Women Need Expanded Musculoskeletal Care During Pregnancy

February 2007 study in the Journal of Manipulative and Physiological Therapeutics (JMPT). Despite the high prevalence of musculoskeletal pain during pregnancy, few women in under-served populations receive treatment for their low back pain and researchers found that pain in a previous pregnancy may predict a high risk for musculoskeletal complaints in future pregnancies. 

According to Clayton Skaggs, DC, the study’s chief author, 85 percent of women surveyed reported that they had not received treatment for their musculoskeletal pain, and of the small percentage who perceived that their back complaints were addressed, less than 10 percent were satisfied with the symptom relief they obtained. 

“Based on the findings of this study, doctors of chiropractic and other health care professionals need to expand the musculoskeletal care available during pregnancy, especially in underserved populations,” Dr. Skaggs said.  “As a proactive step, health professionals should consider including back pain screening as part of early obstetrical care to help identify musculoskeletal risk factors and allow for early education and/or treatment.” 

Researchers surveyed more than 600 women. Surveys were offered to all obstetrical patients and were designed to collect information about pregnancy-related pain and quality of life issues.  Of those women who responded to the survey, two-thirds reported back pain and nearly half of all women reported pain at two or more locations, including pelvic pain and mid-back pain. 

The study findings suggest that pregnant women with back pain are predisposed to sleep disturbances.  In the survey, close to 80 percent of women reporting sleep disturbances had back pain, whereas only 8 percent of women without pain reported problems sleeping.  More alarming was the significant relationship between reports of musculoskeletal pain and the use of pain medication.  Three-fourths of the women who reported pain also described use of pain medication. 

“We saw a direct association between sleep deficiency and back pain,” the authors said.  “These results raise the question of whether or not the high incidence of pain medication use reflects a lack of education about potential risks of medications or more an inability for the pregnant women to cope with the pain.”

The study’s authors also found a relationship between pain in a previous pregnancy and pain in the current pregnancy.  Similar to the results of other studies, researchers found that 85 percent of women who experienced pain in a previous pregnancy reported pain during their current pregnancy. 

The study was the result of on-going collaboration between Logan College of Chiropractic and the Department of Obstetrics at Washington University School of Medicine. 

Can Blindness Be Prevented Through Diet (omega-3 fatty acids)?

 Increasing intake of the omega-3 fatty acids DHA and EPA, found in popular fish-oil supplements, may protect against blindness resulting from abnormal blood vessel growth in the eye, according to a study in Nature Medicine. The study was done in mice, but a clinical trial at Children’s Hospital Boston will soon begin testing the effects of omega-3 supplementation in premature babies, who are at risk for vision loss.

Abnormal vessel growth is the cause of retinopathy of prematurity, diabetic retinopathy in adults, and “wet” age-related macular degeneration, three leading causes of blindness. Retinopathy, affecting about 4 million diabetic patients and about 40,000 premature infants in the United States, is a two-step disease that begins with a loss of blood vessels in the retina (the nerve tissue at the back of the eye that sends visual signals to the brain). In the end stage of the disease, the abnormal vessels pull the retina away from its supporting layer, and this retinal detachment ultimately causes blindness. The researchers, led by Lois Smith, MD, PhD, and Kip Connor, PhD, of Children’s Hospital Boston’s Department of Ophthalmology and Harvard Medical School, and John Paul SanGiovanni, ScD, of the National Eye Institute (NEI), National Institutes of Health, studied retinopathy in a mouse model, feeding the mice diets that emphasized either omega-3 fatty acids or omega-6 fatty acids.  Mice on the omega-3 diet, rich in DHA (docosahexaenoic acid) and its precursor EPA (eicosapentaenoic acid), had less initial vessel loss in the retina than the omega-6-fed mice: the area with vessel loss was 40 to 50 percent smaller. As a result, the omega-3 group had a 40 to 50 percent decrease in pathological vessel growth. “Our studies suggest that after initial loss, vessels re-grew more quickly and efficiently in the omega-3-fed mice,” says Connor, the study’s first author.  Because omega-3 fatty acids are highly concentrated in the retina, a mere 2 percent change in dietary omega-3 intake was sufficient to decrease disease severity by 50 percent, the researchers note. Validating their findings, results were virtually identical in mice whose omega-3 fatty acid levels were increased through genetic means.Omega-3 fatty acids like DHA and EPA are thought to dampen inflammation in the body. They are often lacking in Western diets; instead, omega-6 fatty acids predominate. The ideal omega-6:omega-3 ratio is thought to be 2:1 to 5:1, whereas typical Western diets have ratios of 10:1 or higher. Premature infants are especially lacking in omega-3 fatty acids, because they miss getting this nutrient from their mothers, a transfer that normally happens in the third trimester of pregnancy.“If omega-3 fatty acids, or these anti-inflammatory mediators, are as effective in humans and they are in mice, simple supplementation could be a cost-effective intervention benefiting millions of people,” says Smith, the study’s senior investigator. “The cost of blindness is enormous.”Aside from fish-oil supplements, the most widely available source of omega-3 fatty acids is coldwater oily fish (wild salmon, herry, mackerel, anchovies, sardines). The compounds can also be made synthetically from algae or other non-fish sources. Paul A. Sieving, MD, PhD, director of the NEI, which provided funding for the study, said, “This study shows the benefit of dietary omega-3 fatty acids in protecting against the development and progression of retinal disease. It gives us a better understanding of the biological processes that lead to retinopathy and how to intervene to prevent or slow disease. It will be interesting to see if human clinical trials show similar beneficial effects.” The clinical trial at Children’s Hospital Boston will follow premature newborns who are unable to feed and are receiving parenteral nutrition, with omega-3 fatty acids as part of their IV solution. The hope is that the omega-3 supplementation will allow the retina and its vessels to develop normally. “Once the retina is detached, there’s little you can do,” says Smith. “We want to give omega-3 right from the beginning to mimic what the infants would be getting from their mothers in utero, had they not been born prematurely.”In addition to retinopathy, the researchers speculate that omega-3 fatty acids may help reduce vision loss in people with “wet” or neovascular phase of age-related macular degeneration (AMD), a disease that also involves abnormal vessel growth.  

When is back pain a fracture?

Compression fractures of the spine
Spinal fractures that occur as a result of osteoporosis are actually quite common, occurring in approximately 750,000 people in the U.S. each year. The problem is that the fracture is not always diagnosed—instead, the problem is often just thought of as general back pain, such as from a muscle strain or other soft tissue injury, or as a common part of aging. Because of this, approximately two thirds—or 500,000—of the vertebral fractures that occur each year are not diagnosed and therefore not treated.

Spinal fractures due to osteoporosis often occur while doing something that causes relatively minor trauma to the spine, such as opening a window, an insignificant fall, or twisting while lifting. Advanced cases of osteoporosis can even lead to a vertebral fracture with routine activities that would normally not cause any trauma, such as sneezing, coughing or turning over in bed.

Vertebral fractures are usually followed by acute back pain, and may lead to chronic pain, deformity (thoracic kyphosis, commonly referred to as a dowager’s hump), loss of height, crowding of internal organs, and loss of muscle and aerobic conditioning due to lack of activities and exercise. A combination of the above problems from vertebral fractures can also lead to changes in the individual’s self-image, which in turn can adversely affect self esteem and ability to carry on the activities of daily living.

It’s important to note that fractures from osteoporosis don’t just occur in the elderly, they can also occur in people as young as 40 or 50 years old. Because osteoporosis is a “silent” disease, meaning that there are typically no symptoms until a fracture occurs, it is not uncommon for someone with back pain to be unaware of the fact that she has actually fractured a vertebra (or multiple vertebrae) in her spine.

This article provides an overview of vertebral compression fractures caused by osteoporosis, including symptoms and diagnosis.

Osteoporosis is the main cause of vertebral fractures
Osteoporosis is fairly common disease, and is especially common in postmenopausal women. In fact, it is estimated that approximately 25 percent of all postmenopausal women in the United States have had a vertebral compression fracture.¹ Osteoporosis also occurs in men, but is far more prevalent in women—approximately four times as many women have low bone mass, or osteoporosis, as men.

Osteoporosis causes bones to thin and become more brittle and weak. When the bones in the spine weaken they can break or cave in under normal pressure. The thinning bones can collapse during normal activity, leading to a spinal fracture. These compression fractures can cause a great deal of pain and can permanently alter the shape and strength of the spine.

The type of break in the spine that is typically caused by osteoporosis is called a compression fracture, usually defined as a vertebral bone in the spine that has decreased at least 15 to 20% in height due to fracture (as seen on an x-ray). These compression fractures can occur in vertebrae anywhere in the spine, but they tend to occur most commonly in the upper back (thoracic spine), particularly in the lower vertebrae of that section of the spine (e.g. T10, T11, T12). They rarely occur above the T7 level of the spine.

With a compression fracture caused by osteoporosis, the fracture usually occurs in the front of the vertebra, collapsing the bone in the front of the spine and leaving the back of the same bone unchanged. This results in a wedge shaped vertebra. Because the majority of damage is limited to the front of the vertebral column, the fracture is usually stable and rarely associated with any nerve or spinal cord damage.

Unlike many other conditions that can be treated before a serious complication develops, usually a fracture is the first sign that someone has osteoporosis. By the time a fracture occurs, the osteoporosis is usually advanced and the individual is then susceptible to more vertebral fractures.

Cigarette Smoking Impairs Ligament Healing.

Researchers at Washington University School of Medicine in St. Louis are reporting that smoking interferes with ligament healing.  

The medial collateral ligament (MCL), a ligament that supports the knee joint. Each year in the United States there are more than 20 million reported ligament injuries, and MCL injuries are the most common. They also are the most common injuries seen in competitive and recreational sports.

It’s not clear exactly how many MCL injuries occur annually because many go unreported.  “A lot of MCL injuries never make it to an emergency room because patients will have a sore knee but don’t seek treatment,” says Rick W. Wright, M.D., associate professor of orthopaedic surgery and a senior investigator on the MCL study.  

The researchers say athletes who smoke should keep these findings in mind before driving for a lay-up, sliding into second base or lacing up a pair of ice skates.  The soft tissue healing that occurs following ligament injuries occurs in stages.

There is an immediate pooling of blood near the injury, the sort of hemorrhaging that will cause swelling right away. This initial response is followed by several days of inflammation, in which cells called macrophages flock to the injury site and secrete substances called cytokines and chemokines. Those, in turn, recruit more cells to assist in healing. That process of cellular proliferation and synthesis lasts for several days to several weeks. The final stage of healing involves remodeling of the tissue and can continue for months and even years.  

Between 20 and 25 percent of the U.S. population smokes. Wright and Sandell say that although the prevalence of smoking among athletes is slightly lower, a significant percentage of recreational and even professional athletes continue to smoke.

Breastfeeding And Omega-3 Fatty Acids Help New Moms Fight Depression

Breastfeeding and the good fats in Omega-3 fatty acids help new moms fight depression, according to a new article published in the International “Depression in new mothers is common in many cultures, affecting anywhere from 10 percent to 20 percent of postpartum women. In some high-risk populations, the percentage can even be as high as 40 percent or 50 percent. Since depression has devastating effects on both mother and baby, it’s vital that it be identified and treated promptly. Depressed mothers are also more likely to stop breastfeeding with negative health effects for each,” Kathleen Kendall-Tackett said.

According to Kendall-Tackett, physical and psychological stressors increase inflammation, which is one of the top contributors to depression in new mothers. Most current treatments for depression, including the long-chain Omega-3 fatty acids EPA and DHA, are anti-inflammatory.New mothers experience an increase in inflammation because of increased levels of proinflammatory cytokines. These levels dramatically increase in the last trimester of pregnancy and continue to elevate during the postpartum period. Moreover, common experiences of new motherhood, such as sleep disturbance, postpartum pain, and past or current psychological trauma, act as stressors that cause proinflammatory cytokine levels to rise, according to Kendall-Tackett.“Breastfeeding protects maternal mood by lowering stress. When stress levels are lower, the mother’s inflammatory response system will not be activated, thereby lowering her risk of depression,” she said. “However positive these results, I must issue one caveat: they only apply when breastfeeding is going well. As noted earlier, when breastfeeding that is not going well, particularly if there is pain, it becomes a trigger to depression rather than something that lessens the risk. Mothers’ mental health is yet another reason to intervene quickly when breastfeeding difficulties arise.”