Evidence Based Rehab

Irecieved an interesting study in my in box this morning. It finds that massage after exercise not only does NOT increase blood flow and, therefore, improve lactic acid removal, it decreases both blood flow and lactic acid removal.

It is reported:

Dr. Tschakovsky said that massage may act by decreasing inflammation, or it may produce a placebo effect. “There is so much inconclusive work out there, that we really don’t understand massage in the context of exercise,” he said.

Interesting study that seems to punch a hole in a long accepted belief on how to minimize pain after exercise.

Jason L. Harris

References

1. Wiltshire V, Poitras V, Pak M, et al. Massage impairs rather than enhances lactic acid removal from muscle after strenuous exercise. Presented at: annual American College of Sports Medicine conference; May 27-30, 2009; Seattle, Wash. Presentation Number: 09-SA-4065-ACSM.

Labels: exercise, massage

Acupuncture (sticking needles at specific points to a certain depth in the skin) is not an effective treatment for chronic low back pain. This may sound surprising as the media has jumped all over a new study that supposedly shows that acupuncture is more effective than "usual care". Unfortunately - as the media usually does - they've misinterpreted the results of the study. In fact the study showed that there is no difference in the effectiveness between "fake" and "real" acupuncture. Meaning, there is no effect of acupuncture.

Steven Novella over at Science-based Medicine does a masterful job of explaining this in detail. Please visit his post on this study to become enlightened by logical and scientifically based thoughts and discussion - as opposed to hype.

Jason L. Harris

Labels: acupuncture, back pain, evidence based medicine

E vidence Base Rehab has recently been named one of the top 51 physical therapy resources on the web. I appreciate the recognition Ownward Healthcare has given this blog. You can find the full list on their website here.

Surprisingly absent from the "Blog" list is Mike Reinold's great blog. Make sure you visit his blog. He has currently begun a series on Patellofemoral Pain Syndrome.

Jason L. Harris

Labels: award, blogs

The Insurance Journal released an article discussing how a "surprising" share of work comp case costs come from unanticipated costs or, as they term it, "Adverse Surprise Costs." The study reported on was said to find:

Adverse surprise cases were disproportionately chronic conditions with multiple surgeries. They were also disproportionately back pain cases.

That's no surprise to me, however, and should really not be a surprise to anyone dealing with chronic pain and low back injuries. While back pain is not the only musculoskeletal condition being over-treated with narcotics, expensive imaging, and surgery, it certainly is the most costly of all. In fact, most of my recent posts have centered around this subject (you can find them here, here, and here).

What is surprising is that, despite all this research showing all this imaging, surgery, and narcotic prescription make things worse often, we are still using that recipe to treat most folks with LBP. In fact, those doing it are being the ones rewarded with reimbursement for doing so.

Jason L. Harris

Labels: evidence based medicine, insurance, LBP, Low back pain, over-use