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Research released last week shows that thousands of knee operations may be no more effective than prescriptive knee exercises. Knee surgery (arthroscopy) is currently the most common operation used to try to fix knee problems for British people in middle age. This keyhole surgery is most commonly used to repair a torn meniscus – the cartilage between the knee joint – and it is used in 150,000 operations on middle aged knees each year.
In the operation, surgeons use an arthroscope, a tiny camera on the end of a tube, to enter the knee while they carry out the surgery through other small incisions. The process usually takes around an hour and patients can return home the same day. However, one of the problems is that the simplicity of the operation means that it has become an option for patients who wouldn’t have been considered for surgery in the past.
The study, undertaken by Oslo University Hospital and the University of Southern Denmark, compared patients who had undergone the operation compared with others who had done a 12 week strengthening programme helped by a trainer. After the 3 month trial period, the 140 patients were assessed, and the non-surgery group were found to be performing better and with lower levels of discomfort.
The authors of the study, published in the British Medical Journal noted that ‘Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term.’
A separate piece in the same journal claimed that there was growing evidence that surgeries are still being done despite new research showing exercise to be just as, if not more effective.
Teppo Jarvinen, from the University of Helsinki, and Gordon Guyatt, of McMaster University in Ontario, said: ‘What we should not do is allow the orthopaedic community … to ignore the results of rigorous trials and continue widespread use of procedures for which there has never been compelling evidence.”
At Diets Don’t Work, having had first hand experience of a wide variety of age and sporting related injuries, we can also concur that surgery should only be considered once all other options – physical rehabilitation, training and treatment – have been throughly exhausted. Although it does have it’s place and can resolve some conditions that exercise and therapy cannot, in most cases a similar or better outcome can be had through exercise and rehabilitation.
You may have heard people talk about a rotator cuff injury and rehabilitation; it’s one of the most common injuries to the shoulder for in both sport and everyday life. Here’s a look at what the rotator cuff actually is, how it works, how it gets injured and how to do a successful rehabilitation.
The definition of the rotator cuff is “A tough sheath of tendons and ligaments that supports the arm at the shoulder joint”. The shoulder is an amazing joint – it can swing a tennis racket, reach behind your back, get things down from shelves and help you to play the piano. It is very mobile and dextrous. But this mobility comes at a price – stability. Unlike the hip joint, which very stable and has a much more restricted range of movement – you can’t get your foot above your head, unless you’re an ice dancer- the shoulder sacrifices stability for mobility. It can do lots. But to allow for all this movement, the shoulder is very unstable. Step in the rotator cuff. Just like the name, these 4 muscles are a natural stabilising cuff that prevent the shoulder from dislocating. If we didn’t have one, when we threw a ball our shoulder would dislocate.
The rotator cuff is made up of four smaller muscles that attach to four points on the outside of the shoulder. They are the sub-scapularis, supraspinatus, infraspinatus and teres minor. Together they help to pull the shoulder in towards you so that it stays in place.
One of the most common causes of shoulder pain, rotator cuff injuries can be both sudden onset and also degenerative. Because of the complexity of the joint and the small spaces that the muscles have to go through, wear and tear over time can cause impingement (rubbing or wearing down) of muscle fibres. This is particularly common for people who do repetitive overhead movements of the arm. In these movements the rotator cuff has to go back on itself, rubbing and impinging on bone and tissue, causing injury.
Injuries can also be more sudden, especially in overhead weighted exercises like the shoulder press.
Rotator cuff injuries are quite easy to spot. symptoms include:
Pain and swelling on the front of the shoulder and side of the arm; this can be vague and hard to pinpoint
Pain on raising and lowering the arm
Stiffness and pain when sleeping
Pain when reaching overhead, e.g. to get something from a high cupboard
Pain when reaching behind you, e.g. putting on a seatbelt.
There are also some quite specific tests that a well qualified PT or physiotherapist can do to identify which part of the rotator cuff you have injured.
In any injury there are three phases; the inflammatory or acute phase, the proliferation phase and the chronic or remodelling phase. During the inflammatory phase (0-48 hours after injury) patient should RICED. That’s rest, ice, compression, elevation and drugs (like ibuprofen). In the remodelling phase (48 hours-21 days after injury) RICED can continue but it’s time to start rehab exercises. Massage can also help to ensure that scar tissue is broken down and new fibres are laid down in line with tensile stress. Otherwise this scar tissue will become a site of weakness. In the chronic stage the rehab exercises can become more challenging and complex. The exercises can now also challenge the muscles around and supporting the injury.
In some cases surgery may be required to remove any impingement to the rotator cuff. This is called a sub-acromial decompression (basically removal of debris and crud that is in the way of the rotator cuff). It os the most common shoulder operation in the UK.
In any rehab, exercise should follow the order of passive (someone moves the joint for you), active (you move the joint) and then resisted. It’s always better to start with a light resistance and more repetitions and then build up as you go.
Hectic lifestyles and a lack of sleep have been linked this week to increased eating, a range of diseases, DNA changes and heart disease. Those sleeping less than 6 hours a night have been found to be 12% more likely to die prematurely according to a combination of new studies.
Research from the University of Warwick has found that failing to get enough sleep can have deadly consequences, not just increasing the risk of heart attack and stroke, but encouraging obesity too.
Modern middle age has created a “perfect storm” for sleep deprivation, said the scientists. A combination of having children later in life, late night use of smart phones and tablets, hectic work pressures, increased alcohol consumption at home and late night eating all contribute to either lack of sleep or lack of good quality sleep.
Sleep deprivation upsets our hormonal balance, producing more cortisol, our “stress” hormone and also upsets the balance of the hormones leptin and ghrelin, which regulate appetite and help us to know when we have eaten enough. A University of Surrey study meanwhile has found that lack of sleep can change 700 genes, explaining the wide ranging health consequences of sleep deprivation.
In an effort to help, the UK government has come up with great tips for better sleep:
Other great tips for better sleep are:
Remember that “catching up on sleep” does not work; once it’s missed, it’s missed.
Coffee is one of the most popular drinks in the world, with a Costa or starbucks opening on every street corner it would seem. People spend time and effort trying to stay in shape bbd keeping slim by watching what they eat; often though we neglect the calories hidden in liquids that we drink so often.
That cappuccino on the way to work may well be sabotaging your weight loss. Just a single drink from Starbucks could be as much as 50% of the calorie allowance for a female trying to lose weight. Recent reports from the World cancer Research Fund says “these types of drinks as an occasional treat won’t do you much harm. But if you are having them regularly then they will increase the chances of you becoming overweight, which in turn increases your risk of developing cancer as well as other diseases such as diabetes and heart disease”.
Here are some of the worst culprits from just one chain, Starbucks, and just for interest, some fast food equivalents. It can help to reduce intake (or for you to make better choices) if you make a strong mental link with an unhealthy food that correlates with the energy in your latte.
1. Venti signature hot chocolate with whipped cream and whole milk – 690 calories (Supersize bigmac and fries)
2. Venti white chocolate mocha with whipped cream and skimmed milk – 624 calories (big mac with normal fries)
3. Venti iced hazelnut mocha with whipped cream and semi skimmed milk – 599 calories (supoersixe quarter pounder with cheese and fries)
4. Grande signature hot chocolate with whole milk – 556 calories (big mac)
5. Venti peppermint mocha with whipped cream, drizzle and whole milk – 555 calories (same as a Big Mac)
6. Venti strawberries and cream frappucino with whipped cream – 459 calories (double cheeseburger and fries)
There are of course lots of options for making healthier choices, with just as much caffeine in.
This strong after-meal beverage is traditionally served as a single shot of strong black coffee with no milk. It contains around 80 to 100mg of caffeine, no protein, and around five calories.
Dietitian Catherine Collins of London’s St George’s Hospital says: ‘An espresso has no nutritional value, but for those who want to lose weight it is low in calories. The high dose of caffeine should give you a good kick to last you throughout the afternoon.’
Our health rating: 3/5
Cappuccino is an espresso topped with a generous amount of steamed milk made from full or skimmed milk. It contains about six grammes of protein from milk, a small amount of sodium and 150 calories when made with whole milk and 95 calories when made with skimmed milk.
Although a cappuccino is not best for those looking to lose weight as it is quite calorific, the large amount of milk provides a good source of protein and calcium which is important for bone health and will also help to maintain lean muscle mass.
Our health rating: 4/5
A latte is made from an espresso and much more steamed milk than a cappuccino. Each contains around ten grammes of protein from milk, five grammes of fat – the equivalent to a single butter pack – and around 225 calories when made with whole milk and 135 when made with skimmed milk. Again the protein and calcium content will help offset any sugars.
Coffee and tea
No calories, provided that you don’t have any sugar. If you must have some sweetness then feel free to cheat and have a sweetener. Plant based ones are the least unhealthy, like Stevia based sweeteners.
Our health rating – 4/5
By Adam Atkinson
Out this week is the news that yet another study has shown that waist measurement, as opposed to weight, is the most important guide to health and longevity.
Researchers have come up with a simple formula to deduce how long a person will live for, and how many years you will lose if you are overweight. Measure your waist (without breathing in). If this measurement is half your height or less than you should live to the average life expectancy of 81 in the UK. However, every inch that you are over will represent time that you will have cut off your life. So if a 30 year old man who is 5’10’’ has a waist measurement of 35 inches then he will be likely to live to the age of 81. But, if his waist is 42 inches than his life expectancy drops by 1.7 years. As people get closer to obesity, so the equation becomes more harsh. If the same man has a waist of 56 inches then he loses 20 years, dying at the age of 61.
The research by the Cass Business School in London was based on the medical records of 300,000 adults over 20 years. A high waist circumference is also considered to be a useful indicator of high cholesterol, probability of suffering from diabetes and a higher likelihood of heart disease.
Ongoing assessments with a DDW personal trainer includes body fat %, waist to height measurements and of course structured exercise coupled with healthy eating. This will ensure that you go well past the average 81!!
The thousands of UK patients that go through painful knee surgery may only be getting negligible benefits, a new study has discovered. As people get older the meniscus – the cartilage in the knee that acts as a shock absorber – thins out, making it more likely to tear. Researchers in Canada studies 811 procedures and the results were published in the Canadian medical Association Journal; they found that there was little evidence to show that surgery achieved better outcomes than not operating, or even performing a placebo operation. Other treatments like weight loss, anti-inflammatory drugs, exercise and physiotherapy should be used first, with surgery as a last resort only.
Top physics and personal trainers second this advice through experience. Following surgery the limb will never return to 100% effectiveness. Often, exercise (in particular muscle strengthening and prorioception work) can get the joint into as goo shape as a painful operation. Plus there is no lengthy recovery period where fitness, confidence and strength can decline further.
So before you go under the knife, call us! Remember, surgeons need to do surgery to stay in work and pay the bills!
By Adam Atkinson
Hitting the fridge and going to town is one of the well known effects of taking cannabis. But up until now scientists have been unable to explain the relationship; how does the active ingredient of cannabis (tetrahydrocannabinol or THC) cause such a surge in appetite?
But a new study by researchers at the University of Bordeaux has found that THC binds to cannabinol receptors in the brain dramatically increasing the sense of taste and smell which in turn stimulates the appetite. Although the tests were done on mice, if the findings are the same for humans, says The New Scientist, then doctors might one day be able to treat common conditions like obesity and anorexia with a simple nasal spray that either suppress or increases appetite through manipulation of the cannabinoid receptors in the brain.
Concern grew over the past 2 weeks for the state of Britain’s health and the obesity crisis with the publication of a report showing that in some English towns nearly 75% of the population is overweight. The fattest county was named as Cumbria with 68% of residents being overweight or obese. Next on the list was Linconshire closely followed by North Yorkshire and Staffordshire. All of these three showed a whopping 67% of inhabitants as being overweight.
Most of the fattest districts are North of the Wash; in the Cumbrian area of Copeland, 75% of people are classed as overweight; in Doncaster, South Yorkshire 74%; East Lindsey in Linconshire showed a 74% rate of obesity.
Some southern counties also showed similar rates of obesity with both Essex and Somerset having high rates.
However London was found to have a much lower ratio of fat people; Kensington and Chelsea has 45% with a smiler percentage throughout the city. In the UK as a whole the percentage of the population classed as being overweight currently stands at 63%, reports BBC online.
Those smokers who quit, even in later life, may be able to repair their cardiovascular health in as little as 8 years, a new study has shown. Studies in the past have shown that it takes longer; it was previously thought that 15 years was needed to reduce the ex-smoker’s chances of death from cardiovascular disease to become the same as a non-smokers.
But a new study that tested candidates who were 65 years or older and who had smoked fewer than 32 “pack years” found that for half of them the damage only took 8 years be healed. (A pack year is a formula to work out how much someone has smoked over time. It’s the multiple of the number of cigarettes smoked a day by the number of years smoked. So 10 cigarettes a day over ten years would be 100 pack years).
Despite the healing process the ex-smokers still had a greater risk of cancer and emphysema than those who had never smoked. And those who had smoked more than 32 pack years had higher risks of death from any health condition.
Smoking is the biggest cause of preventable death in the world, but id you smoke, “stop early” says professor Ali Ahmed of the University of Alabama who led the study.
In a separate study, researchers in South Korea found that the effects of passive smoking are also worse than expected. Even the outdoor air quality 30 feet away from a smoker is worse and contains significantly raised levels of fine particle pollutants the research showed.
Want to stop smoking? Never mind the patches – would you really give crack to a crack addict trying to stop? Hypnotherapy, counselling, group therapy and in particular NLP have the highest success rates. Try here for the most successful way to quit.
In most surveys coronary heart disease or CHD is named as Britain’s biggest killer. It develops when blood flow becomes restricted to the heart through the build up of fatty deposits on the walls of the coronary arteries. These are the main arteries that carry blood to the heart.
The heart is a fist sized muscle that pumps blood around the body; but as it is a muscle it needs its own blood supply too. Heart disease occurs when these specialist arteries that feed the heart become clogged and in the worse case scenario, blocked.
The first stage of CHD happens when the inner linings of these coronary arteries gradually become furred with a thick, sludgy porridge of substances known as plaque, Plaque is made from cholesterol. This process of clogging up is known as arteriosclerosis.
These plaques begin to narrow the space through which blood can pass. They also have the knock-on effect of blocking the supply of nutrients to the arteries which makes them lose their elasticity. They also cause high blood pressure; this extra strain on the heart as it tries to pump the same volume of blood through a restricted passage can also lead to heart disease.
To make matters worse, arteriosclerosis happens in all of our arteries, further increasing blood pressure and increasing the strain on the heart.
The first sign of a struggling heart is angina. These severe chest pains are a sign of a heart trying to keep beating on a restricted supply of oxygen.
Although some factors contributing to CHD are genetic, most are lifestyle related. Poor nutrition, lack of exercise, diabetes, high blood pressure and most of all smoking are the main culprits.
When one of the arteries that supply blood to the heart (coronary arteries) become completely blocked then you are in trouble. This full blockage is often caused by a section of plaque cracking or splitting open. The already narrowed artery now forms a blood clot (just like any wound) which then totally blocks it.
As it is no longer receiving any oxygen, the part of the heart that was supplied by that particular artery begins to die. Emergency medical treatment is now needed to unblock the artery and restore the blood flow top that bit of the heart. This can be done either through blood thinning drugs that will help to dissolve the arterial blockage (known as a clot or thrombus) or via a small operation that will physically remove the clot. This is done by threading small instruments up the arteries (usually through the inner thigh).
The seriousness of a heart attack depends greatly on the amount of muscle that dies before the condition is treated. If only a small area is affected then there is a higher chance of recovery and less risk of death.
Although a heart attack will always cause some permanent damage, most of the heart will be able to recover provided that the blood supply is not interrupted for too long.
The symptoms to look out for are: a shortness of breath, a tightness in the chest. This is said to feel like a heavy weight or a squeezing.
There can also be pain travelling outwards from the chest, to the arms, neck and jaw.
You may feel sick or be physically sick.
A panic attack or sharp feeling of anxiety.
Coughing or wheezing.
If any of these symptoms are present, then call emergency!
By Robert Atkinson