Back Pain Myths: Strong Back Muscles

On a daily basis, I see patients who suffer more than they should because of some common back pain myths. Today’s myth: Strong back muscles will protect your spine.

Wrong!

Your body has two types of muscle (really more than this, but the others are in your internal organs), movers and stabilizers. Movers are big muscles that move your body parts, hence the name. Stabilizers are muscles that hold your parts in place and prevent you from being damaged while the movers are moving you.

Your multifidus muscle, pictured below, is an example of a stabilizer muscle.

To prevent back pain, you need your stabilizer muscles to have endurance. They protect your spine. If they work as long as you do, everyone is happy. If they quit before you do….ouch!

These muscles don’t need to be strong, but they need to be able to keep going and going….and going.

The problem with exercises for strength is that they tend to work the “movers” more than the stabilizers. And, when they do work the stabilizers, they can change them from slow-twitch (endurance) muscle to fast-twitch (powerful) muscle.

Studies of back pain patients show that high percentages of patients with chronic back pain have a different mix of fast vs. slow twitch muscle fibers. Studies also show that those with back pain tend to have very low endurance of their stabilizers – particularly the multifidus.

Tomorrow: preventing back pain with endurance exercises. Stay tuned!

What do surgeons say about disc replacement?

While reading this morning about the first spinal disc transplant, I was reminded of the excitement over the artificial disc a while ago. It was a big deal! It was revolutionary! The Seattle Times did a big piece on a woman who was miraculously cured, etc. etc.

I was skeptical, partly because it made sense to be and partly because………hey, I was born that way. About this time I talked to a local neurosurgeon and asked him about it. He didn’t think it was very effective. But, people will want it….”so I’ve got to offer it.”

More recently I was at a continuing education meeting with a group of mostly local spine surgeons. The presenter gave a clinical vignette (i.e. a made up patient case, describing a patient with intense, persistent back pain). He then asked how many, by a show of hands, would opt to get a disc replacement surgery if THEY WERE THE PATIENT. Not one hand went up. 50-75 spine surgeons in the room and not one would subject themselves to a disc replacement!

Do unto others as………..?

Sleep Apnea Causes Brain Damage!

Read the article here!

Back Pain, Lies and Videotape

I was watching a TV show, or movie the other night. One of the characters tried to help someone out and got sued for injuring her. The good guys got smart, videotaped the “injured” person and the law suit was dropped.

This makes for great fantasy. The good guys win and the case is clear cut. However, in real life, it doesn’t work like this.

We cannot see back pain. We can take x-rays, MRI’s, CAT scans, bone scans and more. On these images we see potential problems. It’s not like a broken bone, or cancer. It is not anywhere near that straightforward.

In cases with litigation this can cause some….discord, or skepticism and heated debate at least. Defense lawyers – both the evil, scheming and the others – think that they might get some insight on the case by following the patient with a video camera.

I was at a conference awhile ago. A lawyer showed some video of an “injured” patient. This guy was climbing fences, running around. He actually, by himself, hoisted a full size couch into the back of a truck which had sides higher than his head!

Not all cases of video surveillance are clear cut. Some could be argued legitimately either way….not this one. Well, what do you think the judge said after he saw the tape………c’mon guess.

This is actually a trick question. The judge refused to look at the tape! Apparently, according to this defense attorney, this is common. Judges don’t like the invasion of privacy caused by the video surveillance.

Truth is stranger than fiction.

Shedding light on Scoliosis

For many years it has been known that we can cause scoliosis in chickens if we remove their pineal gland. The pineal gland is almond shape and sits, more or less, above and between your eyes. The pineal gland releases melatonin and is a big player in maintaining our sleep wake cycle.

If this gland is removed in young chickens, 50-80% will develop scoliosis. A study has also shown that exposing young chickens to bright lights 24 hours a day (which decreases their melatonin levels to almost zero) can cause scoliosis in 15% of otherwise normal chickens.

However, when we look at humans with scoliosis, they don’t have changes in melatonin levels. (Reference here.) But, changes are found in the melatonin receptors along the spine from side to side. (Reference here). But, the researchers seem to think this is secondary to some other change.

And a recent study showed a much higher rate of scoliosis in blind women. (Reference here.) Vision, light, melatonin…all seem related, but the relationship is not clear.

Unfortunately, we really have more questions than answers.

Adult Scoliosis: The Real Story

Earlier I wrote a mild rant about doctors scaring adult patients with mild scoliosis (click here to read).

After finding out that some of the common fears are overblown, some of you wanted to know what is a realistic expectation. I am glad you asked. Some Swedish researchers followed a group of patients with adolescent idiopathic scoliosis, who were treated with bracing as adolescents, for more than 20 years.

Over this time, the average increase in the size of the scoliosis curve was 7.9 degrees. One scoliosis patient out of 127 had a large increase of 27 degrees and ended up with surgical treatment. The odds of having a large curve increase were 0.079% in this study. Or looking from the other side, the odds of having mild curve progression were 99.21%.

The scoliosis patients did have more degenerative disc disease and more mild back pain. Of those with scoliosis 75% had back pain compared to 47% of those without scoliosis. Remember, the pain was mild and only 24% had daily pain.

Clearly this is not the horror story that some clinicians are selling to patients with scoliosis. And, if you are one that has a very mild curve, these statistics don’t even apply to you.

If you had scoliosis as a teenager – enough to require bracing – you can expect to have mild back pain and some extra spinal degeneration. Not great, but not too bad either. (click here for the study)

Must Read on Cancer Screening!

Click here for the article.

What does your doctor know?

There is a famous basic competency test to test doctors’ knowledge of musculoskeletal medicine (necks, backs, shoulders, knees, etc). Many studies have shown that most medical school graduates fail this test.

In one particularly galling study, 70 out of 85 orthopedic residents – students who had graduated from medical school and were doing a residency in this very subject – failed.  There are many, many more studies like this. Osteopathic school students, who study spinal manipulation and would be expected to have a decent passing rate, showed a 70% failure rate. In other specialties it is worse.

So, when a study came out testing chiropractic students came out I was pretty interested and thought you might be as well. They used the same test as previous studies, but did not count 5 of the questions which were outside the scope of a chiropractor. The average score was 80% (vs. 55-59% in the studies of medical students.

Does this mean that MD’s are idiots? No! The graduates that failed these exams are bright and have vast knowledge in many other areas. This expectation that a doctor should know everything is crazy and dangerous.

It doesn’t matter too much what your doctor knows. Every doctor knows some areas well and others less so. The question is, does your doctor know what he doesn’t know?

The Skinny on Fat

Fat is bad right? After all, you are what you eat….right? Eat fat and you will be fat.
We have known for years that saturated fat increases cholesterol and that cholesterol causes heart attacks. In fact, that is why they started using trans-fats so much. The food industry was pushed into getting rid of that evil SATURATED  fat.

Now, of course, they are being forced to get rid of that evil TRANS-fat (the ones that they were told to use a few years ago).

Some researchers at Stanford University followed about 320 women randomly put on one of four diets. One of the diets was the Atkins (very high in saturated fat). Another diet was the Ornish diet which is extremely low in fat – especially saturated fat.

They followed these women for a year. They were given weekly training sessions for 2 months and a follow-up at 10 months.

Women in the Atkins group lost the most weight over the year (more than twice as much as the Ornish group). But, your saying, they probably had sky high cholesterol. Uhh…no. They had as good or better cholesterol levels, ratios and triglyceride levels.

Does that mean the Atkins is the perfect diet? No, I think you need more fruits and vegetables than that to be healthy (particularly relating to risk of cancer).

While too many calories is clearly a problem, we might want to worry less about fat.

Scoliosis: Be Afraid…Be Very Afraid!

On a regular basis, patients come into my office with big worries about their scoliosis. The thing is, most of these patients DON’T HAVE SCOLIOSIS….never had it, never will. But, someone, either at school or some doctor (often, I am ashamed to say, a chiropractor) has told them falsely that they have a scoliosis.

As a result, they carry these visions of future pain and disability around for years. Sometimes they even avoid activities they love because they think it will be bad for their scoliosis.

Here is an example of a mild case of scoliosis. He has probably had this curve for decades. I would guess that his curve is about 20 degrees. Looking at his back, you can see he has a curve. But if you didn’t know to look for it, would you notice it? Probably not.

Even with this long-standing scoliosis, he does not have much disk disease. Looking on his x-ray (it is a little hard to read on the computer at this size), I don’t see any more degeneration than I would expect in someone who has gray hair.

He is doing well. Most of the patients who come into my office have a curve that is half the size of this curve and usually more like 1/4 or 1/8. They have no more reason to worry about their backs than anybody else – at least not related to the curve.

So, what about people with a real scoliosis – as big as the picture or more?…………I’ll put that in another post.