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x The Encyclopedia of the Back and Spine Systems and Disorders
motor movements and gives you creative tools and
training to regain your independence in complet-
ing daily routines, such as dressing yourself or
bathing.
With or without surgery, questions may con-
tinue to arise about what is best for you. For
example, do you need cold therapy to alleviate
vertebral swelling or heat therapy to increase the
circulation in your back? Would water therapy
ease pain in your arthritic joints, or would a spe-
cific exercise work best for your particular con-
dition? Is someone in your area trained to treat
the pain of arthritis or postoperative nausea with
acupuncture? Would increasing your intake of fil-
tered water and natural nutrients help your body
to heal faster?
Successful treatments depend, in part, on the
type of treatment you give yourself, but success
may also reflect the quality and extent of train-
ing a therapist or other specialist has received. An
Internet search may provide important informa-
tion about the credentials, experience, and suc-
cess rate of a health-care practitioner. For more
details about a specific condition of the back or
spine, Appendixes I, II, and III list relevant Web
sites sponsored by reputable hospitals, universi-
ties, organizations, and government agencies. For
an overview of anatomy and function, the Intro-
duction may give you a clearer picture of your ver-
tebrae and, perhaps, a better idea of what to ask
your therapi st or phy sician as you conti nue to seek
solutions and question almost everything.
xi
S
pec i al tha n ks g o t o m y d ea r f r ie nd of ma ny yea r s,
Lynda Anderson Edwards, for her help in gath-
ering the resources for this book. Her work within
the library system of Kentucky gave her access to
a wealth of publications, which she generously
shared and which led me to discover the extensive
resources available to almost anyone with a library
card. In my own state, for example, I had only to go
to the Florida State Library system Web site, check-
in via the numbers on the back of my local library
card, and check-out hundreds of recently published
articles on the back and spine. Living, as I do, in a
small community on a sand road where the only
honking traffic comes from a family of sandhill
cranes, I had not anticipated such instant access to
up-to-date findings on the spine.
I also want to thank my talented and supportive
siblings, especially my sister, Marcia A. Harwell, an
occupational therapist in Tennessee, who provided
me with materials she uses in her work and gave
me valuable insight into occupational and physical
therapies. I am also grateful to my brother, Mark A.
Harwell, an academic scientist who served on the
Science Advisory Board of the Environmental Pro-
tection Agency for many years and, for two terms,
chaired the Ecological Processes and Effects Com-
mittee. By giving me a glimpse into the complexi-
ties of environmental factors, he helped me to find
direction in researching an entry for this book.
Thanks also go to Dana Cassell, another writer
for the Health and Living series published by Facts
On File and the director of the national organiza-
tion Cassell Network of Writers. Not only did Dana
introduce me to medical writing in general, she
has often contributed articles and ideas on my top-
ics of interest.
Once again, I am delighted to say how much I
appreciate the excellent staff at Facts On File. Their
responsiveness, guidelines, and commitment to
high publishing standards make my work with
editor in chief James Chambers, associate editor
Vanessa Nittoli, and editorial assistant Matthew
Anderson a pleasure and privilege. I also appreci-
ate greatly the time Nick Shamie took to proofread
this manuscript and write an informative fore-
word. Literally and literarily, I could not have done
this book without their assistance.
Last in word, but first in thought, I thank
my husband, Bob, for his confidence in me and
his ongoing enthusiasm for my work as a medi-
cal writer and poet. When I feel discouraged, he
helps me to recall courage. When my back aches,
he massages knotted muscles and releases trigger
points. Although he has not completely cooked his
way around the kitchen, he has custom-built cabi-
nets to my height, so I do not have to bend over a
standard-sized counter. Then he regularly washes
dishes! How much I have to be thankful for and
acknowledge.
Mary Harwell Sayler
Lake Como, Florida
ACKNOWLEDGMENTS
xii
A
t this very moment, 31 million people in the
United States have a backache. Throughout
the year, half of our working population will have
some type of spinal concern. Within five years, 33
percent of Americans over 18 will seek medical
attention to alleviate back pain. Indeed, 90 percent
of our citizens will encounter back pain at some
point in their lives. If similar statistics occurred
with a manufactured product, we would probably
investigate the misuse of the merchandise or the
defects in design.
The Spine’s Design
From a posterior or back view, an inside look at
a healthy spinal column gives the impression of
stacked petals of bone whose beauty lies in the
strength of its construction. Fitted together in
a three-dimensional puzzle, 32 to 33 vertebrae
extend from the neck to the tailbone, not as a rigid
pole, but as a sequence of curves. This intricate
design brings flexibility in movement, while the
interlocking bones also provide vertebral strength.
As seen from a lateral or side view, the natural
curves of the neck and spine distribute weight
evenly while holding the head and body upright.
Besides this amazingly efficient design, 19 of
the 33 vertebral bones comprise the spinous pro-
cess you feel as your fingers bump along the bony
projections down the middle of your back. If you
could see inside that protective column of bone,
your spinal cord might look like a finger-thick
stem, flowering into your brain. Or you might
see it as an electric cord, fraying at one end. With
either visual to aid your glimpse, the lower por-
tion of this 17- to 18-inch-long stem terminates in
a picture of root-like nerves sinking into the lum-
bar region. A more humorous comparison arose
in Latin-speaking times as people noticed hair-
like nerves fanning above the pelvic bones like a
horse’s tail, then appropriately named this area
the cauda (horse) equina (tail.)
Stripped of other metaphors, and also of body
matter, spinal nerves up and down the back look
like the elongated skeleton of a fish or a long,
skinny caterpillar legging in all directions. The lat-
ter simile comes with a creepy connotation of eas-
ily being squished, but a slight shift in focus shows
each vertebra, viewed from above, looking like
Brunhilda’s helmet. As any Viking warrior could
see, those irregularly shaped rings of vertebral
bone protect the spinal nerves, spinal fluid, and
arteries encased inside.
Literally speaking, every little vertebra is not, of
course, the same. Some vary by design, depending
on their function. For example, the first cervical
vertebra, known as the atlas, looks like a small but
stout yoke or collar of bone on which the skull rests.
The second ring of cervical bone, the axis, includes
a rounded “tooth” known as the dens (Latin for
tooth) that fits in a space notched into the atlas.
When the atlas and axis work well together, this
unique pair of bones eases movement and allows
rotation of the head.
The remaining cervical bones look similar to
other vertebrae of the spine. Because neck verte-
brae support the head and not the weight of the
body, these cervical bones remain smaller than
INTRODUCTION
Introduction xiii
the vertebrae of the upper and lower back. Those
larger back bones graduate in size to protect your
internal organs and support your body weight. The
back vertebrae also connect to your ribs that are
shaped like the bottom of a boat, except for the
lowest ribs, which seem to be afloat.
To locate a specific bone with greater accuracy,
each vertebra has been assigned a sort of area code
according to its region. For example, C1 through
C7 specify the seven cervical bones of the neck,
including the atlas (C1) and axis (C2.) The twelve
thoracic vertebrae of the upper back or thorax have
numerical codes of T1 through T12, whereas L1
through L5 indicate the five vertebrae of the lum-
bar or lower back. Several small bones then fuse
together for strength in the sacral region, which,
in keeping with the Latin word, sacrum, may be
somewhat sacred to some.
Back Pain Potential
Assuming no accident, injury, or genetic flaw re-
arranges the design, a healthy spine supports the
body’s weight and pain-free movement. Some-
times, however, tension creates pain as tightened
muscles twist the spine, or an underlying medi-
cal condition causes an otherwise healthy back to
ache. For example, a problem with either kidney
may generate pain since those organs reside in the
middle of the back beneath the lower ribs. More
commonly, backaches result from improper main-
tenance, poor posture, overuse, repetitive use,
misuse, or general wear and tear.
With advanc ing age or frequent fric tion, movable
joints generally do not wear too well. In addition to
this problem, the spine has even more possibilities
for discomfort since each vertebra connects with
the one above and below, creating various types
of joints. To cushion those joints, soft-centered
discs of fibrous cartilage separate individual verte-
bral bones from C2 through L5, but these protec-
tive pads can rupture, subsequently compressing
or irritating the nerve tissue in that area. Usually,
strong fibrous ligaments help to protect the spinal
discs by acting as strapping devices that secure one
vertebra to another, but those ligaments can them-
selves cause pain if torn or pulled. In good work-
ing order, the sturdy spinal system has remarkable
strength and flexibility. Yet, the spine does have
its nerve.
Through a large hole in the center of each verte-
bral bone, millions of nerve fibers travel th rough the
spinal canal. Housed in the protective membrane
(dura mater) of the spinal cord and surrounded by
spinal fluids, this nervous system connects your
brain to the rest of your body. Between the verte-
brae, small spaces (neural foramina) in the bones
allow nerve roots to exit. These pairs of nerves
then act like tiny extension cords, connecting
the spinal cord to related parts of your body. For
example, nerves extending from the cervical spine
affect your upper chest and arms. Nerves in the
thoracic region connect to your chest and abdo-
men, whereas the lumbar nerves affect your legs,
bladder, and bowels.
Besides controlling body movement and organ
function, spinal nerves send electrical impulses to
your brain, giving sensations, including pain, in
the associated area. When nerves themselves suffer
damage, you might experience tingling or numb-
ness instead of pain. If nerve compression occurs,
which happens most often in the weight-bearing
lumbar region, the nerves may scream in propor-
tion to the pressure felt.
Unhindered, spinal nerves quietly await your
every thought of getting up and moving. Fortu-
nately, you do not have to remember to set your
heart or other organs into motion, but your body
will not move unless your muscles receive instruc-
tions to that effect from your central nervous sys-
tem. Then movement will likely involve your spine
because of its unique attachment to the paraspinal
muscles of your back. On either side of each tho-
racic and lumbar vertebra, muscles affix to little
protrusions of bone called transverse processes. As
the brain stimulates nerves in the area, muscles
contract and relax, moving bones and enabling
your body to bend, flex, sit, stand, walk, or run.
Too much movement too quickly, though, can
prod muscles and connective tendons into pain or
muscle spasm. That problem has an obvious means
of prevention, but with so many connections and
so much going on throughout the spine, numer-
ous factors can converge to produce back pain.
Addressing every possibility or preventative could
take a lifetime or, perhaps, a lifestyle. The ques-
xiv The Encyclopedia of the Back and Spine Systems and Disorders
tion is, what signs of the spine signal a need for
change?
Back in Style
As you evaluate the effects your lifestyle has on
your back and spine, begin by covering the basics.
For instance, everyone needs to drink adequate
water, eat nutritious foods, get enough sleep, and
exercise regularly. As a mnemonic device for those
pain-reducing basics, just remember to defuse
with FEWS: Food, Exercise, Water, Sleep. Natural
foods, sensible activities, fresh water, and restful
sleep naturally help you to maintain your health.
Such steps will not cure a neurological disorder,
spinal cord injury, or other severe conditions of
the back, but a healthy lifestyle generally does no
harm. Therefore, the following pages will include
natural aids whenever possible.
Meanwhile, the FEWS in your lifestyle can
offer clues about back pain. If other symptoms,
such as fatigue, tension, or dryness in your joints
and skin, add to your discomfort, those warning
signs may suggest solutions or preventatives too.
For example, if you notice a pad of tummy fat pull-
ing your lower back into a painful position, you
can see such options as losing weight or beginning
an exercise program to tighten the stomach and
strengthen your back muscles. By paying attention
to pain and any other symptoms, your body alerts
you to potential problems. So, as you question
what works wellness for you, consider your basic
needs and the kind of accommodation with which
you treat your aching back.
References
American Chiropractic Association. “Back Pain Statis-
tics.” Available online. URL: http://www.amerchiro.
org/media/whatis/benefits.shtml. Downloaded on
June 13, 2005.
Back.com. “Anatomy - Lumbar Spine.” Available online.
URL: http://www.back.com/stripcontent.php?parent_
file=/anatomy-lumbar.html. Downloaded on August
30, 2005
Bridwell, Keith, M.D. “Vertebral Column,” SpineUni-
verse. Available online. URL: http://www.spineuniverse.
com/print.php/article1286.html. Last updated June 30,
2005.
Shiel, William C. Jr., M.D. “Lower Back Pain,” Medi-
cineNet.com. Available online. URL: http://www.
medicinenet.com/script/main/art.asp?articlekey=289
&pf=3&page=1. Downloaded on August 31, 2005.
Southern California Orthopedic Institute. “Anatomy of
the Spine.” Available online. URL: http://www.scoi.
com/spinanat.htm. Downloaded on August 30, 2005.
Spine University. “Introduction.” Available online. URL:
http://www.spineuniversity.com/public/print.asp?
id=71. Downloaded August 30, 2005.
A
1
abatacept
This drug literally belongs in a class by
itself. As the first of a new class of agents known
as selective costimulation modulators, abatacept
blocks a key signal the body awaits before activat-
ing T-cells. Figuratively speaking, that signal opens
a gate for T-cells to search and destroy the invasion
of foreign agents, such as bacteria or a virus. In an
autoimmune disease such as
RHEUMATOID ARTHRI-
TIS (RA), the gate stays open, confusing T-cells into
attacking healthy cells. To stop this reaction, abata-
cept intercepts and unscrambles mixed signals, thus
causing T-cells to cease firing on friendly targets.
As explained in the Briefing Document For Abata-
cept, “it selectively modulates T-cell activation, and
secondarily affects key mechanisms of inflamma-
tion and progressive joint destruction in RA.” For
patients who have had an inadequate response to a
DISEASE MODIFYING ANTI-RHEUMATIC DRUG (DMARD),
“abatacept is indicated for reducing signs and symp-
toms, inducing major clinical response, inhibiting
the progression of structural damage, and improv-
ing physical function in adult patients with moder-
ately to severely active rheumatoid arthritis. . . .”
Dosage and Potential Side Effects
Lauded as “generally safe and well-tolerated” at
doses of 2 mg/kg and 10 mg/kg, the briefing docu-
ment also described the most common adverse event
(AE) as headache. However, “no specific AE led to
discontinuation in more than 0.2% of patients,
with the exception of back pain in 0.3% of placebo-
treated patients,” but “infections were the most
common reason for study discontinuation. . . .”
Statistics and Studies
Since abatacept acts on the immune system, the
manufacturing company, Bristol-Myers Squibb
(BMS), anticipated incidents of infection. Indeed,
the researchers found “the overall frequency of
infections was slightly increased in abatacept-treated
patients, but the severity, treatment, and outcome
was similar to that in placebo-treated patients. Seri-
ous viral, fungal, or mycobacterial infections were
uncommon.” To better define the risks, the manu-
facturer announced “a post-marketing pharmaco-
vigilance plan” to last at least until the year 2010.
Bristol-Myers Squibb Company, Briefing Document for
Abatacept (BMS-188667) Biological License Application
125118, Food and Drug Administration, Arthritis Advi-
sory Committee, September 6, 2005, pages 14, 15, 19,
97, 145, 147, 148. Available online. URL: http://www.
fda.gov/ohrms/dockets/ac/05/briefing/2005-4170B1_
01_01-BMS-Abatacept.pdf. Downloaded November
11, 2005.
absorptiometry This type of BONE MINERAL DEN-
SITY TEST uses protons or X-RAY to reveal spinal
strengths and weakness. If bones thin too much,
a person’s own body weight can cause break-
age, such as occurs in a
VERTEBRAL COMPRESSION
FRACTURE. That type of deterioration often hap-
pened without warning until the development of
single proton absorptiometry (SPA) in the 1960s.
Radiologists later used dual proton absorptiom-
etry (DPA) to assess spine health and the risk of
fractures, but high costs and technical limitations
made DPA less popular after dual energy X-ray
absorptiometry (DEXA or DXA) arrived in the late
1980s.
Although other types of bone tests have since
been developed, DEXA presently provides the most
commonly used diagnostic tool to detect
OSTEOPO-
ROSIS and other conditions causing bone loss. DEXA
monitors those conditions, too, by establishing a
baseline. To do this, a peripheral DEXA measures
the bone density in the arms, legs, or wrist, while a
central DEXA assesses bones in the hips and spine.
Once a baseline has been established, follow-up tests
note further deterioration as well as the strength-
ening effects of
BONE BUILDING treatments. Com-
parisons also occur as DEXA scores are themselves
graded on a curve. For example, the T-score com-
pares a person’s bone density to that of a healthy
young adult of the same sex. Normal bone rates a -1
while a score of -1 to -2.5 indicates the first stage of
bone loss or
OSTEOPENIA. T-scores below -2.5 suggest
osteoporosis. Similarly, the Z-score compares bone
density to that of other people of the same age, size,
and gender.
Procedure
Cramming for a DEXA test must exclude
CALCIUM
supplements for at least 24 hours. Besides that
dietary change, a week must lapse between DEXA
and other tests involving barium or contrast dye, so
absorptiometry usually comes first.
Prior to DEXA, a radiologist or radiologic tech-
nician explains the procedure, answers questions,
and also asks a few. Those questions concern recent
tests, current medications, and previous treatments
for bone loss, such as
HORMONE REPLACEMENT THER-
APY. A medical history will be taken, too, with par-
ticular emphasis on metal implants or anything that
could affect bone density measurements. Metal-free
street attire, such as sweat pants and a plain T-shirt,
can be worn for this outpatient procedure, but a
poor wardrobe choice may necessitate changing
into a hospital gown or scrubs. With no shoes, belt,
or jewelry to mar the readings, clothes need to be
loose enough and comfortable enough to accom-
modate a few minutes of lying still.
A scan table about three feet high allows most
people to get on and off easily. Table padding gen-
erally increases comfort, but patients with
KYPHO-
SIS, SCOLIOSIS, or other problems with POSTURE may
require additional accommodation. Instead of the
patient lying flat on the back as typically occurs,
such devices as rice bags, rolled towels, or firm
sponges may be used to assist patient position-
ing. If so, that information needs to be recorded to
ensure use of the same aids and angles in follow-
up DEXA tests.
Even small variations can mar the results, so the
X-
RAY angle also bears noting. Some DEXA tests
acquire data from a small angle beam or pencil
beam of X-ray that moves over the spine in a lin-
ear fashion. With its wider angle, a fan beam DEXA
sweeps the body more rapidly, using less time but
more radiation. Often, new equipment incorporates
both angles, combining the lower dose of radiation
with a faster scan. Regardless of the equipment,
the same type of X-ray should be used for the next
test to ensure the most accurate readings of patient
progress or decline.
Risks and Complications
Painless, noninvasive, and fairly quick, absorptiom-
etry demands no exertion but the effort of remain-
ing motionless for 20 minutes or less, depending on
the equipment. Misdiagnosis is rare. Nevertheless,
collected data can mislead doctors and patients into
inappropriate treatments, especially if bone density
readings have been obtained from different types
of machines or taken from too small an area. The
latter seldom affects tests of the
LUMBAR SPINE, but
other variations can occur because of differences
in computer software, incorrect positioning, or
inconsistencies in reading DEXA data. Other types
of scans, such as
QUANTITATIVE COMPUTED TOMOGRA-
PHY (QCT), may be more accurate in assessing bone
density, but QCT costs more and uses 10 times the
radiation.
Although researchers continue to work toward
standardizing measurements and techniques, vari-
ables increase for young patients, mainly because
DEXA was devised to determine bone density in
adults. Everything from the equipment to the
T-scores to the distance between the X-ray source
and the bones being measured has been calibrated
with full-grown bones in mind. Pediatric software
can overcome this problem by enabling the techni-
cian to adjust readings to evaluate smaller bones.
Often, though,
CHILDREN with chronic spinal condi-
tions experience slower bone growth, so that po-
tential variable must also be considered.
Outlook and Lifestyle Modifi cations
Within a few days, the primary physician will
receive a report and consider DEXA data in con-
junction with general observation, medical history,
2 absorptiometry
current symptoms, and results of other diagnostic
tests. This information shapes suggestions for any
changes to be made. For example, a reading slightly
below normal may indicate a need to increase cal-
cium intake or reassess any medications and supple-
ments known to interfere with calcium absorption.
The addition of
WEIGHT-BEARING EXERCISE, such
as walking or dancing, may be recommended to
strengthen the spine. Other lifestyle modifications
may include changes in daily
ACTIVITY, NUTRITION,
PAIN MANAGEMENT, the type of therapy, or medica-
tion, such as
ANTIRESORPTIVE DRUGS. To allow newly
initiated treatments time to take effect, a follow-
up DEXA may be scheduled in one to two years.
For growing children, new readings may be needed
every six to 12 months.
Brigham and Women’s Hospital. “Dual Energy X-ray
Absorptiometry (DEXA or DXA).” Available online.
URL: http://healthgate.partners.org/browsing/browse
Content.asp?fileName=22174.xml&title=Dual%20
Energy% 20X-ray%20Absorptiometry%20(DEXA%2
0or%20DXA) Downloaded October 1, 2005.
Fewtrell, M. S. “Bone Densitometry in Children Assessed
by Dual X-ray Absorptiometry: Uses and Pitfalls,”
Archives of Disease in Childhood 88, no. 9 (September
2003): 795–799.
Johnson, Kate. “Do Careful Reading of DEXA Reports
for BMD Assessment,” Family Practice News 30, no. 8
(April 15, 2000): 33.
Reynolds, Jim. “Dual Energy X-Ray Absorptiometry/
Densitometry (DEXA),” Nuclear Medicine at NIH.
Available online. URL: http://clinicalcenter.nih.gov/
imaging/nucmed/. Last modified October 1, 2005.
Staff. “Bone Densitometry,” Patient Page, Radiologic Tech-
nology 73, no. 2 (November–December 2001): 200.
Trevino, Merlina. “Site Selection, Measurement Strategies
Could Reduce Variability in Densitometry Readings—
DXA Evaluation Moves toward Standardization,”
Diagnostic Imaging vol., no. NA (April 1, 2002): 12.
acetaminophen Sold under brand names, such
as Tylenol and Liquiprin, or combined with other
analgesics, as occurs in Excedrin and Percocet,
acetaminophen reduces fever and peaks pain relief
within an hour or two. True to advertising claims,
this popular
PAIN RELIEVER seldom affects the stom-
ach as can
ASPIRIN and other types of NONSTEROIDAL
ANTI-INFLAMMATORY DRUG (NSAID) THERAPY. How-
ever, acetaminophen lacks the anti-inflammatory
benefits of an NSAID, so the medication may not
be as effective in easing
ARTHRITIS or other inflam-
matory conditions that affect the back and spine.
In some situations, inflammation can be wel-
comed. For example, quick recovery from back
SURGERY relies on natural inflammation to assist
healing and aid
BONE BUILDING. To keep from inter-
fering with that normal healing process, an inject-
able form of acetaminophen can deliver high-speed
relief directly into a pain site.
Dosage and Potential Side Effects
Even an infant can be given liquid drops of acet-
aminophen within the recommended dosage. For
children, choices include chewable tablets and
suppositories in smaller doses than the regular
strength (325 mg) and extra strength (500 mg) tab-
lets, caplets, or gel-caps available for adults. Each
dosage must comply with the instructions on the
label, because an excess can cause liver damage or
even death. Alcohol consumption adds to the risk
as does taking acetaminophen with other drugs or
herbs known to affect the liver.
Unless a doctor prescribes otherwise, acetamino-
phen should not be used for back pain lasting longer
than ten days. Rare side effects include lighthead-
edness and a rash, the latter of which may indi-
cate a potentially serious allergic reaction requiring
emergency medical attention. Regular users of
acetaminophen may be more likely to aggravate
or acquire a respiratory problem such as asthma.
However, symptoms of nausea, sweating, or loss of
consciousness indicate an overdose that can lead to
liver failure and death unless emergency treatment
begins within a few hours. If the presence of tox-
icity seems unclear or emergency facilities too far,
the National Poison Control center offers advice on
a toll-free hotline: 1-800-222-1212.
Statistics and Studies
According to the Food and Drug Administration
(FDA), 100 deaths and 56,000 visits to the emer-
gency room each year can be attributed to acet-
aminophen poisoning. To reduce the risk of liver
failure, the FDA approved an injectable antidote,
acetaminophen 3
Acetadote, to be administered within eight hours
of overdose. N-acetylcysteine (NAC) also coun-
teracts toxicity. Despite these emergency efforts,
acetaminophen poisoning causes more deaths
from overdose than any other drug in America,
but then it is the most widely used drug in Amer-
ica too.
Often,
OVER-THE-COUNTER PRODUCTS for children
favor this pain reliever and fever reducer, which
can be toxic at a single dose of 150 mg. Since
young children metabolize acetaminophen at a
higher rate than adults, parents should err on the
side of caution. Unfortunately, parents and also
adult patients sometimes ignore label instructions
and warnings, expecting a higher dosage to work
better or faster. They may be unaware, too, that
approximately 600 other medicines, such as cough
syrup, contain acetaminophen, thus increasing
potential for an inadvertent overdose. People can
also confuse the times and amounts of a dosage,
especially when alternating acetaminophen with
other pain relievers such as
IBUPROFEN. Unless a
physician prescribes a specific combination as a
means of
PAIN MANAGEMENT, various types of anal-
gesics, including
HERBAL THERAPY for pain, should
not be combined or interchanged.
A.D.A.M., U.S. National Library of Medicine, NIH. “Acet-
aminophen Overdose,” MedlinePlus. Available online.
URL: http://www.nlm.nih.gov/medlineplus/ency/arti-
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Acetaminophen,” Prevention 54, no. 4 (April 2002): 54.
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Magazine 130, no. 2681 (February 2002): 10–11.
Tenenbein, Milton. “Acetaminophen: The 150 mg/kg
Myth,” Journal of Toxicology: Clinical Toxicology 42, no. 2
(March 2004): 145–149.
Tucker, Jeffrey, M. D. “Toxicity, Acetaminophen,” eMedi-
cine.com, inc. Available online. URL: http://www.
emedicine.com/ped/topic7.htm. Last updated Decem-
ber 12, 2003.
ache See BACKACHE; FIBROMYALGIA.
achondroplasia See DWARFISM.
acromegaly See GROWTH HORMONE DISORDERS.
activity, daily Unlike the precise movements that
usually accompany
EXERCISE, an activity can be
anything that gets a person up and moving. This
motion may be less than a workout but more of
an accomplishment as people retain their ability
to remain mobile, maintain independence, and
decrease the risks of a fall. Besides improving over-
all health, daily activity lowers the risk of a
VERTE-
BRAL COMPRESSION FRACTURE due to OSTEOPOROSIS or
other conditions involving bone loss in the
SPINE.
Many decades divide
CHILDREN from ELDERLY per-
sons, but the heightened activity typical of child-
hood maximizes bone mass acquired at full growth
and minimizes the bone loss that occurs during
aging. One energetic hour each day for children and
a half-hour for adults will be well-spent time on
the spine.
WEIGHT-BEARING EXERCISE can especially
be bone-strengthening, but recreational activities
have been proven more effective in reducing
LOW
BACK PAIN than exercises with that goal. Studies do
not say why, but moving around and having fun
apparently has an advantage.
Risks and Complications
The biggest risk in daily activity seems to be avoid-
ing it. According to sources cited by the Centers for
Disease Control and Prevention (CDC), common
barriers to a physically active lifestyle include phys-
iological, behavioral, and psychological influences
that patients view as a personal deficit. Also, lack
of time, energy, skill, companionship, motivation,
resources, and good weather discourage sedentary
people from enjoying activities, but just identify-
ing a barrier can often bring a workable solution.
Many people, for example, express fears about tak-
ing a walk in their own neighborhoods. However,
an enclosed mall can be ideal for walking breez-
ily beyond obstacles of unsafe surroundings or
inclement weather. Indoor gyms, dance studios,
4 ache
multistoried buildings with stairs, and social events
involving activities offer options too.
Statistics and Studies
More than half of the adults and one-third of the
adolescents in America do less physical activities
than needed to maintain optimal health. According
to the American Academy of Orthopaedic Surgeons
(AAOS), only one in four school-aged children
spends the 35 to 60 minutes recommended for
daily activity. Yet childhood offers the best oppor-
tunity for
BONE BUILDING the bone mass that a per-
son draws from throughout life.
In April 2004, researchers from the University
of California, San Diego (UCSD) School of Medi-
cine reported on their study of the effects of
NUTRI-
TION and exercise on 878 young people, ages 11
to 15. To record physical activity accurately, each
student wore a measuring device continuously for
one week. The device showed that boys and girls
of normal weight spent only two to four minutes
more per day in vigorous activity than did students
who were overweight, but those small increments
of energy made a discernible difference. By con-
trast, moderate increases in activity produced little
change.
In June 2005, the President’s Council on Physi-
cal Fitness and Sports reported that 33.4 percent of
students in grades nine through 12 do not join in
enough activities, particularly as their attendance in
physical education (PE) classes steadily declines. In
general, “non-Hispanic Black and Mexican Ameri-
can children were less likely to participate in vig-
orous physical activity than non-Hispanic Whites.
Girls consistently tended to participate less in vigor-
ous activities than boys. More troublesome is the
fact that as girls get older there is a steady decline
in physical activity; however, as boys get older the
percent who participate in vigorous active pursuits
increases.” The report also said, “Environmen-
tal variables included perceived physical activity,
behavior of parents and peers, access to sporting
and/or fitness equipment at home, involvement
in community physical activity organizations . . .
and self-reported hours spent watching television
or playing video games. Results showed that active
African American boys exhibited higher levels of
self-efficacy toward physical activity and reported
greater involvement in community-based, physical
activity organizations than low-active boys. Active
African American girls were more likely to have
higher levels of self-efficacy and higher scores on
beliefs regarding physical activity outcomes (e.g.,
keep me in shape, make me more attractive, be
fun) than less active African American girls. Self-
efficacy—the belief that a person possesses the abil-
ity to perform a particular behavior—is consistently
an important predictor of physical activity in chil-
dren and adults regardless of race.”
Special Aids and Adaptations
Generally, studies of children rely on various types
of devices to record movement, whereas adult par-
ticipants often just fill out a questionnaire. How-
ever, Dixie Thompson, Director of the Center for
Physical Activity and Health at the University of
Tennessee, distributed pedometers to two groups
of women between the ages of 33 and 55 to use
four days a week while they walked a pet or took
a ten-minute stroll during lunch break. Instructing
one group to walk for a half-hour and the other
to take a total of 10,000 steps throughout a day,
Thompson discovered the 30-minute walkers took
about 9,505 steps whereas the 10,000-step group
averaged 11,775.
For most people, physical activity requires no
measuring device or special equipment except a
reasonably sound body and a mind set on moving
it. However, excellent aids come through simple
devices, such as a lawn mower, garden rake, vac-
uum cleaner, dust cloth, or broom. Many occupa-
tions offer an outlet for physical activity, too, as
construction workers, maintenance staff, hospital
personnel, cable installers, stay-at-home moms, and
others get a hard workout by working hard. Prior to
industrialization, employment often involved phys-
ical activity, and before the two-car garage, children
typically walked or rode bicycles to school. Cultural
changes discourage such activities now. However,
parents, teachers, and other educators can help chil-
dren to become more active by providing adequate
PE classes, safe playground equipment, ample time
for recess, and encouragement of intramural sports
or before-and-after school activities.
Just being aware of the fun and benefits of
physical activity helps too. In 2002, for example,
activity, daily 5
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