06 dezembro, 2012

Curso de Taping Miofascial

Divulgo o curso de Taping Miofascial, já em Fevereiro, facilitado pelo Dr. Nuno Matos, que de resto dispensa apresentações. É uma presença frequente na área da formação, da Fisioterapia e Osteopatia. O curso é de 2 fins de semana e para além de bem estruturado, tem um valor muito convidativo com material incluído. Aconselho!

Para mais informações:


15 novembro, 2012

Newsletter Nov 2012



Está seguro nas minha mãos!

Ofereço-lhe: 
  • Melhoria da qualidade de vida para qualquer idade 
  • Plano terapêutico individual; 
  • Relação inter-disciplinar com outras especialidades; 
  • Conselhos sobre postura e exercícios 
  • Experiência no tratamento de atletas e de distúribios musculares relacionados com o trabalho 
  • Um plano de manutenção de saúde 
A Osteopatia é eficaz no tratamento ou alívio de:

Dores lombares e cervicais ( agudas e crónicas), dores articulares, dores de cabeça de origem cervical,
ombro doloroso ( tendinites, ombro congelado), contraturas musculares ( torcicolos, outras), problemas
discais, tendinites, desiquilíbrios mecânicos, melhora problemas viscerais de origem ou contributo
mecânico, compressões de nervos, lesões desportivas, dores relacionadas com movimentos no trabalho.

A minha experiência e conhecimentos estão ao seu dispor!

Porque há causas para as suas dores que requerem tratamentos continuados, acompanhamento de rotina
e reavaliações como forma de manutenção ou prevenção, pensei num plano que possa ir de encontro à
realidade de hoje.


Acordos com Seguradoras e outras Identidades

Um plano de pagamento adequado ao caso clínico

Um plano terapêutico adequado às suas possibilidades!


31 outubro, 2012

Colesterol elevado: qual é a causa?

Resistina

Investigadores canadianos descobriram que os níveis elevados de colesterol LDL, também conhecido por “mau“ colesterol, são causados por uma proteína denominada resistina que é produzida pelas células adiposas, sugere um estudo apresentado no Canadian Cardiovascular Congress.

Neste estudo os investigadores da McMaster University, no Canadá, verificaram que a resistina aumenta a produção de LDL nas células hepáticas humanas e também degrada os recetores do colesterol LDL no fígado. Deste modo o fígado fica com uma menor capacidade de o degradar. A resistina acelera assim a acumulação de colesterol LDL nas artérias conduzindo a um maior risco de doença cardíaca.

O estudo demonstrou igualmente que esta proteína tem também impacto nos efeitos de um dos fármacos utilizados no tratamento e prevenção das doenças cardiovasculares, as estatinas.

A líder do estudo, Shirya Rashid, revelou que cerca de 40% dos indivíduos que toma este fármaco não apresenta uma diminuição nos níveis de colesterol LDL. “Uma das grandes implicações dos nossos resultados é que níveis elevados de resistina no sangue podem ser a causa da incapacidade das estatinas diminuírem os níveis e colesterol LDL”, acrescentou a investigadora.

Na opinião de Shirya Rashid esta descoberta poderá conduzir a novos e revolucionários fármacos, que tenham por alvo e inibam a resistina aumentando deste modo a eficácia das estatinas.

Por último, este estudo também confirma a importância da manutenção de um peso e níveis de colesterol saudáveis, dois fatores críticos para a prevenção das doenças cardíacas. Beth Abramson, da Heart and Stroke Foundation, aconselha as pessoas a terem consultas frequentes com os médicos, monitorizarem o peso e perímetro da cintura, ingerirem uma grande variedade de alimentos nutritivos e com baixo teor de gordura e serem fisicamente ativas, de modo a conseguirem manter um coração saudável.



Nota do Blogger

A resistina também conhecida por factor excretório específico do tecido adiposo, foi descoberta em 2001 e pensa-se que tenha um papel importante na resistência à insulina e nos mecanismos inflamatórios. Resistência à insulina é um processo fisiológico em que as células não têm uma resposta normal à hormona insulina. As células não são capazes de reter glucose, ácidos gordos e aminoácidos, o que faz com que haja um aumento destes no sangue, aumentando o risco de doenças cárdio- vasculares,  como descrito no artigo.


Tomate diminui risco de acidente vascular cerebral

  

O consumo de tomate diminui o risco de acidente vascular cerebral (AVC), revela um estudo publicado na revista “Neurology”. Estudos anteriores já tinham constatado que o tomate apresentava vários benefícios para a saúde. Em 2011, os investigadores do the National Center for Food Safety & Technology, revelaram que um maior consumo de tomate poderia proteger contra o desenvolvimento de cancro, osteoporose e doenças cardiovasculares.
-
Neste estudo, os investigadores da University of Eastern, na Finlândia, contaram com a participação de 1.031 homens finlandeses que tinham entre 46 e 65 anos. A concentração sanguínea de um antioxidante presente no tomate, o licopeno, foi medida no início do estudo e periodicamente ao longo de uma média de 12 anos.
-
Os investigadores constaram que ao longo do período de acompanhamento 67 homens sofreram um AVC. Foi verificado que entre os 258 participantes que tinham as concentrações mais baixas de licopeno, 25 tiveram um AVC. Por outro lado, apenas 11 dos 259 que tinham concentrações mais elevadas deste oxidante sofreram um AVC.
-
Os autores do estudo concluíram que os indivíduos que apresentavam concentrações mais elevadas de licopeno tinham um risco 55% menor de desenvolverem um AVC quando comparados com aqueles que tinham concentrações mais baixas deste antioxidante. Esta associação foi ainda mais evidente quando os investigadores se focaram nos acidentes vasculares cerebrais isquémicos. Foi constatado que, em comparação com os homens que tinham concentrações mais baixas de licopeno, os que tinham concentrações mais elevadas apresentavam um risco 59% menor de AVC isquémico.
-
“Este estudo evidencia a associação entre o consumo de frutas e vegetais e um menor risco de AVC. Estes resultados apoiam as recomendações dadas no sentido de se consumir mais do que cinco porções diárias de frutas e vegetais, o que conduziria a uma diminuição considerável do número de acidentes vasculares cerebrais em todo o mundo”, conclui, um dos autores do estudo, Jouni Karppi.


2012-10-11 Estudo publicado na revista “Neurology”


Ref: univadis.pt
http://www.univadis.pt/medical_and_more/pt_PT_Noticiario_Inv_Cient?articleurl=/CT/noticiario_medico/investigacao_cientifica/Tomate-diminui-risco-de-acidente-vascular-cerebral

29 outubro, 2012

Biomecânica vertebral em relação à artéria vertebral durante a manipulação cervical


Partilho com o leitor um estudo relativamente recente, do Journal of manipulative and physiological therapeutics, que no seu relatório preliminar conclui que a artéria vertebral ( AV) durante a manipulação cervical, é alongada bem dentro do limite fisiológico da sua amplitude, mais, o alongamento da AV durante a manipulação é menor, do que aquele provocado pelos testes de amplitude de movimento ( ROM Tests), que se fazem nas consultas ( de várias especialidades) para perceber a mobilidade dos tecidos. Os testes são passivos e activos e respeitam sempre os limites fisiológicos de amplitude. 


Este tema continua a ser bastante discutido e continua a existir a crença de alguns profissionais de saúde, mas sobretudo de pacientes, que as manipulações cervicais são potencialmente fatais pelo risco de lesão ou compressão da artéria vertebral. Por isso, escolhi este estudo, embora existam muitos mais, para ajudar a desmistificar este tema e os receios que apesar de tudo ainda permanecem em muitos pacientes.  


Preliminary report: biomechanics of vertebral artery segments C1-C6 during cervical spinal manipulation.


Abstract


OBJECTIVE:

The purpose of this study was to measure strains in the human vertebral artery (VA) within the cervical transverse foramina and report the first results on the mechanical loading of segments of the VA during spinal manipulation of the cervical spine.

METHODS:

Eight piezoelectric ultrasound crystals of 0.5-mm diameter were sutured into the lumen of the left and right VA of one cadaver. Four hundred-nanosecond ultrasound pulses were sent between the crystals to measure the instantaneous lengths of the VA segments (total segments n = 14) at a frequency of 200 Hz. Vertebral artery engineering strains were then calculated from the instantaneous lengths during cervical spinal range of motion testing, chiropractic cervical spinal manipulation adjustments, and vertebrobasilar insufficiency testing.

RESULTS:

The results of this study suggest complex and nonintuitive strain patterns of the VA within the cervical transverse foramina. Consistent (for 2 chiropractors) and repeatable (for 3 repeat measurements for each chiropractor) elongation and shortening of adjacent VA segments were observed simultaneously and could not be explained with a simple model of neck movement. We hypothesized that they were caused by variations in the location and stiffness of the VA fascial attachments to the vertebral foramina and by coupled movements of the cervical vertebrae. However, in agreement with previous work on VA strains proximal and distal to the cervical transverse foramina, strains for cervical spinal manipulations were consistently lower than those obtained for cervical rotation.

CONCLUSIONS:

Although general conclusions should not be drawn from these preliminary results, the findings of this study suggest that textbook mechanics of the VA may not hold, that VA strains may not be predictable from neck movements alone, and that fascial connections within the transverse foramina and coupled vertebra movements may play a crucial role in VA mechanics during neck manipulation. Furthermore, the engineering strains during cervical spinal manipulations were lower than those obtained during range of motion testing, suggesting that neck manipulations impart stretches on the VA that are well within the normal physiologic range of neck motion.

Referência:  2010 May;33(4):273-8.

25 outubro, 2012

Trate da sua saúde!

Trate as causas primeiro...a prevenção é o melhor tratamento!

A Osteopatia pode ajudar em muitas das condições, que ignoradas, ficam crónicas e mais difíceis de combater.

Trate de si! Comece pela sua Saúde!


Foto: Address the cause not the symptoms





18 julho, 2012

"Experiências que apontam para uma nova compreensão do cancro"

Um princípio Osteopático basilar é o da inter-relação recíproca entre a estrutura (forma) e a função celular. É na verdade uma espécie de máxima universal, transversal a muitas áreas (ou todas). ''Muda a forma e a função altera-se em simultâneo''. 

A Dra. Mina Bissel faz uma apresentação e descoberta extraordinária, sobre como a matriz extra celular ('forma') troca de informação constantemente com o núcleo da célula ('função'). Acreditava-se que a informação do ADN contida no núcleo era a única causa para uma célula se degenerar e multiplicar em células cancerígenas. Neste estudo, em doentes com cancro de mama, percebeu-se que ao mudar o exterior, a forma da matriz extra celular, consegue-se obter uma resposta do núcleo da célula alterando a sua própria forma, conseguindo reverter o movimento de uma célula cancerígena para os de uma célula normal. " We know nothing about the language and alphabet of the form". Como diz Mina Bissel, a arrogância de se achar conhecedor de tudo mata a curiosidade e por sua vez a descoberta. 


05 julho, 2012

'Can Too Much Information Harm Patients?'



Faz-me lembrar aquela frase ' no dia que for ao médico, saio de lá doente.' Muito interessante este excerto. Concordo que se deve informar o paciente de tudo, porém, reconheço, que às vezes muita informação pode preocupar o paciente, retardar a cura, provocar novos sintomas ou mesmo aumentá-los. Pelos menos, é a minha experiência na prática de Osteopatia. Toda a informação deve ser bem usada, enquadrada e sobretudo entendida. Muitas vezes existem achados clínicos nos exames de diagnóstico, que na prática traduzem-se em nada. Aqui fica o apelo e um alerta aos pacientes que navegam pela net à procura de informação. Pode ser muito positivo se for ' encaminhada' para o sítio certo, partilhada com o profissional de saúde que o/ a acompanha, mas sobretudo, se existem dúvidas, consulte um profissional de saúde, para enquadrar todo o quadro clínico e aconselhá-lo/ a da melhor forma.

12 junho, 2012

Early Imaging of Low Back Pain Unnecessary, Harmful


No Reino Unido, por ex, não existe o "hábito" de fazer exames de imagiologia ( rx, tac, rm) se não houverem fortes razões que o justifiquem. Por um lado, são exames potencialmente danosos para o paciente, por outro, o estado ( no caso do sector público) gasta muito dinheiro em fazer exames de diagnóstico e a informação adicional, que poderia direccionar ou ajudar na terapêutica escolhida, é muitas vezes, a maior parte, insuficiente ou sem dados novos. Por isso, fazem parte dos cuidados de saúde primários, os profissionais de Osteopatia, que são especialistas no aparelho músculo-esquelético e têm conhecimentos para fazer diagnósticos diferenciais. Se houverem sinais de alerta, o paciente é encaminhado para outro profissional de saúde ( regra geral o médico de especialidade ou de clínica geral) e pode-se optar por fazer exames de diagnóstico complementares. Lembrem-se: Fazer um rx ou tac, grande parte das vezes não muda em nada a estratégia do tratamento. Somos muito mais que imagens estáticas. Esses exames são essencialmente para diferenciar, afastar, patologias graves. Existem outros meios de diagnóstico primários, suficientes para o tratamento da maior parte das queixas neuro-músculo-esquléticas e que estão ao alcance, ou deveriam de estar, de qualquer cuidador de saúde ( primário), em particular os Osteopatas, que, como disse, são especialistas nesta matéria e somos bem mais eficazes que um rx e anti- inflamatório :).
Deixo-vos um artigo que corrobora a ineficácia de um exame imagiológico precoce nas lombalgias comuns.
                                                                                                                                                     
'As part of its "Promoting Good Stewardship in Clinical Practice," the National Physicians Alliance recommended against imaging for low back pain within the first 6 weeks of onset unless red flags are present. Now, a new literature and financial analysis supports and explains that recommendation.
In one sense, the analysis by Shubha V. Srinivas, MD, MPH, from the Department of Medicine, University of Connecticut Health Center, Farmington, and colleagues covers well-traveled ground from the 30-year history of clinical guidelines indicating that most cases of lumbar back pain resolve themselves with minimal clinical intervention.
However, the findings of the analysis, published online June 4 in the Archives of Internal Medicine, as part of the "Less is More" series, also help maintain momentum for Choosing Wisely, a multi–medical society initiative designed to encourage physicians and their patients to make smart choices about the use of expensive medical technologies that do not deliver improved clinical outcomes in every situation.
The recommendation to avoid early imaging for low back pain was included in the National Physicians Alliance’s list of " 'Top 5' Health Care Activities for Which Less Is More" which was published in the August 8, 2011, issue of the Archives of Internal Medicine.
In the current literature review, Dr. Srinivas and colleagues report that imaging for lower back pain is extremely common. A 2011 study ( Spine J. 2011;11:622-632) indicated that 42% of patients with back pain undergo imaging (mainly plain radiography) within a year of the onset of pain. Of that total, 6 of 10 patients had imaging on the same day as their diagnosis. Eight of 10 underwent imaging within a month.
Dr. Srinivas and colleagues also note that another review concluded that lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes ( Lancet. 2009;373:463-472).
Furthermore, Dr. Srinivas and colleagues estimated that nearly $300 million could be saved annually by restricting imaging during the first 6 weeks of lumbar back pain to specific severe indications, including severe or progressive neurological deficits or when serious underlying conditions, such as osteomyelitis, are suspected.
They surmised that the only benefit of authorizing early low back imaging would be to cater to the patient's demands and emotional need for clinical action. With that issue at hand, they cited an article titled, "Getting to 'No': Strategies Primary Care Physicians Use to Deny Patient Requests" as an example of how to deny imaging to patients with lower back pain without inciting rebellion ( Arch Intern Med. 2010;170:381-388).
Daniel Wolfson, MHSA, executive vice president of the American Board of Internal Medicine Foundation, Philadelphia, Pennsylvania, picked up on this theme in an invited commentary.
"Srinivas et al recognize the problem of translating guidelines and comparative effectiveness research into practice, but they do not offer solutions," he wrote.
So, Wolfson has offered for consideration the efforts of the American Board of Internal Medicine Foundation, along with 9 medical specialist societies and Consumer Reports, to bring their lists of scientifically questionable medical practices to the attention of the general public.
Choosing Wisely features "Five Things Physicians and Patient Should Question," lists, which are geared to educating each society's physician members and their patients about the clinical appropriateness and costs of popular medical tests and therapies. The lists were announced simultaneously April 4.
"Choosing Wisely will test whether this type of campaign will spur translation of clinical recommendations into practice," Wolfson said.
Consistent with Dr. Srinivas's article, lists supported by the American Academy of Family Physicians and the American College of Physicians both advise against imaging of low back pain within the first 6 weeks unless red-flag conditions are suspected.
The authors and commentator have disclosed no relevant financial relationships.
Arch Intern Med. Published online June 4, 2012'
                                                                                                                                                      

Retirado deMedscape Medical News, James Brice


09 junho, 2012

Barriers and MET: ‘feather-edge’ or stretched?


Palpating end-of-range barrier of the hip adductor muscles

The essence of Muscle Energy Technique (MET) is that it harnesses the energy of the patient (in the form of muscular effort) to achieve a therapeutic effect.  Goodridge (in Goodridge & Kuchera 1997) summarises the essential as follows: 
"Good results [with MET] depend on accurate diagnosis, appropriate levels of force, and sufficient localisation. Poor results are most often caused by inaccurate diagnosis, improperly localized forces, or forces that are too strong"
In order to achieve those requirements of accuracy and appropriate focusing of effort, the ideal barrier from which to commence the sequence needs to be identified.
Kappler &  Jones (2003) suggest that we consider joint restrictions from a soft tissue perspective. They suggest that, as the barrier is engaged, increasing amounts of force are necessary, as the degree of free movement decreases. They note that the word barrier may be misleading, if it is interpreted as a wall or rigid obstacle to be overcome with a push:
“As the joint reaches the barrier, restraints in the form of tight muscles and fascia, serve to inhibit further motion. We are pulling against restraints rather than pushing against some anatomic structure.”
If this is indeed the case, then methods such as MET - that address the soft tissue restraints – should help to achieve free joint motion. And it is at the moment that a‘ restraint’ to free movement is noted, that the barrier has actually been passed, also described as moving from ‘ease’ towards ‘bind’. The ‘feather-edge’ of resistance is a point that lies a fraction before that sense of ’bind’ or restriction is first noted, and it is suggested that it is from this point that any MET contraction effort should commence. (Stiles 2009)
Different barriers of resistance

An example
Stiles (2009) has described the following approach when preparing spinal articulation restrictions for MET application: 
In spinal regions, identify the segment(s) of greatest restriction by palpation, observation, motion evaluation etc. With the patient seated, use flexion or extension, together with side flexion, rotation and translation, to maintain the most dysfunctional segment, at the apex of the curve, at the restriction barrier (‘feather-edge’). Establish a counterforce, and instruct the direction for the patient to move towards, using minimal effort.
Stiles reports that a brief (3 to 5 seconds) firmly resisted patient effort, might involve – as examples - either lateral translation of the head/neck, or shoulder, or anterior or posterior translation of the abdomen or upper trunk. The contraction (resisted effort) usually needs to be maintained for a few seconds only, or (gently) for longer, before a brief – few seconds only- rest-period. After this relaxation moment, the new range/barrier in  previously restricted directions should be tested, with a new barrier engaged, and the process repeated, possibly using a different direction for the contraction effort. Stiles confirms his experience of what is a common clinical observation: 
Only a 30-40% improvement in mechanical function is required with MET because the corrective process will continue for several days.
Palpating for lumbar segmental restriction

Soft tissue tension determines the barrier
Parsons & Marcer (2005) note that active movement stops at the ‘physiological barrier.’ determined by the tension (‘bind’) in the soft tissues around the joint (e.g. muscles, ligaments, joint capsule), with normal ranges of movement of a joint (‘ease’) taking place within these physiological barriers. Factors such as exercise, stretching and age – as well as pathology or dysfunction - can modify the normal physiological range, however it is usually possible to passively ease a joint’s range beyond the physiological barrier, by stretching the supporting soft tissues until the anatomical limit of tension is reached.
Any movement beyond the anatomical barrier is likely to cause damage to the local soft tissues or joint surface. Joint restrictions, defined as ‘somatic dysfunction’ occur when normal ranges of movement are restricted, either due to compensatory, adaptive responses, to overuse for example, or to trauma.
Bolin (2010) describes identification of a barrier when using MET in a pediatric setting:
“[If when] evaluating the motion at the 3rd lumbar vertebra in neutral, flexion, and extension, a specific motion restriction can be identified for that particular structure (if dysfunction is present). If the evaluator finds the 3rd lumbar transverse process deeper on the right and more easily rotated on the left, the segment can further be tested in flexion and extension and a positional diagnosis (eg, LERSL) can be established.” 
The barrier would be engaged by having the patient: 
positioned seated, lumbar spine flexed to the Llevel, then rotated and side-bent to the right (See figure).The treatment is performed using a patient’s muscle energy (approximately 5 pounds [2 kilos] of force) to sit upright (extension, side bending, and rotation to left) from that position while an examiner resists. This force is held for 5 seconds, then the patient briefly relaxes; during the relaxation, the slack is taken up and a new barrier in FLEXION, right rotation, and right side bending is engaged. This process is typically performed 3 times.”
Note: No hint is given of forced engagement of the barrier.


Should restriction barriers always be ‘released’?
Clinically, it is worth considering whether restriction barriers ought to be released, in case they might be offering some protective benefit.
As an example, van Wingerden (1997) reported that both intrinsic and extrinsic support for the sacroiliac joint derive in part from hamstring (biceps femoris) status. Intrinsically, the influence is via the close anatomical and physiological relationship between biceps femoris and the sacrotuberous ligament. He states that: 
"Force from the biceps femoris muscle can lead to increased tension of the sacrotuberous ligament in various ways. Since increased tension of the sacrotuberous ligament diminishes the range of sacroiliac joint motion, the biceps femoris can play a role in stabilization of the sacroiliac joint" (Vleeming et al 1989).
Van Wingerden also notes that in low-back patients, forward flexion is often painful, as the load on the spine increases. This happens whether flexion occurs in the spine or via the hip joints (tilting of the pelvis). If the hamstrings are tight and short they effectively prevent pelvic tilting. ‘
"In this respect, an increase in hamstring tension might well be part of a defensive arthrokinematic reflex mechanism of the body to diminish spinal load."
If such a state of affairs is longstanding, the hamstrings will have shortened, influencing both the sacroiliac joint and the lumbar spine. The decision to treat tight (‘tethered’) hamstring should therefore take account of why it is tight, and consider that in some circumstances it might be offering beneficial support to the SIJ, or reducing low-back stress.

Contrary views regarding the appropriate barrier for MET commencement
The ‘feather-edge’ principle of barrier identification has been emphasized in the notes above. In some MET descriptions however a different approach is suggested.
Shoup (2006) describes MET - as used in treatment of hypertonic or shortened muscular structures – as follows:
The [practitioner] treats the hypertonic muscle by stretching the patient’s muscle to the restrictive barrier. Then the patient is asked to exert an isometric counterforce (contraction of a muscle against resistance while maintaining constant muscle length) away from the barrier, while the [practitioner] holds the patient in the stretched position. Immediately after the contraction, the neuromuscular unit is in a refractory or inhibited state, during which a passive stretch of the muscle may occur to a new restrictive barrier.
This model of MET usage mirrors that of van Buskirk (1990) who explains: 
In [patient] indirect ‘muscle energy’ the skeletal muscles in the shortened area are initially stretched to the maximum extent allowed by the somatic dysfunction. With the tissues held in this position the patient is instructed to contract the affected muscle voluntarily. This isometric activation of the muscle will stretch the internal connective tissues. Voluntary activation of the motor neurons to the same muscles also blocks transmission in spinal nociceptive pathways. Immediately following the isometric phase, passive extrinsic stretch is imposed, further lengthening the tissues towards the normal easy neutral position.”

More than two approaches
We have now seen descriptions of MET where the barrier commences from an easy ‘feather-edge’ position, as well as from a position in which the restraining soft tissues are actually stretched (a ‘bind’ barrier) at the start of the isometric contraction. This latter approach raises several clinical questions:

1.   If, as may be the case, the soft tissues held in a stretched position before being required to contract, are already hypertonic, and possibly ischemic, is there a risk that the contraction effort might provoke cramp? This would appear to be a possibility, or even a likelihood, in muscles such as the hamstrings. Would it not be a safer option to employ light contractions, starting with the muscle group at an easy end-of-range barrier, rather than at stretch?

2.   Would the requested contraction effort from the patient be more easily initiated and achieved, if the muscle (group) is in a mid-range or easy end-of-range position, rather than at an end-of-range involving stretch, at the start?

Both comfort and safety issues would appear to support the ‘ease’ barrier rather than a firmer ‘bind’ barrier – provided the outcomes were not compromised -  and clinical experience as well as numerous studies, offer support for the ‘ease’ option.
Both Janda (1990, 1993), and Lewit (1999) have described protocols for the use of MET that support the lighter-barrier approach. In the end each practitioner’s clinical experience will guide therapeutic decision making, supported by research evidence where this is available, or by the clinical experience of others. 
I have opted for the lighter-barrier option.

References
  • Bolin D 2010  The application of osteopathic treatments to pediatric sports injuries. Pediatric clinics of North America, 57 (3):775-794
  • Goodridge J, Kuchera W 1997 Muscle energy treatment techniques. In: Ward R (ed) Foundations of osteopathic medicine. Williams and Wilkins, Baltimore
  • Janda V 1990 Differential diagnosis of muscle tone in respect of inhibitory techniques. In: Paterson J K, Burn L (eds) Back pain, an international review. Kluwer, New York, pp 196–199
  • Kappler RE, Jones JM. 2003 Thrust (High-Velocity/Low-Amplitude) techniques. In Ward RC (Ed) Foundations for osteopathic medicine, 2/e. Philadelphia, Lippincott, Williams & Wilkins pp852-880
  • Lewit K 1999 Manipulation in Rehabilitation of the Locomotor System. 3rd edition. Butterworths, London
  • Parsons J Marcer N 2005 (Eds) Osteopathy: Models for diagnosis, treatment an practice. Churchill Livingston Edinburgh
  • Shoup D DO An Osteopathic Approach to Performing Arts MedicinePhys Med Rehabil Clin N Am 17 (2006) 853–864
  • Stiles E 2009 Muscle Energy Techniques IN: Franke H ED. The History of MET In: Muscle Energy Technique History-Model-Research . Verband der Osteopathen Deutschland, Wiesbaden
  • Van Buskirk R 1990 Nociceptive reflexes and the somatic dysfunction. Journal of the American Osteopathic Association 90(9): 792–809
  • van Wingerden J-P 1997 The role of the hamstrings in pelvic and spinal function. In: Vleeming A, Mooney V, Dorman T, Snijders C, Stoekart R (eds) Movement, stability and low back pain. Churchill Livingstone, New York
  • Vleeming A, Mooney A, Dorman T, Snijders C, Stoekart R 1989 Load application to the sacrotuberous ligament: influences on sacroiliac joint mechanics. Clinical Biomechanics 4: 204–209
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29 maio, 2012

"How to Tap into Your Self-Healing Superpowers"

Um dos "princípios mãe" da Osteopatia é a 'auto-cura'. Fundamenta-se nas capacidades orgânicas de auto-regulação, homeostáticas, defendendo que se todos os mecanismos funcionarem na perfeição, temos no corpo as ferramentas perfeitas de combate à doença. Na verdade, fazia mais sentido no séc XIX, discutir, rebater, discordar ou concordar com este "princípio", do que hoje em dia, se é que alguma vez foi preciso. Desde sempre que a Medicina (em termos globais e desde os seus primórdios) se fundamenta, não só, mas também, na homeostase e nos mecanismos internos de combate à doença, que regulam, equilibram e produzem inúmeras respostas. São indiscutíveis e a evidência mostra isso mesmo. A Osteopatia, no seu início, seguia ( e ainda segue para alguns) um outro princípio. A não-separação do corpo, da mente e do espírito. "Uma pessoa é a interacção dinâmica da mente, corpo e espírito". Estamos, sem dúvida, a viver tempos de transformação. Tempos em que esta não-separação faz cada vez mais sentido...a exploração dos sintomas em várias dimensões do ser humano. A exploração da própria pessoa no seu processo de auto-conhecimento e cura. Cura de tanta coisa. A conexão com Tudo e com o Todo, é verdadeiramente o que me fascina. É essa oportunidade e essa bênção que tenho, em trabalhar com cada paciente, com cada ser humano. A evidência e a ciência têm limites. Limites que são empurrados, expandidos todos os dias. Cada vez mais na direcção de um todo maior. Mas a pessoa, o ser, esse já é a expansão em si. É com esse que trabalho. Deixo-vos este texto escrito por uma médica americana. Lissa Rankin.


How to Tap into Your Self-Healing Superpowers

You practice medicine. You don’t give it or deliver it.
As I described in my personal health journey, I was once a doctor suffering from a wide array of health conditions before I finally woke up to the fact that the root causes of my illnesses were more emotional than biochemical, and that the only way I was going to get well was to treat the emotional, psychological, and spiritual sickness that was manifesting as physical symptoms in my body.

After leaving medicine to spend time healing myself, my body was responding to the treatment thewise, knowing part of me I call my Inner Pilot Light prescribed, but at what price? We were running out of money, I still had no plan, and ever since I left my job, something deep and important was missing from my life. I realized that you can quit your job but you can’t quit your calling. I had been called to medicine at a very young age, the way some are called to the priesthood.

Medicine is a spiritual practice—you practice medicine. You don’t give it or deliver it. You practice it, like you practice yoga or meditation, like you’ll never fully master it. Medicine is about love, about God. Doctors are here to be vessels for Divine love, to use our hands to touch the spirits that live in human bodies. I have been a healer since I was 7 years old, and as my body grew stronger and my heart healed, my soul yearned to get back to my life’s work. I finally realized I had to go back, even though it took me two more years to find my way back to medicine in a way that wouldn’t make me sick.
I wound up working at an integrative medicine center in Marin County, California, where our patients were the most health-conscious people I’ve ever had the pleasure to treat. These people were the proverbial choir. They drank their green juice every day, they had personal trainers, they slept eight hours a night, they took 20 supplements, and they spent a fortune on their health care. They did everything “right,” but they were sicker than ever.

I was baffled. Nothing they taught me in medical school prepared me to take care of patients like these.
So I started asking my patients “What does your body need in order to heal?”
At first, I thought they’d give me treatment intuition, things like “I think I’ll try the 5-HTP supplement instead of the Prozac” or “I think I’ll try changing my diet instead of taking that pill”—and sometimes that’s what they’d say. But more often than not, they answered me with:
  • I need to leave my husband.
  • I need to quit my job.
  • I need to move to Santa Fe.
  • I need to put my mother in a nursing home.
When my patients listened to their intuition and had the guts to follow through on what they prescribed for themselves, seemingly incurable diseases sometimes disappeared.

I was in awe. These patients weren’t responding to conventional medical treatment. They were healing themselves in ways I couldn’t explain. That’s when I discovered a database compiled by the Institute of the Noetic Sciences, which is called the Spontaneous Remission Project. This database compiled more than 3,500 case reports from the medical literature of patients with seemingly incurable diseases that got better - stage 4 cancers that disappeared, HIV + patients that became HIV-, people with diabetes or high blood pressure or thyroid disease whose disease went away, even a patient with a gunshot wound to the head who refused treatment and got better.
Call these miracles or call them inspiring examples of self-healing. I was riveted.

That’s when I got really curious about exactly what makes a person healthy, and what predisposes them to illness. To find my answers, I dug deep into the scientific literature.
What I discovered blew me away. The research proves—without a doubt—that without even being intentional about it, you can heal yourself of about 18-75% of them. We call it the placebo effect, when patients in clinical trials are given sugar pills or even fake surgery, and the simple belief that they are getting the real treatment results in cure.
But from my own experience, I suspected that the ability to heal yourself goes deeper than some sugar pill. So I dug deeper into the medical literature, and what I discovered is that for the body to be healthy, you need to be healthy in all aspects of your life:

 You need:
  • HEALTHY RELATIONSHIPS
  • A HEALTHY PROFESSIONAL LIFE
  • A SENSE OF SPIRITUAL CONNECTION
  • CREATIVE EXPRESSION
  • HEALTHY SEXUALITY
  • HEALTHY FINANCES
  • A HEALTHY ENVIRONMENT
  • A HEALTHY MIND
And of course, not to be completely ignored (biochemistry does still matter!) YOU NEED TO CARE FOR THE BIOCHEMISTRY OF YOUR BODY with diet, exercise, sleepaddiction avoidance, and the traditional “healthy” behaviors.

These expanded categories of what makes a person healthy and whole are now the categories I blog about at OwningPink.com, the website I founded where people in need of healing - and those who serve them - learn how to become healthier in all aspects of life.

What I learned through my exploration into the scientific data led me to write my next book Mind Over Medicine: Scientific Proof You Can Heal Yourself (Hay House, 2013).  What I learned led me to create a new wellness model, inspired by the image of cairns, those balanced stacked stones you see marking beaches and sacred landmarks.

I’m a professional artist, so I love the sculpture of cairns, but what I especially love about cairns is that they are all interdependent on each other. If one stone in the cairn is out of balance, the whole thing topples over, with the stone on top usually being the first to fall.
That’s how I think of the body. The body is the most precarious, the most fragile, the most susceptible to imbalances in the rest of your life.

WHOLE HEALTH CAIRN (view cairn here)


As I described in a popular TEDx talk, the Whole Health Cairn is built upon the firm foundation of your Inner Pilot Light, with all the facets of what makes you whole and healthy balanced upon it in a way that is deeply true for you. Wrapped around the Whole Health Cairn is the Healing Bubble of Love, Pleasure, Gratitude, and Service, which help balance all the stones in the cairn.

The Whole Health Cairn is both a diagnostic tool and a tool for guiding treatment. You can use it to assess your life and diagnose the root cause of your illness, so you can write The Prescription for yourself the way I did. (For a free video training about the Whole Health Cairn, sign up here).
When you think about your health in this way, you’ll realize that health is primarily an inside job. The Prescription for living a wholly healthy life must come from you. Nobody can diagnose the real reason you’re sick or prescribe exactly the right treatment better than you.

I’m not suggesting that your illness doesn’t have a biochemical component. But I am suggesting that illness is rarely purely biochemical, and as such, purely biochemical treatment rarely leads to cure when emotional, psychological, and spiritual factors that contribute to illness are left untreated.

What Can You Do To Optimize Your Health?


What’s out of balance in your Whole Health Cairn? What might be contributing to any physical symptoms you experience? What is your body trying to tell you?
Try inviting your body to write you a letter. (Dear You, Love, your headache). Write back. Have a conversation. What does your body want you to know?
Pay attention when your body speaks in whispers. Please darling, don’t wait until your body starts to yell.

Listening to whispers...


Retirado do site: Pshycholgy Today

24 maio, 2012

Primary Care 2012

Osteopatia na conferência de 2012 organizada pela prestigiada 'Primary Care'. Os Osteopatas no Reino Unido são profissionais nos cuidados de saúde primários. http://www.primarycare2012.co.uk/

16 maio, 2012

Projecto APO


Este fim de semana foi o último módulo de formação complementar no âmbito do projecto da APO ( http://osteopatia-aartedotoque.blogspot.pt/2011/12/projecto-de-acreditacao-membros-apo_2714.html). Tive o prazer, juntamente com outro colega, de partilhar o saber e de interagir com os candidatos. Já vamos a meio caminho pessoal. Agora esperamos que se foquem no estudo para as próximas 2 etapas. Esforço que vai ser e já é certamente recompensado. Continuem com essa dedicação. A nossa profissão é em muito especial e em tudo merece o nosso conhecimento e entrega.

Abraços

09 março, 2012

Cancro da próstata: tomate pode retardar o seu crescimento


Neste estudo, os investigadores da University of Portsmouth, no Reino Unido, testaram o efeito de um nutriente presente no tomate, o licopeno, no mecanismo através do qual as células cancerígenas conseguem obter o sangue necessário para o seu crescimento e disseminação.

As células cancerígenas permanecem dormentes durante anos até o seu crescimento ser despoletado pela secreção de substâncias químicas que iniciam o processo de adesão das células cancerígenas às células endoteliais, presentes no interior dos vasos sanguíneos, permitindo às células cancerígenas obter o sangue necessário para a sua proliferação.

O estudo revelou que o licopeno, a substância que dá ao tomate a cor vermelha, interfere neste processo sem o qual as células cancerígenas não conseguem crescer.

Neste momento os investigadores estão testar se a mesma reação ocorre no corpo humano. “Esta reação química simples ocorreu em concentrações de licopeno que podem ser facilmente atingidas pelo consumo de tomates cozinhados”, revelou, em comunicado de imprensa a líder do estudo, Mridula Chopra.

O licopeno está presente em todas as frutas e vegetais de cor vermelha, mas está presente em maiores concentrações no tomate e torna-se ainda mais facilmente disponível e biologicamente ativo quando este alimento é cozinhado.

Contudo, Mridula Chopra alerta que “os nossos testes foram realizados em tubos de ensaio e são necessários mais estudos para confirmar estes achados. Mas as evidências laboratoriais que encontrámos são claras - é possível interferir com o mecanismo que algumas células cancerígenas utilizam para crescer, e isto pode ser conseguido através de concentrações facilmente obtidas através da ingestão de tomate processado”.

Todas as células cancerígenas utilizam um mecanismo similar para se "alimentar" de uma fonte de sangue saudável, mas os investigadores chamam a atenção para a importância deste mecanismo no cancro da próstata, dado que o licopeno tende a se acumular nos tecidos deste órgão.

 Estudo publicado no “British Journal of Nutrition”

Ref: Univadis

Nozes ajudam no combate ao cancro da próstata

Neste estudo, os investigadores da University of California, nos EUA, criaram ratinhos geneticamente modificados para desenvolver cancro da próstata e alimentaram-nos com cerca de 85g de nozes por dia, ou com uma dieta rica em óleo de soja que continha o mesmo perfil nutricional que a dieta anterior.

O estudo revelou que os tumores dos ratinhos alimentados com uma dieta rica em nozes eram 50% mais pequenos e cresciam 30% mais lentamente que os tumores dos ratinhos controlo.

Os investigadores, liderados por Paul Davis, também verificaram que os ratinhos que foram alimentados com uma dieta rica em nozes apresentavam níveis mais baixos do fator I de crescimento tipo insulina (IGF-1), um biomarcador associado ao cancro da próstata, níveis mais baixos de colesterol LDL, assim como diferenças na forma como o fígado, metabolizava a dieta rica em nozes em comparação com a dieta controlo.

Paul Davis revelou, em comunicado de imprensa, que os resultados deste estudo mostram que o consumo de nozes “tanto pode evitar o desenvolvimento do cancro da próstata como retardar o seu crescimento, e portanto devem ser incluídas numa dieta equilibrada juntamente com a fruta e os legumes”. "As nozes são um alimento completo que contêm várias substâncias saudáveis, incluindo os ácidos gordos ómega-3, gama tocoferol (um tipo de vitamina E), polifenóis e antioxidantes, que atuam de uma forma sinergética”.

Karen Collins, nutricionista e consultora do American Institute for Cancer Research sugere que, de acordo com estes resultados, as nozes devem ser incluídas regularmente na dieta. “A alimentação é um fator chave na prevenção e tratamento do cancro. Uma dieta saudável, a prática regular de exercício físico e a manutenção de um peso saudável é a estratégia recomendada para a redução do risco de desenvolvimento de cancro da próstata e de outros cancros.”

Estudo publicado no “British Journal of Nutrition”
Ref: Univadis


Nota do Bloguer: Num rato o normal o consumo de gordura são 5%, mas se se aumentar esse consumo para 20%, os tumores crescem bastante, 'como cogumelos'- citando o autor do estudo, Paul Davis- a não ser que esse acréscimo de gordura seja à custa de nozes, neste caso, os tumores cresciam mais lentamente que o normal. Foi isso que o estudo revelou. Portanto, há um aumento grande do consumo calórico diário, num humano representaria cerca de 500 cal/ diárias,  em nozes, mas o resultado é aparentemente um abrandamento do crescimento do tumor.