How Motion Aids Healing

The therapy most often taught to deal with acute injury uses the acronym RICE: Rest, Ice, Compression, and Elevation. While it is important to give an injured body part rest, it is equally important to not rest it too much. The R in RICE should stand for Range of Motion, according to many sports therapists. In fact, the developer and main teacher of Soft Tissue Release, Stuart Taws, uses the acronym MICE (Movement, Ice, Compression, and Elevation) for his method of therapy.

Almost any person that hears the word “surgery” automatically assumes that bed rest will be next. This is due to the fact that almost all hospitals enforced bed rest after surgery for many years. Because of resting too long, patients had big adhesions that took a long time to heal.

Patients now recover more quickly, since they are encouraged to utilize mobility opportunities following a surgery procedure. In fact, a patient who has had knee surgery will be put into a device that flexes and extends the knee on a continuous basis to keep adhesions from forming.

Adhesions, resulting in an inhibition of normal range of motion, can occur if an area is given too much rest after an injury. The client may accept the reduced range of motion as normal. It is common to not notice any difference at all. This is one of the reasons that people regularly re-injure an area that was formerly injured.

To know how and how much to move an injured area, you need to know how the body responds to injuries and about the inflammatory process's different stages.

The beginning stage of inflammation is the reactive or acute stage. Redness and swelling will occur because of vascular changes during this stage and are likely to extend over a three to four day time-period.

In this stage, range of movement is decreased due to swelling, as well as muscle spasms and intentionally or unintentionally guarding the area to prevent further injury and pain. To help reduce the swelling during this stage lymphatic massage is suggested. After the muscle spasm has been reduced, gentle movement may be conducted.

Regeneration is phase two in inflammation. This step can last for several weeks. While this phase is ongoing, collagen formed by fibroblasts helps to reconnect tissues that have been torn apart. Collagen fibers are formed in a random fashion, and may block movement when they intersect muscle fibers or other tissues. At this time, motion is essential to ensure that the collagen fibers align with the muscle and fascia so that movement is facilitated.

Remodeling and scar maturation is the last stage of inflammation. During this phase, the patient needs to move the area on a regular basis so that scar tissue doesn't restrict future movement or lead to unpleasant scars. After scar tissue forms, deep massage work must be utilized to break it up.

Taking the following things into account, movement should be done.

Gain a full understanding of the history of any former injuries and the symptoms that are being experienced at this time. You should use active movement, resisted muscle tests, and passive range of motion assessments to determine the health of the area. If you suspect that a muscle tear has occurred, avoid resisted muscle testing.

Once you have gathered the client history, start with passive movement. Gently examine and work limitations in the range of motion. The patient should not endure any pain during this process.

Do not move a joint beyond its normal range for motion. Look at the opposite, unaffected side to determine the patient's normal range of motion.

The muscle may be pressed into while being stretched. This process is referred to as passive stretching. This process ensures that collagen fibers that cross the grain of the muscle are broken while those that run parallel to the muscle fibers are not. If pain free, the person can return to active movement.

You can press into the muscle while the recovering client is actively stretching it. The muscle being stretched, because of reciprocal inhibition, will become more relaxed, as the client will be using the antagonist muscle. This process is more effective than passive stretching.

At this point, you should start slowly with passive movement, and then graduate towards active and resisted movements, remembering to stay within the comfort range of the client. Motion is quite effective in accelerating your clients' healing process.

Ayurvedic Management of HIV/AIDS

At present, there is no scientifically proved cure for HIV /AIDS. Globally, the number of infected HIV /AIDS patients is increasing at an alarming rate; with a current estimate of 33.2 million people who are living with HIV 1. Hence, there is a dire need to search for a safe, effective and economical treatment for HIV /AIDS.

In a retrospective study in 55 patients, Ayurvedic treatment has proved to be very promising in the management of HIV/AIDS. Fifty-Five adult patients were given Ayurvedic treatment for HIV/AIDS, during the period from April 1999 to November 2004.Each patient had tested positive for HIV/AIDS on at least 2 different occasions. No patient was taking anti-retroviral drugs at the time of commencing Ayurvedic treatment. All patients were started on treatment after written, informed consent.

The Ayurvedic Herbal Combination ( AHC ) comprises of eleven different herbs in different dosage strengths, based upon their respective potencies, reported anti-viral and immunomodulatory properties, and their traditional usage according to Ayurvedic principles of medicine 2 -4 .The constituents of AHC with their respective dosages are as follows:-Terminalia arjuna: 250 mg. ;Zinziber officinale: 250 mg. ;Phyllanthus niruri :1 gm ;Glycyrrhiza glabra:1gm. ;Withania somnifera:1gm. ;Eclipta alba: 250mg. ;Centella asiatica: 250mg. ;Boerhavia diffusa: 250mg. ;Emblica officinalis: 250mg. ;Tinospora cordifolia: 250mg. ;Rubia cordifolia: 250mg. This AHC was dispensed in a combined dose of 5 gms. t.i.d., to be taken with water after meals. Aqueous herbal extracts of all the medicines were used, in tablet form.

All patients were advised to eat a well-balanced, nutritious diet. Therapeutic counseling sessions were conducted regularly to help the patients achieve mind relaxation, to modify their risk behavior , and to increase adherence and compliance to therapy.

All patients were followed up at monthly intervals. Detailed clinical examination was done at each visit and significant findings were recorded. In addition, in affording and willing patients, investigations like CBC, Hb, Liver and Renal functions, X-Ray of chest, Western Blot, CD4 count and Viral Load were done wherever possible. Other investigations were done, if required, for Opportunistic Infections (O.I.).All O.I. were promptly and aggressively treated with modern medicines. A close watch was kept for adverse reactions of the drugs.

Therapeutic outcome was assessed by overall clinical examination, change in Karnofsky score (assessment for overall well-being of patients), change in weight, occurrence and response to O.I., and change in CD4 and Viral Load values. Maximum number of patients was in the age ranging from 20 - 39 years (80 %). Of the total number of 55 patients, 39 were male (71 % ) and 16 were female (29 %), with the male: female ratio being 2.4: 1. There were 7 couples who took treatment together.

Of the 55 patients, 5 patients died, 42 patients took treatment for varying periods and then stopped treatment, while 8 patients continued treatment till the end of the study period. The 5 patients who died were critically ill at the time of presentation, and died mostly within the first two months of starting Ayurvedic treatment. The cause of death varied ; 1 patient died from cirrhosis of the liver, 3 died of extensive Pulmonary Tuberculosis (multi-drug resistant) and 1 died of a combination of Pulmonary Tuberculosis and demyelination disease of the brain.

In the 50 patients who were alive till the time of their last follow-up , there was an average weight-gain of 2.3 kgs.(range = - 4 to + 7.5 kgs), usually within the first 3 months. In those patients who took continuous treatment for more than 3 months, the Karnofsky score increased from an average of 75.9 at the commencement of treatment to 87.4 at the last follow-up. Almost all the patients had 1-3 O.I. at the time of presentation. Other than Tuberculosis, all the O.I. cleared up rapidly within the first 2 months of treatment.

Long-term administration of Ayurvedic medicines (upto 30 months) did not seem to have any major adverse effects. In fact, in a few patients, the tests for liver and renal function appeared to normalize further, with treatment. Haemoglobin readings gradually improved in those patients taking regular, prolonged treatment.The most striking effect of the Ayurvedic medicines was on the Viral Load and CD4 counts. Because of financial constraints, only 15 patients (27 % ) agreed to do either the Viral Load or the CD4 count, or both. In most patients, there was a definite and steady decrease in the Viral Load, and an increase in the CD4 cell counts.

Antiretroviral medicines are the mainstay in the modern treatment of HIV/AIDS. However, a plethora of side-effects, development of resistance to drugs and escalating treatment costs are serious concerns. In the absence of a definite cure for HIV/AIDS, Ayurvedic medicines may provide a useful alternative for long-term management of patients, since these medicines are economical and devoid of serious side-effects. However, scientific research is necessary to determine efficacy of these medicines. This retrospective study is one such effort to assess long-term therapeutic effects of an Ayurvedic Herbal Combination in the management of HIV /AIDS.

In this study, 4 patients died within the first 2 months of commencing treatment. Onset of therapeutic effect is slow with Ayurvedic medicines, and these patients probably could not benefit from Ayurvedic treatment. This emphasizes the need to start treatment as early as possible in immuno-compromised patients. The causes of death indicate that Tuberculosis and CNS involvement are major killers in HIV patients. Multi-drug resistance to Tuberculosis is also a major concern.

16 patients ( 29% ) did not come back after just one ( 11% ) or two ( 18% ) visits. The reasons cited were, a complete inability to pay for treatment, or a search for a ‘better’ or a ‘guarenteed cure’. Fortunately, perceptions have changed in the last few years. Even illiterate patients from the lower socio-economic strata are no longer asking for a ‘guarantee’ or a ‘cure’. ‘Long-term management with minimum expenses’ is a mantra being readily accepted by the HIV positive patient of today.

All the patients who took medicines regularly, had a high-protein diet and kept themselves busy, improved very well and put on weight. Even 2 to 3 years after stopping Ayurvedic treatment, most of the patients are doing very well, some inspite of very low CD4 counts. This is probably one of the biggest long-term advantages of taking Ayurvedic medicines for HIV /AIDS. However, patients with socio-economic difficulties and a lot of psychological pressure who could not have access to regular treatment, started losing weight after initially improving with treatment. A comprehensive management of each patient thus needs to address several issues relevant to each individual patient.

This study also brought forth some interesting results. One patient who subsequently died, had severe demyelinating disease of the brain (as diagnosed in a major hospital), and had lost most of his motor control and sensory senses, since several months. After being given Ayurvedic treatment for about 1 ½ months he became alert, and could speak clearly, albeit temporarily, for 1 week. Another patient with Nephrotic syndrome resulting in long-standing generalized oedema (2 years ) had complete regression of the oedema after 2 months of Ayurvedic treatment without any other treatment. One HIV positive patient with suspected malignancy of lung in the right upper lobe was steadily losing weight. After starting Ayurvedic treatment, he started putting on weight. Another patient with history suggestive of HIV Encephalopathy was semi-conscious at presentation. He was passively fed on liquid diet and a combination of both modern drugs and Ayurvedic treatment. This patient be!

came ambulatory within 2 weeks, and after 2 months of treatment he was faring well, even with a CD4 count of just 6.The above 4 instances indicate that the Ayurvedic medicines may have multi-faceted properties and need further evaluation.

Thus,the retrospective study of 55 HIV positive adult patients treated with an Ayurvedic Herbal combination from April 1999 to November 2004 proved the Ayurvedic medicines to be highly effective as anti-viral and immuno-stimulant,and safe on long-term use. A nutritious diet, Ayurvedic baseline therapy, timely allopathic treatment of Opportunistic Infections and regular counseling support appears to be an ideal combination in the management of HIV/ AIDS patients.