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specific gene variants can foresee which martial service members are more effected to develop persistent,

From 2000 to 2011, there were 6,144 amputations among 5,694 injured service members, according to the Armed Forces Health Surveillance Center. More than one-third had main amputations, defined as the loss of a hand, foot, leg and more. The reported happening for persistent, residual limb pain after amputation

“Traumatic amputations of limbs profoundly change the lives of affected martial service members,” Andrew D. Shaw, MD, associate professor of anesthesiology and critical care medicine, Duke University Medical Center, Durham, N.C., said in a news release. “Persistent pain after amputation is a serious problem with no effective treatments. By identifying these ‘pain genes,’ we may be able to discover the reasons why pain occurs and predict which patients are more likely to have it. In the future, we hope to discover the biology of persistent pain and develop ways to combat it.”

In the study, investigator collected blood from 49 return active duty service members who had amputations and persistent pain. DNA, RNA and plasma were extracted from the persons samples, which then were mapped using Whole Exome Sequencing technology to identify any variations the participants have in common.

Hundreds of new DNA sequence variations were identified as pathways of biological importance as the possible source of chronic, persistent pain for service members, according to the study.

“In particular, inflammation and the interaction between white cells and the extracellular matrix appear to have central importance,” the researchers wrote in the abstract.

According to Shaw, the study was one of the first to identify pain genes in humans using sequencing, even though some of them have been identified in lab studies.

“Now that we have identified these gene variations, we need to study them and then create new medicines to prevent and relieve the chronic pain for these patients,” Shaw said in the release

chronic pain after amputation, according to a study presented Oct. 14 at the Anesthesiology 2013 annual meeting in San Francisco.

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Many different modalities used in physical therapy plan of treatment local heat or local cold is on of this modalities, It was used from long years , The therapeutic uses of heat is know as thermotherapy while the therapeutic uses of cold is know as cryotherapy

A- Local Heat

1- Hot Packs

kept at 70-75 C , requires 2 hours for initial heat and 30 min between uses

Advantage : 

easily , inexpensive
short time required
safe , and there is different shapes

2- Paraffin Paths

The temp of Paraffin Paths 45 - 50 C

Advantage :

maintain good contact,
easily , inexpensive
the part can be elevated

3- Fluidotherapy 

the temp is controlled its dry heating agent that transfers heat by convection

Effect and uses of heat
A- Effect

1- Increase blood flow, application of heat causes Vasodilation ( dilation of capillary )
2- Reduction of muscle spasm and relaxation of muscle contraction
3- heat causes increase extensibility of soft tissues ( stretching )

B- Uses

1- Pain control
2- Increase Rang of motion (ROM)
3- Acceleration of healing

1- Avoid use heat in Acute injury or Inflammation or muscle strain

2- Avoid use heat in hemorrhage cases or over an open wounds or burn
3- Avoid use heat in poor sensation cases
4- Avoid use heat in cases of Thrombosis


1- Cold Packs

temp 0-5 C
duration : 10-15 min, can be repeated after 1-2 hours

Advantage

easy, inexpensive
cover large area of body
can be applied with elevated

2- Ice Massage

Advantage

inexpensive
can be observed during treatment
can be use for small or large area of body

Effect and uses of Cold

A- Effect

1- initial decrease of blood flow then increase in blood flow ( Vasoconstrection then Vasodilation )
2- increase pain threshold and decrease sensation of pain
3- decrease spasticity
4- facilitation of muscle contraction

B- Uses

1- inflammation , acute injury control
2- Edema control by decrease intravascular fluid pressure and increase blood viscosity After trauma using ice with compression and elevation
3- Pain control
4- symptom management in multiple sclerosis

Contraindication of use cold
1- cold hypersensitivity
2- cold intolerance
3- over an area with peripheral vascular disease
4- over an area with circulatory compromise
5- over regenerating peripheral nerve

What the muscles strain? 

muscle strain is overstretch or may be tear of the muscle fibers its common in hamstring muscles and low back muscles

There are 3 grades of strain :

1- Mild strain : its mild tear of muscle fibers and its take from 1-3 weeks to recovery 

2- Moderate strain : its more that mild and the tear is take more number of fibers and need more than 4 weeks or more to recovery 

3- Sever strain or full rupture : its complete tear of muscles fibers or tendons its not common and its can be recovery by surgery then physical therapy that's may take 6 weeks or more 

Sign and Symptoms

1- Pain 

2- Limitation in rang of motion (ROM)

3- Muscle weakness

4- Swelling 

5- Inability to do actives by effected part

Warning 

Avoid using heat, stretching, and massage 

A- Heat can increase risk of inflammation 

B- Stretching delay heeling and make time more longer for recovery
C- Massage can increase severity of the case and can distributed the inflammation area 

Treatment of muscles strain

Physical therapist have a great experience in muscles strain cases and they can deal with muscle strain 

At first physical therapist plan of treatment is to apply The optimal management is the RICE technique its ( Rest, Ice, Compression and Elevation ) for mild and moderate grade of muscles strain
Rest and never use the muscles of effected part at lest 14 week 

Ice to prevent any inflammation and to reduce pain
Compression to keep joint or part as whole from and unwanted movement and reducing swelling by using compression with Elevation the part 

For Sever muscles strain with complete rupture the physical therapist not starting any plain of treatment until the surgery give good result and then applying the same in mild and moderate muscles strain some cases need to use assistive devices like crutches