tag:theconversation.com,2011:/us/topics/musculoskeletal-1331/articlesMusculoskeletal – The Conversation2023-07-25T12:23:27Ztag:theconversation.com,2011:article/2051852023-07-25T12:23:27Z2023-07-25T12:23:27ZHorse health research will help humans stay healthy, too, with insights on reining in diabetes and obesity<figure><img src="https://images.theconversation.com/files/537361/original/file-20230713-29-i9gl5q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Learning how to treat endocrine disorders in horses may also lead to treatments in people, and vice versa.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/horse-royalty-free-image/1168570610">Catherine Falls Commercial/Moment via Getty Images</a></span></figcaption></figure><p>As a <a href="https://scholar.google.com/citations?user=61GznXIAAAAJ&hl=en">veterinary science researcher</a>, equine surgeon and sports medicine and rehabilitation specialist, I’ve seen firsthand the similarities between horses and humans. </p>
<p>Both horses and people with endocrine disorders like Type 2 diabetes can suffer multiple types of musculoskeletal disorders. For example, horses with <a href="https://cvm.msu.edu/vdl/client-education/guides-for-pet-owners/equine-endocrinology-pituitary-pars-intermedia-dysfunction-ppid">pituitary pars intermedia dysfunction</a> – similar to Cushing’s disease in people – suffer <a href="https://doi.org/10.1016/j.ando.2008.06.003">from tendon</a> and <a href="https://doi.org/10.1016/j.tvjl.2014.12.037">ligament degeneration</a>. Horses can also experience <a href="https://doi.org/10.1016/j.domaniend.2021.106620">muscle loss</a>, which can cause joint instability. That, and the chronic low-grade inflammation associated with endocrine disorders, can contribute to osteoarthritis.</p>
<p>There’s a principle in medicine called <a href="https://www.cdc.gov/onehealth/index.html">One Health</a>, which says that animals, humans and the environment are inextricably connected – for one to be healthy, all must be healthy. It also means that we can learn a lot about our own health by studying the health of animals, and vice versa, including the many parallels in endocrine disorders between humans and horses.</p>
<h2>Human and horse endocrine systems</h2>
<p>Your <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/endocrine-system#">endocrine system</a> produces hormones that support many of your body’s basic functions, including growth and development, metabolism, <a href="https://theconversation.com/your-body-has-an-internal-clock-that-dictates-when-you-eat-sleep-and-might-have-a-heart-attack-all-based-on-time-of-day-178601">sleep</a> and more. Your hormones also play a role in the health of your bones, tendons and ligaments. Some endocrine disorders change how your body produces and releases hormones and can lead to <a href="https://doi.org/10.1155/2015/206853">osteoporosis</a>, <a href="https://doi.org/10.7759/cureus.26726">arthritis</a>, <a href="https://doi.org/10.1111/sms.13984">ligament</a> <a href="https://doi.org/10.1016/j.ando.2008.06.003">injury</a> <a href="https://doi.org/10.1016/j.otsr.2018.01.009">and other</a> orthopedic diseases. </p>
<p>Humans aren’t the only species affected by this dynamic – <a href="https://doi.org/10.1016/j.tvjl.2018.03.002">horses</a> <a href="https://doi.org/10.1371/journal.pone.0190309">are</a>, <a href="https://doi.org/10.1016/j.tvjl.2014.12.037">too</a>. In fact, <a href="https://doi.org/10.1111/evj.13378">approximately 20% of horses</a> and <a href="http://dx.doi.org/10.5888/pcd14.160287">over 34% of people in the U.S.</a> are affected by endocrine disorders such as metabolic syndrome. These disorders are often accompanied by obesity.</p>
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<a href="https://images.theconversation.com/files/537366/original/file-20230713-23-3t1qzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of horse legs running" src="https://images.theconversation.com/files/537366/original/file-20230713-23-3t1qzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537366/original/file-20230713-23-3t1qzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537366/original/file-20230713-23-3t1qzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537366/original/file-20230713-23-3t1qzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537366/original/file-20230713-23-3t1qzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537366/original/file-20230713-23-3t1qzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537366/original/file-20230713-23-3t1qzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Like people, horses with endocrine disorders are also prone to orthopedic diseases.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/come-to-me-baby-royalty-free-image/127850478">Alberto BN Junior/Moment via Getty Images</a></span>
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<p>For both species, the degree to which endocrine disorders are connected to obesity and its associated negative health effects is complex. As mammals, horses and people share <a href="https://doi.org/10.1530/EC-14-0038">similar anatomy and endocrine physiology</a>, and researchers have noted their parallel <a href="https://doi.org/10.3390/genes11111378">genetic links between obesity and metabolic disease</a>.</p>
<p>Like people, obese horses with endocrine disorders often develop <a href="https://doi.org/10.1186/s13028-020-00515-5">low-grade inflammation</a>. Inflammation is a normal response to injuries and sickness. But chronic, low-grade inflammation can have long-term negative effects on the body. For example, low-grade inflammation is associated with <a href="https://doi.org/10.1038/nrrheum.2012.135">metabolic osteoarthritis in people</a>, and my laboratory is studying this possible link in horses.</p>
<p>In people, childhood obesity, which is related to <a href="https://doi.org/10.1136/bmj.j1">maternal obesity</a>, is associated with a type of <a href="https://doi.org/10.1097/BPO.0000000000001158">joint disease called osteochondrosis</a>. Foals born from obese mares are also predisposed to this <a href="https://doi.org/10.1371/journal.pone.0190309">same type of joint disease</a>.</p>
<h2>Research to note</h2>
<p>Because of the similarities between people and horses, research on diagnostics and treatments for metabolic conditions could provide health benefits to both species.</p>
<p>For example, a class of drug called <a href="https://doi.org/10.1016/j.molmet.2020.101102">glucagonlike peptide-1 agonists</a>, which includes such brands as Trulicity (dulaglutide) and Ozempic (semaglutide), is commonly used to treat metabolic syndrome and Type II diabetes in people. This class of medication is also effective in <a href="https://doi.org/10.1186/s12917-022-03394-2">treating these conditions in horses</a>, similarly slowing down how quickly food empties the stomach and blunting glucose release into the bloodstream.</p>
<p>Another class of drugs called <a href="https://doi.org/10.1136/bmj.m4573">sodium-glucose cotransporter protein-2 inhibitors</a>, which include such treatments as Jardiance (empagliflozin) and Farxiga (dapagliflozin), are used to treat Type 2 diabetes in people and <a href="http://dx.doi.org/10.5455/OVJ.2023.v13.i3.14">a similar condition in horses</a>. These drugs alter the kidneys’ ability to absorb sugar from urine such that the body eliminates some of the glucose it would normally absorb. This greatly reduces blood insulin spikes, which can help prevent obesity, metabolic syndrome and cardiovascular disease in both horses and people.</p>
<p>Some dietary supplements, <a href="https://theconversation.com/many-drugs-have-mirror-image-chemical-structures-while-one-may-be-helpful-the-other-may-be-harmful-186975">such as resveratrol</a>, especially when used <a href="https://doi.org/10.1016/j.jevs.2020.102930">in combination with an amino acid</a> called leucine, also help with weight loss, <a href="https://doi.org/10.2460/javma.249.6.650">mobility</a> and insulin sensitivity in people and horses. Lowering blood insulin concentrations can also prevent horses from <a href="https://ceh.vetmed.ucdavis.edu/health-topics/laminitis">developing laminitis</a>, a disease that inflames tissues in hooves that can necessitate euthanasia because of incurable pain. </p>
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<a href="https://images.theconversation.com/files/537362/original/file-20230713-27-e17gns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Veterinarian in scrubs examining a horse's mane in a stable" src="https://images.theconversation.com/files/537362/original/file-20230713-27-e17gns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537362/original/file-20230713-27-e17gns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537362/original/file-20230713-27-e17gns.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537362/original/file-20230713-27-e17gns.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537362/original/file-20230713-27-e17gns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537362/original/file-20230713-27-e17gns.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537362/original/file-20230713-27-e17gns.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Certain drugs can treat similar conditions in both horses and people.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/black-young-woman-as-veterinarian-royalty-free-image/1408512719">SeventyFour/iStock via Getty Images Plus</a></span>
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<h2>Expanding precision medicine</h2>
<p>I find one of the most exciting avenues of research in both animals and people to be the expansion of <a href="https://theconversation.com/lack-of-diversity-in-clinical-trials-is-leaving-women-and-patients-of-color-behind-and-harming-the-future-of-medicine-podcast-199487">precision medicine</a>. Instead of the standard one-size-fits-all protocol, precision medicine uses information from a person’s genes, environment and medical history to create a customized treatment plan. For example, precision medicine is <a href="https://theconversation.com/every-cancer-is-unique-why-different-cancers-require-different-treatments-and-how-evolution-drives-drug-resistance-199249">often applied in oncology</a> when doctors gather genetic information about the patient’s tumor to inform which treatments might work best for them.</p>
<p>In horses, precision medicine currently focuses on <a href="https://www.aqha.com/-/genetic-test-roundup">DNA-based diagnostic tests</a> to inform exercise regimens, treatment and breeding decisions. Recent work with horses also suggests that measuring the <a href="https://doi.org/10.1111/evj.13053">heritability of certain metabolic traits</a> could be used to screen for metabolic syndrome in the future.</p>
<p>Within precision medicine, doctors aim to get a full-picture view of an individual and their metabolic health by using <a href="https://pubmed.ncbi.nlm.nih.gov/36817343">multiomic analysis</a>. Multiomics entails looking at <a href="https://www.britannica.com/science/omics">multiple “omics</a>” – or information from a range of biological disciplines, such as epigenomics, lipidomics, genomics and transcriptomics – to better treat an individual patient.</p>
<p>The more researchers learn from individual patients, including horses, the better doctors will be able to treat every patient. My lab and others <a href="https://doi.org/10.2460/ajvr.22.11.0194">use multiomic analysis</a> to generate data that may one day help us identify more effective and safer therapies for horses and – likely – people with metabolic conditions.</p><img src="https://counter.theconversation.com/content/205185/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Manfredi receives funding from the Michigan Alliance for Animal Agriculture, USDA NIFA, AAVMC CIVME. </span></em></p>Horses and humans share biological similarities that lead them to suffer from similar endocrine and orthopedic diseases. A number of treatments that work for one species often work for the other.Jane Manfredi, Associate Professor of Pathobiology and Diagnostic Investigation, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2037862023-05-30T11:37:27Z2023-05-30T11:37:27ZAnkylosing spondylitis: machine learning could pave the way for early diagnosis of inflammatory arthritis<figure><img src="https://images.theconversation.com/files/526271/original/file-20230515-21229-5sc62o.jpg?ixlib=rb-1.1.0&rect=0%2C18%2C4140%2C3526&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An X-ray image comparing a healthy spine and one showing signs of ankylosing spondylitis.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ls-spine-xray-image-ap-view-274780355">Suttha Burawonk/Shutterstock</a></span></figcaption></figure><p><a href="https://www.nhs.uk/conditions/ankylosing-spondylitis/">Ankylosing spondylitis</a> (AS) is the second most common type of inflammatory arthritis, often affecting teenagers and young adults. Symptoms of AS can include back pain, stiffness, joint inflammation (arthritis), inflammation where tendons attach to bones (enthesitis), and fatigue. Over time, these symptoms can lead to spinal fusion, which significantly affects quality of life, particularly in young people.</p>
<p>Unfortunately, diagnosing AS can be a lengthy process, taking up to ten years from the onset of symptoms and usually requiring X-rays. The slow progression of the condition, coupled with the lack of a definitive test, contributes to these delays. </p>
<p>However, early detection of the condition can make a tremendous difference, halting the degenerative process and preserving a good quality of life for those affected.</p>
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Read more:
<a href="https://theconversation.com/unexplained-lower-back-pain-it-could-be-ankylosing-spondylitis-56809">Unexplained lower back pain? It could be ankylosing spondylitis</a>
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<p>Our study explored the potential of using routinely collected healthcare data from GPs and hospitals, combined with advanced machine learning techniques, to identify AS at an earlier stage. Machine learning involves using algorithms to analyse sample data, enabling predictions and decisions without explicit programming. </p>
<p>We analysed data separately for men and women, and <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0279076">our findings</a> could transform the way in which GPs detect and diagnose AS.</p>
<h2>A valuable tool</h2>
<p>To conduct our study, we used anonymous data from a national data repository at Swansea University Medical School. Patients with AS were identified and matched with people with no record of a diagnosis.</p>
<p>Our analysis of this data found that factors such as lower back pain, <a href="https://www.nhs.uk/conditions/uveitis/">uveitis</a> (inflammation of the middle layer of the eye), and use of non-steroidal anti-inflammatory drugs before the age of 20 were factors associated with an increased risk of developing AS in men. </p>
<p>In contrast, our model revealed that women tend to experience AS symptoms at a later age, and often rely on multiple pain relief medications compared with men. This possibly indicates a higher likelihood of misdiagnosis of the condition in women.</p>
<p>Machine learning is a valuable tool for profiling and understanding the characteristics of people who are likely to develop AS. It performs well in test data sets with artificially high prevalence rates. </p>
<p>However, when applied to the general population in GPs and hospitals, where AS is rare, even the best model can only achieve a low positive predictive value of 1.4%. (That’s the probability that following a positive test result, the individual will truly have AS.)</p>
<p>So, using multiple models over time may be necessary to narrow down the population and improve this predictive value, which would result in a faster AS diagnosis.</p>
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<img alt="A person wearing a long sleeved white top faces away from the camera clasping the bottom of their back." src="https://images.theconversation.com/files/526283/original/file-20230515-24356-b8m735.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526283/original/file-20230515-24356-b8m735.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526283/original/file-20230515-24356-b8m735.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526283/original/file-20230515-24356-b8m735.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526283/original/file-20230515-24356-b8m735.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526283/original/file-20230515-24356-b8m735.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526283/original/file-20230515-24356-b8m735.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Ankylosing spondylitis is the second most common cause of inflammatory arthritis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/herniated-discspondylosis-scoliosis-asian-woman-she-1481955053">jaojormami/Shutterstock</a></span>
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<h2>Acknowledge the challenges too</h2>
<p>Machine learning techniques have tremendous potential to improve patient care. But it is also crucial to acknowledge the challenges associated with using these techniques effectively. </p>
<p>These models depend on high-quality data that is diverse and comprehensive to produce reliable, accurate results. But healthcare data can be limited due to privacy concerns, data sensitivity and lack of standardisation. These limitations may therefore compromise the accuracy and reliability of the models.</p>
<p>It’s important to acknowledge that machine learning in relation to this topic is still in its infancy. To develop this further, we will need to gather more detailed data to improve prediction rates and clinical usefulness.</p>
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Read more:
<a href="https://theconversation.com/from-a-deranged-provocateur-to-ibms-failed-ai-superproject-the-controversial-story-of-how-data-has-transformed-healthcare-189362">From a 'deranged' provocateur to IBM's failed AI superproject: the controversial story of how data has transformed healthcare</a>
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<p>But our study demonstrates the enormous potential that machine learning has to help identify people with AS and better understand their diagnostic journeys through the health system. </p>
<p>We know that the early detection and diagnosis of AS is crucial to secure the best outcomes for patients. We believe machine learning could help with this. It could also empower GPs, helping them to detect and refer patients more effectively and efficiently.</p><img src="https://counter.theconversation.com/content/203786/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonathan Kennedy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our new study demonstrates the enormous potential that machine learning has to help identify people with ASJonathan Kennedy, Data Lab Manager, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1909782022-11-06T19:04:06Z2022-11-06T19:04:06ZGlute force: why big, strong bum muscles matter for your overall health<figure><img src="https://images.theconversation.com/files/490521/original/file-20221019-21-rw40xd.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5980%2C3965&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The glutes are the large, powerful muscles in your bum that help support the pelvis, stabilise the hip joint and allow the hip to move. </p>
<p>Countless social media posts extol the virtues of building strong glutes through exercises such as squats. However, most of what you hear from such “gymfluencers” is about how the bum muscles look.</p>
<p>Forget about how they look; what about what they <em>do</em>? Why is having big, strong glutes important for your body to function well?</p>
<p>In fact, having strong bum muscles is crucial to good musculoskeletal health.</p>
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<a href="https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C6720%2C4456&q=45&auto=format&w=1000&fit=clip"><img alt="A person does squats in the park." src="https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C6720%2C4456&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Strong glutes are important for overall health.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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Read more:
<a href="https://theconversation.com/were-two-physios-who-ran-away-with-the-circus-heres-what-we-learned-177739">We're two physios who ran away with the circus. Here's what we learned</a>
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<h2>Bum muscles hold your body up and protect the hip joint</h2>
<p>The gluteal muscles are a group of three separate muscles, each with unique anatomical structure and function.</p>
<p>The deepest and smallest muscle is called the gluteus minimus, which is very close to the hip joint itself. </p>
<p>Overlaying gluteus minimus is the gluteus medius. This one is relatively large and spans the whole outer surface of the pelvis.</p>
<p>The gluteus maximus is the largest of the three gluteal muscles and <a href="https://pubmed.ncbi.nlm.nih.gov/19449297/">overlays</a> both gluteus medius and minimus. This muscle is what gives the the bum its distinctive bum-like shape, but it plays a very important role in the way your body functions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram of the gluteal muscles." src="https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=563&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=563&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=563&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=707&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=707&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=707&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The gluteal muscles are a group of separate muscles that work together.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>In combination, the gluteus maximus, medius and minimus gives rise to many hip movements, and provide shock absorption when you’re walking or running. </p>
<p>These muscles work together with your brain to generate a lot of power to hold your body up as gravity tries to pull it down. They also protect the hip joint from impact and from shearing forces that might cause long term damage.</p>
<p>Some of <a href="https://onlinelibrary.wiley.com/doi/10.1002/ca.23510">our</a> <a href="https://www.sciencedirect.com/science/article/pii/S1063458418315127?via%3Dihub">work</a> has identified some people with hip pain also have impairments in the gluteal muscles.</p>
<p>These impairments could reduce the bum muscles’ ability to protect the joint against long term damage and potentially affect a person’s ability to bear weight (for example, when standing on one leg or climbing stairs).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man does hip thrusts in the gym." src="https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Don’t skip the glutes.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>A reduction in muscle size and an increase in non-active tissue such as fat has been <a href="https://pubmed.ncbi.nlm.nih.gov/31689358/">reported</a> in hip conditions such as greater trochanteric pain syndrome (a common type of hip pain, also known as gluteal tendinopathy).</p>
<p>The same is also true for <a href="https://www.oarsijournal.com/article/S1063-4584(16)30064-4/fulltext">hip osteoarthritis</a>, which affects the whole joint.</p>
<p>The rates of osteoarthritis in Australia are <a href="https://doi.org/10.1111/imj.15933">increasing</a>, with <a href="https://aoj.amegroups.com/article/view/3664/4322">one in every seven</a> hip joint replacements conducted in people under the age of 55. However, it’s worth noting just because you have signs of arthritis on hip x-ray or MRI, it doesn’t mean you will have pain or <a href="https://www.sciencedirect.com/science/article/pii/S1063458420312310?via%3Dihub">develop</a> <a href="https://bmjopensem.bmj.com/content/7/4/e001199">pain</a>.</p>
<p>Research <a href="https://pubmed.ncbi.nlm.nih.gov/29439949/">suggests</a> the way a person moves may contribute to the risk of hip osteoarthritis in young people.</p>
<p>If you do have hip pain, bum muscle strengthening is <a href="https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf">recommended</a> as the first line treatment.</p>
<p>But strong glutes have also been shown to improve your day-to-day function, especially in those with hip osteoarthritis. </p>
<p>In particular, people with hip osteoarthritis who have stronger glutes walk faster and longer <a href="https://onlinelibrary.wiley.com/doi/10.1002/jor.1100150421">distances</a> and climb stairs <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.22329">faster</a> than those with weaker glutes.</p>
<h2>Should I do my bum exercises?</h2>
<p>Ultimately, better bum muscle function is likely to be helpful and is often recommended by doctors, physiotherapists and other health-care practitioners.</p>
<p>They may prescribe certain exercises to strengthen your glutes and target problems around the hip area.</p>
<p>Having weak glutes is associated with:</p>
<ul>
<li><p><a href="https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2833-4">low back pain</a></p></li>
<li><p><a href="https://pubmed.ncbi.nlm.nih.gov/18838402/">patellofemoral</a> pain (pain under the knee cap) and</p></li>
<li><p>greater <a href="https://www.sciencedirect.com/science/article/pii/S1050641117300111?via%3Dihu">trochanteric pain syndrome</a> (the common type of hip pain we mentioned earlier, also known as gluteal tendinopathy).</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people do deadlifts in a gym." src="https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your physio might prescribe glute exercises.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Glute strength may even have a role to play in keeping your <a href="https://journals.lww.com/jwhpt/Abstract/2021/07000/Hip_and_Pelvic_Floor_Muscle_Strength_in_Women_With.5.aspx">pelvic floor</a> in good shape (although further research is required).</p>
<p>That’s not to say doing your bum exercises will automatically cure all these ailments; each case is unique and involves a range of factors. But having strong glutes is, in general, very important for hip and pelvis stability and function.</p>
<p>No matter if you are a gymfluencer, a professional sports person, or just a regular bum-owner, having strong glutes will keep you in good stride.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/physio-chiro-osteo-and-myo-whats-the-difference-and-which-one-should-i-get-149993">Physio, chiro, osteo and myo: what's the difference and which one should I get?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/190978/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Ganderton receives funding from Arthritis Australia, Physiotherapy Research Foundation, Swinburne University of Technology, National Institute of Circus Arts and La Trobe University.
Charlotte Ganderton is a member of the Australian Physiotherapy Association and Sports Medicine Australia.</span></em></p><p class="fine-print"><em><span>Adam Semciw is affiliated with Northern Health. </span></em></p><p class="fine-print"><em><span>Matthew King receives funding from the Physiotherapy Research Foundation, Australian Physiotherapy Association, La Trobe University and the Transport Accident Commission . He is affiliated with the Australian Physiotherapy Association, Sports Medicine Australia and the International Hip-related Pain Research Network.. </span></em></p>Forget about how your bum muscles look; what about what they do? In fact, having big, strong glutes is crucial to good overall musculoskeletal health.Charlotte Ganderton, Physiotherapy lecturer, Swinburne University of TechnologyAdam Semciw, Associate Professor in Allied Health, La Trobe UniversityMatthew King, Postdoctoral Research Fellow, Lecturer, and Physiotherapist, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1868012022-09-28T12:32:30Z2022-09-28T12:32:30ZYour mighty tendons help you sprint, jump and move – a genetic mutation in one key protein may increase athletic performance<figure><img src="https://images.theconversation.com/files/486922/original/file-20220927-26-skh2t7.jpg?ixlib=rb-1.1.0&rect=0%2C3%2C2139%2C1396&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A variant of Piezo1 may boost tendon strength and, subsequently, athletic ability.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sprinters-in-motion-royalty-free-image/a0091-000172">Yellow Dog Productions/The Image Bank via Getty Images</a></span></figcaption></figure><p>The ability to move is an essential part of daily life. The <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/locomotor-system">locomotor, or musculoskeletal, system</a> of the body consists of muscles, bones, tendons, ligaments, joints, cartilage and other connective tissue. <a href="https://www.physio-pedia.com/Ageing_and_the_Locomotor_System">Loss of motor function</a> due to disease or injury can result in a lifetime of disability. In a rapidly aging society, maintaining and improving motor function can be a significant challenge for many people.</p>
<p>But there are ways to get around motor failure. As <a href="https://scholar.google.com/citations?user=6NvNu40AAAAJ&hl=en">molecular biologists</a> and <a href="https://www.researchgate.net/profile/Ryo-Nakamichi">orthopedic surgeons</a> who study the locomotor system, we believe one key part of it has been underestimated – the tendons.</p>
<p><a href="https://my.clevelandclinic.org/health/body/21738-tendon">Tendons</a> are tough tissues that connect muscle to bone. Tendons are what allow <a href="https://a-z-animals.com/blog/how-high-and-far-can-a-kangaroo-jump/">kangaroos</a> to jump over 25 feet (7.62 meters) high and run up to 40 mph (64 kph). While their leg muscles are small, the kangaroos’ highly developed and long tendons act like powerful springs. People can also jump higher if they squat down first because their tendons <a href="https://spaniardperformance.com/muscle-tendon-unit-characteristic-to-potenciate-training/">store elastic energy</a> that helps propel them upward.</p>
<p>In our research, we found that the presence of <a href="https://doi.org/10.1126/scitranslmed.abj5557">one particular protein in tendons</a> plays a key role in how tendons heal – and a genetic mutation in that protein may also enhance athletic performance.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/hdes6W76OOw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Tendons connect muscle to bone and are essential to movement.</span></figcaption>
</figure>
<h2>Identifying tendon proteins</h2>
<p>Tendon damage can be <a href="https://doi.org/10.1002/jor.22869">difficult to heal</a>. Approximately <a href="https://doi.org/10.1177/0363546520939897">60% of tendon injuries</a> lead to <a href="https://www.cdc.gov/arthritis/basics/osteoarthritis.htm">osteoarthritis</a>, a disease resulting from the breakdown of the cartilage in joints that can make movement even more difficult.</p>
<p>Developing treatments for tendon injuries has likewise been challenging. One of the reasons is that the proteins controlling the genes instructing the body to create tendons, called <a href="https://www.nature.com/scitable/definition/transcription-factor-167">transcription factors</a>, had been unknown.</p>
<p>To identify these proteins, we <a href="https://www.embrys.jp/embrys/html/MainMenu.html">created a catalog</a> of the 1,600 transcription factors in the human body. Based on this catalog, we examined what genes were active in the Achilles tendon of genetically engineered mice and found that a protein called Mkx was a central transcription factor for the health of tendons.</p>
<p>Researchers have long considered tendons to be inert tissue unable to contract like muscles can. But we discovered with our colleague, <a href="https://scholar.google.com/citations?user=2aSu29oAAAAJ&hl=en">Ardem Patapoutian</a>, the <a href="https://www.nobelprize.org/prizes/medicine/2021/advanced-information/">Nobel Prize-holder</a>, that one particular protein on the surface of tendon cells, Piezo1, can sense when the tendon is engaging in moderate exercise and stimulate the Mkx transcription factor.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/wtkKyZ9vjq4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The discovery of Piezo1’s role in the perception of touch won the 2021 Nobel Prize in physiology or medicine.</span></figcaption>
</figure>
<h2>Piezo1 and athletic performance</h2>
<p>We then wondered about the role that Piezo1 plays in athletic performance. We were particularly interested in a variant of Piezo1 called E756del, which is found in around <a href="https://doi.org/10.1016/j.cell.2018.02.047">a third of people of African descent</a> and thought to play a potential role in <a href="https://doi.org/10.1038/s41551-021-00716-x">how high people can jump</a>. </p>
<p>So we genetically engineered mice to produce an equivalent mouse version of Piezo1 E756del proteins throughout their body and then <a href="https://doi.org/10.1126/scitranslmed.abj5557">tested their performance</a> on different physical activities, including long jump and running on a treadmill. Surprisingly, we found that mice with E756del proteins were able to jump about 1.6 times farther without training than mice without the E756del proteins. Mice with Piezo1 in their tendons were also able to run about 1.2 times faster than those without Piezo1.</p>
<p>To identify which body part was producing this jumping ability, we then created mice that produced Piezo1 proteins either in their muscles or their tendons. The results were even more surprising: Mice with Piezo1 in their tendons improved in their jumping ability just as well as mice with Piezo1 throughout their entire body. Mice with Piezo1 only in their muscles, however, did not have any improvement in jumping ability.</p>
<p>We then decided to test the role of Piezo1 in human athletic performance. In collaboration with the <a href="http://www.athlomeconsortium.org/">Athlome Consortium</a>, an international athletic genomics organization, we compared the prevalence of the gene that codes for E756del in 91 Olympic-level Jamaican sprinters and 108 people in the general population in Jamaica. We found that 54% of Jamaican sprinters had an active gene for E756del, compared to just approximately 30% of the general population.</p>
<p>Our findings show that changing a single protein, in this case E756del, can play a role in athletic performance. Further research on tendons and other parts of the human motor systems could help improve treatments for musculoskeletal conditions.</p><img src="https://counter.theconversation.com/content/186801/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hiroshi Asahara receives funding from National Institute of Health, Japan Society for the Promotion of Science, Japan Agency for Medical Research and Development.</span></em></p><p class="fine-print"><em><span>Ryo Nakamichi does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The discovery of the role that the protein Piezo1 plays in touch and body awareness won the 2021 Nobel Prize in physiology or medicine. Piezo1 may also be a significant player in motor function.Hiroshi Asahara, Professor of Molecular Medicine, The Scripps Research InstituteRyo Nakamichi, Postdoctoral Researcher in Molecular Medicine, The Scripps Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1870682022-09-15T02:59:09Z2022-09-15T02:59:09ZHow do we support Indigenous people in Australia living with musculoskeletal conditions?<figure><img src="https://images.theconversation.com/files/481245/original/file-20220826-23-r0mowc.jpg?ixlib=rb-1.1.0&rect=5%2C130%2C3783%2C2545&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mri-scan-human-spine-168563063">shutterstock</a></span></figcaption></figure><p>There have been national, state and local campaigns to “<a href="https://www.closingthegap.gov.au/national-agreement/targets">Close the Gap</a>” in Australia. Despite this, considerable health gaps still exist between Indigenous and non-Indigenous people.</p>
<p>Musculoskeletal conditions are an area of health where there is a significant difference between Indigenous and non-Indigenous people. Although Indigenous people experience musculoskeletal conditions <a href="https://pubmed.ncbi.nlm.nih.gov/29245188/">more</a>, their access to high-quality and culturally informed support remains low.</p>
<p>Musculoskeletal conditions can have a considerable <a href="https://pubmed.ncbi.nlm.nih.gov/22392923/">effect</a> on people’s lives. Such conditions can affect a person’s ability to walk, complete simple tasks at home without help, and participate in sports or work.</p>
<p>Government health organisations need to provide better support for Indigenous people suffering from these conditions by encouraging culturally safe community-based care.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-mothers-are-more-likely-to-die-during-childbirth-more-first-nations-midwives-could-close-this-gap-182935">First Nations mothers are more likely to die during childbirth. More First Nations midwives could close this gap</a>
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<h2>What are musculoskeletal conditions?</h2>
<p><a href="https://www.health.gov.au/health-topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-musculoskeletal-conditions#:%7E:text=We%20are%20providing%20%244%20million,and%20training%20for%20health%20professionals">Musculoskeletal conditions</a> include disorders that affect the bones, muscles and joints such as back pain and osteoarthritis. They affect approximately one in three <a href="https://pubmed.ncbi.nlm.nih.gov/35505334/#:%7E:text=In%202019%2C%2022.3%25%20and%2039.8,particular%20females%20and%20older%20Australians">Australians</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1560044779941302272"}"></div></p>
<p>Internationally, low back pain is the leading cause of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext">disability</a>, and osteoarthritis is the leading cause of physical activity <a href="https://pubmed.ncbi.nlm.nih.gov/24553908/">limitation</a>. Both of these ailments are more common in <a href="https://pubmed.ncbi.nlm.nih.gov/29245188/">Indigenous people</a>, who are 20-50% more likely to have osteoarthritis and 10% more likely to report current back pain than the non-Indigenous population in Australia. </p>
<p>Musculoskeletal conditions have also been shown to contribute to the development of <a href="https://pubmed.ncbi.nlm.nih.gov/30249247/#:%7E:text=Pooled%20adjusted%20estimates%20from%20these,total%20n%20%3D%202%2C686%2C113%20people">chronic diseases</a> such as diabetes and cardiovascular disease. With 46% of Australia’s Indigenous population having at least <a href="https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/latest-release">one</a> chronic condition, this may lead to even <a href="https://pubmed.ncbi.nlm.nih.gov/22818936/">higher</a> rates of chronic diseases.</p>
<p>Many Indigenous people resign themselves to being in <a href="https://pubmed.ncbi.nlm.nih.gov/15885010/">pain</a> and living with their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808686/">condition</a>. The social impact of living with these conditions is important to consider. For some First Nations people, it has the potential to restrict participation in activities of cultural significance and minimising connection with family and Country. </p>
<p>For example, the ability to care for and connect with extended family, attend community and family gatherings and enjoy activities on Country. These <a href="https://pubmed.ncbi.nlm.nih.gov/22392923/">limitations</a> often have considerable emotional effects on individuals, leading to feelings of anger, depression and fear.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/colonial-ideas-have-kept-nz-and-australia-in-a-rut-of-policy-failure-we-need-policy-by-indigenous-people-for-the-people-188583">Colonial ideas have kept NZ and Australia in a rut of policy failure. We need policy by Indigenous people, for the people</a>
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<h2>Community-based care is needed</h2>
<p>Indigenous people’s <a href="https://pubmed.ncbi.nlm.nih.gov/24127305/">access</a> to health-care services to manage pain is half the expected rate compared to non-Indigenous people. Part of the reason for lower health care access is due to <a href="https://pubmed.ncbi.nlm.nih.gov/25945587/">negative experiences</a> with health-care services due to discriminatory attitudes toward pain from health-care providers. Unfortunately this is a common occurrence for Indigenous people. More than half (53%) of all Indigenous people have <a href="https://www.westernsydney.edu.au/__data/assets/pdf_file/0009/1201203/OMAC1694_Challenging_Racism_Report_4_-_FINAL.pdf">experienced racism</a> when when seeking health care. </p>
<p>Ways to increase Indigenous peoples’ access to health services is for them to have better support with self-managing their condition. In addition, community-based approaches to health care would provide a safer space for these patients. The <a href="https://www.health.gov.au/initiatives-and-programs/indigenous-australians-health-programme">Indigenous Australians’ Health Programme</a> and other funding bodies must work with communities, clinicians, and researchers to deliver programs addressing musculoskeletal conditions and chronic diseases. These programs need to ensure local communities are at their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999419/">centre</a> and cultural safety for participants is a priority. Such programs could be led by community-based allied health clinicians, but should include a range of health professionals to ensure optimal care is provided that addresses all factors related to musculoskeletal conditions.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/indigenous-people-with-disabilities-face-racism-and-ableism-whats-needed-is-action-not-another-report-187528">Indigenous people with disabilities face racism and ableism. What's needed is action not another report</a>
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</em>
</p>
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<h2>Health care needs to include cultural safety</h2>
<p>A whole of system approach is required to improve access to health care for Indigenous people in Australia. National, state, and local services must work together to ensure culturally safe care is provided, placing Indigenous clients and local communities at its <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999419/">core</a>. This shift will likely require changes in how clinicians deliver care, how the services organise care, and how the health-care system supports this care.</p>
<p>Ineffective communication is often sighted as a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808686/">barrier</a> to care for Indigenous people. This is why clinicians building connections and rapport with the Indigenous community they are treating is important. Undertaking training in cultural safety and effective communication strategies is essential to assist clinicians in providing optimal care.</p>
<p>To improve health services, programs providing care for musculoskeletal conditions should aim to partner with Aboriginal Community Controlled Health Organisations and ensure Indigenous people are trained and employed as part of the team. The health system should also ensure <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808686/">policies prioritise</a> these employment opportunities as well as the importance of providing culturally safe care and working with local Indigenous communities.</p>
<p>A person’s musculoskeletal pain and the presence of chronic diseases are often intertwined. We must develop community-based models of care to address these conditions in Indigenous people, and ensure culturally safe care is being provided.
These changes will require ongoing training for health-care staff. </p>
<p>The fundamental shift is the inclusion of local Indigenous communities in all health care initiatives. These improvements will help ensure Indigenous people have the opportunity to self-manage their musculoskeletal pain, general health and well being.</p><img src="https://counter.theconversation.com/content/187068/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Williams receives funding from National Health and Medical Research Council of Australia. </span></em></p><p class="fine-print"><em><span>Jane Linton and Simon Davidson do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Government health organisations need to provide better support for Indigenous people suffering from musculoskeletal conditions.Simon Davidson, PhD Candidate, University of NewcastleChristopher Williams, Associate Professor, University of SydneyJane Linton, Affiliate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1859192022-08-16T14:42:07Z2022-08-16T14:42:07ZMobile app offers new learning tools for anatomy students. But tech isn’t a silver bullet<figure><img src="https://images.theconversation.com/files/473717/original/file-20220712-12-6z2q67.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Anat_Hub app gives anatomy students a new way to really peer into the human musculoskeletal system.</span> <span class="attribution"><span class="source">Donenko Oleksii/Shutterstock</span></span></figcaption></figure><p>For most people who finished school or university even a decade ago, the idea of virtual reality in the classroom probably seems like the stuff of science fiction. But immersive technologies like virtual reality (VR), augmented reality (AR) and mixed reality – which all aim to marry the physical and digital worlds – are increasingly being used to <a href="https://www.universityworldnews.com/post.php?story=20211121141027398">bolster teaching and learning</a>.</p>
<p>Its proponents <a href="https://www.immersivelearning.news/2022/02/04/how-virtual-reality-can-change-schooling-in-south-africa/">argue</a> that immersive technology could be especially useful in low-resource settings. No laboratory equipment at school? Can’t afford pricey field trips? No problem: mobile phones and tablets could take entire labs and libraries into schools and universities.</p>
<p>Those opposed to an all-out migration to such technology point out that poorer countries’ education sectors already have serious resource and infrastructure constraints.</p>
<p>The <a href="https://journals.sagepub.com/doi/full/10.1177/0036933020956317">COVID pandemic</a>, with its resulting lockdowns and university closures, forced countries to shift towards online teaching and learning. But it didn’t miraculously improve infrastructure issues – if anything, it made them worse. Still, it seems likely that some element of online learning will become the norm in many parts of the world. </p>
<p>How might educational institutions in poorer contexts adapt without leaving students behind? Our experience in developing an immersive mobile phone application for university anatomy students offers some insights. </p>
<p>The departments of computer science and medical biosciences at South Africa’s University of the Western Cape collaborated to develop <a href="https://www.mdpi.com/2076-3417/12/11/5694">Anat_Hub</a> for two reasons. First, we wanted to reach students who were no longer on campus because of the pandemic, and create an avenue for self-paced learning. Second, practical training in medical biosciences has been hampered by resource constraints and limited teaching staff. In anatomy, for instance, there is <a href="https://journals.lww.com/academicmedicine/fulltext/2018/09000/bodies_for_anatomy_education_in_medical_schools_.17.aspx">a global lack of cadavers</a>. That makes practical training difficult.</p>
<p>In <a href="https://www.mdpi.com/2076-3417/12/11/5694">a recent paper</a>, we outlined how students experienced the app as well as the constraints and problems they faced. </p>
<h2>An immersive experience</h2>
<p>Anat_Hub is a practical immersive AR technology for the musculoskeletal system. It teaches the names, attachments and actions of muscles of the human musculoskeletal system. The app provides detailed graphics of both the upper and lower limbs. The models can be viewed in four different sections: the shoulder and arm; forearm and hand; hip and thigh; and leg and foot. </p>
<p>In the AR mode, the animation functionality built into the app allows the student to view and interact with the model from different sides. As with the 3D version, users can start by looking at the muscles of each limb, and peel away layers down to the nervous system.</p>
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<img alt="" src="https://images.theconversation.com/files/473715/original/file-20220712-31713-e10y9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/473715/original/file-20220712-31713-e10y9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=613&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473715/original/file-20220712-31713-e10y9a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=613&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473715/original/file-20220712-31713-e10y9a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=613&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473715/original/file-20220712-31713-e10y9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=770&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473715/original/file-20220712-31713-e10y9a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=770&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473715/original/file-20220712-31713-e10y9a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=770&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>The application, based on the Android operating system, offers a wide range of useful features intended to promote active and self-regulated learning. These include 3D mode, a glossary, and a quiz where students’ cognitive abilities are tested on the material covered.</p>
<p>Anat_Hub is about 300MB in size and internet access is needed for it to be downloaded and installed. However, it can be used offline once it’s downloaded. Internet access was a foremost consideration in the app’s development process given its African context. It has <a href="https://www.universityworldnews.com/post.php?story=20210707124818759">been reported</a> that some 82% of university students in sub-Saharan Africa do not have internet access. In South Africa, a survey by publishers Juta found that 32% of responding students struggled with internet access. </p>
<p>We piloted the system on a group of volunteer first-year undergraduates from several anatomy-related disciplines. Then we evaluated their experiences of the app’s functionality and usability. There were, ultimately, 53 respondents. Only 13.2% had used AR prior to seeing Anat_Hub. Most had relied on lecture notes (96.2%), internet resources (77.4%), videos (75.5%) and textbooks (56.5%) to study anatomy. Few had turned to alternative sources such as mobile applications (24.5%), anatomy atlases (11.3%) and e-learning software (7.5%).</p>
<p>Students rated the app well. Nearly two-thirds of the volunteers scored it a 4 or 5 on a scale of 1-5 (“poor” to “excellent”). Nearly 70% of the respondents particularly liked the app’s 3D mode. Many found the glossary useful. And 96.2% told us they would recommend the app to others. This all hints at the potential and opportunities for such technology. </p>
<h2>The digital divide</h2>
<p>Of course, there were problems too. These largely centred on faulty or missing features, user interface and navigation, 3D elements in the navigation bar and difficulty with the AR mode. These issues could possibly be ascribed to the type of mobile device used not meeting the app’s required specifications (Android API level 26 to 30 with a mobile screen aspect ratio of 16:9).</p>
<p>This is a reminder that not all mobile or smart phones and computer tablets are made equal. They are not all configured the same way and some students simply cannot afford the high-end phones that are more likely to meet the app’s specifications. This emphasises South Africa’s <a href="https://theconversation.com/digital-equality-south-africa-still-has-a-long-way-to-go-131864">deep digital divide</a> and its <a href="https://databank.worldbank.org/data/download/poverty/33EF03BB-9722-4AE2-ABC7-AA2972D68AFE/Global_POVEQ_ZAF.pdf">high poverty levels</a>. Many students at our university, and others in South Africa, come from households with no basic infrastructure and where parents have neither the education nor means to provide them with a technology leg-up.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/digital-equality-south-africa-still-has-a-long-way-to-go-131864">Digital equality: South Africa still has a long way to go</a>
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</em>
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<p>This is not the end of our work with Anat_Hub. For one thing, future research will aim to determine whether students’ performance in anatomy tests and examinations will improve as a result of the app. Further effort is planned to optimise and reduce the size of the app. The ultimate goal is to roll out the app as a learning tool for anatomy within the University of the Western Cape and other institutions. </p>
<p>Applications like Anat_Hub show that home-grown technologies can be developed to meet local needs. But the availability of the technology itself is no “cure” for shortcomings elsewhere in the education system or society more broadly.</p>
<p><em>Professor Okobi Ekpo and Marjorie Smith contributed to this article.</em></p><img src="https://counter.theconversation.com/content/185919/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The development of an immersive mobile phone application for university anatomy students offers insights into the future of online learning.Omowunmi Isafiade, Senior Lecturer in Computer Science, University of the Western CapeChristina Kotze, Lecturer in anatomy and physiology, and researcher in invertebrate reproductive biology, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1836192022-07-06T03:38:00Z2022-07-06T03:38:00ZIs netball actually bad for knees and ankles? What does the research say?<p>Netball is one of the biggest team sports in Australia with more than <a href="https://www.clearinghouseforsport.gov.au/kb/women-in-sport/current-state">1.2 million men, women and children playing each week</a>, underpinned by a nationwide footprint of more than 4,000 community clubs.</p>
<p>Across the world more than <a href="https://netball.sport/">20 million people play netball in more than 70 countries</a>. And it’s not just for young women; men play in mixed and male only competitions, 5-7 year olds play in the <a href="https://netball.com.au/woolworths-netsetgo">NEtSetGO</a> program and older players play in the <a href="https://www.playwalkingnetball.com.au/home/">Walking Netball competition</a>.</p>
<p>Despite its popularity, netball continually gets bad rap for joints. Time and time again in physiotherapy clinics, we hear patients say, “I have bad knees because I used to play netball” or “I’m scared of letting my child play netball – isn’t it terrible for joints?”</p>
<p>The research, however, shows a more nuanced story. </p>
<p>Yes, there is a risk of injuring yourself while playing netball but the overall risk of serious injury is relatively small – and far outweighed by the benefit of being fit, active and part of a team. </p>
<h2>What are the knee and ankle risks with netball?</h2>
<p>Unlike other court-based sports, netball has strict <a href="https://netball.com.au/sites/default/files/2020-02/INF-RulesofNetball2020.pdf">rules</a> on footwork.</p>
<p>Players can only take one and a half additional steps after receiving the ball.</p>
<p>They’re also restricted to certain areas of the court, depending on which position they’re playing. </p>
<p>The sudden braking required of netball players requires good strength, body control and footwork. </p>
<p>A recent <a href="https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-020-00290-7">systematic review</a> reports netball injuries in people aged over 15 predominantly occur in the lower limb, particularly the ankle and knee. Ligament sprains are the most common injury. </p>
<p>Ankle injuries are more common than knee injuries, the systematic review found. And younger players tend to experience more upper limb injuries (such as fractures) than lower limb injuries.</p>
<p>There are more injuries in matches than in training. Pain at the <a href="https://www.researchgate.net/publication/322264795_Incidence_and_prevalence_of_patellofemoral_pain_A_systematic_review_and_meta-analysis">front of the knee-cap</a> is also very common in adolescent girls who participate in jumping and pivoting sports such as netball. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/19236296">Insurance claim</a> data indicates damage to the ACL (<a href="https://www.physio-pedia.com/Anterior_Cruciate_Ligament_(ACL)">anterior cruciate ligament</a>, a major stabiliser of the knee) represents about 13% of the most serious netball injuries presenting to emergency departments. </p>
<p>This equates to a rate of only one injury for every 2,500 participants. However, this figure likely underestimates the actual injury rate as many people with these injuries go straight to their GP or local physiotherapist (rather than hospital). </p>
<p>The limited data available makes it hard to accurately indicate the injury rate in community netball. But in similar court-based sports (such as handball or basketball), the ACL injury rate is <a href="https://pubmed.ncbi.nlm.nih.gov/18063176/">one in every 100-200 players per calendar year</a>. </p>
<p>Though ACL injuries are rare, they are a serious injury often requiring time off work or study and are costly to the <a href="https://pubmed.ncbi.nlm.nih.gov/30587436/">individual</a> and the <a href="https://pubmed.ncbi.nlm.nih.gov/33852440/">health care system</a> via increased risk of arthritis.</p>
<p>So is netball terribly much worse than other sports for joint injury risk? We don’t have enough data to conclusively answer this question. But what we can say from the limited evidence available is the overall risk of knee and joint injury in community netball is low.</p>
<h2>Can anything be done to reduce injury risk for netballers?</h2>
<p>Yes! There is great evidence <a href="https://pubmed.ncbi.nlm.nih.gov/29737024/">injury prevention programs work</a>, reducing ACL injuries in female athletes by up to 67%, other knee injuries by up to 50%, and all lower limb injuries by 30%.</p>
<p>Netball even has its own injury-prevention program, known as <a href="https://knee.netball.com.au/about/">the KNEE program</a> (KNEE stands for knee injury prevention for netballers to enhance performance and extend play).</p>
<p>The KNEE Program is an on court warm-up program aimed at all levels of netball. It aims to improve the way players run, change direction, jump and land (as this is how many knee and ankle injuries happen).</p>
<p>For pain at the front of the knee-cap (<a href="https://bjsm.bmj.com/content/bjsports/50/4/247.full.pdf">patellofemoral pain</a>), there is also great <a href="https://bjsm.bmj.com/content/52/18/1170">evidence</a> that exercises that strengthen the hip and knee muscles – combined with <a href="https://bmjopensem.bmj.com/content/2/1/e000086">advice about activity modification</a> – can help.</p>
<p>For adolescents, patellofemoral pain often occurs during periods of rapid growth, but it is important to see a health professional for exercises and advice, as <a href="https://doi.org/10.1136/bjsports-2016-096384">one in three</a> continue to experience pain 12 months down the track.</p>
<h2>Yes there are risks with netball, but the benefits far outweigh them</h2>
<p>As a fast moving non-contact sport, netball is fantastic way to keep active, improve hand eye coordination and reap the physical, mental, and social benefits of participating in a team sport.</p>
<p>Being physically fit and strong can improve your health and reduce your <a href="https://www.who.int/publications/i/item/9789240015128">risk of illness</a>. </p>
<p>Knees in particular like to be exercised; recreational runners have healthier knees than those who <a href="https://pubmed.ncbi.nlm.nih.gov/28504066/">lead a sedentary lifestyle</a>. </p>
<p>Participation in sport is particularly important for adolescent girls, who are dropping out of sport at <a href="https://www.suncorp.com.au/learn-about/teamgirls/teamgirls-powered-by-suncorp-research.html">alarming rates</a>. </p>
<p>Girls who do play sport have a more positive body image and better states of <a href="https://www.suncorp.com.au/learn-about/teamgirls/teamgirls-powered-by-suncorp-research.html">psychological well-being</a>. </p>
<p>Being <a href="https://www.suncorp.com.au/learn-about/teamgirls/truth-about-teen-girls-and-sport.html">part of a team</a> also helps girls enjoy shared experiences, reduce isolation and be part of something bigger than themselves.</p>
<p>Many sports provide similar benefits but all sports have some risks. If you or your children enjoy netball, keep playing – the overall benefits of netball outweigh the possible risks. </p>
<p>Importantly, netball in Australia can serve as a vehicle for empowerment, providing strong female roles models to inspire current and future generations.</p><img src="https://counter.theconversation.com/content/183619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kay Crossley receives funding from the National Health and Medical Research Council to investigate knee injuries in sport</span></em></p><p class="fine-print"><em><span>Brooke Patterson and Sallie Cowan do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Yes, there is a risk of injuring yourself while playing netball but the overall risk of serious injury is relatively small – and far outweighed by the benefit of being active and part of a team.Sallie Cowan, Senior Research Fellow and Musculoskeletal Physiotherapist, La Trobe UniversityBrooke Patterson, Research Fellow, La Trobe UniversityKay Crossley, Professor, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1777392022-03-30T19:08:58Z2022-03-30T19:08:58ZWe’re two physios who ran away with the circus. Here’s what we learned<p>Circus fuses extreme athletic performance, diverse artists and stunning spectacles with a truly global appeal. </p>
<p>Circus is exciting, although sometimes unpredictable. At any moment during rehearsal, performance or travel, injuries can occur.</p>
<p>The task of looking after the health of circus performers is unique. And we’ve been privileged to do that, as physiotherapists treating and helping coordinate artists’ medical care. </p>
<p>We’ve done this in well over 100 cities through 30 countries across North and South America, Europe, Australasia, Asia and the Middle East. While we’ve mainly toured with professional circuses, we’ve also advised junior artists and circus training facilities.</p>
<p>This is what it’s like to work behind the scenes of some of the greatest shows on Earth.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/circus-oz-is-to-close-after-44-years-they-irrevocably-changed-australian-circus-and-brought-it-to-the-world-173586">Circus Oz is to close after 44 years. They irrevocably changed Australian circus, and brought it to the world</a>
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<h2>A diverse crew</h2>
<p>Circuses and their performers are diverse. Disciplines include ground acrobatics (for instance, tumbling, hand balancing, contortion); aerial acrobatics (trapeze, silks, straps); manipulation (juggling); character (clowning); and music. Rehearsals and performances may feature fire, ice, water, heights or a range of props and equipment.</p>
<p>You could compare the cast of a large show to an Olympic squad, with a variety of ages, body shapes, sizes and injury risk.</p>
<p>At the elite level, performers may come from a range of different countries, languages and cultural backgrounds. This can add potential challenges such as differing belief systems and attitudes about injury cause and management, training and performance.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Circus performers, including clown, juggler" src="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Circuses and their performers are diverse, as are their injuries.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/circus-226087540">Shutterstock</a></span>
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<h2>A diverse set of injuries</h2>
<p>While headline-grabbing falls and catastrophic injuries do occur, they are fortunately rare. Most injuries are chronic (long-term) injuries and less-serious acute ones. </p>
<p>The most commonly reported circus injuries are to the <a href="https://www.ingentaconnect.com/content/scimed/mppa/2017/00000032/00000001/art00008">spine and ankle</a>. We also see sprains, strains, and sore lower backs and shoulders.</p>
<p>You might be familiar with many of these injuries. However, circus performers have unique skills, and sometimes require extreme ranges of movement, coordination and strength. They need their bodies to function in ways you or I don’t. This influences how we work with performers to get them back on their feet (or hands).</p>
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<p>
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Read more:
<a href="https://theconversation.com/hot-pack-or-cold-pack-which-one-to-reach-for-when-youre-injured-or-in-pain-161086">Hot pack or cold pack: which one to reach for when you're injured or in pain</a>
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<p>Circus injury rates are <a href="https://www.ingentaconnect.com/content/scimed/mppa/2017/00000032/00000001/art00008">7.37-9.27</a> per 1,000 artist exposures (the number of training/performance hours, or number of training sessions/shows). Acrobatic injuries are the <a href="https://www.ingentaconnect.com/content/scimed/mppa/2014/00000029/00000004/art00010">most</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445642/">common</a>. </p>
<p>However, the limited research we have on circus injuries suggests
circus is safer then many other sports. That includes having lower injury rates than contact football (rugby, American football and Australian rules), and gymnastics. </p>
<p>In professional circus, <a href="https://journals.sagepub.com/doi/abs/10.1177/0363546508331138">injuries tend to be minor</a>, requiring seven or fewer treatment sessions and resulting in one or no missed shows. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Fit woman in exercise wear clutching sore lower back" src="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Injuries, such as sore backs, are common, and not always reported.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-sportswoman-sitting-on-mat-1745717915">Shutterstock</a></span>
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</figure>
<p>However, injuries are likely under-reported. Common definitions of injury rely on artists missing training or shows, or seeking formal medical care. Some injuries don’t meet these criteria.</p>
<p><a href="https://www.ingentaconnect.com/content/scimed/mppa/2021/00000036/00000001/art00008">Our research</a> looked at performers’ self-reported lower-limb problems, regardless of whether they missed work or saw a health-care practitioner. We asked them about injuries and/or symptoms such as pain, ache, stiffness, clicking/catching, swelling and instability.</p>
<p>In any given week, we found more than 50% of performers reported problems. In an 18-week period, 86% of performers reported having had at least one week with work-related lower limb problems.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-from-delicate-teens-to-fierce-women-simone-biles-athleticism-and-advocacy-have-changed-gymnastics-forever-124485">Friday essay: from delicate teens to fierce women, Simone Biles' athleticism and advocacy have changed gymnastics forever</a>
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<h2>A diverse range of issues</h2>
<p>Some performers also face barriers to recovering from their injuries. <a href="https://www.ingentaconnect.com/content/scimed/mppa/2019/00000034/00000001/art00003">One study</a> found financial constraints and a lack of health-care support were issues.</p>
<p>For instance, full-time artists may have access to travelling medical staff with experience working with circus performers. These artists may also have paid injury leave and comprehensive health insurance. </p>
<p>However, artists performing on short-term contracts or doing gig-based work may need to source their own medical care and are more likely to suffer financial loss if they miss performances. </p>
<p>Other researchers have also reported how aspects of circus culture influence how we manage circus injuries. In <a href="https://www.ingentaconnect.com/content/scimed/mppa/2019/00000034/00000001/art00003">one study</a>, performers said they didn’t always trust health-care practitioners’ knowledge of work demands. This includes circus skill requirements, and training or show schedules. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Athlete's taped wrist and ankle" src="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">To tape or not? Some performers may prefer colleagues’ and coaches’ advice.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/injured-athlete-thumb-ankle-injuries-tape-1481951810">Shutterstock</a></span>
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<p>Some performers may prioritise advice from colleagues and coaches over medical recommendations. This may be partly because circus is a historic art form where, in many disciplines, training methods have been passed down through generations of performers. </p>
<p>For health-care practitioners, this knowledge can be valuable. So clinicians need to work with artists to come to a shared understanding of how to manage injuries. </p>
<p>Acknowledging the unique nature of circus training and performance, as well as the lack of evidence base to guide medical decision-making in the field, can also help build rapport and ensure a collaborative approach to managing injuries.</p>
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<p>
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<a href="https://theconversation.com/are-clowns-scary-ha-ha-aaaargh-32492">Are clowns scary? Ha ha aaaargh</a>
</strong>
</em>
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<h2>Preventing injuries is the goal</h2>
<p>Circus performers are generally adept at managing their bodies, using strength, flexibility and conditioning training to try to prevent injuries and improve their acts.</p>
<p>We have worked with performers to promote self-management, using techniques from more established fields such as sports and dance medicine.</p>
<p>For instance, we looked at adding self-directed <a href="https://www.ingentaconnect.com/content/scimed/mppa/2021/00000036/00000001/art00008">endurance exercises</a> to a performing, touring show. This was welcomed by many performers.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-ice-baths-after-sport-help-recovery-or-improve-results-44829">Health Check: do ice baths after sport help recovery or improve results?</a>
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</em>
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<h2>A lot goes on behind the scenes</h2>
<p>For the shows to go on, much behind-the-scenes work is needed from the artists and dedicated support staff. </p>
<p>For those involved in the care of circus artists, this provides not only a uniquely challenging and fascinating workspace, but an amazing view of some of the greatest shows on Earth.</p><img src="https://counter.theconversation.com/content/177739/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Ganderton is a research consultant for the National Institute of Circus Arts. Charlotte was previously employed for Cirque du Soleil in its performance medicine team.</span></em></p><p class="fine-print"><em><span>Michael Henry receives funding from the Australian Government in the form of RTPd fee offset and stipend scholarships. He was previously employed by Cirque du Soleil in its performance medicine team. </span></em></p>Circus is exciting, though sometimes unpredictable. At any moment during rehearsal, performance or travel, injuries can occur.Charlotte Ganderton, Physiotherapy lecturer, Swinburne University of TechnologyMichael Henry, PhD candidate, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1311892021-03-26T12:24:27Z2021-03-26T12:24:27ZHow humans became the best throwers on the planet<figure><img src="https://images.theconversation.com/files/391246/original/file-20210323-13-1dlrzok.jpg?ixlib=rb-1.1.0&rect=20%2C20%2C3407%2C2312&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New York Yankees closer Aroldis Chapman routinely tops 100 mph with his fastball.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/aroldis-chapman-of-the-new-york-yankees-in-action-against-news-photo/1278868402?adppopup=true">Jim McIsaac/Getty Images Sport via Getty Images</a></span></figcaption></figure><p>Pitchers’ fastballs are getting better and better.</p>
<p>From 2008 to 2020, the average speeds of all major league baseball pitches combined <a href="https://www.theringer.com/mlb/2021/3/15/22331075/pitching-mound-move-distance">rose by between 1.5 mph and 2 mph</a>. In the 2019 season, nearly 90% of the 281 pitchers who threw more than 1,000 pitches <a href="https://baseballsavant.mlb.com/leaderboard/pitch-arsenals?year=2019&min=1000&type=avg_speed&hand=">threw fastballs that averaged over 90 mph</a>. The 100 mph fastball – once a newsworthy event – <a href="https://www.usatoday.com/story/sports/mlb/2017/03/30/with-all-the-100-mph-pitchers-how-long-will-the-arms-last/99813546/">is now relatively common</a>.</p>
<p>But MLB pitchers aren’t the only expert throwers; most healthy people can throw faster than our <a href="https://doi.org/10.1038/nature12267">much stronger chimpanzee relatives</a>, who max out at around 30 mph. <a href="https://doi.org/10.1177/036354659602400506">A study of boys</a> from the ages of 8 to 14 who were only moderately trained in throwing could still throw two times faster than chimps.</p>
<p>So how and why did humans evolve to become expert throwers? </p>
<p>In two papers in The Quarterly Review of Biology, we explored the <a href="https://doi.org/10.1086/696721">ecological causes</a> and <a href="https://doi.org/10.1086/698225">evolutionary consequences</a> of throwing in humans. </p>
<h2>Sticks and stones that break bones</h2>
<p>Humans are the only species that can throw well enough to kill rivals and prey. Because throwing requires the highly coordinated and extraordinarily rapid movements of multiple body parts, there was likely a long history of selection favoring the evolution of expert throwing in our ancestors.</p>
<p>Most people probably don’t think throwing is important outside of sports because they’ve forgotten its usefulness. Part of that has to do with the fact that people have been using weapons like bows and firearms <a href="https://www.simonandschuster.com/books/Technology-and-War/Martin-Van-Creveld/9780029331538#">for centuries</a>.</p>
<p><a href="https://books.google.com/books/about/Throwing_Fire.html?id=vyFxldb2GJQC">But before the invention of these weapons</a>, our hunter-gatherer ancestors threw darts, knives, spears, sticks and stones at rivals and prey. Even today, stones remain effective weapons; <a href="https://www.reuters.com/article/us-health-coronavirus-india/migrant-workers-throw-stones-at-police-in-india-in-protest-against-lockdown-idUSKBN22L0JZ">you’ll see protesters heave stones at police</a> and <a href="https://www.rferl.org/a/afghan-rights-group-investigates-video-of-woman-being-stoned-to-death/30414665.html">stoning used as a form of punishment</a> in some places.</p>
<p>Darwin considered the evolution of throwing to be critical to the success of our ancestors. As he wrote in “<a href="https://books.google.com/books?id=Na9LAAAAMAAJ&printsec=frontcover&dq=darwin+1871+descent+of+man&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwiZuKzpwu3nAhVOip4KHWVTDF0Q6AEwAXoECAUQAg#v=onepage&q=darwin%201871%20descent%20of%20man&f=false">The Descent of Man, and Selection in Relation to Sex</a>,” it allowed “the progenitors of man” to better “defend themselves with stones or clubs, to attack their prey, or otherwise to obtain food.”</p>
<p>The development of the skill begins with the evolution of bipedal locomotion, or walking on two feet. <a href="https://doi.org/10.1007/978-3-642-27800-6_48-3">This happened about 4 million years ago</a>, and it freed the arms and hands to learn new abilities like making tools, carrying goods and throwing.</p>
<p>The Australopithecines, the relatively small-brained, bipedal ancestors of our genus that lived in Africa <a href="https://doi.org/10.1016/B978-0-12-802652-6.00010-4">somewhere between 1 million and 4 million years ago</a>, probably threw projectiles as well, since <a href="https://doi.org/10.1046/j.1469-7580.2003.00144.x">their hand bones</a> hint at their ability to grip objects and throw them. </p>
<p>But just because you can throw doesn’t mean you can throw well. Anatomical adaptations like a tall mobile waist that decoupled the hips and thorax allowed for more torso rotation. A laterally oriented shoulder joint that better aligned the main axis of the upper arm with the action of chest muscles allowed for a greater range of motion. Both are necessary for high-speed throwing, <a href="https://doi.org/10.1038/nature12267">and these first appeared together in <em>Homo erectus</em></a> – the first member of our genus – about 2 million years ago. </p>
<p>The two main theories for why selection favored throwing are fighting and hunting. Most scholars have favored the <a href="https://doi.org/10.1016/0162-3095(82)90010-3">hunting hypothesis</a>. However, <a href="https://jhupbooks.press.jhu.edu/title/animal-tool-behavior">monkeys and apes</a> – especially chimpanzees, our closest relatives – frequently throw sticks, stones and vegetation during combat with each other and potential predators. Only rarely do they do so while hunting. Because throwing at other members of the same species is an ancestral trait in primates, <a href="https://doi.org/10.1086/696721">we argue that our throwing abilities evolved first in the context of combat and only later became a hunting tactic</a>.</p>
<h2>A skill that diverges by sex</h2>
<p>Once the ability to throw quickly and accurately became critical to success in combat and hunting, our male ancestors would have been more likely than females to develop, through natural selection, these skills, since anthropologists have shown that males <a href="https://global.oup.com/academic/product/war-in-human-civilization-9780199236633?cc=us&lang=en&">tended to fight</a> and <a href="https://www.jstor.org/stable/3773347">hunt big game</a>.</p>
<p>Over time, men who were better throwers became better warriors and hunters. This further accelerated the evolution of throwing ability in men because success in <a href="https://science.sciencemag.org/content/239/4843/985">war</a> and <a href="https://doi.org/10.1007/s12110-004-1013-9">hunting</a> increases male status within groups and influenced female mate choice.</p>
<p>Interestingly, while all modern humans can throw well relative to other primates, sex differences in throwing are among the <a href="https://doi.org/10.1037/0003-066X.60.6.581">largest behavioral differences between the sexes</a>. These differences emerge early in life and are not strongly influenced by experience or practice. </p>
<p>Anthropologists and biologists <a href="https://doi.org/10.1037/0033-2909.98.2.260">have extensively documented</a> this advantage in throwing velocity, distance and targeting ability, although a recent study <a href="https://doi.org/10.3389/fpsyg.2017.00212">suggests training may eliminate differences in throwing accuracy</a>.</p>
<p>Sex differences in throwing do not exist just because males are, on average, larger and stronger. <a href="https://doi.org/10.1086/698225">The relative size, shape and orientation of the shoulders of men</a> increase the range of motion of the arm during the cocking phase, which facilitates better throwing. Some of these differences begin early in life and exist even when taking into account sex differences in body size and the fact that males, from a young age, tend to throw more often than females.</p>
<p>Even among men, large size and strength do not always result in faster throwing. Throwing speed is influenced by a variety of factors including <a href="https://doi.org/10.1080/02701367.2006.10599378">the range of motion of the throwing arm</a> and <a href="https://doi.org/10.1080/02701367.2006.10599377">stride length</a>. That’s why relatively svelte pitchers like <a href="https://www.baseball-reference.com/players/l/linceti01.shtml">Tim Lincecum</a> and <a href="https://www.baseball-reference.com/players/m/martipe02.shtml">Pedro Martinez</a> were able to throw faster than most of their taller, stronger and bulkier counterparts.</p>
<p>Their bodies are the paragons of an evolutionary adaptation that has made humans the best throwers on the planet. If rising pitch speeds are any indication, the skill continues to develop. There are even some who argue that pitchers have become too good – and that <a href="https://www.theringer.com/mlb/2021/3/15/22331075/pitching-mound-move-distance">it’s high time to move back the mound</a>.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/131189/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We’re the only species that can throw at speeds that kill.Michael P. Lombardo, Professor of Biology, Grand Valley State University Robert Deaner, Associate Professor of Psychology, Grand Valley State University Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1479872020-10-16T11:02:18Z2020-10-16T11:02:18ZWhat is osteopathic medicine? A D.O. explains<figure><img src="https://images.theconversation.com/files/363792/original/file-20201015-19-1k9z1ap.jpg?ixlib=rb-1.1.0&rect=73%2C5%2C3388%2C2057&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">D.O.s like Sean Conley, physician to the president, can face stigma from people who don't understand the practice.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/white-house-physician-sean-conley-answers-questions-news-photo/1228914747">Saul Loeb/AFP via Getty Images</a></span></figcaption></figure><p><em>When President Trump was diagnosed with COVID-19, many Americans noticed that his physician had the title D.O. stitched onto his white coat. Much confusion ensued about doctors of osteopathic medicine. As of a 2018 census, they made up <a href="https://doi.org/10.30770/2572-1852-105.2.7">9.1% of physicians in the United States</a>. How do they fit into the broader medical field?</em></p>
<p><em>Andrea Amalfitano is a D.O. and dean of the Michigan State University College of Osteopathic Medicine. He explains some of the foundations of the profession and its guiding principle: to use holistic approaches to care for and guide patients. And don’t worry, yes, D.O.s are “real doctors” and have full practice rights across the U.S.</em></p>
<h2>How did osteopathic medicine get started?</h2>
<p>In the years after the Civil War, without antibiotics and vaccines, many clinicians of the day relied on techniques like arsenic, castor oil, mercury and bloodletting to treat the ill. Unsanitary surgical practices were standard. These “treatments” promised cures but often led to more sickness and pain.</p>
<p>In response to that dreadful state of affairs, a group of American physicians <a href="https://www.aacom.org/become-a-doctor/about-osteopathic-medicine/history-of-osteopathic-medicine">founded the osteopathic medical profession</a>. They asserted that maintaining wellness and preventing disease was paramount. They believed that preserving health was best achieved via a holistic medical understanding of the individual patients, their families and their communities in mind, body and spirit. They rejected reductionist interactions meant to rapidly address only acute symptoms or problems.</p>
<p>They also embraced the concept that the human body has an inherent capacity to heal itself – decades before the immune system’s complexities were understood – and called for this ability to be respected and harnessed.</p>
<h2>What do osteopathic doctors do today?</h2>
<p>Doctors of osteopathic medicine – D.O.s, for short – can prescribe medication and practice all medical and surgical specialties just as their M.D. counterparts do. Because of the focus on preserving wellness rather than waiting to treat symptoms as they arise, more than half of D.O.s gravitate to primary care, including family practice and pediatrics, particularly <a href="https://www.healthaffairs.org/do/10.1377/hblog20171023.624111/full/">in rural and underserved areas</a>.</p>
<p>D.O. training embraces the logic that understanding anatomic structures can allow one to better understand how they function. For example, alongside contemporary medical and surgical preventive and treatment knowledge, all osteopathic physicians also learn strategies to treat musculoskeletal pain and disease. These techniques are known as “manual medicine,” or osteopathic manipulative treatment (OMT). They can provide patients an alternative to medications, including opioids, or invasive surgical interventions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman manipulating a man lying on a treatment table" src="https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An osteopathic medical student practices an adjustment that is part of osteopathic manipulative treatment.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sarah-fang-a-3rd-year-osteopathic-medical-student-does-a-news-photo/566007125">Gary Friedman/Los Angeles Times via Getty Images</a></span>
</figcaption>
</figure>
<p>D.O.s pride themselves on making sure their patients feel they’re treated as a whole person and not simply reduced to a symptom or blood test to be rapidly dealt with and then dismissed. We say we aspire to care for “people, not patients,” with an empathetic attitude and an emphasis on making sure those closest to those in their care, such as family and loved ones, as well as other social factors, are all taken into account.</p>
<h2>What’s different between a D.O. and an M.D.?</h2>
<p>The osteopathic philosophy around prevention and wellness might seem like common sense today, but it was revolutionary. Aspects of osteopathic medicine, including the use of alternative therapies such as OMT, were originally met with skepticism or outright hostility by some medical doctors who questioned their scientific bases. Indeed, in 1961, the <a href="https://doi.org/10.1001/jama.1961.73040370010008">American Medical Association’s code of ethics declared it “unethical”</a> for an M.D. physician to professionally associate with doctors of osteopathy.</p>
<p>So with the guidance of the American Osteopathic Association, D.O.s created their own D.O. hospitals, residency and fellowship programs, and four-year D.O. degree-granting medical schools. Instruction around the current science of health and illness is similar between D.O.s and M.D.s – it’s the philosophical delivery of that knowledge that’s different.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p>
<p>Certainly a holistic approach to health is no longer exclusive to D.O.s. In fact, many M.D., nursing, physician assistant and other health professional schools now embrace parts of it as they deliver care. And now, D.O.s and M.D.s often work side by side in medical settings across the country. More recently, the AMA has recently <a href="https://www.ama-assn.org/residents-students/usmle/comlex-do-matching-and-gme-accreditation-what-you-need-know">recognized the D.O. licensing exams as equivalent</a> to the exams M.D.s take. D.O.s compete for the same training residencies as M.D.s and, eventually, the same jobs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="crowd of D.O. students wearing their white coats" src="https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Michigan State University College of Osteopathic Medicine students take the osteopathic pledge.</span>
<span class="attribution"><span class="source">Michigan State University</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<h2>How prevalent is osteopathic medicine today?</h2>
<p>Osteopathic medicine is now <a href="https://www.healthaffairs.org/do/10.1377/hblog20171023.624111/full/">one of the fastest-growing health professions</a>, with over 150,000 D.O.s and D.O. medical students practicing in the U.S. and internationally. <a href="https://osteopathic.org/wp-content/uploads/OMP2019-Report_Web_FINAL.pdf">One in four newly minted U.S. physicians</a> <a href="https://www.aamc.org/data-reports/students-residents/interactive-data/2019-facts-enrollment-graduates-and-md-phd-data">in the class of 2019</a> graduated from an osteopathic medical school.</p>
<p>Osteopathic medicine is now a mainstay of contemporary medical practice, with D.O.s active in all aspects of the nation’s health care systems.</p><img src="https://counter.theconversation.com/content/147987/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrea Amalfitano is Dean of the College of Osteopathic Medicine, and the Osteopathic Heritage Foundation Professor of Pediatrics, Microbiology and Molecular Genetics at Michigan State University. Dr Amalfitano also consults for ImmunityBio, Etubics Corp., and Avasure Inc, and has received external funding from a number of government, corporate, foundational, and private sources, including the NIH, MDA, and AMDA.</span></em></p>Almost 10% of physicians in the US are doctors of osteopathic medicine, and that proportion is rising. Their medical knowledge matches that of other doctors; the difference is the philosophy behind it.Andrea Amalfitano, Dean of the MSU College of Osteopathic Medicine and Professor of Pediatrics, Microbiology and Molecular Genetics, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/947462018-05-16T01:40:09Z2018-05-16T01:40:09ZThe guidelines on low back pain are clear: drugs and surgery should be the last resort<figure><img src="https://images.theconversation.com/files/216438/original/file-20180426-175038-1fq8089.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most people with low back pain aren't getting the most effective treatment.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Low back pain is the <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30488-4.pdf?code=lancet-site">leading cause of disability</a> worldwide and is becoming more common as our population ages. Most people who have an episode of low back pain <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30480-X.pdf">recover within six weeks</a>, but two-thirds still have pain after three months. By 12 months, pain may linger but is usually less intense. </p>
<p>Still, <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30480-X.pdf">recurrence is common</a> and in a small number of people it may become persistent and disabling. Chronic back pain affects well-being, daily functioning and social life. </p>
<p>A series on low back pain by the global medical journal <a href="https://www.thelancet.com/series/low-back-pain?code=lancet-site">The Lancet</a> outlined that most sufferers aren’t getting the most effective treatment. The articles state that recommended first-line treatments – such as advice to stay active and to exercise – are <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30489-6.pdf?code=lancet-site">often overlooked</a>. Instead, many health professionals seem to favour less effective treatments such as rest, opioids, spinal injections and surgery.</p>
<p>So, here’s what evidence shows you need to do to improve your low back pain.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/needless-treatments-spinal-fusion-surgery-for-lower-back-pain-is-costly-and-theres-little-evidence-itll-work-91829">Needless treatments: spinal fusion surgery for lower back pain is costly and there's little evidence it'll work</a>
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<h2>Risk factors for low back pain</h2>
<p>The cause of most people’s low back pain remains unknown. But we do know of a number of <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30480-X.pdf">risk factors</a> that could increase the chance of developing low back pain. These include a physically demanding job that involves lifting, bending and being in awkward postures. Lifestyle factors such as smoking, obesity and low levels of physical activity are also associated with developing low back pain. </p>
<p>People with low back pain should see a health professional to rule out the more serious causes of pain such as fracture, malignancy (cancer) or infection.</p>
<p>Once patients are cleared of these, the <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30489-6.pdf?code=lancet-site">current guidelines</a> from Denmark, the UK and the US advise self-management and psychological therapies as the initial response for persistent low back pain. These include staying active, doing appropriate exercises and undertaking a psychological program to help manage the pain.</p>
<p>Exercises such as Tai Chi, yoga, motor control (to restore strength, co-ordination and control of the deep core stabilising muscles supporting the spine) and aerobic exercises (such as walking, swimming, cycling and general muscle reconditioning exercises) are recommended.</p>
<p>If any of these therapies fail or stop working, the guidelines point to manual and physical therapies such as spinal manipulation (Denmark, UK, US), massage (UK and US) and yoga and acupuncture (US) – particularly for low back pain lasting more than 12 weeks. </p>
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<h2>Exercise and psychological therapy</h2>
<p>The guidelines are based on many studies that have shown the benefits of exercise and psychological therapies. For instance, a 2006 study compared pain levels across two groups of <a href="https://www.researchgate.net/publication/36215732_Evaluation_of_a_targeted_exercise_rehabilitation_approach_and_its_effectiveness_in_the_treatment_of_pain_functional_disability_and_muscle_function_in_a_population_with_longstanding_unresolved_low_back">physically active people</a> with chronic low back pain. </p>
<p>Participants who followed a four-week program using Pilates exercise equipment reported a more significant reduction in pain and disability than those in a control group who received usual care (consultations with a health care professional as needed). The benefit for the exercise group was maintained over a 12-month period.</p>
<p>Another, 2011 trial explored the benefits of Tai Chi for those with <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/acr.20594">persistent low back pain</a>. Participants who completed a ten-week course of Tai Chi sessions had less bothersome back symptoms, pain intensity and self‐reported disability, compared with a control group who continued with their normal medical care, fitness or health regimen.</p>
<p>Chronic pain is linked with chemical and structural changes at all levels of the nervous system. These include the level of neurotransmitter changes that alter pain modulation, and sensitisation of the nerves involved in transmitting pain signals. Incoming pain signals can be modified by our response to persistent pain. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-pain-and-what-is-happening-when-we-feel-it-49040">Explainer: what is pain and what is happening when we feel it?</a>
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<p>Psychological treatments – such as mindfulness-based stress reduction – focus on increasing awareness and acceptance of physical discomfort, as well as challenging emotions often associated with chronic pain. </p>
<p>In a trial including 342 participants, around 45% of those who had completed eight sessions of cognitive behaviour therapy or mindfulness-based stress reduction had clinically <a href="https://jamanetwork.com/journals/jama/fullarticle/2504811">meaningful improvements</a> in bothersome pain at 26 weeks of follow-up. This was compared to only 26.6% of people who had received usual care.</p>
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<a href="https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Exercises such as swimming can help strengthen the core.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<h2>Manual therapy</h2>
<p>In Australia, physiotherapists, chiropractors and osteopaths use manual and physical therapy to treat lower back pain. The treatments often include some form of spinal manipulation and massage, as well as advice to stay active and do exercises. This is consistent with The Lancet’s recommendations, also based on evidence from studies. </p>
<p>A 2013 trial of <a href="https://www.ncbi.nlm.nih.gov/pubmed/23026869">people with acute low back pain</a> compared the effects of spinal manipulation with those of the non-steroidal anti-inflammatory drug diclofenac (Voltaren) and placebo on their pain. Spinal manipulation was found to be significantly better than diclofenac and clinically superior to placebo in reducing disability, pain and the need for rescue medication. It was also found to improve quality of life.</p>
<p>Similar results came from <a href="https://www.ncbi.nlm.nih.gov/pubmed/15319761">another study</a> of 192 people with low back pain that lasted around two to six weeks. Participants were randomly allocated to one of three groups: chiropractic manipulation with a placebo medication; muscle relaxants with sham manipulation; or placebo medicine with sham manipulation. All subjects improved over time, but the chiropractic group responded significantly better, with a bigger decrease in pain scores, than the control group.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ouch-the-drugs-dont-work-for-back-pain-but-heres-what-does-72283">Ouch! The drugs don't work for back pain, but here's what does</a>
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<p>Physiotherapists, chiropractors and osteopaths are required by law to be registered with the Australian Health Practitioner Regulation Agency (AHPRA) to practise in Australia. To be registered, a person must complete a minimum of four years’ study at a university in a degree that includes a focus on non-pharmacological (drug-based), non-surgical management of musculoskeletal conditions, including low back pain. </p>
<p>Under the government’s <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-chronicdisease-pdf-infosheet">Chronic Disease Management Plan</a> patients with persistent low back pain may be referred to physiotherapists, chiropractors or osteopaths for evidence-based therapies such as spinal manipulation and massage. If patients are unfamiliar with these therapies, they can discuss referral with their GP.</p>
<p>Physiotherapists, chiropractors and osteopaths can also be consulted without referral. Their services are usually covered by private health insurance. The AHPRA website lists <a href="https://www.ahpra.gov.au/">registered practitioners</a> in your area. </p>
<p>One thing to look out for when you see a practitioner is the number of treatments they recommend. Patients usually start with a short course of two to six treatments to see if the treatment helps. It shouldn’t take many treatments for a change in symptom pattern to become obvious.</p>
<p>The message to the public and to health professionals is clear. People with non-specific low back pain need to learn how to independently manage their pain while remaining active, staying at work and maintaining their social life as far as possible.</p><img src="https://counter.theconversation.com/content/94746/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sandra Grace is an academic member of Chiropractic & Osteopathic College of Australia Research Ltd and a member of Osteopathy Australia.</span></em></p><p class="fine-print"><em><span>Roger Mark Engel is an academic in the Department of Chiropractic, Faculty of Science Engineering at Macquarie University and an academic member of the Chiropractors Association of Australia, the Chiropractic and Osteopathic College of Australasia, Chiropractic Australia and Osteopathy Australia. </span></em></p><p class="fine-print"><em><span>Subramanyam R Vemulpad is an academic in the Department of Chiropractic, Faculty of Science Engineering at Macquarie University. </span></em></p>A recent series on low back pain by the global medical journal The Lancet shows doctors often overlook recommended treatments, such as advice to stay active and to exercise.Sandra Grace, Associate Professor in Osteopathy, Southern Cross UniversityRoger Mark Engel, Senior Lecturer, Department of Chiropractic, Macquarie UniversitySubramanyam R Vemulpad, Associate Professor, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/801382017-06-29T03:50:56Z2017-06-29T03:50:56ZThe yoga paradox: how yoga can cause pain and treat it<figure><img src="https://images.theconversation.com/files/175968/original/file-20170628-15714-5x6iec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Yoga moves like downward dog put strain on your hands, wrists, elbows and shoulders.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=SqZdRAsPESxkYRnkOqC1cQ-1-0">from www.shutterstock.com</a></span></figcaption></figure><p>Yoga carries with it a higher than expected risk of a painful wrist, elbow and shoulder, possibly due to poses like downward dog, new research suggests.</p>
<p>But it’s not all bad news. The same <a href="http://www.sciencedirect.com/science/article/pii/S1360859217301225">study</a> adds to growing evidence yoga can help manage low back and neck pain.</p>
<p>These findings highlight the complex relationship between yoga and musculoskeletal pain, the <a href="http://ard.bmj.com/content/73/6/949">second most common</a> cause of disability worldwide. </p>
<p>Our findings are not only important for people who do yoga or are thinking of taking it up, but also for yoga teachers and health care professionals who treat patients with musculoskeletal problems.</p>
<h2>What did we do?</h2>
<p>We surveyed 354 people who took at least one yoga class in the previous year in a yoga studio with two locations in suburban New York City. Participants were mainly women (95%) and were on average 45 years old. The studio offers classes in <a href="https://www.theguardian.com/lifeandstyle/2014/jan/10/yoga-beginners-guide-different-styles">Vinyasa-style yoga, Iyengar yoga</a> and prenatal yoga, among others.</p>
<p>Participants completed an online electronic questionnaire so we could assess their musculoskeletal pain at the start. We then contacted them again a year later to assess the effect of yoga on bone, joint and muscle pain in any body region. </p>
<p>At that point, we asked about the effect of yoga on their pain (whether they thought yoga had caused it, made it worse, had no effect, or made it better) and the intensity of pain. </p>
<p>When people reported yoga caused pain we asked them to tell us if they felt the pain during yoga class (and in what position), within an hour after yoga class or the next day.</p>
<h2>What did we find?</h2>
<p>Almost 87% of participants reported musculoskeletal pain within a year. Of those
who reported pain in at least one body region, most (66%) said yoga improved their bone, muscle and joint pain, particularly neck and back pain.</p>
<p>However, 21% said yoga made their pain worse and more than 10% said yoga had caused the pain particularly to the upper limbs (hand, wrist, elbow, shoulder). This was possibly due to poses, like downward dog, that need you to put weight on this part of the body. </p>
<p>A large number (44%) said yoga did not affect their pain. As participants were instructed to check all body regions where they had pain, some participants may have reported yoga helps in one region but causes pain in another region, so these numbers exceed 100%.</p>
<p>More than half of injuries were minor, while others resulted in time away from yoga (39%) or pain lasting for longer than three months (42%). People who had yoga-related musculoskeletal pain rated their pain between two and five (on a scale of zero to ten).</p>
<p>While we didn’t ask how these injuries came about, previous research suggests overexertion, inadequate instruction and poor technique <a href="http://iaytjournals.org/doi/abs/10.17761/ijyt.19.1.922087896t1h2180?code=iayt-site">increases the risk</a> of injury.</p>
<h2>How does this compare to other research?</h2>
<p>Our study, which shows yoga causes pain in 10% of people over a year, has much higher pain rates than other studies, which have previously reported levels of <a href="http://www.ijoy.org.in/article.asp?issn=0973-6131;year=2014;volume=7;issue=2;spage=152;epage=154;aulast=Holton">1%</a> and <a href="http://www.ijoy.org.in/article.asp?issn=0973-6131;year=2012;volume=5;issue=2;spage=92;epage=101;aulast=Penman">2.4%</a>.</p>
<p>One reason for our higher numbers could be because we followed up participants over one year, which provides a more accurate estimate than previous studies that assessed people at one point in time.</p>
<p>Yet our study has good news for people who do yoga as it backs a common belief that yoga can help with neck and back pain. Our study also confirms <a href="http://annals.org/aim/article/2633222/yoga-physical-therapy-education-chronic-low-back-pain-randomized-noninferiority">recent research</a> that shows the beneficial effects of yoga for chronic low back pain.</p>
<p>While our research goes part-way to investigating the complex relationship between yoga and pain, our sample was limited. So future research needs to look at yoga injuries among male and younger participants, which may be more typical of those who practice yoga in urban centres.</p>
<h2>So, what’s the take-home message?</h2>
<ul>
<li><p>People should practice yoga conscientiously and should be aware of the potential for injury. They should limit the time spent with weight on the arms (such as downward dog posture), especially if they had a previous injury</p></li>
<li><p>yoga teachers should inform participants about the potential for injury and encourage them to move out of positions that are uncomfortable or feel unsafe. They should communicate with physiotherapists to modify positions when participants are recovering from injury</p></li>
<li><p>patients should discuss with physiotherapists and doctors if they intend to practice yoga and assess the potential risks, benefits and modifications that may make yoga practice safer.</p></li>
</ul><img src="https://counter.theconversation.com/content/80138/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research shows yoga can improve back and neck pain, but can put strain on the body in some poses.Evangelos Pappas, Sr. Lecturer of Musculoskeletal Physiotherapy, University of SydneyMarc Campo, Professor, Physical Therapy, Mercy CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/628272016-07-24T20:03:49Z2016-07-24T20:03:49ZTeenage pain often dismissed as ‘growing pains’, but it can impact their lives<figure><img src="https://images.theconversation.com/files/131531/original/image-20160722-21037-qied6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Between a third and half of all adolescents aged 13 and over report back pain about every month or more often.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This is part of our series on kids’ health. Read the other articles in our series <a href="https://theconversation.com/au/topics/kids-health">here</a>.</em></p>
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<p>Most of us know someone who has “a bad back”. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25572198">Research</a> tells us up to 70% of people will experience back pain at some stage during their lives. But what about when a child or teenager complains of musculoskeletal pain such as back or neck pain?</p>
<p>The most common type of musculoskeletal pain is spinal (back or neck pain), and many more adolescents complain of pain than is commonly recognised. Between one-third and half of all adolescents aged 13 and over report <a href="http://www.scielo.br/pdf/rbfis/2016nahead/1413-3555-rbfis-bjpt-rbf20140149.pdf">back pain about every month or more often</a>. In fact, the prevalence of these conditions rises so sharply in early adolescence the rates approach adult levels by 18 years.</p>
<p>It’s becoming increasingly clear so-called non-specific “musculoskeletal conditions”, the leading causes of disability worldwide, are significant health issues in children. By non-specific conditions we mean pain that cannot be attributed to a defined and diagnosable anatomical cause. In adults, these conditions are recognised as complex disease states that have biological, psychological and socio-environmental underpinning.</p>
<h2>Aren’t they just growing pains?</h2>
<p>In the absence of an identifiable injury such as a sprain or fracture, we often disregard childhood and adolescent spinal and musculoskeletal pain. A common belief is that pain in kids will just go away or be forgotten when life takes over.</p>
<p>However, for a significant proportion of adolescents, non-specific pain has extensive impacts on health and quality of life. For example, in a study in <a href="http://www.ncbi.nlm.nih.gov/pubmed/22304903">Western Australia</a>, about 20% of 17-year-olds reported either missing school, seeking health care, taking medication, interference with normal activities, or interference with physical/sporting activities due to back pain. </p>
<p>Worryingly, there is <a href="http://www.ncbi.nlm.nih.gov/pubmed/16481960">evidence</a> persistent pain symptoms in adolescence predict chronic pain problems in adulthood.</p>
<p>The blame for pain in kids is often directed at school bags, computer and small-screen device usage, posture, or other biomechanical targets. It is also sometimes believed (permanent) damage is being done to the spine, with lifelong consequences. </p>
<p>However, there is little evidence this is true. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22078064">Studies</a> show socioeconomic, lifestyle, cognitive and psychological factors are just as strongly, or even more strongly, related to pain, particularly chronic pain, as physical factors. </p>
<p>These societal beliefs about physical causes of pain may be not only incorrect, but detrimental if they cause worry about the spine being fragile and discourage children from physical activity.</p>
<h2>Back pain and health</h2>
<p>Health issues such as excess weight and obesity, diabetes, substance use and poor mental health among children are causes for concern, and the targets of national public health campaigns. </p>
<p>Recent <a href="http://www.scielo.br/pdf/rbfis/2016nahead/1413-3555-rbfis-bjpt-rbf20140149.pdf">evidence</a> has shown these general risk factors for poor health and chronic disease cluster in children with spinal pain. At this point, it is not possible to say whether pain precedes poorer general health or vice-versa. Relationships between them are likely to be complex. </p>
<p>However, given the high rates of musculoskeletal pain across the population, and in particular in kids with other health risks, a case can be made for considering the influence of pain in the effectiveness of lifestyle-related public health campaigns. For instance, pain could be an important barrier to participation in physical activity. </p>
<p>Addressing health behavioural risk factors, such as inactivity, weight gain, diet and even substance use, when treating young patients with pain is likely to be important. This will be important whether these behavioural risks are (partially) responsible for the pain itself or develop in response to painful symptoms.</p>
<p>Unfortunately, to date we don’t really understand the complex interaction between painful events, the growing body and broader health influences, and other social or environmental influences from family, health care providers and schooling. In particular, we know very little about what brings on the initial episodes of painful conditions and whether this underpins the link with future chronic pain.</p>
<p>Given wide recognition that early life events are critical in shaping health as people grow older, understanding the context of common painful conditions in early life is critical to inform future health.</p>
<h2>Overdiagnosis and overtreatment</h2>
<p>It is important we provide effective treatment to those at risk of developing persistent pain. It is also important we don’t create medical problems out of transient aches and pains. We definitely don’t want to be sending every child who complains of back or neck pain off for diagnostic tests and intensive treatments. A problem currently is we don’t have sufficient quality evidence to enable us to decide who we should be concerned about, and who can be reassured and sent on their way.</p>
<p>While we don’t have good evidence about what specific treatments are effective for childhood and adolescent spinal pain, it is possible to engage the community in better conversation about what causes “non-specific” musculoskeletal conditions.</p>
<p>The role of social influences needs closer examination, and pain must be considered within the broader context of chronic disease and long-term health risk factors. A shift away from the narrow and outdated focus on school bags, posture and damaged spines is a must. Efforts to update the narrative around pain are as important for children as for adults.</p>
<hr>
<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p>
<p><em><a href="https://theconversation.com/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal-60257">Nightmares and night terrors in kids: when do they stop being normal?</a></em></p>
<p><a href="https://theconversation.com/bed-wetting-in-older-children-and-young-adults-is-common-and-treatable-60248"><em>Bed-wetting in older children and young adults is common and treatable</em></a></p>
<p><a href="https://theconversation.com/migraines-in-childhood-and-adolescence-more-than-just-a-headache-60712"><em>Migraines in childhood and adolescence: more than just a headache</em></a></p>
<p><a href="https://theconversation.com/drafts/61902/edit"><em>‘Slapped cheek’ syndrome: a common rash in kids, more sinister in pregnant women</em></a></p><img src="https://counter.theconversation.com/content/62827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Williams receives funding from National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Steve Kamper receives research funding from the National Health and Medical Research Council of Australia</span></em></p>The blame for pain in kids is often directed at school bags, computer and small-screen device usage, posture, or other biomechanical targets.Christopher Williams, Research Fellow at Hunter Medical Research Institute, Hunter New England Local Health District, University of NewcastleSteve Kamper, Senior Research Fellow, Musculoskeletal Division, The George Institute for Global Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/496662015-11-22T19:07:30Z2015-11-22T19:07:30ZPain drain: the economic and social costs of chronic pain<figure><img src="https://images.theconversation.com/files/101674/original/image-20151112-9366-osbarc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Chronic pain is a complex health issue.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Chronic pain is a complex health issue. While the person suffers the disabling symptoms, its burden extends to the whole of society. In Australia, the burden of <a href="http://www.arthritisvic.org.au/Useful-Information/About-Us/Publications/Budget-Submission-2014/Pre-Budget-submission-December-2013-FINAL.aspx">musculoskeletal conditions</a> – the most common reason for chronic pain – exceeds that of all other chronic conditions.</p>
<p>The <a href="http://www.arthritisvic.org.au/Research/AOV-Funded-Research/Completed/A-Problem-Worth-Solving/APWS.aspx">cost of these conditions</a> to the Australian economy in 2012 was more than $A55 billion. Back pain and osteoarthritis, the most common of musculoskeletal conditions, accounted for 52% and 41% of cost respectively.</p>
<p>Pain management is one of the most neglected aspects of health care; our failure to adequately address chronic pain is a major driver of its economic and social burden.</p>
<h2>Pain drain</h2>
<p>Low back pain and osteoarthritis are among the leading causes of disability worldwide. In 2010, they represented more than 100 million years of productive life lost due to disability. </p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/23245607">Global Burden of Disease Study</a> ranked low back pain higher than any other condition, including major depression, diabetes and heart disease, on this measure.</p>
<p>In Australia, <a href="http://www.arthritisvic.org.au/Research/PDFs/PLS/APWS-PLS.aspx">there were an estimated</a> 6.1 million cases of arthritis (26.9% of the population) and other musculoskeletal conditions in 2012. These numbers are expected to rise substantially as the population ages. By 2032, the number of cases is estimated to increase by 43%, to 8.7 million (30.2% of the population).</p>
<p>The $A55 billion cost to the economy can be broken down into direct and indirect costs. </p>
<p>Direct costs are described as the “cost of care”. This includes tests and treatments such as X-rays, medications and physical therapy. Around 17% (more than $A9 billion) of total costs goes <a href="http://www.arthritisvic.org.au/Research/PDFs/PLS/APWS-PLS.aspx">directly towards care</a> of musculoskeletal pain. </p>
<p>Indirect costs include lost income, reduced work productivity or participation, and the impact on Gross Domestic Product (GDP). The indirect costs of musculoskeletal pain were around $A20 billion in 2012. More than $A7 billion of these were due to productivity losses alone. </p>
<p>Indirect costs also includes those derived from loss of health or quality of life. For musculoskeletal pain, this cost is a profound $A34 billion per year.</p>
<h2>Chronic neglect</h2>
<p>The burden of chronic health is largely a result of its neglect by the health care system. Many patients miss out on critical aspects of care from an early point in their condition. </p>
<p>In 2010, <a href="http://www.ncbi.nlm.nih.gov/pubmed/20142573">we found</a> that only around 20% of patients with low back pain received the care universally recommended by clinical practice guidelines in Australia and internationally. </p>
<p>The data, which spanned eight years, showed doctors’ consistent failure to provide simple and recommended treatments, such as advice about how to manage pain and reassurance about its nature. Instead, patients were more commonly given inappropriate tests and medications – which are <a href="http://www.australianprescriber.com/magazine/34/5/128/32">discouraged by guidelines</a>.</p>
<p>As a recent <a href="http://www.abc.net.au/4corners/stories/2015/09/28/4318883.htm">ABC Four Corners program</a> pointed out, overusing such tests and ineffective treatments are a major source of avoidable cost. </p>
<p>Our continued observation that most patients miss out on critical treatment may have a far greater economic impact in indirect costs than is generally understood.</p>
<p>Chronic pain is currently conceptualised within a <a href="http://www.ncbi.nlm.nih.gov/pubmed/17592957">bio-psychosocial model</a>. This means its experience is influenced by physical, psychological (mood and beliefs) and social (relationships, environment and culture) factors. </p>
<p>Unfortunately, it’s estimated <a href="http://www.painaustralia.org.au/images/pain_australia/NPS/National%20Pain%20Strategy%202011.pdf">less than 10% of patients</a> with chronic pain receive coordinated multidisciplinary care (involving a team of specialists, which could include a physiotherapist, neurologist and psychologist) to target the multiple drivers of pain. </p>
<p>In our yet-to-be-published research, we found that up to 80% of patients referred for back, neck, hip, knee, or hand pain surgery hadn’t trialled other effective treatments such as multidisciplinary care; or even single modes of care such as exercise or weight loss.</p>
<p>As a consequence, many patients in this category develop multiple risk factors for other chronic disease, such as weight gain and declining activity. These conditions likely contribute much more to the currently recognised social and economic costs.</p>
<h2>Addressing the problem</h2>
<p>Health policy has long focused on the concept of <a href="http://www.federalfinancialrelations.gov.au/content/npa/healthcare/national-agreement.pdf">integrated care</a> – meaning the involvement of multiple health services for comprehensive care of complex chronic conditions. But, in practice, pain has largely been left out of the mix.</p>
<p>Various organisations have advocated for better policy and funding to address the burden of chronic pain. In its <a href="http://www.painaustralia.org.au/images/pain_australia/NPS/National%20Pain%20Strategy%202011.pdf">National Pain Strategy</a>, Pain Australia recommends better identification of patients at risk of developing chronic pain and providing early access to multidisciplinary care. </p>
<p>Arguably, a more widespread preventive approach would be beneficial. <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Musculoskeletal+pain+on+the+global+stage%3A+what+next%3F">Other organisations</a> have justifiably called for a common risk factor approach to address generic factors associated with chronic pain and other chronic disease. Such factors include being overweight, inactivity, alcohol misuse, poor diet and smoking.</p>
<p>Unfortunately, federal and state governments are yet to adopt a national policy for preventing and dealing with chronic pain. Moreover, the policy landscape remains fragmented by state, region, hospital and health network priorities.</p>
<p>If we are to adopt such a policy, we must also focus efforts on developing strategies to support its local implementation. We have seen time and again the failure of policy alone to make an impact on real health, even when such policy is mandated by government.</p>
<p>For pain, it is no different. Without the crucial step of an implementation plan and importantly, action, the health care system will continue to produce poor patient outcomes with significant economic impact. </p>
<hr>
<p><em>This article is part of a series focusing on Pain. Read other articles in the series <a href="https://theconversation.com/au/topics/pain-series">here</a>.</em></p><img src="https://counter.theconversation.com/content/49666/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Williams receives funding from NHMRC. </span></em></p>Pain management is one of the most neglected aspects of health care; our failure to adequately address chronic pain is a major driver of its economic and social burden.Christopher Williams, Research Fellow at Hunter Medical Research Institute, Hunter New England Local Health District, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/21122011-08-30T20:39:38Z2011-08-30T20:39:38ZPause… stem cell therapy dogged by insufficient research<figure><img src="https://images.theconversation.com/files/3188/original/540794034_3223f10a43_o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We aren't quite in the place to say stem cell therapy can treat osteoarthritis and related conditions, in dogs or humans.</span> <span class="attribution"><span class="source">TheGiantVermin/Flickr</span></span></figcaption></figure><p>A recent <a href="http://www.heraldsun.com.au/news/more-news/crippled-dogs-can-run-away-thanks-to-stem-cell-trials/story-fn7x8me2-1226083781584">article published in the Herald Sun newspaper</a> reported anecdotal evidence of animals almost crippled from arthritis or joint damage recovering their function after stem cell therapy.</p>
<p>Although the article refers to treatments for animals, a range of stem cell types are currently being evaluated for their regenerative capacity in a variety of potential clinical applications – in both human and animal studies. </p>
<p>But promises of instantaneous or miraculous cures must be viewed with caution until results can be verified by properly conducted preclinical and clinical trials, the results of which can be appropriately scrutinized.</p>
<h2>Types of stem cells</h2>
<p>Stem cells encompass a wide variety of cell types, including embryonic and post-natal (adult) blood and tissue-derived cells. They are characterised by their different biological properties. </p>
<p>Cells that are likely to have an impact in orthopaedic (musculoskeletal) applications are those with the capacity to differentiate into tissues such as bone or cartilage and/or are able to secrete factors that promote tissue repair and regeneration. </p>
<p>Laboratory studies have shown that some stem cell types possess anti-inflammatory properties and/or dampen immune responses, both of which could be responsible for the initial successes noted in the article above. </p>
<p>These combined characteristics, together with their regenerative capacity, make stem cells prime candidates for advancing current treatments in a range of clinical applications, including those related to orthopaedic damage or disease.</p>
<p>The stem cells in the newspaper article were taken from patients or young healthy donors and multiplied millions of times before being injected into inflamed joints. </p>
<p>This process of using stem cells from a donor of the same species is called allogenic transplantation, while re-administration of the patient’s own stem cells is called autologous transplantation. </p>
<p>Only some specific stem cell types can be used allogeneically (administered to a foreign recipient) because of the potential for rejection of some foreign stem cell types by the recipient’s immune system.</p>
<h2>Developing treatments</h2>
<p>The treatments mentioned in the newspaper article are being conducted under the direction of a highly respected immunologist who is the Director of the Monash Immunology and Stem Cell Laboratories at Monash University. </p>
<p>Hopefully the anecdotal results reported in the article will be verified by carefully conducted preclinical trials in animals that can inform potential similar trials in humans in the future.</p>
<p>Such preclinical trials on treatment of acute and chronic or degenerative musculoskeletal conditions are already being undertaken in Australia and internationally, predominantly through the publicly listed Australian biopharmaceutical company <a href="http://www.mesoblast.com/">Mesoblast</a>. </p>
<p>Mesoblast is the world’s leading developer of innovative biological products in the field of regenerative medicine, using adult-derived stem cells known as mesenchymal precursor cells. </p>
<p>These cells are a sub-population of adult mesenchymal stem cells that can be isolated from bone marrow and adipose (fat) tissue. </p>
<h2>Relief at hand?</h2>
<p>Osteoarthritis is the most common musculoskeletal disorder in animals and humans. It has been defined as a group of conditions that lead to joint symptoms of pain and disability together with radiological evidence of loss of articular cartilage (the smooth white tissue that covers the ends of bones where they come together to form joints). </p>
<p>Pathologically, the disease is characterised by extensive degradation of articular cartilage, largely in areas of high contact loading such as knee joints.</p>
<p>The therapeutic options for its management are limited with current treatments mainly relying on analgesics, corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs). So new types of treatment, such as use of specific stem cell types, are currently the subject of intensive research. </p>
<p>The claims that treatment of osteoarthritis can potentially be “cured” and that “stunning improvements occur in less than a week” remain unverified. </p>
<p>Initial improvements following cell-based therapies may be due to the anti-inflammatory properties of the injected cells. In this instance, it’s likely the improvements reported in the article are due to the acknowledged anti-inflammatory properties of the, presumably, mesenchymal stem cells that were injected.</p>
<p>But in assessing the potential of stem cell treatments for osteoarthritis sufferers, it’s important not to give premature hope through hyperbole by presenting results from preliminary observations that haven’t yet been properly verified by appropriately conducted peer-reviewed trials. </p>
<p>Damaged cartilage, particularly articular cartilage, can take weeks or months to heal after treatment. So a “cure” would be expected to take much longer than weeks and hasn’t yet be scientifically verified. </p>
<p>Since the preferred differentiation pathway for mesenchymal stem cells is to form bone, it’s necessary for such cells to be placed in an effective cartilage-forming (chondrogenic) environment before they can initiate repair in diseases such as osteoarthritis. Preliminary results are promising since <a href="http://www.ncbi.nlm.nih.gov/pubmed/20167057">such cells are capable of forming articular cartilage when cultured in the laboratory</a>.</p>
<p>So although the verdict is out on the long-term efficacy of cell-based therapeutic treatments for osteoarthritis and related conditions, such treatment offers the promise of a potential cure for these debilitating diseases in the future.</p><img src="https://counter.theconversation.com/content/2112/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Graham Jenkin receives funding from NHMRC Grants and from Sponsored Research Agreement Grants from Mesoblast Ltd . He is affiliated with Monash University.</span></em></p>A recent article published in the Herald Sun newspaper reported anecdotal evidence of animals almost crippled from arthritis or joint damage recovering their function after stem cell therapy. Although…Graham Jenkin, Deputy Director, The Ritchie Centre, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.