Wednesday, 27 June 2012 14:46

Post Polio Syndrome

Note: I will continue to update this page as I learn more so do return here from time to time.

Background

Since the mid 1960s, in the UK and other ‘western’ countries Polio has been little known. However before then it was a serious concern, particularly to children. Paralytic poliomyelitis is a ribonucleic acid virus that invades the central nervous system. There was no ‘cure’ for it as the virus caused paralysis in muscles. Those affected suffered a range of disability so there is no ‘typical’ victim. With some it affected one or both legs, with others an arm.

For many years it was considered a chronic but stable condition so no one took much notice after the initial care.

Now, however those people who suffered as children are reaching their late 50s and those who contracted it as young adults are even older, and they have been living with the disability for all those years. This will have taken a toll on the rest of their body and functionality.

Symptomology and Reasons

There is a range of symptoms associated with this:

  • Increased weakness in muscles and in new groups of muscles
  • Fatigue
  • Pain in muscles or joints
  • Intolerance of coldness
  • Problems with breathing or swallowing
  • Change in functional ability associated with the disability

Medically the term Post Polio Syndrome (PPS) has been coined for this. The reasons, according to medical professions, for reaching this stage, when many people will seek medical support, are several, including:

  • Reactivation of the virus
  • Some immunopathologic condition
  • Genetic predisposition
  • Ageing
  • Reduced ability to compensate for the disability

There can also be spinal problems such as scoliosis and/or kyphosis and/or hyperextension (ie forward bend) of the neck.

The first of these will relate to the original illness and the second probably does. The third is probably just a guess while the fourth and fifth are probably to be expected as a result of living with a disability over many years. All of which gives strict diagnosticians problems in reaching their diagnosis because some symptoms and reasons can relate to other problems such as simply living with a physical disability for many years.

To these I, personally, would add:

  • Decreasing ability to compensate for weakness
  • Overuse of compensating muscles
  • Many years of your body being out of balance
  • Stress of living with disability

It seems to me inevitable that anyone who, for many years, has not had full and balanced use of all their physical body will start to suffer as they age. Apart from anything else there is a natural set of changes with anyone as they age. Even those who are very fit, will notice a lessening of their ability in physical activity and changes in their body. There are no 60 year old world record holders of 100 metre sprint – and this does not surprise us.

Treatment Possibilities

As with Polio, there is no cure for these problems. There are some drugs that have helped some people in some cases but as it is difficult to diagnose the exact cause their use is not fully proven.

There are two forms of treatment that have been shown to help and often bring improvements of abilities in daily living. The most tried and demonstrated for helpful long-term treatments are based on physical therapy. The second, less tried but generally found effective when used, is treatment with pulsed electro-magnetic field (PEMF) therapy.

Treatment with Physical Therapy

  1. Hands-on Treatment
    Spineworks does most of its work on the muscle and soft tissue so can be highly appropriate to supporting PPS. It also works on spinal vertebrae and the tissue surrounding the spine so can help with spinal problems and deformity. Other systems, including physiotherapy can also be used.
    1. Passive movement
      Passive movement, with or without stretching, is where the therapist takes (for example) a limb with the client relaxing and moves it just to the edge of its comfort – but not through! It helps to regain joint flexibility and also starts to open new nerve pathways as the limb can be moved in ways the client has not done before, or at least for a long time.
    2. Muscle Release
      It may seem contradictory that when muscles are weak they can also be contracted and this also applies to over-stretched muscle. Within someone with PPS, different muscles can be in different states. Some muscles will also be over strong as they have been used to compensate for weakness in other muscles.
    3. Vertebral Realignment
      In a person with PPS, as with others, there is no advantage in forced realignment but gentle techniques, such as with Spineworks, can help remove both scoliosis and kyphosis. Releasing tightness in the ribs can also help with breathing and flexibility, including in the spine.
    4. 2. Exercise and Movement
      Exercise and movement should form part of a recovery and maintenance programme but there are some specific guidelines to note in the recovery of PPS. Exercise and movement form a large part of Spineworks and most clients will be given some movement – regardless of whether they have PPS.
      1. a. The exercises must not over-fatigue. If a client is already getting fatigue from normal use then doing exercise to increase this will not help. Moderate effort with rest is the mantra and probably not on consecutive days. Pacing yourself and knowing or learning your limits is important.
      2. b. Isometric type exercise and isotonic movement with resistance can both be used both to release muscle tension (with only light effort) and to strengthen weak muscle (with slightly more effort). Thus they are ideal for many muscle problems. In physical therapy this type of work is called Muscle Energy Techniques (MET) and there are many varieties and they can be adapted to work with any muscle given some imagination on the part of the therapist and the client.
      3. c. Occupational Therapy
        Some specialized training such as occupational therapy can help with regular activity, such as walking (gait) and the stress of daily tasks. These usually will need specially trained people.

Treatment with PEMF
PEMF, as previously noted, stands for pulsed electro-magnetic field and is the name given to a range of devices that do precisely what that suggests! They pulse electro-magnetism into your body at varying frequencies.

Don’t be confused by the term TENS since you will doubtless have heard of TENS machines, developed decades ago. TENS stands for trans-cutaneous electrical nerve stimulation which, simply put, means it passes an electrical stimulus across the skin. So, precisely, the general term TENS covers all and any device that passes a current through the skin, including modern PEMF devices. However the term has come to be used for the specific device that many people know, which has the purpose of reducing pain, still a disputed claim.

Modern PEMF has a different aim – to support cell healing. In brief, our cells work at a specific voltage and pH which changes when they are damaged physically or by disease. If  your  body system has insufficient energy to complete healing then a chronic condition sets in. PEMF can restore the voltage to encourage and support the completion of healing.

Wikipedia reports, “The value of pulsed electromagnetic field therapy has been shown to cover a wide range of conditions, with well documented trials carried out by hospitals, rheumatologists, physiotherapists and neurologists.” It is even approved by the FDA in America!

Based on a 2007 clinical trial, Thomas et al. concluded, ”PEMF may be a novel, safe and effective therapeutic tool for use in at least certain subsets of patients with chronic, nonmalignant pain.“ (Thomas, AW; Graham, K; Prato, FS; McKay, J; Forster, PM; Moulin, DE; Chari, S (2007). "A randomized, double-blind, placebo-controlled clinical trial using a low-frequency magnetic field in the treatment of musculoskeletal chronic pain". Pain research & management : the journal of the Canadian Pain Society = journal de la societe canadienne pour le traitement de la douleur 12 (4): 249–58. PMC 2670735. PMID 18080043)

A report in the British Medical Journal stated, “The scores of the 20 placebo patients and the 20 treated patients in each of the measured categories of swelling, pain, and disability were added together. In each category the percentage improvement in the treated patients was about twice that of the placebo patients.” (Fudenberg et al, Treatment of Soft-tissue Injuries by Pulsed Electrical Energy)

There are many PEMF devices available today though cost really determines that some are essentially for clinical use while others are good for home use. The difference is in the sophistication of the internal circuitry and levels of different frequencies and intensities. Most low-cost, home use devices have few or no choice of setting.

For treatment of PPS I would suggest a course of treatments at a clinic with devices such as the Myopulse/Acuscope, Skenar/Cosmodic or the Tennant Bio-modulator. Frequency of treatments could be at least weekly for a time, reducing as symptoms improve. In between sessions home use with a device such as the Micro-Doctor or Painsolv would help to maintain healing. (The Tennant system is the cheapest of the clinical devices and could be considered for home use also as an investment for a lifetime of use.) There are many other devices available but I do not have personal experience with them, do your own research and make your decision.

There are also special thin mats or mattresses ( eg Vita-Life) that give a pulsed field all over your body.  You may find that a mattress cover with magnets can help generally and also for improved sleep.

Some Resources

Feel free to contact me at Spineworks for more information. I can help with treatments in the midlands and London but in any other region you will have to search locally.

These are given without any guarantee:

Wikipedia has articles and many references on polio and post polio syndrome as well as both TENS and PEMF.

General searches on the internet for PEMF and TENS will find more than you can read including many articles and research papers as well as organisations and journals (eg the Journal of Cellular Biochemistry)

In the UK the British Polio Fellowship (www.britishpolio.org.uk) has information and the NHS also on www.nhs.uk/conditions/Polio-and-post-polio-syndrome

And, again, general searches on the web will find many sites with a polio and pps interest.

Your primary doctor or other medical carer may be able to help but detailed knowledge is not widespread.

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