The BBC News-Health webpage currently links to the BBC Health site. The title of the link is “Back-pain danger signs, Symptoms to take straight to your doctor”. I followed it, read through the information and found it incomplete. In my opinion, a few things could be added to the list, but before adding anything…it’s important to bear in mind that the vast majority of low back pain is trivial and usually disappears after a couple of days or weeks. In a very small minority of cases the low back pain is a sign of something more serious. You should make an appointment to see your doctor if your back pain is associated with:

• Significant trauma (such as RTA or a fall)
• Osteoporosis
• Prolonged use of corticosteroids
• History of cancer
• Unexplained weight loss
• Fevers
• History or high risk of decreased immune response (AIDS or HIV, recreational drug use, steroid or immunosuppressant use)
• Unremitting pain (even when lying down)
• Neurological symptoms (urinary incontinence or retention, fecal incontinence, loss of sensation in the genital region, weakness or loss of sensation in the lower limbs)

Please note that the signs and symptoms listed above don’t automatically mean that something sinister is at hand but simply that further questioning and examination is required. Lastly, remember that the overwhelming majority of low back pain is insignificant…apart from the inconveniencing pain obviously!

“To ensure good health: eat lightly, breathe deeply, live moderately, cultivate cheerfulness, and maintain an interest in life.”

William Londen

Osteoarthritis is the gradual degradation of a joint. It can lead to pain, stiffness and swelling. One of the most common joints to be affected is the hip. In 1940 Dr Austin Moore performed the first total hip replacement (THR) and the technique was later refined by Dr John Charnley. Modern replacements consist of a metal stem and head that is inserted into the top of the femur. It fits into a plastic cup which is cemented into the pelvis. Post surgery, patients usually experience less pain and enjoy greater range of motion. However, several studies have shown that the prosthesis wears and loosens prematurely if excessive running and impact activities are undertaken. This can lead to another operation to revise the THR with the associated risk of complications.

More recently, hip resurfacing was developed by Dr Derek McMinn as an alternative to THRs. It requires less of the femur to be removed. A metal cap is placed over the head of the femur and a metal cup is placed in the socket. The advantages of a hip resurfacing compared to a THR are numerous: bone preservation, less chance of dislocation, less leg length inequality, better lower limb alignment and easier revision to a THR if necessary.

A recent article in Reuters has quoted work done by Dr Julien Girard in France. Hip resurfacings were performed on 40 physically active patients. Their average age was 51 years. After surgery, 90% of the patients returned to running. Three years later 33 out of 40 were still running albeit they had decreased their mileage from 24 miles per week to 16 miles per week. The study didn't look at the long-term effects of running on the implant.

An article in today's Medical News Today summarises research presented at the 2012 Annual Meeting of the Academy of Orthopaedic Surgeons.  Over 10 years, 445 patients (average age of 49 years) who had undergone a hip resurfacing were monitored. A correlation between higher activity scores and revision of surgery was found and it was concluded that impact activities such as running and tennis were harmful to long-term success.

In conclusion, although a return to running and impact sports is possible after a hip resurfacing...even to high level competitive sport...it does bear risks...such as the untimely wear and deterioration of the prosthesis. This would require further surgery...and possibly a total hip replacement. With that in mind, my advice for anyone with a hip resurfacing, wondering how much they can or can't do...would be to stick to non-impact exercise such as cycling, rowing, cross-training, etc. That doesn't mean that you shouldn't run at all...I wouldn't want you to miss that train...but it should remain occasional.

Parkinson’s disease is a degenerative disorder that affects dopamine-generating cells in the central nervous system. The physical symptoms are the classic triad: shaking, rigidity and slowness of movement. Posture, walking and balance are also impaired. Dr Fuzhong Li and colleagues studied the effects of Tai Chi on patient’s with Parkinson’s. Amongst other benefits, they found that Tai Chi improved posture, walking ability and decreased the number of falls.

Previous research has already found that Tai Chi reduces falls among the elderly. In fact it’s slow, fluid movements over a firm, balanced stance seem like an ideal form of exercise for aging populations.