Studio Medico Bassani, dr. Luciano Bassani specialista in terapia fisica e riabilitazione (English NEWS)http://www.studiomedicobassani.itStudio Bassani, viale L. Majno 15 20122 Milan - tel. 02 76021267itStudiomedicobassani.it 2012http://www.studiomedicobassani.it/sito/images/logorss.gifStudio Medico Bassani - RSS NEWShttp://www.studiomedicobassani.it20060 <![CDATA[Prolotherapy course day two Verona 04/05/february 2012]]> Prolotherapy Course Day Two Verona febrauary 2012ù

For info push here

]]> http://www.studiomedicobassani.it/en/index.asp?NewID=21 Luciano Bassani Fri, 7 Oct 2011 0:0:0 +01:00 <![CDATA[Trigeminal Neuralgia]]> TRIGEMINAL NEURALGIA

The pain and inflammation of the Trigeminal nerves is caused by peptidergic nociceptors. As far as I know there is no anatomical textbook that can give  the exact location of all the receptive fields of these peptidergic C-fibers.
Simply because anatomist have never looked for them as they are a recent immune-reactivity and electro-physiological finding. Peptidergic C-fibers (nociceptors) are not nerve fibers one can easily identify with an electron microscope.
They can only be identified by immune reactivity studies for CGRP and SP and electro-physiological transduction studies. Incidentally the receptive field of a peptidergic C-fiber is thought to cover at most 1 cm2 (=100 mm2)
]]> http://www.studiomedicobassani.it/en/index.asp?NewID=20 Luciano Bassani Thu, 28 Apr 2011 0:0:0 +01:00 <![CDATA[The mechanism of action of the Neural Prolotherapy]]> The mechanism of action of the Neural Prolotherapy

Subcutaneous prolotherapy’ was targeting the peptidergic sensory nervous system and its effectiveness was directly due to the effect of glucose on the Capsaicin/Vanilloid receptor, now better known as the TRPV1 receptor. I am postulating that Dextrose 5% in sterile water (D5W) is a TRPV1 antagonist.
We now have conclusive scientific evidence that inflammation is under the control of the peptidergic sensory nervous system, not the immune system. In fact it is Substance P released from peptidergic sensory nerves that activates the Immune system, which then results in a positive feedback loop between neurons and immune cells directing the direction of inflammation.
The peptidergic sensory system also directs anti-inflammatory mechanisms through the release of anti-inflammatory neuropeptides Galanin and Somatostatin. All of this is under the control of TRPV1 receptors.
The cloning of the TRPV1 receptor in 1997 by David Julius and his team and published in Nature is a breakthrough of unpredictable magnitude in Medicine and all of us are forced to give a scientific explanation about what we are doing in terms of its effect on TRPV1, as this molecule is the principal mediator of inflammation and pain.
For prolotherapy this means explaining how hypertonic glucose works on TRPV1, how P2G, sodium morrhuate and Sarapin work on TRPV1. The Self-regeneration process is now known to be directed by the same peptidergic sensory nerves, but only during normal physiological conditions through the tonal, non-inflammatory release of CGRP and SP. This means that prolotherapy’s ‘regeneration concept’ has to be explained in terms of peptidergic sensory neurological control.
The cloning of TRPV1 should be a wake up call for all prolotherapist (and all of Medicine) to re-examine our rationale for what we are doing.
George Hackett was always re-examining his rationale and solutions. He introduced the connection between the nervous system and prolotherapy in his 1962 articles. I strongly recommend you read them as it illustrates his brilliance and open-mindedness in a time when there was little of basic science to go on. he was for his time exceptionally up to date with the literature.
If anything my choice of the name ‘neural prolotherapy’ is a primarily a tribute to George Hackett's innovations (Glucose) in the treatment of chronic pain.
 
 John Lyftgt
 ]]> http://www.studiomedicobassani.it/en/index.asp?NewID=19 John Lyftgt Mon, 7 Mar 2011 0:0:0 +01:00 <![CDATA[Prolotherapy solutions]]> Prolotherapy solutions

I use a number of different prolotherapy solutions and make adjustments based on the individual's tolerance and response to treatment. While I start most patients with a 15% dextrose solution and adjust upward as appropriate, individual factors are important.
For instance, I usually start someone with a diagnosis of congenital hypermobility on a 20% dextrose solution and if that is well tolerated I will increase it to half strength or full strength P2G. Based on my experience, these patients will generally have a better long–term outcome if I provide more stimulation to the tissues for a healing response. In some cases however, going from a dextrose solution to P2G is simply too difficult.
 I use a solution that I call "half–strength P2G" that makes a good intermediate solution for injection.The standard stock solution of P2G that is received from the pharmacy is dextrose 25%, phenol 2.5% and glycerin 25%. Before it is injected, this stock solution is diluted by 50% (with something/anything) so that the actual injection solution concentration is dextrose 12.5%, phenol 1.25% and glycerin 12.5%. My intermediate (half-strength) solution is mixed as follows in a 10 cc syringe: P2G 2.5 cc, dextrose 50% 2 cc, lidocaine 1% 2.5 cc and normal saline 3 cc. The solution actually has more dextrose (16.25%) than the standard P2G injection solution but with half as much of the phenol and glycerin (0.625% phenol and 6.25% glycerin). This provides a good option for those patients that seem to need more than just dextrose but have a difficult time tolerating full strength P2G for injection.

Carl Osborn
 ]]> http://www.studiomedicobassani.it/en/index.asp?NewID=18 Carl Osborn Thu, 13 Jan 2011 0:0:0 +01:00 <![CDATA[Psoas Syndrome]]> PSOAS SYNDROME

By Joel Berenbeim, D.O.

The iliopsoas muscle is one of the longest and thickest muscles in the body. In animals, it is known at the tenderloin. It's importance cannot be understated in the etiology of back and anterior hip pain. The iliopsoas muscle consists of the psoas major, minor and iliacus. Functionally the three muscles act together to flex the lumbar spine and flex the hip. They help to maintain posture while standing and during locomotion and control lumbar lordosis and pelvic tilt. Psoas syndrome may include muscular imbalance, strain, sprain, spasm, tendinosis, and acute or chronic contractures of the iliopsoas muscle and sciatica. A common cause of iliopsoas dysfunction is suddenly resuming an upright position following prolonged muscle shortening, which does not allow the reflexes to reset appropriately resulting in muscle contraction. Examples of this include prolonged sitting, possibly in a soft easy chair, prolonged kneeling when gardening, prolonged crouching, leaning over a table, or bending forward for a prolonged or extended period of time. Strains of the muscle can also occur from forceful contractions; for example, performing straight leg sit–ups, hooking the feet when doing sit–ups, soccer and kicking sports, or forceful running on an incline. There are also organic causes of psoas spasm that need to be ruled out by history and physical. These include femoral bursitis, arthritis of the hip, diverticulosis of the colon, urethral calculi, prostatitis, cancer of the descending or sigmoid colon, salpingitis, appendicitis, abdominal aortic aneurysm, intra–abdominal abscess, inguinal hernia, or Crohn's disease. Pain can present in the groin or can present as painful muscle spasm in the back. In adolescence, avulsion of the lesser trochanter could be seen, and in adults, enthesopathy and tendinosis may be present. It has also been described with inappropriate use of a heel lift.
Anatomy: The psoas major crosses many articulations including T12–L1, lumbar spine, lumbosacral junction, sacroiliac and hip joints. It attaches to the anterior surface of the transverse process and bodies of T12–L4 and inserts on the lesser trochanter of the femur. The psoas minor does not cross the hip joint. It attaches to T12 and L1 and the iliopectineal eminence. Psoas minor is inconsistent and may be absent. The iliacus crosses the sacroiliac and hip joint. It attaches to the iliac fossa and crest, the anterior sacroiliac, lumbosacral and iliolumbar ligaments and ala of the sacrum. It inserts on the tendon of the psoas major, lesser trochanter, hip capsule and femur. Innervation is L2–L3 for psoas major, L1–L2 for psoas minor and motor branch of the femoral for iliacus.
Clinical presentation: Psoas contracture can present either unilaterally or bilaterally. It may be acute or chronic. The patient presenting with bilateral spasm will be forward bent and unable to stand straight up. The usual presentation, however, is a unilateral presentation with pain on walking and standing. The result of psoas contracture will cause L2 to flex, rotate and side–bend to the side of the psoas contracture. This will create a contralateral hip shift and lumbar convexity as it induces rotation and sidebending to the side of the contracture. A sacral dysfunction on an oblique axis will be present on the side of contracture. On the ipsilateral side, the femur will externally rotate due to the connection on the lesser trochanter and the foot will become everted. With prolonged contracture, spasm of the contralateral piriformis muscle will occur. Mechanical and chemical irritation of the sciatic nerve will cause posterior thigh pain above the knee. Gluteal muscles and quadratus lumborum may also become involved. Gluteus maximus may become pseudoparetic. Shortening of the psoas muscle may be diagnosed using the modified Thomas position. The patient is supine with their buttocks at the end of the table. The operator stands at their side. The patient holds their knee flexing it to their chest on the side not being tested. The leg being tested is extended over the end of the table. If the back of the thigh does not contact the table, psoas shortening is present. If the knee flexes to less than 45 degrees, there is shortening of the quadriceps.
Treatment: Treatment of the psoas is directed initially at the dysfunctional flexed, rotated and sidebent L2. Until this is corrected, it is very difficult to treat the rest of the contracture. Stretching should not be done to the psoas if it is in contracture without correcting the accompanying somatic dysfunction or further shortening and contracture can occur. Strengthening should not be initiated until the psoas muscle is back to its normal resting length or else further contraction will also occur. In order to avoid this reflex shortening, osteopathic techniques to turn off this spasm are usually very successfully which include counterstrain. Counterstrain is used to reduce the pain during treatment and allow the full increase back to normal resting length. Other techniques that can be used are facilitated positional release and other indirect techniques. Direct osteopathic techniques such as muscle energy might prove painful in the contracted, shortened iliopsoas and indirect technique until the acute spasm is resolved is preferable. If chronic psoas contracture has progressed to enthesopathy or tendinosis, appropriate regenerative injection techniques can be employed to treat the lesser trochanter and hip capsule.
With appropriate diagnosis including comorbid conditions, treatment of psoas syndrome can be easily recognized and treated in the office setting with good resolution of dysfunction and pain for your patient.
]]> http://www.studiomedicobassani.it/en/index.asp?NewID=17 Joel Berenbeim D.O. Tue, 26 Oct 2010 0:0:0 +01:00 <![CDATA[Italin neural prolotherapy seminar 2010]]> http://www.studiomedicobassani.it/en/index.asp?NewID=16 John Lyftogt Mon, 30 Aug 2010 0:0:0 +01:00 <![CDATA[Prolotherapy and Baker's cyst]]> Prolotherapy and Baker's cyst

A cyst is a fluid filled sac in any location of the body. One of the more common areas where cysts occur is the back of the knee. These cysts are called popliteal cysts or Baker's cysts. Typically, damage within the knee causes swelling and the fluid is pumped from the knee to this fluid filled sac. This creates swelling and sometimes pain in the back of the knee. This may cause problems achieving full bending or full straightening of the knee.
Typically, draining or cutting out this cyst does not help unless the cause of the fluid accumulation inside the knee is cured. Orthopedic surgeons will recommend that the person get an MRI and subsequent Arthroscopy to 'fix' the problem. For the person who desires not to have a 24 inch probe stuck in their knee and undergo general anesthesia, there is another option: Prolotherapy.
Let's think about it. Someone has a trauma to the knee and eventually a baker's cyst forms. What most likely would be injured to cause instability in the knee so joint fluid accumulates. You got it...ligament damage. In my opinion the best treatment option for a ligament being stretched is Prolotherapy.
Can Arthroscopy fix a ligament that is stretched? No. Prolotherapy to the injured structure will stimulate the body to repair it. Once it is repaired and the joint is stable, no more joint swelling. Once there is no more joint swelling there is no more baker's cyst.
In summary: For those of you with baker's cysts, just draining the cyst doesn't repair anything, it alleviates swelling. Even then the physician will tell you the likelihood is that the cyst will return. Why? Because the damage into and around the knee joint remains. Damage to the following structures could cause a baker's cyst to form: the menisci, ligaments, cartilage, or joint capsule. All of these structures respond to the repair stimulating effects of Prolotherapy. By a person receiving Prolotherapy to the inside of the knee, the joint structure causing the swelling is often repaired. Once it is repaired, the joint swelling stops. Once the joint swelling stops, the baker's cyst ceases to exist. We call this ìceasing to existî a cure. So if you want your baker's cyst cured, get a Prolotherapy evaluation and, if appropriate, Prolo Your Baker's Cyst Away!

Ross Hauser, M.D.

]]> http://www.studiomedicobassani.it/en/index.asp?NewID=15 Ross Hauser, M.D. Sun, 27 Jun 2010 0:0:0 +01:00 <![CDATA[Reflex topognosia of ear points]]> REFLEX TOPOGNOSIA OF EAR POINTS


The somatic representation point. 

Areas are three-dimensional (complex neuro vascular) or Voxel neurophysiological and not simple steps, tied to a retinaculum whose shape evolves continuously.
Are constantly adapted, according to the  segmental primary and genera homeostasisl, depending on the variations of the supported disease , may vary in shape but always staying within the perimeter embryological assigned (same value volume). 
This volutomo tissue is genetically dedicated to receive information or a physiological or pathological mixage between the 2.

If cosmetic surgery, the destinated place  don’t change! 
It 's a dynamic process active throughout life and genetically determined! In the absence of disease points receive afferents of physiological action potentials (through the reticular formation) from various organs. 
If there is a disease, the pathological potentials action  coming from a diseased area, occur with a potential difference between one point and another.
These pathological potentials action  remains mostly trapped in their corresponding somatotopically ear. The reticular do filter , the potentials are developed, settles on the pavilion. This representation of the ear is more intense (and spotter) as the disease is important, significant and durable. There is a descending order of value: the most important representations are those with strong limbic emotional connotation.
They also represents the visceral and somatic disorders (painful) especially during acute diseases disturbing the balance motor postural muscle. The message then disable and shut down  gradually or suddenly if the disease loses its meaning for the homeostatic process management (intregrated and tolerated). 
Electrically, there will be gradual reduction of potentials action for habituation, adaptation, compensation ,is a mechanism of economics points topical reflex. 
If a chronic process is disabled in the ear and suffers worsening , turn the ear (in proportion to the intensity and duration of aggressive process) and then undergoes the same laws of electrophysiological regression, but may leave place for a  meaning of higher representation. 
You can have on the point a puzzle of representation of different powers in the same somatotopically.

REPRESENTATIONS

PROPORTIONALITY '

SELECTIVITY '

POINTS VARIABILITY
ECONOMICS 
PLASTICITY '
POINTS EXHAUSTION]]> http://www.studiomedicobassani.it/en/index.asp?NewID=14 David Alimi Thu, 8 Apr 2010 0:0:0 +01:00 <![CDATA[Osteoarthritis and Leptins]]> OSTEOARTHRITIS AND LEPTINS

Carl Osborne AAOM President

 
Many patients come to my office seeking prolotherapy for "arthritis". There are over 100 different classifications of arthritis, but generally what they mean is "osteoarthritis".We know from various studies that people over 30 have a probability of degenerative spine or joint changes of approximately 50%. If they are over 40 years of age it is closer to 90%. Many of these people don't have pain initially but if they start to hurt and get an x–ray they are told they have osteoarthritis. NSAIDs, physical therapy and cortisone injections are frequently prescribed, but when the pain persists they are commonly told they must "live with it". When we do prolotherapy and the pain resolves do they still have "arthritis" or just degenerative changes that are clinically asymptomatic.
Osteoarthritis is generally considered a "wear and tear" problem, and abuse and injury or ligament damage can clearly destabilize joints, affecting joint health and function. But it is probably more appropriate to think of osteoarthritis as a disease of the whole musculoskeletal system including cartilage, muscle, ligaments, bone and adipose tissue. Research has shown that obesity increases the risk for osteoarthritis in nonweightbearing joints such as fingers as well as the spine and hips or knees. Because osteoarthritis can be a generalized disease, there is more than mechanical force involved in joint destruction.
Adipose tissue secretes leptons which can trigger inflammation and joint instruction. At Duke University, an animal study compared two groups of mice. The first group of normal mice were fed a high fat diet to make them obese, and they subsequently developed arthritic knees. A second group included a breed of obese mice that were leptin deficient. This group showed no signs of joint damage even though they weighed about twice as much as the first group. This suggests a link between leptin signaling in obesity and osteoarthritis. Considering our current epidemic of obesity in the U.S., we are likely to see development of osteoarthritis in a much younger population.


]]> http://www.studiomedicobassani.it/en/index.asp?NewID=13 Carl Osborne Mon, 22 Mar 2010 0:0:0 +01:00 <![CDATA[Pain and D vitamin]]> A research letter published in the April 14, 2008 issue of the American Medical Association journal Archives of Internal Medicine reported that vitamin D supplementation reduced pain levels in patients with diabetic neuropathy. The condition occurs when high levels of glucose damage the nerves, and can include burning, tingling, numbness, and throbbing sensations.

Drs Paul Lee and Roger Chen of the Concord Repatriation General Hospital in New South Wales, Australia enrolled 51 type 2 diabetics with neuropathy for the study. Pain severity was rated via two questionnaires and serum 25 hydroxyvitamin D and parathyroid hormone levels were measured at the beginning and end of the treatment period. All participants were found to have insufficient levels of vitamin D at less than 24 nanograms per cubic milliliter at the study’s onset, and were given a mean dose of 2,059 IU of the vitamin for three months.

Lower pain scores were found to be correlated with higher levels of serum vitamin D but not with parathyroid hormone levels. Treatment with vitamin D resulted in a 48.5 percent reduction in pain scores on the first questionnaire and a 39.4 percent reduction on the second by the end of three months. Drs Lee and Chen remark that there is evidence that vitamin D promotes nerve growth and modulates neuromuscular function and neuronal growth and differentiation.

Having inadequate levels of the vitamin could increase nerve damage and impair pain receptor function. They note that vitamin D supplements are unlikely to have harmful effects and may also benefit bone health and glycemic control in diabetic patients. To the authors’ knowledge, the study is the first of its kind to address the effect of vitamin D on patients with diabetic neuropathic pain. “Vitamin D insufficiency is underrecognized and may be a significant contributor to neuropathic pain in type 2 diabetes,” they conclude. “Vitamin D supplementation may be an effective ‘analgesic’ in relieving neuropathic pain.”

]]> http://www.studiomedicobassani.it/en/index.asp?NewID=12 Archives of internal medicine Sun, 10 Jan 2010 0:0:0 +01:00 <![CDATA[Neural Prolotherapy]]> NEURAL PROLOTHERAPY BY DOCTOR JOHN LYFTOGT MD

 INTRODUCTION

Classical Prolotherapy was developed in the 1940s by an American Trauma surgeon Dr George Hackett. He used injections of Sylnasol, a sclerosing agent commonly used at the time for sclerosing varicose veins, haemorrhoids and hernias.

He targeted ‘lax’ or ‘weak’ ligaments with Sylnasol injections to make them stronger. He reasoned that ‘weak’ ligaments were the cause of most joint and ligament pain and that strengthening would resolve the pain. He was certainly most successful and published 16 articles and one textbook. He claimed an 80% success rate for the treatment of low back pain and many other painful conditions. After Sylnasol was taken off the market in the 1950s a number of other sclerosing solutions were used and are still being used in the USA.

One of the solutions developed was P2G containing Glucose, Glycerine and Phenol. This solution was also used in New Zealand by Dr Milne Ongley but caused too many side effects leading to Dr Ongley being struck off the medical register in 1974. It was identified that the Phenol component was responsible for the occasional serious adverse reactions.

Other Doctors in the USA, Australia and elsewhere continued to use glucose injections and no side effects have been recorded from glucose other then temporary and mild irritation. A growing number of prolotherapy studies over the last 40 years have indicated good to excellent results from treatment with glucose injections for painful conditions affecting joints, ligaments and tendons.

With the advent of Evidence Based Medicine in the last 20 years the requirements for scientific research have become intensely demanding and financially well out of reach of most researchers, unless supported by large grants or the Pharmaceutical industry. As a result good high level evidence (level 1&2 out of a scale of 5) research on prolotherapy has been almost impossible to fund, but three researchers, Professor Michael Yelland from Australia and Professors David Rabago and K Dean Reeves from the USA have bucked the trend with some excellent studies published recently.

 Doctor John Lyftogt has published six level 4 studies in the Australasian Journal of Musculoskeletal Medicine since 2005 and is a co-author of one level 2 randomised trial published in the British Journal of Sports Medicine in June 2009

SUPERFICIAL PROLOTHERAPY

Dr John Lyftogt has been in General Practice since 1978 and was the senior partner in Parklands Medical Centre, Christchurch until 2008. He has extensive post graduate training and experience in sports medicine and musculoskeletal medicine. He started practising prolotherapy after completing a prolotherapy course with Dr Margaret Taylor in Adelaide in 2003. ù

He has been a full time prolotherapist at Active Health since 2004. Dr Lyftogts early research focussed on the treatment of Achilles tendon problems and he has now treated more then 300 Achilles tendons with a success rate of more than 90%. He has published two level 4 articles on Achilles tendons. The technique developed for the treatment of Achilles tendons differs from classical prolotherapy in that the injections are given immediately under the skin while taking great care avoiding contact with the exquisitely sensitive tendon.

This ‘neural prolotherapy’ or subcutaneous prolotherapy protocol was successfully extended to the treatment of tennis elbow, painful knees, shoulders, neck, hips, ankles, muscle injuries and low back. Results are consistent and two year follow up studies have shown success rates between 80-100%. The treatment is also less invasive than classical prolotherapy.

Because neural prolotherapy does not target tendons, ligaments or joints the question had to be asked what causes the sometimes dramatic decline in pain levels after even a few treatments. A working hypothesis was developed that glucose assists in the repair of connective tissue in the nerve trunks under the skin in a similar way as repairing connective tissue in ligaments and tendons with classical prolotherapy.

These skin nerves are now known to be responsible for painful conditions generally identified as ‘neuralgias’ or ‘peripheral neuropathic pain’. The skin nerve trunks consist for up to 80% of connective tissue and are structurally quite similar to tendons and ligaments.

There is now also compelling scientific evidence that the very small nerves innervating the nerve trunk, known as ‘nervi nervorum’ are responsible for inflammation of the connective tissue of the nerve trunk and surrounding tissues. Interestingly and surprisingly this fact has been known for over 125 years. It is also known that this ‘neurogenic inflammation’ differs from conventional inflammation in that it does not respond to anti-inflammatories or cortisone injections.

This is one of the reasons why these commonly used drugs are proving to be ineffective in many painful conditions in addition to a growing awareness that their use is not without side effects. It is clear from clinical observations on more than three thousand patients and large case series that neural prolotherapy effectively reverses ‘neurogenic inflammation’ and resolves neuralgia pain.

This realisation opens the way for exploring other substances that may have the potential to reverse ‘neurogenic inflammation’ similar to glucose but without having to inject. One such substance has already been identified in Vitamin D in tablet and dermal cream form. Dr John Lyftogt is pursuing other promising drugs and is currently trialling these potential ‘cures’ of debilitating pain and injuries.

Copies of Dr John Lyftogts articles are available on request.

]]> http://www.studiomedicobassani.it/en/index.asp?NewID=11 John Lyftogt Thu, 7 Jan 2010 0:0:0 +01:00 <![CDATA[Dr. Samuel Rosen, ear-surgery pioneer]]> http://www.studiomedicobassani.it/en/index.asp?NewID=10 The New YorkTimes Sun, 6 Dec 2009 0:0:0 +01:00 <![CDATA[Want to live longer?]]> Want to live longer?

Try Vitamin D Posted by: Dr. Mercola November 26 2009 | 29,568 views

Writing in the journal Clinical Endocrinology, scientists from the Netherlands, Austria, and the U.S. report that low blood levels of the sunshine vitamin are associated with increased risk of all-cause mortality, and mortality from heart disease, in the elderly. The research follows hot on the heels of similar findings published in Nutrition Research and in the Archives of Internal Medicine.

The new study used data from 614 people participating in the Hoorn Study, a prospective population-based study with men and women with an average age of 69.8. Blood levels of 25(OH)D were measured at the start of the study. After an average of six years of follow-up, 51 deaths had been documented, 20 of which were due to cardiovascular health.

People with the lowest average vitamin D levels were found to be at a 124 and 378 percent increased risk of all-cause mortality and cardiovascular mortality, respectively. Commenting on the potential mechanism, the researchers note: “Apart from the maintenance of muscular and skeletal health, vitamin D may also protect against cancer, infections, autoimmune and vascular diseases, suggesting that vitamin D deficiency might contribute to a reduced life expectancy.” Adults with lower blood levels of vitamin D may also be more likely to die from heart disease or stroke.

Scientists in Finland compared blood levels of vitamin D, and deaths from heart disease or stroke over time in more than 6,000 people. Those with the lowest vitamin D levels had a 25 percent higher risk of dying from heart disease or stroke. In addition, in a study of 166 women undergoing treatment for breast cancer, nearly 70 percent had low levels of vitamin D in their blood, according to a study presented at the American Society of Clinical Oncology’s Breast Cancer Symposium.

The analysis showed women with late-stage disease and non-Caucasian women had even lower levels. Said Luke Peppone, Ph.D., research assistant professor of Radiation Oncology, at Rochester’s James P. Wilmot Cancer Center: “Vitamin D is essential to maintaining bone health and women with breast cancer have accelerated bone loss due to the nature of hormone therapy and chemotherapy. It’s important for women and their doctors to work together to boost their vitamin D intake."

]]> http://www.studiomedicobassani.it/en/index.asp?NewID=9 Mercola Thu, 3 Dec 2009 0:0:0 +01:00 <![CDATA[Eye and neck proprioceptive messages]]> http://www.studiomedicobassani.it/en/index.asp?NewID=8 Roll e C. Sun, 29 Nov 2009 0:0:0 +01:00 <![CDATA[Strain Counterstrain]]> http://www.studiomedicobassani.it/en/index.asp?NewID=7 Erik Gandino Tue, 24 Nov 2009 0:0:0 +01:00 <![CDATA[Research in prolotherapy]]> Finger osteoarthritis: Injection of chronically painful fingers in osteoarthritis with dextrose proliferant has been studies in randomized controlled fashion with benefit over the control solution. (Reeves 00–1). However, that study has not been repeated. Unless a larger study with randomized design or a larger consecutive patient study demonstrating improvement in objective measure such as finger size and improvement in standard function arthritis outcome measures are performed and confirm benefit, we do not recommend coverage of prolotherapy for finger arthritis.

Golfer's Elbow: A small consecutive patient study on 20 consecutive patients with objective radiographic ultrasound measures was published. (Suresh 2006) Dry needling was performed, followed by autologous blood injection. Although only one injection was significant reduction in pain at 10 months post procedure as well as improvement in echogenicity on ultrasound and a decrease in abnormal (neo) blood vessels. 3 patients failed and opted for surgery but in the remaining 17 VAS for pain improved from 8 to 2.2 and Nirschl score from 6 to 1.vHypoechoic change in the flexor tendon significantly decreased between pre–procedure, when there was a mean (SD) of 6.45 (1.47), and at 10 months, when it was 3.85 (2.37) (p 0.001).

Doppler ultrasound showed that neovascularity decreased between pre–procedure. The measurement of objective tendinosis changes enhanced the power of this study. A larger study with usual treatment or non injection control is recommended prior to insurance coverage consideration.

Groin Pain: Return of elite athletes to full sport after failure with other methods of treatment, as long as there is avoidance of data dropout and a strict consecutive patient design, is a powerful outcome. A study of 24 elite level athletes with chronic groin pain, failure of all standard therapies, and failure to play at high level was reported in 2005. (Topol 2005) 22/24 returned to full play in sustained fashion, with 22 of them to rugged play (rugby). This study was then in essence repeated with 48 additional athletes with identical results. (Topol 2008) IE: 51 more were enrolled, 48 completed a minimum of 2 treatments (average of 3 treatments) and 44/48 returned to full level sustained play, with a variety of sports involved.

This is a remarkable efficacy rate and compares nearly identically to outcome from the best surgically–based studies with many times the expense. This is sufficient evidence to recommend a three treatment trial of prolotherapy in patients with groin pain, although additional studies are recommended in non–elite athletes.

Knee Osteoarthritis: A single randomized controlled trial showed benefit of dextrose injection over simple lidocaine. (Reeves 2000-2) Although this was in knees near or at end stage (3 mm average cartilage and with substantial symptoms), this study has not been reproduced. Prior to consideration of coverage of prolotherapy for knee arthritis it is recommended that a second randomized controlled trial be performed or that an arthroscopically based study demonstrate visual proof of cartilage growth in response to the proliferant utilized.

Low Back Pain: Four randomized controlled trials have been performed. (Ongley 87, Klein 93, Dechow 99, Yelland 04). One was egregioiusly flawed (Dechow 99). The lead author had neither performed prolotherapy, nor learned typical radiation patterns of ligaments. The lead author assigned patients based on incorrect referral pattern assumptions and required the injector to treat areas that had nothing to do with the pain the patient was having without allowing any examination to take place. This was with a strong proliferant and naturally led to pain flare in the proliferant group with a worse outcome than the control group. The other three studies demonstrated long term and substantial reductions in disability in both active and control groups, favoring the proliferant group but not with statistical significance.

This is because even the control groups were not placebo groups. Repetitive needling causes a proliferant effect through several mechanisms. Note that all other consecutive case series of low back pain patients have also confirmed substantial and sustained improvements in pain and function with injection of connective tissue with proliferant in patients with chronic low back pain. (Hooper 04, Wilkinson 05, Cusi 07).

There is no other modality of treatment that has more evidence of long term benefit for low back pain than prolotherapy in such chronic patients. Insurance coverage for low back pain treatment is recommended after another study is published in which a usual treatment control or other non injection control is utilized in the study design to definitively confirm statistically significant improvement in low back pain. It is recommended that the treatment method be clearly described and easily reproducible to allow for clear coverage decisions.

Patellar tendinosis: Two pilot studies have been performed. One used platelet rich plasma with ultrasound guided delivery to areas of tendinosis (Volpi 07) and one used polidocanol with ultrasound guided delivery to areas of neovascularization which is intimately connected to tendinosis. (Alfredson 05) Both were favorable in outcome with excellent pain reduction and improvement in function, although neither emphasized objective followup by ultrasound of changes in neovessels or hypoechoic areas. Prior to coverage consideration a large consecutive patient collection with little or no drop out and long term followup is recommended for either or both of these modalities of treatment.

Plantar fasciosis: There are no no regenerative approach alternatives to proliferant injection except extracorporeal shock wave which has a much higher cost. A consecutive patient study of 20 patients with chronic plantar fasciosis treated with dextrose proliferant injection was reported. (Ryan 09). A mean of 3 treatments were given with a good to excellent results in 16/20. A second and larger study using dextrose proliferant with chronic plantar fasciosis with minimal dropout and long term outcome with more precise measurement tools will merit attention for coverage consideration.

Tennis elbow (Lateral or Extensor tendinosis): A well–designed randomized control trial was published in 2008 in which 24 subjects with chronic elbow pain were assigned to injection with saline or injection with a combination of dextrose and sodium morrhuate. 0, 4 and 8 week injections were performed. (Scarpone 2008) Followup at 16 weeks demonstrated 32% versus 90% improvement, highly significant, favoring the proliferant group. Functional and pain improvement persisted in the proliferant group at 1 year. Another study was reported by Mishra in which 20 surgical candidates were assigned randomly to receive either PRP or bupivicaine injection. Withdrawal of blood in all patients to allow full blinding was not approved by the human subject committee.

Injection was only given once, resulting in a VAS improvement for pain at 8 weeks of 16% (bupivicaine) versus 60% (PRP) improvement. At mean followup of 25.6 months 91% improvement in pain was noted. Both studies represent good pilot outcomes and there are other studies reviewed as well in a a recent review publication. (Rabago 09). Coverage of a treatment trial may merit consideration given the cost and limited efficacy of other approaches (surgical or non surgical in this condition. However it is recommended that another study be conducted using any of the above methods with larger size comparing usual therapy or non injection control to injection of dextrose or PRP with long term outcome measures.

Summary This has been a brief summary of research findings in common conditions and recommendations for reimbursement. It should be noted that all of the above conditions have been shown at least at pilot study level to be successfully treated with a minimum of treatment which would represent considerable cost efficacy. Although insurance reimbursement is recommended only for groin pain at this time, in most areas discussed only one additional high quality study is needed to recommend consideration of insurance coverage. Reimbursement methods are problematic.

It is recommended that at this time that insurance coverage be made according to treatment time at a rate of $400 per hour for non sedation procedures and $600 per hour for treatments that require sedation. The patient would need to pay in addition for proprietary components of treatment (IE PRP) that are not included in usual proliferant injection.

References in Order of Citation Borg–Stein J, Zaremski JL, Hanford MA. New concepts in the assessment and treatment of regional musculoskeletal pain and sports injury. Phys Med Rehabil. 2009. 1(8):744-754. Yelland MJ, Sweeting KR, Lyftogt JA, Ng SK, Scuffham PA, Evans KA. Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial [epub ahead of print] Br J Sports Med (England), Jun 22 2009, pages pending. Maxwell NJ, Ryan MB, Taunton JE, Gillies JH, Wong AD. Sonographically guided intratendinous injection of hyperosmolar dextrose to treat chronic tendinosis of the Achilles tendon: a pilot study. JR Am J Roentgenol. 2007 Oct;189(4):W215–20.

Reeves KD Hassanein K Long term effects of dextrose prolotherapy for anterior cruciate ligament laxity: A prospective and consecutive patient study. Alt Ther Hlth Med May–Jun 2003, 9(3): p58–62. Reeves KD, Hassanein K. Randomized prospective placebo controlled double blind study of dextrose prolotherapy for osteoarthritic thumbs and finger (DIP, PIP and Trapeziometacarpal) joints: Evidence of Clinical Efficacy. Jnl Alt Compl Med 2000;6(4):311–320. Suresh SP; Ali KE; Jones H; Connell DA Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment? Br J Sports Med (England), Nov 2006, 40(11) p935–9. Topol GA, Reeves KD, Hassanein K.

Efficacy of Dextrose Prolotherapy in Elite Male Kicking–Sport Athletes With Chronic Groin Pain. Archives Phys Med Rehabil, 2005;86:697–702. Topol GA, Reeves KD. Regenerative injection of elite athletes with career–altering chronic groin pain who fail conservative treatment: a consecutive case series. Am J Phys Med Rehabil. 2008;87(11):890–902.

 Reeves KD, Hassanein K. Randomized Prospective Double–Blind Placebo–Controlled Study of Dextrose Prolotherapy for Knee Osteoarthritis With or Without ACL laxity. Alt Ther Hlth Med 2000;6(2):68–80. Ongley MJ, Klein RG, Dorman TA, et al: A new approach to the treatment of chronic low back pain. Lancet 2:143, 1987. Klein RG, Bjorn CE, DeLong B, et al: A randomized double–blind trial of dextrose–glycerine–phenol injections for chronic low back pain. J Spinal Disord 6:23, 1993.

Dechow E, Davies RK, Carr AJ, et al: A randomized, double–blind, placebo–controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology 39:1255, 1999. Yelland MJ, Glasziou PP, Bogduk N, et al: Prolotherapy injections, saline injections, and exercises for chronic low–back pain: A randomized trial. Spine 29(1):9, 2004. Hooper RA; Ding M Retrospective case series on patients with chronic spinal pain treated with dextrose prolotherapy J Altern Complement Med (United States), Aug 2004, 10(4) p670–4. Wilkinson HA Injection therapy for enthesopathies causing axial spine pain and the "failed back syndrome": a single blinded, randomized and cross–over study.: Pain Physician (United States), Apr 2005, 8(2) p167–73. Cusi M; Saunders J; Hungerford B; Wisbey–Roth T; Lucas P; Wilson S.

 The use of prolotherapy in the sacro–iliac joint. [E pub ahead of print] Br J Sports Med (England), Published On line Apr 9 2008. Volpi P, Marinoni L, Bait C, De Girolamo L, Schoenhuber H. Treatment of chronic patellar tendinosis with buffered platelet rich plasma: a preliminary study. Medicina DelloSport. 2007;60(4):595–603. Alfredson H; Ohberg L Neovascularisation in chronic painful patellar tendinosis–promising results after sclerosing neovessels outside the tendon challenge the need for surgery. Knee Surg Sports Traumatol Arthrosc (Germany), Mar 2005, 13(2) p74–80. Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell E. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Clin J Sport Med (United States), May 2008, 18(3) p248–54. MIshra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet–rich plasma. American Journal of Sports Medicine Dec 2006 Volume 34: 1774–1778.

]]> http://www.studiomedicobassani.it/en/index.asp?NewID=6 Dean Reeves Wed, 11 Nov 2009 0:0:0 +01:00 <![CDATA[Achilles tendinosis]]> ACHILLES TENDINOSIS

Dextrose prolotherapy versus eccentric loading exercises or a combination for Achilles tendinosis. Yelland et al 2009

This study used a measure called the VISA-A. The VISA-A score is a measure specifically of Achilles pain and functionality that is an 8 question score graded from 0 to 100 with 100 the best and with questions such as duration of stiffness when first getting up, pain with stretch once warmed up, pain afer walking for 30 minutes, pain with walking downstairs, pain after doing 10 single leg heel raises, how many single leg hops can be done without pain, whether sport is modified or being done, and how long can the athlete train or practice.

Each group has less than 15 so it was not powered sufficiently. In addition the type or prolotherapy here was not intratendinous (Inside the tendon) but rather was a subcutaneous type of prolotherapy which is described on this web site under "options" and has not been tested versus intratendinous types of proliferant injection.

Nevertheless it is of interest that reduction of stiffness and limitation of activity was faster with proliferant injection and that both eccentric loading and proliferant injeciton combined was significantly better than eccentric activity alone.

Yelland MJ, Sweeting KR, Lyftogt JA, Ng SK, Scuffham PA, Evans KA. Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial [epub ahead of print] Br J Sports Med (England), Jun 22 2009, pages pending.

ABSTRACT: OBJECTIVE: To compare the effectiveness and cost-effectiveness of eccentric loading exercises (ELE) with prolotherapy injections used singly and in combination for painful Achilles tendinosis. DESIGN: A single-blinded randomised clinical trial. The primary outcome measure was the VISA-A questionnaire with a minimum clinically important change (MCIC) of 20 points on a 100 point scale.

SETTING: Five Australian private primary care centres. PARTICIPANTS: 43 patients with painful mid-portion Achilles tendinosis commenced and 40 completed the treatment protocols. INTERVENTIONS: Participants were randomised to a 12 week program of ELE (n=15), or prolotherapy injections of hypertonic glucose with lignocaine alongside the affected tendon (n=14) or combined treatment (n=14).

Main outcome measurements: VISA-A, pain, stiffness and limitation of activity scores and treatment costs were assessed prospectively over 12 months. RESULTS: At 12 months, the proportions of participants achieving the MCIC for VISA-A scores were 73% for ELE, 79% for prolotherapy and 86% for combined treatment. Mean (95% CI) increases in VISA-A scores at 12 months were 23.7 (15.6 to 31.9) for ELE, 27.5 (12.8 to 42.2) for prolotherapy and 41.1 (29.3 to 52.9) for combined treatment. At 6 weeks and 12 months, these increases were significantly less for ELE than for combined treatment.

Compared with ELE, reductions in stiffness and limitation of activity occurred earlier with prolotherapy and reductions in pain, stiffness and limitation of activity occurred earlier with combined treatment. Combined treatment had the lowest incremental cost per additional responder (AU$1539) compared with ELE.

CONCLUSIONS: For Achilles tendinosis, prolotherapy and particularly ELE combined with prolotherapy give more rapid improvements in symptoms than ELE alone but long term VISA-A scores are similar. Condition Research Home Achilles and Patellar Tendon: Aprotinin injection Orchard et al 2008 Injection of Solutions that block breakdown of tissue may also help healing.

]]> http://www.studiomedicobassani.it/en/index.asp?NewID=5 Dean Reeves e coll. Sun, 25 Oct 2009 0:0:0 +01:00 <![CDATA[Chronic low back pain]]> Chronic low back pain: an integrated diagnostic and therapeutic approach

Dott. Bassani Luciano 

 Introduction

Chronic low back pain is a social problem. 47% of the population suffer from back pain. Third health expense.

13 million missing days at work.93% suffered, suffer  or will suffer  for back pain.The goal is to made a correct clinical diagnosis and to plan an effective treatement.

Chronic low back pain  is the great parodox for modern medicine.  The traditional medical model called by Alf  Nachmeson  “ The  dynasty of the disc” can only explain  about 20% of back pain.

This  academical medicine  seems to  have forgotten the power of the two most basic tools of medicine: the history and the physical examination. In the low back the questions of the physician about the pain and the examination of the patient contains  most of the missing  80%  of the diagnoses.

 

 

 

 

•          The objective is to demontrate that  the troubles of the static is the key to explain  constraints, abnormal strain, pains, differents pathologies and that differents kinds of  non surgical treatements can achieve good results.

The large ligamentous and fascial  structures of the low back  and how they work to maintain the stability it is the most important subject in low back pain. When the ligaments  fibers become relaxed, abnormal tension  will then produce a bombardment of afferent somatic  proprioceptive  sensory impulses from the ligament into the spinal posterior root ganglion where some are transmitted to the brain as consciousness of local pain .

Biotensegrity models  shows that the musculoskeletal system mechanically stabilizes itself  by balancing  and distributing  all tension and compression force vectors within it.

The physician who includes painful problems created by joints, muscles, ligaments , fascia, scars, discs, nerve compression  in his diagnostic paradigm should be able to make the correct diagnosis of the cause of low back pain at least 90% of the time. 

 

 

Once a good working diagnosis is made,  applaying the rights treatements the phisician can achieve  90% of good results.

The treatements included in a conservative approach to chronic  low back pain are various and their use follows a scale depending of  differents elements estimated from the physician: kind of pain, degree of pain, psychological aspect etc.

Once a good working diagnosis is made,  applaying the right global postural reprogramming  (extero-proprioceptive sole, eye’s correction, TMJ correction,scar neutralisation etc.) the phisician try to  rebalance all the postural  system in order to facilitate the action of  the others treatements.

Generally  the physician should  combine  the postural reprogrammation with  neuroauricolotherapy in order to facilitate  the changing  of  abnormals cerebrals patterns. Basically the physician should  use in combine with posture reprogrammation  certains auriculars points as: 1) 01 bilateral which is the rappresentation of “corpus callosus, 2) PMS motor  which is a  general point representing the eye , the associatifs areas and integratives  areas 3)   cerebellum which is the core of postural system.

Neuroauricolotherpy  is also used in the followings sessions  with the purpose  of reduce the back pain.

The  principals points used in case  of low back pain are all points which corresponds to the same dermatomeric area: disc, muscle, plexus, cord both sensitive and motorial.

In addition it can be usefull to add thalamus, master point of reticular, W2  which is the master mesodermic point, and  cosmonaut point.

In addition to neuroauricolotherapy  in case of ligament, tendon and fascia degeneration,first cause of chronic back pain   due to insufficient connective tissue,  prolotherapy is very usefull since reduce pain and disability stimulating ligamentous laxity, chronic enthesopaty or thendinosis by provoking an acute infiammatory response by injecting irritants solutions into damaged tissue.

The  patient suffering from chronic low back pain, since his problem is lasting for more than 6 months, has created multiples adaptations   concerning  specially the muscular system; the muscules during these period have become stiffs and fibrosous  provoking also functional  locked joints.

The purpose of the physician is to  release the locked joints  by manipulations and to recreate a normal muscular play by postural gymnastique.

Conclusions

This  free communication is the synthesis of  several years of experience done directly on the patients which are, each one ,a single person needing a personalized  therapy.

In the field of chronic back pain, more then for others pathology, the physician must try to create a good feeling with the patient and try to riequilibrate both the cerebral patterns and the balance.

A good aid  to this situation comes from postural reprogramming, neuroauricolotherapy, prolotherapy and manual medicine  which, if well managed, can give exellents results.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

]]> http://www.studiomedicobassani.it/en/index.asp?NewID=4 Luciano Bassani Fri, 16 Oct 2009 0:0:0 +01:00 <![CDATA[Gagne returns to preconcussion form]]> USA TODAY ARTICLE JANUARY 16, 2009 http://www.usatoday.com/sports/hockey/nhl/2009-01-16-2018525195_x.htm Gagne returns to pre-concussion form PHILADELPHIA


— Simon Gagne hated the mornings he would wake up with that familiar pounding headache. He couldn't even blame a night of revelry. The throbbing would surface, and no pain reliever would cure it. His neck ached, and there were days when he felt woozy or had blurred vision. All Gagne wanted was to grab a stick and play hockey again for the Philadelphia Flyers. But even when he did skate, well, good luck keeping track of the whizzing puck. Missing the playoffs, losing in the playoffs, none of it pained Gagne like the agony of living with a concussion. "Last year," Gagne said, "was a tough situation.


Tough. I wouldn't wish it on anyone." The head injuries limited Gagne to 25 games and he missed Philadelphia's run to the Eastern Conference final. Gagne had nagging fears about his future, about what another traumatic hit to the head might mean for his career. He wondered if he could resume the high-scoring pace that made him an All-Star and an Olympian. Those doubts all seem behind Gagne, for now at least. While Gagne has cooled a bit from one of the fastest starts of his career, the quick forward has 18 goals and 42 points in 41 games this season. And the Flyers are in the thick of a tight race in the Atlantic Division, one point behind the New York Rangers headed into Friday night's game at the Florida Panthers. For Gagne, the miserable side effects and cobwebs in his nerves have vanished. "The way I feel now is back to where it used to be," Gagne said.



Gagne, who turns 29 next month, considers himself lucky. He might not even be playing this season had he not caught a local TV report about a doctor who eschews traditional anti-inflammatory drugs, cortisone injections, and surgery in favor of an approach that stimulates natural healing processes to strengthen joints, tendons and ligaments. Gagne hoped the treatment would cure his chronic neck pain and headaches and, after checking with the Flyers trainer, met with Dr. Scott Greenberg last April. Greenberg, a Cherry Hill, N.J., physician, didn't like what he saw. "The damage that Gagne had was very significant," he said. The nerves running from Gagne's neck and head, neck and shoulder blades and other joints, ligaments and tendons were all damaged. That was the cause of the dizzy spells, the loss of balance and blurred vision. Greenberg's approach is to repair the joints and nerves with pinpoint injections into selected areas of the spine and the symptoms clear. The treatment is called prolotherapy. The shots, a concoction that sparks the body's immune system, regenerate the damaged tissue and strengthen joints.


Greenberg said Gagne's neck is now as strong as it was before he was hurt. The player needed 20 to 30 injections in his neck his first few visits, but he hasn't visited Greenberg since November. Gagne might go again around the All-Star break for a checkup. His neck and spine stable, Gagne proclaimed himself "good to go" the rest of the season. All he has to do is look at recent Flyers history to know his day-to-day life could be much worse. Former Flyers captains Eric Lindros and Keith Primeau both had their promising careers curtailed because of concussions and still suffer from post-concussion trauma.


Gagne has had two minor setbacks this season - a bout with the flu and dehydration in December, and he was the victim of a blindside hit against Vancouver that caused a shoulder injury and kept him out of two games. A scary moment came in November when Montreal's Alexei Kovalev plowed his shoulder into Gagne's head. Gagne was able to shake off the hit, but any shot near his neck or head is an immediate cause for concern.


Gagne believed Kovalev deliberately targeted his head and shared his view with NHL disciplinarian Colin Campbell. If Gagne had his way, shoulder-to-head hits would be banned from the game. "If you get hit shoulder-to-head, you're going to have a concussion no matter what," Gagne said. "You see it too much. Almost every night you look at highlights on TV and you see someone get knocked out."


He also talked with Glenn Healy, the player affairs director for the NHL players' association, about what could be done to better protect the players. Hockey will never become a non-violent sport, but Gagne and others feel it could be a safer one. Healy said the NHLPA is working on adding soft caps, which are already on elbow pads, to shoulder pads to reduce the impact of hits. Last season, of the 65 diagnosed concussions, Healy said 39 were from a shoulder-to-head blow.


On the NHLPA's fall tour of all the teams, videos were shown of players deciding not to finish their body checks in a situation where an opposing player was vulnerable or the outcome had already been decided. Healy also does not want to see players launching themselves at someone's head. "That's going to take a lot longer to change that cultural view of how we play the game," Healy said. The NHLPA hopes to sit down with the league this summer and discuss possible solutions or punishments.


Gagne was diagnosed with three concussions (two in juniors, one early in his career with the Flyers) before last season. He suffered a fourth concussion after his jaw crashed into the shoulder of Panthers defenceman Jay Bouwmeester early last season. Gagne returned after only four games, then was hurt again and missed the next 26 games. He was reinjured in February and didn't play again.


Gagne eventually learned that he didn't suffer three more concussions, but that the first one in October never healed and was aggravated with each additional blow. Gagne says he might have returned too quickly from the initial hit and wonders whether last season would have been different had he been more patient. "Until you go through a tough time like that, you know nothing about concussions," Gagne said. "Now I know the brain takes a lot of time to heal." But this pre-season, Flyers coach John Stevens was so encouraged by Gagne's play that he had no reservations about playing him his regular minutes. "We didn't expect him to get back to where he was so quickly," Stevens said. Gagne totalled 31 points in his first 22 games and was on pace to at least match his career high of 47 goals set in 2005-06. Gagne's numbers have tailed off lately and the winger has gone eight straight games without a goal entering Friday's game. Some of the scoreless slump can be blamed on the shoulder injury.


Another factor is just simple fatigue. Gagne, the Flyers' first-round pick in the 1998 draft, is still working his way back to his physical peak after a seven-month layoff. "People forgot, I didn't play for a while last year," he said. "For me to play at that level again, it takes time to get back." When he's playing, Gagne can't think about absorbing a hard hit, he just has to attack the net and play as hard as he did in an Olympic or playoff game. He does admit to a different approach this season. Gagne comes to the rink to have fun, be able to play all his shifts and feel good when the game is over. He's not concerned with goals, points and other personal achievements. So far, that style has worked out fine. "It's just fun being back to normal and being able to play the game that I love to play," Gagne said.

]]> http://www.studiomedicobassani.it/en/index.asp?NewID=3 USA TODAY Wed, 7 Oct 2009 0:0:0 +01:00 <![CDATA[Spinal disc problems]]> SPINAL DISC PROBLEMS

Why i believe disc degeneration has very little to do with chronic low back pain.

 A patient asked, “will my disc always be degenerated?” You might say the question was legitimate but what you don’t know is I spent 10 minutes explaining why the MRI finding of lumbar disc degeneration is a nothing (usually).

As I explained to the patient “Do you want to replace the disc or do you want to correct the reason the disc became degenerated?” In other words is it better to just replace the disc (because surgeons can do this now) or correct the underlying problem that led to the disc degeneration?

You see very seldom is there just one disc that is degenerated, the condition often affects many discs. Another issue is the underlying problem that caused the disc degeneration is not fixed by disc replacement or other surgical procedures. Even spinal fusion does not fix the underlying problem.

Prolotherapy can fix it. The underlying problem typically when someone has disc degeneration is spinal ligament weakness. When the ligaments allow excessive movement of the vertebrae, subluxations, disc herniations, and disc degeneration begin to occur.

Anyone who has a vertebrae that keeps slipping out of place has vertebral ligament laxity may consider Prolotherapy. Most folks who come to Caring Medical with low back pain, thoracic or neck pain have MRI’s that show disc degeneration but seldom is that what is causing their pain.

Here are some signs/symptoms that allow you to know that your pain is not coming from the disc problem (none of these is absolute but give a good idea): Pain on either side of the spine not on the midline;Sensation is intact ;Muscle strength is fine ;Pain upon lying down ;Pain is not worse with sitting ;Pain is not worse with bending over ;Numbiness (tingling down the arm but sensation is ok) ;Cracking All of the above symptoms suggest ligament laxity of spine or sacroiliac ligament problems. Disc problems are more indicative if the person has low back pain for instance that is: Central ,Sitting makes it worse ,Standing (compared to lying) makes it worse ,Bending over while standing increases the central pain.

 Realize the only way to truly get out of pain is to stop the process that is causing the body injury. This process for those in chronic pain is typically either ligament laxity or what I and my wife Marion call "connective tissue deficiency". The latter involves the breakdown of collagen in the body. This often occurs because the body is in a catabolic state because anabolic hormones are low. Correction of this through natural hormone replacement, diet, and supplements can relieve some of the pain, but typically Prolotherapy also has to get done. Prolotherapy toward the supraspinatous, interspinus and lumbosacral ligaments is what the person with chronic low back needs, regardless if disc degeneration shows up on the MRI. For such a person “yes after Prolotherapy it is possible for the MRI to look the same, but I suspect your back pain won’t be. You’ll have a hard time finding it!”

]]> http://www.studiomedicobassani.it/en/index.asp?NewID=2 Ross.A.Hauser Mon, 20 Jul 2009 0:0:0 +01:00