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Welcome to Advance Physical Therapy, Inc. Newsletter

Ahhh, spring has sprung and it's time to get that body outside! Whether you're heading for the hiking trails, or getting the garden beds ready for beautifying, the warmer weather entices us to be more active.

This month's newsletter features a joint that takes extra load when we step up our activity level. The considerable mobility in the knee joint leaves it vulnerable to strain if we overexert or accumulate excess weight. We're also examining the role of physical therapy in providing the latest information and most cost-effective care for low back pain and a safe alternative to one of our favorite drugs: caffeine.

To your health,

Advance Physical Therapy, Inc.
 Physical Therapy & Knee Pain

The basic design of many of our joints is two bony ends lined with a slick form of cartilage, called articular cartilage, and enveloped by a thick connective tissue capsule lined with a fluid-secreting membrane, called synovium. Five of our joints, including two in the shoulder, one in the wrist and our temporomandibular joint, or jaw joint, contain a special cartilaginous disc. The tibiofemoral joint, or (one of) our knee joints, is the fifth joint that contains a special disc to allow it to function.

What we call the "knee" is actually a small collection of three joints. The tibiofemoral, which approximates one of the leg bones (tibia) with the thigh (femur), the patellofemoral joint, which defines the meeting of the knee cap (patella)with the femur, and the proximal tibiofibular joint, which is a relatively motionless union of the top portion of the leg bones, the tibia and fibula.

We will define the types of problems encountered when there is damage to the tibiofemoral and patellofemoral joints. The tibiofemoral joint is the largest synovial joint in the body. Besides a generous synovium, its features include the load-dispersing articular cartilage, which lines the bony surfaces, the  inner (medial) and outer (lateral meniscus), specialized ligaments that stabilize the joint surfaces (ACL, PCL, LCL, MCL) and the iliotibial band (IT Band), which is a thick, stabilizing piece of connective tissue on the lateral surface of the knee. These strong, thick ligaments allow a surprising amount of stability when the knee is in a straightened position. The tibiofemoral joint is primarily a "hinge" joint." It absorbs the loading of repetitive weight bearing largely due to the medial and lateral meniscus and load-reducing work of long, strap-like muscles which attach to the front (quadriceps), side (adductors) and back (hamstrings, gastrocnemius) of the knee. Many of these muscles originate in the hip and pelvis.Commonly injured sites include the medial or lateral  meniscus, and ligaments, especially the ACL (anterior cruciate ligament). Muscle and tendon strains and tears are also quite common in the athletic population. When our supporting ligaments and load-bearing meniscus are injured, it is often due to unintended twist or over straightening. In the older population, meniscus tears can occur spontaneously and may go undetected. Osteoarthritis of the articular cartilage is rampant in the middle aged and elderly. Degenerative changes in the cartilage cause areas of uneven force distribution across the joint.Painful weight bearing is the result.

The patellofemoral joint is superficial to the tibiofemoral joint. It also has a layer of articular cartilage that lines the underside of the patella and front surface of the end of the femur. The patella glides slightly down and up on the front surface of the femur when the underlying tibiofemoral joint bends and straightens. It lacks the same ligamentous support of the tibiofemoral joint, and instead, relies on supportive forces of the muscles that cross and attach to the patella, such as the rectus femoris, and the quadriceps. Its positioning and movement is also supported by the IT Band. The position of the patella at the "top" of the knee and the angle of muscle/tendon attachment allows the quadriceps to generate the tremendous amount of force that is necessary for running, climbing and kicking. The muscles that attach the pelvis to the hip (gluteus medius, in particular) have gained increasing attention as research indicates that the stabilizing power of these muscles keep the patella sliding, or "tracking" properly when the knee straightens and bends during weightbearing activities. Osteoarthritis is also very prevalent in athletes and older people in this joint.

Next month, we will discuss common pathologies that affect the knee joint, and physical therapy treatment.

Caffeine: Seeking Natural Alternatives


It seems as if every day there is a new study released on caffeine. A recent published study in the journal Mayo Clinic Proceedings looked at 43,727 men and women ages 20-87 and found that men under 55 who drank more than 4 cups of coffee per day had a 56% higher all-cause mortality risk and women in that age group had a 113% higher risk.1

However, there are other studies telling us that coffee is actually good for us. For example, Harvard’s School of Public Health revealed that consuming between 2-4 cups a day may reduce risk of suicide in adults by 50%.2 The American Cancer Society has shown that drinking four or more cups may reduce mortality from mouth and throat cancer.3

We're unsure if this type of information is helping anyone to decide. Pediatricians are very concerned about the use of caffeine in children and teens. It’s a time we should be focusing on how to help them learn and prepare for their future. But in a society that believes the answer for every time one is tired is caffeine; the use of caffeine in children is growing faster and in higher amounts than ever before.

I am alarmed to see that the market is encouraging our youth to choose caffeine for energy. Our children need a healthy diet and proper sleep (not caffeine) for energy.

Teenagers are back in school and even more prone to use energy drinks as they get into the day to day grind. Typical diets are so far from perfect. I believe we need to supplement their diet choices. But not only due to their food choices, the fact that we eat a majority of food that is pre-packaged for us already means that food has lost a great amount of nutrition. Nutrition studies indicate that once we wash, prepare, or cook foods there is a great loss of the nutrient value. Preston Andrews, PhD, a plant researcher and associate professor of horticulture at Washington State University states, “the nutrients in most fruits and vegetables start to diminish as soon as they are picked.” These prepared meals are a strong reason we should supplement with the daily essential vitamins and minerals they are lacking. Children need B vitamins, Vitamin C, and minerals like magnesium for energy, not caffeine.

Rhodiola rosea is a caffeine alternative for young adults. This appears to help provide energy and does not appear to interfere with the health of the body as caffeine does. This may be a great way to start to re-educate the population on energy drinks. Can we find a better alternative? Would this be better for the body and the brain? If we can re-educate the adult population to look for healthier alternatives will our children grow up to not think caffeine is the be-all?

Physical Therapy Offers Low-Cost Solutions to Increasing Health Care Costs

Health care expenditures for patients with spinal conditions are rising without an associated increase in health status, according to a February, 2008 research report appearing in the Journal of the American Medical Association. The study suggests Americans may be wasting their money for treatments as the overall proportion of people with impaired function increased from 1997-2005, despite a 65% increase in expenditures to treat spine conditions. Physical therapists offering spinal manipulation, exercise and advice can provide an effective alternative for patients with back and neck problems, often at a lower cost. "I think the truth is we have perhaps oversold what we have to offer," said Richard A. Deyo, a physician at Oregon Health & Science University in Portland and a coauthor of the report. "All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients. But I think in each of those situations we've begun using those tests or treatments more widely than science would really support." What science does support is the effectiveness of physical therapy for affecting outcomes in patients with spinal conditions. “Research has consistently shown the value of particular physical therapy interventions for patients with back and neck problems,” said Dr. Timothy Flynn of Regis University in Denver, CO, and President of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). “Specifically, spinal manipulation and exercise
have repeatedly been shown to be effective in managing patients’ current pain and preventing future episodes.” Particularly discouraging in this recent report was an increase in pharmaceutical expenditures of 171% during the study period. This suggests that the medical community is  over-utilizing an ineffective treatment for spine pain. “You have drugs, you have surgery, or you have us,” explained Flynn. “The reality is that very few treatments have shown the ability to truly affect patients with spine conditions. Physical therapists can do just that.”These treatments include hands-on therapies to mobilize the spine and exercises designed to alleviate low back pain. Flynn suggests that patients should seek out physical therapists as a first-line treatment for these conditions. A separate study in 2006 demonstrated that patients with back pain were experiencing an increase in the rates of imaging and injections, meanwhile realizing a significant under-utilization of physical therapy.
It's important to be proactive about your care and understand how conservative treatment for many orthopedic conditions can be resolved with physical therapy. Please contact us for more information on the benefits physical therapy can provide in the management of your orthopedic problems.

Caffeine: Seeking Natural Alternatives continued...

Let’s do some comparisons.

Caffeine

Rhodiola rosea

Non-adaptogen

Adaptogen:  it causes minimal disturbance to the normal physiological function, the action is nonspecific, and it has normalizing action.

Provides a “crash and burn”  energy

Increases physical work capacity and shortens the recovery time between periods of high-intensity exercise.

Digestive discomfort and acidity

No negative effect known on digestion.

May increase blood pressure and heart beat irregularities

Supports the heart during emotional and physical stress supports C-reactive protein and creatinine kinase.

CNS stimulation; irritability, nervousness, and jitteriness

Positive effects on the CNS- may affect many neurotransmitters (chemical messengers) in the brain, including norepinephrine, serotonin, dopamine, and acetylcholine. These are responsible for thinking, analyzing, evaluating, calculating, planning, and remembering.  The antioxidant effects of R. rosea may help protect the nervous system from the effects of free radicals.

Rhodiola rosea should be standardized for 3% rosavins and 1% salidroside, matching clinical trials. In a double-blind randomized placebo controlled study on rhodiola for 20 days, students in the rhodiola group had significant improvement in physical fitness, mental fatigue and neuromotor tests. The self-assessment of the general well-being was also significantly better in the rhodiola group.

A double-blind, placebo-controlled study of 56 physicians on night-duty evaluated the potential benefits of rhodiola for maintaining mental acuity. Participants received either placebo or rhodiola extract (170 mg daily) for a period of 2 weeks. The results showed that participants taking rhodiola retained a higher level of mental function as measured by tests, such as mental arithmetic.

Another double-blind, placebo-controlled study evaluated one-time use of the same rhodiola extract (at a dose of 370 mg or 555 mg) in 161 male military cadets undergoing occasional sleep deprivation and stress. The results showed that rhodiola, at either dose, was more effective than placebo at fighting the effects of fatigue.

Reference from Natural Partners.

If we can answer any questions or field any topics of interest regarding  physical therapy, health and wellness or about our programs, please contact us. We'd love to hear from you.
info@advanceptinc.com
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2944 Broadway Street                         1208 E. Arques Avenue Suite #105
Redwood City, CA 94062                     Sunnyvale, CA 94085

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