Published by
Stanford Medicine

Category

Orthopedics

Aging, Health and Fitness, Orthopedics, Pain, Research

Exercise programs shown to decrease pain, improve health in group of older adults

Exercise programs shown to decrease pain, improve health in group of older adults

LASHER ILICEvery time I read about research on the benefits of exercise, I become eager to go outside and run. (Or, realistically, take a pleasant walk.) But before I do that today, I wanted to share a study showing that participating in an exercise program led to a decrease in pain from arthritis and other musculoskeletal conditions, as well as an improvement in mobility and overall health, among a group of older adults.

The research, which was presented today at the American Public Health Association Annual Meeting in Boston, involved 119 adults of Asian descent – most of them female and age 65 or older – living in New York City. Participants took part in multiple eight-week yoga exercise classes and sessions of the Arthritis Foundation Exercise Program between 2011 and 2013. The community-based classes were conducted by the Hospital for Special Surgery‘s Asian Community Bone Health Initiative using bilingual instructors at senior centers in the Chinatown, Flushing and Queens neighborhoods.

A release explained why the researchers focused on Asian adults:

The Asian older adult population in New York City grew by 64 percent from 2000 to 2010, and one in four seniors lived in poverty in 2010. “This population is at risk for osteoarthritis and osteoporosis,” said Laura Robbins, DSW, senior vice president of Education and Academic Affairs at HSS. “They are more than twice as likely to have no health insurance coverage compared to other major race and ethnic groups. Cultural and linguistic barriers limit access to healthcare services.”

And as for results:

In the survey, many participants reported that their pain intensity dropped and interfered less with their quality of life. The following statistically significant results are noteworthy:

  • 48% fewer participants had pain on a daily basis after completing the program
  • 69% more participants could climb several flights of stairs after the program
  • 83% more participants could bend, kneel, or stoop
  • 50% more participants could lift/carry groceries
  • 39% of participants felt the program reduced their fatigue
  • 30% participants felt that the program reduced their stiffness

Previously: Exercise is valuable in preventing sedentary deathModerate physical activity not a risk factor for knee osteoarthritis, study showsResearchers look at brain activity to study falling and Help from a virtual friend goes a long way in boosting older adults’ physical activity
Photo by ASSOCIATED PRESS

Aging, NIH, Orthopedics, Technology

Support for robots that assist people with disabilities

Support for robots that assist people with disabilities

As if medical research funding wasn’t tight enough, now scientists must compete with robots for grants. Wait… I have that wrong. The National Institutes of Health recently announced the awarding of $2.4 million over the next five years for projects with robots. (The humans are still in charge of the studies.)

Now that that’s cleared up, let’s talk about the robots. As part of the second year of the National Robotics Initiative – a shared project of multiple federal agencies to design “co-robots” to improve mobility and functioning in people with disabilities – the NIH is funding three projects.

One is a co-robotic cane that can aid the visually impaired by sensing information about the environment and relaying it to its user. Another is a co-robotic active catheter for heart procedures.

And my favorite, the novel platform for rapid exploration of robotic ankle exoskeleton control, is a wearable robot. People with impaired mobility or strength from aging or due conditions such as cerebral palsy or spinal cord injury may be assisted by this device. Researchers from North Carolina State University and Carnegie Mellon University will test robotic control methods in patients recovering from a stroke to improve the product’s design.

Previously: Biotech start-up builds artful artificial limbs

Health Costs, Medicine and Society, Orthopedics, Research

How much for those healthy knees?

How much for those healthy knees?

hurt kneeWhat’s the cost of healthy, functional knees for life? Priceless, you might say, especially if yours feel achy or injured. But rehabilitation after a major injury, such as an anterior cruciate ligament (ACL), can be expensive, and results after surgery vary.

A recent study published in the Journal of Bone and Joint Surgery has examined the cost-effectiveness and quality-of-life impact of surgery to repair an ACL tear in relation to the price of the procedure, versus rehabilitation without surgery. Researchers found the average lifetime societal benefit of having ACL reconstruction surgery to be $50,000 per patient – or $10.1 billion across the U.S., which reports approximately 200,000 ACL tears annually.

This price includes not only money that would have been spent on rehabilitation and future injury repair, but also comparative lost wages and disability payments after surgery versus non-surgical rehabilitation. It also considers the patient’s ability to live with high function, low levels of pain and minimal risk of developing knee osteoarthritis.

From the study:

In the short to intermediate term, ACL reconstruction was both less costly (a cost reduction of $4503) and more effective (a [quality-adjusted life years - QALY] gain of 0.18) compared with rehabilitation. In the long term, the mean lifetime cost to society for a typical patient undergoing ACL reconstruction was $38,121 compared with $88,538 for rehabilitation. ACL reconstruction resulted in a mean incremental cost savings of $50,417 while providing an incremental QALY gain of 0.72 compared with rehabilitation. Effectiveness gains were driven by the higher probability of an unstable knee and associated lower utility in the rehabilitation group. Results were most sensitive to the rate of knee instability after initial rehabilitation.

Previously: Study shows men, rather than women, may be more prone to ACL injuries, Stanford study shows protein bath may rev up sluggish bone-forming cells andIron-supplement-slurping stem cells can be transplanted, then tracked to make sure they’re making new knees
Via Medical News Today
Photo by Carolyn Tiry

Cardiovascular Medicine, Orthopedics, Sports, Stanford News

Following treatment for thoracic outlet syndrome, Stanford athlete dives back to life

Following treatment for thoracic outlet syndrome, Stanford athlete dives back to life

diver2

Those of us who spend hours on a keyboard each day – especially ones that torque our wrists and thumbs out of their natural stance – may have already experienced the pain and stiffness that can come from asking our body parts to do the same thing over and over again. And such is the case for athletes, as well.

When Taylor Sishc arrived at Stanford as an All-American high school diver, with years of devoted practice responsible for that achievement, he found himself with a similar repetitive use injury. He had severe weakness in his left arm, and the trick – as with many medical challenges – was to figure exactly what was going on and how to fix it.

As a member of Stanford’s elite diving team, Sishc had access to expert coaches, trainers, therapists and doctors, including vascular surgeon Jason Lee, MD. As I wrote in an Inside Stanford Medicine article:

Lee, an associate professor of surgery at the School of Medicine, had his suspicions about what the problem was: Sishc might have thoracic outlet syndrome, a condition often seen in athletes but also found in people who use their arms in a repetitive motion, which can lead to the compression of nerves or blood vessels, or both, in the thoracic outlet — an area bounded by the base of the neck and the first rib.

Diagnosis of thoracic outlet syndrome, also known as TOS, is not straightforward. “There’s no one blood test or radiographic test or physical exam finding that gives you that ‘aha’ moment,” Lee said. “It’s a combination of positive and negative tests.”

Sishc had been a gymnast since childhood and a serious competitive diver since he was 13. By the time he reached Stanford, he had been lifting his arms over his head in a similar motion for years — exactly the kind of long-term overuse that creates thoracic outlet syndrome…

My story details how Lee’s hunch was correct and how the therapies Sishc received slowly but surely got him back on the diving board in championship form.

Previously: ‘Snorkel’ stents create lifeline to organs in method of treating complex abdominal aortic aneurysms
Photo by Todd Holland

Orthopedics, Pediatrics, Research, Stanford News

Spinal bracing for adolescents with scoliosis

Spinal bracing for adolescents with scoliosis

Scoliosis_cobbScoliosis, a condition marked by a spine curvature in the shape of an “S” (sideways) or a “C” (forward and backward), ranges in severity from mild to debilitating, affecting not only posture but sometimes also respiratory function. Children and adolescents who develop scoliosis may be monitored with X-rays to measure the degree of curvature and can be prescribed exercises, encouraged to wear a stiff brace around the torso or even undergo corrective surgery.

In the current issue of the New England Journal of Medicine, Eugene Carragee, MD, a professor of orthopaedic medicine at Stanford, co-authored an editorial titled “Spinal Bracing in Adolescent Idiopathic Scoliosis.” The piece considers whether spinal bracing – previously a problematic form of treatment for post-polio paralysis – is an effective solution for young people with adolescent idiopathic scoliosis (AIS) who have spinal curvature of 50 degree or greater. Carragee and his co-author, Ronald Lehman, MD, professor of orthopaedic surgery and neurological surgery at Walter Reed National Military Medical Center, review a multicenter study from the same NEJM issue measuring the effectiveness of bracing as means of preventing AIS progression.

Carragee and Lehman write that the study authors found bracing for AIS patients to be effective, and that longer times of wearing the brace each day was associated with greater effectiveness. Also noted in the editorial were challenges to the 242-subject study: difficulty with participant enrollment and compliance meant that much of the data was drawn from a non-randomized cohort.

From the editorial:

The decision to commit a12 or 13 year-old to several years of brace wear requires careful consideration of both the benefits and downsides. Although brace-wear in AIS does not have the serious physiological side effects apparent in polio-related scoliosis, it carries financial, emotional and social burdens to consider.

As the authors appropriately point out, 48% of the untreated subjects had a successful outcome, as did 42% of the braced subjects with little to no time in treatment. In retrospect, the bracing indications described are likely too broad, resulting in what may be unnecessary treatment for many patients. We agree with the authors that the equally important finding of this study is that so many growing children with AIS seem to do just fine with no treatment at all; the challenge for the field going forward is to identify those children who are most likely and those who are unlikely to benefit from bracing.

Previously: How orthopedic surgery straightened out one man’s lifeThe burden of carrying a heavy backpack and Image of the week: brass corset, 19th century
Photo by Skoliose-Info-Forum.de

In the News, Orthopedics, Research, Sports

Barefoot running: the conversation continues

Barefoot running: the conversation continues

footprint

Running au naturel could feel freeing or painful, and runners and sports medicine specialists argue both ways about going bare…foot. As previously reported on Scope, sans-shoe or reduced-shoe running has been shown to promote landing further forward on the foot, which may prevent injury, but the practice could introduce other physical problems if adopted into a routine too quickly.

At this year’s British Science Festival in Newcastle, U.K., an overview of research suggested that runners who wish to begin running barefoot should introduce the practice slowly into their routine. A BBC News article on the conference proceedings reports that experts differ on recommendations for running footwear, but they agree that more research needs to be conducted.

From the article:

[Mick Wilkinson, PhD, an exercise physiologist from Northumbria University] was one of the first people to run the Great North Run completely barefoot, which he did in 2011. But he believes that those using thin-soled shoes which claim to emulate barefoot running may be missing out on the potential benefits from running without footwear.

“Studies in the late 80s suggest there needs to be a sense of friction before the impact avoidance behaviour is triggered. So if you put anything between you and the ground, even if it’s only 4mm thick, people tolerate extremely high vertical loads, without doing anything about it,” Dr Wilkinson explained.

Other researchers suggest that thinner-soled shoes still encourage front-foot striking and the associated benefits. According to Mark Burnley, PhD, a senior lecturer in exercise physiology at the University of Kent, barefoot running “will save you money on shoes, but is not some injury-eliminating/performance-enhancing panacea.”

Previously: Seeking to reduce stress on the body, some runners are reversing their strideIs barefoot running better for the body? and “Barefoot” running craze still going strong
Photo by Gordon Tarpley

Orthopedics, Research

Moderate physical activity not a risk factor for knee osteoarthritis, study shows

IMG_4191As my wise yoga teacher once said after advising a student to skip a certain pose if she felt any joint strain, “Once knees get weird, they tend to always be weird.” She looked around the class. “A lot of you are nodding; I’m sorry you know that already.”

Coming from a weird-kneed family, I’ve been careful not to overdo any type of movement likely to contribute to a meniscus tear or cartilage disintegration, as my elders have endured. But research strongly suggests that maintaining an exercise routine is advantageous for healthy knee function and injury prevention. So, what to do as the days wear on?

More support for “keep moving” came today as I read about a study of 1,522 adults age 45 and older who engaged in moderate physical activity for up to two-and-a-half hours per week and showed that their risk of developing knee osteoarthritis did not increase over a six-year period.

Published in the journal Arthritis Care & Research, the study (subscription required) found that participants who were physically active for up to five hours a week showed a slightly higher, but not statistically significant, risk for knee osteoarthritis.

From a release:

[The analysis] tested whether or not there was an association between meeting Department of Health and Human Services (HHS) guidelines for 150 minutes of physical activity per week and the development of knee osteoarthritis, as confirmed both by X-rays and the presence of knee pain or other symptoms.

The study’s findings support HHS recommendations and concludes that activities such as walking, conditioning exercises and household activities such as gardening or yard work that amount to moderate weekly levels of physical activity should continue to be encouraged.

Previously: New thinking about osteoarthritis, older people’s nemesisInflammation, not just wear and tear, spawn osteoarthritisExercise may alleviate symptoms of arthritis regardless of weight loss and Study links high heels to osteoarthritis and joint problems
Photo by Even and Donabel

Medical Education, Orthopedics, Stanford News

Teen girls become orthopaedic surgeons for a day

Teen girls become orthopaedic surgeons for a day

girls in orthopedic classThere was a time when high-school girls were taught how to use a needle and thread to make and mend their clothes. On Saturday, in a large conference room at the Stanford Medicine Outpatient Center in Redwood City, a group of Bay Area high-school girls was also taught how to use a needle and thread. Gloved, and dressed in scrubs as if they were in the OR, these girls learned how to suture an incision. They also practiced drilling into bones to set pins, they straightened scoliotic spines, and they tackled intramedullary nailing of a femoral shaft fracture - and that was just the morning portion of the all-day workshop.

Together with the Perry Initiative, Stanford’s Department of Orthopaedic Surgery hosted 38 girls, giving them a hands-on sneak-peek into the fields of orthopaedic surgery and engineering.

The Perry Initiative is relatively new. It was established five year ago by two women from University of California, San Francisco: Lisa Lattanza, MD, an associate professor of orthopaedic surgery, and Jenni Buckley, PhD, who is now an assistant professor of mechanical engineering at the University of Delaware. They are committed to inspiring young women to become leaders in orthopaedic surgery and engineering, and are now partnered with medical centers nationwide to hold these day-long outreach programs.

Amy Ladd - small Both women participated in Saturday’s event, along with Stanford’s Amy Ladd, MD, a professor of orthopaedic surgery and plastic surgery and chief of the Robert A. Chase Hand & Upper Limb Center. Ladd is intent on improving the odds for women by changing the face of science and technology to be more inclusive, especially with a focus on improving healthcare for everyone. “In my speciality, 4 percent of board-certified orthopaedic surgeons are women, and, despite that now women make up half of medical student classes, that number really hasn’t changed since I started almost 30 years ago.”

The large conference room transformed into a veritable beehive of blue-clad young women, hunched over their projects, asking questions, giving suggestions, drilling, pounding, stitching, laughing. Ladd notes that, “in today’s program, we’re doing exactly the same sorts of things I do with our med students and residents every day. In fact, in some ways we’re doing more because it’s so focused.” She takes another look at the scene and says, “I’ve got the best job in the world. We need to share the wealth!”

Judging by the enthusiasm in the room, and the electricity in the air, it’s not hard to imagine that a change is going to come, and the balance is soon to shift.

Previously: A day at med school for Bay Area teensBay Area students get a front-row seat to practicing medicine, scientific researchTeens interested in medicine encouraged to “think beyond the obvious” and Image of the Week: Med School 101
Photo by MA Malone

Aging, Anesthesiology, Neuroscience, Orthopedics, Research

Researchers look at brain activity to study falling

Researchers look at brain activity to study falling

5089256378_bb06d1562dFalling down is an inevitable hazard of walking, even for a seasoned runway model. Basketball players practice taking a charge and modern dancers learn fall and recovery techniques, but what about those who are at greater risk of injury upon impact, such as older adults?

Researchers from the University of Michigan School of Kinesiology are working to understand why the elderly suffer more serious falls than younger people. In a recent study published in the Journal of Neurophysiology, scientists used an electroencephalogram to watch the electrical response in different regions of the brain before and during a fall to determine which parts first identify the fall.

The study used EEG on healthy young adults, who walked heel-to-toe on a balance beam attached to a treadmill, and who were able to continue walking without injury if they fell off the beam.

From a release:

[Lead researcher Daniel Ferris, PhD] and colleagues then used a method called independent components analysis to separate and visualize the electrical activity in different parts of the brain. They found that people sense the start of a fall much better with both feet on the ground.

The researchers were surprised that so many different parts of the brain activate during a fall, and they didn’t expect the brain to recognize a loss of balance as early as it does.

Future studies comparing the elderly with younger subjects could determine if the elderly sense falls too late, in which case, pharmaceuticals might help them regain their balance. If it’s a simple motor problem such as muscles not responding properly, strengthening exercises could help.

Photo by aurélien

Clinical Trials, Genetics, Orthopedics, Pediatrics, Research

Treatments to reduce fractures for children with brittle-bone disease

Imagine having a skeleton so fragile a sneeze could land you in the ER with a broken bone. For people with osteogenesis imperfecta (OI), a rare genetic disorder characterized by brittle bones due to inadequate or imperfectly formed collagen, fracturing without trauma or a even a known cause can be both routine and excruciatingly painful.

An estimated 20,000-50,000 people in the United States live with OI, including a good friend who has endured more than 90 fractures and 25 surgeries in 31 years, and once broke his arm by simply waving goodbye. The disorder is classified in four types by severity and presents symptoms that vary by person but may include short stature, spinal curvature and loose joints as well as dental, respiratory and hearing problems.

Standard treatment for children diagnosed with the condition may include physical therapy, wearing braces, and using a wheelchair or other assisting device. Rodding—surgically inserting metal bars to support long bones—may help to prevent injury and deformity in the limbs, but rods must continually be exchanged for larger sizes as children grow. More trips to the hospital could include intravenous treatments with bisphosphonates, a class of drugs shown to reduce fractures in adults with osteoporosis. Both oral and intravenous bisphosphonates have been tested in small pediatric studies to help boost bone mineral density and reduce fractures. One study found that alendronate (an oral bisphosphonate) was no better than placebo at reducing bone pain or fractures in OI. For this reason, intravenous bisphosphonates have been the mainstay of therapy used for compassionate treatment of children with moderate to severe OI and fractures.

But a new study published in The Lancet suggests that risedronate, a different oral bisphosphonate, may reduce fractures in children with OI. An international team, including researchers from the University of Sheffield and Sheffield Children’s Hospital, conducted a clinical trial of 147 children, ages 4 to 15. Ninety-seven participants received a daily dose of risedronate for one year while 50 received a placebo, but all the children were given the drug for two more years during an open-label extension. Medical Daily reports:

The oral medication reduced fractures in non-spinal bones by nearly 20 percent over the course of the year. A subgroup continued taking risedronate for another two years and witnessed similar beneficial rates of less injury. This improvement was correlated with better bone density.

Study authors concluded that oral risedronate should be considered as a home-treatment option for children with OI.

Continue Reading »

Stanford Medicine Resources: