A recent survey found that:
“Men drink more per day than women, while people in the Northeast consume more than those in any other region.

One in five would swap lunch for coffee.

Twelve percent would give up three hours of sleep and one in 10 would skip brushing their teeth.”

What would you give up for coffee?

I would glady never eat breakfast again to preserve my coffee, then again, I am a male hailing from the Northeast…what do you expect?

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Value-Based Insurance Design

This, from the Evidence in Motion Blog…really nerdy article , but fun for me…

I agree, this would never go over, but the idea is great!

Value-Based Insurance Design:
” I read with great interest an article [2 week access] in Health Affairs written in part by Michael Chernew professor of health care policy at Harvard.

One feature of this design has co-pays varying inversely to the ‘benefit’ of the service. This would encourage those to seek out services whose benefit exceeds the cost of the service while discourag…”

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"The benefits are overstated, overpromoted, and giving people false expectations"

Minimally Invasive Total Hip Replacement surgery. Those were the comments on such from Dr. Kristaps J. Keggi, an orthopaedic surgeon at Yale University.

Hip Replacement is my topic today as it’s been on my mind due to a patient I saw this morning for an evaluation. This man’s x-rays told the story of a severely degenerated hip, “with total loss of joint space.” This man needed a hip replacement. Here’s the catch: neither he nor his orthopaedic surgeon wanted to give him one. He was too active. Too active can be interpreted two ways: either he was still functioning at such a high level the insurance company would not reimburse it or, he was still to active so he obviously must not be in that much pain.

There is a segment of the population that will seek out surgery as an almost instant gratification, but that is another blog entry, and this man was surely not in this category. I was impressed by his tenacity in caring for his hip, his toughness in dealing with what must surely be a painful condition, and his pride for doing both of these things with class. Obviously, I was very motivated to help him. I was able to modify his exercise routine, prescribe some joint mobilizations, and work on improving adjacent joint actions. These things not only offered him some immediate relief, but I’m guessing will help him for some time until he is ready to have his replacement.

I like to keep this blog somewhat based on headlines I find and give my input on such. This article, in the New York Times discusses my headline about Minimally Invasive Joint Replacements. In short, it reads: make sure you need a joint replacement, make sure you have a joint replacement specialist who performs plenty of operations each year, and do not place so much emphasis on minimally invasive that you end up with minimally effective. Which ever way you look at it, it’s a major operation and results are the most important. As with most operations, good outcomes are a result of matching patients with the right procedure. So if your hips are hurting, take your time, maximize your strength, function and flexibility before hand, and talk to your health care team. Then come see me for therapy afterwards!


Trade your back pain for one in the neck!

This week the Radiological Society of America released a snippet from their recent annual conference concerning the “best biomechanical sitting posture .” Media outlets quickly spread the word to all of us that according to, Waseem Amir Bashir, MBChB, clinical fellow in the department of radiology and diagnostic imaging at the University of Alberta Hospital, Canada, the best anatomical sitting posture is a reclined position of about 135 degrees.

I am both totally in agreement and totally abhorred.

This is a classic example of what pines me when the media covers scientific exploits. In this study, the researchers used a nifty type of positional MRI machine that allowed subjects to move freely as they were imaged. The joint spaces were then measured and it was determined that 135 degrees of recline was the position that produced the least amount of forces in the low back. They added that low back pain treatment should be treated at the initial stage to avoid the consequences.And they concluded that sitting upright might not be the way to go. In this, I agree. The best position for your spine is actually standing, upright sitting being the worst with respect to intradiscal forces, or the force that your spine experiences from gravity. However, to make a statement is dangerous.

You can try this out to get rid off neck pain. “This may be all that is necessary to prevent back pain, rather than trying to cure pain that has occurred over the long term due to bad postures,” Bashir continues.

This postural study cannot take into account muscle support, associative reactions in the cervical spine and physiologic effects from compressed organs. What about adaptive shortening of anterior cervical muscles from a head held in a prolonged flexed position? I can picture the company now that runs out and spends to put all their workers in this reclined position only to lose all of them to severe neck pain in short time.

Please talk to a professional before any seating is purchased. Remember, the media are not scientists or health care practitioners and so we cannot really hold them too accountable for such reporting, can we?

If you’re really in a press for seating guidelines, here we go: Sit up straight and comfortable with some lumbar support, change positions often, find a reason to get up and stretch. Simple.

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