Vertebroplasty Controversy

A few patients brought this to my attention and I saw this very insightful blog post on the topic. Here is the NYTimes article about it also.

Arthritis is one of the toughest diagnoses to deal with and to combine it with low back pain (another of the more difficult to manage) and you have a recipe for some controversy. Surgery, especially for the back, will be very interesting to follow as the technology changes so constantly and the current methods seem to be less than ideal. My solution... start young, exercise wisely and avoid back problems... easier said than done, eh? Naive? Maybe, but it is the best "treatment" we have at this time. This leads very neatly into my next project of beginning an injury prevention program for high school athletes here in NYC, stay tuned or contact me if interested in participating.

Have a healthy day!

Health Care Crisis

Is this really what passes for fitness nowadays? 6 minutes a day is going to fix it all... No wonder we have a crisis, fix things congress, please...

SmartPhone Results

Here are the results to the previous/recent survey I linked to. Interesting stuff, but now I am more confused as to which phone I want to get next. My current phone, the Treo 755p, is becoming obsolete and breaking down fairly rapidly. I think it would be awesome if we could do all of our documentation on a handheld device like the iPhone or Palm Pre. The Palm Pre offers multitasking which can be great if you can pull up a patients x-rays and input data into their medical record. I want to switch to the Palm Pre as my Treo breaks down but they are charging 500+ dollars, even though I have been with Sprint for almost 4 years they cant give me any price break on the phone, while new customers get it for $199... pissing me off a lot of bit. Have to weigh out cost of the plan, quality of the phones, etc. A lot going on... enjoy the survey results, hopefully I can be mobile blogging much more efficiently with a new phone :)
Have an awesome day!

Different Feet

Reading through a running magazine I saw an advertisement for these shoes that allow for more custom fit than most shoes offer. Check out the fitting video here.

I recently took a Vasyli course about biomechanics of the foot which was very useful. Brian Hoke is an excellent speaker, very engaging and insightful. I highly recommend any course he presents. There is still much reflection and further analysis that I need to do to best implement the information into my clinical practice. Are orthotics more a crutch or a tool for the foot? There seems to be those who believe they can ease everything up the kinetic chain including back pain while others say we can fix the issues with exercise, stretching and some manual therapy. This is the beauty of being a New Professional; learning is a lifelong process, and I am excited for the opportunities that lay ahead.

SmartPhone Survey

An interesting survey to take if you are involved in a healthcare field:
http://www.softwareadvice.com/articles/medical/which-smartphone-will-own-the-healthcare-market-1072109/

Good Weekend

On a boltbus up to Boston (as a Yankee fan and New Yorker this trip always feels wrong). The mobile blogging is harder with my 1.5 year old treo 755p... need to upgrade to palm pre or switch to iphone (darn at&t for being so expensive - I pay fairly low rates with sprint).
Making this trip to attend a biomechanics course on the foot given by Brian Hoke of 'when the feet hit the ground' fame. It's a 1 day workshop tomorrow. After that I get to catch up with my godson which is long overdue. Hope everyone has a dry weekend - why is it chilly and pouring down rain at the end of July?

Prolotherapy

A patient of mine asked about prolotherapy so I did some information gathering. In my blog reader which is actually a useful adjunct to more formal types of literature I found 7 entries dating back to 2007. There was a NYTimes article from 08/07/07 that touted the promises of this intervention. An entry in the CAM report from 01/06/08 had an interesting review/summary of the following article: The Spine Journal, Volume 8, Issue 1, January-February 2008, Pages 203-212 Simon Dagenais, John Mayer, Scott Haldeman and Joanne Borg-Stein.

the authors concluded, it’s not possible to separate the benefits of prolotherapy from the other treatments because “there is no evidence of efficacy for prolotherapy injections alone without cointerventions.”

The best was this youtube video, the part on prolotherapy is towards the end:
Nothing too concrete... so I went to pubmed where there were 59 search results to the term "prolotherapy" including a Cochrane review article from 2007 (highest level of research) that concluded

There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.

I doubt I will (within the confines of my practice act) recommend it to others based on the current literature out there but do any of you have any experiences with this form of treatment, please share in the comments and have a nice day, it is gorgeous here in NYC.

Addendum: Platelet-rich plasma injections seem to be the wave of the future here. We are seeing a lot more of them in NY. I am sure there will be posts coming soon on this topic.