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Support for Performing Artists

On August 17 and 18, 2013, Ando & Aston Physical Wellness Therapy,  Arthur D. Ando, DPT, CFMT, and James V. Sposa, DPT, OCS, participated in the Third Annual Conference of the Performing Arts Medicine Association at Chapman University in Orange, California.   Art and James joined other therapists, movement specialists, physicians, and of course, musicians, dancers, and actors, to examine what keeps performing artists performing at their best.  Look forward to the 4th Annual everyone!

Arthur Ando, DPT, discussing rib and other thoracic issues seen in dancers

Arthur Ando, DPT, discussing rib and otherr thoracic issues seen in dancers.

James Sposa, DPT, teaching pivot-prone work for the shoulder

James Sposa, DPT, teaching pivot-prone work for the shoulder

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Evidence Does Not Back-Up Spinal Manipulation for Acute Lower Back Pain, Review Finds

Manipulating or “adjusting” the spine is a popular way to treat occasional or acute lower back pain and is covered by many health insurance plans, but a recent review by The Cochrane Library finds no evidence to suggest it is more effective than other therapy options.

According to the National Institutes of Health, lower back pain affects eight out of 10 people, and is commonly caused by injury or overuse. Spinal manipulation (SMT), a technique used by chiropractors, osteopaths, naturopaths and some medical doctors, is used to improve the range of motion of the joints in the spine.

“SMT is a worldwide, extensively practiced intervention; however, its effectiveness for acute lower back pain is not without dispute,” said lead reviewer Sidney Rubinstein, senior researcher at the VU University Medical Center in Amsterdam.

The reviewers studied the results from 20 randomized controlled trials representing 2,674 participants with lower back pain of less than six weeks duration. Reviewers concluded that SMT neither reduced pain nor sped recovery faster than treatment options such as exercise, the use of NSAID pain medications or physiotherapy. Surprisingly, the review also found no evidence to suggest that SMT was more effective than therapies known to be ineffective. “This last finding would suggest more research is needed,” said Dr. Rubinstein. If SMT is just as effective as accepted interventions, it should be better than ineffective therapies, such as using ultrasound or heat therapy.

“Such reviews may be confusing because they are not comparing apples to apples,” said Mitchell Freedman, D.O., director of Physical Medicine and Rehabilitation at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia. “For a start, there are different kinds of manipulation, some more aggressive and some limited to stretching. Also, while spinal manipulation is not useful in all circumstances, it can be in some. You do need to look across a whole spectrum.”

Another complicating factor is the nature of acute lower back pain. Defined as lasting six weeks or less, it tends to go away on its own in almost 90 percent of all cases.”Studies do promote the use of manipulation in subacute to chronic pain which is different from acute pain,” said Freedman.
ScienceDaily (Sep. 21, 2012)
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Comment from Dr. Art Ando, Physical Therapist:
This type of review, when available, is the most reliable, providing a much better base on which to influence clinical practice upon. Notably in a Canadian study, the average time from injury to chiropractic care was 5 days; whereas the average time from injury to physical therapy care was 5 weeks. This study suggests medications and earlier physical therapy interventions would be more effective in pain relief and speedng recovery than manipulation.

4 Surgeries to Avoid: Reasons to think twice before going under the knife

4 Surgeries to Avoid: Reasons to think twice before going under the knife
by: Karen Cheney | from: AARP The Magazine | July/August 2011 issue

Think twice before going under the knife — even if your doctor recommends it.
Any surgery is dangerous. The body considers an operation a serious insult, and even some minor procedures come with major risks, such as bleeding, blood clots, infections, and damage to other organs. So it’s essential to know if surgery is necessary — or beneficial.

The AARP artice covers four operations that are overperformed for a variety of reasons: Some are moneymakers for hospitals and doctors, others are expedient, and still others seem to work, at least in the short term. But evidence shows that all have questionable long-term outcomes for treating certain conditions, and some may even cause harm. Here’s what to do if your doctor recommends one of them.

Knee Arthroscopy for Osteoarthritis is one of these overperformed surguries.

With this procedure a surgeon places a tiny camera in the knee, then inserts small instruments through other incisions to repair torn or aging cartilage. Studies show the operation works well when patients have in fact torn their meniscal tissue, but it is no more successful than noninvasive remedies in treating osteoarthritis of the knee. In a 2008 study, 178 patients with osteoarthritis received either physical and medical therapy without surgery, or therapy plus surgery. After two years the two groups had nearly identical outcomes, reporting less pain and stiffness and more mobility.

Alternatives to Surgery
If you have knee pain, “start with the least harmful and invasive treatment and work your way up the ladder,” says Colin Nelson, a senior research associate at FIMDM. This includes lifestyle changes such as exercise, as well as medication and cortisone injections.

Comment from Dr. Ando
At Ando & Aston Physical Wellness Therapy a trial of rehabilitation before undergoing the high cost and side-effects of surgery is one of our stocks in trade. I like the emphasis on lifestyle changes such as exercise as an alternative to surgery.
Keep up the good articles Karen!

Overactive Bladder Linked to Sleep Apnea in Women

The research, presented Monday (Sept. 3, 2012) at the European Respiratory Society’s Annual Congress in Vienna, has provided new evidence suggesting a connection between the two conditions.

Overactive bladder syndrome is characterised by an increased frequency to urinate along with incontinence and frequent awakening periods during night time to use the toilet (nocturia). The need to urinate during the night is also a common symptom of sleep apnea, but little research has been carried out to investigate any links between the two conditions.

Lead author, Núria Grau from the Hospital del Mar in Spain, said: “Overactive bladder has a prevalence of 16% among people over 40 years in Europe and it is a difficult condition to live with, affecting a person’s quality of life. The findings of this study provide evidence that bladder control could be linked to sleep apnea, although we do not know whether one of the conditions causes the other.

“The next step in our research is to investigate the role of continuous positive airway pressure therapy in these patients and its impact on the symptoms of overactive bladder.”
ScienceDaily (Sep. 2, 2012) — Sleep apnea in women has been linked to overactive bladder syndrome in a new study.

Comment from Dr. Art Ando
Our Women’s Health program at Ando & Aston Physical Wellness Therapy applauds research such as this. It adds to the body of knowledge we rely on in managing our patients with incontinence and nocturia.

Exercise, Even Mild Physical Activity, May Reduce Breast Cancer Risk

ScienceDaily (June 25, 2012) — A new analysis has found that physical activity — either mild or intense and before or after menopause — may reduce breast cancer risk, but substantial weight gain may negate these benefits.
Women who exercised either during their reproductive or postmenopausal years had a reduced risk of developing breast cancer. Women who exercised 10 to 19 hours per week experienced the greatest benefit with an approximate 30% reduced risk. Risk reductions were observed at all levels of intensity, and exercise seemed to preferentially reduce the risk of hormone receptor positive breast cancer (ER or PR positive), which is the most commonly diagnosed tumor type among American women.
When the researchers looked at the joint effects of physical activity, weight gain, and body size, they found that even active women who gained a significant amount of weight — particularly after menopause — had an increased risk of developing breast cancer, indicating that weight gain can eliminate the beneficial effects of exercise on breast cancer risk.
Related Stories on Science Daily.com
Recent, Vigorous Exercise Is Associated With Reduced Breast Cancer Risk (Sep. 30, 2009) — Post-menopausal women who engage in moderate to vigorous exercise have a reduced risk of breast cancer.
Reduced Breast Cancer Risk: Physical Activity After Menopause Pays Off (Jan. 15, 2009) — The breast cancer risk of women who are regularly physically active in the postmenopausal phase is reduced by about one third compared to relatively inactive
Girls, Young Women Can Cut Risk Of Early Breast Cancer Through Regular Exercise (May 13, 2008) — Mothers, here’s another reason to encourage your daughters to be physically active: Girls and young women who exercise regularly between the ages of 12 and 35 have a substantially lower risk of breaqst cancer
Physical Activity More Likely To Prevent Breast Cancer In Certain Groups (May 12, 2008) — Physically active women are 25 percent less likely to get breast cancer, but certain groups are more likely to see these benefits than others

Study: No-Fat, Low-Fat Dressings Don’t Get Most Nutrients Out of Salads

The vegetables in salads are chock-full of important vitamins and nutrients, but you won’t get much benefit without the right type and amount of salad dressing, a Purdue University study shows. If you want to utilize more from your fruits and vegetables, you have to pair them correctly with fat-based dressings.
In a human trial, researchers fed subjects salads topped off with saturated (butter), monounsaturated (canola oil) and polyunsaturated ( corn oil) fat-based dressings and tested their blood for absorption of fat-soluble carotenoids — compounds such as lutein, lycopene, beta-carotene and zeaxanthin. Those carotenoids are associated with reduced risk of several chronic and degenerative diseases such as cancer, cardiovascular disease and macular degeneration.
The study, published early online in the journal Molecular Nutrition & Food Research, found that monounsaturated fat-rich dressings required the least amount of fat to get the most carotenoid absorption, while saturated fat and polyunsaturated fat dressings required higher amounts of fat to get the same benefit.
See the full story at ScienceDaily (June 19, 2012)

High Blood Caffeine Levels in Older Adults Linked to Avoidance of Alzheimer’s Disease

Those cups of coffee that you drink every day to keep alert appear to have an extra perk — especially if you’re an older adult. A recent study monitoring the memory and thinking processes of people older than 65 found that all those with higher blood caffeine levels avoided the onset of Alzheimer’s disease in the two-to-four years of study follow-up. With new Alzheimer’s diagnostic guidelines encompassing the full continuum of the disease, approximately 10 million Americans now fall within one of three developmental stages of Alzheimer’s disease. “Moderate daily consumption of caffeinated coffee appears to be the best dietary option for long-term protection against Alzheimer’s memory loss,” researcher Dr. Arendash said. “Coffee is inexpensive, readily available, easily gets into the brain, and has few side-effects for most of us. Moreover, our studies show that caffeine and coffee appear to directly attack the Alzheimer’s disease process.”

In addition to Alzheimer’s disease, moderate caffeine/coffee intake appears to reduce the risk of several other diseases of aging, including Parkinson’s disease, stroke, Type II diabetes, and breast cancer. However, supporting studies for these benefits have all been observational (uncontrolled), and controlled clinical trials are needed to definitively demonstrate therapeutic value.

A study tracking the health and coffee consumption of more than 400,000 older adults for 13 years, and published earlier this year in the New England Journal of Medicine, found that coffee drinkers reduced their risk of dying from heart disease, lung disease, pneumonia, stroke, diabetes, infections, and even injuries and accidents
Get the full story at ScienceDaily (June 4, 2012)

Got Bananas?

Sometimes common sense and whole foods really do deliver, in this case during eating bananas during sports. Bananas have long been a favorite source of energy for endurance and recreational athletes. Bananas are a rich source of potassium and other nutrients, and are easy for cyclists, runners or hikers to carry.
Researchers in North Carolina wanted to see which was more beneficial when consumed during intense cycling — bananas or a carbohydrate sports drink.
They found that not only was performance the same whether bananas or sports drinks were consumed, there were several advantages to consuming bananas, the bananas provided the cyclists with antioxidants not found in sports drinks as well as a greater nutritional boost, including fiber, potassium and Vitamin B6
In addition, bananas have a healthier blend of sugars than sports drinks.
This type of research shows that you can have healthier carbohydrate sources before and after exercise that will support athletic performance just as well as a sports drink.

See the whole story ‘Bananas Are as Beneficial as Sports Drinks, Study Suggests’ at ScienceDaily (May 29, 2012) —

Extended Daily Fasting Overrides Harmful Effects of a High-Fat Diet: Study May Offer Drug-Free Intervention to Prevent Obesity and Diabetes

ScienceDaily (May 17, 2012) — It turns out that when we eat may be as important as what we eat. Scientists at the Salk Institute for Biological Studies have found that regular eating times and extending the daily fasting period may override the adverse health effects of a high-fat diet and prevent obesity, diabetes and liver disease in mice.

In a paper published May 17 in Cell Metabolism, scientists from Salk’s Regulatory Biology Laboratory reported that mice limited to eating during an 8-hour period are healthier than mice that eat freely throughout the day, regardless of the quality and content of their diet. The study sought to determine whether obesity and metabolic diseases result from a high-fat diet or from disruption of metabolic cycles.
“It’s a dogma that a high-fat diet leads to obesity and that we should eat frequently when we are awake,” says Satchidananda Panda, an associate professor in the Regulatory Biology Laboratory and senior author of the paper. “Our findings, however, suggest that regular eating times and fasting for a significant number of hours a day might be beneficial to our health.”
Panda’s team fed two sets of mice, which shared the same genes, gender and age, a diet comprising 60 percent of its calories from fat (like eating potato chips and ice-cream for all your meals). One group of mice could eat whenever they wanted, consuming half their food at night (mice are primarily nocturnal) and nibbling throughout the rest of the day. The other group was restricted to eating for only eight hours every night; in essence, fasting for about 16 hours a day. Two control groups ate a standard diet comprising about 13 percent of calories from fat under similar conditions.
After 100 days, the mice who ate fatty food frequently throughout the day gained weight and developed high cholesterol, high blood glucose, liver damage and diminished motor control, while the mice in the time-restricted feeding group weighed 28 percent less and showed no adverse health effects despite consuming the same amount of calories from the same fatty food. Further, the time-restricted mice outperformed the ad lib eaters and those on a normal diet when given an exercise test.
The Salk study found the body stores fat while eating and starts to burn fat and breakdown cholesterol into beneficial bile acids only after a few hours of fasting. When eating frequently, the body continues to make and store fat, ballooning fat cells and liver cells, which can result in liver damage. Under such conditions the liver also continues to make glucose, which raises blood sugar levels. Time-restricted feeding, on the other hand, reduces production of free fat, glucose and cholesterol and makes better use of them. It cuts down fat storage and turns on fat burning mechanisms when the animals undergo daily fasting, thereby keeping the liver cells healthy and reducing overall body fat.
The daily feeding-fasting cycle activates liver enzymes that breakdown cholesterol into bile acids, spurring the metabolism of brown fat — a type of “good fat” in our body that converts extra calories to heat. Thus the body literally burns fat during fasting. The liver also shuts down glucose production for several hours, which helps lower blood glucose. The extra glucose that would have ended up in the blood — high blood sugar is a hallmark of diabetes — is instead used to build molecules that repair damaged cells and make new DNA. This helps prevent chronic inflammation, which has been implicated in the development of a number of diseases, including heart disease, cancer, stroke and Alzheimer’s. Under the time-restricted feeding schedule studied by Panda’s lab, such low-grade inflammation was also reduced.
“Implicit in our findings,” says Panda, “is that the control of energy metabolism is a finely-tuned process that involves an intricate network of signaling and genetic pathways, including nutrient sensing mechanisms and the circadian system. Time-restricted feeding acts on these interwoven networks and moves their state toward that of a normal feeding rhythm.”
Amir Zarrinpar, a co-first author on the paper from the University of California San Diego, said it was encouraging that a simple increase in daily fasting time prevented weight gain and the onset of disease. “Otherwise, this could have been only partly achieved with a number of different pills and with adverse side effects,” he says.
The multimillion-dollar question is what these findings mean for humans. Public health surveys on nutrition have focused on both the quality and quantity of diet, but they have inherent flaws such as sampling bias, response bias and recall errors that make the results questionable. Thus, says Panda, with the current data it is difficult to connect when we eat, what we eat with how much weight we gain.
“The take-home message,” says Panda, “is that eating at regular times during the day and overnight fasting may prove to be beneficial, but, we will have to wait for human studies to prove this.”
The good news, he adds, is that most successful human lifestyle interventions were first tested in mice, so he and his team are hopeful their findings will follow suit. If following a time-restricted eating schedule can prevent weight gain by 10 to 20 percent, it will be a simple and effective lifestyle intervention to contain the obesity epidemic.
See the article on ScienceDaily (May 17, 2012)
Comments from Dr. Art Ando: WOW! This could be a game changer for anyone with obesity, diabetes or liver disease and has implications on heart disease, cancer, stroke and Alzheimer’s. We’ll stay in touch with developments from this group of researchers.

Art is ‘My Favorite Professor’ at Chapman U.

Dr. Ando was a student-nominated ‘My Favorite Professor Nominee’ and was recognized at the
Chapman University 12th Annual Faculty Appreciation Reception – Creating a World of Difference
at the Sandhu Conference Center, Orange CA Thursday April 26, 2012. The student qoute submitted with the nomination was “He uses real-life examples in Anatomy class, I learn something new about my body every day”.

In academia, awards like these are cherished as they just don’t happen very often. Pretty much all of the 100 Faculty members similiarly recognized were in attendance at the reception. Besides that, it is just nice to be someone’s ‘Favorite’ …
– Dr. Art Ando