Back Troubles

Adhesive Capsulitis, also known as Frozen Shoulder is a condition that causes restriction of motion in the shoulder joint. The cause of a frozen shoulder is not well understood, but it often occurs for no known reason. Frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue.

What causes frozen shoulder?

Most often, frozen shoulder occurs with no associated injury or discernible cause. There are patients who develop a frozen shoulder after a traumatic injury to the shoulder, but this is not the usual cause. Some risk factors for developing a frozen shoulder include:

Age & Gender
Frozen shoulder most commonly affects patients between the ages of 40 to 60 years old, and it is twice as common in women than in men.

Endocrine Disorders
Patients with diabetes are at particular risk for developing a frozen shoulder. Other endocrine abnormalities, such as thyroid problems, can also lead to this condition.

Shoulder Trauma or Surgery
Patients who sustain a shoulder injury, or undergo surgery on the shoulder can develop a frozen shoulder joint. When injury or surgery is followed by prolonged joint immobilisation, the risk of developing a frozen shoulder is highest.

Other Systemic Conditions
Several systemic conditions such as heart disease and Parkinson's disease have also been associated with an increased risk for developing a frozen shoulder.

What happens with a frozen shoulder?

No one really understands why some people develop a frozen shoulder. For some reason, the shoulder joint becomes stiff and scarred. The shoulder joint is a ball and socket joint. The ball is the top of the arm bone (the humeral head), and the socket is part of the shoulder blade (the glenoid). Surrounding this ball-and-socket joint is a capsule of tissue that envelops the joint.

Normally, the shoulder joint allows more motion than any other joint in the body. When a patient develops a frozen shoulder, the capsule that surrounds the shoulder joint becomes contracted. The patients form bands of scar tissue called adhesions. The contraction of the capsule and the formation of the adhesions cause the frozen shoulder to become stiff and cause movement to become painful.

A frozen shoulder causes a typical set of symptoms that can be identified by your doctor. The most important finding is restricted movement. Other shoulder conditions can cause difficulty with movement of the shoulder, such as a rotator cuff tear; therefore it is important to have an examiner familiar with this condition for a proper diagnosis.

What are the typical symptoms of a frozen shoulder?

 Shoulder pain; usually a dull, aching pain
 Limited movement of the shoulder
 Difficulty with activities such as brushing hair, putting on shirts/bras
 Pain when trying to sleep on the affected shoulder

What are the stages of a frozen shoulder?

 Painful/Freezing Stage
This is the most painful stage of a frozen shoulder. Motion is restricted, but the shoulder is not as stiff as the frozen stage. This painful stage typically lasts 6-12 weeks.

 Frozen Stage
During the frozen stage, the pain usually eases up, but the stiffness worsens. The frozen stage can last 4-6 months.

 Thawing Stage
The thawing stage is gradual, and motion steadily improves over a lengthy period of time. The thawing stage can last more than a year.

What tests are needed to diagnose a frozen shoulder?

Most often, a frozen shoulder can be diagnosed on examination, and no special tests are needed. An x-ray is usually obtained to ensure the shoulder joint appears normal, and there is not evidence of traumatic injury or arthritic changes to the joint. An MRI is sometimes performed if the diagnosis is in question, but this test is better at looking for other problems, rather than looking for frozen shoulder. If an MRI is done, it is best performed with an injection of contrast fluid into the shoulder joint prior to the MRI. This will help show if the capsule of the shoulder is scarred down, as would be expected in patients with a frozen shoulder.

Frozen shoulder treatment primarily consists of pain relief and physical therapy. Most patients find relief with these simple steps, although the entire treatment process can take several months or longer.

 Exercises and Stretching
Stretching exercises for frozen shoulder serves two functions:
 First, to increase the motion in the joint
 Second, to minimize the loss of muscle on the affected arm (muscle atrophy)

The importance of stretching and exercises cannot be overemphasized as these are the key to successful frozen shoulder treatment. Patients cannot expect to have successful frozen shoulder treatment if they perform exercises only when working with a therapist. These exercises and stretches must be performed several times daily.

 Moist Heat
Applications of moist heat to the shoulder can help to loosen the joint and provide relief of pain. Patients can apply moist heat to the shoulder, then perform their stretching exercises--this should be done at least three times daily. Moist heat can be applied by using a hot-soaked washcloth on the joint for 10 minutes before stretching.

 Physical Therapy
Physical therapists can help a patient develop a stretching and exercise program, and also incorporate ultrasound, ice, heat, and other modalities into the rehabilitation for frozen shoulder. As said previously, it is important that patients perform their stretches and exercise several times daily-not only when working with the therapist.

 Anti-inflammatory Medications
Anti-inflammatory medications have not been shown to significantly alter the course of a frozen shoulder, but these medications can be helpful in offering relief from the painful symptoms.

 Cortisone Injections
Cortisone injections are also commonly used to decrease the inflammation in the frozen shoulder joint. It is unclear the extent of the benefit of a cortisone injection, but it can help to decrease pain, and in turn allow for more stretching and physical therapy. What is known, is the cortisone is only effective when used in conjunction with physical therapy for the management of a frozen shoulder.

Will I need surgery for frozen shoulder?

If the above treatments do not resolve the frozen shoulder, occasionally a patient will need to have surgery. If this is the case, the surgeon may perform a manipulation under anaesthesia. A manipulation is performed with the patient sedated under anaesthesia, and the doctor moves the arm to break up adhesions caused by frozen shoulder. There is no actual surgery involved, meaning incisions are not made when a manipulation is performed.
Alternatively, or in conjunction with a manipulation, an arthroscope can be inserted into the joint to cut through adhesions. This procedure is called an arthroscopic capsular release. Surgical capsular release of a frozen shoulder is rarely necessary, but it is extremely useful in cases of frozen shoulder that do not respond to therapy and rehab. If surgery is performed, immediate physical therapy following the capsular release is of utmost importance. If rehab does not begin soon after capsular release, the chance of the frozen shoulder returning is quite high.

Will my shoulder motion return to normal?

Most patients who have a frozen shoulder will have slight limitations in shoulder motion, even years after the condition resolves. However, this limit in motion is minimal, and often only noticed when performing a careful physical examination. The vast majority of patients who develop a frozen shoulder will recover their functional motion with therapy and stretching alone.

Sources:
Warner, JJ. "Frozen Shoulder: Diagnosis and Management" J. Am. Acad. Ortho. Surg., May 1997; 5: 130 - 140.
Griggs, SM; Ahn, A; Green, A. "Idiopathic Adhesive Capsulitis: A Prospective Functional Outcome Study of Nonoperative Treatment" J. Bone Joint Surg. Am., Oct 2000; 82: 1398.
Rizk, TE; Pinals, RS; and Talaiver, AS. "Corticosteroid injections in adhesive capsulitis" Arch. Phys. Med. and Rehab., 72: 20-22, 1991.

This condition is a controversial diagnosis, since it deals with nerve compression.

Chronic pinched nerves are rarely caused by a structural abnormality, as indicated in the TOS diagnosis, so patients are advised to be vigilant for signs of a misdiagnosed back pain syndrome.

Thoracic Outlet Syndrome is most commonly blamed on impingement of the various neurological structures which compose the brachial plexus. The brachial plexus is a network of nerve tissue stemming from the spinal nerve roots at C5 through T1, which bring nerve messages to the parts of the neck, shoulders and upper back regions.

This most often diagnosed form of the pain syndrome is called neurogenic TOS. Less commonly, vascular tissue is implicated in the compression process, typically the subclavian artery or subclavian vein. This far less common cause of symptoms is referred to as arterial or venous TOS. Occasionally, some patients might be diagnosed with both the neurogenic and arterial/venous forms at the same time.

TOS can result from a back injury such as sports trauma or a car accident TOS can also come about gradually or spontaneously, even though no trauma has been endured. These idiopathic forms of TOS are even more likely to be misdiagnosed and typically turn out to be regional ischemia syndromes caused by a psycho-emotional process. Abnormalities with the scalene muscles have been linked to TOS development, but this is no surprise, since medical science always looks to a structural source for all physical pain, even when the anatomical condition might be purely coincidental and innocent of symptomatic expression. Enlargement (hypertrophy), overuse or injury to the scalene muscles does seem to have some bearing as to who might develop TOS, but is not a factor in all patients.

Symptoms

Symptoms of TOS vary from patient to patient and from causation to causation. Typically, there is pain, stiffness and loss of mobility, functionality and range of motion in the neck, shoulder and upper back. There might be pain in parts of the upper chest or underarm region. Patients might also experience radiating neurological symptoms in the neck, shoulder, arms and hands, such as tingling, weakness and numbness. Arterial or venous forms of the condition might demonstrate a weak pulse in the affected arm and wrist. Certain activities or postures typically worsen or relieve symptoms, although in many cases, this can merely be a conditioned response. TOS is more prevalent in woman than in men and is particularly common in athletes, office workers, people with bad posture and workers with repetitive motion jobs.

Advice

TOS certainly exists, mostly due to obvious trauma. Even minor muscular injuries near the brachial plexus can cause TOS symptoms, although most of these issues should resolve in a few days to a few weeks. Long term structurally induced TOS is rare and generally might indicate a possible mistaken diagnosis.

Tension Myositis syndrome in the upper back and lower neck is generally diagnosed as TOS almost 100% of the time. Obviously, this often leads to treatment resistant pain, which plagues the medical community, as patients continue to suffer despite a battery of seemingly appropriate, but unsuccessful treatment options.

Physical therapy, such as Osteopathy and Chiropractic are the most common conservative treatment options. Injection therapy is common as a next line of defence, along with the ever present pain management drugs which rule the back pain therapy industry. Surgery is sometimes used in extreme or long term cases, but should be avoided unless there is no other option and the diagnosis is confirmed with 100% certainty…

If you are suffering from a sport related injury or have been injured in an accident, the chances are you will require some professional medical treatment to help you to recover more quickly and more fully from your injuries.

In most cases, this rehabilitation will take the form of either physiotherapy, osteopathy or chiropractic (for moderate injuries such as whiplash and other soft tissue damage) or surgical procedures (to help broken bones to heal more cleanly or to repair damage to ligaments that may have been torn in an accident. However in an increasing number of injured patients are also receiving alternative rehabilitation therapies, often with very positive results.

Pilate's, the full body conditioning technique developed in 1920's Germany to help injured soldiers recover, is one of the most widely used alternative rehabilitation technique for accident victims. Although it was designed to benefit all areas of the body, Pilate’s works particularly well for injuries to the knees, neck, back, hips, shoulders and also for rehabilitation following surgery. As the exercises involved are mainly performed whilst sitting or reclining, Pilate’s is very useful for people who may not be able to stand or support much weight after an accident.

Another alternative form of rehabilitation that is offered to some patients is a pain management program. These programs aim to provide relief for people suffering from chronic pain conditions after an accident or other injury. In many chronic pain conditions, it might be the case that the sufferer is continuing to feel the pain of an injury even after the injury has healed and the physical evidence has disappeared. This might be because pain receptors in the body are still transmitting the sensation of pain to the brain. Pain management programmes aim to treat the pain itself, rather than any underlying injury, which might be treated separately or which might have healed already.

Pain management programs might prescribe medicines to reduce pain or to target problems with the way the sufferer’s brain is interpreting the pain signals, these medicines can include painkillers, anti-depressants and anti-convulsants. On the other hand they might involve the use of physical therapies and exercise routines.

A third approach would be to look at the way the sufferer thinks about the pain and how it affects their mental well being, which can be done using psychological techniques such as biofeedback and cognitive behavioural therapy. The goal of all these treatments is to help people to experience a pain-free life, so that they can return to work and carry out day-to-day tasks, which can have benefits, themselves.

The Silent Disease is the name that is often given to Osteoporosis, as most people don't know they have osteoporosis until it has progressed often to the point of fracture, usually in the hip, wrist or spine. Even when undiagnosed osteoporosis results in a vertebral fracture, the pain is frequently dismissed as general back pain.

This lack of awareness can lead to serious illness, deformity and even death.

Osteoporosis alone does not cause back pain. It can, however, weaken the spine to where it is no longer able to withstand normal stress or minor trauma, resulting in vertebral fracture. It is the ensuing fracture that causes pain.

Osteopenia is a condition where bone mineral density is lower than normal, but not low enough to be classified as osteoporosis. While often a precursor to osteoporosis, not everyone with osteopenia will develop osteoporosis. Since a diagnosis of osteopenia puts one at greater risk for osteoporosis, patients are encouraged to seek the advice of their physicians about implementing preventive measures.

Osteoporosis Causes and Risk Factors

Bones are made of complex, constantly changing, living tissue and they are able to grow and heal, and are also susceptible to changes in diet, body chemistry, and exercise levels.

Early in life, more bone is laid down than is removed by the body. People typically achieve peak bone mass by around age 30, after which more bone is lost than is replaced. Too much bone loss leads to osteoporosis.

Both of the two primary types of osteoporosis are far more common in women than men:

Type I osteoporosis (postmenopausal osteoporosis) -generally develops after menopause, when estrogen levels drop precipitously, leading to bone loss - usually in the trabecular (spongy) bone inside the hard cortical bone.

Type II osteoporosis (senile osteoporosis) - typically happens after age 70 and involves a thinning of both the trabecular (spongy) and cortical (hard) bone.

In addition, certain medications and medical conditions can damage bone and lead to what is known as "secondary osteoporosis". Patients being treated for any of the following conditions should discuss the risk of osteoporosis with their physicians:

Endocrine disorders

Marrow disorders

Collagen disorders

Gastrointestinal disorders

Seizure disorders

Eating disorders (such as anorexia or bulimia)

It is important to distinguish between primary and secondary causes of osteoporosis because treatment is often different. To determine the cause, a thorough medical history, physical examination, and appropriate diagnostic tests need to be conducted (see Diagnosing Osteoporosis).

Key risk factors for developing osteoporosis include:

Advanced = age over age 65.

Gender = Women are four times more likely to develop osteoporosis than men.

Heredity = Family history of osteoporosis or fracture on the mother's side.

Personal history = any type of fracture after age 45.

Race = Caucasian and Asian women are at greater risk.

Body type = small-boned women weighing less than 127 pounds.

Menstrual history = Normal menopause increases the risk of osteoporosis and early menopause can exacerbate this risk.

Lifestyle = calcium and/or vitamin D deficiency; little or no exercise especially weight-bearing exercise); alcohol abuse; smoking; too much cola/soda.

Testosterone deficiency (hypgonadism) = in men.

Why women are at greater risk for developing osteoporosis

Estrogen plays an important part in maintaining bone strength. Starting at about age 30 through onset of menopause, women lose a small amount of bone every year as a natural part of the ageing process. When women reach menopause and estrogen levels decrease, the rate of bone loss increases for approximately 8 to 10 years before returning to premenopausal rates.

Osteoporosis Symptoms

Osteoporosis can go undetected for years and fracture is typically the first outward sign.

Advanced osteoporosis is potentially disabling, often leading to one or more of the following:

Fractures of the spine, wrist or hip

Spinal deformity (e.g., lost height, hunched back)

Chronic or severe pain

Limited function and reduced mobility

Loss of independence

Decreased lung capacity

Difficulty sleeping

Osteoporosis is the leading cause of spine fractures, especially in women over age 50, but only about one third of all spine fractures are diagnosed.

Most osteoporotic spine fractures (vertebral compression fractures) start with sudden back pain, usually after routine activity (lifting or bending) that slightly strains or jars the back. After a month or two, this acute pain is usually replaced by an achy pain (see Diagnosing vertebral compression fractures).

Osteoporosis Prevention

Postmenopausal ( Type I ) osteoporosis can be significantly influenced by preventive measures. Most of these behaviours are up to the individual and should be started as early in life as possible. For those genetically predisposed to osteoporosis, the following practices are even more important:

Exercise regularly weight-bearing exercises (activities that work one's bones and muscles against gravity) are essential to maintaining bone health.

Ensure adequate calcium intake, Calcium plays a key role in keeping bones strong. Vitamin D is also essential, as it helps ensure absorption and retention of calcium in bones. Calcium and vitamin D requirements vary depending on age and gender.

Eat a balanced, healthy diet Certain foods provide excellent sources of calcium, while diets high in protein and/or sodium increase calcium loss.

Quit smoking - Smoking has a detrimental effect on bone density, leading to greater risk of injury and longer recovery times.

Limit alcohol consumption - While the exact way alcohol affects bone isn't entirely understood, excessive alcohol use has been proven to accelerate bone loss.

Limit intake of colas/sodas - recent research indicates that too much cola or soda can increase the risk of osteoporosis.

Undergo bone density testing - every 1-2 years if you are postmenopausal, over age 65, or have other risk factors. Bone mineral density (BMD) tests indicate normal, low or osteoporotic bone density levels, as well as any increased risk of fracture.

For more information, see How to prevent osteoporosis.

Osteoporosis Treatment

Once osteoporosis has been diagnosed, patient and physician should work together to develop a treatment plan where the goal is to slow bone loss and prevent fractures. Treatment may include:

Education on diet/nutrition - see Food for Thought: Diet and Nutrition for a Healthy Back.

Exercise (if no fracture) - to help maintain bone density and reduce the risk of falls.

Medication - to slow bone loss and prevent fractures. Osteoporosis medications fall into two categories:

Medications that slow or stop bone resorption (loss);

Medications that increase bone formation.

Treatment for vertebral fractures, which may include:

Rest, though long-term rest accelerates bone loss;

Rigid back braces to support the spine;

Ice/heat and pain medications;

Surgery (kyphoplasty or vertebroplasty), which may be necessary in certain situations where the fracture is causing severe pain and/or deformity, or has failed to respond to three months of non-surgical treatment.

Do be positive because even once osteoporosis has been diagnosed, it is possible to slow bone loss, build bone density and prevent fractures. Continually advancing osteoporosis and related fractures are not an inevitable outcome of being diagnosed with osteoporosis.

It's 6:00 p.m. You've just left work and all you can think about is how much you have to do when you return tomorrow. And before you can get home to try and relax, you have to fight bumper-to-bumper traffic.
Often, a stressful day like this goes hand-in-hand with a headache. But not all headaches are caused by stress.
Learn what could be causing your headaches and the best way to head off the pain.

Tension headaches

Symptoms: Mild to moderate aching pain on both sides of your head. You may also feel tightness in your neck, shoulders, face, and scalp.

Why you hurt: Occasional tension headaches are often related to stress, anxiety or frustration. When you're under stress, the muscles in your face, neck, and jaw contract, sometimes resulting in a headache. In other cases, poor posture such as hunching over at your desk or computer may cause muscle tension that leads to a headache. Daily or chronic tension headaches may be related to a chronic state of anxiety or depression.

What you can do: For occasional tension headaches, taking an over-the-counter pain reliever such as acetaminophen, aspirin, or ibuprofen usually does the trick. Be careful to follow the label instructions, and consult your doctor or pharmacist if you have any questions. Exercise, relaxation techniques, massage, and warm compresses may also ease the pain. If you have chronic tension headaches, consult your doctor for evaluation and treatment options.

Eyestrain headaches

Symptoms: Mild pain in your forehead.

Why you hurt: Straining your eyes may cause muscle contractions that result in a headache.
What you can do: Read in a well-lit area and have your eyes examined regularly. Sometimes, eyestrain signals a need for glasses or a new prescription. If you work at a computer for long periods of time, take frequent breaks to rest your eyes. Look away from the computer and focus on something more than 6 feet away every 10 to 20 minutes. Adjust your monitor so that it's about one arm's length in front of you. If necessary, increase the font size for easier reading.

Migraine headaches

Symptoms: Throbbing pain on one or both sides of your head that worsens with activity. The headache may be accompanied by nausea and vomiting, as well as sensitivity to light and sound. The pain may last from four to 72 hours. You may have a warning or "aura" that a headache is coming, during which you see wavy lines or bright lights or have a blind spot. You may also experience emotional changes, such as depression, several hours or days before the headache strikes.

Why you hurt: Migraines are caused by an initial constriction of blood vessels in the head, followed by a dilation of these blood vessels. Migraines are more common in women, and they tend to run in the family. For some people, various substances can trigger migraines, including chocolate, aged cheeses, alcohol, citrus fruits, monosodium glutamate (often found in Chinese food), nuts, sulfites, and nitrates (commonly found in hot dogs and lunch meats). Many other factors -- including hormonal fluctuations, stress, and a change in sleep patterns can also trigger migraines.

What you can do: As much as possible, avoid anything that triggers your migraines. If you're not sure of your triggers, keep a headache diary. Jot down a list of factors or circumstances about each particular headache and look for patterns or specific triggers. Taking acetaminophen, ibuprofen or aspirin may relieve some of the pain. Again, be careful to follow the label instructions, and consult your doctor or pharmacist if you have any questions. When over-the-counter pain relievers aren't effective, prescription medications may help prevent an oncoming migraine or cut it short. Consult your doctor for help. A technique called biofeedback -- the process of voluntarily controlling bodily functions, such as blood pressure, muscle tension, or heart rate, to improve health and performance -- may be beneficial as well.

Cluster headaches

Symptoms: Episodes of intense, steady pain, often behind one eye. Sometimes the pain is felt above the eye or near the temple. Cluster headaches may be accompanied by symptoms such as tearing, reddening of the eye, drooping or swelling of the eyelid, constriction of the pupil, nasal stuffiness, runny nose, and facial sweating. These symptoms appear on the same side as the headache. Restlessness is also common during a cluster headache, typically lasting from 15 minutes to three hours.

Why you hurt: Although there's no known cause, cluster headaches can be triggered by alcohol, nitrates, and certain stages of sleep during a cluster episode. Cluster headaches may occur at exactly the same time every day for weeks or months, and then not return for months or even years. They may also be seasonal, often striking during spring and autumn. Cluster headaches are most common among men in their 20s to 50s.

What you can do: Generally, prescription medications are needed to prevent a cluster headache or stop one that's in progress. If you're experiencing cluster headaches, consult your doctor for diagnosis and treatment.

Take headaches seriously

Nearly everyone experiences headaches at some point. Although most headaches aren't serious, it's important to be cautious. Seek medical attention if you develop:
 a sudden or intense headache
 a headache that begins during exertion, such as exercise or sex
 a headache associated with fever, stiff neck, rash, or other neurological symptoms
 headaches that become progressively more severe
 a significant change in a previous headache pattern
 headaches that don't respond to treatment

Do you think that you may have Arthritis?

There are more than 100 different types of arthritis, and each has its own treatment. And, there are other conditions that can cause similar symptoms.

To help evaluate the condition, the GP will want to know about the type of pain or discomfort you've been experiencing. How often and when does it occur? How intense is it? What parts of your body does it affect the most? What seems to cause it to worsen? Are there symptoms that accompany it, such as fever? And, what seems to help it get better?

It would be a great help if you kept an arthritis diary for a couple of weeks to document your pain or discomfort, as well as other factors that may be related. Write down information about what you eat, activities, medications including over-the-counter drugs and vitamins, how much sleep you get and even what the weather is like each day. Take your diary with you to your GP, as it will assist your doctor to determine the best course of treatment for your situation.

Further Tests for Rheumatoid Arthritis

No one-lab test can diagnose rheumatoid arthritis. Instead, rheumatoid arthritis is diagnosed by symptoms and physical signs and by eliminating other diseases that can cause similar symptoms. Physical signs include joint swelling or tenderness. Symptoms that help in diagnosis are stiffness and pain in the same joints on both sides of the body (symmetrical), morning stiffness, and development of rheumatoid nodules.

Diagnosis is based on a set of classification criteria for rheumatoid arthritis.

The following tests may be done to evaluate your symptoms, to rule out other problems, or to monitor treatment:

 Complete blood count (CBC)
 Erythrocyte sedimentation rate (ESR) (may help to assess disease activity)
 C-reactive protein (may help to assess disease activity)
 Rheumatoid factor (RF)
 Antinuclear antibody assay (ANA)
 Anti-CCP (cyclic citrullinated peptide) antibody test (helps confirm diagnosis and may show your risk of having severe symptoms)
 Joint fluid analysis
 Tissue type (human leukocyte antigen) test
 X-rays

Other tests may be done to check for side effects of treatment.

These tests may include:
 Kidney function tests.
 Liver and muscle enzyme tests.
 Bone density test, to check for bone loss (osteoporosis).
 Eye examination.

Because rheumatoid arthritis can lead to severe joint destruction and disability over time, regular evaluation by a health professional is important to determine whether current treatment is working or needs to be adjusted.

Marfan Syndrome is a disorder of connective tissue, the tissue that strengthens the body's structures. Disorders of connective tissue affect the skeletal system, cardiovascular system, eyes, and skin.

Marfan syndrome is caused by defects in a gene called fibrillin-1. Fibrillin-1 plays an important role as the building block for elastic tissue in the body.

A problem with this gene leads to changes in elastic tissues, particularly in the aorta, eye, and skin. The gene defect also causes too much growth of the long bones of the body. This causes the tall height and long arms and legs seen in people with this syndrome. How this overgrowth happens is not well understood.

In most cases, Marfan syndrome is inherited, which means it is passed down through families. However, up to 30% of cases have no family history. Such cases are called "sporadic." In sporadic cases, the syndrome is believed to result from a spontaneous new gene defect.

People with Marfan syndrome are usually tall with long, thin arms and legs and spider-like fingers-a condition called arachnodactyly. When they stretch out their arms, the length of their arms is much greater than their height.

Other symptoms include:
• Coloboma of iris
• Flat feet
• Funnel chest (pectus excavatum) or pigeon breast (pectus carinatum)
• Highly arched palate and crowded teeth
• Hypotonia
• Learning disability
• Movement of the lens of the eye from its normal position (dislocation)
• Nearsightedness
• Scoliosis
• Small lower jaw (micrognathia)
• Thin, narrow face

A GP will perform a physical examination.
There may be hypermobile joints and signs of:
• Aneurysm
• Collapsed lung
• Heart valve problems

An eye exam may show:
• Defects of the lens or cornea
• Retinal detachment
• Vision problems

The following tests may be performed:

•Echocardiogram
•Fibrillin-1 mutation testing (in some people)
An echocardiogram should be done every year to look at the base of the aorta.

Treatment:
Vision problems should be treated when possible. Take care to prevent scoliosis, especially during adolescence.

Medicine to slow the heart rate may help prevent stress on the aorta. Avoid participating in competitive athletics and contact sports to avoid injuring the heart. Some people may need surgical replacement of the aortic root and valve.

People with Marfan syndrome should take antibiotics before dental procedures to prevent endocarditis. Pregnant women with Marfan syndrome must be monitored very closely because of the increased stress on the heart and aorta.

Prognosis:
Heart-related complications may shorten the lifespan of people with this disease. However, many patients survive well into their 60s. Good care and surgery may extend the lifespan further.

*Experts recommend genetic counseling for couples with a history of this syndrome who wish to have children.

Support: National Marfan Foundation -- www.marfan.org

Back pain, including thoracic spinal pain, is a common, potentially disabling, routine presenting complaint to general practitioners. Macromastia is the state of having disproportionately large breasts. Some macromastic women report breast pain and other symptoms, and the intuitively logical assumption is that breast size is the key influence on clinical presentation. Clinical symptoms attributed to macromastia include neck, thoracic spine and shoulder pain, breast pain, headaches, grooving and associated pain caused by bra straps, intertrigo (inflammation of skinfolds), and ulnar nerve paresthesia.

Breast size and mass changes across the life-span suggesting that macromastic symptoms may occur episodically during particular stages of life. Although these symptoms are widely reported, the relationship between breast size and symptoms is somewhat unclear. Breast mass and breast density appear to be important variables. Most outcome studies of reduction mammaplasties support the view that larger breasts equate to greater health burden and demonstrate this relationship through symptom improvement post-surgery, but a recent review of 59 women who underwent reductions involving the removal of less than 1000 g of breast tissue showed that small reductions in breast mass may result in statistically significant improvements in macromastic symptoms.

Breast-related thoracic spinal pain is thought to result from changes in centre of gravity. Recent research has demonstrated that static spinal posture differs significantly according to breast size. large breasts can increase cervical lordosis and thoracic kyphosis, shift the centre of gravity away from the spine and increase muscular effort required to maintain balance. The research also suggested that large or heavy breasts may also lead to continuous tension on the middle and lower fibres of the trapezius muscle and associated muscle groups.

They estimated that 70% of women wear bras that are incorrect sizes or poorly fitted. It was proposed that elevation of the breasts in a bra increased downward forces on the outer scapula. It was also suggested that the posterior straps of a bra act as pulleys over the shoulders, effectively doubling the total downward pull on both shoulders. Associated neck, shoulder and back pain could then, at least partially, be attributed to fatigue in muscles that reverse scapular depression (eg: trapezius, serratus anterior). Bra-strap pressure is only somewhat linked to bust mass: small busted women with tight straps may experience considerable downward pressure on their shoulders.

Breast size and mass vary throughout life, influenced by hormonal changes, body fat composition, stage of reproductive cycle, and breast pathology. Bra size, when fitted according to defined industry standards, may be used as an estimate of breast size. Across the life span and across the population, bra size is not a consistent measure of breast mass which is most accurately estimated from radiographic measures of volumetric density, but among healthy women who have never been pregnant or experienced breast pathology, bra size is likely to be a consistent measure.

Follow these easy steps to ensure you are shopping for your correct bra size:
Measurement number 1: Measure under your bust line.
Put on your best-fitting, unpadded, under wire bra. Measure underneath the bust line and make sure to measure tightly. Be sure the tape measure is straight across your back.

The general rule of thumb for all measuring is: less than ½”, round DOWN, more than a ½”, round UP. So if your measurement is 32 ¼”, call it 32. Write this number down.

Band Size: Calculate your band size.

If measurement 1 is UNDER 33 inches, add 5 inches. If this number is odd, round up to the next EVEN number. If measurement 1 is OVER 33 inches, add 3 inches. If this number is odd, round up to the next EVEN number. Write this EVEN number down. This is your band size.

Measure over the bust line
Measure over the biggest point of your bust line. This is a looser measurement. Make sure the tape measure is straight. Write this number down.

Cup Size: Calculate your cup size.
First subtract measurement number 1 from measurement number 2. Then consult the following chart to find your cup size.

Original Message:
-----------------
From:
Date: Sun, 17 May 2009 04:06:51 -0700 (PDT)To:
Subject: non-surgical spinal decompression question

hello there,

i am trying to find out about non-surgical spinal decompression in the uk.
do you happen to know if anyone does it here? i've seen all sorts of stuff
on the web about it in the states but can't seem to find it here in london.
i'd be most grateful if you'd let me know anything you know about the
therapy. is there perhaps some negative reason why it doesn't seem to be
used in the uk?
i've never had the treatment myself but am interested in it.

yours sincerely,

XXX XXXXXX

----- Original Message ----
From: Spinal Heath UK
To: xxxx@yahoo.com
Sent: Sunday, May 17, 2009 1:52:09 PM
Subject: RE: non-surgical spinal decompression question

For Advice:

Traction therapy has been utilized in the treatment of low back pain for
decades. The most recent incarnation of traction therapy is non-surgical
spinal decompression therapy. This form of therapy has been heavily
marketed to manual therapy professions and subsequently to the consumer.

Only one small randomised controlled trial and several lower level efficacy studies have been performed on spinal decompression therapy.
In general the quality of these studies is questionable.

Many of the studies were performed using the VAX-D® unit which places the patient in a prone position.
Often companies utilize this research for their marketing
although their units place the patient in the supine position.

In Summary:
Only limited evidence is available to warrant the routine use of
non-surgical spinal decompression, particularly when many other well
investigated, less expensive alternatives are available.

If you are seeking a non surgical treatment option for your back condition may I suggest that you get yourself assessed at "The Lulinski Clinic" London.

At any given time, millions of adults are trying to lose weight. Sadly, many of them won't succeed. Others will reach their goal, only to gain back most or all of the pounds they lost.
But some of those hopeful dieters do succeed in their determination to lose weight. And they'll keep the weight off for the rest of their lives. Here are their secrets to long-term success.

Make permanent changes in the way you eat
Accept the fact that your healthy eating habits aren't temporary. Once you've lost weight, you can't go back to eating the way you used to or you'll go back to looking the way you used to.

Your new attitudes and eating habits may forever change your relationship to food. After all, a positive body image and high self-esteem are major factors in dieting success. A healthy lifestyle involves a lifelong process of understanding yourself and understanding that how you feel about yourself affects your behavior.

This doesn't mean you'll stop craving the foods you used to crave or that you have to skip an occasional special treat. It does mean that you'll build this awareness into your daily eating habits, however.

When you "must" have chocolate, for example, eat a little bit to satisfy the craving. Don't deny yourself until the craving becomes so intense that it can only be satisfied by devouring an entire pound of assorted truffles.

On the other hand, there are no "days off" when you can eat whatever you want, whenever you want. Recognize your own temptations and limits.

Eat breakfast
Taking time to eat a nutritious breakfast every morning will start your day on a healthy note -- and keep you from eating too much during the rest of the day. A good breakfast can stave off the late-morning snack attack and get your metabolism moving. Eating breakfast prompts your body to begin burning calories by providing the fuel necessary to start the process. Without breakfast, your body stores calories all morning because it lacks the fuel to burn them.

Keep track
Many people find it helps to keep a food journal. It doesn't take much time, and it encourages you to pay attention to what you eat on a daily basis. You might also want to note any feelings associated with the food you've eaten. This can help you identify any patterns of eating for reasons other than pure hunger.

Some successful dieters also opt to weigh themselves regularly. This lets them take quick corrective measures if their weight starts to edge up over the course of a week or more. It's often easier to lose an errant pound or two than to discover you've tacked on an extra 10 pounds without realizing it.

Of course, keep in mind that small fluctuations in weight can be related to water weight, heavier or lighter clothing, or even the time of day you weigh yourself. Take care to avoid obsessing over the numbers on a daily -- or hourly -- basis.

Exercise regularly
Successful long-term weight loss is nearly always accompanied by consistent exercise. Always consult your doctor before beginning an exercise program.

To lose weight and keep off extra pounds, start exercising. This doesn't have to involve strenuous exertion, any level of physical activity is fine for starters. As a next step, establish a habit and work up to a goal. Walking is one of the safest and most effective forms of exercise. The faster the pace, the more pronounced the results are likely to be.

You may also find you're more likely to exercise if you add variety to your daily routine. You might want to rotate among several different forms of exercise you enjoy, such as biking, walking, swimming and weight training.

Think positively
Physical activity often improves your mood -- a crucial part of maintaining weight loss. When you focus on the good results and positive changes of a healthier lifestyle, you're more likely to stick with your new healthful habits. Focusing on what you've given up or what you can't have will probably lead you back to your old habits.

Surround yourself with supportive friends and loved ones who'll respect and enable the changes you've made, rather than tempt you back to old vices. Join a gym or find exercise buddies in your neighborhood. You'll improve your chances of exercising on a regular basis and enjoy the support of others who're fighting the battle of the bulge.

Losing weight takes hard work and commitment, but keeping the weight off may require even more. Often, the sacrifices lead to improved fitness, energy and self-respect.

Please remember, feature articles provide general information only. They are not meant to replace professional advice or imply coverage of specific clinical services or products.

Honeywell.