Steroid Epidurals Can Help Relieve Sciatica

A recent randomised trial published in Annals of Internal Medicine by Cohen and his colleagues shows that steroid epidurals can help relieve sciatica. They found that “75% of patients treated with epidural steroids reported 50% or greater leg pain relief and a positive global perceived effect at 1 month”.  Of course, an epidural is an invasive treatment with associated risks and would probably not be the first choice of treatment. Conservative therapies such as physiotherapy, osteopathy, chiropractic, acupuncture, etc. should be the first port of call. In addition, your GP may prescribe anti-inflammatories and analgesia. Only in cases of severe sciatica when conservative treatment has not been effective should an epidural be envisaged.

Over time the healing process should help settle the sciatica, irrespective of whether or not a steroid epidural is performed, but an epidural can catalyse the process by decreasing pain, decreasing anxiety and stress, increasing mobility and allowing the participation in physiotherapy and rehabilitation.

An Integrated Approach To Low Back Pain Improves Results

An article in Medical News Today reviews a study in The Journal of Alternative and Complementary Medicine on the treatment of low back pain. A combined program of complementary and conventional therapies was found to be more helpful than the usual care provided by the primary care physician. The benefits of the program were a decrease in pain and an improvement in function. The complementary therapies provided included physiotherapy, acupuncture, massage, mind-body techniques, chiropractic and nutritional advice. Healing in Motion in St Albans aims to treat musculoskeletal disorders using a holistic, integrated approach.

The Effects Of Smoking On Musculoskeletal Health

It’s common knowledge that smoking is bad for health. In the UK, according to the NHS, 114,000 people die each year of smoking related illnesses. In the US, the figure is 443,000 and as reported by Centers for Disease Control and Prevention, smoking is the cause of one out of every five deaths. Smoking damages the lungs and causes conditions such as bronchitis, emphysema, pneumonia and 90% of lung cancers…in addition to several other types of cancer. It also damages the heart and circulatory system and increases the risk of getting coronary heart disease, heart attacks and strokes…but we know all that, what we’re less familiar with are the effects on the musculoskeletal system.

Lets take a closer look at some of the harmful constituents of cigarette smoke: nicotine, carbon monoxide and hydrogen cyanide. Nicotine causes a narrowing of blood vessels and thus decreases blood flow to tissues. Nicotine also increases the risk of blood clots by increasing platelet stickiness. Carbon monoxide and hydrogen cyanide both hinder oxygen metabolism and transport. In summary, smoking decreases the blood flow and transport of oxygen to tissues. The supply of nutrients, minerals and oxygen via blood flow is vital for the development and regeneration of cells.

Some of the numerous documented musculoskeletal risk factors associated with tobacco use are:

• poor wound healing and increased rates of postoperative complications such as infections, haematoma, tissue death and skin graft loss
• delayed or deficient ligament healing (in mice)
• shoulder rotator cuff disease
• the development of osteoporosis and osteoporosis related hip fractures
• an extensive body of evidence shows that smoking delays mineralization during the bone healing process, decreases the strength of regenerating bones and increases the incidence of non-union (failure to heal). In one study on wrist fractures, non-smokers took 4.1 months to heal whereas smokers took 7.1 months…almost twice as long! Smokers have been estimated as having 2.5 times more risk of ensuing complications.
• an increase in the incidence of rheumatoid arthritis
• a greater likelihood of developing systemic lupus erythematosus (an inflammatory autoimmune disease affecting connective tissue)

In order to enhance soft tissue healing and fracture healing, as well as for general musculoskeletal health, it’s definitely advisable to stop smoking!

“Everything can be taken from a man but one thing: the last of the human freedoms…

to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

Viktor Frankl

Skiing And Snowboarding Injuries

A study by Suezie Kim et al. published in The American Journal of Sports Medicine has shown that injury rates in snowboarders are slightly higher than injury rates in alpine skiers. Snowboarders more commonly injure their wrists, shoulders and ankles while skiers tend to injure their knees.

In skiers the knee accounts for a third of all injuries but female skiers are twice as likely to injure their knees as men and 3 times as likely to strain their anterior cruciate ligaments (ACL). Gerhard Ruedl et al. found that women “showed a 2-fold higher risk of suffering an ACL rupture of their non-dominant leg”. Men had an equal chance of injuring the right or left knee. Ruedl told Reuters Health that women showed greater discrepancies in strength and proprioception (sense of joint positioning)  between their dominant and non-dominant legs. Most female skiers injured their left (non-dominant) ACLs during right turns when the forces on the left (outside) leg were greatest.

Shift Work May Cause Obesity And Diabetes

An article in today’s BBC News Health discusses recent research published in Science Translational Medicine. Dr Orfeu Buxton et al. have shown that “prolonged sleep restriction with concurrent circadian disruption alters metabolism and could increase the risk of obesity and diabetes”. This has implications to people performing shift work.

“All that we are is the result of what we have thought,

What we think we become“.

Siddhartha Guatama Buddha

Have Some More Chocolate!

Easter is upon us and as usual, we’re about to indulge in fistfuls of chocolate….so I thought I’d remove the guilt by telling you about some of the potential benefits! Extensive research has shown that the cocoa in chocolate can help: improve arterial blood flow and decrease blood pressure, improve glucose and fat metabolism, and improve vascular and platelet function. A 50% decrease in mortality, mostly due to decreased myocardial infarction, has been seen. The mechanisms underlying the effects are thought to be due to the activation of nitric oxide as well as antioxidant and anti-inflammatory effects.

What type of chocolate is best and how much should we have? It’s been recommended that we eat up to 25g/day of flavanol rich dark chocolate (85% cocoa content) for cardiovascular prevention. The belief is that, at this dose, the effects on weight gain and Cadium intake are minimal.

Enjoy…Happy Easter!

Sitting And Mortality

A few days ago the Archives of Internal Medicine published the timely results of the effects of sitting on mortality rates. van der Ploeg and her colleagues followed over 220,000 Australians over a 3 year period. The subjects were 45 years or older and sadly 5405 people passed away during the course of the study. The researchers found that mortality risks increased with daily sitting time. Compared to people who sat less than 4 hours a day, those that sat for 4-8 hrs had a 2% increased risk of mortality. Whereas those that sat for 8-11 hrs a day increased their risk by 15% and the subjects that sat for over 11 hrs increased their risk of death by a whopping 40%!

Fascinatingly, their results revealed that prolonged sitting was a risk factor for mortality independent of physical activity. Probably because “time spent doing moderate or vigorous exercise and time being totally sedentary may affect long-term disease risks separately.”

Don’t be too depressed about it…we all have to go at some stage…but if you prefer to leave later rather than sooner, have a look at my previous post ‘I Wouldn’t Sit For That (Part 2)‘ for some helpful tips!