Timelines of mobilization occurring immediately after surgery or early after the institution of mechanical ventilation in cases of respiratory failure may be beneficial in preventing weakness and allowing patients to return to functional independence at the time of discharge. Incorporation of this multimodal, evidence-based approach has been shown to reduce postoperative pulmonary complications and shorten hospital length of stay.

Bed rest in the postoperative period could prove detrimental to patient recovery. Fast-track surgery methodology that incorporates intensive mobilization has been shown to improve clinical outcomes. Among the patient-centered and science-based post-surgery protocols, we also provide valuable pre-surgery sessions for maximum outcome. Preoperative physiotherapy in some cases can prime patients for enhanced recovery in the postoperative period.

Preoperative care physiotherapy sessions aim to decrease edema, strengthen soft tissues, and preserve the mobility of the joint. These clinical outcomes contribute to a better environment for the surgeon to penetrate and operate. Physiotherapy in the preoperative period can also improve physical deconditioning and may potentially affect subsequent post-surgical outcomes.

Updated sources:

• https://pubmed.ncbi.nlm.nih.gov/34593498/
• https://pubmed.ncbi.nlm.nih.gov/33356804/
• https://pubmed.ncbi.nlm.nih.gov/27555213/
• https://pubmed.ncbi.nlm.nih.gov/35313897/

Being physically active is one of the most important actions that people of all ages can take to improve their health. The evidence about the health benefits of regular physical activity is well established and has shown that everyone gains benefits from exercising: men and women of all races and ethnicities, young children to older adults, women who are pregnant or postpartum, people living with a chronic condition or a disability, and people who want to reduce their risk of chronic disease.

First of all, prior to begin any exercise program, every individual needs to seek medical evaluation and clearance to engage in the activity. Not all exercise programs are suitable for everyone.

Are you searching for reasons to start or continue exercising?

Let's talk about the benefits of exercising.

Exercise includes some immediate results such as short-term reduction of feelings of depression and stress, and improvement of sleep, mood, thinking, learning and judgment skills. A good motivation in order to start and continue exercising is to focus on how you feel mentally before and after physical activity. (2)

Most results of exercise are not instantaneous, so set realistic expectations.

Exercise can help improve the strength of bones and muscles, endurance, weight management, physical function, mental health, life expectancy, daily living activities and independence. Exercise can help reduce mortality, and risks of developing dementia, Alzheimer’s disease, cardiovascular diseases, Type 2 Diabetes and Metabolic Syndrome. It can also help manage chronic health conditions and disabilities by reducing pain, and nerve damage, improving function, mood, and quality of life and helping control blood pressure and blood sugar levels. Physical activity is a powerful ally in the prevention of falls and it can reduce the risk of developing some cancers like bladder, breast, colon (proximal and distal), endometrium, esophagus (adenocarcinoma), kidney, lung, stomach (cardia and non-cardia adenocarcinoma). If somebody is a cancer survivor, getting regular physical activity not only helps give him a better quality of life but also improves his physical fitness. (2)

Having talked about the benefits of exercising, it is time to answer the original question of this blog: How much exercise is enough in order to look good, feel good and be healthy?

(Picture from: https://blog.1life.co.uk/fitness-class-ideas-for-you-and-your-kids )

(Picture from: https://www.dallashomecareassistance.com/how-much-exercise-does-my-older-loved-one-need/ )

According to the latest guidelines of the American College of Sports Medicine (ACSM) 2018, preschool-aged children (ages 3 through 5 years) should be encouraged to be physically active, which includes a variety of activity types, throughout the day to enhance growth and development. (1)

Children and adolescents should be encouraged and given opportunities to participate in physical activities that are appropriate for their age, that are enjoyable, and that offer variety. Children and adolescents ages 6 through 17 years should do 60 minutes (1 hour) or more of moderate-to-vigorous physical activity daily, which includes:

• Aerobic exercise: Most of the 60 minutes or more per day should be either moderate- or vigorous-intensity aerobic physical activity at least 3 days a week.
• Muscle-strengthening exercise: As part of their 60 minutes or more of daily physical activity at least 3 days a week. (1)

As for adults, for substantial health benefits, should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) per week of moderate intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) per week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week. Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity a week. Adults need a mix of physical activities. For this reason, they should also do muscle-strengthening activities of moderate or greater intensity that involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits. (1)

Older adults should follow the same guidelines and also do multicomponent physical activity that includes balance training as well as aerobic and muscle strengthening activities in the safest way as part of their weekly physical activity. When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow. (1)

Examples of Aerobic Physical Activities based on their intensity:

A good way to estimate the intensity of aerobic activity is the Talk Test.
A person doing a moderate-intensity aerobic activity can talk, but not sing, during the activity.
A person doing a vigorous-intensity activity cannot say more than a few words without pausing for a breath.

Answering the question of this blog, it is important to evaluate the priorities, in order to start or continue exercising.

• Place a high value on your health
• Plan ahead by marking your workout time on your calendar.
• Find the joy in a physical activity instead of viewing it as one more thing on the to-do list that will keep you motivated. With so many exercise options, there is some form of activity for everyone.
• Find opportunities to be active. For instance, if your schedule doesn’t allow for a full workout, figure out ways that you can get shorter bursts of activity. Even short bouts of activity carry many benefits.
• Avoid long periods of sitting by standing up and moving throughout the day.

In case you are facing any musculoskeletal problems or other health issues, such as chronic cardiovascular and respiratory problems or problems with your blood sugar levels, contact us in order to plan an exercise program together and get the maximum benefits for your health.

Do not forget that staying active pays off!

References:

1. American College of Sports Medicine (ACSM), Physical Activity Guidelines for Americans, 2nd edition, 2018.
2. Ruegsegger G. N., Booth F. W. Health Benefits of Exercise. Cold Spring Harbor Perspectives in Medicine. 2017; 8(7):a029694.

By Zacharias Sifakis & Marios Papachristopoulos

Following a stressful day, many people suffer from a telltale pain that radiates from their neck and head and is only preceded by an ongoing stiffness in the jaw.  Pain from the temporomandibular joint (TMJ) can be easily mistaken for a common headache, mostly because the symptoms are so similar. It often causes for repeated dentist visits without any outcome however as the symptoms arise from a different structure even if you feel it around your teeth.

But there are a few key differences that set a TMJ-related headache or facial pain apart from a common tension headache. When the symptoms are associated with TMJ then the pain state is also known as a temporomandibular disorder (TMD). TMD is a broad term that encompasses disorders of the TMJ and its associated anatomical structures. A TMD can often be very painful and disabling. With an accurate and opportune identification of the type of pain you're experiencing, you can find relief before the sensation becomes unbearable. But let us have an insight into what we know about one of the joints that we use more on our body.

The TMJs are complex structures made up of two bones, the temporal bone and condyle, which are separated by a fibrous disk, and surrounded by a capsule. The TMJ is mainly composed of fibers like those in ordinary connective tissue. This gives the joint the tendency to remodel. Injury to or disorders of these structures can all result in pain in the jaw area. Jaw pain may occur on one side or on both sides, depending upon the cause and may be associated with myofascial pain and headache.

A typical TMD consists of:

• Recurrent pain in one or more regions of the head and/or face.
• X-ray, MRI and/or bone scintigraphy findings that demonstrate TMJ disorder.
Important clinical evidence that pain can be attributed to the TMD are:
- Pain precipitated by jaw movements such as laughing, yawning and/or chewing of hard or tough food.
- Jaw stiffness and reduced range of motion or irregular jaw opening.
- Noises like clicking or popping) from one or both TMJs during jaw movements.
- Tenderness of the joint capsule(s) in one or both TMJs.
Temporomandibular disorders may occur following a direct trauma or secondary due to indirect mechanism of injury. Usually, direct trauma is a blow or a fall to the chin or jaw. Indirect mechanisms of injury may be triggered by numerous causes. Most common are whiplash injury following an accident, heavy chewing, teeth grinding (bruxism), clenching of the jaw, disorders of dental occlusion, loss of dental height due to worn down or missing teeth, prolonged periods of mouth opening such as a dental or a general anaesthetic procedure etc.

Common intra-articular temporomandibular disorders are inflammation, internal derangement conditions, and degeneration. These conditions are commonly related to a disk/condyle incoordination and noise can be detected on movements. This may progress to locking (where the condyle can’t ride over the forward located disk) where the mouth can not open causing symptoms and severe limitations in daily activities such as chewing, laughing or yawning. Overuse of the jaw muscles such as excessive gum chewing can inflame the TMJ, resulting in pain and stiffness. 

Arthritis can also occur in the TMJ as a result of age-related degeneration (usually seen in the over 50s), or secondary to trauma occurring at a younger age. In arthritis, crepitus can be felt or heard and changes can often be seen on a plain x-ray or on an MRI.
Muscle spasm of one or more muscles of mastication, is an extra-articular cause of TMD usually following prolonged dental procedures or anaesthetics or due to stress, bruxism etc. Muscle spam can also cause significant pain and limitation of the jaw movements. Mismanagement of fractures rehabilitation, at the mandibular symphysis or the condylar neck, as well as the dislocation of one or both condyles, can also be a cause for a TMD.

It is not always clear what triggers a TMD and there are numerous other conditions that can cause pain in the TMJ region. Pain in the areas of the face around the TMJ’s, jaws and ears, often derives from common disorders of the upper cervical spine.

Specialised clinical examination, as well as an interdisciplinary approach where needed, is required to ensure a reliable differential diagnosis & treatment is given, and that potentially serious problems such as trigeminal neuralgia, systemic diseases and other medical conditions are not overlooked.

What is the treatment and prognosis for temporomandibular disorders?

TMD is a recurring, but self-limiting condition that tends not to be progressive and usually responds to conservative therapy. TMJ-related pain is commonly misdiagnosed as a regular stress-induced headache. TMJ-related pain in fact is a much more preventable source. Following successful treatment, headache resolves within 3 months and does not recur.

Satisfactory management requires a thorough clinical examination. The examination should include complete history of the patient, assessment of jaw/tongue/neck position, palpation of the TMJ, assessment of both active and passive range and quality of movement of the jaw and cervical spine, and assessment of the patient’s bite. Also, signs of sleep bruxism/grinding are checked. Important clinical signs including the presence of swelling, muscle spasm and stiffness or hypermobility of one or both TMJ. Complaints of limited mouth opening and other signs of joint dysfunction must also be interpreted and assessed in the context of age, gender, and general health.

Α personalised identification of the factors contributing to a TMD, can be decisive in establishing the most effective therapy. In some of the cases, a simple modification of lifestyle and oral habits may be sufficient to alter symptom intensity. Non-invasive, conservative treatments include physical therapy, occlusal adjustment, splint therapy (especially when symptoms are related to bruxism during sleep), medications etc.

Given the self-limiting nature of most TMD, surgical intervention is rarely the treatment of choice, but may be justified in cases where circumstances are extreme, and disability associated with joint disease impacts greatly on the quality of life.
Physiotherapy treatment is an effective and safe approach in the treatment and management of TMD, even when the symptoms are long-standing and severe. With the appropriate comprehensive approach, most patients will see a significant improvement in pain intensity and range of motion within 3 to 6 weeks. Individualized accustomed mobility exercise programmes and selection of manual therapy techniques have the most promising effects in people with TMD.
This article is intended to promote understanding of and knowledge about a common health topic and does not intend to be a substitute for professional advice, diagnosis or treatment. As the evidence cannot determine the most appropriate type, intensity, and duration of therapy, we recommend you to always seek the advice of your dentist, specialized physiotherapist or other qualified healthcare providers with any questions you may have regarding a medical condition or treatment on the TMJ area.

Sources:

• https://physio-pedia.com/Temporomandibular_Disorders#sts=Other%20Causes%20of%20TMJ%20and%20Facial%20Pain
• https://www.sciencedirect.com/science/article/abs/pii/S1532338217302956?via%3Dihub
• https://www.medicinenet.com/temporomandibular_joint_syndrome_tmj/article.htm
• https://americanmigrainefoundation.org/resource-library/temporomandibular-disorders-and-headache/
• https://www.healthline.com/health/tmj-headache#causes
• https://www.sciencedaily.com/releases/2006/05/060514082537.htm?_ga=2.121202568.1427160655.1564678119-848101992.1564678119
• https://www.colgate.com/en-us/oral-health/conditions/temporomandibular-disorder/tmj-headache-1115
• https://journals.sagepub.com/doi/abs/10.1177/0269215516672275?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=crea
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706597/
• https://www.ncbi.nlm.nih.gov/pubmed/17185065
• https://www.nhs.uk/conditions/trigeminal-neuralgia/causes/  

• https://www.nhs.uk/conditions/trigeminal-neuralgia/causes/ 

Back pain is among the most common musculoskeletal conditions of our time, with a continuous increase in incidence rates in the general population, and with frequent reference to age groups among children and adolescents.

Epidemiological studies over the world in these age groups have shown that 1 in 4, 1 in 3, and 1 in 2 children aged 11, 13 and 15 respectively will report at least once an episode with back pain.

Back pain is defined as the occurrence of symptoms spreading as height as up to the shoulder blades and low as the pelvic/sacral area.

Nearly 1 in 5 children reported having requested medical care for this episode, and nearly 1 in 10 children were absent from school for one or more days due to back pain. In a similar survey, 75% (3 out of 4 children) of children with non-specific (undefined source of pain that cannot be directly associated with pathology, both in clinical examination and/or with imaging) chronic back pain reported that the transportation of a school bag exacerbated their symptoms.

In many countries, guidelines have been adopted that set specific weight limits for school bags. These limits usually range from 10% to 15% of children's body weight, but in some cases, they are set at 5% while there are guidelines up to 20% of body weight. While reviewing the scientific research on the topic, the question arises if all these “recommendations” are backed up by the data so far. Despite the apparent lack of reliable research data, school bags have been inseparably linked to the occurrence of back pain in children and adolescents.

For years, researchers globally have been trying to figure out the risk factors for such symptoms appearing in children and adolescents. Up until recently, there have been findings linking psychosocial factors (such as anxiety, emotional stress, family environment, etc.), female gender, and smoking with an increased risk of back pain in pupils. Several studies have also investigated load strain characteristics, such as contributing factors of biomechanics (eg technique, duration of loads, etc.) or anthropometric parameters (eg height, weight, body type etc.), that are considered to be contributing to the occurrence of such episodes. However, these claims do not appear to be adequately supported by current scientific evidence.

In particular, in a recent Australian survey, data from 69 studies, corresponding to over 72,000 children and adolescents, were collected and evaluated. Several parameters were recorded, evaluated, and analyzed, such as the weight of the bag, the duration of the transfer, the type of the bag (backpack, postman, etc.), the transfer method, and the referred schoolbag weight (as it is perceived from the child).

The results were published in May 2018 in the British Journal of Sports Medicine and are summarised as follows:

1) None of the studies included in the survey indicated sufficient evidence, that the use of school bags (in its various features) is a contributing factor associated with the occurrence of back pain in children.

2) One study has shown that a child's likely report that the school bag he is carrying is heavy, is associated with the appearance of back or middle back pain symptoms.

3) In another study, children with pre-existing back pain and reported difficulty in transferring their bag showed an increased risk of symptoms aggravation and turning them into a chronic condition.

Based on the data analysis from the 69 studies available, it seems that the characteristics of the backpack (such as weight, bag design, transfer method, etc.) do NOT increase the risk of back pain occurrence in children and adolescents. Therefore, any relationship between the use of the backpack and the back pain is at best minimal and the researchers should turn their attention to other causes of symptoms in this population.

In conclusion, parents do not need to be particularly worried about what kind of bag they should choose, how the child should use it, and how heavy they should be, as there is no convincing evidence that these parameters increase the risk for pain occurrence on their children.

But there are well-grounded assertions that if the child himself reports that his schoolbag is "too heavy" or has difficulty in transferring it while already experiencing back pain, then it is best not to ignore it. In this case, we can reduce the load or make transportation easier for the child, until he feels able again to carry the full load.

Individualized education on optimal load management is currently the most effective method for people who deal with persistent or chronic pain. In particular, there is a substantial improvement in daily function as well as a significant reduction in the intensity of the symptoms. If the child suffers persistent symptoms which cannot be dealt with sufficient management, then we should contact a healthcare professional.

REFERENCES:

• https://bjsm.bmj.com/content/52/19/1241
• https://bjsm.bmj.com/content/49/5/278