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By admin, October 3, 2007 3:28 pm

Medscape Today is reporting on a study from the September 1st issue of
Spine which stated that greater use of spine fusion surgery and new
surgical techniques have actually resulted in an increase in lumbar
spine re-operation rates.

Apparently the authors of the study expected
the opposite would have been the case. Rates from 1990 – 1993 were
compared with rates from 1997 – 2000 with about 25,000 patients in
each cohort. Between the two time periods the prevalence of fusion
increased from 9.4% to 19.1% while the 4-year cumulative incidence of
re-operation rose from 12.4% to 14%. Fusion patients treated between
1997 and 2000 were 40% more likely to undergo re-operation within the
first year than those patients treated between 1990 and 1993.

Brook I. Martin, lead author from the University of Washington in Seattle,
stated that surgeons “should be alarmed by the rising rates of
re-operation” and should be more careful to select patients whom
surgery will most likely benefit. Furthermore, doctors should inform
their patients that “surgery involves substantial risk for subsequent
operations.”

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By admin, September 22, 2007 4:51 pm

Be Smart About Luggage

• Lift luggage in stages. Move slowly when lifting your luggage and break the action into smaller parts. For example, when lifting a bag into an overhead bin, it can first be lifted to the arm of the seat, then to the top of the seatback, and then into the bin in separate motions.

• Never twist while lifting. Never, never, never. This is a common cause of injury to the low back. Pivot with your feet so that your whole body moves instead of just twisting your back. Nuff said.

• Better yet, avoid lifting. Ask a flight attendant for help. If you explain you have back condition, you will be surprised how helpful the airline staff will often be. If your bags are small and light, it will be less of a burden to ask someone to do this for you.

• Ship ahead. This is my favorite solution for luggage – just mail your stuff on to your destination ahead of time. This way you avoid luggage entirely and can carry just one small bag onboard with you. No schlepping. No hassle. No pain.

• Pack light. Use 2 or 3 smaller bags rather than one large/heavy bag, especially if you will have to lift the bags in/out of car trunks, off airport baggage carousels, into and out of overhead bins, etc.

• Use a backpack. Do not sling a bag over one shoulder (unless it is a very light handbag). Use a good quality lightweight backpack – and wear it using both straps. The generally recommended maximum weight of a backpack is 10 – 15% of your body weight – less if you have a painful back. Using backpack has the added advantage of leaving your hands free to hold onto handrails on escalators, stairs, the boarding ramp, etc.

Proactively Manage the Airline Service

• Get an aisle seat. Ask for an aisle seat out of medical necessity (stress medical necessity). It is easier to get into and out of an aisle seat, and allows you to get up and move around the cabin more easily. Since back pain can’t be seen, traveling with a letter from your doctor that explains your condition will help you get accommodations such as an aisle seat.

• Get wheelchair assistance. Make sure the airline knows you are handicapped so they will wheel you around with a wheelchair. You won’t have to carry your bags, walk to the gate, or stand while waiting in line at security. It is best to do this when you make the reservation. You just need to ask for wheelchair assistance to the plane door. Even if it is supposed to be just a short walk to the gate, remember that gates can change, there may be a lot of standing in line when going through security, and other issues may arise that would make a wheelchair worthwhile.

• Ask for a row of seats. If the airplane isn’t full, when booking see if you can get the last row of seats (which usually no one else wants). Then you can pull up the seat arms and lie down.

• Recline. For many back conditions, sitting in a slightly reclined position is least stressful on the back. If this is the case, remember to check that your seat will recline when making your reservation and getting a seat assignment. Some seats in exit rows or at the back of the plane to not allow you to recline.

• Stretch key muscles. Sitting for extended periods can cause stiffness and tension in the hamstrings (the muscles in the back of the thighs) and hip flexor muscles, which in turn puts added stress on the low back. Ask your doctor for a few safe hamstring and hip stretches you can do while traveling.

• Preboard. When they call for pre-boarding for people who need assitance, that’s you. Make sure the gate agent knows you will need to pre-board. Conversely, if sitting for a moment longer than necessary will be unbearable, then board very last. If you do this, make sure your carryon can fit beneath your seat, because if you board last the overhead bins might already be full.

• Consider a handicapped parking sticker. If you will be parking at the airport but have trouble walking very far, you can ask your doctor to fill out an application for a handicapped parking sticker to be able to park nearest the airport entrance.

• Avoid getting bumped. Due to overbooking, a practice that seems common lately, getting a seat assignment in advance can reduce the risk of getting ‘bumped’. If no seat assignment is given when you buy your airline tickets online, call the airline to get seat assignment immediately. If you arrive at the ticket counter without seat assignment on an overbooked flight, you probably will get bumped off the flight and forced to take a later flight – which can be several hours or even one or two days later.

Sit with support

• Fix the seat. Place a small rolled-up airline pillow, blanket, or a towel or lumbar pillow between your back and the seat to support the natural inward curve of your lower back. You may also use commercial low back supports if you prefer. Supporting the curve in your low back is especially important with many airplane seats, as they are often worn out and force your lower back to an unnatural, stressful position. If the bottom of the seat is concave from too much use, place a folded blanket on the seat.

• Use your feet. Bottom-up leverage from your feet is also required to support your low back. While seated, your knees should be bent at a right angle. If your seat is too high, place your feet on something that can act as a firm footrest – like a book or box – to keep your knees at a right angle and avoid stressing the low back.

General advice

• Bring a letter. Get a letter from your physician explaining your condition, medications and treatment requirements. This can come in handy in many ways — when requesting an aisle seat, wheelchair assistance, getting your medications through security, if you need medical care while traveling, etc.

• Drink water. Water circulates healing nutrients and oxygen throughout the body. Drink water frequently to help keep your pain at bay and keep your body nourished.

• Get up and move. Sitting in one position for extended periods of time stiffens the back muscles, which can put stress on the spine. Get up and stretch and move around every 20 to 30 minutes if possible. Movement stimulates blood flow, and blood brings important nutrients and oxygen to your back, reducing stiff muscles, helping curb inflammation. Movement also helps prevent blood clots from forming in the leg (called deep vein thrombosis), which is one of the most dangerous risks of sitting still for long periods.

• Wear slip on shoes. Wear good, comfortable supportive shoes if you will be walking distances through airports, train stations, etc. Slip on shoes are the best, because its easy to get them on and off (without having to bend over) when going through security.I also advocate diversion to help keep the pain at bay, especially if traveling will be stressful for you. One option is to treat yourself to something special – a great new book or movie – during the flight. Another option is to do something for someone else (write a letter to an elderly relative or neighbor, write down memories of your children, etc.) to focus your mind elsewhere.

Happy travels!

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By admin, September 19, 2007 12:27 pm

This doctor is the only one in the world who does this technique? Sorry but there are 10,000 chiropractors in California alone who would beg to differ. This is standard stuff taught in chiropractic school. Watch the video below and make sure to call us if you have knee pain.

http://cbs13.com/health/local_story_257182857.html

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By admin, September 14, 2007 11:33 am

Trauma patients 5 times more likely to suffer facial dysfunction after a crash

THURSDAY, Aug. 30 (HealthDay News) — About one in three people who suffer whiplash is at risk of developing delayed jaw pain/dysfunction that may require treatment, a Swedish study finds.
Publishing in the August issue of the Journal of the American Dental Association, researchers at Umea University studied short- and long-term temporomandibular joint (TMJ) pain and dysfunction in 60 patients involved in rear-end car collisions. The patients were checked when they were brought to hospital emergency rooms after a crash, and again one year later.
Patients who suffered whiplash were five times more likely to have TMJ pain and/or dysfunction immediately after a crash than uninjured people in a control group. A year later, 34 percent of whiplash patients had developed TMJ symptoms, compared with 7 percent of those in the control group.
The TM joints, located on each side of the head, work together to enable movements needed to speak and chew. Problems that affect the proper function of this system of muscles, ligaments, discs and bones can result in a painful TMJ disorder, according to the American Dental Association.

If you are having jaw or TMJ pain call us today to make an appointment, we have successfully treated many people with jaw pain.

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By admin, September 12, 2007 8:49 am

Recently I had a disturbing conversation with a patient from a company which supplies drug data to many hospitals and doctors to help them minimise Adverse Drug Reactions (ADRs). “One in twenty deaths is associated with ADRs.” she told me. I was amazed. I knew there had been a report in the British Medical Journal in 2004 that had concluded that ‘the true rate of death in Britain from adverse drug reactions, excluding potential overdoses, may therefore be greater than 10,000 per year.’(the author was Pirmohamed).

But this woman was suggesting the true figure was far more; three times more in fact. You can do the math. Approximately 600,000 people die every year, so one in twenty gives you 30,000 annual deaths. Compare that with the 3,200 a year killed by road accidents.

However it’s the kind of figure that supporters of prescription drugs would dismiss as anecdotal. But today her figures receive dramatic confirmation. A large study published in the Archives of Internal Medicine reports that in the States the number of reported fatal ADRS from prescriptions drugs has gone up by about three times.

“From 1998 through 2005,” it concludes “reported serious adverse drug events in the US increased 2.6-fold from 34,966 to 89,842, and fatal adverse drug events increased 2.7-fold from 5,519 to 15,107.” At first sight that doesn’t look like very many. But remember that the number of reported ADRs are a tiny fraction of actual ADRs. In fact back in 1994, the number of fatal ADRs in America was estimated to be over 100,000 per year (Lazarou, JAMA, 1998). If that figure were a true reflection, and the situation has got three times worse, then one would be talking in excess of a quarter of a million people!

One reason for the increase could be that people are taking three times as many drugs. But the study covered that. “Reported serious events,” wrote the authors “increased 4 times faster than the total number of outpatient prescriptions during the period.” It is, of course possible to dream up other reasons for the huge increase but the authors drew the obvious conclusion: “These results highlight the importance of this public health problem and illustrate the need for improved systems to manage the risks of prescription drugs.”

What amazes me most is the complacency we, as a society, have about this. Where is the Citizens Action Group, the Government Commissioned investigation or independent department charged with urgently reducing this tragic state of affairs with independent funding?

Until that happens it obvious that anyone on drugs is going to have to be much more aware of balancing the harm against the benefit. The next time you have an ache or pain think twice about taking drugs, pick up the phone and call us for natural healthy chiropractic care.

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By admin, September 10, 2007 2:33 pm

Relationship Between Early Opioid Prescribing for Acute Occupational Low
Back Pain and Disability Duration, Medical Costs, Subsequent Surgery and
Late Opioid Use.

Spine. 32(19):2127-2132, September 1, 2007.

Study Design. Retrospective cohort study of workers’ compensation (WC)
claims with acute disabling low back pain (LBP).

Summary of Background Data. Opioid analgesics have become more accepted
for acute pain management. However, treatment guidelines recommend
limited opioid use for acute LBP management. Little is known about the
long-term impact on outcomes of opioid use for acute LBP.

Conclusion. Given the negative association between receipt of early
opioids for acute LBP and outcomes, it is suggested that the use of
opioids for the management of acute LBP may be counterproductive to
recovery.

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By admin, August 29, 2007 6:20 pm

August 23, 2007 — Daily back pain is associated with decreased quality of life, mobility, longevity, and increased risk for coronary heart disease (CHD) in elderly women, according to the results of a study reported in Spine.

“The consequences of back pain in elderly people have not been well studied, perhaps because its high frequency has resulted in the symptom being regarded as ‘normal’,” write Kun Zhu, PhD, from the Sir Charles Gairdner Hospital in Nedlands, WA, Australia, and colleagues. “Because there has been no study that investigated the association between the frequency of back pain, a good index of the severity of back pain, and the risk of incident heart disease and mortality, the aim of this study was to assess the prevalence of self reported back pain frequency at baseline and 5 years later in a community based cohort of 1484 elderly Australian women and evaluate its long-term impact on the health of the individuals with this complaint.”

The investigators analyzed data from 1484 community-dwelling Australian women 70 to 85 years old who were enrolled in a 5-year randomized controlled trial of calcium intervention with observational cohort design.

“Daily back pain is associated with reduced quality of life, mobility and longevity and increased risk of coronary heart events,” the investigators write. “The adverse health effects of chronic back pain deserve greater recognition.”

“Management of back pain and health conditions related to back pain is likely to be important in the maintenance of functional independence and well-being of elderly women,” the study authors conclude.

The Healthway Health Promotion Foundation of Western Australia, the Australasian Menopause Society, and the National Health and Medical Research Council of Australia supported this study.

Spine. 2007;32:2012-2018.

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By admin, August 17, 2007 9:41 am

In this day and age many people use their laptop as their primary computer, so it’s important to have it setup correctly in order to avoid back pain, neck pain, and other musculoskeletal injuries or strains. The problem is that laptop computers are designed with portability in mind rather than sound ergonomic principles. Basically, if the screen is at the right height then keyboard is too high, and if the keyboard is in the right position, then the screen is too close and too low.And laptop touchpads and trackballs are never very user friendly. Given these challenges, here are 10 simple tips for the best laptop setups:

1. Use a large screen. Get a laptop with the largest screen possible for your needs to avoid the stressful posture that results from straining to see the text on a small screen. Many laptops offer large screens (15″ plus), but these can be difficult to use while on the go. There are a number of smaller notebook and ultra-portable laptops on the market, and while a smaller screen (12.1″) can be useful in mobile settings, make sure that you’re able to read the screen characters and easily use the keyboard (the smaller the laptop, the smaller the keyboard). If you find yourself straining to see your screen, increase the font size.

2. Place the screen at eye level. Ideally, set your laptop height and screen angle so you can easily view the screen without bending or rotating your neck, and put it about an arm’s length in front of you. To do this, you will usually need to elevate the laptop a few inches above your desk, which you can do by placing it on a stable support surface such as a laptop stand or on a thick book.

3. Don’t slouch. Despite the name “laptop”, you want to avoid propping your laptop on top of your lap as this requires you to slouch down to see the screen.If you have to work on your lap, such as while you’re on the train, at least put the laptop on top of your computer bag or briefcase so you can raise it up slightly.

4. Use a separate keyboard. When using the laptop for extended periods, use an external, full-sized keyboard with your laptop and position it at a height that allows your shoulders and arms to be in a relaxed position, with your elbows at a 90° angle when typing. Ideally, place the separate keyboard on a keyboard tray beneath your desk surface to help ensure that your wrists stay in a neutral (flat) position.

5. Use a separate mouse. Be kind to your wrists by using an independent mouse rather than the mouse that’s incorporated into your laptop keyboard. Ideally, place the mouse on an adjustable-position mouse platform so you can keep it near your body and keep your wrist flat while using it.

6. Recline slightly. If you can’t use a separate keyboard and mouse, an alternative is to find a chair that allows you to recline slightly. This will allow you to position the laptop keyboard and mouse with the least strain on your neck. Angle the screen slightly upward so that you can view the screen without having to bend your neck too far down.

7. Prop up your feet. If you have to raise your chair so that your arms and wrists are positioned comfortably, check to see how your legs are angled. Your knees should be at about the level of your hips. If your hips are too high, you need to put a footrest or small box under your feet to prop them up and keep excess strain off your lower back.

8. Make your chair work for you. The type of office chair you use is critical.Basically, any office chair that is fully adjustable and has lumbar support will work, but you need to be sure to set it up correctly.Follow this diagram on how to set up your office chair.

9. Take a break. Take brief breaks every half hour, at the very least taking your eyes off the screen and letting them rest on something in the distance, and doing some simple stretches while at your desk, such as stretching your neck, shoulders, arms and legs. Every one or two hours, leave your desk to walk around to get your blood flowing and move your muscles. Downloadable Stretch Break™ software reminds you to stretch and gives you stretching ideas.

10. Travel light. Be careful when carrying your laptop around. The power supply cord, spare battery and other accessories in your laptop bag may add a lot of weight. If you carry your laptop to work and home again, get duplicate power cords and other peripheral components to leave in each place so that you don’t have to carry everything back and forth. Carry your bag across your lower back in a messenger bag style, or use a backpack with dual padded shoulder straps (and avoid draping the bag over just one shoulder). If your laptop and components weigh more than 10 lbs, a roll-along carrier is the best choice.

I realize that not all of the above tips will always be practical, but if you use your laptop daily, paying attention to how you set it up will go a long way to easing back pain and strain on your joints and muscles.

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By admin, August 8, 2007 2:07 pm

http://www.memag.com/memag/article/articleDetail.jsp?id=144764&sk=&date=&&pageID=1

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By admin, August 8, 2007 2:01 pm

1: Clin Orthop Relat Res. 2005 Aug;(437):251-9. Links
More evidence of educational inadequacies in musculoskeletal medicine.

Schmale GA.
Children’s Hospital and Regional Medical Center, University of Washington, Seattle, 98105, USA. gschmale@u.washington.edu
In their study, Freedman and Bernstein suggested that 80% of a group of graduates from many of the best medical schools in the United States were deficient in their knowledge of basic facts and concepts in musculoskeletal medicine. How do these results compare with results from students attending a medical school with a long-standing dedicated program to musculoskeletal education? Does additional clinical experience in musculoskeletal medicine improve understanding of the basic facts and concepts introduced in a second-year course? A modified version of an exam used to assess the competency of incoming interns at the University of Pennsylvania was used to assess the competency of medical students during various stages of their training at the University of Washington. Despite generally improved levels of competency with each year at medical school, less than 50% of fourth-year students showed competency. Students who completed a musculoskeletal clinical elective scored higher and were more competent (78%) than students who did not take an elective. These results suggested that the curricular approach toward teaching musculoskeletal medicine at this medical school was insufficient and that competency increased when learning was reinforced during the clinical years.

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