February 28, 2001 [Volume 2, Issue 5]

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In this issue of To Your Health:

• Get Out of Bed and Fight Back Pain
• Corticosteroid Therapy Increases Fracture Risk
• Exercise Now = Strong Bones Later?
• Back Belts Do Little to Reduce Injury Claims

The classic symptom of sciatica is shooting pain down the back of the leg, often accompanied by back pain. Clinical management of sciatica and low back pain (LBP) involves a variety of approaches, including bed rest - although evidence suggests that bed rest does little or nothing to reduce LBP or any spine-related conditions.

The Cochrane Collaboration Back Review Group conducted a recent systematic review of clinical trials (considered one of the highest forms of research evidence) comparing bed rest with other approaches to managing LBP and sciatica. Nine studies meeting predetermined criteria were included in the final analysis, representing study results for 1,435 patients. Overall, results showed no significant differences in pain intensity of functional status following bed rest, leading the authors to draw three powerful conclusions:

1) Bed rest is not effective in the treatment of low back pain.

2) Bed rest may have slightly harmful effects on acute LBP.

3) No further research on the role of bed rest in the treatment of acute LBP is necessary.

Reference: Hagen KB, Hilde G, Jamtvedt G, et al. The Cochrane review of bed rest for acute low back pain and sciatica. Spine 2000: Vol. 25, No. 22, pp2932-39.

Corticosteroid Therapy Increases Fracture Risk

Corticosteroids are anti-inflammatory medications prescribed for the treatment of allergic conditions, asthma and other diseases. Many elderly patients take corticosteroids to treat chronic inflammatory and immune disorders, despite mounting evidence that corticosteroid use may accelerate bone loss.

Case in point: A recent study in the Archives of Internal Medicine compared rates of vertebral deformities and vertebral fractures between 229 patients and 286 control subjects. Patients reported taking corticosteroids for at least six months' duration, whereas control subjects reported no prior use of corticosteroids.

Results showed that average lumbar spine and neck bone mineral density (BMD) were lower in corticosteroid patients with vertebral deformities than nonusers with deformities. These effects were maintained when adjusting for the effects of age, sex, body mass index, and duration of use. Older age also proved a significant risk factor for deformity: patients 70-79 years old had five times the risk as patients 60 years and younger.

If you're currently taking corticosteroids (or any medication), ask your doctor for more information on the potential dangers before you renew that prescription. Your doctor can also tell you about possible nonpharmaceutical options for managing your condition. For further information on the dangers of drugs, go to https://www.chiroweb.com/find/archives/general/drugs/index.html.

Reference: Naganathan V, Jones G, Nash P, et al. Vertebral fracture risk with long-term corticosteroid therapy. Prevalence and relation to age, bone density, and corticosteroid use. Archives of Internal Medicine, Oct. 23, 2000: Vol. 160, pp2917-22.

Exercise Now = Strong Bones Later?

The human skeleton appears to respond more favorably to physical activity during the childhood "growth years" than in adulthood. Previous research has shown 10-20% higher peak bone mineral density (BMD) in young people who exercise compared with nonexercisers. In contrast, this figure is only 1-5% higher in adults who exercise regularly compared with sedentary adults.

If exercise is to be recommended during childhood, gains in bone density must be maintained in later life, particularly with respect to the risk of suffering fractures. To investigate this premise, the authors of a study published in The Lancet measured BMD in 22 active soccer players, 128 former soccer players, and 138 age-matched control subjects. Frequency of fractures was also assessed in 284 additional former soccer players and 586 controls.

Results: Leg BMD was significantly higher in active soccer players and former soccer players retired for five years or less. However, these increases declined with more lengthy retirement, such that players retired for 35 years or more had similar BMD levels as control subjects. Additionally, the separate analysis of fracture rates showed no difference between former athletes and controls.

If you have children, talk to them about the benefits of regular, moderate exercise, but remember: consistency is the key. As these results suggest, maintaining bone mineral density and avoiding debilitating bone fractures is a lifelong challenge. For online information on exercise and fitness, visit https://www.chiroweb.com/tyh/sports.html.

Reference: Karlsson MK, Linden C, Karlsson C, et al. Exercise during growth and bone mineral density and fractures in old age. The Lancet, Feb. 5, 2000: Vol. 355, pp469-70.

Back Belts Do Little to Reduce Injury Claims

If you've ever walked through a department or grocery store while employees were stocking shelves or moving supplies, you've probably witnessed a back belt in action. Many employers recommend or require back belts to reduce employee injuries and injury claims.

But are back belts effective? Not according to a study in the December 6, 2000 issue of the Journal of the American Medical Association. In the largest study of its kind, incidence rates of workers' compensation claims and six-month incidence rates of self-reported low back pain were gathered from 13,873 employees at 160 retail merchandise stores in 30 states. Eighty-nine stores required back belt use; 71 had a voluntary back-belt policy.

All employees were interviewed at the study's inception and again at a two-year follow-up. Results showed that neither frequent back belt use nor a store policy requiring such use had any significant effect on back injury claim rates or self-reported back pain. Accounting for multiple risk factors, such as lifting frequency and/or a history of previous back injury, did not substantially alter these findings.

In 1998, a U.S. Bureau of Labor Statistics survey revealed that Americans suffered nearly 300,000 back injuries due to overexertion, and resulting in lost workdays. As this study shows, back belts probably aren't the answer to this growing problem. Fortunately, there are other options, including sound advice and care from an expert in dealing with back pain: your local doctor of chiropractic. For more information on back pain, go to https://www.chiroweb.com/tyh/backpain.html. To find a chiropractor near you, go to https://www.chiroweb.com/cgi-bin/locator.

Reference: Wassell JT, Gardner LI, Landsittel DP, et al. A prospective study on back belts for prevention of back pain and injury. Journal of the American Medical Association, Dec. 6, 2000: Vol. 284, No. 21, pp2727-32.

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