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Posts tagged ‘Lumbar vertebrae’

Placebo!! How can it be so powerful?

They are the miracle pills that shouldn’t really work at all. Placebos come in all shapes and sizes, but they contain no active ingredient. Now they are being shown to help treat pain, depression and even alleviate some of the symptoms of Parkinson’s disease. How is this possible?

Well, it all lies inside the brain and scientists are trying to figure out why, but I want to give you a couple of examples to show you how powerful a placebo can be.

In one test they had professional  bicycle riders do a time trial around a track as fast as they could. After that was done, they gave each cyclist a placebo pill. Now, the cyclist thought they were getting this ¨legal¨ caffeine pill that would improve their results but in reality there was NOTHING in the pill.  The normal thing would be that the second time trial they would go slower because they were already tired from the first. But all cyclist performed better and some even register their best record ever!! So how can a pill with nothing inside help someone cycle faster than ever before??

But a placebo doesn´t even have to be a pill, for instance lately there have been different studies where they have done ¨fake operations¨ and have gotten the same results as real operations (1). In one these ¨fake operations¨, patients thought they were getting a vertebroplasty. This means that ¨cement¨ is injected into a fracture spinal bone to provide extra strength to it. So what they did is they had thirty-six patients believing they were undergoing this procedure (while another group was actually getting the real surgery).  To mimic the effect of the operation, surgeons just tapped against the spine making the patients believe the needle containing medical cement was being inserted into the spinal bone. To make it even more authentic, they also made sure that the odour of the cement was present in the operating room. The results were that the patients who had the sham surgery reported that they experienced the same relief of pain as those who had the real operation (2)!!! This is not an isolated finding as they have done the same thing with knee arthroscopic surgery and found the same results!!! Incredible or what?

In another test, Professor Fabrizio Benedetti (University of Turin) is using low oxygen levels at high altitudes to conduct his investigations, to test whether placebos can cause real changes in the body. Subjects strapped with fake oxygen canisters were requested to hike for 30 minutes whilst their brain activity, heart rate and neurotransmitters were all monitored. You see, when we come to high altitudes the low oxygen levels cause our blood levels to fall, this makes our PGE2 (a neurotransmitter) levels to go up, and that leads us to feel some of the familiar symptoms of altitude sickness like pain, but extra oxygen can ease the problem. Well guess what, the fake oxygen cause those PGE2 levels go down.  A placebo, meaning nothing, has changed something physically in the body. How crazy is that?

I will leave it at that today so that you guys can digest all the information. But I will do a second part with more examples to try to explain a little more of what placebo is and how we can use it.

Hope you liked it!!

References:

1)J. Bruce Moseley, M.D., Kimberly O’Malley, Ph.D., Nancy J. Petersen, Ph.D., Terri J. Menke, Ph.D., Baruch A. Brody, Ph.D., David H. Kuykendall, Ph.D., John C. Hollingsworth, Dr.P.H., Carol M. Ashton, M.D., M.P.H., and Nelda P. Wray, M.D., M.P.H. A controlled trial of Arthroscopic Surgery for Osteoarthritis of the Knee.N Engl J Med 2002; 347:81-88

2)http://www.dailymail.co.uk/health/article-2558438/The-remarkable-power-PLACEBO-effect-Patients-FAKE-surgery-broken-recovered-just-documentary-reveals.html#sthash.6BeKXKul.dpuf

 

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Lower back pain part 3: Prevention

Ok, so in part 2 of lower back pain I explained a little about what a herniation is, now I want to start talking about how to prevent a herniation. First, let me go into a little more detail about what a disc is. ( read https://sports-diet-pain.com/2013/10/18/lower-back-pain/ and https://sports-diet-pain.com/2013/10/21/low-back-pain-part-2-herniation/ )

A disc is the substance between the vertebrates. It has a nucleus and a annulus. The annulus surrounds the nucleus and prevents it from coming out. The nucleus is a gel like substance, and a herniation is when the annulus breaks and the nucleus comes out ( more or less). The disc varies in size depending on the time of day. In the morning the discs are usually bigger than at night, because we have been laying down for hours and the discs have absorbed liquids. That is why in the morning we are usually taller than at night and a reason why we shouldn´t be doing flexion activities in the morning. The bigger the disc, the more stress you put on it and on your ligaments. A study estimated that disc-bending stresses were increased by 300% and ligament stresses by 80% in the morning compared to the evening (1). In another study it was demonstrated that simply avoiding full lumbar flexion in the morning reduced back symptoms (2). So first factor in preventing herniation and lower back pain, don´t do flexion activity in the morning, wait at least 30 minutes to an hour, that is usually what it takes for the disc to return to normal size.

Spine has memory. The function of the spine is modulated by certain previous activity. This occurs because the loading history determines disc hydration, which in turn modulates ligament rest length, joint mobility, stiffness and, load distribution. In simple words, when we are sitting down, we are in flexion. This means that the nucleus of the disc has moved posteriorly, and we have ¨stretched¨ the posterior ligament (3). So it would be unwise to lift things after a bout of prolonged flexion, like for example when we are sitting for a long time . Then, a second factor in preventing herniation and lower back pain, don´t lift things up after being in flexion for a long time. Meaning if you have sat down the whole day, don´t go right away and try to pick up something heavy, the changes of hurting yourself are going to increase. All you have to do is stand up, wait 5 minutes, and your changes of getting hurt will greatly diminish. This can also be said to all those that play sports like for example, basketball. When you are on the bench sitting down, you are in flexion. So it would be much wiser, if you know that you are going to go into the game, to stand up, or to try sit in a way that your back isn´t in flexion.

Too much of anything is usually bad. In a study done in 1975 (4-5) , it proved that seated work posture creates an increase in lower back pain (LBP).  Another one  in 1996 (6)  also suggested that people who sit for long periods of time have a greater risk of low back troubles (8%), but what was even more interesting is that active workers, meaning people who worked moving around or standing up, reduced their probability of getting back pain by 14% if they would sit once in a while. This suggest that variable work, and not too much of any single activity is the best thing. In other words, if your job consist of sitting down the whole day, it would make sense to get up and move around once in a while. And if your job consist of being active the whole day, it would be clever to do the opposite. So any business man out there thinking of creating their own business or ones who already have one, make your workers do VARIABLE WORK, and you will save up money in the long run.

I already said how easily it is to hurt yourself from flexing your back, how you shouldn´t pick up heavy things after prolonged bouts of flexion, how the best thing to do to prevent LBP is to do variable work, but the number one thing you should really try to avoid is FREQUENT BENDING AND TWISTING (gardening is an example of frequent bending and twisting). The U.S. Department of Labor (1982) and many more studies noted the increased risk of lower back pain from frequent bending and twisting (7-8). In this report vibration was also included, especially seated vibration. So all those power plates fanatics carefull with the vibration (7,9).

80 % of us will probably get back pain at one point or another, that´s a lot! But I´m pretty sure that if we try to avoid things I have mentioned in this blog the chances of us getting hurt will greatly diminish.

Hope you enjoyed it

References

  1. Adamas M, Dolan P. Diurnal variations in the stresses on the lumbar spine. Spine 1987,12(2):130.
  2. Snook SH, Webster BS, McGorry RW, Fogleman MT, McCann KB. The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion. Spine 1998, 23: 2601-07.
  3. Mcgill S. Low Back Disorders Evidence Based Prenvention and Rehabilitation 2nd. Human Kinetics 2007.
  4. Kelsey JL. An Epidemiological Study of Acute Herniated Lumbar Intervertebral Disc. Rheumatol Rehabil 1975:14;144-5.
  5. Kelsey JL. An Epidemiological Study of Acute Herniated Lumbar Intervertebral Disc. Int J. Epidemiol:4;197-204.
  6. Liira JP, Shannon HS, Chambers LW, Haines TA. Long-term back problems and physical work exposures in the 1990 Ontario Health Survey. Am J Public Health. 1996;86:382–387.
  7. The U.S Department of Labor Report (1982)
  8. Marras WS, Lavender SA, Leurgans SE, Fathallah FA, Ferguson SA, Allread WG, Rajulu SL. Biomechanical risk factors for occupationally related low back disorders. Ergnomics 1995 Feb:38(2):377-410.
  9. Seroussi RE, Wilder DG, Pope MH. Trunk muscle electromyography and whole body vibration. J Biomech 1989:22(3):219-29.

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