20 Dec 2008 12:53 pm

Writer’s Block Dec 20

Dec 20, 2008

Neck Pain and the Cold

Naughty list


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:


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?


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?



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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.


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.


“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…)


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.


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,


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.


23 Nov 2008 07:29 pm

Writer’s Block Nov 23

Nov. 23, 2008

Twisting and the Herniated Disc

This is Part 4 in the series I’m tentatively calling: “What Causes Herniated Discs?”


In the previous installment, we discussed the various stress factors that contribute to disc failure and then examined one of those risk factors. This time I’d like to take a look at another one of those factors, but before we do that here’s a little something to refresh your memory:

“In physics, stress is classified according to type such as tensile strength (stretching the object), torsional strength (twisting the object), shear strength (lateral tearing of the object), and compressive strength (load bearing ability).

Of course, the normal intervertebral disc is designed to withstand all of these stress factors, but the two that appear to have the most impact on herniation are twisting and compressive loading.”

In that last article, we specifically looked at the effect of compressive loading and the role it plays in producing herniated discs. This time we’re going to examine torsional stress — sometimes referred to as axial torque — or what we laymen would simply call twisting.

And, for the sake of simplicity, we’re going to confine ourselves to answering the following three questions:

  1. What does twisting do to the walls of the disc?
  2. Can axial torque result in a herniated disc?
  3. What activities present the greatest risk for disc failure?

Let’s start with number one…

What Does Twisting Do to the Walls of the Disc?

You will recall that the outer portion of the disc is called the annulus and is a series of concentric rings of fibrous connective tissue that surrounds the nucleus much like a ring of forts built one inside the other.

Also, you may remember that the basic hypothesis is that as the disc dries out (either because of age, inactivity or both) the tough fibrous rings of the annulus start to break down and cracks begin to form. This process of deterioration is often referred to as degenerative disc disease.

So the question that is of most interest to us is what happens to this crumbling fortress when a twisting force is applied? McGill gives us a clue based on his observations…

“While we have not performed a lot of research on the effect of twisting on the discs, it appears that repeated twisting causes the annulus to slowly delaminate. This is evidenced by the tracking of the nucleus into the annulus in all directions. While we do not yet know the relationship between number of cycles and loads, we do know that added torsion reduces the compressive strength of the joint (Aultman et al., 2004).” [1]

That seems reasonable. If you take a sheet of rotten plywood and start flexing it, it would not be unexpected for the various layers to begin to separate (or delaminate as McGill puts it). So what about our next question:

Can Axial Torque Produce a Herniated Disc?

I believe that technically a disc can be considered herniated the moment the nucleus begins its initial break through the walls of the annulus even though it may not be to the point of causing a bulge and may be years away from actually extruding into the spinal canal.

So perhaps a better question might be, could a sudden twisting force cause a disc on the verge of rupturing to finally fail?

McGill gives us an interesting example that he and his colleagues observed during one of their research efforts:

“Our most recent work on disc herniation uncovered the dependency of the location of the herniating bulge on the axis of motion (Aultman et al., 2005). For example, in 20 motion segments, we flexed them repeatedly about an axis that was 30 degrees rotated from the pure flexion axis (mostly flexion with some lateral bend). One specimen simply failed abruptly and was removed…” [1]

When flexing disc segments about an axis of rotation, that is, ones that were twisted, one of them failed (herniated) immediately. The rest just took a little longer.

Again, this result comes as no surprise. It’s what you would expect to happen if you started applying torque to a weak disc. Perhaps a good analogy would be wringing the water out of a dishrag. Twisting the rag (disc) causes the liquid (nucleus) to seek a way out.

What is important to note is that this has been observed under laboratory conditions. It is not just the result of speculation.

So, since we know for a fact that twisting is a potentially harmful movement…

What activities present the greatest risk for disc failure?


The type of activity, which would apply a twisting force to the spine similar to what McGill is describing, would include such things as a golf swing, bowling, swinging a tennis racket, pitching a baseball, certain high velocity thrust-type spinal manipulations or any other forceful rotational movement.

None of the above activities are inherently dangerous or harmful to a healthy spine, but their cumulative effect needs to be recognized as a possible contributing factor to disc degeneration.

Discs that are not in perfect condition are no doubt going to be delaminating and accumulating additional cracks and tears each time one of these movements is performed.

And this says nothing about the impact of these activities on discs that are already in a weakened state and may be on the verge of catastrophic failure. Just teeing off on the ninth hole or bowling that last set may be all it takes.


That’s as far as we’re going to go today, next time we’ll take a look at what I call “the Catch-22” of rehabilitation, because there seems to be at least one hidden pitfall that we need to be aware of.

Till then,


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

2. Tampier C, Drake JD, Callaghan JP, McGill SM. Progressive disc herniation: an investigation of the mechanism using radiologic, histochemical, and microscopic dissection techniques on a porcine model. Spine. 2007 Dec 1;32(25):2869-74.

3. Drake JD, Aultman CD, McGill SM, Callaghan JP. The influence of static axial torque in combined loading on intervertebral joint failure mechanics using a porcine model. Clin Biomech (Bristol, Avon). 2005 Dec;20(10):1038-45.

4. Aultman CD, Drake JD, Callaghan JP, McGill SM. The effect of static torsion on the compressive strength of the spine: an in vitro analysis using a porcine spine model. Spine. 2004 Aug 1;29(15):E304-9.


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