Skeletons in the Closet

In addition to chiropractors, many medical practitioners provide care for the muscles and skeleton. It follows logic that these providers, particularly medical doctors (MDs) and physical therapists, should therefore master the basics of musculoskeletal treatment, which requires a broad knowledge of conditions and symptoms related to the bones, muscles, ligaments, and tendons. Based on a recent study in The Journal of Bone and Joint Surgery, however, medical students may not be studying the skeletons hanging in their classroom closets.

The authors of this study previously reported that 82% of 85 recent medical school graduates failed to show even basic knowledge of musculoskeletal medicine, based on a written examination scored by orthopedic program directors. This follow-up study was designed to evaluate if the more than 400 program directors of internal medicine departments in the U.S. would similarly rate the importance of the exam questions and required passing score.

Over half of the program directors responded to the exam questionnaire; they suggested an average passing score of 70%. The mean score of the medical-school examinees had been 59.6%, however. Therefore, a full 78% of the examinees would have been unable to demonstrate "basic competency" on the exam, based on review by the internal medicine program directors.

The majority of medical students, who have received all of their scholastic training required to be medical doctors, may lack basic competency in musculoskeletal medicine upon graduation. Chiropractors often treat different conditions than MDs, but are an excellent source of information when it comes to your spine, joints, and other "moving" body parts. Chiropractors have all completed a minimum of four years of education with an emphasis on muscle and skeleton management and care.

Reference: Freedman KB, Bernstein J. Educational deficiencies in musculoskeletal medicine. The Journal of Bone and Joint Surgery 2002:84-A(4), pp. 604-608.

For more information about musculoskeletal conditions click here.

Hypertension: Highly Likely

Do you think you're safe from high blood pressure? Think again. A study in the Journal of the American Medical Association shows that 90% of Americans may develop hypertension (high blood pressure) in their lives. This health condition potentially leads to heart disease and premature death.

The authors of the study determined lifetime risk for hypertension in 1,300 people aged 55-65 years and hypertension-free at the start of the study. Hypertension was defined as a blood pressure of at least 140/90 mm Hg (millimeters of mercury - the standard measure of blood pressure), or the use of antihypertensive medication.

Lifetime risk for the development of hypertension was 90% in both age groups. In other words, nine out of 10 people in the 22-year study had high blood pressure at some point later in life. Also, 60% of the individuals took antihypertensive medication at some point.

Besides detrimental effects on health, hypertension creates a financial burden on society, which will likely increase as the percentage of older Americans increases in the near future. The best ways to prevent high blood pressure are essentially free: Exercise regularly (30 minutes of aerobic exercise, five times per week is ideal) and maintain a diet high in fruits, vegetables, and whole grains, and low in fats, simple sugars, and sodium.

Reference: Vasan RS, Beiser A, Seshadri S, et al. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. Journal of the American Medical Association 2002:287(8), pp. 1003-1010.

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Arming Yourself Against Osteoporosis

As women age, a common problem they face is thinning of the bones - also called osteoporosis. Bone mineral density, or BMD, is a measure of bone strength related to fracture risk and the weight-bearing capacity of the skeleton. Eating calcium is recommended to maintain bone strength; are there other nutrients women need for strong bones?

To determine the association between total, animal, and vegetable protein consumption in those 55 years or older, the authors of a recent study in the American Journal of Epidemiology administered a diet questionnaire to almost 600 women and 400 men. These individuals, all residents of the Rancho Bernardo senior living community in California, were also examined to determine bone density initially and four years later.

For women, eating higher amounts of animal protein (e.g., meat, fish, eggs, and dairy products) was related to increased bone density. The added bone strength from consuming more animal protein was more dramatic in women who had less calcium in their diets. In both men and women, eating more vegetable protein (e.g., soy or beans and rice) was linked to lower bone density, however.

This information does not imply that you shouldn't be a vegetarian or eat soy products. The study does suggest, however, that if you don't regularly eat meat, be sure to eat enough protein and include additional calcium in your diet. Protein is by itself a critical component of bones, making up a quarter of their total mass and roughly half of their volume.

Reference: Promislow JHE, Goodman-Gruen D, Slymen DJ, et al. Protein consumption and bone mineral density in the elderly: The Rancho Bernardo Study. American Journal of Epidemiology 2002:155(7), pp. 636-644.

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Youth Football Earns an Extra Point

About 1.5 million people play football, from Pee Wee and Pop Warner right up to the professional ranks. An estimated 1.2 million of these players are injured each year. The majority of studies on football injuries concentrate on high school students or older athletes. How dangerous is youth football compared to collegiate and professional ball?

All players in a youth football league of grades 4-8 were followed for an entire fall season to gather injury data. Researchers tracked more than 40 teams and almost 1,000 players age 14 or younger, and recorded all injuries during games that removed a player from the game or required a physician. Injuries were rated severe (removed from play over 14 days), moderate (return to play in 4-14 days), or mild (return within three days).

Overall, only 6% of players suffered some injury over the season; over 90% of these were considered mild. The most common injuries were bruises, which accounted for 60% of all injuries, followed by muscle strains and ligament sprains. Seven percent of the injuries removed players for the remainder of the season due to their severity, representing less than 1% of all the players.

It appears that youth football may be no more dangerous than other children's sports, but there are still signs you're your child may be at a higher risk. Players were more likely to be injured if they were older and heavier: Eighth graders were four times as likely as fourth graders to be injured. Offensive players, especially running backs, were also prone to injury.

Reference: Stuart MJ, Morrey MA, Smith AM, et al. Injuries in youth football: A prospective observational cohort analysis among players aged 9 to 13 years. Mayo Clinic Proceedings 2002:77, pp. 317-322.

For additional information on pediatric health and safety click here.

Back Pain: Rapid Recovery or Long Lasting?

Most back pain research is devoted to identifying risk factors for acute low back pain, or pain that is severe and short-lasting, although long-term back pain is responsible for far more days missed and dollars lost at work. Risk factors for chronic back pain are different than those for acute back pain; chronic cases involve more individual, psychological, and workplace variables. Is it possible to identify which acute back pain cases will progress into costly chronic cases?

The authors of this study, published recently in Spine, examined workers' compensation claims to determine if a variety of factors reported by back pain sufferers at their initial time of injury claim could distinguish those at high risk for chronic pain. Three high-risk groups were assessed: nurses and nurses' aides, manual workers, and drivers.

Of the 24% of claimants still receiving monetary compensation three months after their initial claim, job dissatisfaction and poor workplace relations were not linked to chronic low back pain. Factors associated with progression from acute to chronic back pain were moderate-to-severe disability, severe leg pain, obesity, and no "light" duties available upon returning to work.

If you injure your back on the job, be sure to talk to your doctor of chiropractic about any symptoms that appear after injury, even if they may seem unrelated. By obtaining the most diagnostic information possible, your chiropractor can help get you back on your feet and working again in a short amount of time.

Reference: Fransen M, Woodward M, Norton R, et al. Risk factors associated with the transition from acute to chronic occupational back pain. Spine 2002:27(1), pp. 92-98.

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Happiness Is... A Filet of Fish

It's no secret that eating fish is good for you. The omega-3 fatty acids found in abundance in cold-water fishes are well-documented to have an association with a lowered risk for heart disease. The best fish for dietary omega-3 include salmon, mackerel, tuna, lake trout, and sardines. The purpose of a study in the American Journal of Psychiatry was to determine if a specific omega-3 acid called "E-EPA" prevents clinical depression.

Twenty people with major depressive disorder were divided into two equal groups and given either two grams per day of an omega-3 supplement or a placebo, along with their current antidepressant drug therapy. The supplement contained 96% pure fish oil. Patients were followed for four weeks; a depression rating scale was administered to evaluate depression.

Significant improvements from adding E-EPA to therapy were observed by the third week of the study. Six of 10 patients taking the fish-oil supplement noted a 50% reduction in their depression levels, while only one of 10 patients taking the placebo saw a similar reduction. The omega-3 supplement reduced depressed moods, feelings of guilt and worthlessness, and insomnia; no side effects were reported.

The authors of the study caution that they are unsure whether E-EPA works independently as an antidepressant, or simply amplifies the effects of antidepressant drugs. Regardless, fish and fish oil containing omega-3 acids have numerous other health benefits, and fish are excellent sources of protein.

To learn about additional benefits of eating healthy click here.

Reference: Nemets B, Stahl Z, Belmaker RH. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. American Journal of Psychiatry 2002:159(3), pp. 477-479.

Cough Medicine Results Sickening

Doctors often recommend over-the-counter cough medicine to treat this frustrating symptom of the common cold. Cough medicine sales are rising: In the United Kingdom (U.K.), sales rose 3% between 1998 and 1999. Believe it or not, this type of medicine has gained widespread support despite evidence that it really works. The results of a recent study in the British Medical Journal may surprise you.

To determine whether over-the-counter cough medicines are effective for treating acute cough, the authors of the review searched all studies in the U.K. involving adults with cough for less than three weeks who were administered cough medicine. All studies included placebo groups or no-medicine groups for comparison to the group taking medicine. Fifteen studies involving 2,000 individuals were assessed.

In nine (60%) of the studies, cough medication was deemed "no better than placebo" for treating a cough. In the remaining six studies, the positive results "were of questionable clinical relevance." This was true for multiple forms of medication: antihistamines, antitussives, expectorants, decongestants, and combinations of these types of drugs.

Given the amount of over-the-counter cough medicines available, one would think they possessed some effectiveness. This paper counters such "conventional" thinking. Over-the-counter cough medicines for acute cough may be ineffective for reducing symptoms. Talk to your doctor about other options for treating cough and cold symptoms, and also remember that when it comes to sickness, an ounce of prevention is worth a pound of cure.

Reference: Schroeder K, Fahey T. Systematic review of randomised [sic] controlled trials of over-the-counter cough medicines for acute cough in adults. British Medical Journal 2002:324, pp. 329-331.

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Weekly Training Prevents Weakness

As adults get older, preserving muscle strength is necessary to continue an active and independent lifestyle. Exercise helps maintain strength, especially in the elderly, who lose muscle continually as part of the aging process. However, the frequency of exercise necessary to preserve strength is unclear.

In a recent study appearing in the Journal of Gerontology: Biological Sciences, researchers required 10 elderly men to perform resistance exercises three times per week for 12 weeks. Next, the men were divided into two groups: half returned to a normal lifestyle free of resistance training, while the other half continued to train, but at a frequency of only once per week.

Men in both groups experienced strength gains of about 50% during the initial 12 weeks of training. Six months after this training session, the men who had continued to train only once per week managed to maintain essentially all their muscle size and strength. The men who returned to a normal lifestyle lost 11% of their strength, however, and their muscles were reduced almost to pre-study sizes.

Don't use this study as an excuse to only exercise one day per week. The point is, even if you can only perform a high-intensity workout once per week, it is far more effective than never working out if you want to maintain your strength and mobility. Ideally, seniors should perform mixed aerobic and resistance exercises several times per week to prevent injury and disease.

Reference: Trappe S, Williamson D, Godard M. Maintenance of whole muscle strength and size following resistance training in older men. Journal of Gerontology: Biological Sciences 2002:57A(4), pp. B138-B143.

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