Massage helps relieve muscular pain
Dr Ravinder Chadha

Massage is a systematic and scientific manipulation of soft tissues for remedial and restorative purposes. Massage through repetitive pressure results in the relaxation of muscles and dilatation of blood vessels. The mechanical process involved in massage improves blood and lymph flow, promotes mobilisation of fluid and breaks down adhesions, thereby reducing oedema and enhancing tissue mobility.

The history of massage dates back to the time of existence of mankind. Massage along with exercise was an integral part of daily existence. It not only helped relieve muscle pain but also induced mental relaxation and sleep. Ancient Indians practised massage for fulfilling objectives like aiding sleep, relaxation as well as for weight reduction. It was a usual ritual to undergo massage prior to a bath. Ancient Greek soldiers used it on a day-to-day basis along with exercises to ease pain and fatigue of training. Ancient Chinese literature quotes exercise, massage, marshal art and meditation as constituents of a complete health package.

Muscular pain and soft tissue pain are caused due to the lack of blood and oxygen supply which could be caused by muscle spasm, increased metabolic waste, compression of nerves by soft tissue-swelling, lack of nutrition, stress and strains, etc.

Massage benefits are achieved through physiological and psychological processes. When the body is massaged, blood flow to that area increases, bringing oxygen and nutrients. Lymphatic drainage also increases thereby removing waste products and chemicals that are responsible for inducing pain. Massage reduces pain-producing chemicals like histamine and bradykinin. Psychologically, as the body is touched during the massage, pain-relieving chemicals (resembling morphine) such as endorphin are released. Massage reduces stress by lowering the level of stress hormone like Cortisol.

Massage is useful in the treatment of various conditions like migraine, headache, joint pain, muscular spasm, back pain and stress. Blood pressure also remains under control following massage.

In sports injuries different types of massage is done for different conditions. Longitudinal stroking, transverse friction and myofacial point therapy are some such techniques. Massage enhances the repair process, which is impaired due to restricted movement.

Basically, three techniques are used to treat injuries although different methods of massage are known.

* Effleurage or stroking is a massage performed by running the hand over the skin surface. The direction of the stroke moves from distal to the proximal end of the body or towards the heart like "toes to groin" or "hand to axilla". This type of massage helps in decreasing in venous and lymphatic flow thereby decreasing edema and relaxation of the muscles. The pressure thus applied is firm and deep but not heavy.

* In Petrissage, the skin and the underlying tissue are kneaded and lifted to improve tissue mobility, relax muscle and promote circulation.

* Friction is deep pressure movement of the superficial soft tissue against the underlying bone, muscle, etc. Friction helps in loosening the scar tissue and adhesions of tendon, ligaments, etc. It also helps in improving the circulation of the area. It is applied through firm pressure by the thumb or fingers. The circulation friction movement is used to break up thickened edema, particularly around a joint.

Massage is contraindicated in the presence of infection, skin disease, blood clots, etc. Whenever massage is to be given, the hand should be clean, warm with trimmed nails so as to avoid injury to the skin. Sometimes a lubricant like Aloe Vera cream, vegetable oil and almond oil is used to reduce friction.

Sports massage is used in the case of players to prevent injuries, to prepare them for participation in tournaments and to help in recovering from workouts and injuries. Sports massage is not given for an hour or so but is used for a particular muscle group for relaxation or rehabilitation of muscle injury.

Misconception is widely prevalent in society that massage helps in reducing weight. It only helps the masseur to burn some calories. Therefore, the use massage to "rub away" pain and not for weight reduction.

— The writer is a former doctor/physiotherapist, Indian cricket team

Health care for all: medical insurance is the key
Dr R. Kumar

In India those who have the capacity to pay for health care most often get it free, and those who are below the poverty line are forced to make payments, often with a heavy burden of debt. This is the painful reality. The poor who need an insurance cover are burdened with out-of-pocket expenditures. The government is opening the insurance sector to private companies, and the availability of private health insurance is expected to increase the access to private heath care facilities for millions of families. But this to be made possible the entire health care system needs to be reorganized so that it functions according to rules and regulations, uses standardised protocols for treatment and care, is subject to price regulations and is financed through the pooling of all resources under an independent and autonomous authority, which is accountable to all.

About half the country’s population has the potential to be part of a social insurance mechanism. The other half of the population can be supported through tax revenues and other forms of publicly raised revenues.

The rich have seen the growth of the private health care sector as a boon. But the dominance of the private sector not only denies access to poorer sections of society, but also skews the balance towards urban-biased, tertiary level health services with profitability overriding equality, and rationality of care often taking a back seat. Over 20 million Indians are pushed below the poverty line every year because of the effect of out-of-pocket spending on health care. In the absence of an effective regulatory authority for the private sector the quality of medical care is constantly deteriorating. Prime Minister Manmohan Singh cautioned against the ills of over-privatisation of medical services recently.

Who is in charge of the US health care system? Anarchy and chaos stand side by side. Government funding in aggregate constitutes nearly 50 per cent of all US health care expenditures. Who can “order” that patient safety measures should be put into effect? Who can arrange compatible computerised medical records at home, the doctor’s office and the hospital? Who can ensure that the quality of care provided in the physician’s office is above a certain standard? No one. Actually, we get a lot of testing, medication, surgeries, hospitalisations and all the rest.

In India, the situation resembles that of the US except that our health budget is very low in comparison. The money spent from all sources in the American health care system is extraordinarily large, some $1.7 trillion in 2004, one-seventh of the total US economy, and larger than the total economies of most countries of the world. Worse yet, over 45,000,000 Americans are without health insurance. The uninsured are charged up to three times more than those who have insurance. As for emergency rooms, the average visit costs a little over $1,000, which is a high price.

How to fix the broken system? The simplest way is to roll out “Medicare for all”.

Make no mistake, patients should take charge of their own health. Don’t leave everything in the hands of officials in the hospitals. Don’t fall prey to overtesting and overmedication. In the United States, patients are beginning to understand the importance of preserving their own medical records. The ready access to the medical Internet encourages patients to understand their own health problems better.

This is the time for Indian managers of the health care system to devise a mechanism to provide medical facilities to all on the pattern of that in the US No body should be left out, even if he cannot afford to pay the premium for health insurance. The resources of the state and charities can be pooled.

— The writer, an eye specialist, has many books on health to his credit.

Early screening can prevent death from prostate cancer

Washington: Early screening of prostate cancer in men may reduce their risk of death from prostate cancer by as much as 35 per cent, researchers from the University of Toronto have found.

“Early screening with the prostate specific antigen (PSA) is quite controversial. There are many arguments both for and against the efficacy of this form of early screening,” says Vivek Goel, professor of public health sciences and health policy management and evaluation at University of Toronto and one of the senior authors of the study. “Our study shows a fairly significant benefit, and this benefit is demonstrated even among men who were not screened regularly as part of a screening program. There may be greater benefit from an organised screening program,” he added.

Published in the August issue of the Journal of Urology, Goel and Jacek Kopec, a professor at the University of British Columbia, did much of this work while both were part of U of T’s public health sciences department. — ANI

Hernia: the laparoscopic treatment
Dr Navin Chander Raina

Only those not trained or not willing to accept the technology propagate about laparoscopic hernia repair as not being the ideal technique. About 15 years ago when laparoscopic cholecystectomy (gall bladder removal) was introduced in this country a big lobby of surgeons was against its application. Today, how many patients in our country want their gall bladders removed by open surgery and not laparoscopically, particularly if both procedures are adequately detailed to him or her? Frankly speaking, hardly any.

Circumstances eventually prompted most surgeons to accept laparoscopic cholecystectomy and those who failed to keep pace with the technology have gone into oblivion.

Hernia repair too is expected to have a similar evolution.

More than 100,000 inguinal herniorraphies (hernia repairs) are carried out each year in the United Kingdom, making it one of the commonest operations. Newer techniques have superseded the simple suture technique popularised by Bassini about 100 years ago.

Laparoscopic repair has been subjected to a number of randomised trials recently summarised by the European Hernia Trials Group which found that the incidence of recurrence in laparoscopic and Lichtenstein repairs were similar (2.3 per cent and 2.9 per cent, respectively). The only differences in clinical outcomes were a reduction in postoperative pain and an earlier return to work for patients after a laparoscopic repair.

With laparoscopic repair, undiagnosed hernias in the other groin can be identified and repaired at the same time as the index hernia at minimal additional cost in up to 15 per cent of patients.

“Patients do not seem to prefer open repair” — a recent survey of patients who had experienced both open and laparoscopic repairs from the Royal Surrey County Hospital, Guildford, found that 9 out of 10 preferred the laparoscopic approach. A higher cost has always been an issue with the laparoscopic technique. However, taking various factors into account, one feels whatever we spend is overall lower cost for laparoscopic hernia repair. In India, nevertheless, the scenario is different.

With an increasing use of the laparoscopic hernia repair technique, the cost of consumables is expected to come down and, in the years to come, options for open surgery for hernia repair are likely to take a back-seat. About 25 per cent patients need a second operation to repair a hernia in the contra-lateral groin. Many of these hernias would be identifiable laparoscopically at the time of the initial repair and could be treated with little additional cost.

Laparoscopic hernia repair, factually, has not taken off so far, because of lack of training and reluctance of non-laparoscopic surgeons to accept its advantages. Therefore, the following situations are possible: a patient with a primary hernia may see either a surgeon untrained or a surgeon trained in laparoscopic repair.

Unfortunately, quality assurance in medical practice with strict adherence to the code of medical practice is still evolving in India. Therefore, surgeons generally get away with conveying limited information to patients and obtaining “so-called” informed consent. Like the National Institute for Clinical Excellence (NICE), UK, it is possible that a similar medical body would oversee strict following of ethical codes in surgical practice in India in the near future. For the time being, the surgeon does not seem to be under any obligation to refer the patient to a laparoscopically trained colleague unless the patient requests for it.

— The writer is a general and laparoscopic surgeon.

Aspirin therapy for heart patients

London: A new study published in the July 1, 2005, issue of the American Journal of Health System Pharmacy is urging health care providers to recognise that despite decades of evidence that aspirin can prevent heart attacks, some patients are still not receiving this simple and cost— effective therapy.

It is titled the “ASHP Therapeutic Position Statement on the Daily Use of Aspirin for Preventing Cardiovascular Events” and affirms that daily use of aspirin, in combination with other effective drug therapies and modifying controllable risk factors, can prevent first and subsequent heart attacks.

“A daily aspirin is simple, inexpensive, and very effective, yet not all eligible patients are receiving this therapy. That means we are missing opportunities to help patients avoid the devastating effects of heart attacks.” ASHP President Jill E. Martin said.

The therapeutic position statement acknowledges the importance of assessing a patient’s risk for bleeding, which can be a serious adverse effect of taking aspirin.

“Pharmacists are uniquely positioned to help patients reduce their risk factors. The best way to reduce the chance of a heart attack is to combine aspirin therapy with changing controllable risk factors, such as obesity, smoking, high cholesterol and high blood pressure,” Martin added. — ANI