Short video demonstrates limitations of anterior-posterior spinal mobilisation for herniated discs.

The latest dynamic spine models allow us to see the effects of forces on intervertebral discs.

Manual therapy typically uses an anterior-posterior directional mobilisation to treat spinal segments.

IDD Therapy treatment comprises a targeted longitudinal distraction, with a longitudinal oscillation/ mobilisation at the point of maximum joint distraction.

IDD Therapy 25 minute treatment graph

This decompresses the discs and works soft tissues simultaneously in a way which is not possible with the hands alone.

Author: Stephen Small
Director, Steadfast Clinics Ltd
www.steadfastclinics.co.uk

Low Back Pain Treatment – Inflammation, IL-6 and the new FAR infrared treatment connection.

I recently posted an article regarding drug-based Rheumatoid Arthritis treatment targeting the IL-6 protein.

I was interested in the potential implications of a study by Wong et Al (1), showing that as well as pain relief, post knee surgery patients treated with FAR infrared exhibited reduced levels of the proinflammatory IL-6 protein.  I raised the question whether the new FAR infrared modalities be an effective treatment aid for Rheumatoid Arthritis.

FAR infrared and IL 6 protein

http://www.ncbi.nlm.nih.gov/pubmed/22339105

“This study demonstrated that the FIR can lower the NRS of pain and thus reduce the discomfort experienced by the patient. Findings indicated that effective application of FIR decreased the serum level of Interleukin-6 (IL-6) and Endothelin ET-1, which represent the subjective indicator of pain.”

Working so heavily with low back pain and IDD Therapy spinal decompression treatment, this got me thinking about inflammation, IL-6 and low back pain.  What are the potential applications of new infrared modalities as a cost-effective tool to ease inflammation and reduce low back pain … without the need for steroid injections and anti-inflammatory medication?

With regards to Low Back Pain, we observe on many occasions that patients using Thermedic infrared pads report pain relief beyond what might be expected from a standard conductive heating aid.  I have written at various times that the humble “heat pad” offers more profound benefits than we might think, see evidence.

Looking at some of the research into IL-6 and back pain, Heffner et al (2) show that higher levels of IL 6 are associated with chronic low back pain (CLBP) and sleep disturbance:

“Individuals with CLBP had more sleep disturbance than controls. Circulating IL-6 levels were similar for the 2 groups; however, in adults with CLBP, poorer sleep quality was associated with higher IL-6 levels, and both sleep and IL-6 related to pain reports.”

Burke et al show that there are high levels of proinflammatory IL-6 in the nucleus pulposus of painful intervertebral discs:

“We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E2 (PGE2) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay. There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively). The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc.”

Kraychete et al (4) show that:

“…  patients with chronic low back pain due to disc herniation presented higher levels of TNF-alpha and IL-6, but not of IL-1 or sTNF-R.”

Thus whilst looking at the Wong et al study showing reduced levels of IL-6 for knee pain post surgery using infrared,  we can also see that elevated levels of IL-6 are associated with CLBP.

Could Wong et al help us to explain more fully the observed benefits of FAR infrared for relieving low back pain?

TherMedic is a new technology which uses a mains powered carbon-fabric element which emits FAR infrared.   It replaces lamps.  Worn against the body TherMedic provides a localised constant infrared heat/energy source.  Evidence shows both thermal and non-thermal effects from the resonant energy for pain reduction for a variety of conditions.

Most of the evidence comes from Asia where the technology is developed and being applied to many medical conditions.  We expect that European academic interest will develop as awareness of the new technology and its applications spreads.

PW140-Lower-Back-Thermography-heat-only   l220103-heat-pad_jpg   l220103-temp-control_jpg

Regular users of Thermedic for low back pain report “not being able to live without their TherMedic” infrared pad.  Patients with sciatica report that their pain has disappeared which is surprsing for something viewed as a simple heat pad and used on the lower back.

PW140-TherMedic-Lower-Back-PackShotRather than simple pain relief from heat and increased blood flow which “feels nice”, might Thermedic infrared have a deeper effect by helping to reduce levels of inflammation-causing IL-6 in LBP?

There is clearly a lot to explore, but as you look into the new FAR infrared fabric application for low back pain relief, you will see that there is a lot more than meets the eye.

Convention has it that heat should not be applied when there is inflammation.

Having heard from people suffering with inflammation but reporting relief when using TherMedic Infrared, could the new infrared turn some of that conventional thinking about heat and inflammation on its head?

Author: Stephen Small
Director www.steadfastclinics.co.uk  www.thermedic.co.uk  www.iddtherapy.co.uk

1) Wong CH, Lin LC, Lee HH, Liu CF. The analgesic effect of thermal therapy after total knee arthroplasty.  J Altern Complement Med. 2012 Feb;18(2):175-9. doi: 10.1089/acm.2010.0815.  http://www.ncbi.nlm.nih.gov/pubmed/22339105

2) Heffner KL, France CR, Trost Z, Ng HM, Pigeon WR Chronic low back pain, sleep disturbance, and interleukin-6. Clin J Pain. 2011 Jan;27(1):35-41. http://www.ncbi.nlm.nih.gov/pubmed/21188850

3) Burke JG, Watson RW, McCormack D, Dowling FE, Walsh MG, Fitzpatrick JM. Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br. 2002 Mar;84(2):196-201. http://www.ncbi.nlm.nih.gov/pubmed/11924650
4)  Kraychete DC, Sakata RK, Issy AM, Bacellar O, Santos-Jesus R, Carvalho EM. Serum cytokine levels in patients with chronic low back pain due to herniated disc: analytical cross-sectional study. Sao Paulo Med J. 2010;128(5):259-   62. http://www.ncbi.nlm.nih.gov/pubmed/21181064

Rheumatoid Arthritis Treatment – A link between drug treatments, new FAR infrared and targeting the IL-6 protein.

Last month a news article in The Daily Express, a UK newspaper, appeared referencing a new drug treatment for Rheumatoid Arthritis (RA).  The drug targets the IL-6 protein which is responsible for inflammation.

This stimulated my memory banks for a different study for knee pain which I vaguely remembered made reference to an IL protein … hang on, it’s the IL-6 protein!

Have I just discovered a link to a potential treatment for RA?

Here is the extract from the article and a link, but read on.

Sarilumab

http://www.express.co.uk/news/health/444653/New-breakthrough-jab-to-ease-arthritis-agony-and-slow-disease

Whilst preparing a summary of evidence for new FAR infrared (FIR) elements, I came across a study showing the effects of the FIR treatment on patients who had undergone knee surgery (total knee arthroplasty).  As well as significant pain reduction, reference is also made to IL-6 reduction:

FAR infrared and IL 6 protein

http://www.ncbi.nlm.nih.gov/pubmed/22339105

“This study demonstrated that the FIR can lower the NRS of pain and thus reduce the discomfort experienced by the patient. Findings indicated that effective application of FIR decreased the serum level of Interleukin-6 (IL-6) and Endothelin ET-1, which represent the subjective indicator of pain.”

FAR Infrared TherapyNow, anecdotally we hear countless testimonials from people with arthritis (not specifically RA) reporting significant pain relief from using TherMedic infrared ProWraps, as well as other conditions including low back pain, Frozen Shoulder and more.

Some of these effects may be down to the thermal effects of sustained vasodilation but other studies detail non-thermal effects which may explain other significant properties and benefits of TherMedic FIR for pain relief, see evidence summary.

For some people living with Rheumatoid Arthritis, medication does not always work and can include side-effects.

l220100-heat-pad_jpgThe above paper looking at the application of FIR for knee arthroplasty and reduction of IL-6 protein is not a large double-blind randomised controlled trial.

HOWEVER, in the context of this and other scientific evidence surrounding the re-emergence of FAR infrared, as well as the growing anecdotal evidence, there is surely a case for more detailed investigation into the potential applications of the new localised carbon-fabric infrared modality, TherMedic for the relief of pain caused by Rheumatoid Arthritis.

This question may well be being addressed in Asia where the new carbon fabric infrared element was developed, but to the scientific community in the UK, the new technology is still unknown.  That is changing.

NOTES:

Endothelins are proteins that constrict blood vessels and raise blood pressure. They are normally kept in balance by other mechanisms, but when they are over-expressed, they contribute to high blood pressure (hypertension) and heart disease

Interleukin-6 (IL-6) is an interleukin that acts as both a pro-inflammatory and anti-inflammatory cytokine. Expression of IL-6 is enhanced at the site of inflammation, and blockade of IL-6 and IL-6 signalling is effective at prevention and treatment in models of inflammatory diseases (including arthritis and colitis).  Overall IL-6 is important – indeed, critical under certain conditions – to the development of persistent inflammation.

(C. Gabay Interleukin-6 and chronic inflammation  Arthritis Research & Therapy 2006, 8(Suppl 2):S3 http://arthritis-research.com/content/8/S2/S3

Author: Stephen Small
Director www.steadfastclinics.co.uk

I first came across infrared whilst using it with IDD Therapy spinal decompression.  Initially I saw it as a simple heat modality but it quickly became apparent that there was a lot more to TherMedic than meets the eye.  Steadfast Clinics distribute Thermedic in the UK.

Hamstring Injury Treatment – Doing more with new Thermedic FAR Infrared Therapy

Having had my share of hamstring injuries, I know that the biggest pain is not the physical pain, but the pain of not being able to play your sport.

The risk of injury recurrence with any injury is very strong because for the competitive sports man or woman the desire to play can lead to an overwhelming temptation to play again too soon.

This is particularly the case with hamstring injuries and is especially aggravating because good hamstrings are so essential for running (fast!).  Incomplete healing, scar tissue, inflexibility and muscle imbalance with the quads mean that recurrent hamstring problems are a common (and expensive) problem.

So, can clinicians do more to help their patients with hamstring injury treatment?

Following the acute injury phase, it goes without saying that good blood flow to the injured site is essential to carry oxygen, nutrients and repair cells for efficient healing.  Stretching during the re-modelling phase of healing is essential to ensure that new collagen fibres are laid down neatly. 

Evidence shows that applying heat increases the extensibility of hamstrings1 and improves myofascial relaxation2 , thus applying heat before stretching muscles is beneficial.  Heat causes vasodilation: a widening of the blood vessels which in turn leads to more blood going through the injured area.

The problem to date has been in finding a comfortable and effective heat application for the hamstrings to help with healing and to help with the return to sport.

pw150_2%20close%20upThe new Thermedic Thigh is the ideal treatment tool for hamstring injuries.  It includes a cold pack to limit bleeding in the injured site whilst the support provides compression during the acute phase.

But the main benefit for athletes is a unique carbon-fabric FAR infrared heat element which delivers resonant energy into the tissues.

Mains powered, Thermedic has three temperatures and has been show to increase blood flow in tissues and joints; by 204% in the knee and 49% in the abdomen3.  The exact amount of increased blood flow in the hamstring hasn’t been measured but we might reasonably assume that the amount be somewhere in between.

At the same time FAR infrared has been shown to increase fibroblast proliferation and collagen regeneration, which are key components of healing4 .

Thigh ThighAnother significant benefit of Thermedic FAR infrared over standard heat products is that skin temperatures do not reach burning levels.  Thus, it is possible to apply FAR infrared for longer periods meaning that there is a sustained increased flow of blood through the injured site.

So, rather than 5-10 minutes of superficial warmth, with Thermedic it is possible to increase the blood flow for longer periods for a greater therapeutic effect.  This may have interesting implications for angiogenesis in the injured tissues but that question is for a phd student somewhere!

The key thing is to try the Thermedic Thigh on your hamstring and feel the difference compared to ANY other heat application.  When you feel this difference yourself, you can appreciate why Thermedic is becoming so popular for hamstring injury rehabilitation and many other painful conditions and injuries.

To order a Thermedic Thigh visit www.Thermedic.co.uk

Author Stephen Small
Director Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

1 D. Funk, A. M. Swank, D. Treolo, K. J. Adams.  Efficacy of Moist Heat Pack Application Over Static Stretching on Hamstring Flexibility.  Journal of Strength and Conditioning Research, 2001, 15(1), 123–126

2 T. Muraoka, K. Omuro, T. Wakahara, T. Fukunaga, T. Fukunaga, K. Kanosue, Passive mechanical properties of the human muscle-tendon complex at different temperatures.  Journal of BiomechanicsVolume 39, Supplement 1 , Pages S197-S198, 2006

3 B.Y. Liau, A. Yang, T.K. Leung, M.C Ou, C.K. Ho and Y.S. Lin.  Inhibiting Effects of FAR-Infrared Ray-Emitting Belts on Primary Dysmenorrhea.  International Journal of Photoenergy, Volume 2012, Article ID 238468

4 Toyokawa H, Matsui Y, Uhara J, Tsuchiya H, Teshima S, Nakanishi H, Kwon AH, Azuma Y, Nagaoka T, Ogawa T, Kamiyama Y. Promotive effects of far-infrared ray on full-thickness skin wound healing in rats.   Exp Biol Med (Maywood). 2003 Jun;228(6):724-9.

IDD Therapy Spinal Decompression of Targeted Intervertebral Discs


This article examines the physics and mechanics of how IDD Therapy Spinal Decompression is able to distract and mobilise specfic segments of the spine and thus decompress a targeted intervertebral disc.

Traditional traction has been outmoded for a number of years and one of the shortcomings of traction was the inability to focus and control forces at specifc spinal levels.

The four goals of IDD Therapy spinal decompression are to:

  1. Release pressure on nerves
  2. Improve Disc Health
  3. Re-educate soft tissues
  4. Re-align spinal structures

IDD Therapy treatment is applied by distracting and mobilising targeted spinal segments at precisely measured angles, using high distraction forces which incorporate joint mobilisation in a longitudinal plane.

Controlled forces are high enough to comfortably stretch the paraspinal tissues, open and create pressure differentials in the disc space and are applied for sufficient time to have a therapeutic effect.

Ergonomic pelvic and thoracic harnesses secure the patient to the bed and a computer controlled cyclic distraction force is applied.  Treatment is delivered by CE & FDA cleared Class II SPINA devices.  All aspects of treatment and outcomes are recorded as part of a commitment to evidence-based medicine.

Decompression of a Targeted Spinal Segment.Vector Diagram Showing Application of Forces at Varying Angles

In order to decompress a targeted level, engineers applied the principles of vector forces from physics to the spine.  They observed that by focussing a controlled distraction force at a specific angle, they could open targeted spinal segments by between 5mm -7mm1.

As the angle which a pulling force makes with the horizontal increases, the component of force in the horizontal direction (Fx) decreases and the vertical component of force (Fy) increases.

This causes the relative direction of the pulling force to change and therefore the focus point of application of the pulling force to move progressively along the x-axis.

Measured changes in the angle of applied pulling force enable clinicians to focus and direct distraction forces accurately to injured spinal segments.

Sinusoidal distraction force:  This patented waveform replaces linear pulling forces allowing greater comfort and application of higher distraction forces of up to half body weight plus 5-10kgs.

 

Longer treatment duration:  Twenty-five minute treatment during which time joints are distracted for 13 times to a high tension, whilst soft tissues are worked and remain under constant tension.

Joint Mobilisation:  The sinusoidal waveform allows for the application of oscillatory forces to mobilise the joint in a longitudinal, rather than anterior-posterior plane at the point when the joint is distracted.


Low frequency    Mid Frequency  High Frequency     Low Amplitude     High Amplitude

The sum of the parts:  Improved harnessing secures the pelvis, measured angle of distraction, computer controlled sinusoidal waveform, cyclical distraction and patient remains completely relaxed for 25 minutes.

Low Back Pain Treatment Programme

SUMMARY

In order to decompress (take pressure off) a joint, it is necessary to distract it in the opposite direction to the compressive force.  Where a joint has become stiff and immobile, gentle mobilisation at the point of distraction helps to improve mobility in the joint and allow the natural mechanisms which keep joints healthy to operate freely.

IDD Therapy Spinal Decompression applies new technology to physical laws to enable clinicians to distract and mobilise targeted spinal segments as part of a complete programme of care, including manual therapy and exercise rehabilitation.

Author: Stephen Small www.steadfastclinics.co.uk

1 Shealy N, Leroy P: New Concepts in Back Pain Management. AJPM (1) 20:239241 1998 

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