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Writer's Block 17 Jan 2009 06:29 pm

Writer’s Block Jan 17

Jan 17, 2009

Health Care Reform and Sciatica Recovery

syringe2

Okay, you’re correct, sciatica has nothing to do with health care reform, but it’s been such a busy month that I’ve decided to give you a tufor… that is two blog posts for the price of one. Both are short and I promise to get right to the point.

First off, since the theme for Grand Rounds this week is Health Care Reform, I will start with that one, which I have aptly named…

Part One: Health Care Reform

I don’t know about you, but I’m not too enthusiastic about what some would call socialized medicine, however, it looks like we’re going to get a national health care plan whether we like it or not. With that in mind, let’s hope they come up with one that’s not a bureaucratic nightmare.

Naturally, the ultimate goal of a national health care plan would be to lower costs while maintaining and improving quality of care. With that in mind, here’s a brief shopping list of what I’d like to see as a consumer.

I. A National Health Insurance Policy

The ideal plan would include the following points:

  1. It should be optional, not mandatory
  2. It should be affordable so that most will purchase it
  3. Its main purpose should be to cover major medical expenses
  4. Minor expenses such as routine office visits, etc., need not be covered or could be a secondary optional policy (a rider) with some form of deductible or co-pay provision

Having two separate policies would allow major medical to be less expensive. Furthermore, two separate policies would allow for independently adjusting rates to match the cost of each area of coverage. Major medical would not have to bear the weight of routine care and vice versa.

II. Malpractice Tort Reform

Perhaps we should also have a national medical malpractice insurance program.

Key points would be:

  1. Coverage for lost wages and medical-related expenses only
  2. Create a victim’s fund that cannot be used for any other purpose
  3. Eliminate punitive damages in malpractice lawsuits

To clarify that last point:

Suing an insurance company for punitive damages amounts to whipping Paul because Peter did something wrong. The errant physician suffers punitive repercussions from the malpractice suit itself.

The public is not served by attaching a monetary value to some esoteric concept of punishment. We consumers end up paying the cost in higher health care expenses.

Eliminate punitive damages and you will eliminate the incentive to sue for profit. Frivolous lawsuits fueled by greed or other ulterior motives would be greatly reduced.

Cutting the burden of malpractice insurance would have a major impact on cutting health care costs.

III. Medical School Student Loan Reform

Student loan repayment should be waived for any medical student that agrees to serve a certain number of years in primary care upon graduation.

Key points:

  1. Medical students could simply apply for a “primary care” deferment upon graduation, which would become permanent after serving the required number of years in the field
  2. Taxpayers would not fund students who fail to become primary care physicians
  3. Physicians would still have the flexibility to change their specialty if primary care turned out not to be right for them

The above scenario would not change the educational process and would provide students with the flexibility to choose a specialty in the usual manner while still offering an incentive for those desiring to enter the less lucrative field of primary care.

IV. Serious Medical Intervention

Lastly, I think doctors should go back to passing out lollipops. I distinctly remember my pediatrician used do this following the exam. The last one I got was green. I felt much better.

Part Two: Sciatica Recovery

Okay, now back to business.

Since I get a lot of email asking for my advice or opinion on the topic of sciatica, I’ve decided to start out the New Year by condensing all of my usual answers into one concise list. Here it is…

Key points to remember when dealing with sciatica:

  1. Sciatica symptoms are caused by a pinched or irritated sciatic nerve
  2. The symptoms will persist as long as the nerve continues to be irritated
  3. There is no time frame for how long it will take to get the bulging disc, bone spur, scar tissue, (or whatever) off the nerve so it can begin healing
  4. Once the source of irritation is removed from the nerve, it will still take a minimum of (an additional) six months for the nerve to heal

So there is no set timetable for recovery. Most find it to be a long, slow — sometimes-frustrating — process.

Rehabilitation is the ideal outcome, but sometimes isn’t possible.

Some rehabilitation exercises may irritate the nerve and have to be modified or eliminated from your program. For example, when dealing with herniated discs, some people find that skipping the forward bending exercises (and avoiding forward bending / sitting postures as much as possible) helps considerably.

How’s that for keeping it short and to the point?

Till next time,
Dean

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Writer's Block 20 Dec 2008 12:53 pm

Writer’s Block Dec 20

Dec 20, 2008

Neck Pain and the Cold

Naughty list

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I received an email this week from a reader who had a very timely question to ask about neck pain and the weather. He wrote:

Dean,

I tweaked my neck yesterday while out hanging the Christmas lights. It was freezing cold and windy and I was working overhead stapling the lights around the soffet when I felt a twinge in back of my neck on the left side… [snip]

My wife insists that it was caused by the cold weather… [snip]

I realize that I just strained a muscle or something and I’m not worried about it, but I was wondering why do I always get more aches and pains when the weather turns bad?

Regards,
John

Hi John,

Does the weather affect neck strains, not to mention, other forms of joint pain? It would seem so judging from the amount of mail I receive on the subject each year.

I don’t know if anyone has come up with a real scientific explanation for why this is so, but there are several theories including such things as:

  • Barometric pressure
  • Temperature and/or humidity
  • And even Seasonal Affective Disorder (SAD)

These have yet to be proven, but I think it’s a safe bet to assume that all of the above could play a role in one way or another. So just to be on the safe side, here’s my checklist for dealing with winter:

  1. Dress warmly and keep your environment warm and humid
  2. Keep active
  3. Turn on more lights

Transform Your Indoor Weather

First off, while it might sound like I’m bucking the latest trend of “going green” and trying to conserve energy, I actually recommend that you turn up the thermostat in your home or office to a point that you’re reasonably comfortable.

After all, you’re not going to save much green if joint pain is sending you to the ER or the drugstore.

Secondly, get a humidifier. One characteristic of summer that is often lacking during the winter months is humidity.

Keeping the humidity levels at about 40 percent will make your home feel much more comfortable and experts agree that moist air is much easier (cheaper) to heat. Dry air just feels colder and requires a higher thermostat level to achieve the same level of comfort.

If you dress warmly enough and keep the humidity levels high, you will feel comfortable even with the thermostat set at a very green 68 degrees.

So invest in a humidifier. It’s better for you and better for your furniture and it actually saves energy.

Keep Active

funny 5

During the winter months it just seems natural to want to hibernate.

Inactivity followed by sort bursts of activity seems to lead to more joint injuries than when we stay active on a regular basis. Sitting inside during inclement weather may be tempting, but it’s not good for your joints.

Also, before hanging those Christmas decorations, be sure to warm-up with some good gentle neck and shoulder exercises. And don’t try to do everything in one long marathon session. Take frequent breaks to come inside and warm up with some nice hot cocoa.

Finally, Lighten Up

Just because it’s gray and overcast outside, doesn’t mean you have to sit around in a dark gloomy room. Instead, experts recommend transforming your indoor environment into a warm, sunny day.

For example, if it’s nasty and depressing outside, get translucent blinds that you can keep closed so you don’t have to see how bleak the weather is. Translucent blinds will block the view, while still allowing sufficient light to pass through.

Next, turn on plenty of additional lights. Fluorescents are the most economical, but also try to include incandescent, or halogens so you can get full spectrum light. Spending a little extra for full spectrum lighting will pay off in the long run. They’re a heck of a lot cheaper than anti-depressants.

Also, paint your walls and ceilings in white or bright, sunny pastel shades such as yellow, beige or cream colors. Lighter colors make the room brighter and take less energy to illuminate.

The theory behind all of this is if you can’t see the bleak landscape, then it’s easier to ignore it and a bright, well-lit environment has been shown to have significant impact in combating Seasonal Affective Disorder (SAD).

Granted, this may not actually help prevent joint injuries, but it’s a worthwhile endeavor for its own sake.

Long story short…

Does cold weather contribute to more neck pain, joint pain and back pain? Yes, apparently it does. Why, we’re not really sure.

No doubt it’s one reason people prefer retiring to places like Florida and Arizona. The hot climate is simply kinder to poor achy joints.

So anyway, until science comes up with a cure for the weather, those of us stuck in the colder regions will just have to make the best of things.

Oh, one last thought. Did I mention snacks?

7.bmp

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Writer's Block 30 Nov 2008 06:55 pm

Writer’s Block Nov 30

Nov. 26, 2008

Back Pain and Lifting Belts

Once upon a time it was commonly believed that wearing a lifting belt would prevent back injury. You couldn’t go to a gym or health club and not see dozens of weightlifters and bodybuilders wearing them. I even have one around here somewhere.

Clipboard

All that has changed now. The last time I was at the gym, I don’t recall seeing a single belt anywhere in sight.

So, does that mean they don’t work? Or that wearing one is a bad idea if you’re dealing with back problems?

That’s a good question. I stopped wearing mine because I had a hunch that it was more a liability than an asset — and it appears that most of the other lifters are of the same opinion.

But hunches and opinions are just hunches and opinions. Everybody has one and they aren’t worth much.

The only way to actually separate the facts from the folklore is to turn to those guys with the white lab coats (and way too much time on their hands) and see what they’ve been up to lately.

Here is a rundown of the latest findings:

First up, is a study published just this year (2008) by the Musculoskeletal Disorders Group at the Finnish Institute of Occupational Health in Helsinki, Finland. They concluded:

“There is no evidence to support use of … lifting equipment for preventing back pain or consequent disability.” [1]

Notice that they didn’t say that wearing a lifting belt was bad for you, only that there was no evidence to suggest that you need to wear one.

Next, we have a study conducted by the Institute for Work and Health, Toronto, Ontario, Canada. Their findings…

“Currently, because of conflicting evidence and the absence of high-quality trials, there is no conclusive evidence to support back belt use… ” [2]

Sort of reminds me of an old Herman’s Hermits song… “Second verse, same as the first.”

Herman's Hermits

Undaunted we move back over the pond to Amsterdam and the folks at the Institute for Research in Extramural Medicine who had this to say…

“There was moderate evidence that lumbar supports are not effective for primary prevention. No evidence was found on the effectiveness of lumbar supports for secondary prevention… There continues to be a need for high quality randomized trials on the effectiveness of lumbar supports.” [3]

Wait a minute…

“There continues to be a need for high quality randomized trials?”

So what exactly is it we’re paying you guys to do? Sorry, just kidding. I know you’ve been tied up lately, what with the kids and everything…

(I swear. You ever get the feeling some of these guys are just phoning it in?)

Speaking of which, here’s a summarization of the prevailing literature by the hardworking crew at the National Institute for Occupational Safety and Health (NIOSH) that further echoes the above opinions…

“They (back belts) appear to have little effect on most back injury risk factors, but may have a limited effect on improving muscle strength and supporting the back during lifting and twisting activities… Based on insufficient objective scientific data, NIOSH recommended against back belt use by healthy people.” [4]

Anyone else starting to notice a pattern here?

Anyway, moving right along, the Program in Physical Therapy at Washington University School of Medicine reports.

“The epidemiological data concerning the efficacy of back belts in the prevention of occupational low back injuries are not sufficient to warrant general use of back belts in the occupational setting for uninjured workers.” [5]

They then go on to add…

“There is actually a potential for increasing the degree of low back injury with general application of back belts in occupational settings.” [5]

Finally, we have at least some indication that wearing a back belt may actually weaken the spine and set you up for injury at a latter date. Nothing conclusive, mind you, but they seem to be thinking along the same lines as the rest of us.

Arbys

“In sum, there are insufficient data in the scientific literature to indicate that general use of back belts in occupational settings is appropriate for uninjured workers.” [5]

At this point, I’m thinking Arby’s, but let’s look at one more, then we’ll wrap this up.

“In the largest prospective cohort study of back belt use, adjusted for multiple individual risk factors, neither frequent back belt use nor a store policy that required belt use was associated with reduced incidence of back injury claims or low back pain.” [6]

My Conclusion

While it may seem — judging from popular opinion — that the verdict is in on back belts, the truth of the matter is, it’s not. We don’t really know if back belts help or not. (Maybe if those guys in Amsterdam would get off the pot…)

TeaTime

Anyway, what we do know is this:

  1. There is little evidence to suggest that they prevent back injuries, and
  2. There is the possibility that wearing them can lead to weak core muscles.

So, should you wear one or not? I guess it comes down to personal choice.

Until there is a truly definitive study, all we can do is speculate.

If you feel that wearing a belt helps support your back when lifting heavy objects, there seems to be no harm in doing so. However, you should probably only wear it when absolutely necessary.

My personal opinion (which is worthless, by the way) is that if you have a healthy back, you shouldn’t really need one. World-class athletes are able to lift safely without them.

Addendum:

By the way, if you’ve been wearing a lifting belt at the gym or at work, you shouldn’t just quit cold turkey. Instead, gradually wean yourself off of the belt as you condition your core muscles to take over that task.

The best way to do that would be to start out performing your preliminary (lighter) lifts without the belt while still using it for the heavy stuff. Then over the next few weeks progressively increase the weight you lift au natural, until you no longer need the belt for support.

Take care,
Dean

References:

1. Martimo KP, Verbeek J, Karppinen J, Furlan AD, Takala EP, Kuijer PP, Jauhiainen M, Viikari-Juntura E. Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review. BMJ. 2008 Feb 23;336(7641):429-31.

2. Ammendolia C, Kerr MS, Bombardier C. Back belt use for prevention of occupational low back pain: a systematic review. J Manipulative Physiol Ther. 2005 Feb;28(2):128-34.

3. Jellema P, van Tulder MW, van Poppel MN, Nachemson AL, Bouter LM. Lumbar supports for prevention and treatment of low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine. 2001 Feb 15;26(4):377-86.

4. Hodgson EA. Occupational back belt use: a literature review. AAOHN J. 1996 Sep;44(9):438-43.

5. Minor SD. Use of back belts in occupational settings. Phys Ther. 1996 Apr;76(4):403-8.

6. Wassell JT, Gardner LI, Landsittel DP, Johnston JJ, Johnston JM. A prospective study of back belts for prevention of back pain and injury. JAMA. 2000 Dec 6;284(21):2727-32.

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