Chapter List

• Introduction
• Achilles Tendon
• Adrenal Glands
• Ankles
• Appendix
• Arteries
• Back
• Belly Button
• Birth Control
• Birthmarks
• Bladder
• Blood
• Body Hair
• Body Type
• Brain
• Breasts
• Cervix
• Childbirth
• Chin
• Circulatory System
• Clitoris
• Collarbone
• Digestive System
• Ears
• Elbows
• Emotions
• Endocrine System
• Energy
• Esophagus
• Eyes
• Fallopian Tubes
• Fat
• Feet
• Fertility
• Fingernails
• Gallbladder
• Gums
• Gynecological Exam
• Hair
• Hands
• Heart
• Hips
• Hormones
• Intestines
• Jaw
• Joints
• Kidneys
• Knees
• Larynx and Vocal Cords
• Lips
• Liver
• Lungs
• Lymphatic System
• Medical Tests
• Menopause
• Menstrual Cycle
• Moles
• Mouth
• Muscular System
• Neck
• Nervous System
• Nose
• Nutrition
• Ovaries
• Pain Relief
• Pancreas
• Pelvis
• Pregnancy
• Rectum
• Reproductive System
• Respiratory System
• Ribs
• Salivary Glands
• Scalp
• Sex
• Sexually Transmitted Diseases
• Shins
• Shoulders
• Sinuses
• Skeletal System
• Skin
• Skull
• Spine
• Spleen
• Stomach
• Stress
• Sweat Glands
• Tailbone
• Tear Ducts
• Teeth
• Throat
• Thyroid
• Toenails
• Tongue
• Tonsils
• Underarms
• Urinary System
• Urine
• Uterus
• Vagina
• Veins
• Vulva
• Wrists
• Shaping Up
• The Total Body Shaping Workoout
• Abdominals
• Biceps
• Buttocks
• Calves
• Chest
• Forearms
• Neck3
• Shoulders3
• Thighs
• Triceps
• Aerobic Conditioning

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Spine

Spine

Consider the contortionist's spine. Pulled, bent, twisted, compressed, more snake's than woman's, more pretzel's than girl's.

What gives? How can contortionists--whether male or female--achieve those impossible shapes? "Very often the ligaments that support the bones in the spine are very loose and allow a lot more motion than normal at each joint. Many people are extremely flexible," says William Case, P.T., president of Case Physical Therapy in Houston.

Even if you're not as flexible as a contortionist, your spine is still a splendid thing. It handles heavy and light loads alike, trucking the bulky weight of your torso around and protecting the soft, delicate nerve tissue that makes up your spinal cord--the vital communication line from your body to your brain.

A Tilt for Better Curves You might have a great figure, The supine pelvic tilt. but your greatest strength is in the curve of your back, not your front. To help protect and support your spine and its natural small-of-the-back curve, you need to know how to tighten and strengthen your abdominal muscles. That curve is important, says Mary Pullig Schatz, M.D., yoga instructor and author of Back Care Basics. If the curve is either too flat or too pronounced--creating the flatback or swayback postures shown below--it weakens the spine and leads to pain and even degeneration. To begin the fortifying process and learn what a tight, supportive abdomen feels like, practice Dr. Schatz's instructions for the supine pelvic tilt. 1. Lie on your back with your knees bent and your feet parallel on the floor. Let your arms lie comfortably at your sides, with your palms up. Place a flat pillow or folded towel under your head and a rolled-up towel under your neck for support. 2. Inhale fully into your chest and abdomen, letting your chest and belly expand. Then exhale. As you exhale, pull your navel toward the floor using your abdominal muscles. This action will move your lower back toward the floor as well. 3. Inhale again into your abdomen; on the exhalation, again press your navel and lower back toward the floor. At the same time, press your shoulders, elbows and the back of your head toward the floor, keeping your legs completely passive. Repeat the tilt slowly at least ten times. Work toward being able to hold the position for 10 to 20 seconds. When you finish, roll to your side and then sit up . Check your profile. If you have a normal spine position, your posture looks like this. /td> If your spinal position is "swayback," the curve in the back is pronounced--as shown above. /td> A "flatback" spine position thrusts your shoulders forward.

Your spinal column is made up of vertebrae, the bones that are stacked down its length like spools on a stick. "If you look at a person directly from the side, you can appreciate the engineering marvel of the human spine in the way it is curved," says Louis Sportelli, D.C., director of public affairs for the American Chiropractic Association and a chiropractor in Palmerton, Pennsylvania.

Those curves lend strength. "In physics, when you bend a rod, it becomes stronger and more resilient," he says. "And that's what happens with your spine, because of its curves. The curves act as shock absorbers and dissipate some of the forces that can compress the spine."

A spine can also curve too much. "If the angle of the lumbar curve in the small of the back is more than 30 degrees, it very likely will cause low back pain," Dr. Sportelli says. When that curve is even more pronounced, it's called lordosis or swayback.

The opposite is someone with no curve at all--resulting in the hunched appearance that's called kyphosis. Women with advanced osteoporosis--the bone weakening that usually comes with the onset of menopause--develop the condition that was commonly called dowager's hump.

Keeping Your Back Running

As for common back ailments, upper back pain is much less common than lower back pain. "Not much motion occurs in the mid-back," says Dr. Sportelli. "It is fixed in place by the spinal muscles and the stability of the rib cage."

Lower down in your back are the larger lumbar vertebrae that support most of the weight of your trunk. When your back aches, that's usually where it happens.

Between each of the bones, cushioning your every bend and sway, is a squishy spinal disk, sort of like a jelly doughnut. In fact, spinal disks, the dedicated shock absorbers, make up about one-quarter of your backbone. They're good at what they do--protecting the bones and the spinal nerves--but they are not perfect. When we bend, twist and lift anything heavy--like a 30-pound toddler, for instance--that spinal maneuver can rupture a disk. This condition is called a herniated disk. The disk pops open, and some of the cushioning "jelly" squirts into the spinal canal.

It's the combination of twisting and bending that does the dirty work on the disks. "You have to be careful when you bend and twist to pull up even a weed," says John E. Dunn, M.D., clinical professor of orthopedic surgery at the University of Washington School of Medicine in Seattle.

Pressure from other movements and motions, stresses and strains--and poor posture--can also cause a disk to bulge and sometimes rupture. The popular term, slipped disk, refers to either case.

Bulging or ruptured, a disk can press against any of the spinal nerves that thread their way out of the main cord and between each vertebra. That's a pinched nerve--which spells pain. If the disk presses against any of the nerves feeding into the longest nerve in the body--the sciatic nerve--you have the particular form of punishment known as sciatica.

Dodging Disk Damage

Surprisingly, a sloppy disk doesn't necessarily cause pain. When researchers studied 98 people at a hospital in Newport Beach, California, none of them had any back pain, but only 36 percent of them had completely normal spinal disks. The rest all had at least one disk that bulged against the cartilage. Some people even had ruptured disks. So you may be harboring a disk or two that's looking for trouble--and not even know it.

Maybe you'll never be troubled by pain even if you have disk problems. That bulge can shrink back to normal, and often your body can reabsorb the pulp that escapes the disk's crust when it gets compressed.

Whether or not your disks are now in perfect order, there are ways to keep your disks and the rest of your backbone from slowing you down. Here's what experts recommend.

Above all, exercise. Your spinal disks are like hungry sponges feeding on the nutrients squeezed into their pulp by the movements your body makes. The more you move, the better that they're fed. It's that simple. Everyone should be in a regular, reasonable exercise program, says John D. Loeser, M.D., professor of neurologic surgery and director of the pain center at the University of Washington School of Medicine .

Crush out trouble. Smoking and not exercising are the two worst things a woman can do to her back, according to Stanley J. Bigos, M.D., professor of orthopedic surgery at the University of Washington School of Medicine. Smoking decreases blood flow to the back, and that--combined with lack of exercise--leaves your disks in a blood-starved state. In fact, research has shown that smoking speeds the aging of your disks that can lead to herniated disk. That's another reason to stub out the smokes before your health gets burned.

Do the bone stroll. The specific exercise to maintain a healthy back is walking, says James W. Simmons, M.D., orthopedic surgeon with the Alamo Bone and Joint Clinic in San Antonio. "You don't have to run a six-minute mile. Just the physical stress of walking alone will strengthen both your bones and disks."

As you walk you increase blood circulation: In effect, you're feeding energy to your spinal disks. And it's a risk-free exercise. As long as you're in generally good health, you can shape a walking program that will suit your schedule--a 20-minute daily walk, an hour every other day or an hour a day, according to Dr. Simmons. Other ideas for exercise? "Swimming is the number two thing to do. Biking is number three."

Work off some weight. Weight lifting builds strong bones. But if you're carrying excess body weight around, that payload can alter the mechanics of your spine, change your center of gravity and strain your spinal disks. That's why obesity, like smoking, also raises your chances of getting a slipped disk.

Luckily, you can lose weight doing the same thing that you do to ensure healthy disks: aerobic exercise. Working out helps you twice over, according to Mary Pullig Schatz, M.D., yoga instructor and author of Back Care Basics.

If you're overweight, however, you should always consult your doctor on how to get (continued on page 386)

started with weight loss before you get into any heavy-duty exercising.

Save the tough stuff. When you sleep, your spinal disks soak up fluid from the tissues surrounding them. So much fluid is absorbed that your spine can increase in length overnight by as much as an inch, says Dr. Schatz.

You may have experienced this phenomenon. If you've ever worked out vigorously soon after getting up in the morning, you know that you are stiffer then. That's because your disks are still tight with overnight fluid. That also makes them more tense and prone to irritation, according to Augustus A. White III, M.D., professor of orthopedic surgery at Harvard Medical School and former orthopaedic surgeon in chief at Beth Israel Hospital in Boston. If you can, Dr. White suggests waiting until later in the day before any strenuous workout. By then, the tissues will have given up their bloat.

Sciatica--Pulp Friction

Take a look at your five closest friends. Chances are that two of them will have an episode of sciatica at some time in their lives. Sciatic pain follows a course all the way along the sciatic nerve, from your lower back down one thigh and into a foot. In its mildest form, sciatica can feel like nothing more than pins and needles running along that track. But when you have it bad, the pain can rival any toothache.

"Sometimes people are so frightened, and they hurt so much, that they'll do anything, even if it's surgery, to try and get out of the pain," says Annie Pivarski, orthopedic physician's assistant and supervisor of ergonomics and injury prevention at St. Francis Memorial Hospital in San Francisco. Sometimes people with sciatica have loss of bowel or bladder control, or they're unable to lift their feet to walk. If you have these symptoms, call your doctor immediately. Once you've seen your doctor, however, try to wait before making the decision to have surgery--even if you're frightened by the severe symptoms, Pivarski advises.

Sciatica can be caused by a herniated disk pressing against any of the nerves that make up the large sciatic nerve. Indeed, a common back operation in America is a discectomy to remove the pulp pressing on a nerve. There are 142,000 discectomies performed on women each year, according to the National Center for Health Statistics National Hospital Discharge Survey.

Need a New Lineup? Just mention back pain in a crowded room, and you're likely to hear--within seconds--someone say, "Oh, let me tell you about the most wonderful chiropractor!" To believe or not to believe. For many people with back pain, that is the question. Until recently, many M.D.s and Ph.D.s dismissed chiropractors as semiprofessionals with a status between quack and faith healer. Then a panel of medical experts convened by the federal Agency for Health Care Policy and Research pored through more than 10,000 studies of treatments for back pain. The panel looked at the reported results of spinal manipulation--the most common treatment offered by chiropractors--which includes touch, pressure and movement of the spine. Based on the research, the experts concluded that spinal manipulation was one of the very few treatments that relieved acute back pain--except for the pain associated with sciatica. "The guidelines on back treatment issued by the panel raised the prestige of chiropractic considerably," says Scott Haldeman, M.D., D.C., Ph.D., associate clinical professor of neurology at the University of California, Irvine, and adjunct professor at Los Angeles Chiropractic College in Whittier. "Spinal manipulation looks very good compared with the other treatments for low back pain." Other treatments didn't hold up under scrutiny, including traction, acupuncture, steroid injections and the use of lumbar belts or corsets. What are you getting when you visit a chiropractor? "Chiropractic is a profession that deals with conditions of the spine through nonsurgical and usually nonmedical means," explains Dr. Haldeman. This means that a doctor of chiropractic (D.C.) doesn't prescribe muscle relaxants or painkillers and doesn't do surgery. "The more modern chiropractic approach is to include elements of physical therapy and exercise in addition to the hands-on approach," says Edward Hanley, M.D., chairman of the Orthopaedics Department at Carolinas Medical Center in Charlotte, North Carolina.

"But lumbar (lower back) surgery is frequently unsuccessful," says Dr. Schatz. In fact, the federal Agency for Health Care Policy and Research found that only 1 person in 100 has back problems that can be helped by back surgery.

"People need to recognize that back pain is not usually a disease that requires a surgeon or specialist," says Dr. Loeser. "The vast majority of people with episodes of pain lose their symptoms within 30 days. Only 10 percent have pain after 90 days. And after that the figure eventually falls to 3 or 4 percent--the people with chronic pain."

Outwitting by Outwaiting

Sciatic pain usually responds to the same measures that you take for any back pain. That is, time and limited treatment. So there are lots of steps to consider before you start dreading the scalpel. Here's what doctors recommend.

Don't panic. Many people think that sciatica is an automatic reason for back surgery. But that isn't so. Actually, medical experts say that only about 5 to 10 percent of people with sciatica will need surgical intervention.

So ease up on the panic button. Don't let sciatica, or any acute back pain, scare you into a hasty decision. Stop, wait and cogitate "even when pain has you frazzled," says Jeffrey Susman, M.D., member of the U.S. Public Health Service Agency for Health Care Policy and Research and vice-chairman of family medicine at the University of Nebraska College of Medicine in Omaha.

Stall four, six or even eight weeks. If your sciatic pain starts to subside within a day or two, you may not even need to call a doctor. The federal guidelines for back care say that you don't need x-rays or fancier tests, like MRIs (magnetic resonance imaging) or CAT (computerized axial tomography) scans, unless your back pain hasn't cleared up in four to eight weeks, and you're considering surgery.

Normal Wear without the Tear The spine's multitude of joints, called facet joints, are prey to the wear and tear of age, just like every other joint in your body. As you age you might begin to worry about the classic joint disease that many people get--called osteoarthritis, or degenerative joint disease. Many doctors don't use those alarm-bell words, however. "I'm more likely to call it simply an aging process--wear and tear," says Louis Sportelli, D.C., director of public affairs for the American Chiropractic Association and a chiropractor in Palmerton, Pennsylvania. "It's normal, natural. Anyone who is over 50 has a little bit of it." Actually, wear and tear starts moving in at about the time you hit age 40. If your joints have been taxed hard during your sprightly youth, the aging process can wear your joints down even earlier. "It can show up in young people who play football or weight lift or do gymnastics," says Dr. Sportelli. With so many facet joints, the spine is a true tattletale. "You can tell how old a person is by an x-ray of her spine. There are a wide variety of changes in the structure of the bones and joints and in the water content of the spinal disks, says John D. Loeser, M.D., professor of neurologic surgery and director of the pain center at the University of Washington School of Medicine in Seattle. Those changes have to do solely with age--not with significant symptoms, notes Dr. Loeser. In other words, it's perfectly normal for the spine of a 45-year-old woman to show some worn-down areas in x-rays. Unfortunately, many radiologists think that the x-ray of a 20-year-old spine is the only normal one. As aging spinal disks become drier and more brittle, the vertebrae themselves take on the weight that the disks used to bear. That added pressure of bone on bone can produce bone spurs on the vertebrae or on the edges of the degenerating disks. The bony outgrowths can press on spinal nerves and cause pain. Most cases, however, are so mild that you wouldn't even know they exist.

"To keep your body well, stay away from the doctor," says Dr. Loeser. He's only half-joking.

Be normal. Resume regular activity as soon as you can, says Dr. Loeser. In fact, a study of 186 people in Finland with low back pain found that the 67 folks who continued as much ordinary activity as they could tolerate had shorter bouts of pain and less intense pain than the 52 people who were put on a back-mobilizing exercise program. The 67 people who spent two days getting straight bed rest took the longest to recover from pain.

Bone: The Thick and Thin of It If your spine could sing, one of its favorite tunes would be a blues number: "Oh, Oh, It's Hard to Be a Woman." That's because women develop osteoporosis at four times the rate that men do. In fact, 45 percent of all Asian and Caucasian women in America over the age of 50 are in some stage of the bone-thinning disease. And the bones in the spine can suffer the most. What makes osteoporosis so sexist? No one knows, but the loss of estrogen at menopause plays a large role in bone depletion. Bone loss can start as early as age 30 in some women--and in all women, osteoporosis gathers speed during the first five years of menopause. If you get an adequate supply of bone-building calcium in your food as you grow, you can establish an unwavering balance between the buildup and the breakdown of bone cells. With menopause, however, you hit the accelerator on the breaking-down process, so it's crucial to build up a calcium deposit big enough to see you through that change. Women who do develop advanced osteoporosis have bones so porous that they can be fractured just from bending over. A brittle spine may develop a network of tiny fractures, essentially fragmenting under its own weight. "These compression fractures are a very common source of back pain in older women," says John D. Loeser, M.D., professor of neurologic surgery and director of the pain center at the University of Washington School of Medicine in Seattle. In extreme cases the collapsing spine curves over into what's called a dowager's hump and pushes the inner organs around--interfering with normal breathing if the lungs are compressed. The abdominal organs can pouch out, too, into a prominent belly. Your Chance of Encounter Some women are at particular risk of osteoporosis. The leaders are Caucasian and Asian women. But any small-framed woman is more likely to get osteoporosis than someone who is large-boned or heavy-framed to begin with. No matter what your race, frame or body type, however, the risks shoot up for all women around the time of menopause. Researchers have also found what may be an early warning signal of increased risk: premature gray hair. Based on studies at the Maine Center for Osteoporosis Research in Bangor, where scientists studied the bone scans and gray hair of 63 men and women, early gray hair might turn out to be a very significant indicator. The folks who went at least half gray before the age of 40 had four times the chance of showing low bone density as the people with normal graying. A Bone-Tone Plan Whatever risk group you're in, you need to know how to fatten up your bone account and build up your spine deposit. If you haven't reached menopause, the more you can do now, the better. Even if you're in menopause or past it, these bone-saving tactics may help you build toward a fracture-free future. Walk a mile a day. In a study of 239 women at Tufts University in Boston, researcher Elizabeth Krall, Ph.D., and her colleagues learned that those who walked at least a mile a day had up to seven more years worth of bone on deposit than nonwalkers. They concluded that women who start a walking program during and after menopause can help stave off the bone loss that occurs then. Walking is a weight-bearing exercise. "What happens when you do weight-bearing exercise is that your muscles pull on your bones and stimulate new bone formation," says Stephanie Beling, M.D., medical director of Canyon Ranch in the Berkshires, a health spa in Lenox, Massachusetts. Capture that calcium. The National Institutes of Health in Bethesda, Maryland, recommends that you get 1,000 milligrams of calcium a day before you reach menopause and 1,500 milligrams per day after menopause. The champion food sources are dairy products that have little or no fat (so that you won't put on weight), such as skim milk, nonfat or low-fat yogurt and low-fat cheese. Some leafy green vegetables, such as Chinese cabbage (bok choy) and mustard greens and broccoli, are other good sources. You'll add some calcium whenever you have canned fish with bones, like sardines or sardines, or if you have cooked kidney beans, dried figs and prunes, toasted unblanched almonds, hazelnuts and Brazil nuts. Remember, though, that nuts are high in fat and dried fruits are loaded with calories. Tag a Tum. If your diet doesn't take care of your daily calcium needs, "just take one or two Tums a day," says James W. Simmons, M.D., orthopedic surgeon with the Alamo Bone and Joint Clinic in San Antonio. "It's so simple. Tums carry as much free calcium as any calcium tablet. That will give you all the calcium you need." Get a bone mineral density test. At the first signs of menopause ask your physician where to get a test that will measure your bone mineral density. If your bone is thin, you'll want to beef up your bone-building efforts by getting more calcium and more exercise. Consult your doctor to find out whether you should take medication to help prevent further bone loss, suggests Dr. Beling. Start strength training. Another important way to build bone is through strength training, sometimes called toning or weight training. Strength training can be done with any kind of weights--dumbbells, plastic bottles weighted with sand or water or weight machines found at a gym. See the toning routines beginning on page 446 to learn how you can target specific body parts--the back, the hips, the legs and so on. Consider hormone replacement therapy. If your bone mineral density has tested low, you may want to begin hormone replacement therapy (HRT). Women on an HRT program get a combination of estrogen and progestin, the synthetic form of the hormone progesterone. HRT has been found to be the most effective weapon against bone loss during the first five years of menopause, when bone loss is most rapid.

"The best thing to do is get up and get active," says Dr. Susman. "Let nature heal you naturally."

Avoid reinjury. If you know what activity has triggered your sciatica, avoid it until you heal, suggests Dr. Susman. If you increased your workout schedule, for instance, or if you were doing heavy lifting when sciatica struck, make sure that you don't exercise as hard for a while.

You should also be aware that vibrations from a moving car can set off sciatica. Though it may be tough to avoid driving as much, try to reduce your time in the car, at least until your pain is gone, he says. "Time, plus avoiding the stressful activity, makes all the difference."

Know your red flags. Not all sciatica or back pain benefits from the wait-it-out method. There are a few symptoms that should prompt a phone call to your doctor.

Weakness or numbness in your legs is one. So is loss of bladder or bowel control. If you have a fever or abdominal pain or if the sciatica doesn't start to subside within 72 hours, you need a medical exam. You may have a fracture, tumor, infection or more serious nerve problem. "These are the symptoms that would call for more aggressive treatment," says Dr. Susman.

 

See also Nervous System, Skeletal System