For at least twenty years there has been a debate about the treatment of osteoarthritis, about the use of the joint supplements glucosamine and chondroitin.

Osteoarthritis is a condition that causes problems of wearing out of the normal smooth cartilage surfaces of the joints. Often called wear-and-tear arthritis, osteoarthritis causes joint pain, swelling, and deformity. Osteoarthritis is the most common type of arthritis.

What do the supplements do?

Glucosamine and chondroitin are two molecules that make up the type of cartilage found within joints. Inside your joints, cartilage undergoes a constant process of breakdown and repair. However, to be properly repaired, the building blocks of cartilage must be present and available.

The theory behind using the glucosamine and chondroitin joint supplements is that more of the cartilage building blocks will be available for cartilage repair.
Glucosamine is a precursor to a molecule called a glycosaminoglycan-this molecule is used in the formation and repair of cartilage.

Chondroitin is the most abundant glycosaminoglycan in cartilage and is responsible for the resiliency of cartilage.

However treatment with these joint supplements is based on the theory that oral consumption of glucosamine and chondroitin may increase the rate of formation of new cartilage by providing more of the necessary building blocks.

So does glucosamine and chondroitin supplements increase cartilage formation?

While it is an interesting theory, oral consumption of glucosamine and chondroitin has not been shown to alter the availability of these cartilage building blocks inside an arthritic joint. It has not been shown that consumption of joint supplements increases the quantity of these cartilage building blocks within any joint.

Has any research been done to investigate the effectiveness of glucosamine and chondroitin?

There have been numerous studies to examine the treatment effects of glucosamine and chondroitin over short periods of time. Most of these studies last only one to two months; however, they have indicated that patients experienced more pain reduction when taking glucosamine and chondroitin than patients receiving a placebo. The improvement experienced by these patients was similar to improvements experienced by patients taking nonsteroidal anti-inflammatory medications (NSAIDs) that have been a mainstay of non-operative arthritis treatment. The difference is that NSAIDs carry an increased risk of side effects including gastrointestinal complaints and bleeding.

The joint supplements glucosamine and chondroitin have few side effects, and thus their use would be preferred if the effects of pain reduction were indeed the same. Furthermore, there is an indication that NSAIDs may increase the progression of arthritis, whereas glucosamine and chondroitin may offer a more protective effect to the cartilage surface.

So when it comes to choosing joint supplements there are many options. Use caution when choosing both the supplement and brand. Recent studies have shown that some brands come far short of the label claims. In one study of eleven chondroitin products, tests showed four of the products contained less than half the stated amount of chondroitin. How do you choose a product? The Arthritis Foundation says to pick the most reputabile brand--don't try to save with a cheaper imitation.

Diagnosing ankylosing spondylitis can be quite difficult in the early stages or indeed in very mild cases. As back pain is very common and is usually caused by muscle strain.

An x-ray of the spine and sacroiliac joints is taken, as degenerative changes are usually first seen in the sacroiliac joints. A rheumatologist that specializes in ankylosing spondylitis can usually make an accurate diagnosis.

Ankylosing Spondylitis Symptoms

The symptoms and severity of ankylosing spondylitis vary from mild to severe back pain, from mild stiffness to loss of mobility. Symptoms may come and go. In the early stages, inflammation of the sacroiliac joints causes hip pain (deep within the buttocks) and lower back and stiffness, especially at night, in the morning, and after periods of inactivity.

Later, the inflammation may spread further up the spine and to other joints. If inflammation occurs in the joints between the ribs and spine, pain may be felt in the chest area. The hips, shoulders, heels or knees are sometimes affected. Sometimes there is inflammation of the eyes. Very rarely, the inflammation may involve the heart.

There may be fatigue, lack of appetite, weight loss, a low-grade fever. In severe cases, the spine sometimes fuses in a stooped over position. However this can be avoided.

Preventing Stooping

Inflammation damages the joints. Scarring of the tissues and extra bone overgrowth can develop as a result of chronic inflammation. Eventually, in some severe cases of ankylosing spondylitis, the ligaments of the spine become fused together by bony overgrowth of the vertebrae this is called ankylosis.

Not all cases of Ankylosing spondylitis reach this stage, but maintaining good posture is essential so that if the spine does fuse the spine will be in a fixed upright position rather than a fixed hunched over position.

Strengthening exercises for the muscles that support the spine and stretching exercises help maintain proper posture. A physical therapist can create a customised exercise program for a patient to follow. Exercise plays a vital role in managing this disease.

Medications Used to Treat Ankylosing Spondylitis

Medications for Ankylosing spondylitis are geared at reducing inflammation.

NSAIDs:

Non-steroidal Anti-Inflammatory Drugs. NSAIDs treat the pain and inflammation. Ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox, ) and indomethacin (Indocin) are NSAIDs.
When NSAIDs are not effective enough other medications are often used.

Sulfasalazine, often used for inflammatory bowel disease, also can reduce pain and inflammation in the joints and is sometimes used to treat ankylosing spondylitis.

Immunosuppressive agents:

Drugs that suppress the immune system, such as Azathiprine, or Methotrexate are sometimes used to treat Ankylosing spondylitis. Immunosuppressive agents are used to suppress the inflammatory response by suppressing the immune system.

The immune system seems to be overly sensitive in people with Ankylosing spondylitis and certain cells of the immune system that initiate inflammation may be triggered too easily.

Corticosteroids (such as prednisone) have extremely powerful anti-inflammatory properties and also suppress the immune system. The problem with corticosteroids is that the side effects are severe in long-term use and the person taking them can develop a host of other unwanted problems.

TNF Inhibitors:

One class of drugs, TNF Inhibitors (such as Remicade), has shown a lot of promise in treating ankylosing spondylitis along with other chronic inflammatory diseases. Remicade suppresses inflammation by binding to and neutralizing substances (TNFa) that act as an alarm signal that triggers inflammation. New drugs in this class are being developed.

Remicade infusion contains the active ingredient infliximab, which is a type of medicine called a monoclonal antibody. It works by suppressing part of the immune system and modifying the process of inflammation.

Monoclonal antibodies are manufactured antibodies that are specifically designed to recognise and bind to unique proteins in the body. Infliximab works by binding to and preventing the activity of a specific protein produced by the body, called tumour necrosis factor alpha (TNF alpha). TNF alpha is involved in producing inflammation. It controls the activity of other inflammatory chemicals.

This medicine can compromise the body's ability to fight infections, and cases of tuberculosis (T have been seen. For this reason, you should be tested for TB prior to treatment. Tell your doctor immediately if you experience persistent coughing, weight loss or fever, as these can be symptoms of TB.

It is important to try and avoid exposure to infections during your treatment. Contact your doctor as soon as possible if you get any symptoms of any infection so that it can be treated without delay. This applies for up to six months after finishing treatment, as this is how long it may take for the medicine to be removed from the body. Be aware that this medicine can mask some of the usual symptoms of infection, such as a high temperature (fever), so it is important to be extra vigilant. If you develop a serious infection, further treatment with this medicine should not be given.

Even with the many advances in medicine and in particular skeletomuscular medicine, Whiplash is still not that well understood. Severity of injury varies considerably between people in the same types of car accidents, even when circumstances are similar. Speed is a major factor, as is the weight of the vehicles. There are several other factors involved. When the person sees the accident coming, the injury is often less severe. This may be because the nervous system has time to prepare. The position of the neck at the time of impact also plays a role. Risk of injury appears to be greater when the head is turned to the side than when it is facing straight ahead - except in very low speed crashes. The position of the headrest is important - it needs to be at the proper height and distance from the head to reduce severity of injury. The strength of a person’s neck also plays a role. Females, having less strength in their necks, generally suffer more severe whiplash injuries than males.

Seatbelts with shoulder harnesses should always be used and head rests at the proper height for the person. The height of the headrest should be just above the ear. The distance between the headrest and back of the head should be two to four inches.

Symptoms may occur immediately after the injury or set in gradually over the next couple of days. It is common for a person with no immediate symptoms to wake up stiff and sore the next morning. Whiplash can vary greatly in severity and cause a wide range of symptoms. Not all people experience the same symptoms. Symptoms that develop rapidly often indicate a serious injury.

The most common symptoms of whiplash are neck pain and stiffness. The neck becomes stiff as muscles tighten up to protect the injured area from further injury by reducing motion.

Headaches are also common. Pain originating in the neck (from muscle spasms in the neck and/or irritated nerves in the back of the neck) is often referred to the head. The pain may felt be over the entire head or any area of the head - often over the forehead and behind the eyes.

There may be back pain or shoulder pain, or numbness or tingling in the arm. Other symptoms of whiplash include problems with memory and concentration, feelings of disorientation, dizziness, ringing in the ears, impaired hearing, blurred vision, sensitivity to sound and light, irritability, depression, and difficulty sleeping.
Neurological symptoms may be the result of injury to soft tissue injury to the neck or a mild brain injury or concussion. A sudden jolt to the head can jar the brain. Neurological symptoms often resolve within a week.

If symptoms occur immediately or shortly after the accident an ambulance should be called so that the neck can be immobilised during transport to a hospital emergency ward.
There may be serious injuries that may require immediate medical treatment (such as hemorrhage, fracture, dislocation, or spinal cord injury). In addition, auto accidents that result in whiplash may also result in other injuries such as chest injuries, back injuries, internal injuries, etc.

Always seek a proper diagnosis from a GP, even if the symptoms are mild. The diagnosis may be based upon symptoms alone, or an MRI or CT may be taken to see the extent of soft tissue injury. X-rays may be taken to rule out fractures or dislocation.

Treatment depends on severity of symptoms. If the injury is mild, applying ice packs at home for the first couple of days along with the short-term use of NSAIDs may be sufficient. If symptoms are moderate (especially if there is limited range of motion), physical therapy is often recommended. Massage therapy and/or spinal manipulation may also be beneficial.

Applying Ice
Applying ice every four hours for the first couple of days helps reduce inflammation (the main cause of the pain). Inflammation is greatest for the first two days. Wrap ice in a cloth and apply to area of neck pain for 20 minutes every three to four hours.

Medications
Anti-inflammatory medication to relieve both pain and inflammation such as Ibuprofen or Aspirin are often helpful. Your GP may prescribe muscle relaxants or pain medication that contains codeine for temporary use.

Physical Therapy
Depending upon the severity of the whiplash injury, physical therapy may be recommended by your GP. A physical therapist can prescribe range-of-motion exercises, teach proper posture to avoid excess strain on neck, treat pain with cold and heat, etc.

Prolonged Use of Soft Collars do Delay Recovery.

Soft collars may be helpful for the first two or three days, when pain and inflammation is at its greatest. Inflammation may trigger muscle spasms - a protective mechanism to restrict movement to prevent further injury. Wearing a soft collar helps relax the muscles to relieve pain. However, prolonged use of soft collars has been shown to delay recovery from whiplash. Intermittent use may be recommended in some cases.
*If a fracture or dislocation is involved, a wearing molded collar may be necessary to stabilize the neck.
How quickly one recovers from whiplash depends largely upon the severity of the injury. How quickly the symptoms develop often correlate with the seriousness of the injury.

Mild whiplash injuries often heal completely within two to three weeks, moderate whiplash injuries within two to three months. Severe whiplash injury may take several months to heal. For some people, symptoms (such as mild neck pain and/or headaches) may linger for longer periods of time. If symptoms are still present after six months, the pain is considered to be chronic. Chronic symptoms may last for years. Whiplash injury may increase risk of degenerative changes in the discs and spinal joints.

Their have been cases were people report that new symptoms appear years after the initial whiplash injury, though it is difficult to determine whether or not symptoms that appear years later are related to the whiplash injury.

Are Computer games responsible for increased back pain cases among the nation’s teenagers?

The problem of low back and neck pain in teenagers is likely to increase significantly in years to come.

This seems on the cards considering the associated health problems of obesity, reduced levels of activity, and the popularity of passive entertainment systems such as play stations that encourage further inactivity and prolonged sitting posture in the adolescent age group.

Terry O’Brien of Back Trouble UK says “While 80 percent of the population are likely to experience low back pain at some stage in their life, there is a worrying trend in the amount of back pain experienced by teenagers.

It is well founded that having another family member with a history of back pain means you are more likely to develop back pain as an adolescent. As does poor family functioning and increased life stress.

Higher levels of stress, anxiety and depression are also associated with adolescent back pain.

Back pain is commonly provoked by sporting activity and static postures such as sitting. It is also known that specific sporting groups such as rowers are at higher risk of back pain.

Children seem to fall into two broad groups, those doing very little activity and those doing too much. Both groups are prone to back pain. However it is the worrying trend of inactivity amongst adolescents that is the greatest cause for concern. Fuelled by the dramatic increase in computer games and multi-media consoles.”

Advice:

We’ve all felt neck or back pain at one point or another, especially those of us who spend a lot of time in front of a computer. Sitting puts stress the back and neck and the longer you sit, the more strain you place on yourself. With back and neck pain it is important to know that the torso is a system of interrelated parts, and symptoms in the arms, legs, head, and chest such as tingling, sharp pains, burning, spasm, vague aches, soreness, lack of muscle strength, and stiffness are all possible indicators of back or neck problems.

Neck Pain often begins gradually as a result of fixed staring at a small area or glancing repeatedly from one to another (from the screen to a document on your desk for example). If the head is held at an angle greater than 15 degrees (for example holding the phone between your neck or shoulder, or looking down at your keyboard) will cause greater muscular fatigue and pain will become apparent more rapidly.

Prevention
Be sure you have a proper workstation set-up.
Take active breaks, move around and do a few stretches.
Shift positions every now and then. Try not to fall habitually into one computer position – even small changes help avoid overtaxing certain muscles.
Use a headset for your phone – crooking a phone between your shoulder and cheek is one of the worst things you can do to your neck.
Use a document stand so you aren’t constantly looking down while you are typing. Position it at the same height as your monitor, and close to one side.

Back Pain
Sitting is one of the hardest positions in which to maintain proper posture, and many computer users regularly feel back pain. Spinal compression is one of the most common problems because sitting tends to tilt the pelvis backward, flattening the lumbar curve and resulting in uneven and increased pressure on spinal disks.

Prevention
Along with the same preventative measures mentioned above for neck pain you can:
Try not to round your shoulders – this puts extra pressure on your upper spine.
Stay active, get up and move around to circulate your blood. Sitting still for too long can slow blood circulation and muscle fatigue can set in.
Practice back safety everywhere – bend at the knees to pick up heavy objects, watch your posture, don’t slouch, keep your shoulders back, head high, and stomach tucked in to help the back muscles hold your own weight.
Consider pain medication such as aspirin or ibuprofin for mild or occasional back pain, but if pain persists see a doctor or a professional physical therapist.

Terry O’Brien
BackTrouble.co.uk

Piriformis Syndrome.

The Piriformis is one of the small muscles deep in the buttocks that rotates the leg outwards. It runs from the base of the spine and attaches to the thigh bone (femur) roughly where the outside crease in your bum is. The sciatic nerve runs very close to this muscle and sometimes even through it! If the muscle becomes tight it can put pressure on the sciatic nerve and cause pain which can radiate down the leg.

A common cause of Piriformis syndrome is having tight adductor muscles (inside your thigh). This means the abductors on the outside cannot work properly and so put more strain on the Piriformis.

Symptoms of piriformis syndrome:

Tenderness in the area of the muscle.
Pain in the buttocks.

Reduced range of motion of the hip joint.

What can you do to help combat piriformis syndrome?

Apply heat.
Stretch the Piriformis muscle.
Strengthen the Piriformis muscle.
See a Physical Therapist professional who can advise on treatment, rehabilitation and prevention

What can a Physical Therapist do?

Apply specific sports massage techniques.
Stretch the Piriformis muscle using Muscle Energy Techniques.
Apply ultrasound.
Advise on strengthening and rehabilitation to avoid injury recurrence.

Rehabilitation (Piriformis syndrome)

The guidelines below are for information purposes only. We recommend seeking professional advice before starting any rehabilitation.

Aims of rehabilitation of Piriformis syndrome:

Reduce pain.

Improve flexibility and condition of the surrounding muscles through deep massage and stretching and strengthening.
Return to full fitness.

Injury prevention.

Reducing pain.
Ice (apply for 20 minutes)
Heat in the form of a hot bath or hot water bottle.
Rest from activities that produce pain. This is likely to include running.
Gentle stretching if pain allows.

Flexibility and conditioning

After the first two to three days a stretching and strengthening programme can begin.
It is important to stretch in conjunction with strengthening and massage.
Deep sports massage techniques can be used to release the tension in the Piriformis muscle. Massage can be applied on alternate days. At the very least two to three sessions at the start of rehabilitation is a good idea.

Muscle energy techniques are an excellent way of improving the stretch of the muscle.

On a daily basis perform Piriformis strengthening exercises immediately followed by stretching.

Hold stretches for 30 seconds and repeat 5 times.

In addition to the specific Piriformis stretches it is important to stretch the hamstrings, hip abductors and lower back.

Return to full fitness.

In most cases a return to jogging is possible within 5 days.
But this should be a gradual process combining running and walking.
It is essential that stretching and strengthening are continued throughout the rehabilitation process and beyond.

Injury Prevention

The following steps can be taken to avoid Piriformis syndrome returning:
Stretch religiously before and after training.
If you have a break from training, keep doing the stretches as you may find things tighten up, especially if you sit for long periods.
Get a regular sports massage. A good therapist will spot potential problems before they happen.

Get a bio mechanical assessment. If you over pronate or have one leg longer than the other then this may make you more susceptible to injury.
Maintain regular hip and Piriformis strengthening exercises.

Make sure you have the right footwear for your activity and that they are not too old.
Finally when recovering from injury, do not do too much too soon.

Degenerative Joint Problems

Alternative Names: Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis-Osteoarthritis.

Causes

Unfortunately most of the time, the cause of OA is unknown. It is mainly related to aging, but metabolic, genetic, chemical, and mechanical factors can also lead to OA.
The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.
The disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. As the disease gets worse, the cartilage disappears and the bone rubs on bone. Bony spurs usually form around the joint.

OA can be primary or secondary.

Primary OA occurs without any type of injury or obvious cause.
Secondary OA is osteoarthritis due to another disease or condition. The most common causes of secondary OA are metabolic conditions, such as acromegaly, problems with anatomy (for example, being bow-legged), injury, or inflammatory disorders such as septic arthritis.

Symptoms

The symptoms of osteoarthritis include:
 Deep aching joint pain that gets worse after exercise or putting weight on it and is relieved by rest
 Grating of the joint with motion
 Joint pain in rainy weather
 Joint swelling
 Limited movement
 Morning stiffness
Of course some people might not have symptoms.

Examination and Tests

A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness.
An x-ray of affected joints will show loss of the joint space, and in advanced cases, wearing down of the ends of the bone and bone spurs.

Treatment

The goals of treatment are to relieve pain, maintain or improve joint movement, increase the strength of the joints, and reduce the disabling affects of the disease. The treatment depends on which joints are involved.

MEDICATIONS

The most common medications used to treat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). They are pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen, and naproxen.

Although NSAIDs work well, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding. Manufacturers of NSAIDs include a warning label on their products that alerts users to an increased risk for cardiovascular events (heart attacks and strokes) and gastrointestinal bleeding.

Other medications used to treat OA include:
 COX-2 inhibitors (coxibs). Coxibs block a substance called COX-2 that causes swelling. This class of drugs was first thought to work as well as other NSAIDs, but with fewer stomach problems. However, reports of heart attacks and stroke have led the Drug Licensing Authorities to re-evaluate the risks and benefits of the COX-2s. Ask your doctor whether the drug is 1. Still available and if so 2. Right and safe for you.
 Steroids. These medications are injected right into the joint. They can also be used to reduce inflammation and pain.
 Supplements. Many people are helped by over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage.
 Artificial joint fluid (Synvisc, Hyalgan). These medications can be injected into the knee. They may relieve pain for up to 6 months.

LIFESTYLE CHANGES
Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.
Applying heat and cold, protecting the joints, using self-help devices, and rest are all recommended.
Good nutrition and careful weight control are also important. If you're overweight, losing weight will reduce the strain on the knee and ankle joints.

PHYSICAL THERAPY

Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3-6 weeks, then it likely will not work at all.

BRACES
Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.

SURGERY
Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:
 Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty )
 Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
 Cartilage restoration to replace the damaged or missing cartilage in some younger patents with arthritis
 Change in the alignment of a bone to relieve stress on the bone or joint (osteotomy)
 Surgical fusion of bones, usually in the spine (arthodesis)

Outlook (Prognosis)

Your movement may become very limited. However Treatment generally improves function.

Possible Complications

 Decreased ability to walk
 Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
 Adverse reactions to drugs used for treatment
 Surgical complications

When to Contact a Medical Professional
Do contact your health care provider if you have symptoms of osteoarthritis.

Prevention

*Weight loss can really help the condition and certainly reduce the risk of knee osteoarthritis in overweight women.

When our body is in the standing position it is in a state of unsteady equilibrium because the base is small and the centre of gravity is a long way above it. That is why it has to be balanced by keeping the centre of gravity over the base, otherwise the body would fall over.

Equilibrium: The steadiness of the body depends on the size of its base and the distance of the centre of gravity from that base. An object having a large base and a low centre of gravity is not easily upset.

The first thing necessary in order to accomplish good posture is to straighten the neck, keep the chin down and back. The second important thing is correct deep breathing.

The line of gravity in the fundamental standing position falls in front of the ears, and in front of the cervical and dorsal vertebrae, through the lumbar vertebrae, through the hip joint, and slightly in front of the ankle joint. But this probably varies in individuals according to their build and height.
"Biomechanics is that branch of science concerned with the understanding of the interrelationships of structure and function of living beings with respect to the kinematics and kinetics of motion"

Poor Posture associated by the following:

Genetic disorders, Familial association, Irregular/no exercise, Bad habits when sitting or standing, Carrying excess loads, (School/shopping) Underweight/Overweight (Inadequate diet)
Mental Attitude towards oneself.

Biomechanics is our way of describing how each bit of your body moves in relation to another bit.

Our bodies are fantastic at compensating when things are not quite perfect but unfortunately when we run out of compensations we usually end up with pain and stiffness.

Let’s have a look at some of the more common biomechanical problems:

Problem 1.

It’s the fashion not to tie trainers and shoes up but this prevents the shoe from supporting the inside of the foot and allows the foot to roll or ‘pronate’ too much in standing and walking.

This means the knee and the hip rolls inwards too much which makes the inside calf and inside thigh muscle shorter. The iliotibial band can then rub against the outside knee giving pain.

Further up, the bottom muscles become too long and stop working as they should do which puts added stress on the pelvis and low back joints. Before you know it you have back pain, knee pain and ankle pain! And all because of fashion!

Problem 2.

Whether you drive 5 miles or 500 miles a day your car seat is really important. In many cars the base of the seat slopes backwards. In fact some of the more expensive cars are the worst because they want you to feel ‘snug’ and safe in the seat. However, this position forces your pelvis to sit too far backwards.

Once this happens your low back and upper back flex forward too much but then your neck muscles have to work really hard to stop your head from flexing too much and allow you to see where you are going. This position then forces your shoulder blades to stretch too far forwards and a large stress is placed on both the front and the back of the shoulder.

The result is neck pain and /or upper or low back pain. This position can exacerbate sciatica as it is a big stretch for the nerves.
The solution is to raise the back of the seat so it becomes more horizontal. Some cars allow you to alter this angle but if yours does not then sit on a small cushion or buy a special wedge shape cushion that fits into the seat.

Our lumbar spine (lower back) provides a foundation to carry the weight of the upper body. It also houses the nerves that control the lower body. With aging, degenerative changes in the spine can occur. The disks between the vertebrae (bones) may become dehydrated, and the joints may become overgrown due to arthritis. Over time, these changes can also lead to narrowing, or stenosis, of the spinal canal.

Narrowing of the lumbar spinal canal pinches the nerves that go to the skin and muscles of the legs. Sometimes, the pinched nerves become inflamed, causing pain in the buttocks and/or legs.

Degenerative changes in the lower back also can diminish the ability of the spine to carry the load of the upper body. This can lead to forward slippage of one vertebra on another, a painful condition called spondylolisthesis.

Lumbar spinal stenosis usually affects middle-aged and older adults. People who are born with narrower spinal canals are more likely to develop this problem.

Symptoms
Typically, patients with lumbar spinal stenosis have a long history of pain in the back, buttocks, and/or legs that gradually worsens over time. Standing or walking upright usually increases the symptoms, resulting in an achy pain, tightness, heaviness, and a sense of weakness in the buttocks and/or legs. These symptoms are generally relieved by sitting down or leaning forward.

Although patients with lumbar spinal stenosis are unable to walk for long periods of time, they may be able to ride an exercise bicycle for much longer. Some patients also find that it is easier to walk while leaning forward on a shopping cart. This position tends to create more space in the spinal canal and can relieve some of the pressure on the nerves. Leaning on the handlebars of a bicycle creates the same effect.

Diagnosis
An orthopaedic surgeon can diagnose lumbar spinal stenosis using a combination of:

Symptoms
Physical examination
Plain radiographs (X-rays)
Magnetic resonance imaging (MRI)
Radiographs can show the presence of arthritis and slippage of vertebrae. An MRI scan can show whether nerves are being pinched.

For people who cannot get an MRI (for example, people with pacemakers), a special test called a computed tomography myelogram may be necessary. In this test, dye is injected into the spine to make the nerves visible. The doctor can then determine whether the nerves are being pinched.

Treatment

Nonsurgical Treatment

Most patients with lumbar spinal stenosis do not require surgery. However, if a patient is experiencing severe pain that limits the activities of daily living, surgery may be recommended.

Generally, nonsurgical treatment for lumbar spinal stenosis consists of:

Physical therapy A program of physical therapy usually includes aerobic conditioning and exercises for strength and flexibility. The exercise bike is a good way for patients to exercise without pain. Pool exercises can be useful for people who cannot do aerobic exercises on land.

Anti-inflammatory medications Medications such as ibuprofen and naproxen may be prescribed to decrease pain and inflammation; however, they can have serious side effects. Prolonged use can lead to gastrointestinal ulcers, bleeding, and kidney problems. Some anti-inflammatory medications may also increase the risk of heart attack and stroke.

Epidural steroid injections These injections deliver anti-inflammatory steroid medication directly into the spinal canal—straight to the pinched nerve roots. The injections can provide relief for weeks to months, and may allow the patient to participate in more aggressive rehabilitation. In some cases, they may enable the patient to postpone or avoid surgical treatment altogether. Epidural steroid injections are more effective than anti-inflammatory medications taken by mouth, and they may also have fewer side effects.

Bracing A lumbar brace or corset can provide some support and help the patient gain some mobility, but bracing is generally not recommended for long-term use. If used for too long, bracing can lead to deconditioning of the muscles that support the back. Acupuncture or chiropractic manipulation can also be attempted.

All of these nonsurgical treatments are aimed at decreasing inflammation and providing relief of symptoms. However, nonsurgical treatment will not improve the narrowing of the spinal canal.

Surgical Treatment
In general, surgery is only considered as a last resort if all attempts at nonsurgical therapies are unsuccessful, and if the overall potential benefits of surgery are greater than the potential risks. Surgery may be recommended on an urgent basis if a patient has severe weakness or loss of bowel and bladder control.

Decompression
The surgical procedure for lumbar spinal stenosis involves removing the bone and soft tissues of the spine that are pinching the nerves. This procedure is called a "decompression" or a "laminectomy."

Spinal Fusion
Some patients with lumbar spinal stenosis require only a decompression. However, if there is also forward slippage of a vertebra or curvature of the spine, a "spinal fusion" may be needed. In this procedure, two or more vertebrae are permanently fused together, using a bone graft harvested from the hip. Fusion eliminates motion between vertebrae and prevents the slippage or curvature of the spine from worsening after surgery, which would cause more back and/or leg pain. The surgeon may use screws and rods to hold the spine in place while the bones fuse together.

The use of rods and screws makes the fusion of the bones happen faster and speeds postoperative rehabilitation. Overall, the results of spinal fusion are good to excellent in approximately 80% of patients. Patients tend to see more improvement of leg pain than back pain. Most patients are able to resume a normal lifestyle after a period of recovery from surgery.

Complications of Surgery
There are some risks to surgery for lumbar spinal stenosis, including:
 Bleeding
 Infection
 Blood clots
 Reaction to anaesthesia
 Tear of the sac covering the nerves (dural tear)
 Failure to relieve symptoms
 Return of symptoms after some time
 Failure of the bone fusion to heal
 Failure of screws or rods
 Need for further surgery
 Injury to the nerves

The risks of surgery depend on the patient and the exact procedure being performed. Elderly patients have higher rates of complications from surgery. So do overweight patients, diabetics, smokers, and patients with multiple medical problems.

Rehabilitation
After surgery, patients may be hospitalised for several days, depending on the patient and the procedure performed.

Relatively healthy patients who undergo only decompression may be discharged from the hospital the same day, and may return to normal activities after only a few weeks.

Patients who undergo spinal fusion are hospitalised for several days. They usually receive an outpatient physical therapy program.

A lumbar corset or brace may also be prescribed after surgery. Patients generally return to normal activities after 2 to 3 months.

Older patients who need more physical therapy may be transferred from the hospital to a rehabilitation facility.

Prevention
The best way to avoid lumbar spinal stenosis is to stay as physically fit as possible. Regular exercise can improve endurance and keep the muscles that support the spine strong.
Avoiding weight gain can decrease the load that the lumbar spine has to carry.

Patients should also avoid cigarette smoking. Both the smoke and the nicotine cause the spine to degenerate faster than normal.

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, 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 GP’s about implementing preventive measures.

Osteoporosis Causes and Risk Factors

Bones are made of complex, constantly changing, living tissue. 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 aging 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 behaviors 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.

Osteopathy originated from the common sense principle that a patients history of illnesses and physical traumas are written into the body’s structure. Practitioners have a highly developed sense of touch which allows them to palpate (feel) the patients living anatomy (i.e. flow of fluids, motion of tissues, and structural make-up).

Their job is to set the body up to heal itself. To restore its normal function, Practitioners gently apply a precise amount of force to promote movement in areas of congestion to restore normal motion of the body, release the compression of bones and joints, thus allowing restoration of normal tissue function.

When the body is balanced and efficient, just like a well tuned engine, it will function with the minimum of wear and tear, leaving more energy for living.
As Osteopaths, they quite rightly consider each person as an individual. On your first visit, they will spend time taking a detailed medical history including important information about your lifestyle. You will normally be asked to remove some of your clothing and perform a series of simple movements. This will allow a full diagnosis and a treatment plan to be devised, tailored to your individual needs.

Through a variety of stretching, mobilising and manipulative techniques they aim, through working with you, to restore the body’s harmony. This, coupled with exercises and health advice, enable them to reduce the symptoms and restore your health and quality of life.

Osteopaths treat a variety of common conditions including changes to posture in pregnancy; repetitive strain injury (RSI), postural problems caused by driving or work strain, the pain of arthritis and sports injuries.

Remedial Massage – This therapy consists of therapeutic massage and soft tissue manipulation for the treatment of muscular-skeletal conditions, sports injuries etc. When most people think of massage they think of relaxation massage, where the primary aim is to relieve stress and soothe muscular aches and pains. Remedial massage, however, takes this a little further focusing on the root cause of persistent chronic muscular or skeletal pain and then seeks to alleviate it permanently. Often such pain is the result of injury, caused by specific trauma or imbalances in the joints, muscles and ligaments.

Therapists are trained to assess these imbalances and establish an effective programme of therapeutic treatment. The remedial massage treatment process involves the application of scientifically based treatments, often in conjunction with a rehabilitation programme.

The application of remedial massage and manipulation is based upon a thorough understanding of anatomy and physiology. It aims to re-balance the musculo-skeletal system, by working specifically on muscles, tendons, joints, fascia and ligaments, thus making the treatment a powerful yet non-traumatic therapy. This re-balancing of soft tissue, allows freedom of movement within the joints so facilitating the normal function of the vascular and neural systems.

Many studies have demonstrated the wide-ranging benefits of massage. It is useful for specific ailments such as asthma, depression, back and neck pain, insomnia, immune deficiency disorders and diabetes. It can be helpful during pregnancy and labour and is also used to help premature babies thrive. It can also be taught to their mothers to help them bond with their infants while they are still in incubators. Massage is often a part of therapy for people with cancer since it promotes relaxation and a sense of wellbeing.

Electrotherapy – Therapists apply electrotherapy where appropriate to be of benefit to the condition being treated. Modalities used in the Practice include interferential, pulsed electromagnetic energy fields and medium frequency modulated current (Likon).

Some of the equipment available is designed for continuation of therapeutic treatment at home.

Interferential – This is based on the crossing of two separate applied electronic currents of two different frequencies which “interfere” at their cross points, creating the required therapy frequency. This is done by applying four electrodes to the body (in direct contact). The reason for this form of therapy is to create this interferential field deep within the localized tissue.

Pulsed Electromagnetic Treatment - Electromagnetic Therapy does not need any electrical contact with the body and creates a much larger area of therapy field within the body and penetrates easily through the body. It works by applying a low frequency pulsing magnetic field to the injured area. This pulsating field influences the ions within the body cells to enhance ion exchange which, in turn, improves oxygenation to the cells which accelerates healing and cell regeneration.

Osteopathy offers a wide range of modalities that can be extremely beneficial in both the treatment and management of various medical conditions. However please ensure that you liaise with your GP and if it is your first visit to an Osteopath always check that they are registered with the appropriate governing body. Here in the UK that is the GOC.-osteopathy.org.uk.