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Massage News - April 2013

Massage News - April 2013

Static Stretch doesn't enhance Sports Performance

Researchers recently have discovered, this so-called static stretching can lessen jumpers’ heights and sprinters’ speeds, without substantially reducing people’s chances of hurting themselves. Now, two new studies are giving us additional reasons not to stretch.

One, a study being published April in The Journal of Strength and Conditioning Research, concluded that if you stretch before you lift weights, you may find yourself feeling weaker and wobblier than you expect during your workout. Those findings join those of another new study from Croatia, a bogglingly comprehensive re-analysis of data from earlier experiments that was published in The Scandinavian Journal of Medicine and Science in Sports. Together, the studies augment a growing scientific consensus that pre-exercise stretching is generally unnecessary and likely counterproductive.

Many issues related to exercise and stretching have remained unresolved. In particular, it is unclear to what extent, precisely, subsequent workouts are changed when you stretch beforehand, as well as whether all types of physical activity are similarly affected.

For the more wide-ranging of the new studies, and to partially fill that knowledge gap, researchers at the University of Zagreb began combing through hundreds of earlier experiments in which volunteers stretched and then jumped, dunked, sprinted, lifted or otherwise had their muscular strength and power tested. For their purposes, the Croatian researchers wanted studies that used only static stretching as an exclusive warm-up; they excluded past experiments in which people stretched but also jogged or otherwise actively warmed up before their exercise session. The scientists wound up with 104 past studies that met their criteria. Then they amalgamated those studies’ results and, using sophisticated statistical calculations, determined just how much stretching impeded subsequent performance. The numbers, especially for competitive athletes, are sobering. According to their calculations, static stretching reduces strength in the stretched muscles by almost 5.5 percent, with the impact increasing in people who hold individual stretches for 90 seconds or more. While the effect is reduced somewhat when people’s stretches last less than 45 seconds, stretched muscles are, in general, substantially less strong.

They also are less powerful, with power being a measure of the muscle’s ability to produce force during contractions, according to Goran Markovic, a professor of kinesiology at the University of Zagreb and the study’s senior author. In Dr. Markovic and his colleagues’ re-analysis of past data, they determined that muscle power generally falls by about 2 percent after stretching. And as a result, they found, explosive muscular performance also drops off significantly, by as much as 2.8 percent. That means that someone trying to burst from the starting blocks, blast out a ballistic first tennis serve, clean and jerk a laden barbell, block a basketball shot, or even tick off a fleet opening mile in a marathon will be ill served by stretching first. Their performance after warming up with stretching is likely to be worse than if they hadn’t warmed up at all.

A similar conclusion was reached by the authors of the other new study, in which young, fit men performed standard squats with barbells after either first stretching or not. The volunteers could manage 8.3 percent less weight after the static stretching. But even more interesting, they also reported that they felt less stable and more unbalanced after the stretching than when they didn’t stretch.

Just why stretching hampers performance is not fully understood, although the authors of both of the new studies write that they suspect the problem is in part that stretching does exactly what we expect it to do. It loosens muscles and their accompanying tendons. But in the process, it makes them less able to store energy and spring into action, like lax elastic waistbands in old shorts, which I’m certain have added significantly to the pokiness of some of my past race times by requiring me manually to hold up the garment.

Of course, the new studies’ findings primarily apply to people participating in events that require strength and explosive power, more so than endurance. But “some research speaks in favor” of static stretching impairing performance in distance running and cycling, Dr. Markovic said. More fundamentally, the results underscore the importance of not prepping for exercise by stretching, he said. “We can now say for sure that static stretching alone is not recommended as an appropriate form of warm-up,” he said. “A warm-up should improve performance,” he pointed out, not worsen it. A better choice, he continued, is to warm-up dynamically, by moving the muscles that will be called upon in your workout. Jumping jacks and toy-soldier-like high leg kicks, for instance, prepare muscles for additional exercise better than stretching. As an unscientific side benefit, they can also be fun. From: Quick Switch to 'Barefoot' Shoes Can Be Bad to the Bone

A new study from a team of exercise science professors found that runners who transition too quickly to minimalist shoes ("barefoot" five-finger running shoes) suffer an increased risk of injury to bones in the foot, including possible stress fractures. With minimalist shoes now making up 15 percent of the $6.5 billion running shoe market, the findings are nothing to run from. "Transitioning to minimalist shoes is definitely stressful to the bones," said Sarah Ridge, study lead author and assistant professor of exercise science at BYU. "You have to be careful in how you transition and most people don't think about that; they just want to put the shoes on and go."

The research, appearing in the journal Medicine & Science in Sports & Exercise, studied 36 experienced runners over a 10-week period. Each runner first underwent MRIs on their feet prior to the study period. Half of the runners were then asked to gradually transition into five-finger minimalist shoes while the other half continued to run in traditional running shoes. Subjects in the experimental group followed an industry suggested protocol. They did one short (1-2 mile) run in the minimalist shoes the first week, and added an additional short run each week so that they ran at least 3 miles in the new shoes by week three. They were then told to add mileage in the minimal shoes as they felt comfortable, with the goal of replacing one short run per week in traditional shoes with the new shoes. At the end of the 10-week period, MRIs were again conducted.

The MRIs revealed that those who had transitioned to the minimalist shoes suffered greater increases in bone marrow oedema (inflammation causing excessive fluid in the bone) and more stress injuries than those in traditional shoes. "Whenever a bone is impacted by running (or some other repetitive action), it goes through a normal remodeling process to get stronger," Ridge said. "Injury occurs when the impact is coming too quickly or too powerfully, and the bone doesn't have a chance to properly remodel before impact reoccurs." Interestingly, the study found the majority of those who suffered stress injuries were women. The authors said the study does not mean minimalist shoes are bad. Rather, to minimize the risk of injuries, runners should transition over a longer duration than 10 weeks and at a lower intensity (miles per week). "People need to remember they've grown up their whole life wearing a certain type of running shoes and they need to give their muscles and bones time to make the change," Johnson said. "If you want to wear minimalist shoes, make sure you transition slowly." This is the first of many studies looking at minimalist running shoes, the authors said.

Journal Reference: Sarah T. Ridge, A.Wayne Johnson, Ulrike H. Mitchell, Iain Hunter, Eric Robinson, Brent S. E. Rich, Stephen Douglas Brown. Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes. Medicine & Science in Sports & Exercise, 2013; : 1DOI: 10.1249/MSS.0b013e3182874769 Exercise to Strengthen your hip muscles

Weak hip muscles lead to poor hip motion, and poor hip motion can cause knee, hip, and back pain. By exercising to strengthen the hip muscles that control how your hip moves, you can reduce your pain in these parts of your body. The 2 key muscles to include in your exercise program are the gluteus maximus (the chief muscle on the back of your hip—your buttocks) and the gluteus medius (the main muscle on the side of your hip). However, it is often difficult to strengthen these muscles without also strengthening a muscle called the tensor fascia lata, which is located toward the front of the hip. Too much activation of that muscle may create unwanted hip motion that may worsen knee, hip, or back pain. A study published in the February 2013 issue of JOSPT (J Orthop Sports Phys Ther) provides information intended to help physical therapists and their patients select exercises that target the buttock muscles without causing other unwanted muscle actions.

In this study, the researchers had 20 healthy people perform 11 different hip exercises commonly used for both fitness and rehabilitation. While the participants performed the exercises, fine wires were used to record the amount of electrical activity within the 3 muscles. This indicated how much each muscle was working. The researchers’ goal was to discover which exercises used the gluteus maximus and gluteus medius muscles the most, while minimizing the action of the tensor fascia lata. They found that 5 specific exercises worked best: the clam, the single-leg bridge, hip extension while on both hands and knees (with the knee bent or straight), and the sidestep.

Patients with certain types of knee, hip, or back pain may benefit from focusing on the 5 exercises recommended by these researchers. Your physical therapist can help determine which of these exercises are best for you and customize a treatment program based on your diagnosis, your level of pain, and your current and desired hip function. Even if you do not have any pathology or pain, you may want to incorporate these 5 exercises in your general fitness or strength program.

This news is based on an article by Selkowitz et al, titled “Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes,” J Orthop Sports Phys Ther 2013;43(2):54-64. doi:10.2519/jospt.2013.4116. Get the article PDF including patient handout Motor control exercises reduces pain and disability in chronic and recurrent low back pain

STUDY DESIGN.: Meta-analysis of randomized, controlled trials. OBJECTIVE.: To determine the short-term, intermediate, and long-term effectiveness of Motor control exercises (MCE), with regard to pain and disability, in patients with chronic and recurrent low-back pain.

SUMMARY OF BACKGROUND DATA.: Previous meta-analyses have shown no difference between the effects of MCE and general exercise in the treatment of low back pain. Several high quality studies on this topic have been published lately, warranting a new meta-analysis.

METHODS.: We searched electronic databases up to October 2011 for randomized controlled trials clearly distinguishing MCE from other treatments. We extracted pain and disability outcomes and converted them to a 0 to 100 scale. We used the RevMan5 (Nordic Cochrane Centre, Copenhagen, Denmark) software to perform pooled analyses to determine the weighted mean differences (WMDs) between MCE and 5 different control interventions.

RESULTS.: Sixteen studies were included. The pooled results favored MCE compared with general exercise with regard to disability during all time periods (improvement in WMDs ranged from -4.65 to -4.86), and with regard to pain in the short and intermediate term (WMDs were -7.80 and -6.06, respectively). Compared with spinal manual therapy, MCE was superior with regard to disability during all time periods (the WMDs ranged between -5.27 and -6.12), but not with regard to pain. Furthermore, MCE was superior to minimal intervention during all time periods with regard to both pain (the WMDs ranged between -10.18 and -13.32) and disability (the WMDs ranged between -5.62 and -9.00).

CONCLUSION.: In patients with chronic and recurrent low back pain, MCE seem to be superior to several other treatments. More studies are, however, needed to investigate what subgroups of patients experiencing LBP respond best to MCE. Yoga and acupressure could both play an important role in helping patients with atrial fibrillation

Yoga and acupressure could both play an important role in helping patients with atrial fibrillation (AF). Two abstracts presented at the at the European Society of Cardiology's EuroHeart Care Congress, which takes place in Glasgow, 22 to 23 March, 2013, show the potential for medical yoga¹ and acupressure², in addition to pharmacological therapies, to reduce blood pressure and heart rates in patients with AF. In a third abstract³, a survey found that complementary and alternative therapies (CATs), were widely used by patients attending cardiology clinics, raising concerns people may not be routinely informing health care staff about their use.

"One of the overall aims of treatment for AF is lowering heart rate because high and irregular heart rates can lead to emboli forming and result in stroke," said Professor Ozlem Ceyhan, a nurse trainer from Erciyes University, Kayseri, Turkey. "In these studies both acupressure and yoga are reducing heart rate, which should have a really beneficial effect. Furthermore, both approaches have the advantage of being easy to administer and cost effective, with no serious side effects."

The ESC guidelines4 have classified AF patients into five types based on duration: first detected (only one diagnosed episode); paroxysmal (recurrent episodes that self-terminate in less than seven days); persistent (recurrent episodes that last more than seven days); long standing (where it has lasted for longer than a year); and permanent (an ongoing long-term episode).

Medical Yoga shows beneficial effect in Paroxysmal AF

In the first abstract Maria Nilsson, a nurse from Danderyd Hospital, Stockholm, Sweden, who has practiced yoga for the last 10 years, set out to investigate whether yoga might help patients with paroxysmal AF (PAF) ¹.

"We chose to use medical yoga, which is a form of yoga involving deep breathing, light movements, meditation and relaxation. The advantage here is that the movements are easy to learn and can be performed while sitting in a chair," said Nilsson. PAF, she added, is thought to involve between 25% and 62% of all cases of AF. In the prospective study, 80 patients with a diagnosis of PAF were randomized to the usual treatment and yoga (n=40) or just usual treatment (n=40). Patients in the yoga group attended hour long sessions of yoga once a week over the course of three months. Results show that after three months patients in the yoga group, showed significant decreases in systolic blood pressure (p=0.03), diastolic blood pressure (p=0.007) and heart rate (p=0.02) compared to those in the control group. Systolic blood pressure for patients in the yoga group dropped from 137 mmHg at the start of the study to 132mmHg after three months; whereas the systolic blood pressure of patients in the control group increased from 138 mmHg at the start of the study to 141 mmHg after three months. Diastolic blood pressure for patients in the yoga group decreased from 83 mmHg at baseline to 77 mmHg after three months; whereas diastolic blood pressure for patients in the control group rose from 84mmHg at baseline to 87mmHg after three months.

Heart rate decreased in the yoga group from 64 beats/minute at the start of the study to 60 beats per minute after three months; whereas heart rate rose in the control group from 65 beats per minute at the start of the study to 69 beats per minute after three months. According to the "self reported" health questionnaires, patients who received yoga showed improvements in physical quality of life (p=0.01) and mental quality of life (P=0.02) at three months, compared to those in the control group. "Our study suggests doctors could do worse than prescribing yoga for all patients with hypertension and fast heart rates," said Nilsson. The team, she added, are now undertaking further research to see if reductions in blood pressure and heart rate result in a decreased frequency of PAF episodes.

Acupressure shows benefit in patients with persistent AF

In the second study ², Professor Ozlem Ceyhan, a nurse trainer from Erciyes University, Kayseri, Turkey, investigated the use of acupressure among patients hospitalized for persistent AF. In the study 60 patients were randomized to an intervention group (n=30) or a placebo group (n=30). Patients in the intervention group had acupressure performed on acupressure points PC6, HT7 and CV17; while patients allocated to the placebo group underwent a "sham" procedure were the acupressure device was bound in place without applying pressure. Treatments were performed between two and four times a day, with pulse and blood pressure readings taken before, during and after the session, and information on fatigue collected via patient questionnaires.

Results showed that significant decreases in pulse rate, systolic and diastolic blood pressure were found for patients allocated to the intervention group compared to those allocated to the placebo group (p<0.05, for all three). Heart rhythm, however, did not turn into sinus rhythm and acupressure was not found to have a statistically significant beneficial effect on symptoms of fatigue. "One thing that was really notable in our study was that we did not observe that any patients in the intervention group had further attacks of AF while in hospital, compared to 10% of patients in the placebo group suggesting acupressure may be preventing further attacks," says Ceyhan.

Acupressure, she said, was an easy to use technique that patients could administer on themselves at home to reduce the frequency of AF attacks. The team, she added, are now looking to explore other acupressure points to see if they might have an effect on sinus rhythm.

Professor Stephen Leslie, Dr Jenny Jones and colleagues, from the University of Stirling, Scotland, undertook a survey of 116 people attending a cardiology outpatient's clinic over an eight week period about use of complementary and alternative therapies (CATS) The results showed that 52% of respondents (60 people) reported use of at least one CAT; 66% (77 people) believed that CATs should be available within the NHS; and that 88% (102) believed that more research should be performed in these areas. Furthermore, the investigators found that the top five most popular CATs were reflexology, acupuncture, osteopathy, massage and chiropractic therapies.

"When we looked back at patient notes, we found that very few people had volunteered this clinically important information in consultations, suggesting that they don't often disclose CAT use to cardiology teams," said Leslie. Information about CATs and complementary and alternative medicines (CAMs) use is undoubtedly important. Popular herbal remedies, such as Ginger, Ginko biloba, Ginseng and St John's wort have been shown to affect platelet aggregation, prolong bleeding time, and increase or decrease INR in patients on warfarin. Additionally it is known that extracts of Hawthorne, which are recommended for patients with heart failure and arrhythmia, have digoxin like effects, with the potential to interact with digoxin.

"In light of the potential for adverse interactions we believe that clinicians should routinely ask all their patients whether they use any forms of CATs or CAMs," said Jones. The survey, she added, highlighted the fact that cardiac patients would like to see further research carried out to assess the risks and benefits of CAM in relation to cardiovascular disease. "This would enable the balance between risks, benefits and efficacy of various CATs and CAMs to be honestly discussed with cardiac patients," said Jones.

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