Sunday, September 11, 2011

Ergonomics fitness


So Many Gadgets, So Many Aches

LOOK around, they’re everywhere: hunched shoulders, angled necks and wrists, hands twisted like claws. As people harness their bodies to use more electronic devices in more places, they may unknowingly be putting themselves at a greater risk of injury.
Koren Shadmi
Things were much simpler 20 years ago, when employees worked mainly on desktop computers that could be adjusted for maximum comfort. Now people have added laptops, smartphones and tablets to their arsenals, and they’re using — or perhaps misusing — them at work, at home and in trains, planes, hotels and coffeehouses.
Visit any airport waiting area, said Alan Hedge, an ergonomics professor at Cornell, and you can see people using their laptops in awkward and contorted positions. Too much of this activity is bound to take a physical toll.
By positioning themselves improperly, people are at greater risk of eye strain, tendinitisand carpal tunnel syndrome, to name just a few ailments. Repetitive actions that lead to overuse of muscles and tendons can inflame them, causing pain in the hands, shoulders, neck and back.
Laptops are adding to these problems because “they do not meet any of the ergonomic requirements for a computer system,” Professor Hedge said. The keyboard and the screen are connected, so if you place the keyboard at the ideal position for typing, the screen won’t be at the best distance for viewing, he said. Docking stations that provide an extra keyboard or monitor can help solve this problem.
Another lurking danger is touch screens, Professor Hedge said. Keys that move up and down provide more of a cushion for the fingers, whereas the drumming of fingers against screens is harsher and can lead to soreness. For that reason, he said, a tablet should not be used heavily for typing.
And think of our poor thumbs, which have been pressed into a level of service they were never meant to provide. Thumbs are more vulnerable than fingers because they have two bones instead of three, Professor Hedge said.
“If you want to get injured, do a lot of texting,” he added (and that includes the chance that you will collide with something while walking or driving).
  Texting has led to an increase in a condition known as De Quervain’s tenosynovitis, where the tendons become so inflamed that it becomes painful to move your thumb, affecting your ability to hold things, Professor Hedge said.
These days, you can be texting your boss one minute and a friend the next. And this greater mingling of work and personal life is placing more stress on the body. It can also make it harder to pinpoint what is causing a new physical problem.
Adding a device or routine can tip the scales toward an injury, said Carol Stuart-Buttle ofStuart-Buttle Ergonomics in Philadelphia. She gave the example of a client who recently began typing on a propped-up tablet computer at home. That placed extra strain on her wrists so that typing at work — never a problem before — suddenly became painful.
To trace a pain’s origins, you may need to become a detective in your own life. As you seek to lessen or prevent pain, she said, look for any repetitive and sustained activity in all the devices you use.
Don’t discount psychological factors, she added. Mental stress can cause you to tense your muscles, aggravating any existing physical stress.
If you can, consult an ergonomics expert at your company to arrange the best possible setup for your devices at both work and home, along with a discussion of best practices. And notify your employer or consult a doctor if you experience pain or vision problems.
Ms. Stuart-Buttle says a common health issue is vision impairment stemming from a monitor being placed at the wrong distance from the eyes. And she often finds problems like tendinitis because people aren’t supporting their arms when they use a mouse, causing a tighter grip and increasing muscle tension.
IF you are hunched over while working, something is wrong, she said. Look for the things that are pulling you forward and fix them. Sit back in your chair, support your feet if needed and make sure your arms are relaxed as you type. Check that the screen is close enough so that you can see clearly without strain, enlarging the type size if necessary.
Be aware of these factors and try to approximate them as much as possible when you aren’t at your primary workstation.
As you work, “match the technology to the task you want to perform,” Professor Hedge said. “If what you’re doing is a lot of typing, you need a keyboard,” he added. “Don’t try to type ‘War and Peace’ with your thumbs.”
The simplest and most well-worn piece of advice is one that people too often forget to follow: take a break. Separating yourself from your machines gives your muscles, and your mind, a rest that they richly deserve.

Bone drugs for women

September 7, 2011, 2:52 PM

F.D.A. Staff: 5 Years May Be Enough for Bone Drugs

Most women who take bone-building drugs like Fosamax can safely stop taking them after five years, the Food and Drug Administration said Wednesday in a staff report leading up to a broad safety review scheduled Friday by two scientific advisory committees.
Studies show that the drugs do have proven benefits in preventing osteoporosis fractures for the first three years of treatment, but continuing beyond five years does not demonstrate such benefits over no drug use at all, the report said. And women who stop taking the drugs after five years have similar levels of increased bone density and reduced fracture risk as those who continue taking them, it said.
“These results suggest no significant advantage of continuing drug therapy beyond 5 years,” according to agency’s 45-page review of scientific evidence.
As for side effects, the report said, there is no solid evidence the drugs, called bisphosphonates, cause unusual breaks of the femur bone, a jaw injury called osteonecrosis, or esophageal cancer. At the same time, the agency said, those rare but dangerous outcomes cannot be ruled out because it has been so difficult to study them for various reasons.
“The safety of long-term bisphosphonate therapy continues to be unclear as study results are conflicting,” according to the F.D.A. report.
The drugs under review include Fosamax from Merck, first approved in 1995, Boniva from Roche Therapeutics, Actonel and Atelvia from Warner Chilcott, and generic copies. The F.D.A. has never conducted a broad review of the long-term safety and efficacy of the drugs.
A so-called “drug holiday” may be warranted for many of the women who take the drugs for longer terms, the report said, but adding a note of caution: “There are no substantial data available to inform decisions regarding the initiation or duration of a drug holiday.”
Between 5.1 million and 5.7 million patients in the United States have received prescriptions for the drugs for each of the years 2005 through 2009, the agency said, citing drug tracking from the data firm SDI. Most patients were over 55 years old. At least one in 11 women in that age group received the bone drugs, the agency said.
Sally Fullman, 69, of Murray Hill, N.J., started taking Fosamax in 2006 after being diagnosed with osteoporosis. She stopped taking it last year partly because of concern about the possible side effects.
“I’m troubled by all the confusion and the stress that’s out there with respect to the advisability of taking them,” Ms. Fullman said in an interview shortly before the F.D.A. issued its report. “I’m still on a drug holiday. But when I talk to people, everybody is confused and angry about this.”
Perhaps the F.D.A. safety review will help patients like Ms. Fullman – at least more than media reports on conflicting studies, anecdotal cases and lawsuits. “When I read articles or see things on TV, what I hear are side effects that are taken out of context,” she said. “So they’re catchy and they kind of scare you a little bit, but they don’t really tell you the risks of not taking the medication.”
Drug makers including Merck issued their own safety reports on Wednesday at the F.D.A.’s request.
The Merck report, using the chemical name for Fosamax, said: “The available data support a favorable benefit to risk profile during long-term (10-year) treatment with alendronate in osteoporotic patients who remain at risk of osteoporotic fracture and who have not experienced adverse reactions that required discontinuation of therapy.”
But Merck also said it would support the notion of taking a break from the bone drugs.
“A drug holiday may be considered for patients who have previously received long-term treatment and are no longer considered to have a sufficiently high fracture risk,” the company said.

Tuesday, September 6, 2011

Sports Medicine


As Sports Medicine Surges, Hope and Hype Outpace Proven Treatments

Alex di Suvero for The New York Times
Tina Basle is back running again, but she has lost speed and endurance after a hamstring tear that doctors were unable to heal.
Until she tore her hamstring a year and a half ago, Tina Basle ran marathons. Since then, she has been on a desperate search for a cure.


Share your thoughts on this column at the Well blog.

    The Athlete’s Pain

    A Rush for Cures
    Articles in this series will look at popular sports medicine procedures that remain unproven.
Josh Cochran
It took her from doctor to doctor, cost her thousands of dollars and led her to try nearly everything sports medicine has to offer — an M.R.I. to show the extent of the injury, physical therapythat included ultrasound and laser therapy, strength training, an injection of platelet-rich plasma (or P.R.P.), a cortisone shot, another cortisone shot.
Finally, in February, she gave up.
“I decided this is never going to heal, so let’s get on with it,” she said.
And so Ms. Basle, a 44-year-old digital media consultant who lives in Manhattan, started running anyway. She has lost a lot of speed and endurance. And, she added, “the stupid hamstring is really no better.”
Medical experts say her tale of multiple futile treatments is all too familiar and points to growing problems in sports medicine, a medical subspecialty that has been experiencing explosive growth. Part of the field’s popularity, among patients and doctors alike, stems from the fact that celebrity athletes, desperate to get back to playing after an injury, have been trying unproven treatments, giving the procedures a sort of star appeal.
But now researchers are questioning many of the procedures, including new ones that often have no rigorous studies to back them up. “Everyone wants to get into sports medicine,” said Dr. James Andrews, a sports medicine orthopedist in Gulf Breeze, Fla., and president-elect of the American Orthopaedic Society for Sports Medicine.
Doctors love the specialty and can join it with as little as a year of training after their residency, as compared with the more typical two to four years for other specialty training. They see a large group of patients eager for treatment, ranging from competitive athletes to casual exercisers to retirees spending their time on the golf course or tennis court.
The problem is that most sports injuries, including tears of the hamstring ligament like Ms. Basle’s, have no established treatments.
Of course, some remedies for certain injuries do work: putting a cast on a broken bone or operating to repair a torn Achilles tendon. But patients whose injuries have no effective treatment often do not know that medicine has nothing to offer. And many expect cures.
“They watch ‘Grey’s Anatomy’ and think we can do anything,” said Dr. Raymond Monto, a sports medicine orthopedist in West Tisbury, Mass. “And to a certain extent, we allow that.”
Added to that is the effect of sports stars and their doctors. Patients “see a high-profile athlete and say, ‘I want you to do it exactly the same way their doctor did it,’ ” said Dr. Edward McDevitt, an orthopedist in Arnold, Md., who specializes in sports medicine.
The result is therapies that are unproven, possibly worthless or even harmful. There is surgery, like a popular operation that shaves the hip bone to prevent arthritis, that may not work. There are treatments, like steroid injections for injured tendons or taping a sprained ankle, that can slow the healing process. And there are fads, like one of Ms. Basle’s treatments, P.R.P., that soar in popularity while experts debate whether they help.
All this leads Dr. Andrew Green, a shoulder orthopedist at Brown University, to ask, “Is sports medicine a science, something that really pays attention to evidence? Or is it a boutique industry where you have a product and sell it?”
“For a lot of people it is a boutique business,” he said. “But are you still a doctor if you do that?”
A Theory Becomes a Fad
If ever anyone wanted to know how untested sports medicine treatments come into use, they would need only look at platelet-rich plasma, medical experts say. They joke that it is the perfect example of what is a tried-and-true path to popularizing a new treatment. It is what Dr. John Bergfeld, an orthopedic sports medicine specialist at the Cleveland Clinic, calls the Orthopedic Triad: famous athlete, famous doctor, untested treatment.
While there are no official statistics on P.R.P. treatment, all agree that it has exploded on the scene, propelled by testimonials from celebrity athletes.
Part of its appeal was that it made sense. Blood contains platelets that secrete growth factors that, in turn, can help tissue heal. So if a patient’s own platelets are injected into the injury site, they might speed recovery. And since it is the patient’s own platelets, the treatment is unlikely to be harmful.
It is easy to extract platelets. A doctor spins a tube of a patient’s blood in a centrifuge and then removes the middle layer of cells. Those are the platelets.