Friday, August 29, 2014

Backpacks for Back-to-School

Backpacks have become the most popular means for school-age children to carry their books and school supplies.  In fact, when used correctly, a properly designed backpack is an excellent way to carry the necessities of the school day. Unfortunately, thousands of children each year experience back pain related to use of school backpacks that are too heavy or used incorrectly. Public awareness of backpack-related back injuries has helped to reduce its incidence, but with the start of the new school year, it is worth offering a reminder to parents and children of ways to prevent these from occurring.

Choose the right backpack – Be sure that the backpack is the appropriate size for the child.  A well-designed backpack will include wide, padded straps to reduce strain on the shoulders and spine.  A chest (sternum) strap and waist belt will help distribute the load over the entire trunk. Some of the best ergonomically designed backpacks are made by companies that specialize in equipment for hiking (Jan Sport, Osprey, North Face, etc.). Additionally, salespersons in outdoor specialty shops can be helpful in making sure that the backpack fits properly. Straps that compress the contents of the backpack will stabilize the load and keep it closer to the back. If carrying heavy loads is unavoidable, a convertible backpack with wheels may be a consideration.  Reflective material to enhance visibility is an important safety feature for children who walk at dusk or after dark.

Wear the backpack properly-- A proper fitting backpack rests evenly in the middle of the back, rather than hanging below the level of the lower back or waist. Both shoulder straps should be used rather than just one. Shifting the weight of the backpack to one side by using only one strap alters back symmetry, which can lead to neck and back strain. This advice also applies to backpacks that are designed with only one strap that crosses the front of the body. When walking a significant distance, encourage your children to use the sternum strap.

Avoid overloading— Most experts recommend that children carry no more than 15% of their body weight in their packs. For a 50 pound child, this would mean that the backpack and its contents should not weigh more than 7.5 pounds. This amount would double to 15 pounds for a 100 pound child. One way of gaging this is to weigh the child with and without the backpack on the bathroom scales. More weight than this compresses the discs that serve as cushions between the bones of the spine and cause excessive curvature of the spine. Studies have shown that the amount of back pain reported by children increases along with the load in the backpack. Parents can help to reduce the weight in their child’s backpack by seeing that only those items needed for the school day are packed. Unnecessary books or items (cell phones, music devices, video games, etc.) should be left at home.
Consider alternatives—Whenever possible, children should use lockers or their desks during the school day to minimize the load carried in the backpack. If there is an option, purchase paperback rather than hard-bound books in order to decrease the weight of the books that are being carried. Only those textbooks that are needed for completing homework should be brought home in the backpack.  If unavoidable due to the number or weight of required textbooks, a second set could be purchased for use at home.

Back pain in children should not be ignored.  Since backpack-related back pain is so common, however, parents should consider this as a possible explanation for their child’s problem.  A few of the symptoms or signs that could indicate that a backpack may be responsible for the child’s pain include:
  • Back pain that is present when wearing a backpack but goes away when removed.
  • Excessive back curvature or alteration of posture when wearing a backpack
  • Numbness or tingling affecting the arms or legs
  • Struggling due to excessive weight when putting on or removing the backpack.
Following the recommendations for proper use of the backpack will, in many cases, take care of the problem. Back pain in children that persists despite these measures or that inhibits normal activities, requires regular medication, or affects sleep habits, deserves medical attention.

Thursday, August 21, 2014

Why we yawn…and other physiologic peculiarities

Muscles are responsible for numerous bodily functions. Their actions can be broken down into two categories, voluntary and involuntary.  Voluntary actions, such as walking or talking, are functions that are prompted and controlled by conscious decision.  Involuntary actions, such as when our heart beats or our food undergoes digestion, occur without us having to think about it.  Many involuntary actions are highly specialized and essential to our existence. Some  involuntary actions, such as those we will consider today, either have a purpose that defies logic or one that science has yet to uncover.

Yawning---Although commonly linked with boredom or fatigue, there is little evidence to link yawning with either of these. The two main theories for why we yawn are: 1) it improves our breathing function or, 2) it serves as a form of social communication.   From a respiratory standpoint, it was once thought that low levels of oxygen or elevated levels of carbon dioxide triggered yawning.  Yawning, it was believed, could help restore a normal oxygen/carbon dioxide balance.  More likely than this is the premise that yawning appears to be a way to “stretch” the lungs and fill the small air sacs (alveoli) that partially collapse when we are breathing at rest. In regard to its proposed communication function, the best supportive evidence has to do with its “infectious” nature. How many times have you seen others (or yourself) yawn when someone else does?  Exactly what is being communicated is not clear, but yawning is a behavior that is common among many animal species, not just humans.

Hiccups--- During normal respiration, the diaphragm muscles contract, pulling air into the lungs.  Relaxation of the diaphragm allows air to flow back out the lungs.  Certain irritations can cause the diaphragm to spasm, resulting in a sudden, involuntary inhalation. When the inhaled breath is stopped by closure of the glottis, the characteristic “hic” sound occurs.  Reasons for the diaphragm becoming irritated include:
  • Eating too much or eating too quickly
  • Emotional stress or excitement
  • Overdoing it with alcoholic beverages
  • Swallowing air while chewing gum or sucking on candy
  • Taking certain medications, including corticosteroids (e.g. Prednisone), opiate pain medications and tranquilizers in the benzodiazepine class.
  • Certain medical conditions such as gastroesophageal reflux (GERD), diabetes and asthma
Sneezing---There is a wealth of medical mythology attached to sneezing.  One legend has it that when sneezing, the heart stops beating. The saying, “bless you" was meant to encourage the heart to resume beating.  Other sources say that blessing someone after sneezing came about in the 14th century during the bubonic plague epidemic.  At that time, sneezing was considered to be an early sign that someone had contracted the disease. The physiologic reality is that sneezing is your body's way of removing an irritation from your nose. During a sneeze, air is expelled forcefully from the mouth and nose in an explosive manner, hopefully removing the irritant in the process. Sneezing can be very bothersome, but is generally not a sign of a serious problem. The most common causes for sneezing include:
  • An allergy to pollen, mold, or dander, often part of the “hay fever” constellation of symptoms
  • Viral infections of the upper respiratory tract, including the common cold
  • Nasal irritants such as dust, powders, or snuff
  • Exposure to bright light, known as “photic sneezing”, that affects up to a third of all people
Sighing--- A sigh is an involuntary deep inhalation immediately followed by an exhalation. Unlike yawning, sighing is not “contagious” and does not seem to have a role in communication.  Similar to one of the theories regarding yawning, its purpose is thought to be more physiologic in nature by “resetting” the respiratory system. When breathing, particularly while at rest, blood oxygen levels can drop slightly and many of the small air sacs (alveoli) in the lungs collapse. With the deep inspiration associated with sighing, blood oxygen levels are boosted and the lungs are fully expanded.  Sighing does appear to occur more often along with certain emotional states. Relief of stress (“sigh of relief”), yearning (“sigh for the good old days”), and weariness (“sign of despair”) are feelings often expressed through this most peculiar involuntary action.

Friday, August 15, 2014

Benefits of Core Strengthening

Many people have heard about the benefits of having a strong “core”, but few really understand which muscles are parts of the core group or why they are so important.
Which muscles are considered to be part of the core?   Although definitions of which muscles constitute the core vary, in general, they are considered to be the muscles of the back, side, and abdominal regions of the trunk.  These muscles connect the upper body to the lower body and are important in stabilizing the spine. Specific muscles generally considered to be part of the core group are:
  • Rectus abdominis --- Also known as the “abs”, this paired muscle runs vertically on each side of the abdominal wall.  The abs are used in bending over and help with maintaining posture. 
  • Erector spinae --- A bundle of muscles and tendons that runs vertically, connecting the vertebrae from the cervical (neck) to the lumbar (lower back) regions. These muscles are used when standing up straight or bending backwards. Also important in stabilizing the spine.  
  • Internal and external obliques  --- Located on the sides of the abdomen and used when twisting to the left or right and when bending the trunk sideways.
  • Transverse abdominis--- Located on the front and side of the abdominal wall, beneath the internal oblique muscle. Provides stability to the thoracic spine and pelvic region. 
  • Multifidi--- Connects adjacent vertebrae the entire length of the spine.  Works in tandem with the transverse abdominis to help stabilize the spine.
What actions do core muscles perform?  The core muscles serve as an important link between the muscles of the upper and lower body. By stabilizing the spine and pelvis, they create a solid base of support for movement of the arms or legs. Activities that involve lifting, bending, twisting or standing all benefit from having a strong core.

What are the advantages of having a strong core?
  • Improved sports performance---Almost any sports activity can be enhanced by having strong core. Hitting a golf ball, swinging a tennis racket, running a 10K, kayaking, and cycling all rely on having a strong core.
  • Help with physically demanding jobs---Those that involve lifting, twisting, or prolonged standing benefit from a strong core. Even desk jobs can be less taxing to the back when core muscles are strong.
  • Maintenance of posture and balance. Core exercises teach the muscles in your abdomen, low back, hips and pelvis to work in concert with one another. This leads to better balance and posture. Improved balance helps to prevent falls and injuries.
  • Prevention of low back pain.  Core strengthening is one of the best ways to manage and prevent low back pain.  Stabilizing the spine during activities such as lifting or bending over makes it more resistant to injury.
What are some examples of core strengthening exercises?  Most core exercises incorporate the use of abdominal and back muscles in a coordinated manner.  Perhaps the best known example is the abdominal crunch.  Another is the bridge exercise demonstrated in this video.  Other core exercises include the plank, abdominal press, superman, and quadruped.   When first starting a core program, it is best to have these exercises demonstrated and monitored to assure that they are being performed properly.  Physical Therapists, Certified Athletic Trainers and qualified Pilates instructors are good resources for teaching a core strengthening program.   

Friday, August 8, 2014

“Supportive Care” in Ebola Virus Infections

Recently, the term “supportive care” has appeared in news releases in relation to the treatment of Ebola virus victims without providing much information on the specifics of this treatment.  Actually, supportive care has more than one context in medicine.  For example, in terminal cancer, supportive care, also known as palliative care, focuses on relieving suffering and improving quality of life instead of seeking to cure the patient.  Ebola virus infections, like several other infections including Rabies, tetanus, and even the common cold, has no effective antiviral or antimicrobial treatment.  To a large degree, recovery of these infections relies on the body’s immune system.  With Ebola and Rabies, however, the disease is often fatal because the infection overwhelms the body’s immune system.  In these cases, supportive care means that measures are taken to address complications of the illness, such as blood loss, low blood pressure, dehydration, or low oxygen level.  This helps to buy precious time until the immune system is able to recover adequately to begin fighting the infection. 
In the case of Ebola virus infections specifically, supportive treatment hinges around these issues:
  • Nutritional support--- In Ebola infections, getting adequate nutrition may be complicated by nausea, vomiting, and diarrhea.  If the patient is unable to eat, needed calories can be provided through “tube feedings” or via intravenous fluids.
  • Balancing fluids and electrolytes---Fluid may be lost through vomiting, diarrhea, and “leaking” from blood vessels. Replacement is done primarily through the administration of intravenous fluids with added salts (e.g. sodium and potassium) necessary for cells to function normally.
  • Supporting respiratory function---Fluid accumulation in the lungs (pulmonary edema) can make breathing difficult. This can be helped with administration of supplemental oxygen and medicines to remove excess fluid.
  • Maintaining blood pressure---Low blood pressure can be addressed with the administration of fluids, blood or medications to raise blood pressure.
  • Providing blood transfusions---Excessive bleeding from the gastrointestinal tract and mucous membranes occurs commonly in Ebola victims. Blood transfusions may be required to replace lost blood and clotting factors.
  • Treating complicating infections—In addition to the primary viral infection, secondary infections, often due to bacteria, can require treatment with antibiotics.
In infections in which there is no effective antimicrobial treatment, the body’s immune system can sometimes be given a “boost” along with supportive care.  This could come through the administration of a vaccine (active immunization) to stimulate the body to produce antibodies or with the use of immune globulins (passive immunization), which contain antibodies that have been obtained from someone who has had the infection and survived.  Rabies is an example of a viral disease that can be effectively treated in this manner if begun soon after contracting the virus. In the case of Ebola, however, there is currently no vaccine or approved immune globulin treatment available.  News reports, however, have appeared indicating that one of the American Ebola patients being treated here in the U.S. has received an investigational “cocktail of antibodies” developed by a California biopharmaceutical company and a blood transfusion from a surviving Ebola victim.

Hopefully, the current outbreak in Africa will be contained soon.  The spread of Ebola infections in the U.S., even considering that two victims have been brought here for treatment, is highly unlikely. The best hope for containing future epidemics of Ebola virus infections is thought to be through the development of an effective vaccine.