Predicting Injury Of Military Personnel And Athletes

MILITARY personnel and sporting professionals could soon be ensuring a far longer period of career success, thanks to a landmark study commissioned in Suffolk.


The first ever randomised trial of its kind* has proven that injury rate among military professionals can be predicted and reduced, as a result of special technology.


A total of 400 new entry trainees were assessed at the Britannia Royal Naval College, Dartmouth in a study led by Dr Andrew Franklyn-Miller. Over 3 years, he researched the trainee population using state-of-the-art equipment supplied by Suffolk-based Footfunction Centre.


The RSscan footscan system, devised by RSscan Lab Ltd and used at the Centre, works by measuring vertical force over a number of sensors and then enables a D3D orthotic to be created. Figures collated this month now show that prescription of this specialist orthotic can reduce injury rate by as much as 31 per cent in those at high and medium risk of injury - but as much as 78 pc in the high risk category.


The finding is a significant one for the military, in which many trainees are lost from duty and ongoing time-dependent training due to injury (particularly lower limb injury). It typically costs ┬г2,000 per week for a trainee to be out with injury.


It will also be music to the ears of those in the sporting profession, proving that injury can be predicted and prevented.


This was an independent study by the Military of Defense where Andrew Franklin Miller led the study.


"We are delighted with the results of the trial," said Ms Smith-Rewse of the Foot Function Centre. "Our work at the Centre has long been confirming that the technology really can predict and reduce injury, but now it has formed part of one of the largest randomized orthotic studies in the world.


"On a daily basis we see athletes, members of the military, and recreational sportsmen and women whose lives can be dramatically improved as a result of this kind of facility.


"We are delighted that now we can confidently share our success with the wider world on the basis of these exciting findings."


Chic Wilkinson, Clinical Team Manager at RAF Honington, has been using the orthotics produced by the Suffolk team and their technology.


He said: "The D3D Performance Orthotic is proving to be very successful in the treatment and management of many of the prevalent lower limb injuries seen in military recruit training.


"This research is a massive step forward and potentially means a saving of many thousands of pounds for the military.


"It typically costs ┬г2000 per week to have a person out of training through injury. We needed proof that the right technology could help us predict and prevent that - and we now seem to have that evidence."


The clinical trial consisted of 400 male participants walked across a 18metre track with a 1m footscan® system, pressure measure system, in-bedded within. Only five tests were taken of each recruit and only 6 minutes were given to each participant. Analysis of taken data and three risk groups were formed of likelihood of injury: LOW, MEDIUM and HIGH.

The conclusions were that the Right Stride D3D™ orthotics reduced injury rate by 31% in those categorised as High and Medium risk groups combined and in the high risk group by as much of 78%!

The D3D™ orthotics are patented and are manufactured to very high standard and are supplied by RSscan Lab Ltd, UK.


*The author of the report believes this to be the first trial of its kind, ever.


The Footfunction™ Centre have dedicated health specialists in podiatry and biomechanics. Bespoke orthotics are manufactured on site, enabling quick and professional service.

Ultrasound-Guided Cortisone Injections May Help Treat Severe Hip Pain

Ultrasound-guided cortisone injections may be an effective treatment method for gluteus medius tendinopathy, a common, painful condition caused by an injury to the tendons in the buttocks that typically affects middle-aged to elderly women and young active individuals, according to a study published in the January issue of the American Journal of Roentgenology.



Gluteus medius tendinopathy can cause severe hip pain. "The underlying causes remain unclear but probably are multi-factorial and involve mechanical and degenerative processes," said Etienne Cardinal, MD, lead author of the study. Medical treatment usually includes physiotherapy, nonsteroidal anti-inflammatory medication, and local injections of corticosteroids.



The study, performed at the University of Montreal's Hospital Center, included 54 patients with gluteus medius tendinopathy. Ultrasound-guided cortisone injections were performed on all patients. "One month after treatment, 72 percent of the patients showed a clinically significant improvement in pain level. Seventy percent of patients were satisfied with the results of the intervention," said Cardinal.



"The use of ultrasound for guiding musculoskeletal procedures has increased over the past several years. Advantages of ultrasound over fluoroscopy include its soft-tissue imaging capabilities that allow a diagnostic study to be performed before cortisone injection," he said.



"This noninvasive, nonionizing imaging technique allows continuous monitoring of the needle position, which facilitates the performance of safe and precise cortisone injections," said Cardinal.



This study appears in the January issue of the American Journal of Roentgenology.



Source:

Heather Curry

American College of Radiology / American Roentgen Ray Society

Lower Back And Foot Pain Associated With More Severe Knee Osteoarthritis Symptoms

A new study found that patients with osteoarthritis (OA) of the knee who also have pain in other joints were more likely to experience greater knee pain. Specifically, pain in the lower back as well as foot pain and elbow pain on the same side as the affected knee were associated with more severe knee pain. Full details appear in the December issue of Arthritis Care & Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology.


Knee OA is the leading cause of disability in the U.S., with nearly 4.3 million adults over age 60 having the symptomatic form of the disease according to the Centers for Disease Control and Prevention (CDC). A study by Helmick et al. published in Arthritis & Rheumatism reported 59 million people have low back pain, which is the most common cause of lost work time among individuals less than 45 years of age and the third most common cause among those 45 to 65 years of age.


The current study team led by Pradeep Suri, M.D., from Harvard Medical School, New England Baptist Hospital, and Spaulding Rehabilitation Hospital in Boston, Massachusetts used data provided by individuals from the Osteoarthritis Initiative a multicenter population-based observational cohort study of knee OA. A subgroup of 1,389 participants, ages 45-79 years who had symptomatic knee OA in at least one knee were included, with patients also asked to identify pain in the lower back, neck, shoulder, elbow, wrist, hand, hip, knee, ankle or foot. Researchers used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to measure the level of pain of patients in the study on a scale of 0 to 20 with lower scores representing less pain and stiffness.


Results indicate that 57.4% of participants reported having pain in their lower back. Participants with low back pain had a mean WOMAC pain score of 6.5, while those without pain in their lower back scored 5.2. Researchers found that low back pain was significantly associated with an increase in the WOMAC knee pain score, with similar associations demonstrated in all other individual joint locations that were studied. Those models analyzing pain locations simultaneously show only low back pain, and ipsilateral foot pain and elbow pain were significantly associated with a higher knee pain score.


Additionally, researchers determined that having more than one pain location, regardless of the site, was associated with greater WOMAC knee pain score. In participants with four or five pain locations the severity of knee pain was even higher. "Our findings show that pain in the low back, foot and elbow may be associated with greater knee pain, confirming that symptomatic knee OA rarely occurs in isolation. Future studies are needed to determine whether treatment of pain occurring elsewhere in the body will improve therapy outcomes for knee OA," Dr. Suri concluded.


Sources: Wiley - Blackwell, AlphaGalileo Foundation.

European Edition Of SAGE's 'Foot & Ankle Specialist' To Launch

SAGE is to launch Foot & Ankle Specialist - European Edition from February 2011. The journal will be an international edition of Foot & Ankle Specialist (FAS), a bimonthly controlled circulation journal launched in 2008 publishing peer-reviewed clinical information for foot and ankle caregivers.



Written and edited by podiatrists and orthopaedic surgeons, FAS offers the latest techniques and advancements in foot and ankle treatment through research reports and reviews, technical perspectives, case studies, and other evidence-based articles. FAS enables practitioners to address a broad range of disorders and provide their patients with the best current diagnosis and therapy.



Topics covered in the journal include ankle instability & arthritis; sports podiatry or orthopaedics; diabetic foot & wound care; heel pain, plantar fasciitis and heel spurs; dermatology and skin care; surgeries and infection. It is of interest to all those involved in foot and ankle specialisms, including surgery, nerve and wound specialists, physicians, nurses, and physical therapists.



Content in the European edition of FAS will be the same as the existing journal, and the website for both will be fas.sagepub. All content published is free to access.



"We have been delighted with the response from health professionals to FAS in the US market and see real potential for the forthcoming European edition," said Tessa Picknett, Associate Director, STM Journals, SAGE. "FAS has both a truly outstanding Editor and Editorial board, and equally has attracted a list of incredibly strong contributors making this a high-quality journal that is valued by caregivers from across the foot and ankle specialisms."



The first edition of Foot & Ankle Specialist - European Edition will be vol. 4, issue 1, year 2011. Foot & Ankle Specialist is published six times a year in February, April, June, August, October, and December.



Source:

Jayne Fairley


SAGE Publications UK

First Asia-Wide Osteoporosis Awareness Campaign Launched

International Osteoporosis Foundation's first TV ad encourages women to take the One Minute Risk Test, materials aimed at
physicians to help them treat patients effectively


The first Asia-wide advertising campaign promoting action against osteoporosis was launched today in Hong Kong.


The campaign, prepared by International Osteoporosis Foundation and its 24 member societies in Asia, urges women to take
control of their bone health by taking the "IOF One Minute Osteoporosis Risk Test".


The advertising will appear on television and in print. In addition, IOF has prepared a special campaign aimed at physicians,
to enable them to do an even better job of diagnosing and treating patients with osteoporosis.


The campaign is spearheaded by a TV spot that urges women to take responsibility for their bone health.


In the 30-second public service announcement, the form of one mannequin, representing the one in three women over 50 who will
get osteoporosis, suffers the three most common osteoporosis fractures - wrist, spine and hip.


Leading TV stations throughout the region have agreed to broadcast the TV spot without charge. They include CNBC, CNN, Star
TV, Discovery Health Channel, National Geographic Channel, MediaCorp News, in print, the International Herald Tribune, and in
outdoor media, Clear Channel. In addition, numerous corporate sponsors* will support the campaign in order to generate
maximum reach. This donated airtime and sponsorship is valued at around US$ 200,000.


The film, shot in Mumbai, India, was directed by Naren Multani, one of India's leading film makers - he won a One Show Pencil
(Silver) in 2002, was a Clio Finalist in 2001, and his first independent film, "Mindgame" has been shown at the New York
Short Film Festival and San Francisco Film Festival.


Osteoporosis, when the bones become brittle and break easily, is one of the world's most widespread and debilitating
diseases.


In Europe and the United States together, the lifetime risk of hip fracture in women is larger that sum of lifetime risks of
having breast, endometrial and ovarian cancer. The lifetime risk of hip fracture in men is greater than that of prostate
cancer.


Speaking at the advertising launch, Daniel Navid, IOF chief executive officer, warned, "Osteoporosis is already a huge health
problem in Asia, and getting more serious every day. It is a time bomb ticking -- Asian women and men must take immediate
action to protect themselves from fractures and disability."


Osteoporotic fractures are expensive both in terms of human stress and in cost of care. By 2050, 6.4 million people worldwide
will suffer a hip fracture annually, with 51% of these fractures occurring in Asia. In China, one in six men have one or more
vertebral fractures.















Prof. Edith Lau, president of Hong Kong Osteoporosis Foundation and an IOF Board member said, "Asians are at high risk of
osteoporosis. We have a lower bone density, we don't get a calcium-rich diet as children and we increasingly lead a sedentary
lifestyle." She noted that in Hong Kong, 45% of women aged 65 and above have osteoporosis, while 42% of them have low bone
mass (osteopenia). A total of 300,000 women and 70,000 men who are 50 years and older suffer from osteoporosis, as defined by
the WHO criteria. In 2001, 8 in every 1000 women and 3 per 1000 men fractured their hip. The death rate for hip fractures is
10 percent and 50 percent become disabled due to the hip fracture.


Yet about half of hip and vertebral fractures can be prevented, if the disease is treated promptly and adequately, Dr. Lau
said. Both diagnosis and treatments of osteoporosis are painless, simple and easy, but doctors need to be informed, which is
one of the objectives of the part of the campaign aimed at health professionals.


Prof. Annie Kung, president of Osteoporosis Society Hong Kong, urged people to take responsibility for their bone health by
taking the IOF One Minute Risk Test. She said, "Osteoporotic fractures often result in a loss of productivity and mobility.
Only by regularly checking our bone density can we Asian women be sure we will be able to retain our independence. The TV
spot will alert women throughout Asia that they can easily find out if they are at risk of osteoporosis by taking the risk
test."


Similar launches are planned in other Asian countries.


The film and the campaign's coordination and launch were realized through services donated by agencies within the Interpublic
Group of Companies. Torre Lazur-McCann Healthcare Worldwide, a member of the IOF's Committee of Corporate Advisors, provided
coordination support and connected their affiliates with IOF member osteoporosis societies throughout Asia to initiate the
campaign in local markets. McCann Healthcare also developed the creative concept and produced the television commercial. The
launch event and media relations were undertaken by Weber Shandwick, the world's largest public relation agency.


ENDS


Notes to Editors:


For more information about IOF contact : Paul Sochaczewski:

psochaczewskiosteofound


For more information about the advertising campaign contact: Caroline Brivoal

McCann Healthcare (Singapore)

Tel: +65 6737-9911

caroline.brivoalap.mccann


For media enquiries in Asia: Pamela So

Weber Shandwick Worldwide

Tel: 852 2533 9916 / 852 8109 8166

psowebershandwick


Winnie Hui

Weber Shandwick Worldwide

Tel: 852 2533 9920 / 852 9345 3657

whuiwebershandwick


* Corporate sponsors to date include: Aventis, Bright Milk, GSK, Lilly, MSD, Nestle, NZDB, Novartis, Sohu, Subway, Tetra Pak,
Ultronics, Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and
debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One
out of three women over 50 will experience osteoporotic fractures, as will one out of five men (1,2,3).


Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be
prevented, it can be easily diagnosed and effective treatments are available.


1 Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992;
7:1005-10


2 Kanis JA et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporosis International, 2000; 11:669-674


3. Melton LJ, et al. Bone density and fracture risk in men. JBMR. 1998; 13:No 12:1915


The International Osteoporosis Foundation (IOF) is a worldwide organization dedicated to the fight against osteoporosis. It
brings together scientists, physicians, patient societies and corporate partners. Working with its 167 member societies in 85
locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early
detection and improved treatment of osteoporosis.


osteofound

Muscles And Bones In Cahoots

Traditionally, doctors and clinicians thought diseases that affect muscles or bones affected those areas specifically. For example, bone diseases only affect bones, or muscle diseases only concerned muscles. But recent evidence supports the notion that bones and muscles are more interconnected than previously thought. It seems that bones and muscles can release signals that directly affect one another's function or disease state. Even more remarkable is that these systems seem to produce secreting factors that communicate to distant parts of the body.


Dr. Marco Brotto, the director of the Muscle Biology Group at the Schools of Nursing and Medicine, University of Missouri-Kansas City (UMKC) will be discussing the latest findings about the shared communication and dependence between muscles and bones at the annual 2010 Experimental Biology conference in Anaheim, CA being held April 24-28 Brotto will deliver his presentation, "Evidence for Pathophysiological Crosstalk Between Bones, Cardiac, Skeletal and Smooth Muscles," on behalf of his team, which includes Leticia Brotto, Todd Hall and Michael Loghry, Sandra Romero, and collaborations between two other principle investigators from the University of Missouri-Kansas City, Kansas City, MO, Jon Bonewald and Mark Johnson; and Thomas Nosek, J. Shen and C-K Qu of Case Western Reserve University, Cleveland, OH.


The Cost of Aging


With new revolutions in medicine, the average lifespan in developed countries continues to increase. As a result, the incidence and cost of treating age-related diseases has skyrocketed, particularly those that result from years of wear and tear of muscles and bones.


Every year, the cost alone in the United States of treating osteoporosis an aging disease predominantly found in women that causes fragile bones is $14 billion, according to The National Institutes of Health website. Other diseases, like sarcopenia a muscle wasting disease affects every individual over the age of 50 resulting in the loss of one to two percent of muscle mass each year. As the baby boomers get older, the trend in rising costs continues.


This is why Brotto's findings that muscle and bone diseases affect one another may have an astronomical impact when considering the long-term effects of designing new preventatives and treating age-related muscle and bone disorders.


The Lines of Communication


Brotto's collaborative group observed that mutations or defects in specific genes important for muscle function, also created changes in bones. The reciprocal effect happens when mutations are made that affect bone function. These observations led to the search for signaling components that could affect both organs, but the group has also encountered some intriguing surprises along the way.


Brotto researcher's discovered that bones act like glands to secrete hormones that are detected by muscles. Reciprocally, muscles are releasing factors, known as myokines that are detected by bones affecting bone mass and strength. And the separate muscle types, heart (cardiac), skeletal and smooth muscle (like that of the stomach and blood vessels) secrete different signals for different reasons.















The group identified multiple components of signaling systems involved in muscle and bone communication. Specifically, they distinguished a certain type of prostaglandin released from bone cells (osteocytes). Other findings revealed that the Wnt pathway, which is important for normal development, could be linked to wasting diseases in both muscles and bones.


One area Brotto's group focused on was the regulation of calcium metabolism. Calcium is needed both to build strong bones and to make muscles contract. Researchers focused on a muscle specific phosphatase called MIP that decreases naturally as we age that may be involved the regulation of calcium levels in the body. Researchers removed the MIP protein from mice by knocking out the gene that codes for the protein. These mice had muscle weakness and faster aging, as well as reductions in bone densities. The mutant mice also had weakness in smooth muscle function of the contracting arteries and vessels. Interestingly enough, some of these results seemed to be gender specific. The female mice developed osteoporosis, but the males did not. And there was female bias for weakness in heart muscle function that was not seen in the male subjects. This data supports that calcium regulation is different between the two sexes, which may explain why women are more likely to get osteoporosis than men.


A New Approach to Bone Fractures: A Breakdown in Communication Between Muscle and Bone?
For the many diseases that target muscles diet, exercise and hormone therapy are the only treatments. Unfortunately, many patients have health conditions that prevent them from exercising limiting their treatment options. Brotto is hopeful that following the new line of research studying the communication between muscles and bones will identify novel therapies and potentially help millions of people.


When a bone is fractured, it is typically thought to be a defect in the strength of the bone. But the Bone-Muscle team at UMKC hypothesizes that it may be caused from a breakdown in communication between muscles and bones. Muscles put force on bones as they contract, which is known as mechanical loading. Perhaps the muscles put too much force on the bones at the wrong time, which results in a break.


"We would like to discover chemical factors that can bypass the issue of loading and could patch communication on the muscle side or the bone side to make the unity stronger," Brotto said.


Source: Federation of American Societies for Experimental Biology (FASEB)

Disability Transitions And Osteoarthritis In High Functioning Older Women

Osteoarthritis, common among older adults, is strongly linked to late-life disability, but the process by which this happens has not been well studied. A recent study published in the April 2006 issue of Arthritis Care & Research (interscience.wiley/journal/arthritiscare) examined the impact of osteoarthritis in the lower extremities and found that women with this condition have a greater risk of developing decreased mobility, a risk which is further increased by being overweight.



Led by Shari M. Ling of Intramural Research Program, National Institute on Aging/NIH together with investigators in the Center on Aging and Health at the Johns Hopkins Medical Institutions in Baltimore, MD, researchers used data obtained from participants in the Women's Health and Aging Study II (WHAS II) to determine whether patients with osteoarthritis in their lower extremities were more prone to developing mobility limitations than women who did not have the disease. They also looked at whether limitations in mobility tended to develop before difficulty in activities of daily living. Their analysis included 199 women with lower extremity osteoarthritis who had no difficulty with mobility tasks at the beginning of the study and 140 women without osteoarthritis in the knee or hip, all of whom were between 70 and 79 years old. Patients were evaluated as to their osteoarthritis status, the presence of pain, knee strength, knee torque, and their level of mobility 18, 36 and 72 months following the initial evaluation.



The results showed that even though more women with osteoarthritis reported using arthritis medications, a greater proportion reported having pain most days and greater pain severity while walking and climbing stairs compared to women with no OA. In addition, 26% of the women with osteoarthritis were obese compared to 11% of the women without the disease, and an additional 40% were overweight. The two groups were similar, however, with regard to knee strength and torque. Overall, women with osteoarthritis were about 2.5 times more likely to develop difficulty in both lower extremity mobility and activities of daily living than those who did not have osteoarthritis. Greater knee strength reduced the risk of developing difficulty performing daily activities whether or not the woman had osteoarthritis, and greater knee torque had the same effect, although it did not reduce the risk for lower extremity difficulty.



"Despite numerous cross-sectional reports of the associations between OA [osteoarthritis], painful symptoms, low strength and obesity, existing studies have not been able to discern the relative contributions of these closely related factors to the development of specific mobility difficulty characteristics," the authors note. The current study demonstrates that lower extremity osteoarthritis is associated with painful symptoms, excess weight and obesity and that women with painful osteoarthritis are more likely to develop lower extremity limitations combined with limitations on their daily activities. The fact that this is affected by higher body mass is what lends novelty to the current study, according to the authors.



"Longitudinal observations of well-functioning women living in the community who are at risk of functional decline provide a unique perspective from which OA can be examined," the authors state. The findings of the current study are particularly relevant given the increase in the number of older Americans and the trend to higher rates of obesity among Americans in all age groups. The authors conclude: "The trends towards earlier onset of obesity observed between 1991 and 1998 would predictably translate into a higher proportion of adults who could develop painful symptoms and mobility difficulty at an earlier age."







Article: "Transitions to Mobility Difficulty Associated With Lower Extremity Osteoarthritis in High Functioning Older Women: Longitudinal Data from the Women's Health and Aging Study II," Shari M. Ling, Qian Li Xue, Eleanor M. Simonsick, Jing Tian, Karen Bandeen-Roche, Linda P. Fried, Joan M. Bathon, Arthritis Care & Research, April 2006; 55:2; pp.



Contact: Amy Molnar

amolnarwiley

John Wiley & Sons, Inc.