes. This should be performed on a running track with the total distance covered in the six minutes the result of this test. The distance run should gradually improve with training.
The average speed you employ in this test will be very close to your vVO2max (your running velocity at your maximal aerobic capacity) which is known to be one of the very best predictors of endurance performance. If you are not an endurance athlete vVO2max will still predict your endurance capacity on the football pitch, cricket pitch or basketball court, so it is a worthwhile variable to monitor for a variety of athletes.
Non-runners can also use this test. Cyclists, swimmers and rowers can all work as far as they can in six minutes.
Incidentally, if you find that your six-minute test score is not improving over the course of your season, one of the best ways to enhance it is to complete three-minute intervals at your vVO2max (the one you established in your most recent six-minute test).
2. The Hopping Test
Most athletes don’t realize that one of their legs is stronger than the other one and is therefore more injury resistant. This can be easily corrected and therefore improve performance as the weaker leg becomes stronger the athlete will become faster and less injury prone.
To identify the weaker leg the hopping test is used. This involves using a hill with an inclination of about 4-6% and a length from bottom to top of at least 40 meters. Starting from the bottom begin hopping up the hill very quickly on one foot only.
Take 100 hops or as many as you can manage and record this distance covered. Repeat this on the other leg when you are fully recovered.
Over 90% of athletes find a significant difference in the distances covered by their legs, a finding which should not be considered depressing since it actually represents good news: performances can be improved simply by shoring up the poorly performing limb.
To do so, complete the hopping test a couple of times a week, performing extra reps on the weaker leg. Cyclists can perform a similar test on a cycle ergometer by cycling as fast as possible for one minute, using one leg at a time; the poorer performing leg can then be put through extra one-leg exertions.
3. The Gut Check Test
Strength in the core (abdominal and lower back muscles) is very important in all sports. This is because core strength maintains stability of the upper body during movement.
If core strength is poor, the torso tends to move unnecessarily during motion, wasting energy however if core strength is good, an athlete can move with high efficiency. You can test your core strength as follows:
• Assume the prone ‘Chinese-push-up’ position, only your forearms and toes support (the full body weight). Your body should be absolutely linear as you do this and your pelvis tucked (for proper tucking, tighten your butt muscles so that the bottom of your pelvic girdle moves forward or towards the ground);
• Hold the basic position (weight on forearms and toes) for 60 seconds, then lift your right arm off the ground for 15 seconds, supporting your full body weight on your left arm and the toes of both feet (keeping your body linear and your pelvis tucked);
• Return your right arm to the ground and raise your left arm for 15 seconds, again keeping your body in the proper alignment;
• Return your left arm to the ground and raise your right leg for 15 seconds, then return it to the ground and repeat on the other leg;
• Finally, elevate your right arm and left leg simultaneously for 15 seconds, then your left arm and right leg simultaneously for 15 seconds more (don’t try lifting both legs or both arms at the same time!);
• Return to the basic position, and hold for 30 seconds to finish your core test.
If you don’t complete the test, work on this routine four or five times a week until you do and then monitor yourself on a regular basis.
Once you can master the gut check, you will notice your movements will be much more coordinated and stable, and you should be able to run faster
4. The Flying 50 Test
Speed is important in nearly every sport and this test is all about speed. Start with a running start of 20m and then cover 50m as fast as you possibly can (it will be helpful to have a friend or training partner time you with a stop watch).
Over the course of your season, your 50m time should gradually improve. If it doesn’t, you will need to add high speed running drills to your overall program, along with running specific strengthening routines and plyometrics.
By using these four tests you can monitor your endurance capacity, leg strength and power, abdominal strength and speed. This will allow you to monitor your training and fitness improvements.
By repeating tests throughout the year can give you a valid estimate of your progress. If you find your performance is not improving, changes can be made to your training to enhance your fitness. If your fitness is progressing you can gain confidence from knowing your training is successful.
To help you monitor your fitness throughout the year, four tests have been formulated which are easy to perform and can be carried out for a variety of different sports. It is however important that the tests are performed on relatively similar days.
For example running on a cool dry day may provide much different results to performing a test on a hot and humid day. Another example is your mood on a day. You will not produce as good a performance when you are feeling tired as you would on a day when you are feeling great.
At least one day of rest or very easy training should precede each fitness test, and you should always feel fresh and ready to perform at a high level on a fitness testing day.
The four simple tests to assess your fitness are shown below. Make sure you warm up thoroughly before undertaking all the tests:
1. The Six Minute Run
This is an endurance test, which involves running as far as possible in six minutes. This should be performed on a running track with the total distance covered in the six minutes the result of this test. The distance run should gradually improve with training.
The average speed you employ in this test will be very close to your vVO2max (your running velocity at your maximal aerobic capacity) which is known to be one of the very best predictors of endurance performance. If you are not an endurance athlete vVO2max will still predict your endurance capacity on the football pitch, cricket pitch or basketball court, so it is a worthwhile variable to monitor for a variety of athletes.
Non-runners can also use this test. Cyclists, swimmers and rowers can all work as far as they can in six minutes.
Incidentally, if you find that your six-minute test score is not improving over the course of your season, one of the best ways to enhance it is to complete three-minute intervals at your vVO2max (the one you established in your most recent six-minute test).
2. The Hopping Test
Most athletes don’t realize that one of their legs is stronger than the other one and is therefore more injury resistant. This can be easily corrected and therefore improve performance as the weaker leg becomes stronger the athlete will become faster and less injury prone.
To identify the weaker leg the hopping test is used. This involves using a hill with an inclination of about 4-6% and a length from bottom to top of at least 40 meters. Starting from the bottom begin hopping up the hill very quickly on one foot only.
Take 100 hops or as many as you can manage and record this distance covered. Repeat this on the other leg when you are fully recovered.
Over 90% of athletes find a significant difference in the distances covered by their legs, a finding which should not be considered depressing since it actually represents good news: performances can be improved simply by shoring up the poorly performing limb.
To do so, complete the hopping test a couple of times a week, performing extra reps on the weaker leg. Cyclists can perform a similar test on a cycle ergometer by cycling as fast as possible for one minute, using one leg at a time; the poorer performing leg can then be put through extra one-leg exertions.
3. The Gut Check Test
Strength in the core (abdominal and lower back muscles) is very important in all sports. This is because core strength maintains stability of the upper body during movement.
If core strength is poor, the torso tends to move unnecessarily during motion, wasting energy however if core strength is good, an athlete can move with high efficiency. You can test your core strength as follows:
• Assume the prone ‘Chinese-push-up’ position, only your forearms and toes support (the full body weight). Your body should be absolutely linear as you do this and your pelvis tucked (for proper tucking, tighten your butt muscles so that the bottom of your pelvic girdle moves forward or towards the ground);
• Hold the basic position (weight on forearms and toes) for 60 seconds, then lift your right arm off the ground for 15 seconds, supporting your full body weight on your left arm and the toes of both feet (keeping your body linear and your pelvis tucked);
• Return your right arm to the ground and raise your left arm for 15 seconds, again keeping your body in the proper alignment;
• Return your left arm to the ground and raise your right leg for 15 seconds, then return it to the ground and repeat on the other leg;
• Finally, elevate your right arm and left leg simultaneously for 15 seconds, then your left arm and right leg simultaneously for 15 seconds more (don’t try lifting both legs or both arms at the same time!);
• Return to the basic position, and hold for 30 seconds to finish your core test.
If you don’t complete the test, work on this routine four or five times a week until you do and then monitor yourself on a regular basis.
Once you can master the gut check, you will notice your movements will be much more coordinated and stable, and you should be able to run faster
4. The Flying 50 Test
Speed is important in nearly every sport and this test is all about speed. Start with a running start of 20m and then cover 50m as fast as you possibly can (it will be helpful to have a friend or training partner time you with a stop watch).
Over the course of your season, your 50m time should gradually improve. If it doesn’t, you will need to add high speed running drills to your overall program, along with running specific strengthening routines and plyometrics.
By using these four tests you can monitor your endurance capacity, leg strength and power, abdominal strength and speed. This will allow you to monitor your training and fitness improvements.
Sports Nutrition for Vegetarian Athletes
The vegetarian athlete faces many challenges. As all athletes, proper nutrition will directly affect athletic performance. For vegetarians, planning ahead and having variety is essential for proper nutrition and to meet all nutrient needs. The diet must rely on a variety of plant foods including whole grains, fruits, vegetables, nuts, seeds, legumes, and dairy and eggs for some vegetarians. The vegetarian diet may lack adequate energy, protein, calcium, zinc, iron, B6, and B12. All can be obtained with proper planning.
There are several types of vegetarian diets that include:
1) Vegan – Vegans use no animal products at all.
2) Lacto-ovo Vegetarian – Vegetarians that use dairy and eggs.
3) Lacto vegetarian – Vegetarians that use dairy.
4) Semi Vegetarians – Those that just avoid meats and maybe chicken but eat fish and dairy.
ENERGY NEEDS
The primary concern for the vegetarian athlete is obtaining adequate energy and protein, the group most at risk of this is the vegan. As in all athletes, needs for energy and protein are higher than the non-athlete. A high carbohydrate diet is essential to optimize muscle glycogen stores, which are the preferred source of energy during prolonged activity.
Usually protein intake in the vegetarian athlete is lower than the meat-eating athlete and carbohydrate will then need to be 60-65 percent of total calories so protein is not used for energy. Depending on the activity and duration 6-10 grams (gm) of carbohydrate per kilogram (1 kg) (1 kg = 2.2 pounds) of body weight is practiced. This will spare protein from being used as an energy source, carbohydrates in the vegetarian diet come from whole grains, beans and legumes (which are also a protein source), fruits, vegetables and dairy if the athlete is not a vegan.
PROTEIN NEEDS
It is crucial to obtain adequate carbohydrate for energy so protein is not used as an energy source. Protein is needed for tissue repair, building and repairing muscles, building red blood cells and synthesizing hormones and enzymes. Protein requirements are no different for the vegetarian athlete: 1.2 to 2 gm protein per kg of body weight is practiced depending on sport and duration.
A concern with plant protein is not all plants have all nine essential amino acids, while meats and animal proteins are considered complete and have all the essential amino acids. Amino acids make up proteins; the individual amino acids are what our bodies need when we eat proteins. Research shows that as long as a variety of plant proteins are eaten through out the day there is no problem obtaining all amino acids. What one vegetable protein is missing another supplies. Soy protein provides all essential amino acids, and can be an important protein of vegetarian diets that use no animal products.
The vegetarian athlete must make sure protein is taken through the day from sources such as beans and legumes, including soy, nuts and seeds, and whole grains. Dairy and eggs will supply complete proteins if used.
Vegetarian diets are higher in branched chain amino acids
Branched chain amino acids (BCAA) are used by muscle during activity. They are supplements to prevent protein breakdown and help muscles recover quicker. If glycogen stores are low, the use of protein for energy increases. The BCAA are readily available to muscle for energy.
MINERAL NEEDS
Calcium
Calcium is essential for all athletes but a vegan needs to plan sources from plants or supplement in the diet. Athletes with low dietary calcium may have increased risk of bone fractures and stress fractures. Athletes with poor diets and eating disorders may also have early signs of thinning bones and osteoporosis. I recommend that most vegetarian athletes aim for 1,000 milligram (mg) of calcium day through diet and/or supplements.
Food Calcium mg
Bok choy 1/2 cup (c) 79
Broccoli 1/2 c 36
Kale 1/2 c 90
Chick peas 1/2 c 40
Soybeans 1/2 c 86
Tempeh 1/2 c 85
Tofu calcium set 1/2 c 258
Almonds 1/2 c 94
Tahini 2 tablespoons (tbsp) 128
Blackstrap molasses 2 tbsp 274
soymilk – fortified 1 c 200-500
Milk – all varieties 1 c 300
Yogurt 1 c 400
Iron
All athletes, especially female athletes are at risk of iron deficiency. Iron loss is increased during heavy training. Iron is an essential part of red blood cells that helps transport oxygen to your muscles. The main symptoms of deficiency in an athlete are weakness and rapid fatigue upon exertion. Vegetarian sources of iron are less well absorbed than meat sources. Therefore, it is important to look for grains and cereals that have been fortified with iron.
Vitamin C significantly improves iron absorption; a diet high in fruits and vegetables or simply taking a vitamin C supplement with meals may help. Cooking in cast iron pots may also help increase the iron content of foods. Eighteen mg of iron per day should be the goal for the female vegetarian athlete.
Food Iron mg
Soybeans 1/2 c 2.7
Lentils 1/2 c 1.6
Oatmeal 1 c 1.7
Broccoli 1 c
Sunflower seeds 1 ounces (oz) 1.4
Almond 1oz 2.2
Prunes 5 1.3
Dates 5 1.7
Egg 1 1.5
Blackstrap molasses 2 tbsp .7
Zinc 6
Low Zinc levels have been reported in athletes with heavy training. It is a component of all cells in the body and a component of over 200 enzymes. Zinc can be obtained from vegetarian sources such as pumpkin seeds, pecans, split peas, Brazil nuts, rye, whole wheat, oats, peanuts, walnuts, almonds, lima beans and buckwheat.
VITAMIN NEEDS
Riboflavin B2 and B12 are two B-vitamins to be concerned about in the vegetarian diet.
Riboflavin intake is low in vegans, mainly because there are no dairy products consumed. Riboflavin is essential for the production of energy and therefore essential to athletic performance. Plant sources include fortified whole grains, soybeans, dark green leafy vegetables, avocados, nuts and sea vegetables.
B12 is needed for production of normal red blood cells and deficiency can result in anemia. B12 can only be found in animal products. The semi vegetarian that eats fish and dairy will probably obtain adequate B12. Vegans need to supplement through a B12 supplement, nutritional yeast, fortified grains, soymilk and meat analogs.
QUICK AND EASY VEGETARIAN MEAL IDEAS
Breakfast: a) fortified wholegrain cereal like oatmeal with sunflower seeds, dates, and soymilk; b) sprouted whole grain bread with almond butter, honey, and raisins with soymilk and fresh fruit; and c) yogurt with berries, nuts, seeds, dried fruit and wheat germ.
Lunch: a) black beans in a whole grain tortilla with soy cheese, yogurt and fresh fruit; b) bean salads; c) grilled tofu with vegetables in a pita; and d) large mixed green salads with beans, nuts, seeds, avocado and brown rice.
Dinner: a) spaghetti sauce with lentils, chick peas, or “meatless meatballs” made from textured soy protein with a brown rice or whole wheat spaghetti, broccoli and large mixed green salad; b) veggie stir fry with tofu or tempeh, cashew and peanuts and brown rice; and c) homemade veggie burgers on a sprouted grain bun.
Snacks: nuts, seeds, dried fruits, fresh fruits, multigrain cereals, fruit smoothies made with fortified soymilk, rice milk, or almond milk, sports bars fortified with calcium and iron.
BENEFITS OF THE VEGETARIAN DIET
The benefits of a plant-based diet are numerous. Plants are packed with vitamins and minerals, thousands of phytochemicals that are related to preventing long term disease. It is high in antioxidants essential for the athlete putting constant stress on the body. BCAA are abundant in plant protein, and BCAA are used to fuel muscles and help with muscle recovery. It is usually high in essential fats from plants including omega-3’s, omega-6’s and more. These are crucial to keeping the immune system strong and maintaining healthy joints. With proper planning, the vegetarian can have a healthy diet that meets nutrient needs for athletic performance as well as for disease prevention.
For more information: visit www.vrg.org, www.soyfoods.com, and www.eatright.org.
Toasted Pecan & Mushroom Burger
Makes 4 burgers. One serving: calories 294, carbohydrate 12 grams (gm), protein 8 gm, fat 25 gm, calcium 126 gm, iron 1.9 gm. Source: Jeanette Parsons Egan, Soy Soy Soy Cookbook.
1 cup extra firm tofu
1 tablespoon olive oil
1/2 cup finely chopped onion
1/2 cup shredded carrot
1 garlic clove, minced
1 cup finely chopped mushrooms
1 tablespoon sherry
2 tablespoons ketchup
1 tablespoon Dijon mustard
1 teaspoon dried thyme
Dash of hot pepper sauce
1 cup toasted pecans, chopped fine
Preheat oven to 400 degrees Fahrenheit. Crumble tofu with a fork and place between paper towels to dry. Heat olive oil in a skillet over medium heat. Add onion, carrot, garlic and cook until vegetables begin to soften, about 5 minutes. Add mushrooms and cook until moisture evaporates. In a food processor, combine tofu, vegetable mixture, and all remaining ingredients. Pulse until mixed. Shape into 4 patties. Bake on a sheet with non-stick cooking spray until lightly browned 15-20 minutes.
There are several types of vegetarian diets that include:
1) Vegan – Vegans use no animal products at all.
2) Lacto-ovo Vegetarian – Vegetarians that use dairy and eggs.
3) Lacto vegetarian – Vegetarians that use dairy.
4) Semi Vegetarians – Those that just avoid meats and maybe chicken but eat fish and dairy.
ENERGY NEEDS
The primary concern for the vegetarian athlete is obtaining adequate energy and protein, the group most at risk of this is the vegan. As in all athletes, needs for energy and protein are higher than the non-athlete. A high carbohydrate diet is essential to optimize muscle glycogen stores, which are the preferred source of energy during prolonged activity.
Usually protein intake in the vegetarian athlete is lower than the meat-eating athlete and carbohydrate will then need to be 60-65 percent of total calories so protein is not used for energy. Depending on the activity and duration 6-10 grams (gm) of carbohydrate per kilogram (1 kg) (1 kg = 2.2 pounds) of body weight is practiced. This will spare protein from being used as an energy source, carbohydrates in the vegetarian diet come from whole grains, beans and legumes (which are also a protein source), fruits, vegetables and dairy if the athlete is not a vegan.
PROTEIN NEEDS
It is crucial to obtain adequate carbohydrate for energy so protein is not used as an energy source. Protein is needed for tissue repair, building and repairing muscles, building red blood cells and synthesizing hormones and enzymes. Protein requirements are no different for the vegetarian athlete: 1.2 to 2 gm protein per kg of body weight is practiced depending on sport and duration.
A concern with plant protein is not all plants have all nine essential amino acids, while meats and animal proteins are considered complete and have all the essential amino acids. Amino acids make up proteins; the individual amino acids are what our bodies need when we eat proteins. Research shows that as long as a variety of plant proteins are eaten through out the day there is no problem obtaining all amino acids. What one vegetable protein is missing another supplies. Soy protein provides all essential amino acids, and can be an important protein of vegetarian diets that use no animal products.
The vegetarian athlete must make sure protein is taken through the day from sources such as beans and legumes, including soy, nuts and seeds, and whole grains. Dairy and eggs will supply complete proteins if used.
Vegetarian diets are higher in branched chain amino acids
Branched chain amino acids (BCAA) are used by muscle during activity. They are supplements to prevent protein breakdown and help muscles recover quicker. If glycogen stores are low, the use of protein for energy increases. The BCAA are readily available to muscle for energy.
MINERAL NEEDS
Calcium
Calcium is essential for all athletes but a vegan needs to plan sources from plants or supplement in the diet. Athletes with low dietary calcium may have increased risk of bone fractures and stress fractures. Athletes with poor diets and eating disorders may also have early signs of thinning bones and osteoporosis. I recommend that most vegetarian athletes aim for 1,000 milligram (mg) of calcium day through diet and/or supplements.
Food Calcium mg
Bok choy 1/2 cup (c) 79
Broccoli 1/2 c 36
Kale 1/2 c 90
Chick peas 1/2 c 40
Soybeans 1/2 c 86
Tempeh 1/2 c 85
Tofu calcium set 1/2 c 258
Almonds 1/2 c 94
Tahini 2 tablespoons (tbsp) 128
Blackstrap molasses 2 tbsp 274
soymilk – fortified 1 c 200-500
Milk – all varieties 1 c 300
Yogurt 1 c 400
Iron
All athletes, especially female athletes are at risk of iron deficiency. Iron loss is increased during heavy training. Iron is an essential part of red blood cells that helps transport oxygen to your muscles. The main symptoms of deficiency in an athlete are weakness and rapid fatigue upon exertion. Vegetarian sources of iron are less well absorbed than meat sources. Therefore, it is important to look for grains and cereals that have been fortified with iron.
Vitamin C significantly improves iron absorption; a diet high in fruits and vegetables or simply taking a vitamin C supplement with meals may help. Cooking in cast iron pots may also help increase the iron content of foods. Eighteen mg of iron per day should be the goal for the female vegetarian athlete.
Food Iron mg
Soybeans 1/2 c 2.7
Lentils 1/2 c 1.6
Oatmeal 1 c 1.7
Broccoli 1 c
Sunflower seeds 1 ounces (oz) 1.4
Almond 1oz 2.2
Prunes 5 1.3
Dates 5 1.7
Egg 1 1.5
Blackstrap molasses 2 tbsp .7
Zinc 6
Low Zinc levels have been reported in athletes with heavy training. It is a component of all cells in the body and a component of over 200 enzymes. Zinc can be obtained from vegetarian sources such as pumpkin seeds, pecans, split peas, Brazil nuts, rye, whole wheat, oats, peanuts, walnuts, almonds, lima beans and buckwheat.
VITAMIN NEEDS
Riboflavin B2 and B12 are two B-vitamins to be concerned about in the vegetarian diet.
Riboflavin intake is low in vegans, mainly because there are no dairy products consumed. Riboflavin is essential for the production of energy and therefore essential to athletic performance. Plant sources include fortified whole grains, soybeans, dark green leafy vegetables, avocados, nuts and sea vegetables.
B12 is needed for production of normal red blood cells and deficiency can result in anemia. B12 can only be found in animal products. The semi vegetarian that eats fish and dairy will probably obtain adequate B12. Vegans need to supplement through a B12 supplement, nutritional yeast, fortified grains, soymilk and meat analogs.
QUICK AND EASY VEGETARIAN MEAL IDEAS
Breakfast: a) fortified wholegrain cereal like oatmeal with sunflower seeds, dates, and soymilk; b) sprouted whole grain bread with almond butter, honey, and raisins with soymilk and fresh fruit; and c) yogurt with berries, nuts, seeds, dried fruit and wheat germ.
Lunch: a) black beans in a whole grain tortilla with soy cheese, yogurt and fresh fruit; b) bean salads; c) grilled tofu with vegetables in a pita; and d) large mixed green salads with beans, nuts, seeds, avocado and brown rice.
Dinner: a) spaghetti sauce with lentils, chick peas, or “meatless meatballs” made from textured soy protein with a brown rice or whole wheat spaghetti, broccoli and large mixed green salad; b) veggie stir fry with tofu or tempeh, cashew and peanuts and brown rice; and c) homemade veggie burgers on a sprouted grain bun.
Snacks: nuts, seeds, dried fruits, fresh fruits, multigrain cereals, fruit smoothies made with fortified soymilk, rice milk, or almond milk, sports bars fortified with calcium and iron.
BENEFITS OF THE VEGETARIAN DIET
The benefits of a plant-based diet are numerous. Plants are packed with vitamins and minerals, thousands of phytochemicals that are related to preventing long term disease. It is high in antioxidants essential for the athlete putting constant stress on the body. BCAA are abundant in plant protein, and BCAA are used to fuel muscles and help with muscle recovery. It is usually high in essential fats from plants including omega-3’s, omega-6’s and more. These are crucial to keeping the immune system strong and maintaining healthy joints. With proper planning, the vegetarian can have a healthy diet that meets nutrient needs for athletic performance as well as for disease prevention.
For more information: visit www.vrg.org, www.soyfoods.com, and www.eatright.org.
Toasted Pecan & Mushroom Burger
Makes 4 burgers. One serving: calories 294, carbohydrate 12 grams (gm), protein 8 gm, fat 25 gm, calcium 126 gm, iron 1.9 gm. Source: Jeanette Parsons Egan, Soy Soy Soy Cookbook.
1 cup extra firm tofu
1 tablespoon olive oil
1/2 cup finely chopped onion
1/2 cup shredded carrot
1 garlic clove, minced
1 cup finely chopped mushrooms
1 tablespoon sherry
2 tablespoons ketchup
1 tablespoon Dijon mustard
1 teaspoon dried thyme
Dash of hot pepper sauce
1 cup toasted pecans, chopped fine
Preheat oven to 400 degrees Fahrenheit. Crumble tofu with a fork and place between paper towels to dry. Heat olive oil in a skillet over medium heat. Add onion, carrot, garlic and cook until vegetables begin to soften, about 5 minutes. Add mushrooms and cook until moisture evaporates. In a food processor, combine tofu, vegetable mixture, and all remaining ingredients. Pulse until mixed. Shape into 4 patties. Bake on a sheet with non-stick cooking spray until lightly browned 15-20 minutes.
ATHLETIC EXCELLENCE THROUGH CHIROPRACTIC
CHIROPRACTIC RESEARCH AND ATHELETIC PERFORMANCE.
The January 1991 issue of the Journal of Chiropractic Research and Clinical Investigation published findings that demonstrate significant increases in athletic performance after a twelve week program of Chiropractic treatment.
Male and female athletes between the ages of 18 and 42, representing a variety of sports backgrounds, were recruited to participate in the study. None had ever before been under chiropractic care. Each of these participants underwent eleven separate tests, each test designed to measure a specific aspect of athletic performance. Then, half the participants were analyzed chiropractically and placed on a twelve week program of chiropractic treatment.
All subjects continued to train and practice as usual. At the half-way point of six weeks, they were all reevaluated and changes in scores for each group were compared. All increases in performances by each group were measured by the average percent of change of all eleven tests combined.
The control group, those not receiving chiropractic care, showed slight improvement in eight of eleven tests. By combining the average percentages of change on each test it was found that the control group showed an overall improvement of 4.5%.
Those receiving chiropractic treatment, the test group, had dramatically different results. They showed improvement on all eleven tests for a total 10.7% average increase after six weeks. And when retested again after the second six week period of care this test group demonstrated a remarkable 16.7% average increase in athletic ability.
FAMOUS ATHLETES UTILISE CHIROPRACTIC
Today, many athletes are discovering the relationship between proper spinal mechanics, alignment and their own level of achievement. San Francisco Forty-Niners Joe Montana and Roger Craig as well as heavyweight champion Evander Holyfield are just three of the growing number of professional and world-class athletes who utilize the value of proper spinal mechanics and balance in their bodies. They have learned through their own experiences what research has shown; that with chiropractic care, one can demonstrate faster reaction time, better balance, improved coordination and increased muscular power.
THE COMPETITIVE EDGE
Emphasis on athletic excellence continues to escalate in this country in terms of both dollars and extremes in personal sacrifice. Though the dangers of taking anabolic steroids have been widely publicized for years, the number of young athletes who suffer serious health problems caused by steroids continues to grow. Now, however, the athlete looking for the competitive edge need not look beyond the framework of his own body. Increasing public awareness is leading to many to realize that a natural method is available for achieving performance enhancement. That method is Sports Chiropractic! VISIT US TODAY AND SEE HOW WE CAN IMPROVE YOUR PERFORMANCE!
The January 1991 issue of the Journal of Chiropractic Research and Clinical Investigation published findings that demonstrate significant increases in athletic performance after a twelve week program of Chiropractic treatment.
Male and female athletes between the ages of 18 and 42, representing a variety of sports backgrounds, were recruited to participate in the study. None had ever before been under chiropractic care. Each of these participants underwent eleven separate tests, each test designed to measure a specific aspect of athletic performance. Then, half the participants were analyzed chiropractically and placed on a twelve week program of chiropractic treatment.
All subjects continued to train and practice as usual. At the half-way point of six weeks, they were all reevaluated and changes in scores for each group were compared. All increases in performances by each group were measured by the average percent of change of all eleven tests combined.
The control group, those not receiving chiropractic care, showed slight improvement in eight of eleven tests. By combining the average percentages of change on each test it was found that the control group showed an overall improvement of 4.5%.
Those receiving chiropractic treatment, the test group, had dramatically different results. They showed improvement on all eleven tests for a total 10.7% average increase after six weeks. And when retested again after the second six week period of care this test group demonstrated a remarkable 16.7% average increase in athletic ability.
FAMOUS ATHLETES UTILISE CHIROPRACTIC
Today, many athletes are discovering the relationship between proper spinal mechanics, alignment and their own level of achievement. San Francisco Forty-Niners Joe Montana and Roger Craig as well as heavyweight champion Evander Holyfield are just three of the growing number of professional and world-class athletes who utilize the value of proper spinal mechanics and balance in their bodies. They have learned through their own experiences what research has shown; that with chiropractic care, one can demonstrate faster reaction time, better balance, improved coordination and increased muscular power.
THE COMPETITIVE EDGE
Emphasis on athletic excellence continues to escalate in this country in terms of both dollars and extremes in personal sacrifice. Though the dangers of taking anabolic steroids have been widely publicized for years, the number of young athletes who suffer serious health problems caused by steroids continues to grow. Now, however, the athlete looking for the competitive edge need not look beyond the framework of his own body. Increasing public awareness is leading to many to realize that a natural method is available for achieving performance enhancement. That method is Sports Chiropractic! VISIT US TODAY AND SEE HOW WE CAN IMPROVE YOUR PERFORMANCE!
Active People and Water Needs
What do I need water for anyway?
Adequate amounts of water are essential for proper circulation of nutrients to organs and cells throughout the body. Water regulates body temperature, it is important in removal of cellular and digestive waste. Proper water levels aid body tissues heal following an injury, and proper levels of hydration are important to maintain athletic performance and as well as concentration skills.
Exercising in the heat, indoors and outdoors, and exercising for long periods of time should alert you to drink even more than your thirst suggests. Thirst is not an accurate indicator of how much water your body needs.
What happens if I don't drink enough water?
Even small amount of dehydration may affect your performance, stamina and concentration. Muscle cramps are an indication of tired muscles with inadequate amounts of water available to promote recovery. Avoid muscle cramps by making certain you drink plenty of water hours before you actually need it. In addition, dehydration may affect heart function, make you dizzy or weak. Bigger athletes and the hardest working athletes need more water to ensure that their “engines don’t overheat”.
Do I need salt tablets?
The body knows how much salt it requires and the kidneys will conserve salts (sodium and potassium) as it deems necessary. Conditioned athletes will lose less salt in their perspiration as the body holds onto these minerals. With a balanced diet, what needs to be replaced is the fluid to circulate the salts. So, drink, drink, and drink; you can probably leave the salt alone.
How much water and how often?
Drink plenty of cold fluids before, during and after exercise and work outdoors remembering that cold fluids empty from the stomach fastest. Plan ahead and drink 14 to 20 ounces of cold fluids before you start to exercise or work outdoors. Frequent small water breaks during a workout will get water to working muscles better than only one large water break. Remember that water deficiencies add up from day to day and may affect you after a period of time.
During prolonged exercise in the heat, water losses as little as 2 percent of your body weight will affect circulation, heat dissipation and your performance. Develop the habit of drinking enough during practices as well as during competition.
What type of fluid is best?
Several factors enter into answering this question. The two most important, regardless of your personal reasons for choosing your drink, are how fast the fluid is emptied from the stomach and how well it is absorbed from the intestines to become available to working muscles. A general rules to remember is the greater the number of calories in the drink the slower it empties from the stomach. Drinks with slight sugar contents (6 percent) have the ability to move almost as quickly as water. This is important in endurance activities and in repeated daily workouts as a source of both fluid and energy replacement. If you exercise less than one hour, water is sufficient since muscle and blood generally have enough stored energy for exercise bouts less than sixty minutes.
Guidelines for choosing a sports drink
The type of drink you choose to consume before, during and after exercise is based on factors such as cost, availability , and taste preference. Educated athletes will find drinks that don’t cause gastrointestinal distress as well as the sodium content, absorption rate and performance enhancement properties of various commercial sports drinks.
Signs of heat distress
Heat illness may occur over time. Signs and symptoms include fatigue, weakness, irritability, mental confusion and nausea. To monitor adequate fluid replacement, active people should weigh themselves before and after exercise. Immediate weight loss is water; 1 pint of fluid is needed to replace every pound lost due to water. Don’t assume that weight loss in hot weather is all fat loss; it may be due to water loss and inadequate replacement can set you up for heat illness.
Fluid tips to remember
• Cold drinks are encouraged even when exercising.
• Adequate amounts of fluid are vital for the body to control heat buildup during exercise.
• Indoor exercise can produce the same symptoms of heat distress as outdoor activities.
• Heat distress can be life threatening. Be aware that quick weight loss due to exercise may be mostly water.
• Typically, most diets contain adequate amounts of salt. Salt tablets are useful only for certain individuals who are on restricted diets or who exercise in hot weather repeatedly.
• Be aware of which drink does not cause you distress during exercise. High calorie drinks generally leave the stomach slowly.
• Plan ahead. Anticipate heat and be pre- pared with cold drinks when exercising.
Adequate amounts of water are essential for proper circulation of nutrients to organs and cells throughout the body. Water regulates body temperature, it is important in removal of cellular and digestive waste. Proper water levels aid body tissues heal following an injury, and proper levels of hydration are important to maintain athletic performance and as well as concentration skills.
Exercising in the heat, indoors and outdoors, and exercising for long periods of time should alert you to drink even more than your thirst suggests. Thirst is not an accurate indicator of how much water your body needs.
What happens if I don't drink enough water?
Even small amount of dehydration may affect your performance, stamina and concentration. Muscle cramps are an indication of tired muscles with inadequate amounts of water available to promote recovery. Avoid muscle cramps by making certain you drink plenty of water hours before you actually need it. In addition, dehydration may affect heart function, make you dizzy or weak. Bigger athletes and the hardest working athletes need more water to ensure that their “engines don’t overheat”.
Do I need salt tablets?
The body knows how much salt it requires and the kidneys will conserve salts (sodium and potassium) as it deems necessary. Conditioned athletes will lose less salt in their perspiration as the body holds onto these minerals. With a balanced diet, what needs to be replaced is the fluid to circulate the salts. So, drink, drink, and drink; you can probably leave the salt alone.
How much water and how often?
Drink plenty of cold fluids before, during and after exercise and work outdoors remembering that cold fluids empty from the stomach fastest. Plan ahead and drink 14 to 20 ounces of cold fluids before you start to exercise or work outdoors. Frequent small water breaks during a workout will get water to working muscles better than only one large water break. Remember that water deficiencies add up from day to day and may affect you after a period of time.
During prolonged exercise in the heat, water losses as little as 2 percent of your body weight will affect circulation, heat dissipation and your performance. Develop the habit of drinking enough during practices as well as during competition.
What type of fluid is best?
Several factors enter into answering this question. The two most important, regardless of your personal reasons for choosing your drink, are how fast the fluid is emptied from the stomach and how well it is absorbed from the intestines to become available to working muscles. A general rules to remember is the greater the number of calories in the drink the slower it empties from the stomach. Drinks with slight sugar contents (6 percent) have the ability to move almost as quickly as water. This is important in endurance activities and in repeated daily workouts as a source of both fluid and energy replacement. If you exercise less than one hour, water is sufficient since muscle and blood generally have enough stored energy for exercise bouts less than sixty minutes.
Guidelines for choosing a sports drink
The type of drink you choose to consume before, during and after exercise is based on factors such as cost, availability , and taste preference. Educated athletes will find drinks that don’t cause gastrointestinal distress as well as the sodium content, absorption rate and performance enhancement properties of various commercial sports drinks.
Signs of heat distress
Heat illness may occur over time. Signs and symptoms include fatigue, weakness, irritability, mental confusion and nausea. To monitor adequate fluid replacement, active people should weigh themselves before and after exercise. Immediate weight loss is water; 1 pint of fluid is needed to replace every pound lost due to water. Don’t assume that weight loss in hot weather is all fat loss; it may be due to water loss and inadequate replacement can set you up for heat illness.
Fluid tips to remember
• Cold drinks are encouraged even when exercising.
• Adequate amounts of fluid are vital for the body to control heat buildup during exercise.
• Indoor exercise can produce the same symptoms of heat distress as outdoor activities.
• Heat distress can be life threatening. Be aware that quick weight loss due to exercise may be mostly water.
• Typically, most diets contain adequate amounts of salt. Salt tablets are useful only for certain individuals who are on restricted diets or who exercise in hot weather repeatedly.
• Be aware of which drink does not cause you distress during exercise. High calorie drinks generally leave the stomach slowly.
• Plan ahead. Anticipate heat and be pre- pared with cold drinks when exercising.
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