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Tomorrow’s Forecast for Back Pain Is . . . Uncertain

Forecasting weather is a more accurate science than determining if a person will have back pain in the future. Preventing back problems would be much easier if people could simply pass or fail a certain test. But it’s not that easy. Even though various tests have been tried in the past, the real question is whether these tests can accurately tell if someone will end up having a back problem. Unfortunately, there hasn’t been a lot of research to determine the tests’ usefulness. The results are a bit, shall we say, cloudy.

These clouds of doubt loom even larger considering the new information gathered in this study. Researchers looked at back pain in people who worked in either light or moderately strenuous jobs. People were divided into two groups: those with past back pain, and those who were pain free. Subjects went through common clinical tests and tests for back mobility and strength and lower body coordination.

The results were scattered between men and women and between the two groups. Men with less back mobility ended up having problems, but only among the group who were free of pain at the start of the study. Results were just the opposite for women. Women with too much back mobility ended up seeking medical help for their back pain.

Because of the wide variations in test results, the authors question whether the information from these tests is helpful in predicting future back pain. However, the findings did support the authors’ view that “persons with low functional capacity are liable to low back disorders and that those with existing disorders have an adverse outcome if their functional capacity is poor.” For now, the forecast for tomorrow’s back pain remains cloudy at best.

Reality Check for the Effectiveness of Glucosamine and Chondroitin

Reports abound about the effectiveness of glucosamine and chondroitin, granting them newfound stardom in the treatment of osteoarthritis. But as the stardust settles, the actual benefits appear to fall short of the hype.

Researchers recently pooled the best studies done on these two supplements between 1966 and 1999. The studies tested these compounds in the treatment of hip and knee osteoarthritis over at least four weeks.

After plotting the details of the studies, the researchers found that the study methods could exaggerate the actual benefits. Also, the fact that manufacturing companies sponsored nearly all studies made the researchers concerned that the actual benefits might be inflated. When the authors looked at only the highest quality research, the actual benefits of these compounds were the smallest.

The authors note that these compounds are safe and that they do show some benefits. So even if glucosamine and chondroitin don’t live up to their star billing, they may still play an important role in treating the symptoms of osteoarthritis.

Getting Golfers Back on Course

The grass may be greener for golfers who improve the technique of their swing, especially if they’ve been feeling sand-trapped by low back pain. Low back pain is the reason most male golfers stay off course. Golfers’ low back pain has been linked to poor swing technique and the repetitive action of swings.

Researchers videotaped the swing of a 22-year-old male golfer with back pain. They used the video results to create three-dimensional images to plot markers of shoulder, hip, and spine alignment, and to monitor changes in the angles in these body regions as the golfer moved through his entire swing. To see how hard the back muscles were working during the swing, the researchers placed electrodes along the sides of the golfer’s spine.

The images showed several problems in swing technique. The golfer didn’t turn his hips enough during the back swing. He also tended to twist his hips more than his shoulders just before swinging the club downward. Then during the downward motion, he bent his spine too far forward and to the side because he tended to lead with his hips. The electrodes registered extra activity in the spine muscles in this part of the swing. The authors suggest that the awkward movement of the spine combined with the extra muscle activity could cause painful joint compression in the spine.

After the video sessions, the golfer received professional coaching for three months. He also continued doing a series of strengthening exercises for his abdomen and back muscles. The coach had the golfer move closer when preparing for the swing. He also taught better shoulder position. Then the coach worked on keeping shoulders and hips aligned to prepare for the downward motion of the club, and turning the hips and shoulders as a unit rather than leading with the hips.

After completing the coaching sessions, the researchers rechecked the golfer’s swing. The changes in technique were dramatically different from the first time he was videotaped. Instead of twisting his hips and bending his spine in the downswing, he showed good upright alignment of hips and shoulders. This new style helped him hold his trunk steady, and the spine muscles didn’t have to work as hard. The authors suggest that these changes in alignment and muscle activity might ease torsion and compression on the spine. The golfer was able to resume his sport free of pain.

The authors conclude that helping players with low back pain to modify their technique and to take part in muscle conditioning exercises might help prevent problems of back pain among golfers.

New Thermal Treatments Put the Heat on Chronic Low Back Pain

When the fire of low back pain burns out of control, it may be time to fight fire with fire. A newer surgical treatment for disc problems called intradiscal electrothermal therapy (IDET) may come to the rescue. This type of procedure shows promise as an alternate treatment for people with bad back pain.

In IDET, doctors use a TV screen to guide a special needle into the sore disc. They then slip a heating element through the needle and into the injured zone. When the temperature of the element is raised, it is believed to shrink disc material, reducing a bulge or closing off a torn portion. It also seems to have a calming effect on pain sensors within the sore disc.

Doctors recently tested the benefit of this kind of treatment. They chose 25 patients with chronic low back pain who were having problems after at least six months of non-operative treatments. These patients were considered to be candidates for lumbar fusion surgery, but instead they chose to undergo the IDET procedure.

Before having IDET, they rated their pain on a scale between zero and 10. They also filled out a form about their ability to function on a day-to-day basis. The authors checked back with the patients an average of seven months after surgery to measure their new pain and functional levels.

The surgery made a measurable difference. The pain levels of nineteen patients (80%) went down at least two points on the 10-point pain scale. Eighteen patients (72%) either stopped using pain pills or were able to get by with significantly less medication. They also reported improvements in being able to sit for longer time periods. The authors also found that patients who went through IDET treatment used less pain medication.

Future studies are needed to confirm this preliminary report. Yet these results suggest that IDET will likely become helpful way to extinguish the fire of chronic low back pain.

Joint Injury Increases the Risk of Future Osteoarthritis

By keeping a close eye on the rearview mirror of time, researchers have traced what happens after an injury to a hip or knee joint. When a joint is injured in a person’s early years, the chances of having future osteoarthritis (OA) in that joint increase.

Researchers tracked 1337 medical students graduating from Johns Hopkins University in Baltimore between 1948 and 1964. When the study first began, 64 participants reported having injured a hip or knee joint. The average age at injury was 16. Significantly, 13.9% ended up with OA, compared to only 6% of the participants who didn’t have injuries before the study. Also, people who injured their hip or knee joint over the course of the study were much more likely to end up with OA in the injured joint.

Clearly, people who have had an injury to the hip or knee joint, especially in their earlier years, are at higher risk for developing OA. Accordingly, the authors believe these people should be targeted for programs to prevent OA, and younger patients who have had a joint injury should be shown ways to limit extra strain on that joint. They conclude by encouraging doctors to “advocate use of proper sports equipment under safe conditions to prevent joint injuries” to avoid future problems.

ACL Patients Move and Groove Safely Back to High-Level Activity

One of the concerns of people with anterior cruciate ligament (ACL) injuries is whether they can safely return to high-level sports and activity. With or without surgery, patients generally benefit from standard rehabilitation programs designed to improve knee movement, strength, and ability. In some cases, patients can return to high-level activity. Other patients have pain or unsteadiness in their knee that keeps them from doing demanding sports or activities. Either the knee doesn’t hold steady, or it actually slips out.

By adding a new form of training to the standard rehabilitation program, the authors found that a greater number of patients with ACL problems could safely return to vigorous sports and work activities. This new training regiment is called perturbation training. Perturbation training involves standing on an unstable platform. The platform shifts at pre-set speeds, and the patient has to regain balance. As the knee starts to hold better, the exercises gradually get harder. Patients will then stand on a special board with rollers while a therapist carefully pushes the knee back and forth in various directions. The training gets even more difficult by having the patients stand on one leg.

Patients who went through perturbation training had better knee stability and fewer problems with their knee feeling like it was going to slip. Also, they were nearly five times more likely to be able to safely go back to rigorous activity. According to the authors, patients who received the special training had much better long-term results than other patients.

These excellent results may partly be the result of carefully selecting the patients for the study. Some people might not be able to do these advanced forms of exercise. But for ACL patients who are up for the challenge, perturbation training seems able to move and groove them back to optimal health and ability.

Making Dollars and “Sense” of ACL Surgery

Choosing between types of medical treatments requires a careful look at which treatments are most cost-effective. The yardstick to measure whether a treatment is cost-effective has to do with quality of life and the costs to achieve it.

Not everyone with a torn anterior cruciate ligament (ACL) requires surgery. But people who participate in high-level recreation and sports activities usually believe that that their quality of life would be poor if a knee problem kept them from taking part in the sports they enjoy. While surgery for a torn ACL can be expensive, it can help young, active patients remain active. In this respect, ACL surgeries for many young, active people make sense–the surgery is cost-effective.

Cost-effectiveness is also influenced by the overall results of treatment. Doctors rely on various tests to measure the outcomes of surgery. Treatment results are also determined by how well a person is able to function with activity. When people can better participate in their regular activities, they feel a greater sense of well-being and satisfaction–important ingredients of a successful treatment outcome. As technology advances and as doctors learn new and better ways to do ACL surgery, these outcomes will improve. As a result, it is likely that ACL surgery will continue to become even more cost-effective.

A Walk Through Time Shows Best Treatments for Ankle Sprains

Even though sprains of the outer (lateral) ankle ligaments are one of the more common types of injuries, opinions abound as to the best types of treatment. Over the years, treatments have ranged all the way from surgery to no treatment at all. Which treatments are best? To answer this question, the authors analyzed research articles spanning the years 1966 to 1998. In general, treatment options for lateral ankle sprains include surgery, casting for more than six weeks, or functional treatment. The authors also compared cases where patients had functional training or a cast after surgery. Time off work was one way to measure if the treatment was helpful. But the authors concluded that a more accurate test is whether patients had episodes of unsteadiness in the ankle, a condition called give-way. Give-way happens when a joint has become loose, either because the ligaments are unable to support the joint, or because the nerves that give sensations for position have been harmed. Results of the analysis showed that people treated surgically had fewer problems with give-way compared to those who had functional training. People with functional training had fewer problems with give-way than those who were casted. Pain was nearly the same in patients who had surgery and those who had functional training. However, people who had minimal or no treatment had significantly more pain in the long-term than either of the other groups. Also, patients who had surgery did better if they had functional training afterward instead of a cast. Even though surgery showed better results overall, the authors caution that surgery poses higher risks and costs. However, they concluded that surgery is a reasonable choice if functional treatment alone hasn’t helped.

Cartilage, Meniscus, and Ligaments–Oh My!

Oz’s tin man needed a heart, and people undergoing anterior cruciate ligament (ACL) reconstruction need a healthy knee. As long as the meniscus isn’t torn and the joint surfaces are in good shape at the time of surgery, this is a reasonable goal. In fact, of the 1231 patients in this study who weren’t having problems with the meniscus or articular cartilage, 97% were found to have excellent knee health up to 15 years after their ACL surgery. Even their X-rays showed that their knee had good health over this time period. And most patients had returned to their sports and were performing at an intensity level equal to or above their presurgical condition.

The “wizard” is not as optimistic when there are problems with the meniscus or joint cartilage at the time of ACL surgery. People with damaged cartilage or who needed to have part or their entire meniscus removed at the time of ACL surgery reported having more pain and problems as time passed. More damage was related to more symptoms. The knee X-rays taken at follow-up checks (which ranged up to 15.8 years later) showed considerably more arthritis, depending on the amount of damage at the time of surgery. The journey along the yellow brick road of ACL surgery rehab will likely be more challenging for people with damaged cartilage or meniscus at the time of ACL surgery.

Payment for Another’s Labor: Strengthening One Ankle Crosses Over to the Other

It’s like getting paid for someone else’s work. In a phenomenon called the crossover effect, the muscles of one ankle get stronger even when exercises are done only by the opposite ankle.

Researchers measured crossover improvements by comparing two groups of people. Half went through eight weeks of a supervised strengthening program for one ankle using specialized equipment. The other group did normal activities and avoided exercise for the legs. Afterwards, the people in the training group had as much as a 19% improvement in muscles of the untrained ankle.

The authors present a variety of theories on how this could happen. Of the many possibilities, they find it most likely that the nerves going to the muscles on one side of the body cause an effect on the same exact muscles on the other side of the body. The researchers suggest that this crossover effect is most likely controlled by the central nervous system. The authors are optimistic that people who are unable to use their ankle due to injury or surgery could benefit from the crossover effect by using the efforts of one ankle to keep the other ankle strong.

Teenage Girls Get a Jump on Building Stronger Bones

By strengthening bones during their teenage years, people may be better prepared to ward off the harmful affects of osteoporosis later in life. It is well known that bone health is improved by doing weight-bearing exercises. The authors put these two ideas together to develop the first study of its kind, a test to see whether high-intensity jump training could strengthen the skeletons of teenage girls.

The authors assigned 56 ninth-grade girls to two groups, an exercise group and a control group. At the beginning, all participants filled out surveys about their diet and took tests of balance, strength, and power. Bone mineral density testing was done to check the amount and quality of the bones in various parts of their skeletons. These measurements were used to track how the specialized exercise program affected bone health.

For the first three months, the girls in the exercise group prepared their muscles by doing graded resistance exercises. They also advanced through a series of jump training, called plyometrics. This specialized training is an effective way to improve muscle strength and power, but it has not been tested to see whether it can strengthen bones. Participants received high school credit for exercising up to 45 minutes, three times each week. The control group did their routine activities but did not do any specialized exercises.

After nine months, participants repeated the tests of balance, strength, power, and bone density. For the most part, the bones of both groups showed improvement, which might have to do with normal growth patterns. However, compared to the control group, the exercisers showed a lot more bone strength in the upper part of the hip, had up to 29% better side-to-side balance, and had better leg strength.

Based on these measurable improvements and the consistent participation with the program, the authors conclude that “high school PE programs could include plyometric training and potentially reduce future risk of hip fracture.”

Making Moguls of Molehills to Improve the Safety of Kids Who Ski

Snow conditions, temperature, and kids’ attitudes about risk-taking have a big influence on their ski safety, among other factors. Studying these factors is a mogul-sized task. By snowplowing through the many possible risks faced by kids who ski, these researchers attempted to pinpoint the ones that seem to matter the most. By discovering these risks, better safety programs for young skiers can be offered.

Researchers targeted four possible risks that parents and young skiers could change once they learned about them. The four risk areas were lack of formal ski instruction, poorly adjusted bindings, rented equipment, and low skill levels. Information was collected during the 1995-1996 ski season at a large ski area in Canada. A total of 387 youths were assigned to either an injury or control group. The authors sent a survey to the parents of young skiers between the ages of three and 12, and children who skied by themselves were also invited to be part of the study.

When compared to the control group, the injured skiers tended to have low skill levels, use rented equipment, and have poorly adjusted bindings. Skill level mattered the most. Skiers with low skill levels had more injuries. However, formal ski instruction did not seem to have an affect on whether a child was injured. The authors suggest that future studies might show when and where young skiers with low skills are most often injured.

Skiers who used rented equipment also had a higher risk of injury, possibly because they are less skilled than those who own their equipment. Another reason might be that rented equipment is lower quality and not fitted properly. Also, poorly adjusted bindings were a factor in many of the injuries.

According to the authors, parents should be aware that poorly fitted equipment and low skill levels increase the risk of injury in young skiers. They also suggested that ski shops practice a standard way of fitting equipment and adjusting bindings for each person.