Back Pain Hotline

I’m not sure this was designed to be just a back pain hotline, but Intermountain Healthcare ran a unique outreach program and put consumers in touch with Physical Therapists via hotline. Anyone with questions could call in and speak to an expert. Very nice, and deserving of this piece of good press.

Jake Magel was featured in the article which discussed the conservative management of back pain:

“If people get proper care up front, they tend to use less health care in the years following,” he said. “They visit physicians less, take fewer medications and miss less days at work.”

By the way, Jake Magel is the lead faculty for my virtual rounds course in the EIM Fellowship program in addition to his role as the director of the Intermountain Orthopedic and Spine Therapy Clinic at Intermountain Medical Center. Go, Jake!

Another Reason to Wait on That MRI

Mri_accident_rates1
So, we already know that MRI's are routinely over-prescribed, especially in the case of low back pain.  Last year, 1 in 10 people in the U.S. recieved an MRI scan of something.  That's a bunch!  However, we might not be aware that the rate of injuries and incidents involving MRI scans are skyrocketing, beyond that which would be accounted for by increases in volume.

In 2005, the New York Times reported on an increase in accidents.  Since that time, the injury rate is up almost 175%!  The stats are hidden away in this database.  This website contains a collection of images from MRI events, with a surprising culprit, the floor buffer.

The FDA and Joint Commission seem to lack teeth to establish site specific standards for safety in the MRI suite.  Though, they seem to be trying.

Interested parties may wish to check out the MRI Metal Detector blog.  Make sure you really know why you're being sent for an MRI.  Understand that still pictures are hints of function, nothing more.  Sure, MRI's are a great tool, but not for 30,000,000 people a year!

ERIC

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 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.

“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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