Time for another edition of Writer’s Block, where we highlight the best writer’s, bloggers and misfits from across the interweb thingy. Fasten your seatbelts…

Grand Rounds is up at Dr. Edwin Leap. The theme this week is ‘Why do we do it?’ That is, medicine being what it is, many providers (nurses, physicians, PA’s, NP’s, etc) are dissatisfied and frustrated. So why is it that all of these good people keep coming back?

The July edition of The Pain-Blog Carnival is up at How To Cope With Pain. Lots of great reading on the subject of health and pain management.

And, if that’s not enough, check out the Total Mind and Body Fitness Blog Carnival #60 Hosted by FitBuff. This week there are a variety of articles to help you improve your health, wealth, family, nutrition, work…

Also be sure to check out the July 26, 2008 edition of Carnival of Healing over at Libido and Health. Here you’ll find a collection of health related blogs with lots of useful information.

The 22nd edition of the Weight Management and Fitness Forum hosted by Weight Master is chock full of articles pertaining to diet, weight loss, exercise, fitness, nutrition, and general health information.

Next, the Balanced Living Carnival - 2nd Edition is up at One Organized Life. Included are articles on Professional Development, Green Living, Productivity, Motivation, Relationships, Simplicity, Health and Wellness.

Finally we have the August 1, 2008 edition of Living a Real Life blog carnival hosted by The Tall Poppy. This carnival is all about living your life to the fullest. It is about personal growth, stretching out of your comfort zone and really participating in life.

Okay, that’s it. Enjoy!

*******************

August 2, 2008

Neck Pain that Radiates

Mmmm, soothing…

Looks like Kittums is feeling no pain… neck or otherwise.

*****

I received a rather lengthy email this week from a reader who asked a number of really good questions about neck pain, his symptoms and various treatment options. It would take too long to attempt to address them all in a single post so I’ve decided to just focus on one of them this time. I’ll cover the rest in future posts.

Here goes…

Dear Dean

I followed your advice and went to see my doctor today about the pain in my neck and arm. I thought I had sciatica, but he said sciatica was only in the legs and then he called it something different. I should have written it down because we talked about several things after that and now I can’t remember what he said it was.

[Then proceeds with the rest of his questions.]

Sincerely,
Guy Who Writes Really Long emails

Hi Guy,

The term you’re searching for is probably radiculopathy.

Radiculopathy is a condition that gets its name from the fact that the symptoms radiate into the extremities along the path of the affected nerve root. For example, cervical radiculopathy is when a pinched nerve in the neck causes pain, numbness and tingling to radiate into the shoulder, down the arm and possibly even into the hand and fingers.

Radiculopathy that starts in the lower back and radiates down through the legs is often referred to as sciatica. It gets its name from the fact that it follows the sciatic nerve, which exits the spine in the lumbar region and travels all the way from there to your toes.

For lack of a better term, I refer to this as a phantom pain because the injury is actually in the neck or back even though it’s felt at some distant location. There is nothing really wrong with your arm or leg.

These strange symptoms are caused by mechanical problems in the spine including (but not limited to) herniated discs, stenosis (narrowing of the spinal column), loss of disc height, bone spurs or a combination of these and other factors.

Pain that Radiates

Don’t feel bad about getting the term wrong. Your doctor is used to it by now.

Besides, it’s quite understandable when you’re hearing a bunch of strange new terms for the first time to start getting them confused. After all, they’re pretty closely related.

Just remember radiculopathy - the pain that radiates.

• Cervical radiculopathy is in the neck
• Lumbar radiculopathy (commonly referred to as sciatica) is from the waist down.

One Final Thought

Sometimes a bad radiator can be a pain in the neck…




Don’t you just hate it when that happens?

Later,
Dean

********************

Yes indeed folks, it’s time once again to see what everyone is talking about in the health, fitness and medical blogosphere…

Grand Rounds is up over on Grunt Doc. Once again it contains an excellent collection of the best in online medical writing. (Can you believe it’s the 200th Edition?)

Change of Shift, Volume 3, Number 2 is up at Emergiblog with a new logo. Check it out.

Liz from Healthbolt has posted Yet Another Healthbolt Carnival, full of interesting, informative, and entertaining posts about everything to do with health.

The Disability Blog Carnival is up at Pitt Rehab. Check it out for some excellent posts on dealing with disabilities, disability studies, and disability rights.

The July 20, 2008 edition of Take Charge of Your Health Care is up at Health Plans Plus. This month there are some interesting articles on women’s health issues plus beauty and fitness tips to help you look your best.

And, if that’s not enough, check out the Total Mind and Body Fitness Blog Carnival #59 Hosted by FitBuff. This week there are a variety of articles to help you improve your brain power, dating, exercise, family, grooming, money, nutrition, sex, stress and work… you name it.

Enjoy!

********************

July 27, 2008

Are Herniated Discs Caused by Age?

Here’s a question about herniated discs I received the other day that touches on a hot button topic for many people…

Dear Dean,

Ever since my MRI came back showing herniated discs at L3-4 and L4-5 I’ve been reading everything I can find about disc degeneration.

[snip]

One article I read said that disc degeneration is just part of the aging process. If that’s true, why doesn’t everyone my age (over 50) have herniated discs?

What are your thoughts?

Sam

Hi Sam,

Thanks for writing.

You’ve raised a very interesting question.

Is aging a primary cause of herniated discs?

Since you didn’t mention a particular article, I took the liberty of hunting up a similar statement to use for the sake of illustration…

“Although daily activities may cause the nucleus to press against the annulus, the body is normally able to withstand this pressure. However, as the annulus ages, it tends to crack and tear.” [1]

Although the paragraph I pulled this quote from does not come right out and say that age is the cause of herniated discs, anyone reading the above could very easily make that assumption.

The average layman (such as myself) will undoubtedly conclude that cracking and tearing of the annulus (the outer ring of the disc) is strictly related to the aging process and therefore, aging must be the cause of herniated discs.

However, if you’re a natural born skeptic with a nasty habit of questioning everything you read, you may begin to wonder, “If age is the cause…”

• Why doesn’t everyone past a certain age have herniated discs?
• Why don’t all of our discs degenerate and rupture?
• Why do some 20 year-olds have herniated discs while many 60, 70 and even 80 year olds do not?
• And why is it that Nelson and others have produced research showing that discs can heal and the bulges resorb. [2]

Have these doctors found the fountain of youth? Or is the age explanation simply wrong?

My guess is the age assumption is not exactly wrong. It is merely an oversimplification. The above writer (or his editor) was probably attempting to be brief and simply picked what he thought was the best example (i.e., aging) from among the various causes of disc degeneration.

So, while the above quote may be technically correct, it is obviously incomplete and that makes it a bit inaccurate. There must be other factors involved.

For example, McGill writes…

“Herniations tend to occur in younger spines (Adams and Hutton, 1985) … Older spines do not appear to exhibit classic extrusion of nuclear material but rather are characterized by delamination of the annulus layer and radial cracks…” [3]

So we see that while age does seem to correspond to cracking and tearing — as our original quote indicated — this does not necessarily lead to disc herniation.

Instead, according to McGill, it is younger spines that are more inclined to rupture.

To further clarify things, McGill lists what I believe to be a more insidious cause of herniated discs (emphasis mine)…

“Epidemiological data link herniation with sedentary occupations and the sitting posture (Videman, Nurminen, and Troup, 1990). In fact, Wilder and colleagues (1988) documented annular tears in young calf spines from prolonged simulated sitting postures and cyclic compressive loading (i.e., simulated truck driving).” [3]

So, based on this additional information, it would seem that — while age does appear to take a toll on intervertebral discs — herniation appears to be caused by other more destructive factors such as prolonged sitting, compressive loading, and inactivity.

Summation and Hypothesis

Aging is obviously a factor in any degenerative condition. As people get older they begin to notice that their skin, hair, joints, bones and other tissues aren’t what they used to be.

So it stands to reason that older people, to a certain degree, are going to be more susceptible to disc degeneration.

However, I believe it’s incorrect to make aging the primary scapegoat.

Instead, I believe that inactivity and compressive loading are the real culprits and that age is merely a supporting cast member (along with other possibilities such as smoking, poor diet, and external trauma).

Suffice it to say, I believe we do ourselves a disservice to focus on age as the main cause of herniated discs, especially when there is research available that indicates otherwise.

We’re not through with this subject (i.e., the real cause of herniated discs). I intend to continue it in an upcoming post so stay tuned.

Till then,
Dean

References:

1. Orthogate, Lumbar Disc Herniation (eOrthopod) Friday, 28 July 2006

2. Nelson, B. The Herniated Disc: New Concepts and Treatments. Physicians Neck & Back Clinics [2005]

3. McGill, S. Low Back Disorders, Evidence-Based Prevention and Rehabilitation, 2nd Edition. (p. 44-47) Human Kinetics (2007)

********************

Here’s what’s happening in the world of health and medical blogging…

Grand Rounds - The Seinfeld Edition is up at The Blog that Ate Manhattan. Once again it contains a collection of the best in online medical writing. This week’s theme is everyone’s favorite sitcom.

Would you believe that Change of Shift, the nursing blog carnival is about to begin it’s third year? To make this edition special, Kim asked that nurse bloggers revisit their first posts and give us a look at why they started blogging. Check it out.

If that’s not enough, check out the Total Mind and Body Fitness Blog Carnival #57 Hosted by FitBuff. This week there are a variety of articles to help you improve your brain power, dating, exercise, family, grooming, money, nutrition, sex, stress and work… you name it.

Also, The Healthbolt Carnival is back once again over on Healthbolt, full of interesting, informative, and entertaining posts about everything to do with health.

Then be sure to check out A Carnival of Total Well-being - 3rd edition hosted by Ecopolitan Living. This carnival summarizes ways in achieving total well-being - body and mind balance for cosmopolitan dwellers. How to live well, how to achieve work/life balance.

Plus, Carnival of Healing hosted this week by Lessons from a Recovering Doormat, is a weekly round-up of personal blog posts on the topics of holistic health, wellness, spirituality, and self-empowerment.

That should hold you for awhile.

Take care,
Dean

******************

July 11, 2008

Neck Pain and Cervical Collars

Buddy here looks like he’s planning on bilking the insurance company out of some major coin.

*****

I’m sure it comes as no surprise that every once in awhile someone will write to me and ask about those cervical collars you occasionally see people wearing. For example, here’s a letter I received about a month ago…

Hi Dean,

I’m 37 and a working Mom. I slipped and fell at home about a week ago and I’ve had this awful neck pain ever since. It’s worse first thing in the morning, gets better by mid-day, but by the end of the day it’s hurting again. My doctor said there was nothing seriously wrong and prescribed Motrin for the pain but I’ve been wondering if I should go back and ask him about one of those collars to support my neck while it heals. I don’t really want to wear one of those things, but maybe that would help my neck heal faster?

What do you think? Any advice would be appreciated.

Thanks,
Sandy

My response…

Hi Sandy,

There was a time when cervical collars were considered a viable option for treating neck pain. And there was a certain logic behind the practice.

After all, it made sense to try and protect the injured tissue and give it a chance to heal. The goal was to prevent repetitive injury, which would ultimately delay your recovery.

However, these days most doctors don’t prescribe cervical collars for minor neck injuries. They’ve found that it actually slows recovery time and weakens the neck if the collar is worn for any length of time.

Here’s what the American Academy of Orthopaedic Surgeons has to say on the subject…

“In the past, whiplash injuries were often treated with immobilization in a cervical collar. However, the current trend is to encourage early movement, rather than immobilization. The soft collar may be used for a short term and on an intermittent basis.” [1]

The basis for this position can be found in the current research, which indicates that a certain amount of movement actually helps the injury heal faster…

“Research has shown that whiplash patients who rest for several weeks and wear a soft collar actually recover more slowly than those who try to follow a normal routine.” [2]

“In the past, some people have worn a neck collar for long periods after a whiplash sprain, and have been reluctant to move their neck. Studies have shown that you are more likely to make a quicker recovery if you do regular neck exercises, and keep your neck active rather than resting it for long periods in a collar.” [3]

And here are a couple more quotes along the same lines…

“Mealy and associates, in a prospective randomized trial comparing use of a soft cervical collar and analgesic medications with a regimen of active therapy, found that the group treated actively had significant improvement in both neck pain and mobility compared with the group treated with a soft collar.” [4]

“In a third prospective randomized study… Patients encouraged to remain at their normal level of activity had a better outcome than patients treated with immobilization and time off from work.” [4]

So there you have it.

I think the only time cervical collars are used for minor neck injuries is if you need support at night when you’re sleeping. Since you are waking up with neck pain, your doctor may decide that support at night might be helpful in your case.

However, I suspect that he will not want you to wear it during the day. (Even if you are trying to set a new fashion trend.)

As always, be sure to check with your doctor first before acting on your own.

Take care,
Dean

References:

1. Whiplash. Your Orthopedic Connection. American Academy of Orthopedic Surgeons. [Oct 2000]

2. Kasch H. Whiplash: What causes Whiplash? netdoctor.co.uk [Jan 2005]

3. Whiplash Neck Sprain. Patient UK. patient.uk.co [April 2005]

4. Young WF. The enigma of whiplash injury. Current management strategies and controversies. Postgrad Med Vol 109, No 3:179-86 [Mar 2001]

********************