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admin | Category: Electile Dysfunction 2016 | 08.06.2015
The medical literature supports the use of massage for relief of osteoarthritis symptoms, but therapist-administered treatments can be cost-prohibitive. Osteoarthritis (OA) is a chronic condition of the joints characterized by symptoms related to the wearing away of the protective cartilage; those symptoms include pain, stiffness, inflammation, and functional limitations affecting self-care activities. Among the various possible physiological reasons and risk factors for OA, recent research has investigated the causative role of the quadriceps muscle. The reported benefits of massage include breaking the pain cycle, improving function, reducing edema, promoting relaxation, and facilitating healing in various medical conditions.8 However, in a 2009 Cochrane review, Furlan et al9 concluded massage is bene­ficial for relief of patients’ pain and function in subacute and chronic nonspecific low back pain.
In 2012 Perlman et al published a report on the optimal dose of massage among patients with knee OA for improving pain and functionalty.10 Although the study’s evidence suggested weekly 60-minute massage was optimal, the continued use of therapist-administered massage as a regular treatment in the management of this chronic disease can be cost-prohibitive.
This study was conducted with the required inclusion and exclusion criteria, recruitment method, Institutional Review Board approval, and randomization. We randomly assigned 40 participants with diagnosed knee OA with moderate symptoms to an intervention group (n = 21) or a “wait-list” control group (n = 19), which continued their regular care during the study and received the self-massage intervention after its end. For eight weeks, the intervention group received supervised biweekly therapy in a group setting, which involved 20 minutes of self-massage applied over the quadriceps muscle while seated on a chair. The WOMAC instrument is an established, reliable, and validated, disease-specific, 24-question, self-administered questionnaire.
The same type of analysis was also used to assess differences between control and intervention groups after controlling for preexisting factors.
The pain subscale post-treatment score outcomes showed significant differences between control and intervention groups for walking on a flat surface, ascending or descending stairs, at night while in bed, sitting or lying, and standing up (Table 1, Figure 1).
The results also showed significant differences between groups for post-treatment score physical function, including highly significant results for descending stairs, ascending stairs, rising from sitting, getting in and out of bed, going shopping, putting on socks, rising from bed, lying in bed, getting on and off the toilet, and light domestic duties (Table 1, Figure 3). Similarly, in the current study, the last four weeks of at-home unsupervised self-massage continued to generate an average decline in pain and stiffness, which may also demonstrate the benefits of multiple dosing.
Self-massage research is in its early stages, and there is little research to support its therapeutic value, though two studies on the benefit of massage for hand arthritis19 and carpal tunnel syndrome20 have incorporated the use of self-massage. Even though its exact mechanism of action is unknown, our findings indicate self-massage applied to the quadriceps muscle resulted in significant WOMAC improvements in knee pain, stiffness, and physical function.
This on-demand, natural, economical self-help therapy should be examined in future massage therapy research. Download this FREE eBook to see how foot pressure data contributes to more efficient treatment and better outcomes.
March 24, 2014 By Kim A year in reflection – My minimally invasive  bi-lateral percutaneous sacroiliac joint fixation without fusion is still a miracle!  Sacroiliac (SI) Dysfunction, Instability and Pain are gone.
On the anniversary date 1-17-14, I was not up to writing about my SI post surgical status at that moment because I was between the two HyProCure Surgeries on my feet.  I was having a temporary issue going on in the soft tissue over my right SI Joint, specifically  the Posterior Sacroiliac Ligament.
Now as I write this blog after doing my right foot HyProCure Surgery, my right foot arch Navicular bone is not dropping any more.
For further insight or just a listening ear, I’m available to help any patient seeking information on the subjects contained herein on my website.
Sacroiliac joint dysfunction or incompetence generally refers to pain in the sacroiliac joint region that is caused by abnormal motion in the sacroiliac joint, either too much motion or too little motion.
Once termed the great masquerader for its clinical similarity to several other important systemic diseases (eg, polyarteritis nodosa), cholesterol embolism syndrome is often misdiagnosed. Livedo is the most common dermatologic manifestation of cholesterol embolism, comprising 50-74% of cholesterol embolisma€“related skin lesions.[8] This blue-red mottling of the skin in a netlike pattern usually affects the feet, the legs, the buttocks, and the thighs, but can extend to the trunk and the upper extremities. The lower extremities show well-developed livedo reticularis and focal areas of erosion and ulceration. Occurring in 28% of patients, this is a characteristic blue-black or violaceous discoloration of the distal extremities. Symmetric involvement of the feet with livedo reticularis on the plantar surface of the forefoot and cyanosis of the left fifth toe.
Dorsal surface of the toes of the right foot of a patient with discoloration resulting from petechiae. This occurs in 17-39% of patients[8] and is typically unilateral and located on the toes and the feet. Small, pinpoint, purpuric spots, petechiae do not blanch on diascopy and may appear in individuals with cholesterol embolism.
This has been reported with cholesterol embolism, reflecting a distal aortic or iliofemoral source. Receiving 20-25% of the cardiac output, and distal to the abdominal aorta, renal involvement is common.
Acute renal failure is common in cholesterol embolism, and one study estimated it to account for 5-10% of all cases of acute renal failure.
Risk factors for renal insufficiency are the presence of heart failure, lower limb or GI tract involvement, and age older than 70 years.
Visualization of cholesterol crystal clefts in a renal biopsy specimen is pathognomonic for cholesterol embolism. Of patients with GI involvement, 10-30% have hemorrhage, which was found to be the cause of death in at least 1% of patients with fatal cholesterol embolism.
Retinal cholesterol crystals (Hollenhorst plaques) are bright-yellow, glittering intravascular plaques situated at the bifurcation of the narrow arterioles of the retina. Development of rhabdomyolysis after cholesterol embolism is uncommon; however, reports describe this disastrous complication, underscored by Sarwar's[15] report of a patient with extensive myonecrosis and compartment syndrome which led to bilateral below-the-knee amputations. CNS cholesterol embolism may occur after vascular procedures such as carotid angiography or endarterectomy. Alveolar hemorrhage, presumably resulting from cholesterol embolism, has been rarely reported. Postmortem examination of adrenal glands has demonstrated cholesterol embolism.[8] One study reported the presumed death of a patient with visceral cholesterol embolism resulting from necrosis of the adrenals.
Reuter et al reported a case of spontaneous cholesterol crystal embolization to the bone marrow in a 77-year-old woman with fever, mild anemia, and leukocytosis.[18] Bone marrow biopsy revealed an absence of abnormality, with the exception of the presence of cholesterol crystals. Cholesterol embolism may occur spontaneously in patients with atherosclerosis, but a trigger is usually required for full expression of cholesterol embolism syndrome. A history of antecedent therapy with anticoagulants is present in approximately 30-35% of patients.[21, 22, 23] These therapies are thought to predispose to cholesterol embolism by 2 distinct mechanisms. Various surgical or radiologic vascular procedures precede cholesterol embolism in nearly 65% of patients.[24] The introduction of a foreign object into the vessel may cause intimal trauma, exposing the underlying cholesterol-rich matrix to the arterial circulation. An Italian study of 354 patients demonstrated the most common precipitating factor to be coronary angiography via the femoral artery.
Additional risk factors for developing cholesterol embolism after cardiac catheterization include hypertension, a history of smoking, and elevated preprocedural C-reactive protein levels. Although most reports of cholesterol embolism are noted to occur with endovascular procedures involving the large vessels, it is important for the clinician to be aware that this complication may occur after manipulation of any vascular bed. This includes cardiopulmonary resuscitation or sudden deceleration injury, and it may also result in cholesterol embolism. Cholesterol embolism is a destructive disease, and even patients who survive the initial insult may have damaging consequences that preclude return to baseline functioning levels. The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Edwin Rhim, MD, and Heather D. A 76-year-old man with a history of aortobifemoral bypass graft developed this eruption after an angiographic procedure.
Aorta with an ulcerated plaque (black arrowhead) on the luminal side photographed under water to enhance reflection of cholesterol crystals (white arrowhead).
Low-power view of a skin biopsy specimen demonstrating an arteriole within the subcutaneous fat occluded with thrombus material that contains (black arrowhead) needle-shaped cholesterol clefts (hematoxylin and eosin stain, original magnification X40). High-power view of occluded vessel (hematoxylin and eosin stain, original magnification X100). CT scan of an infrarenal abdominal aortic aneurysm showing the mural thrombosis (white arrowhead) and the bright atherosclerotic calcifications (black arrowhead).
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All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. The two main indications for abdominal Manual Lymphatic Drainage (MLD) are to manage chronic abdominal conditions and diseases as well as serve as gateway for the lymphatic collectors of the lower extremity. Similar to the upper extremity, the main indication for MLD treatment in the lower extremity is swelling (edema) in the legs or feet primary in the distal sections from post trauma or edema as a result of surgical interventions. Assuming abdominal MLD therapy is appropriate, the MLD therapist starts with the neck as all the lymphatic collectors in these areas empty into the supraclavicular fossa. During inhalation, the MLD therapist will position their hands over the center of the abdomen.
The abdomen is treated (either through MLD or slow abdominal breathing) prior to treating the lower extremity. Once the anterior side of both legs has been treated, move the client into the prone position.
Treatment of the gluteal area working from the intersection of the sagittal and transverse watersheds towards the inguinal lymph nodes. We are so committed to being number one in customer satisfaction that we promise to meet or exceed your expectations — or the next massage is on us. The Elements Promise™ is not transferable and may not be redeemed for cash, bartered or sold. This study found that self-massage can also be effective, even when the initial supervised sessions are continued by patients at home. Although OA may occur in any joint, it most often develops in weight-bearing joints, especially the knees, hips, or spine, with symptoms ranging from minor pain to debilitation. This group received supervised self-massage instruction narrated by a trained massage therapist (for details and self-massage protocol, consult the related publication by Atkins and Eichler12). It assesses the perceived measurement of three subscales: pain, stiffness, and physical functioning of knee and hip OA.
The post-treatment differences between control and intervention groups were statistically significant. For the stiffness subscale, significant post-treatment score differences between groups were observed for first waking in the morning and lying, sitting, or resting later in the day (Table 1, Figure 2). WOMAC total mean score after 12 weeks was significantly better for the treatment group than the control group (Table 1, Figure 4). The observed improvements are most likely attributed to the self-massage intervention, given the absence of improvement in the control group. This is the first randomized controlled trial to examine the effects of a self-massage protocol applied to the quadriceps muscle on adults with knee OA. A 37-study meta-analysis on the effects of massage therapy yielded a number of theories, including one related to the effects of multiple doses.
Future studies should compare self-massage with an active intervention, such as full-body massage, to reveal potential placebo effects.
Teaching older adults the self-massage intervention successfully requires repetition and sufficient time for them to learn and retain new information. The 4.3 million people in the US with knee OA may benefit from this model as an option for self-managing arthritic knee symptoms. More effective symptom-focused arthritis self-care has the potential to improve quality of life for the ever-growing number of persons living with any form of arthritis. Atkins, ThD, RN, is chief executive officer and founder of Holos Touch LLC, in Audubon, NJ, a resource for self-management of pain.
Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months’ follow-up. The transformation and the excellent results I’ve had from this surgery has been praised by my Dr.
What I mean is that I faced  3 more surgeries and one more in the making as I post this blog update.
I was having an increased anterior drop of my right pelvis due to the excessive pronation of my right foot and instability of my right proximal tib-fib joint. As a result I have less torque and tension in my pelvis and over my Posterior Sacroiliac Ligament.   During the last two months while attending physical therapy for my feet, Joanna my therapist at Peak Performance would use Dynamic Tape over my SI Joints to support the tissue.
If custom orthotics have not helped your feet and stability, then please seek out a foot doctor trained in the HyProCure Surgery such as my Dr. To avoid wondering when I post again, please just subscribe to this blog (form in the below footer) to receive automatic updates whenever I post a blog story about my medical and spiritual journey. The information on this website is not intended to replace the advice or care from a healthcare provider. Patrick Soto-Northwest Medical Rehabilitation, Spokane, WAKim -- "Amazing journey you have had. Thus, a high suspicion is needed, especially in patients with suspected atherosclerotic disease and specific precipitating events.
The presence of livedo reticularis may be noted only while the patient is standing; therefore, examining patients in both the supine position and the standing position is imperative when possible. In cholesterol embolism, it may develop within patches of acrocyanosis or livedo reticularis. The distal half of the great toe is gangrenous, with a sharp demarcation between the necrotic tissue and the normal proximal skin. They can appear on the legs, thighs, toes, or feet as a result of an inflammatory reaction surrounding cholesterol crystals. The lesions resemble those of vasculitis, but, quite unlike other features in cholesterol embolism, purpura typically spares the toes.
These include constitutional symptoms, such as fever and weight loss, as well as those described below. While the skin has an extensive network of collateral circulation, the blood supply to the renal cortex consists of predominantly end-arterioles.
Acute rise in pressure may result from obstruction of vasculature by crystals or high circulating plasma renin and angiotensin levels in the setting of renal damage. Loss of glomerular function in cholesterol embolism is a progressive process, occurring over 4-6 weeks.
The crystals embolize in the arcuate and interlobular arteries of the kidneys, producing an acute inflammatory reaction with endothelial proliferation and occlusion of the lumen, leading to infarction and the formation of a wedge-shaped scar in the kidney. Pulses are purported to be present in cholesterol embolism, even in patients at risk for peripheral vascular disease, because emboli and microthrombi travel to the most distal, small vessels, sparing the dorsal pedalis and posterior tibial arcades.
Unfortunately, GI symptoms may be nonspecific and, thus, are often misattributed to other conditions. Jucgla et al[8] noted that all patients with GI manifestations in their study had concomitant renal involvement.
These are often readily apparent on funduscopic examination and are refractile on fluorescein angiography. Involvement of lower extremity muscles with upper limb sparing is characteristic in cholesterol embolism. The most frequent sources of emboli are the carotid arteries, the thoracic aorta, or the aortic trunk. One patient with severe atherosclerosis was noted to develop hemoptysis, renal failure, and purpura after vascular surgery.
First, anticoagulation and thrombolytics strip away the protective layer of fibrin isolating the subintimal deposits of cholesterol from the bloodstream.
Predictors of renal and patient outcomes in atheroembolic renal disease: a prospective study. The importance of skin biopsy in the diverse clinical manifestations of cholesterol embolism. The challenge of diagnosing atheroembolic renal disease: clinical features and prognostic factors. Catastrophic cholesterol crystal embolization after endovascular stent placement for peripheral vascular disease. Deterioration of vascular dementia caused by recurrent multiple small emboli from thoracic aortic atheroma. Cholesterol embolism of bone marrow clinically masquerading as systemic or metastatic tumor. Acute renal failure, hypertension and skin necrosis in a patient with streptokinase therapy.
The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. Early human atherosclerosis: accumulation of lipid and proteoglycans in intimal thickenings followed by macrophage infiltration. Successful use of heparin and warfarin in the treatment of cholesterol crystal embolization. Cholesterol crystal embolization (CCE) after cardiac catheterization: a case report and a review of 36 cases in the Japanese literature.
Cholesterol crystal embolization (CCE): Improvement of renal function with high-dose corticosteroid treatment.
Pain relief and clinical improvement temporally related to the use of pentoxifylline in a patient with documented cholesterol emboli--a case report. The role of aortic stent grafting in the treatment of atheromatous embolization syndrome: results after a mean of 15 months follow-up.
Renal angioplasty and stenting with distal protection of the main renal artery in ischemic nephropathy: early experience.


Outflow protection filters during percutaneous recanalization of lower extremities' arterial occlusions: a pilot study. This image shows the plantar surface of the right foot with some of the discoloration resulting from petechiae arranged in a reticulated pattern. Topics are richly illustrated with more than 40,000 clinical photos, videos, diagrams, and radiographic images.
The articles assist in the understanding of the anatomy involved in treating specific conditions and performing procedures. Check mild interactions to serious contraindications for up to 30 drugs, herbals, and supplements at a time. Plus, more than 600 drug monographs in our drug reference include integrated dosing calculators. This is the area where the lymphatic vessels and nodes are located inferior to the transverse umbilicus watershed.
Other areas of lymphoid tissue in the abdomen are peyer’s patch as well as several collections of lymph nodes along the small and large intestines and along the along the deeper layer of the lumbar trunk collectors. Depending on the cause of the edema, treatment options include RICE (rest, ice, elevation, and compression), MLD, and compression stockings.
The superficial layer includes peyer’s patch and the lymph vessels that line the large and small intestines.
The pressure is directed toward the center of the abdomen where the cisterna chyli is located.
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During the final four weeks, participants did the same protocol twice a week at home, unsupervised. Between-group analysis of covariance (ANCOVA) was used to assess the differences between control and intervention groups for the post-treatment outcome measures of pain, stiffness, function, and total mean WOMAC scores.
The underlying mechanism explaining the beneficial effects of massage on joint pain and mobility are unclear. Individuals’ health, disease, and any disability can also affect their learning.21 Previously, we conducted a small eight-week knee self-massage pilot study that included only four weeks of in-class supervision and four weeks of unsupervised self-massage. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Massage for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Validation study of WOMAC: a health status instrument of measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.
Massage reduces pain perception and hyperalgesia in experimental muscle pain: a randomized, controlled trial.
I faced a total of 16 weeks of non-weight bearing off of my left leg and a week off of my right leg with those surgeries during this past year.
This drop was more exaggerated as I increased walking during the 4th week post op recovery from my  11-15-13 left foot HyProCure Surgery.  I was fine with physical therapy but excessive walking would aggravate it. Gent-Kitsap Foot and Ankle Clinic which added a piece to my puzzle in helping even more with my low back torsion. Even with all this going on, I still am 100% better than before my SI Surgery as far as sitting and doing office work.
Gent as they understand the far reaching benefits of this surgery in helping the alignment of your entire body.
Chronic subluxation and the fibula bone being stuck out of neutral position causes pain down the leg and into the ankle which does affect your walking and all the soft tissue that connects to this bone both proximally and distally; however like my case, this did not show up on any diagnostic imaging.
In a person older than 50 years, the classic triad of excruciating lower extremity pain, livedo reticularis, and palpable peripheral pulses should be considered cholesterol embolization until proven otherwise. Gangrene is often confined to the toes (bilaterally in 50% of patients), and rarely it involves the scrotal area. Livedo reticularis is present on the distal plantar forefoot, and petechiae are present on the distal pad of the second and fourth toes.
Blue toe syndrome, a term coined by Karmody et al,[11] refers to acute digital ischemia caused by microembolism from the distal aorta, iliac artery, or femoral artery. Isolated case reports describe cholesterol clefts in solitary lesions in unusual locations (eg, a nodule on an ear, red nodules on the chest) with microscopic findings of hemorrhagic panniculitis.
Therefore, embolic events in the kidneys often result in an irreversible loss of glomerular function. Renin is released by the juxtaglomerular cells of the afferent arterioles in response to decreased blood flow, often due to obstruction from cholesterol plaques. It results from periodic showering of emboli and causes renal insufficiency in approximately 30-50% of patients. Indeed, patients with bowel disease frequently have concurrent evidence of embolism to other sites, including the spleen (57%), the liver (15%), and the gallbladder (8%). Patients may be asymptomatic, with microvascular disease occurring distal to the macula, or they may report monocular amaurosis fugax (transient blindness). Case reports have described delirium and dementia attributable to cholesterol embolism.[16] Case reports also describe spinal cord infarction following cholesterol embolism, as well as other symptoms resulting from anterior spinal artery involvement. Another case report documented pulmonary-renal syndrome in a patient with hemoptysis, respiratory distress, and radiographic alveolar shadowing.[17] Although pulmonary symptoms have been considered rare in the past, Jucgla et al[8] reported 57% of patients developed pulmonary edema secondary to cardiac failure. With novel intravascular techniques becoming more common in medical practice, the risk of disease may be increasing. Customize your Medscape account with the health plans you accept, so that the information you need is saved and ready every time you look up a drug on our site or in the Medscape app. The lumbar trunk collectors receive, process and transport all the lymph fluid from the lower extremities. The deeper layer contains the cisterna chyli, the lumbar trunks and the thoracic duct which returns all the lymph fluid collected back into the circulatory system. Substitute massage session equal in value and duration to original massage session; gratuity not included.
However, it seems logical that if massage may increase circulation14 and decrease muscle tension and pain15 then massage of a dysfunctional quadriceps muscle may, in theory, also reduce muscle and joint pain, thus improving mobility. That intervention produced less pronounced effects on pain, stiffness, and function than we had an­ticipated. Eichler, PhD, is professor at Holos University in Bolivar, MO, and educational and behavioral consultant at Project STAY, a multidisciplinary technical assistance team in northeast Kansas.
He will now recommend this surgery to his other patients that suffer with Sacroiliac Joint Dysfunction that has failed to resolve with conservative measures. Without the screws holding my SI Joints in complete neutral, I would have never tolerated standing and weight bearing on one leg only. A delay of as long as 2-6 weeks may occur between precipitating events and the onset of renal dysfunction.
Easily compare tier status for drugs in the same class when considering an alternative drug for your patient. All the lymph vessels in the abdomen meet at the cisterna chyli which then empties into the right thoracic duct. As a result, we revised our study design to include eight weeks of instruction, which produced significant improvements. Now that I finally have a normal left leg with all 3 joints (left SI, left proximal tib-fib and left subtalar joint)  being secured in neutral stable position, it is so obvious that the last missing  link in the ability to walk normally of my medical puzzle is my right proximal tib-fib joint. The clinical diagnosis of cholesterol embolism can be made when stepwise loss of glomerular function is accompanied by cutaneous involvement. In fact, if renal impairment occurs immediately after an invasive procedure, the clinician must first rule out other causes, including contrast-induced nephropathy. Patients with carotid or vertebrobasilar atherosclerosis who undergo endarterectomy are at high risk. I did not realize how bad my feet had been affecting my SI joints, created pubic symphysis dysfunction and played havoc on my proximal tib-fib joints with life long hyper-extended knees. The order that my entire medical journey has taken me on has been with God’s leading each step of the way and I have no regrets. The information should NOT be used in place of visiting with your healthcare provider, nor should you disregard the advice of your healthcare provider because of any information you obtain on this website.
The 2 most common renal manifestations of cholesterol embolism are hypertension and loss of glomerular function. The contrasting colors highlighted the tables and graphs making them easy read and understand. Soto (my pain management specialist at Northwest Medical Rehab) has witnessed the positive changes in me as I have set my course to eliminate chronic pain at its source. Discuss any activities presented in this website with your healthcare provider before engaging in the activity. I am proud to have my research published and read by professional peers and to make a significant contribution in the field of lower extremity research.
It is my goal to always protect and maintain the discs of my lumbar segments to the best of my ability.




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