"Back" to Normal

Common sense used to dictate that a person recently suffering from low back pain should spend a few days in bed, so as not to aggravate the injury or increase the pain. But this recommendation has changed in the last decade, as studies show that when it comes to back pain, bed rest can actually increase pain and delay healing.

To compare two treatments for people suffering from back pain beginning in the previous three days, the authors of a recent study assigned patients to one of two groups for four days. One group of patients spent a minimum of 16 hours a day resting in bed and ceased activities, while the other group spent a maximum of 12 hours a day in bed and resumed normal daily activity. The patients, ages 18-65, were seen three times after the initial "treatment" phase: at day six or seven, at one month, and after three months.

Pain intensity, functional disability, and spine stiffness were similar for patients in both groups at all three appointments after treatment. However, a greater percentage of people in the "bed rest" group initially needed sick leave than people in the "normal activity" group (86% vs. 52%, respectively).

Normal activity has emerged as a better treatment option than bed rest for low back pain. Movement allows your muscles and spine to stay strong and flexible. Stay on your feet to prevent back pain and avert its progression to long-term, debilitating pain. Your chiropractor can recommend safe, effective activities to promote or regain a pain-free back.

Reference: Rozenberg S, Delval C, Rezvani Y, et al. Bed rest or normal activity for patients with acute low back pain: A randomized controlled trial. Spine 2002:27(14), pp. 1487-1493.

To learn more about back pain click here.

Alcohol: Worse with Age?

Don't wait too long to drink that wine in the cellar. Unlike the way wine gets better with age, a recent study hints that the older you are, the worse alcohol may be for you.

The Japanese study, appearing in Gerontology, evaluated the relationship between alcohol consumption and cardiovascular health in over 12,000 male workers 20-69 years old. The men were divided into five age groups, then into three "subgroups" based on alcohol consumption levels: nondrinkers, light drinkers (up to two drinks per day), and heavy drinkers (two or more drinks daily).

Light drinking significantly raised blood pressure in middle-aged and elderly groups (ages 40-69), although not in younger subjects, and only significantly decreased unhealthy cholesterol levels in those younger than 60 years. Heavy drinking at all ages significantly increased blood pressure, despite positively affecting cholesterol levels. In all age groups, light drinking raised "good" HDL cholesterol.

This study raises the often-asked question: Should you drink to your health or not? The results imply that even light drinking may increase blood pressure in older adults, despite its beneficial ability to help prevent other cardiovascular risk factors. One to two drinks daily are acceptable in younger adults, as positive effects on cholesterol may outweigh negative side effects.

Reference: Wakabayashi I, Kobaba-Wakabayashi R. Effects of age on the relationship between drinking and atherosclerotic risk factors. Gerontology 2002:48(3), pp. 151-156.

To read more on senior health click here.

Do You Really Kneed Surgery?

Osteoarthritis is a painful condition caused by inflammation and cartilage breakdown in the joints. Over 600,000 knee-osteoarthritis patients undergo arthroscopic surgery each year because they are unable to find relief through other therapy. These $5,000 procedures - the most common orthopedic surgeries - have been shown to relieve pain in approximately half of patients, yet the basis for pain relief is unclear. In effect, this type of knee surgery may offer no real benefits.

In a recent study in The New England Journal of Medicine, 180 knee-osteoarthritis patients received one of two types of arthroscopic surgery (joint flushing or flushing plus surgical tissue removal) or placebo surgery, consisting of only skin incisions and simulated surgery, with no irrigation or insertion of instruments.

Neither surgery group reported less pain or greater function than the placebo group at any time over the two years after the procedure. Average scores on pain scales for each group were virtually the same at one year, and were in fact better for the placebo group. At two years, scores remained almost identical. Also, surgery groups did not experience greater improvements in function at any point, compared to the placebo group.

Billions of dollars are spent on arthroscopic knee surgeries every year, though they appear to provide no measurable benefits. The gains made by recipients may simply be due to a placebo effect; that is, surgery only helps them because they think it will. Factors known to contribute to knee osteoarthritis include obesity, injury, and overuse of the knees. Talk to your doctor of chiropractic about prevention and alternative treatment of this condition.

Reference: Moseley JB, O'Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. The New England Journal of Medicine 2002:347(2), pp. 81-88.

For extremity-pain studies click here.

Avoid the Morning Train

The human body is known to go through rhythmic physiological cycles each day, as the body responds to ambient light, activity levels, mealtimes, and sleep. Similarly, our immune systems appear to be affected by the time of day, or by the time of day that we exercise, based on a recent study in the British Journal of Sports Medicine.

At 6 a.m., 14 competitive male swimmers performed a 400-meter crawl five times in a row, with one minute of rest between each 400-meter set. They repeated the same swim session on a separate day, but at 6 p.m. After each swim session, saliva samples were taken from the swimmers and measured for secretions of cortisol and IgA. Cortisol is a stress hormone that indicates a weakened immune system; conversely, IgA is a substance that helps the body fight respiratory tract infections.

Morning swims were associated with the production of significantly higher levels of cortisol and lower levels of IgA in the swimmers' bodies. In other words, swimmers who train in the morning may be at a higher risk for upper respiratory tract infections than those who train in the evening.

Don't misinterpret these findings, though. They don't necessarily apply to other sports, and working out in the morning is certainly better than not working out at all. If your schedule is flexible enough, however, consider swimming later in the day, rather than right after you wake up - especially if you're already feeling "under the weather."

Reference: Dimitriou L, Sharp NCC, Doherty M. Circadian effects on the acute responses of salivary cortisol and IgA in well-trained swimmers. British Journal of Sports Medicine 2002:36, pp. 260-264.

For more tips on working out click here.

Some Like It Hot

The two most popular nonprescription medications in the U.S. - ibuprofen (i.e., Advil) and acetaminophen (i.e., Tylenol) - have been promoted as "first-line" management of acute low back pain. These analgesics may cause potential kidney, stomach, and liver problems, however. Self-administered topical heat wraps may offer a drug-free alternative treatment for acute back pain.

In a recent study in the journal Spine, the authors compared eight hours/day of low-level topical heat therapy with maximal recommended dosages of ibuprofen and acetaminophen. Pain, muscle stiffness, disability, and back flexibility were compared in almost 400 people with back pain, ages 18-55, over two days of therapy and two days of follow-up.

Heat-wrap therapy was more effective than either drug. Heat wraps were significantly more effective than ibuprofen and acetaminophen in terms of self-reported pain relief. In the heat-wrap group, back flexibility was greater, and disability and muscle stiffness were lessened to a greater degree.

Based on these findings, continuous low-level heat-wrap therapy may be better than painkillers for acute back pain. Your doctor of chiropractic can tell you more about this noninvasive, drug-free pain treatment, which involves simply wrapping a Velcro belt with a heating element around your torso.

Reference: Nadler SF, Steiner DJ, Erasala GN, et al. Continuous low-level heat wrap therapy provides more efficacy than ibuprofen and acetaminophen for acute low back pain. Spine 2002:27(10), pp. 1012-1017.

To learn more about back pain click here.

Too Many Tonsillectomies?

Tonsillectomy, or removal of the tonsils, is the most common major surgery performed on children in the U.S. In 1996, nearly 300,000 children under age 15 underwent some form of tonsillectomy to prevent serious or recurring infections. This surgery has been around forever, and is proven effective for children with severe, recurrent throat infections. Yet insufficient evidence supports this procedure in children with only moderate infections.

In a study at the Children's Hospital of Pittsburgh, over 300 children ages 3-15 were utilized based on the determination that they suffered from throat infections to a greater degree than recommended for surgery under current guidelines, but to a lesser degree than children in previous studies on the effectiveness of tonsil removal. Children received either no surgery or one of two forms of tonsillectomy.

Although surgery groups showed lower rates of throat infection than nonsurgery groups over the three years after surgery, rates of moderate-to-severe infection were still considered "low" in nonsurgery groups. Also, despite a slightly lower infection rate, nearly 10% of the children who had surgery developed complications.

Under current guidelines, it appears that too many tonsillectomies are being authorized. The authors of this study in Pediatrics conclude that the relatively insignificant advantage currently gained from tonsillectomies in moderately affected children does not justify the risks, pain, and financial costs involved.

Reference: Paradise JL, Bluestone CD, Colborn DK, et al. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics 2002:110(1), pp. 7-15.

For more information about pediatric health, click here.

Caffeine Keeps Going, and Going...

You're not alone drinking that morning cup of coffee. Around 85% of Americans drink caffeine daily in the form of coffee, tea, or soft drinks. People take caffeine because it is a stimulant - our bodies respond to caffeine essentially the same as they do to stress - but its effects may last longer than you might expect, based on a recent study in Psychosomatic Medicine.

Forty-seven healthy, habitual coffee drinkers were followed for three days to monitor blood pressure, heart rate, and hormonal changes based on caffeine consumption. The individuals were monitored through a normal day of drinking coffee; a day when given caffeine pills twice (total equivalent to four cups of coffee); and a day when only given placebo pills containing no caffeine.

Caffeine significantly raised both diastolic and systolic blood pressures and increased levels of epinephrine (a stress hormone) in the body by 32%, which in turn increased feelings of stress. Also, although all caffeine pills were given prior to 1 p.m., their effects lingered until bedtime.

Even eight hours after caffeine consumption, one-quarter of the amount consumed remains in your body. Stress reactions and higher blood pressure caused by caffeine may be dangerous, so try to limit yourself to one cup of coffee or tea each morning, and avoid caffeine altogether in the afternoon and evening.

Reference: Lane JD, Pieper CF, Phillips-Bute BG, et al. Caffeine affects cardiovascular and neuroendocrine activation at work and home. Psychosomatic Medicine 2002:64, pp. 595-603.

To find out more about nutrition studies click here.

"Just" Hormones?

Many women take estrogen plus progestin, a form of hormone replacement therapy, to combat the negative side effects associated with menopause. That may not be the case in the near future, however. After health risks were determined to exceed benefits, earlier this year, the safety monitoring board for the Women's Health Initiative (WHI) halted an eight-and-a-half-year study on postmenopausal women taking estrogen plus progestin.

The WHI, which seeks to define risks and prevention strategies for heart disease, cancer, and fractures in postmenopausal women, enrolled women ages 50-79 in a set of studies between 1993 and 1998. One study of nearly 17,000 women compared estrogen plus progestin in one daily tablet to a placebo tablet (i.e., sugar pill).

Just over five years into the study, however, the risk for invasive breast cancer exceeded the "stopping boundary" for the study, and risks from taking the estrogen plus progestin were deemed too high to continue the trial. Compared to women taking placebo, women taking hormones were significantly more likely to suffer a stroke, breast cancer, or heart disease.

Although progestin plus estrogen is intended in part as a primary prevention for heart disease and death, it actually may increase risk for the condition. If the study had continued for several more years, the risks from taking these combined hormones may have been much worse.

Reference: Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. Journal of the American Medical Association 2002:288(3), pp. 321-333.

For more tips on women's health issues, click here.