Tips Tricks and Truths for dealing with your back and your health
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Sleeping
- 8 to 10 hours per night.
- Most healing happens while you are sleeping. If you can't sleep comfortably, YOU WILL NEVER GET BETTER.
- Do not sleep on your stomach . This will damage your neck and lower back every night when you are supposed to be healing.
- Side posture (fetal position) is best. Place a large pillow between your knees to take the pull of the weight of your upper leg off your spine and pelvis. A body pillow works best for this. Obus Forme makes an excellent one available at Sears for about $40.
- On your back is second best. Place a pillow beneath your knees to take the strain off your lower back.
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Pillows
- Sleep on one pillow only.
- If you are on your side, the pillow should support your head in line with the rest of your spine. If the pillow is too thick it will stretch your neck upward, too thin and your neck will be stretched downward.
- I do not generally recommend orthopaedic pillows unless you have neck pain while sleeping. A loose-fill pillow works best for most people. Most pillows that are sold in department stores are too thick, so choose a thinner pillow if possible.
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Mattresses
- I do not recommend waterbeds or futons.
- Since we are all different, choosing a mattress is a personal decision. A good quality orthopaedic mattress with individual coils in a firmness that's comfortable for you is the best recommendation I can make.
- Most people with back pain think they need a very firm mattress. This is not necessarily the case. Generally people with very upright posture and shallow low back curves are going to be more comfortable on a firm mattress, while those with deeper lower back curves (often called sway back) will be more comfortable on a softer mattress.
- Deal with a mattress supplier that has a comfort guarantee. Sleep Country will allow you to exchange your mattress in the first 60 days after purchase if you are not happy. I've had a few patients that exchanged their beds more than once in that time period.
- Any mattress is a balance between providing support and minimizing pressure points. If the points of your hips or shoulders are sore when sleeping on your side the mattress is too firm. For people with this type of problem, a foam mattress is sometimes best.
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Lifting
- Lift with your legs, not with your back. The strongest position your low back has is a shallow forward sway. Anytime you lift anything you should be conscious of maintaining this curve. That means bending your knees rather than bending forward at the lower back if you are lifting something off the ground. The same principle is even more important when using a shovel.
- One of the most common lifting injuries is caused by lifting things out of the car trunk. Place one hand on the edge of the trunk to support some of your upper body weight as you lean forward. Golf bags are a real hazard in this situation.
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Standing
- If standing for long periods irritates your lower back, try placing one foot on a footstool or low object. Having one foot elevated in this way places your lower spine in a biomechanically stronger position, delaying fatigue. This is what the brass rails are for at the foot of the bars where alcohol is served. They make standing more comfortable.
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Sitting and Chairs
- Over the last twenty years or so a lot has been written on the subject of ergonomics for desk workers. Much of this information recommends an optimal sitting position to reduce repetitive strain injuries. However the most recent research suggests that there is no optimal position. The old recommendation of sitting up straight is still a good one, but beyond that you should change your position often to prevent repetitively straining any one muscle group.
- Choose a chair with as much adjustability as possible.
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Heat vs. Cold
- As a general rule, never put heat on anything that is sore. If it's sore chances are it's already inflamed so you don't want to make it worse. The best example I can think of for this is a skin rash. If you put heat on it, it will get more red and inflamed. Always put ice on injured tissue. Twenty minutes on, followed by thirty minutes off. Repeat as often as needed.
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High Heeled Shoes
- Although research has shown that high heels can be good for your knees, they are bad for your spine. Stay off them. They can aggravate lower back pain and injure your feet.
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Self- adjusting or “cracking your own back.”
- Believe it or not, I have had several patients over the years who came to my office because they or someone they know “cracked their neck or back” resulting in an injury. Never do this. It takes a minimum of seven academic years to learn how to adjust a spine safely and effectively. It is best left to the professionals.
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Magnetic Bracelets
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A study recently published in the British Medical Journal has demonstrated that magnetic bracelets are just as effective as Vioxx or Celebrex at reducing knee or hip pain due to osteoarthritis. In independent studies, both the medications and the bracelets were found to reduce pain index scores by approximately 27%.
Ref: Harlow T, Greaves C et al. Randomized controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee. BMJ 2004; 329: 1450-1454.
Note: No side effects were reported with the bracelets. In the USA , 140,000 people had strokes or heart attacks (56,000 deaths) associated with Vioxx in the four years since it was introduced and subsequently pulled from the market.
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Physical Fitness and Mortality
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A study published in the American Journal of Medicine found that men who are physically unfit are 72% more likely to die within 5 years than their physically fit peers. Being physically unfit has higher risk of mortality than smoking, obesity, high blood pressure or diabetes.
Ref: Myers J, Kaykha A, George S et al. Fitness versus physical activity patterns in predicting mortality in men. AJM 2004; 117: 912-918
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Chiropractic and/orExercise
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A recent study in the British Medical Journal compared the cost effectiveness of physical treatments for back pain. The study found that a combination of spinal manipulation and exercise was most cost effective and provided the greatest improvement in quality of life scores. Manipulation alone was next in terms of cost effectiveness and satisfaction while exercise alone showed the least improvement.
Ref: UK BEAM Trial Team.United Kingdom back pain exercise and manipulation
(UK BEAM) randomized trial: cost effectiveness of physical treatments for back pain in primary care.
BMJ 2004 ; 329: doi= 10.1136/bmj.38282.669225.AE.
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Dark Chocolate is good for you
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A recent study published in the American Journal of Clinical Nutrition has found that ingestion of dark chocolate has significant beneficial effect on insulin sensitivity and decreases blood pressure in healthy individuals.
The effects were seen with eating 100 grams of dark chocolate daily.
Ref: Grassi, D. Lippi, C. et al. Short term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Am J Clin Nutr 2005;81:611-614.
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Get Cracking!
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An extensive review of the scientific literature was recently conducted regarding the effect of eating eggs on the risk of coronary artery disease. For most of the last forty years we've been warned against eating eggs because of their cholesterol content and their presumed effect on serum cholesterol levels. However, the data shows that eating eggs is not associated with elevated serum cholesterol levels and does not increase the risk of coronary artery disease.
The most recent American Heart Association Guidelines no longer include a recommendation to limit egg consumption.
Ref: Kritchevsky, S. A review of scientific research and recommendations regarding eggs. J Am Coll Nutr Vol.23, No.6 :596S-600S, 2004
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