Daily Health and Medicine News

Sit Up Straight. Your Back Will Thank You.

EVERYONE wants to avoid back trouble, but surprisingly few of us manage to escape it. Up to 80 percent of Americans experience back pain at some point in their lives, and each year 15 percent of all adults are treated for such problems as herniated discs, spinal stenosis or lumbar pain.

But back pain is notoriously difficult, and expensive, to remedy.

“The treatments are varied, and we don’t have great science showing what works best for particular patients,” said Brook I. Martin, an instructor of orthopedic surgery at Dartmouth Medical School. “There are questions about the safety and efficacy of a surprising number of therapies, including some types of surgery.”

Those with back pain inevitably end up with higher overall medical costs than those without, studies suggest. Dr. Martin has found that patients with back pain spend about $7,000 annually on health care, while people without back pain spend just $4,000 a year. (Insurers will pay the majority of these costs, but patients often bear some of these expenses in the form of insurance co-payments and deductibles.) These estimates don’t include costs for lost work days or diminished productivity.

Some back problems, of course, can’t be avoided. Over time, spinal vertebrae naturally degenerate and spinal facets become inflamed, causing stress and discomfort.

“The majority of back pain is the result of muscle and ligament strain or weakness, and can often be prevented by developing core strength and proper posture,” said Dr. Daniel Mazanec, associate director of the Center for Spine Health at the Cleveland Clinic.

Maintaining good posture not only helps you look better (there’s a reason inept people are called slouches), it improves muscle tone, makes breathing easier and is one of the best ways to stave off back and neck pain, not to mention the dreaded dowager’s hump of old age.

“Posture is the key,” said Mary Ann Wilmarth, chief of physical therapy at Harvard University Health Services. “If your spine is not balanced, you will inevitably have problems in your back, your neck, your shoulders and even your joints.”

Sitting a little straighter now? Good. Here’s some advice that will help you make it a daily habit and stave off expensive back problems to boot.

THE D.I.Y. APPROACH First, try correcting your slouching habits on your own. Stand up and lift your chin slightly; align your ears over your shoulders and your shoulders over your hips. Place your hands on your hips and pitch forward about two inches.

There should be a slight inward curve in your lower back, an outward curve in your upper back, and another inward curve at your neck. Maintain this posture and sit down.

When you are sitting or driving for long periods of time, place a cushion or rolled-up towel between the curve of your lower spine and the back of your seat. Supporting your lower back will maintain the natural curve of your spine; when the back is supported, the shoulders more naturally fall into place, said Dr. Wilmarth.

Maintaining good posture requires abdominal and back strength. “It’s not enough to just sit up straight if your core muscles are weak,” said Dr. Praveen Mummaneni, a spine surgeon at the University of California, San Francisco. Consider taking a Pilates class, which focuses on developing one’s core — the muscles and connective tissues that hold the spine in place — or hire a physical therapist to create a personalized exercise plan.

A CUBICLE CURE If you sit at a desk all day, ask your human resources department if they have an ergonomics expert on staff (some large companies do) who can assess your work area. An ergonomist can make sure your chair, desk and keyboard are at the optimal height and can adjust your sitting posture.

If no expert is on hand, make adjustments yourself. The center of your computer screen should be at eye level, and the desk height should allow your forearms to rest comfortably at a 90-degree angle. Work with your feet flat on the floor and your back against the chair.

Whether you work in an office or at home, get up and stretch every 30 to 60 minutes. Sitting for long periods puts pressure on discs and fatigues muscles. And most workers spend the majority of their days sitting down. A recent study published in The European Heart Journal found that Americans are sedentary for an average of 8.5 hours a day.

“Stretching helps break bad patterns and allows your muscles to return to neutral,” said Dr. Wilmarth.

Stand up and place your hands on your lower back, as if you were sliding them into your back pockets. Gently push your hips forward and slightly arch your back. Sit back down and circle your shoulders backward, with your chin tucked, about 10 times.

Not likely to remember? Set your phone or computer alarm to remind you to stand up and stretch each hour. An iPhone app called Alarmed has a feature that allows you to create regular reminders throughout the day.

AN EXERCISE PLAN Habits are hard to break. A physical therapist can show you how to align your spine and provide you with exercises to both strengthen your core and loosen up stiff neck, back, arm and leg muscles (tight hamstrings can contribute to back pain).

The American Physical Therapy Association’s Web site (www.moveforwardpt.com) offers a simple tool that lets you search for physical therapists by ZIP code and specialty.

Most insurers cover physical therapy, although some may insist that you get a referral from a physician before they will authorize a visit.

If you decide to go out of network or to bypass your insurer, you’ll pay $150 to $250 for an initial assessment. Follow-up visits will be $50 or so less. Most experts say you can address basic posture issues in just one to three sessions.

A CLASS IN POISE If you want a more systematic, long-term approach to posture change, consider the Alexander technique, a method that teaches you how recognize and release habitual tension that interferes with good posture.

Not all doctors in the United States are familiar with the technique, but recent research suggests that it can help with lower back pain as well as posture. A study published in The British Medical Journal found that lessons in the technique helped patients with chronic back pain. A 2011 study published in Human Movement Science concluded that the Alexander technique increased the responsiveness of muscles and reduced stiffness in patients with lower back pain.

Try one session to see if it’s for you. If so, consider committing to 10 lessons. Individual lessons cost $60 to $125, depending on the teacher’s experience. Insurers will not reimburse you; group lessons may be more affordable. To find a teacher, go to the Web site of the American Society for Alexander Technique.

Still slouching? A study published in The European Journal of Social Psychology found that subjects who were told to sit up straight with good posture gave themselves higher ratings and had more self-confidence on a given task than those who were told to slouch.

Moral: Sitting pretty yields immediate, not just long-term, benefits.

Oswalt’s Back A Pain For Phillies

It is officially time to be very concerned about Roy Oswalt. The back issue lingers. His fastball slows. One wonders if his head and heart are in the game.

Last night’s loss dropped Oswalt to 4-6 with a 3.79 ERA. He has won only once since April 21. Do you realize that Kyle Kendrick has better stats than Roy? Kendrick is 4-4 with a 3.23.

As Richie Ashburn used to say, hard to believe, Harry.

Lower back tightness forced Oswalt out of last night’s game in St. Louis after two innings. He was trailing 4-0. It was his shortest outing in two seasons. “I was more heaving the ball than throwing it,” Oswalt told reporters. He expects to have an MRI on Monday.

The Phillies right-hander has had these back issues before. He left a game against Florida with back spasms on April 15, tried to pitch through it in his next two starts, only to land on the disabled list a couple of weeks later. Now the back is acting up again. Not a good sign.

It may not have helped that he was driving back-hoes and bulldozers, aiding in the tornado clean-up back home in Weir, Mississippi for more than a week. His stint on the 15-day DL began shortly after he returned. Whether that aggravated his condition is anyone’s guess, but it probably didn’t help. While he tended to the problems on the home front with the Phillies’ blessing, it is a bit curious that Oswalt would leave the team for that length of time. His family members were safe and unharmed, and his property suffered minimal damage.

It was the second time the Oswalts had suffered through the horrors of a tornado. The family home, the one Roy grew up in, was completely destroyed the first time around. This storm wasn’t nearly as bad, at least not in their area. Roy seemed to return with a renewed perspective on life in general. He talked about how baseball was “fourth on the list,” of his priorities. It made one question whether Oswalt’s passion for the game still burns. And if it doesn’t, that is a bigger problem than a recurring injury.

It appears that his back has not been right all year and that it is a factor in his struggles. It could be the chief reason for the two-time 20-game winner’s diminished velocity. Oswalt’s WHIP of 1.298 is his highest since 2007. But Phillies fans must hope the MRI is clean, and that he’s not headed for another stay on the DL; that this isn’t a chronic injury that derails his season. With such an impotent offense, the Phils cannot afford to be down to just three aces. They have the best record in baseball thanks mainly to their outstanding pitching. They need all four aces, and each on top of his game. Because a rotation of Halladay, Lee, Hamels, Worley and Kendrick somehow seems far too mortal, doesn’t it? The Phillies aren’t quite as formidable without Oswalt, or for that matter, with a scuffling Oswalt.

The way this team struggles to score runs, they need him to be the Roy Oswalt of a year ago, the one who went 7-1 as a Phillie. They need him. With a healthy back, and his head in the game.

System to cut surgery wait times

A new provincewide system aims to dramatically reduce wait times for patients with lower back pain.

When initial treatments don’t work, back pain patients are often added to a long lineup of people waiting to see a spine surgeon. The average wait time is about six months, and after all that waiting, more than 80 per cent of those patients don’t end up in the operating room, says Dr. Daryl Fourney, associate professor of neurosurgery at the University of Saskatchewan.

Education sessions for front-line health workers, plus two new spine clinics in Saskatoon and Regina, will attempt to steer patients away from long waits for specialists and get them into treatment more quickly. The goal: to whittle the family doctor-to-surgeon wait time down from six months to six weeks for the minority of patients who do need to go under the knife.

“Patients often wait an agonizingly long time to see a spine surgeon in Canada, only to find out – after they’ve had expensive tests like an MRI – that they don’t need surgery,” Fourney said at the opening of Saskatoon’s spine clinic in City Hospital. “The system, the way it is, is just not working very well.”

The strategy, called a “spine pathway,” began last year with education sessions for family doctors, chiropractors, nurse practitioners and physiotherapists, bringing them up to speed with the best evidence-based treatments for back pain.

About 450 health professionals have taken the course so far.

If trying best practices doesn’t work, health professionals can refer patients to the new spine clinics, which opened last month.

The clinics will determine who should see a surgeon, and who could benefit from other therapies – ideally cutting down surgeons’ queues.

The provincial strategy is a Canadian first, and possibly the first of its kind in the developed world, says Fourney .

“I don’t think throwing more money at the existing system is going to fix it,” he said. “What’s going make improvements and changes is really looking at what we’re doing, and trying to change the system around using those resources more effectively.”

Jackie Mann, vice-president of acute care for the Saskatoon Health Region, says the new approach should also help cut down on unnecessary MRI scans, and hopefully reduce wait times for the high-tech images.

More than a third of the MRIs done in the province are done on lower backs, and the new tack aims to reduce their numbers by five per cent within a year.

Treating back pain quicker

After waiting in agony for more than a year to get a diagnosis, Bryce McAuley is relieved the province has a prescription to assess and treat low back pain more quickly.

“I can’t get around – I drag one leg most of the time,” the 76-year-old Manor resident said on Thursday.

McAuley is one of 55 patients who have been referred to Regina’s spine pathway clinic since it opened in early May.

A spine pathway clinic on Broad Street in Regina and one at Saskatoon’s City Hospital have been set up to speed up the treatment and assessment of people suffering from low back pain.

The Ministry of Health worked with a team of national and international experts to classify all spine conditions into four patterns of pain. Family physicians, chiropractors and physiotherapists can take an online course (www. spine pathway.sk.ca) to learn how to use a standardized system to identify whether a patient’s back pain can be resolved with exercises and rest, or if an MRI or surgical referral is required.

“This is the only comprehensive spine care pathway,” said Regina neurosurgeon Dr. Joseph Buwembo. “It is a first for Saskatchewan and it’s a first for Canada. And, as far as we know, there is no other pathway of this nature in the world.”

McAuley is impressed by the treatment he’s received at the Broad Street clinic. After a thorough assessment by a physiotherapist, the senior was finally diagnosed.

“Three vertebraes are completely deteriorated and the sciatic nerve is causing pain down my right hip and leg … I’ve had constant pain for quite a few years,” he said.

On June 30, he’ll learn more about the surgery he requires.

At the Regina clinic’s official opening on Thursday, Health Minister Don McMorris said the spine pathway is part of the government’s overall plan to ensure that by 2014 no residents wait longer than three months for surgery.

“It’s difficult for family physicians to diagnose a patient with one of the 900 possible spine conditions,” McMorris said.

“The volume of referrals means wait times for MRIs and specialist consultations are just way too long. Saskatchewan’s spine pathway is addressing those challenges.”

Each year, about 10,000 Saskatchewan residents see a health-care professional because of back pain. About 5,000 are referred to a spine specialist, but only 20 per cent require surgery.

With a streamlined process, Buwembo expects patients will have shorter waits to see a specialist after their family doctor, chiropractor or physiotherapist refers them.

“We’re looking at 12 weeks as the patient journey to the final decision to treat, which will be a reduction from 42 weeks,” he said.

Dr. Brian Laursen, a busy family practitioner, said the spine pathway “is exactly what I need for my patients with low back pain.”

The pathway allows family doctors to identify patterns of pain based on the patient’s history and a simple examination.

“If I can go directly to managing the symptoms instead of finding out what the causes are, it makes my life a lot easier and it certainly makes it a lot easier for my patients,” Laursen said.

He said the pathway identifies a number of red flags that suggest potentially more serious underlying causes.

“We actually have a failsafe mechanism built into the pathway,” Laursen said.

If a serious problem is identified, the patient will get an urgent referral to a surgeon for assessment.

About 36 per cent of all MRIs performed in the province are for low back pain and injuries.

This year, the pathway’s goal is a five-per-cent reduction in the number of spine patients referred for an MRI.

For every 100 people removed from the wait list for an MRI of the spine, the wait time for an elective MRI is reduced by a week.

The ministry will spend about $675,000 to operate the provincial spine clinics in 2011-12.

“It’s a small number compared to what we’re going to see in savings on the back end,” McMorris said.