Healthy Tips

Simple Therapy for Back Pain

Paracetamol and keeping active are the best cures for back pain, according to Australian researchers who warn that other treatments do not work.

A Lancet study of 240 back pain sufferers found anti-inflammatory drugs and spinal manipulation did not make any difference to recovery time.

Yet currently, both treatments are recommended in several guidelines.

Experts said patients needed to be reassured that avoiding bed rest and taking paracetamol would work.

Researchers at the University of Sydney assigned patients to receive either an anti-inflammatory drug called diclofenac, a dummy drug, spinal manipulation or fake manipulation therapy.

They had already received simple treatment advice from their GP to keep active, avoid bed rest and take paracetamol for the pain.

The study found no difference in recovery times after 12 weeks in patients who also received diclofenac or spinal manipulation.

Almost all the patients had recovered by the end of the study no matter what treatment they had received.

Adverse effects

Study leader Mark Hancock said there was no clinical benefit from the additional treatments.

And both non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac or ibuprofen, and spinal manipulation are associated with adverse effects, he added.

“GPs can manage patients confidently without exposing them to increased risks and costs associated with NSAIDs or spinal manipulative therapy,” he said.

Dr Bart Koes from the Department of General Practice at Erasmus University in the Netherlands, who wrote an accompanying article in The Lancet, said the results were probably applicable to other non-steroidal anti-inflammatory drugs, such as ibuprofen.

He told the BBC: “It is very likely that for many patients with acute low back pain currently treated with NSAIDs and/or spinal manipulation this would not have been needed if adequate first-line treatment with paracetamol and advice and reassurance was given.”

Dr Stuart Derbyshire, senior lecturer in the School of Psychology and expert in pain at the University of Birmingham, also agreed with the findings.

“For most people, providing simple care and advice should guide the patient through their acute phase of pain and allow them to return to normal life when that acute phase is over.”

Back pain is the largest single cause of sickness absence from work.

But Tony Metcalfe, president of the British Chiropractic Association warned the therapy in the study could not be compared with the treatment provided by chiropracters in the UK.

“Spinal manipulation is just part of a package of care offered by BCA chiropractors which also includes lifestyle and posture advice, rehabilitation and specific exercises.”

He added that spinal manipulation therapy is a safe treatment and none of the study participants reported serious adverse reactions.

Nia Taylor, chief executive of BackCare said the key message for people was to keep moving.

“We know that many GPs feel ill-equipped to help patients with low back pain and sometimes people are not given the right advice and reassurance when they first see a GP.”

She added: “In the UK a standard appointment of 10 minutes may not be long enough to give adequate advice and reassurance and convince the patient that a regime of paracetamol and keeping active is enough to ensure recovery.”

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Sources: BBC NEWS:Nov 9th. ’07

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Healthy Tips

Sitting Straight ‘Bad for Backs’

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Sitting up straight is not the best position for office workers, a study has suggested.


Scottish and Canadian researchers used a new form of magnetic resonance imaging (MRI) to show it places an unnecessary strain on your back

They told the Radiological Society of North America that the best position in which to sit at your desk is leaning slightly back, at about 135 degrees.

Experts said sitting was known to contribute to lower back pain.

Data from the British Chiropractic Association says 32% of the population spends more than 10 hours a day seated

Half do not leave their desks, even to have lunch.

Two thirds of people also sit down at home when they get home from work.

Spinal angles

The research was carried out at Woodend Hospital in Aberdeen, Scotland.

Twenty two volunteers with healthy backs were scanned using a positional MRI machine, which allows patients the freedom to move – so they can sit or stand – during the test.

“Our bodies are not designed to be so sedentary” says Rishi Loatey, British Chiropractic Association

Traditional scanners mean patients have to lie flat, which may mask causes of pain that stem from different movements or postures.

In this study, the patients assumed three different sitting positions: a slouching position, in which the body is hunched forward as if they were leaning over a desk or a video game console, an upright 90-degree sitting position; and a “relaxed” position where they leaned back at 135 degrees while their feet remained on the floor.

The researchers then took measurements of spinal angles and spinal disk height and movement across the different positions.

Spinal disk movement occurs when weight-bearing strain is placed on the spine, causing the disk to move out of place.

Disk movement was found to be most pronounced with a 90-degree upright sitting posture.

It was least pronounced with the 135-degree posture, suggesting less strain is placed on the spinal disks and associated muscles and tendons in a more relaxed sitting position.

The “slouch” position revealed a reduction in spinal disk height, signifying a high rate of wear and tear on the lowest two spinal levels.

When they looked at all test results, the researchers said the 135-degree position was the best for backs, and say this is how people should sit.

‘Tendency to slide’

Dr Waseem Bashir of the Department of Radiology and Diagnostic Imaging at the University of Alberta Hospital, Canada, who led the study, said: “Sitting in a sound anatomic position is essential, since the strain put on the spine and its associated ligaments over time can lead to pain, deformity and chronic illness.”

Rishi Loatey of the British Chiropractic Association said: “One in three people suffer from lower back pain and to sit for long periods of time certainly contributes to this, as our bodies are not designed to be so sedentary.”

Levent Caglar from the charity BackCare, added: “In general, opening up the angle between the trunk and the thighs in a seated posture is a good idea and it will improve the shape of the spine, making it more like the natural S-shape in a standing posture.

“As to what is the best angle between thigh and torso when seated, reclining at 135 degrees can make sitting more difficult as there is a tendency to slide off the seat: 120 degrees or less may be better.”

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Back Car

Sources: BBC NEWS:

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Standing Tall, Walking Erect

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Joints are constantly used during a lifetime of activity. Worn out cells are efficiently replaced. If the rate of repair falls below the rate of damage, painful degenerative osteoarthritis sets in. This generally occurs earlier in overweight individuals, smokers and those with complicating medical illnesses such as diabetes.

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Around 75 per cent of the population over the age of 65 has X-ray evidence of osteoarthritis in the hips or knees. Such people may complain of stiffness, especially after a period of inactivity. There may be difficulty in standing up, stepping and walking. The gait may be waddling and abnormal. There may be dull ache or a sharp, stabbing radiating pain. The knees may be obviously deformed and bent. Balance becomes a problem and frequent falls may occur.

Lifestyle modifications are required for the management of osteoarthritis, and this may include cessation of smoking, treatment of underlying diseases and weight loss.

A common misconception is that exercise will “wear out” an osteoarthritic joint. Low-impact exercises such as walking and cycling are actually beneficial. Physiotherapists can teach effective quadriceps-strengthening exercises (for the knees) and hip motion exercises. These increase flexibility. Strengthening the muscles surrounding an affected joint helps to hold the bones in place, reduces pain and maintains mobility. Exercises must be performed every day for them to be effective. If discontinued, accrued benefit disappears in three days. Patients who participate in exercise programmes have less pain and depression and improve faster than those who rely on medications alone.

Topical application of creams and ointments containing capsaicin (an extract of green pepper), applied four times daily, provide excellent pain relief.

Many patients with osteoarthritis of the hip and knee are more comfortable if they wear slippers with good shock-absorbing properties.

Canes are an excellent aid when held on the unaffected side of the body. For maximum effectiveness, the top of the cane’s handle should reach the patient’s wrist crease (when the patient is standing with arms straight down). Such canes can reduce hip and knee weight bearing by 20 to 30 per cent.

If the person is still incapacitated, medications can be used. In older individuals, dosage has to be carefully monitored to prevent kidney or liver damage.

Paracetamol is the probably the safest drug. It provides excellent pain relief. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibubrufen or diclofenac can be used for a short time. The “Cox” group, which includes celecoxib, is also effective.

Anecdotal evidence suggests that “food supplements” such as glucosamine sulphate and chondroitin sulphate are safe and effective in patients with osteoarthritis. Actual studies, however, have not demonstrated any proven benefit.

If there is pain and disability despite these simple measures, affected joints can be injected with steroids or hyaluronic acid analogues.

Surgical intervention is also an option. The joint can be viewed, lavaged and debrided through an arthroscope.

Hips and knees can now be replaced. This should be considered if there is severe persistent pain, loss of motion, inability to stand or climb stairs, deformity and if all other therapies have failed. Earlier, replacement was an option reserved primarily for severely affected adults over 60 years. The artificial joints were heavy and maladroit, and the surgery was long and complicated. But now, research has converted the clumsy, original hinge joint into an engineering marvel. Lightweight biocompatible and durable materials such as plastic, titanium and stainless steel are now used. They resist corrosion, degradation and wear. Surgeons no longer need to make 12-inch incisions to replace the joints. Keyhole surgery is possible.

Replacement surgery is successful in more than 90 per cent of patients. Age is no bar to this procedure though it is marginally riskier in older people with other complicating illnesses. (Britain’s Queen Mother underwent the surgery at the age of 95, and survived for six years after that). If the surgery is performed in active, younger individuals, the replaced joint itself can get worn out after 15 or 20 years, requiring a second surgery.

Physiotherapy speeds recovery and strengthens the muscles supporting the new joint, enabling rapid mobilisation. Within a few days, sitting up or even supported walking with crutches or a walker is possible. Eventually, within a month, unsupported walking is possible.

Squatting is not possible after replacement surgery. High-impact activities such as running are better avoided but swimming, walking and cycling are possible.

Two joints should not be operated simultaneously. There should be least a month’s gap in between surgeries.

Walking is an essential function for all age groups. Effortless walking requires coordination and unhindered functioning of the bones and joints involved. Replacement surgery does this, giving patients a new lease of life.

Sources:The Telegraph (Kolkata,India)