Scoliosis

Scoliosis affects 5 to 7 million people in the United States. More than a half million visits are made to doctors’ offices each year for evaluation and treatment. Although scoliosis can begin at any age, it most often develops in adolescents between the ages of 10 and 15. Girls are more commonly affected than boys. Because scoliosis can be inherited, children whose parents or siblings are affected by it should definitely be evaluated by a trained professional.

What is scoliosis?
Because we walk on 2 feet, the human nervous system constantly works through reflexes and postural control to keep our spine in a straight line from side to side. Occasionally, a lateral (sideways) curvature develops. If the curvature is larger than 10 degrees, it is called scoliosis. Curves less than 10 degrees are often just postural changes. Scoliosis can also be accompanied by lordosis (abnormal curvature toward the front) or kyphosis (abnormal curvature toward the back). In most cases, the vertebrae are also rotated.

In more than 80% of cases, the cause of scoliotic curvatures is unknown; we call this condition idiopathic scoliosis. In other cases, trauma, neurological disease, tumors, and the like are responsible. Functional scoliosis is often caused by some postural problem, muscle spasm, or leg-length inequality, which can often be addressed. Structural scoliosis does not reduce with postural maneuvers. Either type can be idiopathic or have an underlying cause.

What are the symptoms of scoliosis?
Scoliosis can significantly affect the quality of life by limiting activity, causing pain, reducing lung function, or affecting heart function. Diminished self-esteem and other psychological problems are also seen. Because scoliosis occurs most commonly during adolescence, teens with extreme spinal deviations from the norm are often teased by their peers.

Fortunately, 4 out of 5 people with scoliosis have curves of less than 20 degrees, which are usually not detectable to the untrained eye. These small curves are typically no cause for great concern, provided there are no signs of further progression. In growing children and adolescents, however, mild curvatures can worsen quite rapidly—by 10 degrees or more—in a few months. Therefore, frequent checkups are often necessary for this age group.

How is scoliosis evaluated?
Evaluation begins with a thorough history and physical examination, including postural analysis. If a scoliotic curvature is discovered, a more in-depth evaluation is needed. This might include a search for birth defects, trauma, and other factors that can cause structural curves.

Patients with substantial spinal curvatures very often require an x-ray evaluation of the spine. The procedure helps determine the location and magnitude of the scoliosis, along with an underlying cause not evident on physical examination, other associated curvatures, and the health of other organ systems that might be affected by the scoliosis. In addition, x-rays of the wrist are often performed. These films help determine the skeletal age of the person, to see if it matches an accepted standard, which helps the doctor determine the likelihood of progression. Depending on the scoliosis severity, x-rays may need to be repeated as often as every 3 to 4 months to as little as once every few years.

Other tests, including evaluation by a Scoliometer™, might also be ordered by the doctor. This device measures the size, by angle, of the rib hump associated with the scoliosis. It is non-invasive, painless, and requires no special procedures. A Scoliometer™ is best used as a guide concerning progression in a person with a known scoliosis—not as a screening device.

Is scoliosis always progressive?
Generally, it is not. In fact, the vast majority of scolioses remains mild, is not progressive, and requires little treatment, if any.

In one group of patients, however, scoliosis is often more progressive. This group is made up of young girls who have scolioses of 25 degrees or larger, but who have not yet had their first menstrual period. Girls generally grow quite quickly during the 12 months before their first period and if they have scolioses, the curvatures tend to progress rapidly. In girls who have already had their first periods, the rate of growth is slower, so their curves tend to progress more slowly.

What is the treatment for scoliosis?
There are generally three treatment options for scoliosis—careful observation, bracing, and surgery. Careful observation is the most common “treatment,” as most mild scolioses do not progress and cause few, if any, physical problems. Bracing is generally reserved for children who have not reached skeletal maturity (the time when the skeleton stops growing), and who have curves between 25 and 45 degrees. Surgery is generally used in the few cases where the curves are greater than 45 degrees and progressive, and/or when the scoliosis may affect the function of the heart, lungs, or other vital organs.

Spinal manipulation, therapeutic exercise, and electrical muscle stimulation have also been advocated in the treatment of scoliosis. None of these therapies alone has been shown to consistently reduce scoliosis or to make the curvatures worse. For patients with back pain along with the scoliosis, manipulation and exercise may be of help.

Most people with scoliosis lead normal, happy, and productive lives. Physical activity including exercise is generally well-tolerated and should be encouraged in most cases.

Vitamin D

From this review, you will learn what vitamin D is, how you can get it, who tends toward deficiency, why it’s important, and what precautions should be taken. This information is provided by the National Institutes of Health, Office of Dietary Supplements.

Vitamin D is a nutrient generated by the body through exposure to the rays of the sun. It can also be found in some foods. Vitamin D plays an important role in building strong bones by helping the body absorb calcium from food and supplements. People who get too little vitamin D may develop soft, thin, and brittle bones.

Vitamin D is found in cells throughout the body and is vital for many other health functions, as well. It participates in the nerve and muscle function, as well as in the function of the immune system and in the reduction of inflammation.

How can I get vitamin D?
The body makes vitamin D when skin is directly exposed to the sun outdoors. During the warmest months, for example, 5 to 30 minutes of exposure between 10 AM and 3 PM several times a week to the face, arms, legs, or back without sunscreen may be enough to produce sufficient vitamin D. However, excessive exposure to the sun increases the risk of skin cancer. When out in the sun, wear protective clothing and apply sunscreen with a sun protection factor of 8 or more.

Cloudy days, shade, and having dark-colored skin cut down on the amount of vitamin D the skin makes. People who avoid the sun, who cover their bodies with sunscreen or clothing, or who live in the northern half of the United States during the winter months should include good sources of vitamin D in their diets or take a supplement.

Vitamin D is found in supplements in two different forms: D2 (ergocalciferol) and D3 (cholecalciferol). Both increase vitamin D in the blood, but the D3 form may do it better and keep levels raised for a longer time.

Vitamin D in American diets is found mostly in fortified foods:

• Fatty fish such as salmon, tuna, and mackerel, as well as fish liver oils, are among the best sources.
• Beef liver, cheese, egg yolks and some mushrooms provide small amounts.
• Almost all of the U.S. milk supply is fortified with 400 IU of vitamin D per quart. But foods made from milk, like cheese and ice cream, are usually not fortified.
• Vitamin D is added to many breakfast cereals and to some brands of orange juice, yogurt, margarine, and soy beverages. Check the labels for more information.

Am I getting enough vitamin D?
The amount of vitamin D required depends on your age. Average daily recommended amounts for different ages are listed below in International Units (IU):

Children and most adults 200 IU
Adults 51–70 years 400 IU
Adults 71 years and older 600 IU
Pregnant and lactating women 200 IU

Measuring blood levels of 25-hydroxyvitamin D is the best test to check the levels of vitamin D in the body. In general, levels below 15 nanograms per milliliter (ng/mL) are inadequate, and levels above 200 ng/mL are too high. Some nutrition experts think a blood level of at least 30 ng/mL is best for overall good health. By these measures, some Americans are vitamin D deficient and almost no one has levels that are too high.

Certain groups of people may not get enough vitamin D:

• Breastfed infants. The American Academy of Pediatrics advises that breastfed infants be given a supplement of 400 IU of vitamin D each day.
• Older adults, since their skin produces vitamin D less efficiently, and their kidneys are less able to convert vitamin D to its active form.
• People with dark skin, because their skin has less ability to produce vitamin D from the sun.
• People with Crohn’s disease or celiac disease who don’t handle fat properly, because vitamin D needs fat to be absorbed.
• Obese people. Their body fat binds to some vitamin D and prevents it from getting into the blood.

In children, vitamin D deficiency causes rickets, where the bones become soft and bend. Although rare, this disease still occurs. In adults, vitamin D deficiency leads to osteomalacia, causing bone pain and muscle weakness.

How does vitamin D affect health?
As people get older, they develop, or are at risk of, osteoporosis—a condition where bones become fragile and may fracture easily as a result of falls. Women are at an especially high risk for developing osteoporosis. Supplements of both vitamin D3 (at 700-800 IU/day) and calcium (500-1,200 mg/day) have been shown to reduce the risk of bone loss and fractures in people aged 62 to 85 years.

Some studies suggest that vitamin D may protect against cancers of the colon, prostate, and breast. But higher levels of vitamin D in the blood have also been linked to higher rates of pancreatic cancer. At this time, more studies are needed to assess the connection between vitamin D and cancer.

Vitamin D is also being studied for its possible role in the prevention and treatment of low-back and joint pain, diabetes, hypertension, glucose intolerance, multiple sclerosis and other conditions.

What precautions do I need to take with vitamin D?
When amounts of vitamin D in the blood become too high, it can lead to toxicity—nausea, vomiting, poor appetite, constipation, weakness and weight loss. In addition, by raising blood levels of calcium, too much vitamin D can cause confusion, disorientation and problems with heart rhythm. Excess vitamin D can also damage the kidneys.

The safe upper limit for vitamin D is 1,000 IU/day for infants and 2,000 IU for children and adults. Vitamin D toxicity almost always occurs from overuse of supplements. Excessive sun exposure doesn't cause vitamin D poisoning because the body limits the amount of this vitamin it produces.

Tell your health care providers about any dietary supplements and medicines you take.

Ergonomics for Construction Workers

Construction tasks place the body in numerous risky positions. Cramped working areas, working overhead and at floor level, heavy material handling and repetitive tasks are just some of the risk factors construction workers face. The University of Iowa found that 70 percent of construction workers experienced low-back pain over a one-year period. When working in construction, keep in mind the following strategies.

Minimize Awkward Postures
Overhead work places static loads on the neck, back and arm muscles. Standing on a stool, ladder, scaffolding or platform can minimize this reach and bring the work into a safer position. If tasks require work at lower surfaces, sitting on a stool, bucket or the floor can minimize crouching. For forward-leaning tasks, such as floor tiling, a creeper with chest support can be helpful. Use a brick or other surface as a lifted foot rest when standing still. Shoe inserts or custom orthotics can also make standing more comfortable.

Digging
When most people shovel, they twist their body in one direction, bend over and then further twist their spine to toss the dirt. To avoid this risk, a long-handled tool can help decrease bending and minimize twisting of the spine. Alternately using the shovel on the left and right side of the body can reduce fatigue and muscle imbalances.

Handling Tools
Improper or poorly designed tools place the user in awkward postures leading to tendinitis, carpal tunnel syndrome and strain. They also require excessive force, creating fatigue and pain. While there are numerous ergonomically designed tools on the market now, learn proper wrist positioning using the following key points:

• Avoid handles that end in the palm as they create local contact stress.
• Look for soft or cushioned handles without sharp edges or grooves, which keep the wrists straight.
• While handles with ridges for the fingers seem to aide grip, they actually increase the risk for injury owing to the increased contact stresses.
• The handle diameter for tools such as hammers and screwdrivers should be between 1 ¼-inch and 2 inches. Precision tools require smaller handles of between ¼ inch and ½ inch in diameter.
• Power tools create less torque than air tools, reducing forces.
• While the hand or knee should never be used as a hammer, it is common in tasks such as laying carpet. Try to avoid this harmful habit.

Organizing Tool Belts
Carrying 20 pounds of imbalanced tools has many negative effects on the spine. Rearrange the tools to balance the load. Belts with wide suspenders help distribute the weight between the hips and shoulders.

Loading Vehicles
Heavy items should be placed close to the tailgate or doors to minimize reaching. Utilizing truck lockers and bins allows better organization of items and minimizes reaching and crawling into the truck. Roll-out truck beds are also a good investment.

Minimizing the Effect of Vibration
Jackhammers, drills, impact wrenches and other power tools place construction workers at risk for hand-arm vibration syndrome, carpal tunnel syndrome, reduced circulation, paresthesias and pain. Vibration syndromes are often hard to treat, so prevention is important. Anti-vibration gloves, rest breaks and keeping the hands warm are beneficial.

Whole-body vibration occurs when workers sit in forklifts, cranes and other heavy equipment. Proper maintenance, use of a gel cushion on the seat and releasing hold of controls when not actively using them can help minimize the impact.

Reduce Your Risks
Many construction tasks, from turning a screwdriver to using equipment controls, require repetition. Learn to self-initiate rest breaks and alternate heavy and light tasks. Analyze which tasks you perform routinely to develop a personalized stretching program, counteracting the sustained postures you use on the job. Strengthening muscle groups opposing those you use at work is also vital to preventing future injury.

This educational information is provided by Chris Sorrells, president of http://www.ergonomicssimplified.com/.

American Chiropractic Associtation Provides the Following Additional Recommendations...

Material Handling Tips
• Plan ahead. Keep heavy or awkward items close to waist level and away from the floor to minimize lifting effort. Use rolling carts or dollies to move items.
• Lighten the load. Break items into smaller quantities when possible. Can you open the box and take things out individually? Can you order extremely heavy items like concrete and mortar in smaller, lighter bags?
• When you turn, move your feet first—never twist your body.
• Try to work at waist height. This is where you are strongest and safest.
• Get a grip. Use handles on boxes when possible, and be sure you have a secure hold.
• Minimize reach. The farther you reach, the harder you work.
• Widen your stance. Spread your feet about shoulder width to increase support.
• Tighten your stomach muscles, keep the back straight, and use the legs when lifting.
• Get help. The National Institute for Occupational Safety and Health recommends that no item heavier than 50 pounds should be lifted by one person. While workers routinely lift more, being aware of the recommendation may make them less apprehensive about asking for help.

Five Ways to Benefit from Chiropractic Care

There's a lot of talk about Wellness Care these days. But what is it? Compare it with other types of care:

Relief Care Many people begin here. Pain prompts them to begin chiropractic care. If you stop care as soon as you feel better, you'll invite a relapse. Muscles and soft tissues heal after symptoms disappear.

Corrective Care With the most obvious symptoms reduced, many of our patients opt to continue their care. This helps stabilize and strengthen their spine. Some insurance companies recognize the value of corrective care, but many do not.

Maintenance Care Regular chiropractic care helps maintain your progress and avoid a relapse. Your visit schedule varies based on your age, condition and the stresses in your life.

Preventive Care Beyond maintenance is the realm of prevention. Periodic chiropractic checkups can help catch new problems early. This can minimize flare-ups. Those who value their health often take this proactive approach.

Wellness Care We experience life through our nervous system. That's why optimizing our nervous system is the key to becoming all that we can be.

How far will you choose to take your chiropractic care?

Information provided on behalf of local member chiropractors and published monthly by the Association of New Jersey Chiropractors (ANJC).