Back Pain During Pregnancy by Shelly King, DC

A friend of mine from chiropractic school wrote this article. I thought it was excellent and, so, am sharing it here. She practices in Tewksberry, MA and is expecting her first child.

Most expectant mothers will experience some degree of lower back pain during their pregnancy. In order to make room in the pelvis for the growing baby and prepare for delivery, a pregnant woman’s body secretes a hormone aptly named relaxin, which causes the ligaments to relax and loosen. Add to this the extra weight, weakened abdominal muscles, and shifted center of gravity that are unavoidable during pregnancy, and you have a recipe for back pain. While you may not be able to completely avoid back pain during pregnancy, there are some ways you can help make it more manageable.

First of all, prevention is key. Although heavy lifting will not hurt your baby, it is likely to hurt you. Even though I know better, I stupidly tried to move a 300 lb table during my first trimester and ended up spraining my pelvis. Please don’t follow my example! Let someone else do the heavy lifting. How often in life do you have such a great excuse for sitting back and letting others do the work? If you must lift something, make sure to bend your knees and lift with your leg muscles.

Proper foot wear is also essential to prevent back pain. Heels may look cute, but they are horrible for your back, especially during pregnancy. High heels push your center of gravity forward, causing you to arch your back in order to keep from falling over. During pregnancy, your back is already arched due to your big belly, so adding heels to the equation effectively causes you to squish the facet joints in your spine- ouch! My advice: ditch the heels at least during your pregnancy (but preferably forever!) Get some supportive flats, sandals, and walking sneakers. On a side-note, it is also a good idea to have your feet measured before making your purchase. Chances are, your feet have grown a size or two!

So what can you do if you find yourself with back pain despite these precautions? My four recommendations are: exercise, bracing, chiropractic, and massage. Gentle exercise such as walking, swimming, and yoga can do wonders for back pain. A few specific exercises that may be helpful are: lunge stretch, tailor stretch, cat-cow, and leg extensions. To do the lunge stretch, go down on one knee with the other leg bent in front of you at a 90 degree angle with the foot on the floor. Lunge forward slowly at the hips but keep the torso up straight. You should feel a stretch in your hip/groin area. Hold for 30 seconds and repeat on the other side. You can do the tailor stretch while seated. Cross one ankle over the opposite knee and lean forward, keeping the back as straight as possible. Cat-cow and leg extensions are done on your hands and knees. To do the cat-cow, arch your back up like an angry cat and tuck your buttocks under for a few seconds, then let your back relax and your belly sag for a few seconds. Repeat 10-20 times. For leg extensions, slowly move one leg straight behind you, hold for a few seconds, and then return to starting position. Repeat on the other side. Do 10-20 of these, making sure to keep your back as flat as possible.
If you find yourself getting sudden twinges of pain in your pelvis/buttocks whenever you stand up from sitting or if it feels like your hip sometimes “gives out” when you are walking, you may benefit from a sacroiliac brace. Essentially this is a belt that goes around your pelvis and helps hold the joints in place. The best ones that I have found are the “SI-LOC” and “Mother-to-Be” belts. Both can be found online at www.OPTP.com. The SI-LOC is better for earlier stages of pregnancy. The Mother-to-Be is better for the later stages of pregnancy when the belly is very big, or for women who are overweight to begin with. Both can be worn inconspicuously under your clothes.
Chiropractic treatment is another safe, effective option for back pain during pregnancy. A chiropractor can mobilize the joints in your spine and pelvis that have become stuck in the wrong position, thereby reducing inflammation and pain in the joints and helping the surrounding muscles relax. Theoretically, a well-aligned pelvis also maximizes the size of the pelvic opening, which many women have said leads to an easier delivery. Some chiropractors can also adjust your aching feet and address other problems you might be having, like headaches or carpal tunnel disorder. When shopping around for a chiropractor, ask if they regularly treat pregnant women and whether or not they have a special table or pillows to accommodate your expanding belly. Ask if you can meet with or talk to the doctor before making an appointment. It is important to find someone you like and trust. Chances are, you’ll need your chiropractor after having the baby as well; holding and breastfeeding an infant tends to cause some upper back tightness and pain.

Last but not least, I recommend that every mother-to-be gets at least one massage during her pregnancy. Growing a baby puts a lot of strain on the body. Muscles tend to get tight and sore, and you may be retaining water. You also may be feeling tense and anxious about your upcoming bundle of joy. A good massage can not only reduce muscle tension and reduce pain, but also provide mental relaxation and decrease swelling. And besides, every pregnant woman deserves a little pampering, right? Look for a licensed massage therapist who specializes in prenatal massage. He or she will know how to accommodate your changing body, either by doing the massage in a side-lying posture or using special pillows to support your breasts and belly.

In most cases, pregnancy related back pain will resolve several weeks after delivery, when you have lost some of the pregnancy weight and your ligaments have tightened back up again. That being said, there is no need to just wait and suffer throughout your pregnancy. By trying some of the tips that I have mentioned here, you will be more comfortable and able to enjoy the miracle that is happening within you.

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If Your Health Was At Stake, What Would You Change?

Most people know that cardiovascular disease and cancer are the leading causes of death, by a large margin, in the United States [1]. It is also common knowledge that these conditions are highly preventable diseases of our modern lifestyles. Modes of prevention are simple and well known too. So, instead of waiting for that grave diagnosis, how about incorporating a few changes, little by little, into your daily life? It could make the difference between continuing a life that you enjoy, and embarking on some radical green juice diet and intensive exercising in a sauna program, for the sole purpose of saving your life, down the road.

We’ve all heard the stories of people who’ve abruptly changed their nutrition and lifestyles after a scary diagnosis, and have completely turned the illness around and become healthier from it. This phenomena has even been studied. In a 2009 article published in the Journal of the American Medical Association (JAMA), Yale researchers found that “people newly diagnosed with health problems were more likely to change their health habits than those without a new diagnosis.” For example, “smokers newly diagnosed with at least one condition were 3.2 times more likely to quit than those without a new diagnosis [2].”

In 1990, Dean Ornish, MD published a study showing that “heart disease could be not only slowed down, but actually reversed with a plant-based diet and other lifestyle changes. People learned they could literally take their life in their own hands and cure themselves of a debilitating life-threatening disease once thought to be incurable [3].” More recently, in a study of men diagnosed with prostate cancer, Dr. Ornish studied the impact of a plant-based diet, “predominantly fruits, vegetables, whole grains, legumes and soy products,” on patients who already had cancer. “Dr. Ornish found 93 men with early biopsy-proven prostate cancer who volunteered to forgo radiation, chemo and surgery. He then randomized the cancer patients into a lifestyle modification group, which included a strictly plant-based diet along with other healthy behaviors such as walking 30 minutes six days a week, or a control group which just watched and waited. A year later the results were tallied and published in the September 2005 issue of the Journal of Urology. By the end of the year-long study, six of the control group patients had dropped out because their tumors were growing (MRI’s or diagnostic tests of cancer activity showed that their tumors were growing at such a rate that they decided they could wait no longer and opted for a combination of radical surgery, chemotherapy or radiation). However, not one of the vegan diet group suffered the same fate. In fact, while on average cancer activity increased in the control group, as measured by PSA tests, the cancer markers DECREASED in the lifestyle modification group. By the end of the year the cancer growth rate, as measured by these tests, was highly significantly different between the two groups [4].”

Of course, genetics and previous environmental exposures play a role, but people have more power than they might think over their health destiny. So, are you wondering yet, what are these simple changes that can be incorporated? According to the American Cancer Society (ACS), and many other experts and panels, eating right, being active, and maintaining a healthy weight are important ways to reduce your risk of cancer, as well as heart disease and diabetes. In short, it is recommended that you maintain a healthy weight, eat a healthy diet that is high in plant sources, adopt a physically active lifestyle, don’t smoke, and don’t drink too much alcohol.

In regards to eating a healthy diet, you can start immediately by replacing any sugary, salty, high-fat, processed foods in your diet with the whole food versions of them. A good rule of thumb, taken from author, Michael Pollan’s, 7 Rules for Eating, is “eat food, not too much, mostly plants. Don’t eat anything your great grandmother wouldn’t recognize as food,” i.e. “choose food over food-like substances.” Also, drink plenty of clean, pure water and few or no sugary beverages. Don’t drink diet beverages at all.

For exercise, the long term goal is to engage in 30 or more minutes of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week. Start small, though, by doing anything active, such as walking or biking in place of driving whenever possible (that’s good for the environment too), taking the stairs instead of the elevator, jumping in place while waiting for your computer or applications to start up, taking an exercise break at work, going out dancing with friends, or spending time playing with your kids (if applicable). Your increased activity levels will feed your energy capacity and, before you know it, you’ll be out running, biking, or playing a pick-up game of your choice with colleagues over lunch. Maybe you’ll even join a sports team, cycle a century, or run a marathon!

The last two changes, don’t drink too much alcohol and don’t smoke, can be tough, even though they sound pretty straightforward. The American Cancer Society (ACS) writes that moderate to heavy drinking is known to contribute to cancers of the mouth, throat, larynx (voice box), esophagus, liver and breast, and may contribute to colon and rectal cancers. The ACS recommends that people who drink alcohol limit their intake to no more than 2 drinks per day for men and 1 drink a day for women, with a drink being defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits. Quitting smoking is one of the best things you can do for improving, not only your health, but the health of the people around you. To kick the habit for good, you need motivation, dependable support, and sound strategies, and you don’t need to do it alone. There are so many resources available, including these from the Centers for Disease Control (CDC) and the ACS.

At the end of the day, it’s a simple decision to make. Do you want to take control of your long term health status, or would you rather just do nothing and wait to see how it all turns out, as the subject of your own experiment? There’s always week-long cleanse after week-long cleanse if it doesn’t work out.

1. National Center for Health Statistics, Deaths and Mortality Data for the US
2. Disease Diagnosis Can Spur Change in Lifestyle, HealthDay News, SOURCE: JAMA/Archives journals, news release, Feb. 9, 2009
3. Ornish D, et al. 1990. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 336(8708):129-33.
4. Ornish Takes on Cancer (from Dr. Greger Newsletter, Fall 2005)

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Preventing Knee Injury in Female Athletes

Did you know that female athletes who play popular competitive sports, such as soccer, basketball and volleyball, are at up to 8 times greater risk for injury of the anterior cruciate ligament (ACL) of the knee than their male counterparts? Or that, while some of these injuries come about following an external impact, such as a lateral blow to the knee by another player, the majority occur without any contact at all? These statements are both true and disturbing, but there is good news too. With proper conditioning, these injuries are preventable.

Before delving into more details, let’s all get on the same page with some basic information. The ACL is a tough band of tissue that runs from the thigh bone (or femur) to the shin bone (or tibia). It plays an important role in stabilizing the knee joint. When the ACL tears, it’s often the result of a sudden, forceful twist, such as an awkward landing from a jump that torques the knee. Athletes in sports that require quick pivots and jumps have the highest rates of ACL injury.

Following the well-known “pop” and the scream that often follows, the scenario for most of these injured athletes involves reconstructive surgery and a difficult six to nine months of rehabilitation, as well as a pre-disposition to irreversible posttraumatic degenerative joint disease in early adulthood. ACL injuries among young female athletes have reached epidemic levels in many countries, which has athletic trainers, coaches, athletes, parents, and administrators concerned. The prevalence of these injuries has also motivated the athletic and sports medicine communities to work on uncovering the mechanisms underlying the increased susceptibility in these athletes, and developing preventative measures. Many theories have subsequently been proposed, having found significant variations between female and male hip and knee anatomy, muscular balance around the knee, and movement patterns. Female sex hormones, including estrogen, progesterone and relaxin, are also thought to play a role, as they are known to fluctuate considerably during the menstrual cycle, most extremely at the onset of menses (first 1-2 days). Reportedly, these swings in hormone levels result in increased ligamentous laxity, and subsequent compromise of neuromuscular coordination, due to inconsistent tautness of these passive tissues.

While nothing can easily be done to change anatomical differences, muscular balance and movement patterns are pliable. Awareness is key as well. Some recent results, including those from a Centers for Disease Control commissioned study using an ACL injury prevention regimen called the PEP program (Prevent injury and Enhance Performance) on a season of NCAA women’s soccer players, suggest that balance and neuromuscular control play the central role in knee joint stability. Through the PEP program and others, successful methods that can be learned and practiced have been identified. The result? Protection of the knee joint complex and prevention of ACL injuries. Several high school and college level teams have incorporated such programs, consisting of a series of proprioception, plyometrics, agility and strength training exercises, into their training, and have seen significant decreases in ACL injuries among their athletes.

Further information regarding the PEP training program, including a complete PEP conditioning schedule with descriptions for all activities, can be found at the Santa Monica Orthopaedic and Sports Medicine Foundation website.

References
1. Am J Sports Med August 2008 vol. 36 no. 8 1476-1483. A Randomized Controlled Trial to Prevent Non-Contact ACL Injury in Female Collegiate Soccer Players
2. Training May Cut Risk Factors for Knee Injury. Reuters, New York. Copyright © 2009 ABC News Internet Ventures.
3. Female Athletes are Beginning to Implement an ACL Injury Prevention Regimen. Jim Rapier. Reuters Blog. Sept 24, 2009.
4. Arthroscopy. 2007 Dec;23(12):1320-1325.e6. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. Illinois Sports Medicine & Orthopaedic Centers, Glenview, Illinois 60025, USA. research@ismoc.net
5. Orthop Clin North Am. 2002 Oct;33(4):637-51. The female ACL: why is it more prone to injury? Ireland ML. Kentucky Sports Medicine, 601 Perimeter Drive, Lexington, KY 40517, USA. ksm@kysportsmed.com
6. Curr Womens Health Rep. 2001 Dec;1(3):218-24. Prevention of anterior cruciate ligament injuries. Hewett TE, Myer GD, Ford KR. Children’s Hospital Research Foundation, Room 3057 TCHRF, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA. tim.hewett@chmcc.org
7. Instr Course Lect. 2007;56:397-406. Dynamic neuromuscular analysis training for preventing anterior cruciate ligament injury in female athletes. Hewett TE, Myer GD, Ford KR, Slauterbeck JR. Sports Medicine Biodynamic Center, Cincinnati Children’s Medical Center, Cincinnati, Ohio, USA
8. Am J Phys Med Rehabil. 2005 Feb;84(2):122-30. Sports-related knee injuries in female athletes: what gives? Dugan SA. Rush Medical College, Chicago, IL 60614, USA
9. J Orthop Res. 2006 February; 24(2): 124–131. Absolute Serum Hormone Levels Predict the Magnitude of Change in Anterior Knee Laxity across the Menstrual Cycle. Sandra J. Shultz, Bruce M. Gansneder, Todd C. Sander, Susan E. Kirk, and David H. Perrin
10. Sports Med. 2000 May;29(5):313-27. Neuromuscular and hormonal factors associated with knee injuries in female athletes. Strategies for intervention. Hewett TE
11. J Athl Train. 2002 Jul–Sep; 37(3): 275–278. The Menstrual Cycle, Sex Hormones, and Anterior Cruciate Ligament Injury. James R. Slauterbeck, Stephen F. Fuzie, Michael P. Smith, Russell J. Clark, K. Tom Xu, David W. Starch, and Daniel M. Hardy

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Simple Measures Effective in Reducing Transmission of Flu Virus

From Medscape Medical News
News Author: Laurie Barclay, MD

“Our 2007 Cochrane review showed that physical interventions (personal hygiene, barriers, and distancing) are highly effective,” write Tom Jefferson, MD, from the Acute Respiratory Infections Group, Cochrane Collaboration, in Rome, Italy, and colleagues. “However, the current mainstay of pandemic interventions still seems to be vaccines and antiviral drugs, with no evidence supporting their widespread use, especially against a seemingly mild threat such as the novel H1N1 virus.”

Physical measures were highly effective in the prevention of transmission of severe acute respiratory syndrome, according to a meta-analysis of 6 case-control studies. The interventions included the following:

  • Handwashing more than 10 times daily
  • Wearing surgical masks
  • Wearing N95 masks
  • Wearing gloves
  • Wearing gowns
  • Handwashing, masks, gloves, and gowns combined

The combination of handwashing and use of masks, gloves, and gowns also effectively interrupted influenza transmission within households. In younger children and within households, hygienic measures can prevent respiratory tract virus transmission, according to results from the highest-quality cluster randomized trials.

There was limited evidence that the more uncomfortable and expensive N95 masks were more effective than simple surgical masks, but they caused skin irritation. Any additional benefit of adding virucidals or antiseptics to normal handwashing was uncertain, and global measures, such as screening at entry ports, were not properly assessed.

It appeared that social distancing might be effective if used in relationship to the risk for exposure (the higher the risk, the longer the distancing period), but evidence was limited.

“Routine long term implementation of some of the measures to interrupt or reduce the spread of respiratory viruses might be difficult,” the review authors write. “However, many simple and low cost interventions reduce the transmission of epidemic respiratory viruses. More resources should be invested into studying which physical interventions are the most effective, flexible, and cost effective means of minimising the impact of acute respiratory tract infections.”

Limitations of this study include methodologic limitations of the included studies.

“In situations of high risk of transmission, barrier measures should be implemented such as wearing gloves, gowns, and masks with a filtration apparatus, and isolation of likely cases,” the study authors conclude. “Most effort should be concentrated on reducing transmission from young children through regular education at school on hygiene. In addition, society should invest in more comfortable and better designed face masks and barrier apparatus, which would increase compliance with their use.”

The National Health Service research and development programme and the National Health and Medical Research Council of Australia supported this study. The review authors have disclosed no relevant financial relationships.

BMJ. 2009;339:b3675.

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Seven Habits (to Break) of Highly Effective People

Here’s an article that is too appropriate for today’s climate not to share. If you’re one whose finding your stress levels on the rise, this quick and easy read is worth your time. Remember that you are always your number one priority, no matter what is going on around you. You’ll be totally ineffective without your health intact. My wishes for your good health! Dr. Morton

From The Medscape Journal of Medicine
Webcast Video Editorials
Seven Habits (to Break) of Highly Effective People

Posted 01/16/2009

George T. Griffing, MD

During these tough financial times, many people feel they have to push themselves to unhealthy levels in order to succeed. But high-pressure jobs and long hours take a real toll on their immediate and future health. Whether running for president, moving up the corporate ladder, or juggling the family’s activities, success may come at a hefty cost.

The 7 worst habits of these workaholics include:

1. Forgetting to relax: Some stress can be good because it keeps you alert and motivated; too much stress, however, will take its toll on your body.[1]

2. Eating on the go: Who has time to sit down for a healthy lunch? But beware of frozen meals, fast, and processed food that can be high in sodium, calories, and fat.[2]

3. Putting off sleep for work: Lack of sleep can cause irritability, difficulty concentrating, memory problems, poor judgment, and obesity.[3]

4. Not making time for exercise: Humans were not designed to sit at desks for 8 hours a day. Exercise has been shown to reduce the risk for nearly every major disease and to help fight anxiety and depression.[4]

5. Working when sick: 3 common-sense reasons to stay home: avoid spreading the infection, you’ll be less productive, and you need your rest to get better.

6. Drinking (too much): Moderate alcohol consumption has some proven health benefits , but excessive drinking can lead to alcoholism, liver disease, and some forms of cancer.[5]

7. Skipping annual medical checkups: Depending on age, family history, and lifestyle, a comprehensive medical checkup and special screenings is recommended every 1 to 5 years.[6]

Eventually, something’s going to give. If your patients keep burning the candle at both ends, the flame will burn out faster. But, if they maintain a healthy balance, they will be happier and healthier overall.

That’s my opinion. I’m Dr George Griffing, Professor of Medicine at St. Louis University and Editor in Chief of Internal Medicine for eMedicine.

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Natural Flu Prevention

There are three factors that influence a person’s risk for contracting infectious illnesses such as flu and common cold. These are the quality of the host, the quality of the germ, and the quantity of the germ. It may appear that the germ has an advantage over us, as it influences two of the three factors that determine whether or not we get sick. As it turns out, though, we have much more clout than these menacing microorganisms in deciding our health and wellness. In addition to common sense behaviors that can limit exposure, including frequent hand washing, keeping hands away from the face, and avoiding crowded settings, there are several proactive steps that can be taken to make oneself a miserable host for these bugs. Here is a short list.

1. Get enough sleep. Your immune system functions much better when you are well rested. The number of hours needed each night varies by individual, but you know when you’re body is fatigued and, when this is the case, it simply won’t be able to fight off the flu virus, or any other infection, very well [1].

2. Exercise regularly. Exercise helps keep your immune system strong. In fact, a recent study showed that mice who performed mild exercise as soon as they were exposed to the flu virus had much lower death rates [1,2].

3. Avoid sugar. Even small amounts of sugar can significantly impair your immune function, making you more susceptible to a flu infection. A large amount of sugar, such as the amount found in a normal can of soda, hurts your immune function for hours [1].

4. Drink plenty of pure water. Keeping your mucous membranes well-hydrated is key to helping them fight off viruses [1]. The amount of water a person should drink depends on body weight and is determined as follows: body weight in pounds divided by 2 = number of ounces needed per day. For example, a 120 pound person should drink about 60 ounces of water each day.

5. Reduce stress. Too much stress has a highly negative impact on your overall health and, over time, it will make you much more susceptible to a flu infection. Studies show that prolonged stress is at least partially responsible for a significant percentage of all illness and disease. Regular exercise and sufficient sleep both help reduce stress levels. Also, meditation is a proven stress-buster that is easy and enjoyable; perfect for daily use [1].

6. Eat immune-boosting foods on a daily basis. A healthy diet, including a few proven immune-boosting foods, such as plentiful organic fruits and veggies, garlic, green tea, and cayenne, is one of the best ways to avoid catching the flu [1].

7. Get fresh air every day. During the winter months, the dry heat from indoor heating systems dries out mucous membranes, causing increased susceptibility to viruses. When inside, crack open a window or two to give your body some relief [1]. And, of course, get outside to play at every opportunity!

8. Drink little or no alcohol during flu season. Too much alcohol impairs liver and immune function, which leaves you open to all kinds of infections. Heavy drinkers are especially susceptible to flu infections. Also, alcohol dehydrates your body which is always bad, especially during flu season [1].

9. Don’t smoke… and avoid smoke-filled places. First and second-hand smoke significantly impairs your immune system. It also dries out your nasal passages and paralyzes cilia, the small hairs in your nose and lungs that help keep out viruses [1].

In summary, don’t panic, but do stay healthy. Your good health is your most powerful weapon against serious infectious illness. Feel free to get in touch if you have any questions. You can also find additional information regarding flu prevention and treatment @ www.fluhelp.org.

References

1. FluHelp.org (www.fluhelp.org), 04/26/2009
2. Vaccine. 2008 Oct 3;26(42):5407-15. Epub 2008 Aug 14.

Disclaimer: All health-related information on this web site is for educational purposes only. None of the flu prevention and treatment information provided here is to be construed as medical advice. Before applying any flu therapy, you may want to seek advice from your health care professional. The information on this web site should not be a substitute for physician evaluation or treatment by a health care professional and is not intended to provide or confirm a flu diagnosis.

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