Norman Marcus, MD
Exercise and Low Back Pain, Carpal Tunnel Syndrome and Nerve Conduction Velocity
“For every complex problem there is an answer that is clear, simple, and wrong.” HL Mencken
Obesity is more prevalent in neighborhoods with high incidence of poverty. A study in the New England Journal of Medicine showed that encouraging families to relocate to higher income neighborhoods could lower the rate of obesity and signs of diabetes. This finding may lead to a better understanding of how we can combat the obesity epidemic.
Osteoporosis in women is a growing public health challenge with an aging population. New approaches are needed to prevent and treat decreases in bone density and strength. Two recent articles present different and potentially complementary approaches.
Guidelines for care of specific conditions, produced by professional medical organizations, should be based on a rigorous analysis of all existing literature about the treatment of the condition. Guidelines for Low Back Pain were published by the American Pain Society advising that many pain treatments were not clearly effective. Another organization not liking these guidelines offered two systematic critiques (1), (2). The APS responded addressing the need for unbiased assessments of treatments offered by healthcare providers. If you make your living doing a procedure, it may be difficult to admitt that what you do doesn't work well. The results for treatment of low back pain in the US (and elsewhere) are generally not good.
A recent study of a simple resistance exercise program for the neck and shoulders, in office workers who complained of weekly headaches (HAs), showed an approximately 50% reduction in HA frequency vs. a weekly health education control group. The exercise groups were 2 minutes or 12 minutes of daily exercise. The remaining HAs were no different in terms of intensity or duration of pain.
The body can sometimes heal itself in painful conditions. A study of patients with painful osteoarthritis of the knee showed that by mechanically separating the bones in the knee that were touching and causing pain, cartilage regrew and pain and function improved.
In our desperate wish to relieve our pain we sometimes receive treatment that is harmful. One of those treatments may be botulinum toxin, frequently provided as Botox injections to tender muscles. A recent article showed how Botox could produce permanent damage in muscles with normal muscle fibers being replaced with fat cells.
A large study of army recruits demonstrated the protective effect of exercise on the development of knee pain. Male and female recruits who performed 4 stretching and 4 strengthening exercises for 7 weeks, were 75% less likely to develop anterior knee pain.
Years of pain relief in neck and shoulder with muscle injections, when the correct muscle(s) is injected properly.
A patient was seen in 2002 with years of neck pain that radiated into the back of the head and the upper part of the arm. He had failed at attempts of physical therapy. An MRI had shown that there were signs of arthritis in his neck and narrowing of the holes through which the nerves in his neck travelled as they left the spinal cord.
I saw a 56 year old office manager, who I will call Roger, with a 5 year history of neck, shoulder and head pain, which had become much worse in the past year. This is the pain diagram he drew. The darkened lines on the shoulder and upper back are where the pain was experienced.
