Physical Therapy

AIDS / Risk

Male circumcision (MC) markedly decreases the acquisition of HIV infection, the major epidemic of our time. This is the first biological intervention shown to prevent HIV infection and will not depend upon continuing behaviour change to give protection. In 1986, five years after the description of AIDS, the first article suggesting that male circumcision is associated with lower risk of human immunodeficiency virus (HIV) infection was published. During the following 15 years, different studies – almost exclusively from sub-Saharan Africa, which quickly became the centre of HIV epidemic – increasingly supported this hypothesis. For example, tribes and other defined populations with low prevalence of MC had high prevalence of HIV infection, suggesting a correlation between MC and HIV prevention.

Despite that, there was still uncertainty among many scientists and public health scientific societies, mainly due to the fear that circumcised men have different (safer) sexual practices than men who are not, and that this and not male circumcision led to lower rates of HIV infection in circumcised men and in populations where circumcision is common. To eliminate this concern, three specifically designed trials were carried out.

In 2005, the results of the first trial showed a 60% protective effect against HIV infection among the men who were circumcised (Bertran Auvert and colleagues, PLoS Med. 2005;2:e209). The study has been conducted on the behalf of the South African National Institute for Communicable Diseases (Johannesburg) and the Institut National de la Santé et de la Recherche Médicale (ANRS Paris, France), involving 3,274 men who were randomized to receive circumcision or not. The subjects were followed over a mean period of 18.1 months, and the trial was stopped prematurely because of the high efficacy observed among circumcised patients.

In February 2007, the second and third studies found a protective effect of 53% and 51% respectively in men who were circumcised, compared to those who were not (Robert Bailey and colleagues, Lancet 2007; 369:643-56 – Ronald Gray and colleagues, Lancet. 2007; 369:657-66). The second trial enrolled 2,784 men and was carried out on the behalf of the U.S. National Institutes of Health and the Canadian Institute for Health Research, while the third study, also sponsored by the National Institutes of Health, randomised 4,996 men. Each of these trials was also stopped prematurely on 12 December 2006, due to an extremely high efficacy rate. The findings of the studies are similar, and remarkably consistent with the protective effect (58% on average) found in a systematic review of observational studies available in medical literature.

“Current data show that circumcision of adult men results in an approximately 60% reduction in acquisition of HIV infection”, said Dr. George Schmid (Dept. of HIV / AIDS, World Health Organization, Geneva, Switzerland).

About 30% of men are estimated to be circumcised worldwide, although this rate is still less than 20% in Europe.

Sinusitis

Researchers from Sweden have found that humming can help maintain healthy nasal passages and avoid sinus infections. Humming increases the amount of air exhaled from the nose versus other common exhalations, which could lower the risk of sinus infections if done routinely.

Humming increased nitrous oxide (NO) released into the nose from the sinuses (helps blood vessels dilate). Humming also facilitated the exchange of air from sinuses into nasal passages, which essentially ventilates the sinuses and protects them from infection. [Am J Respir Crit Care Med, 2002;166: pp.144-145]

Heel Pain

A new stretch is proving quite effective to help treat and potentially cure plantar fasciitis, a condition that affects nearly 2.5 million Americans each year. In a study recently published in Journal of Bone and Joint Surgery, researchers found that patients suffering from the painful heel spur syndrome had a 75% chance of having no pain and returning to full activity within three to six months of performing the stretch. In addition, patients have about a 75% chance of needing no further treatment.

The study is a two-year follow-up on 82 patients with plantar fasciitis, all of whom were part of an original clinical trial of 101 patients in 2003. The patients were taught a new stretch, specifically targeting the plantar fascia, that was developed by Benedict DiGiovanni, M.D., associate professor of orthopaedic surgery at the University of Rochester and author of the study, and Deborah Nawoczenski, P.T., Ph.D., professor of physical therapy at Ithaca College.

The stretch requires patients to sit with one leg crossed over the other, and stretch the arch of the foot by taking one hand and pulling the toes back toward the shin for a count of 10. The exercise must be repeated 10 times, and performed at least three times a day, including before taking the first step in the morning and before standing after a prolonged period of sitting. More than 90% of the patients were totally satisfied or satisfied with minor reservations, and noted distinct decrease in pain and activity limitations. The most common cause of heel pain, plantar fasciitis occurs when the plantar fascia, the flat band of tissue that connects your heel bone to your toes, is strained, causing weakness, inflammation and irritation. Common in middle-aged people as well as younger people who are on their feet a lot, like athletes or soldiers, people with plantar fasciitis experience extreme pain when they stand or walk. Plantar fasciitis can be a frustrating experience, as the chronic cycle of reinjury and pain can last for up to one year. DiGiovanni likens it to pulling a hamstring, and continuing to run without proper stretching. “Walking without stretching those foot tissues is just re-injuring yourself,” he said.

Most physicians will recommend a non-surgical approach to treating plantar fasciitis, advising a regimen of anti-inflammatory medications, foot inserts, and stretches. Surgery occurs in about 5% of all cases, and has a 50% success rate of eliminating pain and allowing for full activity.

“Plantar fasciitis is everywhere, but we really haven’t had a good handle on it,” said DiGiovanni. “The condition often causes chronic symptoms and typically takes about nine to 10 months to burn itself out, and for people experiencing this pain, that’s way too long to suffer through it.”

DiGiovanni should know. He’s experienced plantar fasciitis first-hand. Deciding to get some extra exercise on a golf outing one recent afternoon, he carried his clubs around all 18 holes instead of taking an easy-going ride in a golf cart. The next morning, he woke up with severe heel pain, which brought the topic of his study close to home.

“We need to further optimize non-operative treatments prior to considering surgical options,” DiGiovanni said. “If you look at the results of the study, I think we’ve succeeded.” [University of Rochester Medical Center, November 13, 2006]

Carpal Tunnel Syndrome

Sometimes, strengthening the extensors can help when your flexors have been overworked. One exercise is done by wrapping a wide rubber band around the fingers of an affected hand, from your thumb to your pinkie. Spread your fingers, hold for a few seconds, then release. You can do the same on the other hand, if needed. I know several people who have remarked how much this has helped them.

A second exercise is to hold one end of an elastic exercise band in one fist, palm up, with the other end securely held under your foot. Slowly flex your wrist against the resistance. Repeat ten times. Now, grip the band with your palm facing down and do the same thing. Repeat with the other hand. You can also do this exercise using a very light dumbbell.

Dupuytren's Contracture

Finger and wrist exercises have helped in trials. Get a sponge ball from a toy department and try to make your thumb meet each finger, one by one, through the sponge ball using a pinching motion. Begin with five repetitions with each finger, and build up to twenty. Then squeeze the ball as firmly as possible, and while holding the squeeze tightly, slowly bend the wrist up and down as if waving goodbye.

In mild cases of the disease, regular stretching of the fingers may be enough to keep the use of your hand. Twice-daily sessions of massaging the hand and gently stretching your fingers back relieves tightness and helps keep your fingers flexible.

Vertigo

In a study, 95% of those using the modified Epley procedure (MEP) for benign paroxysmal positional vertigo (BPPV) for one week no longer experienced symptoms of vertigo. [Neurology July 13, 2004;63(1): pp.150-2]

There are different procedures, basically doing the same thing. There are several demonstrations on YouTube, and many times a patient can successfully do a procedure at home.

Urinary Stress/Overactive Bladder

Here is one of many sites that will show you how to do Kegel exercises for urinary stress incontinence.