Tag Archives: Exercise

Medicine, Men's Health, Opinion, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS And CONDITIONS #23: OLD AGE / GROWING OLD

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Old age is an inevitable condition if you are lucky enough to live a long life. Middle aged people say it begins at 70 years of age. According to an Elysium survey of people 40 and older, the average American FEELS old for the first time at age 47 years.

In the distant past, 50 was CONSIDERED to be old. The generally better conditions and Medicine of modern times keeps extending LIFESPAN, if not always HEALTHSPAN. Old age is certainly a Condition, and it is for sure Chronic, thereby qualifying for inclusion, but is it a Disease?

It is not considered a disease by the authorities, and so it doesn’t gather research funds like it should. What exactly IS old age? Being 88 Years old, and a physician, I feel qualified to comment. Old age is a collection of past accidents and sports injuries plus complications of past illnesses engrafted on a gradually deteriorating body.

Where does Obesity and Metabolic syndrome fit in this rubric? The Plague of our time fits in the disease category. It is definitely preventable, although with difficulty. Please search past postings for more information on this topic.

In what way does the body gradually deteriorate? Any organized, non-random high information structure gradually becomes more disordered, and “worn away” with the passage of TIME, the destroyer. Entropy (disorder) gradually increases, in the absence of corrective energy input.

Even rocks and mountains eventually erode, given enough time. One of the most interesting characteristics of life is that it maintains its integrity for an inordinate amount of time, given its complexity and furious dynamism.

Every day our DNA sustains thousands of molecular ruptures from high energy radiation and other stressors. Proofreading and repair mechanisms are employed, at high energy cost, to repair these breaks. This corrective is especially efficient when we are young and vigorous; In our youth, our reproductive years, growth and repair predominate. Gradually, growth ceases, repair mechanisms age, and we become old.

Our Darwinian “warranty” expires. We are left with an aging body, unimportant to evolution. We are long on experience and short on future. But we still have a marvelous metabolism at our disposal, depending on our lifestyle. There are a number of metabolic pathways which affect aging, 2 of which have been more studied.

The mTOR pathway is most attuned to youth, senses nutrients and gears up for ANABOLISM, or growth. If you have not been careful to tailor your food intake to suit your decreasing requirements, your efficient metabolism stores it away for a rainy day, around your belly and in your arteries, a bad effect from an essential mechanism. Antagonistic Pleiotropy is the name for a body mechanism that can be good for one function (or age) and bad for another.

The Sirtuin system is also important in aging, and has a variety of housekeeping functions, including mitochondrial maintenance. It is activated by exercise. The cells of our bodies change with aging. In old tissues, there are less stem cells and other young, functional units. There are more damaged, dysfunctional “zombie” cells that don’t do much but promote inflammation, and hence more inflammatory cells accumulate.

Controlling the mTOR System and promoting the sirtuins help increase apoptosis and get rid of dysfunctional cells, including cancer. DOCTORS SHOULD PRESCRIBE EXERCISE, as well as SLEEP AND DIET, like they do medicine, and maybe we wouldn’t need so many pills. We might also feel better into old age.

–Dr. C.

Disease, Metabolic syndrome, Entropy, DNA, Metabolism, Apoptosis, Zombie cells

Medicine, Men's Health, Prevention, Women's Health

INFOGRAPHIC: EXERCISE FOR ‘CLAUDICATION’ (BMJ STUDY)

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Exercise training is a safe, effective and low-cost intervention for improving walking ability in patients with IC. Additional benefits may include improvements in QoL, muscle strength and cardiorespiratory fitness. Clinical guidelines advocate supervised exercise training as a primary therapy for IC, with walking as the primary modality.

However, evidence is emerging for the role of various other modes of exercise including cycling and progressive resistance training to supplement walking training. In addition, there is emerging evidence for home-based exercise programmes. Revascularisation or drug treatment options should only be considered in patients if exercise training provides insufficient symptomatic relief.

Abstract

Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. Supervised exercise training elicits clinically meaningful benefits in walking ability and quality of life. Walking is the modality of exercise with the strongest evidence and is recommended in several national and international guidelines. Alternate forms of exercise such as upper- or lower-body cycling may be used, if required by certain patients, although there is less evidence for these types of programmes. The evidence for progressive resistance training is growing and patients can also engage in strength-based training alongside a walking programme. For those unable to attend a supervised class (strongest evidence), home-based or ‘self-facilitated’ exercise programmes are known to improve walking distance when compared to simple advice. All exercise programmes, independent of the mode of delivery, should be progressive and individually prescribed where possible, considering disease severity, comorbidities and initial exercise capacity. All patients should aim to accumulate at least 30 min of aerobic activity, at least three times a week, for at least 3 months, ideally in the form of walking exercise to near-maximal claudication pain.

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Men's Health, Opinion, Prevention, Women's Health

INFOGRAPHIC: ’12 DEMENTIA RISK FACTORS’ (THE LANCET)

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Executive summary

The number of older people, including those living with dementia, is rising, as younger age mortality declines. However, the age-specific incidence of dementia has fallen in many countries, probably because of improvements in education, nutrition, health care, and lifestyle changes.

Overall, a growing body of evidence supports the nine potentially modifiable risk factors for dementia modelled by the 2017 Lancet Commission on dementia prevention, intervention, and care: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact.

We now add three more risk factors for dementia with newer, convincing evidence. These factors are excessive alcohol consumption, traumatic brain injury, and air pollution. We have completed new reviews and meta-analyses and incorporated these into an updated 12 risk factor life-course model of dementia prevention. Together the 12 modifiable risk factors account for around 40% of worldwide dementias, which consequently could theoretically be prevented or delayed.

The potential for prevention is high and might be higher in low-income and middle-income countries (LMIC) where more dementias occur. Our new life-course model and evidence synthesis has paramount worldwide policy implications. It is never too early and never too late in the life course for dementia prevention. Early-life (younger than 45 years) risks, such as less education, affect cognitive reserve; midlife (45–65 years), and later-life (older than 65 years) risk factors influence reserve and triggering of neuropathological developments.

Culture, poverty, and inequality are key drivers of the need for change. Individuals who are most deprived need these changes the most and will derive the highest benefit.

Read full Dementia Study and Report

COMMENTARY:

Lancet’s 2017 Metanalysis mentions 9 Dementia risk factors. The 2020 Paper adds 3 additional factors. TRAUMATIC BRAIN INJURY, ALCOHOLISM, and AIR POLLUTION.

The inclusion of Trauma, with a 3% weighting, may be due to the increased awareness of TBE stemming from football injuries. The preventable 12 Factors are still in the minority. 60% of the factors are not preventable, since they are Genetically determined.

LESS EDUCATION, HEARING LOSS and SOCIAL ISOLATION, 3 of the original 9 factors,all lead to less brain stimulation, and can be unified under the idea of COGNITIVE RESERVE. If a person starts with less Cognition, it is reasonable to think he would be Demented sooner.

Together, less education, hearing loss, and social isolation account for almost Half of the correctable conditions. SMOKING is one of those things which impact almost every human disorder. It is amazing that cigarettes are still manufactured. In fact, their use is actually Increasing,especially the Far East, where they probably account for much of the escalating problem with Dementia in that region.

Our favorite causes, Sleep, Diet, and Exercise, apparently play only a minor role in Dementia. Sleep is completely dismissed in this report. The fact that both Sleeping less than the Ideal 7-8 hours, and more than that amount is thought to correlate with health problems is probably the main reason for the omission.

My own opinion is that people who are in poor health may need more sleep, and therefore sleep longer. My own sleep is interrupted 3-5 times per night, so it is not surprising that I need an hour extra to feel rested. Any less than 9-10 hours, and I need a nap, which in my opinion is a sign of insufficient nighttime sleep. Poor sleep may be a factor in metabolic syndrome, often leading to DIABETES, OBESITY, and HYPERTENSION, which are factors in Dementia, mentioned in the article as bit players.

PHYSICAL INACTIVITY is mentioned as a minor factor in Dementia, but exercise, studied as a treatment of dementia, was found to improve only strength. Diet is not mentioned, but does contribute to OBESITY, which is a minor factor. Dementia is a great emotional and economic burden, afflicting many otherwise happy families with misfortune.

The Lancet metanalysis is admirable. But don’t forget the healthy lifestyle emphasizing Sleep Diet and Exercise; and exercise includes cognitive exercise. Anything we can do to avoid dementia is worthwhile. –

–Dr.C.

Men's Health, Prevention, Women's Health

COVID-19 INFOGRAPHIC: ‘EXERCISE IS MEDICINE’ (BMJ)

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There are over 35,000,000 reported cases of COVID-19 disease and 1 000 000 deaths across more than 200 countries worldwide.1 With cases continuing to rise and a robust vaccine not yet available for safe and widespread delivery, lifestyle adaptations will be needed for the foreseeable future. As we try to contain the spread of the virus, adults are spending more time at home. Recent evidence2 suggests that physical activity levels have decreased by ~30% and sitting time has increased by ~30%. This is a major concern as physical inactivity and sedentary behaviour are risk factors3 for cardiovascular disease, obesity, cancer, diabetes, hypertension, bone and joint disease, depression and premature death.

To date, more than 130 authors from across the world have provided COVID-19-related commentary on these concerns. Many experts4 have emphasised the importance of increasing healthy living behaviours and others5 have indicated that we are now simultaneously fighting not one but two pandemics (ie, COVID-19, physical inactivity). Physical inactivity alone results in over 3 million deaths per year5 and a global burden of US$50 billion.6 Immediate action is required to facilitate physical activity during the COVID-19 pandemic because it is an effective form of medicine3 to promote good health, prevent disease and bolster immune function. Accordingly, widespread messaging to keep adults physically active is of paramount importance.

Several organisations including the WHO, American Heart Association and American College of Sports Medicine have offered initial suggestions and resources for engaging in physical activity during the COVID-19 pandemic. Expanding on these resources, our infographic aims to present a comprehensive illustration for promoting daily physical activity to the lay audience during the COVID-19 pandemic (figure 1). As illustrated, adults are spending more time at home, moving less and sitting more. Physical activity provides numerous health benefits, some of which may even help directly combat the effects of COVID-19. For substantial health benefits, adults should engage in 150–300 min of moderate-to-vigorous intensity physical activity each week and limit the time spent sitting. The recommended levels of physical activity are safely attainable even at home. Using a combination of both formal and informal activities, 150 min can be reached during the week with frequent sessions of physical activity spread throughout the day. Sedentary behaviour can be further reduced by breaking up prolonged sitting with short active breaks. In summary, this infographic offers as an evidence-based tool for public health officials, clinicians, educators and policymakers to communicate the importance of engaging in physical activity during the COVID-19 pandemic.

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Medicine, Men's Health, Studies, Women's Health

STUDIES: OSTEOARTHRITIS PATIENTS USING EXERCISE THERAPY HAVE LESS PAIN, CUT OPIOID & ANALGESIC USE

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Conclusion Among patients with knee or hip OA using analgesics, more than half either discontinued analgesic use or shifted to lower risk analgesics following an 8-week structured exercise therapy and patient education programme (GLA:D). These data encourage randomised controlled trial evaluation of whether supervised exercise therapy, combined with patient education, can reduce analgesic use, including opioids, among patients with knee and hip OA pain.

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Dr. C "Comments", Men's Health, Prevention, Women's Health

TOP NEW BOOKS ON AGING: “EXERCISED” BY DANIEL E. LIEBERMAN – “EXTENDING LONGEVITY” (HARVARD)

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HARVARD MAGAZINE (SEPT – OCT 2020): From the book EXERCISED: Why Something We Never Evolved to Do Is Healthy and Rewarding by Daniel E. Lieberman, to be published on September 8, 2020 by Pantheon Books:

‘….many of the mechanisms that slow aging and extend life are turned on by physical activity, especially as we get older. Human health and longevity are thus extended both by and for physical activity.’

What Happens When We Exercise?
The graph breaks total energy expenditure (TEE) into two parts: active energy expenditure, and resting metabolism. Resting metabolism remains elevated for hours even after exercise ceases, burning additional calories in a phase known as excess post-exercise oxygen consumption (EPOC).

Exercise is like scrubbing the kitchen floor so well after a spill that the whole floor ends up being cleaner. The modest stresses caused by exercise trigger a reparative response yielding a general benefit.

In order to elucidate the links between exercise and aging, I propose a corollary to the Grandmother Hypothesis, which I call the Active Grandparent Hypothesis. According to this idea, human longevity was not only selected for but was also made possible by having to work hard during old age to help as many children, grandchildren, and other younger relatives as possible survive and thrive. That is, while there may have been selection for genes (as yet unidentified) that help humans live past the age of 50, there was also selection for genes that repair and maintain our bodies when we are physically active.

Daniel E. Lieberman is a paleoanthropologist at Harvard University, where he is the Edwin M Lerner II Professor of Biological Sciences, and Professor in the Department of Human Evolutionary Biology. He is best known for his research on the evolution of the human head and the evolution of the human body.

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COMMENTARY

Daniel Lieberman, a Cultural Anthropologist from Harvard, makes the case that paleolithic hunter-gatherers Grandparents were helpful, in fact necessary to their families, and evolved to be active into old age. They did not evolve to sit in front of the TV, and modern men pay a penalty if they do.

INACTIVITY at ANY AGE is bad. If you put 20 year olds to bed, both weight and blood pressure go up. The book addresses a conundrum. Free radicals are bad. Exercise runs O2 through the mitochondria, which produces free radicals.

But EXERCISE REDUCES FREE RADICALS. A metaphor is introduced: you spill some tomato juice on the floor. But you clean it up, and the floor becomes cleaner than it was before. You exercise, the muscles suffer some microtears and injury. The REPAIR RESTORES the muscles to better than before, maybe with some extra mitochondria.

The Bodies MECHANISMS are MEANT TO BE USED. DIET is meant to supply the body energy and units for repair, EXERCISE is meant to use that energy, and keep the mechanism lubricated, and SLEEP is meant to allow for time to accomplish repair.

Sleep, Diet and Exercise can all be reconciled by recourse to Paleolithic man, whose activities imprinted our modern bodies.

–Dr. C.

Dr. C's Journal, Men's Health, Opinion, SLEEP, Women's Health

Dr. C’s Journal: A Little Bit About “Energy & Fatigue”

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Sometimes I wake up in the morning with a feeling of RELAXED ENERGY. My mind is clear, I have no fatigue, and believe once more that the world is wonderful, and it’s great to be alive.

I St-re-tch, exercise my hands (I have Osteoarthritis, and they are stiff), take out my Nite guard ( I grind my teeth at night and would otherwise wear them away), take my beta blocker eye drops ( to lower my intraocular pressure) and wash down my Eliquis ( an anticoagulant to prevent stroke from my Atrial Fibrillation) with 16 oz. of water, while thinking about all of the delights awaiting me.

Yes, my body was in better shape 60 years ago; but I had much more responsibility then, and much less discretionary time. All things considered, I like to believe that I am happier now.

The KEY is to stay in GOOD HEALTH. GOOD SLEEP is critical, but it cannot be had by willpower alone. As I have discussed previously, you need a bedtime routine, good SLEEP HYGIENE.

You also need a…….. GOOD DIET. with lots of fruits, vegetables and whole grains. Fatty, spicy foods will stay in your stomach and bother you at night, particularly if you eat Late. I like to finish eating by 5 PM. Late dinner is also likely to produce GERD, and maybe Sleep Apnea.

GOOD EXERCISE is also critical. If you are not tired at the end of the day, it is hard to get good sleep. I always seem to sleep better on the day when I walk the hills for an hour, which is 3 days a week. Try not to exercise within 2 hours of bedtime. Assuming that you have a good base of SLEEP, DIET and EXERCISE, there are other mechanisms that can foul things up. INFLAMMATORY conditions often cause fatigue.

The most common inflammatory diseases are OBESITY, METABOLIC SYNDROME and DIABETES. OBESITY is the defining disease of our EXCESSIVE SOCIETY, where there is too much of everything, and excessive consumption is relentlessly advertised everywhere.

External correction is probably a pipe dream, since there is no will even to Tax Sugar-containing Beverages, the “low hanging fruit” of dietary excess. Internal correction is all that is left, and that takes WILL POWER, also in short supply.

INFECTIOUS DISEASES are a subset of inflammatory conditions. COVID 19 is the poster child of infection, and FATIGUE is one of the hallmarks of the disease. Interleukins, like TNF-alpha, IL-1, andIL-6 are some of the defense factors which cause the fatigue. AUTOIMMUNE Diseases like Rheumatoid Arthritis and Lupus are also associated with fatigue-producing interleukins.

Fatigue even has its own flagship disease, CHRONIC FATIGUE SYNDROME. Chronic viral disease has been suspected as the cause of this condition, and inflammatory cytokines may be elevated. This condition, and the similar GULF WAR SYNDROME are still poorly understood. Several CFS patients were sent to me when I was in practice, and I had some success in getting them to exercise regularly, which seemed to help. CANCER is another category of diseases where Fatigue is prominent.

Inflammation plays a role in these diseases, which also drain energy substrates from the Patients body; Cancer cells have a high metabolic requirement. MEDICATIONS, Cancer meds especially, but a variety of other Drugs are associated with FATIGUE. I went through MY MEDICATION LIST. Lo and behold, 3 of them are associated with fatigue.

Finasteride is a relic of my prostate operation, recommended to keep it from growing back. It causes fatigue, probably because of its ANTITESTOSTERONE effect. At least I can still pee, and am not bald. I take METFORMIN because of its fame in prolonging life. Its mechanism is that of interacting with the Sirtuin system, and increasing the inefficiency of mitochondria. Isn’t this surprising?

Like many other things in physiology, you place a stress on the body, and the body responds by improving its performance. If you are fatigued, you exercise. Respecting the body works with drugs as well. If you are drinking a ton of coffee and stop it, after a few weeks you will feel less fatigued.

And when you ARE FATIGUED, you drink a LITTLE coffee, and it wakes you right up. Caffeine works by displacing ADENOSINE, which causes Fatigue as it increases through the morning, peaking at SIESTA (or tea) time,at about 2 PM. OMEPRAZOLE, which I take to prevent HEARTBURN, also is related to fatigue especially if it blocks MAGNESIUM for long enough. DEPRESSION overlaps with fatigue, as does SLEEPINESS, to increase the complexity of the situation.

Many chronic LUNG, KIDNEY and LIVER diseases are associated with fatigue as a secondary concern. STAY HEALTHY!

–Dr. C

Dr. C "Comments", Men's Health, Prevention, Resources, Women's Health

INFOGRAPHICS: “HOW TO ACHIEVE YOUR WEEKLY RECOMMENDED EXERCISE”

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COMMENTARY

The idea of “METS” as a unit of energy expenditure is interesting and practical. I agree that EXERCISE IS IMPORTANT.

Frank Wilczek, in an article on Dyson Freeman, talked about another unit that I find even more interesting . He proposed that 100 Watts be the unit of energy expenditure. This is (approximately) the energy used in an old 100 Watt incandescent light bulb. It is also the amount of energy used by the “average” human on a 2000 Calorie diet.

Using this unit, the average U.S. Citizen uses 95 units, compared to a 25 unit world average. The suns output is 5 X ten to the fourteenth power, of which 1X ten to the fourth power units lands on earth. Good cocktail information.

I also read that a professional cyclist has an output of only 400 watts, vs. the 14 Mets mentioned in the article.but when I read that the human body is only 20-25% efficient in converting Calories to Watts  of Output, 14 Mets made more sense.

—Dr. C.

Men's Health, Opinion, Prevention, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #6: OSTEOARTHRITIS (OA)

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Osteoarthritis (OA) was considered a Degenerative disease when I went to Med School in the late 50s. I am more interested in OA since I have developed it myself.

There is a 40-60% hereditary component. My father’s mother had arthritis badly in her hands, as did my mother’s mother, and so on. A lot of genome-correlation work has shown many different genes involved,

But without a single big contributor, OA appears to be “multifactorial”, similar to a lot of common diseases like Diabetes l. Trauma can be a factor. Old sports injuries, like an ACL tear, that you thought a thing of the past, may come back to haunt you in later years.

INFLAMMATION, the most popular explanatory cause of the decade, may be operating in OA. For instance, you can imagine that OBESITY would contribute to hip and knee OA simply through the traumatic force of gravity. But obesity is also a disease of Inflammation, and increases IL-6 and other cytokines as well.

My own OA involves the classic distal 2 interphalangeal joints (go to the wikipedia manekin for a color-representation of OA classic locations). The base of my thumb, neck and back are also a problem.

Strangely, but wonderfully, my “wheels”, the Hips and Knees, are spared. I have exercised a lot in my life. Clearly, you can’t “wear out” your joints with ordinary exercise.

Our joints have evolved to allow us to move. Since bone has a lot of pain fibres, it would be painful to move the joints, directly bone-on-bone. So we have cartilage on the ends of the bones and discs between the vertebrae. The cartilage is slick to reduce friction.

Cartilage has no blood to supply it with nutrients. Instead, it relies on the joint (synovial) fluid. The cartilage is like a sponge. Walking alternately compresses and relaxes the spongy cartilage, increasing the synovial fluid circulation, thus improving the nutrition of the cartilage. If the Cartilage disappears, there is pain.

I am not a fan of pain medication. My belief was strengthened by the side effects of the study of a medication designed to genetically block pain transmission by injection into the painful joints. The side effect was virtual dissolution of the joints in a fraction of those treated. I felt more comfortable with my pain after reading the article.

Although Acetaminophen helps a little, NSAIDs usually work better, perhaps because of their anti-inflammatory action.

If, like me, you have stomach issues, there are the COX-2 inhibitors like Celebrex. The one dose I recently took was almost magical in its effects. Maybe if you don’t use pain Meds much, they work better.

I do take Glucosamine-Chondroitin, thinking that providing building blocks for cartilage couldn’t hurt. Along this line I also EAT CARTILAGE whenever I eat Chicken or ribs, being careful not to damage my teeth in the act of of exercising my jaws.

I also take Curcumin, hoping to relieve some pain, in spite of the fact that it is poorly absorbed (some brave souls take it by injection). I don’t know if any of this helps, How can you know in such a variable disorder, in the absence of controlled studies.

And pain has no OBJECTIVE markers, and is notoriously hard to study. We literally know more about the surface of mars than we know about Pain.

SLEEP, DIET, and EXERCISE, by minimizing OA factors kike OBESITY and INFLAMMATION are the best bet for preventing and treating OA at present.

–DR. C

Men's Health, Prevention, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #5: SCIATICA & BACK PAIN

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Chronic back pain and sciatica are very common, and increasing in prevalence. The human back does not seem to have been designed for obesity coupled with sedentary habits. I have had both back pain and sciatica . My wife had surgery in an attempt to control her back pain, my son successfully controlled his back pain with medical treatment, and an 87 year old friend recently had successful micro-neurosurgical treatment.

I will summarize these stories and will finish with some generalizations I believe will help those wanting to avoid a lot of misery. The sooner you start the better.

My back pain developed after an ill-advised use of a shovel to get rid of some grass intruding on my asphalt driveway, and caused me to miss work for the only day in 35 years of practice. Sciatica then developed on my left side. I could not sleep flat, and would sit all night in a comfortable chair. A hospital bed helped me outlast the impressive calf pain.

My wife developed severe back pain eventually leading to a “laminectomy and fusion”. Some level of back pain and incapacity plagued her the rest of her life.

My son developed severe sciatica and went to an Orthopedist. After a CAT scan revealed a rupture disc, he was penciled in for surgery. When asking about alternative treatments, the doctor told him, half laughingly, to lose 20% of his body weight and to start swimming. He went on a 30 day, 1000 calorie/day diet and lost 30 lbs. He has been swimming daily for the past 10 years. He has had no more back pain.

My 87 year old friend developed sciatica on his right side, had no luck with PT and pain meds including opioids. Microsurgery by a neurosurgeon successfully removed his ruptured disc, and he has had little or no pain after the first week.

Sciatica at least has a well defined cause: something is irritating that long nerve which starts in the small of the back and travels to its’ destination in the foot. That something is often an extrusion from an intervertebral disc, a cushion between the block-like vertebral bodies.

This herniation can be confirmed by a CAT scan or MRI, and removed by minimally invasive microsurgery. Beyond that model problem, down through spinal stenosis and ending in chronic back pain, the understanding gets progressively more fuzzy, treatment ever more contrived.

Prevention sounds better and better. The most important thing in preventing back pain is to MAINTAIN A NORMAL WEIGHT. Our backs were not designed for vertically compressive forces. The lock-step increasing incidences of obesity and back/sciatic problems support this idea.

REGULAR EXERCISE is very important. Swimming and walking are 2 of the best forms of exercise. Exercises like running on hard surfaces, jumping in volleyball, and weight lifting seem less optimal.

The ABDOMINAL MUSCLES stabilize the spine, and prevent excessive motion. Walking and swimming both exercise and strengthen the abdominals.

Maintaining FLEXIBILITY and RANGE OF MOTION are important. flexibility will help prevent those unplanned, sudden motions from throwing your back out of alignment, or maybe generating a painful muscle tear.

Finally, getting into the habit of BENDING YOUR LEGS and tensing the stabilizing abdominals when you pick up something on the floor is a help.

I question the wisdom of back surgery for back pain alone, especially if accompanied by spinal fusion. Even when there is sciatica, the statistics show that treatment with surgery is no better than medical therapy after 2 years.

The development of microsurgical techniques may give surgery an edge, however. At the risk of cliche, AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE.

–Dr. C