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SNOW SHOVELLING NUMBER ONE CAUSE OF WINTER BACK PAIN

"Lift light, shovel right" say back specialists

TORONTO - January 9, 2003 -

A new poll released today points to snow shovelling as the leading cause of back and neck pain during the winter months. 73 per cent of Ontario chiropractors surveyed say improper shovelling technique tops the list of winter back pain woes.

"Chiropractors are finding that some patients experience back and neck pain as a result of improper snow shovelling technique," said Dr. Dennis Mizel, President of the Ontario Chiropractic Association. "Improper technique can be anything from bending at the waist instead of the knees to throwing snow instead of pushing it. When you combine improper technique with the average weight of one shovelful of snow (five to seven pounds) it becomes even more evident that this is a serious problem for both adults and the children who help them."

National public opinion research firm, Pollara, recently conducted the survey among members of the Ontario Chiropractic Association. Pollara surveyed a total of 500 chiropractors from across the province. The survey is accurate to within ±4.4 percentage points, 19 times out of 20.

"Back problems can surface in patients during the winter, especially those who are unaccustomed to participating in challenging physical activity on a regular basis," said Dr. Kristina Peterson, a chiropractor in Thunder Bay. "Activities requiring exertion that is higher than one's daily routine such as winter sports or pushing stuck cars can cause back injuries. However, snow shovelling is the number one reason patients present with back pain in the winter."

Don't let winter be a pain in the back - 'Lift light, shovel right.' Education and preparedness are the keys to correcting this seasonal problem. The Ontario Chiropractic Association offers the following preventive measures to help keep backs in shape:

· Warm-up. Before beginning any snow removal, warm-up for five to ten minutes to get the joints moving and increase blood circulation. A good warm-up should include stretches for the back, shoulders, arms and legs. This will ensure that your body is ready for action.

1. Don't let the snow pile up. Removing small amounts of snow on a frequent basis is less strenuous in the long run. Pick the right shovel. Use a lightweight push-style shovel. If you use a metal shovel, spray it with Teflon first so snow won't stick.
2. Push, don't throw. Push the snow to one side and avoid throwing it as much as possible. If you have to throw, avoid twisting and turning - position yourself to throw straight at the snow pile.
3. Bend your knees. Use your knees, leg and arm muscles to do the pushing and lifting while keeping your back straight.
4. Take a break. If you feel tired or short of breath, stop and take a rest. Stop shovelling immediately if you feel chest or back pain.

Founded in 1929, the Ontario Chiropractic Association represents the professional interests of more than 2,800 Ontario chiropractors. Chiropractic is a regulated health care profession recognized by statute in all Canadian provinces, and is one of the largest primary contact health care professions in Canada. Every year approximately 4.5 million Canadians use chiropractic services. Chiropractors provide diagnosis, treatment, and prevention of disorders related to the spine, nervous system, and joints.

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Chiropractic Health & Wellness
Everything you want to know about chiropractic.


In this issue of To Your Health:
A Failure to Communicate
Heart Failure Risk Doubled in Obese
Which Vitamins Prevent Chronic Disease?
Preemptive Strike

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A Failure to Communicate

Patients who exaggerate their pain or set unreasonable expectations of their chiropractors are known to be at a higher risk for long-term disability. For the most effective treatment from your doctor of chiropractic, he or she must have a clear knowledge of your symptoms and concerns.

A recent survey of 30 chiropractors and 336 patients in Sweden showed that both groups had many similar goals and expectations for treatment. For example, both doctors and patients expected the practitioner to identify and explain a problem, and both expected treatment to reduce symptoms and make patients feel better overall.

There were several differences in treatment expectations, however. Patients had significantly lower expectations of treatment success than their doctors, yet higher expectations for advice and exercise. Patients also disagreed with their doctors of chiropractic on how many treatments were necessary. Out of options ranging from 1-2, 3-5, 6-10, or more than 10 treatments (or no opinion), most chiropractors felt that 3-5 treatments are necessary for "substantial" improvement. Patients expected improvement after 1-2 treatments, or had no opinion on what to expect.

Poor communication between the patient and doctor can negatively affect treatment outcomes. With any health practitioner you seek, be sure to understand one another and have similar treatment expectations for the best results possible.

Reference: Sigrell H. Expectations of chiropractic treatment: What are the expectations of new patients consulting a chiropractor, and do chiropractors and patients have similar expectations? Journal of Manipulative and Physiological Therapeutics 2002:25(5), pp. 300-305.

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Heart Failure Risk Doubled in Obese

Very obese people have been shown to face a much higher risk for heart failure than people of normal weight. With more and more Americans considered overweight or obese, the authors of a recent study in The New England Journal of Medicine wanted to determine if being overweight to a lesser degree also puts a person at a greater risk for heart failure.

Using body-mass index (BMI) to classify a person's weight, almost 6,000 people were divided into one of three categories: normal weight, overweight, or obese. Incidence of heart failure was compared among the groups, who averaged 55 years old.

Overweight women were 50% more likely to experience heart failure than women of normal weight, based on an average of 14 years of follow-up. Obese women and men were approximately twice as likely to have heart failure. The risk for heart failure rose consistently for both genders as BMI increased, regardless of other factors like smoking, alcohol consumption, or age.

To figure out your BMI, multiply your weight (in lbs.) by 703, then divide twice by your height (in inches). Normal weight is considered a BMI of 18.5 to 25; "overweight," 25 to 30; and over 30 is considered "obese."

This measure of "healthy" weight has been criticized, however, as some people who work out regularly and are dense with muscle may be healthy despite a high BMI.

Reference: Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. The New England Journal of Medicine 2002:347(5), pp. 305-313.

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Which Vitamins Prevent Chronic Disease?

Inadequate levels of some vitamins can lead to chronic diseases, including cancer and heart disease. Many Americans get most of the vitamins they need from the foods they eat, but deficiencies involving even one vitamin can lead to problems.

The authors of this report in the Journal of the American Medical Association reviewed nine vitamins key to preventative care in adults (vitamins A, B6, B12, C, D, E, and K; folate; and provitamin A carotenoids) based on studies published from 1966-2002. The following is a list of health conditions and vitamins that may alter their progression:

Osteoporosis: Vitamin D, along with calcium, has been shown to reduce bone loss and fracture risk in the elderly.
Heart Disease: Folic acid, B6, and B12 may decrease risk for heart disease; results from studies on vitamin E preventing heart disease are less conclusive. Beta-carotene (vitamin A) may raise risk in smokers.
Cancer: Lycopene, although technically a non-vitamin antioxidant, may be superior to vitamin E in helping prevent prostate cancer. It is found in tomatoes and tomato products. Folic acid has been shown to decrease risk for colon cancer in both genders, and breast cancer in women who drink alcohol. Beta-carotene may increase risk for lung cancer in smokers.
Birth Defects: Folic acid appears to reduce risk for spinal birth defects in infants whose mothers take these supplements. Excessive vitamin A during pregnancy may cause negative side effects.
The elderly, vegans, and alcoholics are especially at risk for inadequate intake of some vitamins. The best natural sources for these vitamins include: Leafy greens, whole grains, and fortified grain products for folate; fish, poultry, and legumes for vitamin B6; fish, eggs, and milk for vitamin B12; citrus fruits for vitamin C; and margarine, nuts, and salad oils for vitamin E.

Reference: Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: Scientific review. Journal of the American Medical Association 2002:287(23), pp. 3116-3126.

Preemptive Strike

Did you know you can actually protect your baby before she's even born? By taking folic acid supplements before and during pregnancy, you can prevent birth defects, based on a recent study in the Canadian Medical Association Journal.

Birth defects in an infant's developing central nervous system are called "neural tube defects" (NTDs). These defects result when the spine and brain, or the bones that protect the two, don't form correctly during pregnancy. In 1994, Canada recommended that prior to and during pregnancy, all women should include folic acid supplementation in their diets because it has been shown to help prevent NTDs. The authors of this study tracked the success of Canada's recommendation by looking at all births in Nova Scotia from 1991-2000, and comparing the incidence of NTDs:

before the 1994 recommendations;
after the recommendations; and
after November 1998, when Canada began fortifying grain products with folic acid because of little response from mothers to follow recommendations.
The study revealed that following government recommendations to take folic acid supplements, the incidence of NTDs remained the same as before. However, following government fortification of grain products, the risk for these defects dropped by over 50%.

Folic acid is vital for a healthy baby. Women who could become pregnant should take folic acid daily, in addition to a healthy diet, for at least two months prior to a planned pregnancy until at least the end of the first trimester of pregnancy. Everybody should include folic acid in their diet for its many health benefits; simply taking a multivitamin provides enough for most people.

Reference: Persad VL, Van den Hof MC, Dubé

To Your Health is brought to you by:

Chiropractic Health & Wellness
Everything you want to know about chiropractic.

In this issue of To Your Health:
Therapies Not Neck-and-Neck
Washing to Wellness
"Benching" Bad for Backs
Take Salt with a Grain of This

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Therapies Not Neck-and-Neck

Between 10-15% of people suffer from neck pain, which is most commonly seen in middle-aged individuals and women. Chiropractors often provide a form of manual therapy called "mobilization," in addition to cervical adjustments, intended to increase neck flexibility and reduce pain.

In a recent study from the Netherlands, 183 patients with neck pain lasting at least two weeks were divided into three groups and received either manual therapy, physical therapy, or continued care from a general practitioner. Manual therapy involved weekly "hands-on" techniques in which the therapist sought to decrease restrictions in neck range of motion; physical therapy focused primarily on exercise in 30-minute sessions twice per week; and general practitioner care involved advice on recovery, self-care, and ergonomics.

After seven weeks of treatment, the success rate was nearly twice as high in the manual therapy group as in the group receiving care from a general practitioner. The recovery rates were 68%, 51%, and 36% for the manual therapy, physical therapy, and general care groups, respectively. The manual therapy patients had half the absences from work due to pain during the study as the other two groups. Also, manual therapy proved better than physical therapy in all outcome measures in this study in the Annals of Internal Medicine.

The fundamental objective of manual therapy is restoration of normal joint motion. This goal was attained in the study, with a "relatively large" increase in neck range of motion. If you are suffering from neck pain, your chiropractor can treat your symptoms with manual therapy, adjustments, and neck exercises to address not just the pain, but also range of motion and strength.

Reference: Hoving JL, Koes BW, de Vet HCW, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. Annals of Internal Medicine 2002:136(10), pp. 713-722.

Washing to Wellness

One of the best methods for avoiding the spread of germs and infections is handwashing. Yet handwashing rates in schools are low: Research has indicated that only a quarter of middle- and high-school girls wash their hands with soap after visiting the bathroom; less than 10% of boys appear to do the same.

The purpose of a recent study in the American Journal of Infection Control was to evaluate the effectiveness of a handwashing campaign on absenteeism rates in five elementary schools. Two "test" classrooms and two "control" classrooms were included from each school. Only test classrooms completed a one-hour educational class on germ-spreading and handwashing techniques and received a supply of hand sanitizer. Data on absences for nearly 300 children were tallied over three months.

Children using the hand sanitizer were 50% less likely to be absent than children who did not receive sanitizer and handwashing education. Also, absences were decreased in 23 of 27 months for the handwashing groups. Researchers estimated that the handwashing education saved each school approximately $24,000 per year in the form of time saved by teachers (preparing take-home and remedial work).

Schools, similar to hospitals, are areas prone to the transmission of microorganisms because of the high number of people in a small area and the sharing of objects. Teach your children about the importance of handwashing, and provide them the means to do so to reduce their number of sick days this year.

Reference: Guinan M, McGuckin M, Ali Y. The effect of a comprehensive handwashing program on absenteeism in elementary schools. American Journal of Infection Control 2002:30(4), pp. 217-220.

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"Benching" Bad for Backs

In sports like basketball, football, and volleyball, it is common practice to have resting or "second-string" players sit on the bench during a game. Yet long periods of sitting can cause low back pain, and unsupported sitting on a bench results in hunching over, which may shift the spinal ligaments and discs out of place and reduce stability. Athletes who warm up for play and then sit on the bench prior to play may therefore have an increased risk for injury.

Nine male volleyball players were measured for lower back stiffness initially; after a 30-minute warm-up period; and again after 30 minutes of bench rest (post-warm-up). Stiffness was measured for forward, side, and backward bends and twisting in this recent study in Medicine and Science in Sports and Exercise.

On average, bench rest following warm-up led to increased lower back stiffness. Increased stiffness was present in side and backward bending. Surprisingly, warm-up had neither positive nor negative effects on spine stiffness, however.

The common practice of sitting second-string volleyball players on the bench after warm-up exercises for prolonged periods, then later sending them into the game, may increase the likelihood of spinal stiffness and back injury. These results may even apply to other sports that involve "benching" players. Players should always continue moving to keep their muscles warm prior to play. Your doctor of chiropractic can provide you with more tips on preventing back problems.

Reference: Green JP, Grenier SG, McGill SM. Low-back stiffness is altered with warm-up and bench rest: Implications for athletes. Medicine and Science in Sports and Exercise 2002:34(7), pp. 1076-1081.

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Take Salt with a Grain of This

Americans love their salty foods. From potato chips and popcorn to canned and frozen foods, the flavor and long shelf life of high-sodium foods makes them popular items. At the same time, more Americans are dying from congestive heart failure (CHF); roughly 5 million people in the U.S. experience CHF annually.

The authors of this study in the Archives of Internal Medicine compared CHF cases in approximately 5,000 normal-weight and 5,000 overweight individuals. Up until 21 years after an initial diet questionnaire, CHF cases were recorded and classified based on sodium intake.

Overweight individuals in the highest sodium intake category (approximately 4,300 milligrams/day or more) were 43% more likely to suffer CHF than overweight individuals with the lowest intakes (approx. 1,900 mg/day or less). Sodium intake was not linked to CHF in normal-weight persons, however.

An intake of less than 2,400 mg/day of sodium is recommended by several government health agencies, because high sodium intake can also increase hypertension and cardiovascular disease risks. Try to eat fresh foods and prepare your own meals, as prepackaged foods are often loaded with sodium. Start reading labels on pre-prepared meals, too - you might be shocked at how much sodium you're already eating!

Reference: He J, Ogden LG, Bazzano LA, et al. Dietary sodium intake and incidence of congestive heart failure in overweight U.S. men and women. Archives of Internal Medicine 2002:162(14), pp. 1619-1624.