This article reviews the available literature regarding injuries in off-road bicyclists. Recent progress in injury research has allowed the description of several patterns of injury in this sport. Mountain biking remains popular, particularly among young males, although sales and participation figures have decreased in the last several years. Competition in downhill racing has increased, while cross-country racing has decreased somewhat in popularity. Recreational riders comprise the largest segment of participants, but little is known about the demographics and injury epidemiology of noncompetitive mountain cyclists. Most mountain bikers participating in surveys reported a history of previous injuries, but prospective studies conducted at mountain bike races have found injury rates of <1%. The most common mechanism of injury involves a forward fall over the handlebars, usually while riding downhill, which can result in direct trauma to the head, torso and upper extremities. A variety of factors can be associated with this type of fall, including trail surface irregularities, mechanical failures and loss of control. In mountain bike racing the risk of injury may be higher for women than men. Minor injuries such as abrasions and contusions occur frequently, but are usually of little consequence. Fractures usually involve the torso or upper extremities, and shoulder injuries are common. Head and face injuries are not always prevented by current helmet designs. Fatal injuries are rare but have been reported. Improvements in safety equipment, rider training and racecourse design are suggested injury prevention measures. The authors encourage continued research in this sport.

Below is a link to a current research article on emergency care for mountain biking injuries.

Mountain Biking−Related Injuries Treated in Emergency Departments in the United States, 1994-2007

Prolotherapy is helpful for what conditions?

The treatment is useful for many different types of musculoskeletal pain, including arthritis, back pain, neck pain, fibromyalgia, sports injuries, unresolved whiplash injuries, carpal tunnel syndrome, chronic tendonitis, partially torn tendons, ligaments and cartilage, degenerated or herniated discs, TMJ pain syndromes and sciatica.

What is prolotherapy?

First, it is important to understand what the word prolotherapy itself means. “Prolo” is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak.

Ligaments are the structural “rubber bands” that hold bones to bones in joints. Ligaments can become weak or injured and may not heal back to their original strength or endurance. This is largely because the blood supply to ligaments is limited, and therefore healing is slow and not always complete. To further complicate this, ligaments also have many nerve endings and therefore the person will feel pain at the areas where the ligaments are damaged or loose.

Tendons are the name given to tissue which connects muscles to bones, and in the same manner tendons may also become injured, and cause pain.

Prolotherapy uses a dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.

Historical review shows that a version of this technique was first used by Hippocrates on soldiers with dislocated, torn shoulder joints. He would stick a hot poker into the joint, and it would then miraculously heal normally. Of course, we don’t use hot pokers today, but the principle is similar—get the body to repair itself, an innate ability that the body has.

How long will it take to complete a course of treatments?

The response to treatment varies from individual to individual, and depends upon one’s healing ability. Some people may only need a few treatments while others may need 10 or more. The average number of treatments is 4-6 for an area treated. The best thing to do is get an evaluation by a trained physician to see if you are an appropriate candidate. Once you begin treatment, your doctor can tell better how you are responding and give you an accurate estimate.

What conditions can be treated with prolotherapy?

Arthritis

Back pain

Barre-Lieou syndrome

Carpal tunnel syndrome

Cluster headache

Deep aching

Degenerative arthritis

Degenerative disk disease

Disc herniation

Fibromyalgia

Hand (study two)

Headache

Heel spurs

Hip Degeneration

Knee injuries

Low back pain

Migraine headache

Multiple sclerosis

Muscular dystrophy

Osteoporosis (compression fractures)

Pain

Polio

Post-concussion headache

Rotator cuff tears

Sacroiliac sprain

Sciatica

Scoliosis

Slipped spine

Spinal defects

Tennis elbow

Tension headache

Thumb (study two)

TMJ dysfunction

Whiplash

What can I do to prepare for the treatment?

It is important to be properly hydrated before each treatment. Ensure that you drink at least 2 liters of water for several days prior to your appointment. It is also recommended that you discontinue anti-inflammatory medications (unless they are for other than what is being treated) for 48 hours prior to your treatment. Finally, be sure to have a meal before the treatment.

What can I expect during and after a treatment?

Depending on the area being treated and the extent of the injury, each treatment session will take between 30 – 60 minutes. The first part of the treatment will include a review of the injured area and a reassessment, followed by sterilization of the area to be injected. Both povidone iodine and alcohol are used in the sterilization process. Because many of the areas injected have poor circulation, proper sterilization is of utmost importance. This is followed by point location and marking of the area. Once the area is properly prepared the treatment begins. Again, depending on the extent of the injury and area injured will determine the number of injections.

The amount of discomfort felt after the treatment varies from person to person. Typically you can expect several days of discomfort and should minimize activity during this time. It is important to treat the discomfort as you would an acute injury and rest it as much as possible. If the discomfort is high you may ice the area but avoid using anti-inflammatory substances as acute inflammation is an important part of the treatment. If the discomfort lasts longer than a week, or if you have any questions regarding the treatment please contact Dr. Rootes.

Here is a link to describe what Prolotherapy is.

http://video.google.com/videoplay?docid=7878010826100952691#

You may wish to start out by liberally applying lotion or oils to your breasts to assist gliding over the skin and to avoid unnecessary discomfort.

1. Use very light strokes like petting a cat and sweep from just below the collar bone all the way down to the nipple, working one breast at a time. Then, using the same pressure sweep outward from the nipple in all directions like a spoke on a wheel, with the centre being the nipple. Move in straight lines from the nipple out to the sides of the breast working the entire breast. You may wish to work each line one fingers width apart in a clockwise direction until you have worked the entire breast up to three times around. (Note: While doing this technique, try to feel for any changes. You may wish to try and take notes on every aspect of your breasts conditions, such as: lumpiness, shape, colour, texture, contour, volume, symmetry, size, nipple appearance, and even temperature. Every month compare these qualities to see if there are any changes. If you notice any that are very noticeable, you should see your health care provider.)
2. Using both hands, cup the breast on either side with medium pressure and gently massage the breast sweeping from the outside of the breast towards the nipples.
3. Using the same cupping hands on either side of the breast and with medium pressure gently and slowly rotate your hands while sweeping from the outside of the breast towards the nipples. Do this in both directions at least 3 times.
4. Last you can do compressions on the breast. First, slowly compress with fingers on either side of the nipples, and then sweeping from the nipples outwards towards the sides of the breast. Second, Simply cup over the centre of your breast with one hand and put your other hand over top of it, then compress the breast with medium to firm pressure (being sure not to hurt yourself, it should not be too painful, if it is lighten up a little bit) 1-3 times. Now you can repeat this on the other breast starting back at number one.

Breast massage for implants

Breast implant self-massage is also very important for women who have implants. One of the many reasons to get a professional breast massage even when you perform your own self breast massage is to insure that it is done properly and with optimum results! There is never a substitute for a thorough and professional breast massage from a highly trained and certified therapist, because the self breast massage does not compare. The professional Breast Massage is one hour long and the self breast massage is less than 15 minutes tops, so if you think about it, there is a big difference. It is still good, however, to learn how to perform self-breast massage for between appointment maintenance and we encourage women to do it to improve their breast health and to lower their breast cancer risks. The technique shown below is one of the breast implant massage techniques known as displacement, which helps in postoperative augmentation by avoiding what is known as “Capsule Contracture”. Capsule contracture can cause augmented breasts to become unnaturally hard and can also in some cases cause them to shift or look abnormal. Not only is breast massage important for the health of women with augmented breasts, but it is also important to maintain the appearance and feel of the augmented breasts as well.

Hold breast at bottom and squeeze bag from bottom to top to move through capsule and reduce adhesions.

For most people, a diagnosis of cancer is the most serious threat to their existence they will experience. Regardless of the type of cancer, it forces them to confront their own mortality and re-evaluate their life. Managing the fear and anxiety can be an enormous challenge, requiring a profound shift in orientation. The new reality presents a torturous road to navigate. They need all the help they can get. When one is most fearful, overwhelmed, easily confused, and unwell, one cannot digest complicated information about drug options and choices. Yet that is what is demanded at the most vulnerable of times.

Marg Huber writes from the perspective of a cancer patient who has been there. A 62 year old Caucasian Canadian woman, who was diagnosed in November 2007 with stage 3 inflammatory breast cancer, a locally advanced, invasive carcinoma, Huber shares with us what she has learned.

Download her entire Cancer Therapies: A Survivor’s Perspective article.

An adhesion is a band of scar tissue that binds 2 parts of your tissue together. They should remain separate. Adhesions may appear as thin sheets of tissue similar to plastic wrap or as thick fibrous bands.

The tissue develops when the body’s repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation. Although adhesions can occur anywhere, the most common locations are within the stomach, the pelvis, and the heart.

Structures that are separate are meant to glide, when there is tissue injury, the sliding mechanisms that enable our tissues to glide upon each other are compromised.  Manual therapy and myofascial release can restore tissue glide and allow for normal function to return.

Abdominal adhesions:

Abdominal adhesions are a common complication of surgery, occurring in up to 93% of people who undergo abdominal or pelvic surgery. Abdominal adhesions also occur in 10.4% of people who have never had surgery.

• Most adhesions are painless and do not cause complications. However, adhesions cause 60%-70% of small bowel obstructions in adults and to contribute to the development of chronic pelvic pain.
• Adhesions typically begin to form within the first few days after surgery, but they may not produce symptoms for months or even years. As scar tissue begins to restrict motion of the small intestines, passing food through the digestive system becomes progressively more difficult. The bowel may become blocked.
• In extreme cases, adhesions may form fibrous bands around a segment of an intestine. This constricts blood flow and leads to tissue death.

Pelvic adhesions:

Pelvic adhesions may involve any organ within the pelvis, such as the uterus, ovaries, fallopian tubes, or bladder, and usually occur after surgery. Pelvic inflammatory disease (PID) results from an infection (usually a sexually transmitted disease) that frequently leads to adhesions within the fallopian tubes. A woman’s eggs pass through her fallopian tubes into her uterus for reproduction. Fallopian adhesions can lead to infertility and increased incidence of ectopic pregnancy in which a fetus develops outside the uterus.

The link below is to a paper that provides the first evidence that manual therapy can prevent and treat abdominal adhesions.  The work was completed by Susan Chapelle, RMT and Geoffrey Bove, DC, PhD and published in “Journal of Bodywork and Movement Therapies”.

Manual therapy lyses and prevents visceral adhesions

Many studies have documented acupuncture’s effects on the body. Researchers have proposed several processes to explain acupuncture’s effects, primarily on pain.

In general, acupuncture points are believed to stimulate the central nervous system, which, in turn, releases chemicals into the muscles, spinal cord, and brain. These chemicals either alter the experience of pain or release other chemicals that influence the body’s self-regulating systems. These biochemical changes may stimulate the body’s natural healing abilities and promote physical and emotional well-being.

Attention has been focused on the following theories to further explain how acupuncture affects the body:

Conduction of electromagnetic signals:

Evidence suggests that acupuncture points are strategic conductors of electromagnetic signals. Stimulating these specific points enables electromagnetic signals to be relayed at greater-than-normal rates. These signals may start the flow of pain-killing bio-chemicals, such as endorphins, or release immune system cells to specific body sites.

Activation of the body’s natural opiod system:

Considerable research supports the claim that acupuncture releases opiods, synthetic or naturally-occurring chemicals in the brain that may reduce pain or induce sleep. These chemicals may explain acupuncture’s pain-relieving and relaxation effects.

Stimulation of the hypothalamus and the pituitary gland:

Joined at the base of the brain, the hypothalamus and pituitary glands are responsible for many body functions. The hypothalamus activates and controls part of the nervous system, the endocrine processes, and many bodily functions, such as sleep, regulation of temperature, and appetite. The pituitary gland supplies some of the body’s needed hormones. Stimulation of these glands can result in a broad spectrum of effects on various body systems.

Change in the secretion of neurotransmitters and neurohormones:

Studies suggest that acupuncture may alter brain chemistry in a positive way. This is accomplished by changing the release of neurotransmitters (biochemical substances that stimulate or inhibit nerve impulses) and neurohormones (naturally-occurring chemical substances that can change the structure or function, or impact the activity of, a body organ).

National Institutes of Health’s Prospective on Acupuncture:

Clinical studies presented by the National Institutes of Health (NIH) have shown that acupuncture is an effective treatment for nausea caused by surgical anesthesia and cancer chemotherapy, as well as for dental pain after surgery.

The NIH also has found that acupuncture is useful by itself, or in combination with conventional therapies, to treat addiction, headaches, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, and to assist in stroke rehabilitation.

What Conditions Benefit from Acupuncture & Chinese Medicine According to The World Health Organization?

Many North Americans seek acupuncture treatment for relief of chronic pain, such as arthritis or low back pain for which is has great success in treating. Acupuncture also has expanded uses in other parts of the world. The World Health Organization (WHO) lists conditions that may benefit from acupuncture. These conditions include the following:

Digestive

Abdominal pain

Constipation

Diarrhea

Hyperacidity

Indigestion

Emotional

Anxiety

Depression

Insomnia

Nervousness

Neurosis

Eye-Ear-Throat

Cataracts

Gingivitis

Poor vision

Tinnitus

Toothache

Gynecological

Infertility

Menopausal symptoms

Premenstrual symptoms

Musculoskeletal

Arthritis

Back pain

Muscle cramping

Muscle pain and weakness

Neck pain

Neurologica

Sciatica

Headaches

Migraines

Neurogenic bladder dysfunction

Parkinson’s disease

Postoperative pain

Stroke

Respiratory

Asthma

Bronchitis

Common cold

Sinusitis

Smoking cessation

Tonsillitis

Miscellaneous

Addiction control

Athletic performance

Blood pressure regulation

Chronic fatigue

Immune system tonification

Stress reduction

Can Acupuncture Ease the Symptoms of Menopause?

Cohen SM, Rousseau ME, Carey BL.

University of Pittsburgh, 440 Victoria Bldg, 3500 Victoria St, Pittsburgh, PA 15261, USA.

In a randomized, 2-group clinical study, acupuncture was used for the relief of menopausal hot flushes, sleep disturbances, and mood changes. The experimental acupuncture treatment consisted of specific acupuncture body points related to menopausal symptoms. The comparison acupuncture treatment consisted of a treatment designated as a general tonic specifically designed to benefit the flow of Qi (energy). Results from the experimental acupuncture treatment group showed a decrease in mean monthly hot flush severity for site-specific acupuncture. The comparison acupuncture treatment group had no significant change in severity from baseline over the treatment phase. Sleep disturbances in the experimental acupuncture treatment group declined over the study. Mood changes in both the experimental acupuncture treatment group and the comparison acupuncture treatment group showed a significant difference between the baseline and the third month of the study. Acupuncture using menopausal-specific sites holds promise for non-hormonal relief of hot flushes and sleep disturbances.

by Mark Korven, musician and composer

For most of my 30-year career as a musician, I’ve been blissfully free of aches and pains. I could pound away at the keyboard for hours on end and then run out to play a couple of sets of tennis – no problem. I was invincible.

But about five years ago I began noticing sharp pains in my forearm after I’d played tennis. After I stopped that year they went away. The next year, the pains were back. I dismissed it as “stiff muscles”. I decided to just go ahead playing as much tennis as possible in order to build up more strength. Macho athletic slogans bounced through my head: “No pain, no gain! Play through it! Be a man!”

Those sharp pains got worse. Now there was tingling and numbness in my fingers. I stopped playing tennis altogether, and to my alarm the pain didn’t go away – not for the rest of that year or the next year. It didn’t go away in spite of regular treatments to physiotherapists and alternative therapists of virtually every description. I’d been prodded, adjusted, injected, scolded, blessed and jabbed by just about everyone this side of Saskatoon. Turning a key in a car door lock still sent bolt of lightning pains down my arm. Even holding a tea cup made me cautious, knowing that I could be struck at a moment’s notice by the cruel and vengeful god of tendonitis thunder.

Thankfully, although it ended my tennis ambitions, it didn’t seem to interfere with my keyboard or guitar playing. I cut back on my violin playing because how could violin playing possibly do anyone’s arm any good? The only thing that seemed to make the forearm pains manageable was the hot-and-cold contrast baths that one therapist recommended. I decided that this tendonitis that I had was chronic and thought that the best I could do was to learn to live with it.

Then the bursitis in my shoulder started late last year and I gradually lost range of motion in my shoulder. I stopped playing violin and guitar. I stayed away from the computer for a week, but still I lost about a 1/4 inch of range with each passing day. Lifting my arm over my head was a painful ordeal. I again frantically raced around to therapists. One told me that soon I wouldn’t be able to lift my right arm at all. He wasn’t terribly encouraging. “You waited too long”, he said ominously before every treatment session, in his best funeral director’s voice.

I continued therapy but there was no improvement. Along with my range of motion, I was also losing my sense of humour. I was even contemplating turning down a good movie-of-the-week that came with a nice music budget. Could I be sued if I started the score and wasn’t able to finish it?

A bass player friend recommended a deep tissue massage therapist, Susan Chapelle, who apparently specialized in treating RSI (repetitive strain injuries) in musicians. Desperate and feeling that my career was on the line, I contacted her and immediately began treatment.

Susan was an iconoclastic, no-nonsense, down-to-earth sort who demonstrated a deep knowledge of anatomy and approached repairing my damaged muscles as a skilled car mechanic, twisting and pulling my tendons like she was installing a new cam shaft.

At Susan’s massage table there was no incense, and no cheesily synthesized “Pachabel’s Canon” wafting up from a ghetto-blaster. No airy-fairy new age vibrations at all in this place. She treated me three times a week and insisted that I put in the hours stretching and strengthening on my own time to make sure that the gains were not lost.

Within two months my tendinitis and bursitis had improved by about 90%. I was playing violin again and after five years, even played a little girly-man tennis.

During those long and sometimes painful hours on the massage table I talked to Susan about musicians and RSI and decided to conduct an interview with her. The questions were sent to her via E-mail.

Q: What are the most common RSI problems that you come across with musicians?

The most common RSI problems in musicians seem to stem from muscle imbalances related to the particular instrument that is being played. These imbalances can lead to what is commonly known as “tennis elbow” or tendinitis of the elbow. Other problem areas that I see alot of are in the shoulder girdle, low back (sciatica) and carpal-tunnel regions.

Q: How treatable is tendinitis and bursitis?

Tendinitis and bursitis are very treatable. Assessment is a huge factor in “fixing” pain in the soft tissue. A therapist or doctor should be looking at the person as a whole. What are the contributing factors in this persons life that has led to a RSI disorder? Lifestyle and diet, bad ergonomic studio set-up, how the instrument(s) are being played (i.e. posture and muscle use) – all must be addressed in order to permanently change a painful situation.

Q: What are some of the most important things composers (as people who sit in front of a computer all day) can do to prevent RSI?

Take care of your health. Take breaks and stretch. Often, once an idea is at hand, a musician / composer will sit in the studio for hours on end with no break. Movement and stretching the muscles to maintain their length is one of the best things to prevent injury. Every 1/2 hour get up and do some opposite movements for the hands and lower back.

Q: What causes tendinitis? Is it usually one thing or a variety of factors?

Tendinitis is an inflammatory condition of the tendons that occurs as a result of repeated microtrauma. It is characterized by painful scarring within the tendon and pain with use of the affected muscles. It is usually a variety of factors that contribute to the scarring, but with musicians it can be building over many years of using a muscle in a shortened, contracted position. Many musicians are involved in other sports and yet have trouble thinking of their instrument or work environment as physical work. Injuries often occur not as a direct result of playing, but as a secondary injury due to hockey or tennis because the muscles are in a shortened position from the instrument posture. Stretching, icing after long playing sessions, as well as strengthening weakened structures are essential to prevention of RSI.

Q: What are the early warning signs that signal the onset of tendinitis or bursitis?

Pain on activity in the affected muscle. Not being able to lift your coffee cup in the morning is a common one.

Q: I understand that the cause of pain someone might be feeling in the arms or shoulders might be originating somewhere else. Can you talk a little about “referred pain”?

When muscles are used at a shortened length over an extended period of time, the brain uses protective mechanisms commonly referred to as “trigger points”. This mechanism is used by the body to protect shortened muscles from being injured. The definition of a trigger point as defined by Janet Travel, M.D. (Travel, Simians 1992) is “a hyper-irritable spot, usually within a taught band of skeletal muscle or its fascia, that is painful on compression”. Trigger points can give rise to characteristic referred pain, tenderness, and autonomic phenomena (organ or internal pain). They can be worked out of muscle with deep tissue massage. So, often one can feel pain in one part of the body, and the offending tissue is actually in a different location. Fascia (the wrapping of the muscles) can also cause pulling or tension in different locations when it is adhered to other structures.

Q: What’s happening when someone has tingling or numbness in their fingers?

Once someone is experiencing numbness or tingling, it is usually an indicator of tight muscles impinging on the blood or nerve supply to the extremities. A common occurrence in musicians is waking up with numb or tingling fingers from sleeping with their arms over top their heads. Tight muscles in the neck area impinge on nerves and on the blood supply to the arm. This can be stopped by reducing the stiffness in the neck via massage, or stretching.

Q: How are musicians when it comes to seeking treatment for RSI?

Musicians are terrible at seeking treatment! Most often the playing has to become extremely inhibited by physical pain. I find many musicians are in denial about their pain because they fear losing the ability to play. They leave it far too long to get treated, and something that could have been resolved ends up being a chronic problem.

Q: Are there any particular instruments that are bad when it comes to RSI?

Most instruments have unnatural postures, and as a result the musician has muscle imbalances. I would have to say violin, keyboard players, bass and guitar players are the ones I see most in my clinic. Most musicians also work in the studio, and have their racks set up incorrectly for posture, as well as an ergonomically incorrect set-up of their computer or keyboard.

Q: At the onset of my tendinitis years ago, I went to an MD who immediately shot cortisone into my elbow. How effective is cortisone treatment?

Cortisone treatment is or should be the last resort in a line of treatment that usually starts with anti-inflammatories. However, there is no long-term research to prove that cortisone therapy is effective in the treatment of RSI. It is a very strong anti-inflammatory and it is believed that local injection will reduce the inflammation and resolve the problem. The problem with cortisone is it actually breaks down the tissue causing an increased build-up of scarring. This will, over the long term, cause an increase in inflammation and makes the original RSI problem more difficult to treat. I am currently seeking funding for a research project that will compare massage therapy to conventional or allopathic therapy in the treatment of RSI in the long term.

Q: How does your type of massage differ from the more typical relaxation-type massage?

My massage is very treatment-oriented. I like to see my patients back at their instruments as soon as possible. This involves muscle balancing, education and a ton of home care. Most people are shocked when getting treated by me. They come with expectations of relaxation massage, and have no idea how much work I expect them to put in to resolve the problem.

Q: What should someone look for in a therapist? How trained do you have to be? How trained are you?

If someone is seeking massage therapy, they should look for a registered massage therapist. This means the therapist is regulated under the Regulated Health Professions Act and Massage Therapy Act, has insurance and is properly trained, having taken provincial and college exams. I completed 2 years of training at Sutherland Chan and have done extensive post-graduate studies in many areas. I feel that a good therapist should have extensive knowledge of anatomy, and an exceptional ability to link movement with structures.

Q: I know a lot of musicians are in a state of RSI denial. Can you talk a little about the accompanying psychological problems that happen with RSI?

RSI is a difficult diagnosis for a musician to hear. Often they know others who have been told they should stop playing their instrument. A difficult thing if you earn your bread and butter by playing! Musicians are reluctant to try natural or “alternative” therapies, and end up back and forth to many clinics that don’t get results.

Q: In your experience, what’s the most effective treatment for RSI?

The most effective treatment is learning about your body, and being educated on how to care for it, because most musicians live a fairly unhealthy lifestyle. They also tend to not connect their bodies to their instruments, but they are completely connected. Musicians should think of themselves as athletes.

This article orginally appeared in “Spotting Notes” which is the newsletter for the Guild of Canadian film & television composers