BACK PAIN
Back pain is a common reason for absence from work and for seeking medical treatment. It can be uncomfortable and debilitating.
It can result from injury, activity and some medical conditions. Back pain can affect people of any age, for different reasons. As people get older, the chance of developing
lower back pain increases, due to factors such as previous occupation and degenerative disk disease.
Lower back pain may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdominal and pelvic internal organs, and the skin around the lumbar area.
Pain in the upper back may be due to disorders of the aorta, tumors in the chest, and spine inflammation.
Causes
Problems with the spine such as osteoporosis can lead to back pain.
The human back is composed of a complex structure of muscles, ligaments, tendons, disks, and bones, which work together to support the body and enable us to move around.
The segments of the spine are cushioned with cartilage-like pads called disks.
Problems with any of these components can lead to back pain. In some cases of back pain, its cause remains unclear.
Damage can result from strain, medical conditions, and poor posture, among others.
Strain
Back pain commonly stems from strain, tension, or injury. Frequent causes of back pain are:
- strained muscles or ligaments
- a muscle spasm
- muscle tension
- damaged disks
- injuries, fractures, or falls
Activities that can lead to strains or spasms include:
- lifting something improperly
- lifting something that is too heavy
- making an abrupt and awkward movement
Structural problems
A number of structural problems may also result in back pain.
- Ruptured disks: Each vertebra in the spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.
- Bulging disks: In much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
- Sciatica: A sharp and shooting pain travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.
- Arthritis: Osteoarthritis can cause problems with the joints in the hips, lower back, and other places. In some cases, the space around the spinal cord narrows. This is known as spinal stenosis.
- Abnormal curvature of the spine: If the spine curves in an unusual way, back pain can result. An example is scoliosis, in which the spine curves to the side.
- Osteoporosis: Bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
- Kidney problems: Kidney stones or kidney infection can cause back pain.
Movement and posture
Adopting a very hunched sitting position when using computers can result in increased back and shoulder problems over time.
Back pain can also result from some everyday activities or poor posture.
Examples include:
- twisting
- coughing or sneezing
- muscle tension
- over-stretching
- bending awkwardly or for long periods
- pushing, pulling, lifting, or carrying something
- standing or sitting for long periods
- straining the neck forward, such as when driving or using a computer
- long driving sessions without a break, even when not hunched
- sleeping on a mattress that does not support the body and keep the spine straight
Other causes
Some medical conditions can lead to back pain.
- Cauda equina syndrome: The cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. Symptoms include a dull pain in the lower back and upper buttocks, as well as numbness in the buttocks, genitalia, and thighs. There are sometimes bowel and bladder function disturbances.
- Cancer of the spine: A tumor on the spine may press against a nerve, resulting in back pain.
- Infection of the spine: A fever and a tender, warm area on the back could be due to an infection of the spine.
- Other infections: Pelvic inflammatory disease, bladder, or kidney infections may also lead to back pain.
- Sleep disorders: Individuals with sleep disorders are more likely to experience back pain, compared with others.
- Shingles: An infection that can affect the nerves may lead to back pain. This depends on which nerves are affected.
Risk factors
The following factors are linked to a higher risk of developing low back pain:
- occupational activities
- pregnancy
- a sedentary lifestyle
- poor physical fitness
- older age
- obesity and excess weight
- smoking
- strenuous physical exercise or work, especially if done incorrectly
- genetic factors
- medical conditions, such as arthritis and cancer
Lower back pain also tends to be more common in women than in men, possibly due to hormonal factors. Stress, anxiety, and mood disorders have also been linked to back pain.
Symptoms
The main symptom of back pain is an ache or pain anywhere in the back, and sometimes all the way down to the buttocks and legs.
Some back issues can cause pain in other parts of the body, depending on the nerves affected.
The pain often goes away without treatment, but if it occurs with any of the following people should see their doctor:
- weight loss
- fever
- inflammation or swelling on the back
- persistent back pain, where lying down or resting does not help
- pain down the legs
- pain that reaches below the knees
- a recent injury, blow or trauma to the back
- urinary incontinence
- difficulty urinating
- fecal incontinence, or loss of control over bowel movements
- numbness around the genitals
- numbness around the anus
- numbness around the buttocks
When to see a doctor
You should seek medical help if you experience any numbness or tingling, or if you have back pain:
- that does not improve with rest
- after an injury or fall
- with numbness in the legs
- with weakness
- with fever
- with unexplained weight loss
Diagnosis
A doctor will usually be able to diagnose back pain after asking about symptoms and carrying out a physical examination.
An imaging scan and other tests may be required if:
- back pain appears to result from an injury
- there may be underlying cause that needs treatment
- the pain persists over a long period
An X-ray, MRI, or CT scan can give information about the state of the soft tissues in the back.
- X-rays can show the alignment of the bones and detect signs of arthritis or broken bones, but they may not reveal damage in the muscles, spinal cord, nerves, or disks.
- MRI or CT scans can reveal herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles, and bones.
- Bone scans can detect bone tumors or compression fractures caused by osteoporosis. A radioactive substance or tracer is injected into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
- Electromyography or EMG measures the electrical impulses produced by nerves in response to muscles. This can confirm nerve compression, which may occur with a herniated disk or spinal stenosis.
The doctor may also order a blood test if infection is suspected.
Other types of diagnosis
- A chiropractor will diagnose through touch, or palpation, and a visual examination. Chiropractic is known as a direct approach, with a strong focus on adjusting the spinal joints. A chiropractor may also want to see the results of imaging scans and any blood and urine tests.
- An osteopath also diagnoses through palpation and visual inspection. Osteopathy involves slow and rhythmic stretching, known as mobilization, pressure or indirect techniques, and manipulation of joints and muscles.
- A physical therapist focuses on diagnosing problems in the joints and soft tissues of the body.
Chronic or acute pain?
Back pain is categorized into two types:
- Acute pain starts suddenly and lasts for up to 6 weeks.
- Chronic or long-term pain develops over a longer period, lasts for over 3 months, and causes ongoing problems.
If a person has both occasional bouts of more intense pain and fairly continuous mild back pain, it can be hard for a doctor to determine whether they have acute or chronic back pain.
What to know about ADHD
A person with untreated attention deficit hyperactivity disorder (ADHD) has difficulty maintaining attention, managing energy levels, and controlling impulses.
In the United States, around 8.4% of children and 2.5% of adults have ADHD. In some children, ADHD characteristics begin as early as 3 years of age.
Ways of treating ADHD include medication, behavioral management techniques, and other practical strategies.
Below, we explore what ADHD is, how it affects a person, and which treatments can help.
What is ADHD?
People with ADHD have difficulty focusing on tasks and controlling their attention, which can make completing a project, for example, challenging. ADHD can limit a person’s ability to study or work, and it can lead to stress, anxiety, and depression.
Some people with ADHD also find it hard to sit still. They may be quick to act on impulse and become easily distracted.
While children of any age can experience distraction and impulsiveness, these traits are more noticeable in those with ADHD.
Features
ADHD may develop in one of three ways. A doctor may find that the disorder has:
- a predominantly hyperactive and impulsive presentation
- a predominantly inattentive presentation
- a combined presentation
People with ADHD experience hyperactivity, impulsivity, and inattention in varying degrees.
Inattention
Below are some behaviors related to inattention that a person might notice in someone with ADHD:
- daydreaming
- becoming distracted and having difficulty focusing on tasks
- making “careless” mistakes
- appearing to not listen while others are talking
- having difficulty with time management and organization
- frequently losing everyday items
- avoiding tasks that need prolonged focus and thought
- having difficulty following instructions
Hyperactivity and impulsivity
Some or all of the following may be apparent in someone with ADHD:
- seeming constantly “on-the-go” and unable to sit still
- running or climbing at inappropriate times
- having difficulty taking turns in conversations and activities
- fidgeting or tapping the hands or feet
- talking and making noises excessively
- taking unnecessary risks
In adults
Adults and children tend to experience the same symptoms of ADHD, and these can create difficulties in relationships and at work.
The effects of these features vary widely from person to person, and a person may find that their experience of ADHD changes over time.
Not everyone with ADHD is noisy and disruptive. A child may be quiet in class, for example, while facing severe challenges that they do not express.
In females
Females with ADHD may be more likely to have difficulty paying attention, while males may be more likely to experience hyperactivity and impulsivity.
This may be one reason why more males than females receive diagnoses of ADHD. Hyperactivity can be easier to spot than inattention.
Diagnosis
Most children with ADHD receive a diagnosis while they are in elementary school, but some may not do so until adolescence or adulthood.
No single test can identify ADHD, and the symptoms can overlap with those of other conditions. This can make it difficult to diagnose.
A doctor will conduct examinations to rule out other potential causes, such as hearing or vision problems.
Other conditions that can lead to similar behaviors include:
- trouble hearing or seeing
- anxiety
- depression
- learning disabilities
- sleep disorders
A doctor will often ask questions to learn more about the person’s behavioral patterns. They may speak with the individual, members of their family, and any other caregivers, such as teachers.
Many children experience hyperactivity and inattention. For a diagnosis of ADHD, the symptoms must meet specific criteria, including having a significant impact on daily life and schoolwork.
how much physical activity do you need?
Physical activity or exercise can improve your health and reduce the risk of developing several diseases like type 2 diabetes, cancer and cardiovascular disease. Physical activity and exercise can have immediate and long-term health benefits. Most importantly, regular activity can improve your quality of life.
A minimum of 30 minutes a day can allow you to enjoy these benefits.
Benefits of regular physical activity
If you are regularly physically active, you may:
- reduce your risk of a heart attack
- manage your weight better
- have a lower blood cholesterol level
- lower the risk of type 2 diabetes and some cancers
- have lower blood pressure
- have stronger bones, muscles and joints and lower risk of developing osteoporosis
- lower your risk of falls
- recover better from periods of hospitalisation or bed rest
- feel better – with more energy, a better mood, feel more relaxed and sleep better.
A healthier state of mind
A number of studies have found that exercise helps depression. There are many views as to how exercise helps people with depression:
- Exercise may block negative thoughts or distract you from daily worries.
- Exercising with others provides an opportunity for increased social contact.
- Increased fitness may lift your mood and improve your sleep patterns.
- Exercise may also change levels of chemicals in your brain, such as serotonin, endorphins and stress hormones.
Aim for at least 30 minutes a day
To maintain health and reduce your risk of health problems, health professionals and researchers recommend a minimum of 30 minutes of moderate-intensity physical activity on most, preferably all, days.
Physical activity guidelines
Australia’s physical activity and sedentary behaviour guidelines state that:
- Doing any physical activity is better than doing none. If you currently do no physical activity, start by doing some, and gradually build up to the recommended amount.
- Be active on most, preferably all, days every week.
- Accumulate 150 to 300 minutes (2 ½ to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1 ¼ to 2 ½ hours) of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week.
- Do muscle strengthening activities on at least two days each week.
Ways to increase physical activity
Increases in daily activity can come from small changes made throughout your day, such as walking or cycling instead of using the car, getting off a tram, train or bus a stop earlier and walking the rest of the way, or walking the children to school.
See your doctor first
It is a good idea to see your doctor before starting your physical activity program if:
- you are aged over 45 years
- physical activity causes pain in your chest
- you often faint or have spells of severe dizziness
- moderate physical activity makes you very breathless
- you are at a higher risk of heart disease
- you think you might have heart disease or you have heart problems
- you are pregnant.
Pre-exercise screening is used to identify people with medical conditions that may put them at a higher risk of experiencing a health problem during physical activity. It is a filter or ‘safety net’ to help decide if the potential benefits of exercise outweigh the risks for you.
Medical myths: Vegetarian and vegan diets
Following a plant-based diet is becoming increasingly popular. While this is widely regarded as a healthful choice, many myths abound. In this edition of Medical Myths, we dig into the details.
Until fairly recently, vegetarianism was generally considered a fringe lifestyle choice in the United States, and veganism even more so. Anything on the fringes of society tends to inadvertently encourage myths and misconceptions.
Also, deciding to avoid animal products sparks rage in some people. This anger manifests for a range of reasons, which are beyond the scope of this article. Suffice it to say that if a sizable group of the population is against something, conditions are ripe for myths and half-truths.
1. Plant-based diets are always healthful
In recent decades, an increasing number of studies have demonstrated links between red meat consumption and poorer health outcomes. For instance, processed and red meat intake is associated with colon cancer, obesity, heart disease, and diabetes.
This might suggest that a diet without meat is better for the body. But, just as not all meat is red, not all vegetarian or vegan diets are healthful.
To use an extreme example, if an individual only ate potato chips, they would be vegan, but certainly not brimming with vitality, energy, and health.
As with any other diet, it depends entirely on what an individual consumes.
Additionally, lean white meat and fish are not associated with the same health issues as processed and red meats.
And certain meat substitute products can be high in salt.
2. Vegetarianism guarantees weight loss
Sadly, no. As the section above makes clear, not all vegetarian and vegan diets are equally healthful. It is incredibly easy to consume thousands of calories each day without any of them being associated with animals.
The key to weight loss is a healthful diet and regular exercise, and neither requires the avoidance of animal products.
It is still worth noting, though, the evidence that following a plant-based diet is associated with weight loss. For instance, a review published in Translational Psychiatry
explains:
“We found robust evidence for short- to moderate-term beneficial effects of plant-based diets versus conventional diets on weight status, energy metabolism, and systemic inflammation.”
This finding held true for healthy participants, people with obesity, and individuals with type 2 diabetes.
To give another example, another review, published in BMJ Open Diabetes Research and Care, looked at the impact of plant-based diets on people with diabetes. Among other benefits, the authors found that these diets were associated with a “significant improvement” in weight.
3. Vegetarians and vegans cannot get enough protein
This is perhaps the most common of all the myths that we cover today. But it is still a myth. In the world of food, protein abounds.
For people who eat them, dairy products and eggs are high in protein. Vegans also have an array of options, including seitan, tofu, lentils, chickpeas, many types of bean, spelt, spirulina, quinoa, oats, wild rice, seeds, and nuts.
Even some vegetables contain protein, including spinach, asparagus, broccoli, artichokes, potatoes, peas, brussels sprouts, and sweet potatoes.
4. You can’t build muscle without meat
This myth follows on from the protein myth above. In short, the most important nutrient for building muscle is protein, which can easily be found in abundance beyond the animal kingdom.
5. Dairy is essential for strong bones
Dairy is not essential for strong bones, but calcium is. In fact, calcium is important for a number of bodily functions, including maintaining blood pressure, muscle contraction, transmitting signals along nerves, and blood clotting.
Vegans, therefore, need to ensure that they take in enough calcium from plant-based sources.
As with protein, there are plenty of places to pick up calcium, including soy-based foods, beans, lentils, peas, spinach, turnips, figs, flax, chia, sesame seeds, seaweed, and some nuts — almonds, in particular.
6. You cannot get B12 from a vegetarian diet
This is a myth. While vegans often take B12 supplements to ensure that they have adequate levels, vegetarians have a wealth of other options.
Vegetarians can derive B12 from eggs and milk products, including cheese.
Meanwhile, a range of vegan-friendly foods are fortified with B12, including some cereals, tofu, nondairy milks, and spreads.
B12: An interesting aside
Cows need B12, too, and they rely on gut bacteria to produce it.
To produce B12, gut bacteria need cobalt, which a cow normally derives from grazing. However, many cows destined to become meat only spend the beginning of their lives in pasture before being brought inside where they are fed on grain.
Because of this unnatural diet, their gut bacteria are starved of cobalt and cannot produce B12.
But the cow still needs B12 to thrive, so farmers must provide them with either cobalt or B12 supplements.
So even a staunch, dyed-in-the-wool red meat fanatic is likely to derive their B12 from supplements — but in their case, it’s via a cow.
7. Soy increases the risk of breast cancer
As it stands, there is no convincing evidence that eating soy-based foods increases the risk of breast cancer in humans.
This misunderstanding might stem from earlier studies in rodents. Scientists showed that when these animals received large amounts of soy compounds called isoflavones, they were more likely to develop breast cancer. However, humans process soy differently from rodents.
A study published in February 2020 searched for associations between soy, dairy intake, and breast cancer risk. The scientists had followed 52,795 cancer-free women in the U.S. for an average of 7.9 years.
They found no clear association between soy intake and breast cancer, but they did identify a link between dairy milk and breast cancer.
However, the full picture is, perhaps, slightly more complex. Some women use soy-based supplements as a natural alternative to hormone therapy during menopause. One large study investigated whether these supplements might be associated with breast cancer risk.
The researchers found “no association between past use of soy supplements and breast cancer.” But, they also found that taking soy supplements, for some women, might increase the risk of breast cancer, particularly for those with a family history.
Overall, as the American Cancer Society explain:
“The evidence does not point to any dangers from eating soy in people, and the health benefits appear to outweigh any potential risk. In fact, there is growing evidence that eating traditional soy foods may lower the risk of breast cancer, especially among Asian women.”
8. Pregnant people need meat and dairy
During pregnancy, it is important to take in all the nutrients that a growing baby needs. But, as we have seen along the way, plant-based foods can provide the vast majority of them.
Someone who is vegetarian or vegan may need to do a little extra planning to be sure that have enough nutrients, especially at the beginning of pregnancy.
As we mentioned above, it is important to ensure an adequate intake of vitamin B12, through supplements or fortified foods, and this is especially true during pregnancy and breastfeeding. The American Dietetic Association recommend vitamin B12 supplementation throughout pregnancy and breastfeeding for people with vegan or vegetarian diets.
As the authors of a review of research about plant-based diets during pregnancy explain, “The available evidence shows that well-planned vegetarian and vegan diets may be considered safe during pregnancy and lactation, but they require a strong awareness for a balanced intake of key nutrients.”
DIABETES
Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. You can also have prediabetes. This means that your blood sugar is higher than normal but not high enough to be called diabetes. Having prediabetes puts you at a higher risk of getting type 2 diabetes.
Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes.
Blood tests can show if you have diabetes. One type of test, the A1C, can also check on how you are managing your diabetes. Exercise, weight control and sticking to your meal plan can help control your diabetes. You should also monitor your blood glucose level and take medicine if prescribed.
How can I prevent or delay getting type 2 diabetes?
If you are at risk for diabetes, you may be able to prevent or delay getting it. Most of the things that you need to do involve having a healthier lifestyle. So if you make these changes, you will get other health benefits as well. You may lower your risk of other diseases, and you will probably feel better and have more energy. The changes are:
- Losing weight and keeping it off. Weight control is an important part of diabetes prevention. You may be able to prevent or delay diabetes by losing 5 to 10% of your current weight. For example, if you weigh 200 pounds, your goal would be to lose between 10 to 20 pounds. And once you lose the weight, it is important that you don’t gain it back.
- Following a healthy eating plan. It is important to reduce the amount of calories you eat and drink each day, so you can lose weight and keep it off. To do that, your diet should include smaller portions and less fat and sugar. You should also eat a variety of foods from each food group, including plenty of whole grains, fruits, and vegetables. It’s also a good idea to limit red meat, and avoid processed meats.
- Get regular exercise. Exercise has many health benefits, including helping you to lose weight and lower your blood sugar levels. These both lower your risk of type 2 diabetes. Try to get at least 30 minutes of physical activity 5 days a week. If you have not been active, talk with your health care professional to figure out which types of exercise are best for you. You can start slowly and work up to your goal.
- Don’t smoke. Smoking can contribute to insulin resistance, which can lead to type 2 diabetes. If you already smoke, try to quit.
- Talk to your health care provider to see whether there is anything else you can do to delay or to prevent type 2 diabetes. If you are at high risk, your provider may suggest that you take one of a few types of diabetes medicines.
SEXUAL HEALTH BASICS
Sexuality is part of being human. Love, affection and intimacy all play a role in healthy relationships from childhood through old age.
You often hear about the importance of physical, mental and spiritual health, but feeling confident about your sexuality also is important. Achieving sexual health allows for:
- Healthy relationships
- Planned pregnancies
- Disease prevention
It’s essential to be well-informed about all aspects of sexual health and what it takes to have a fulfilling sex life. Similarly, it’s important to be aware of factors that can complicate your sexual health. Don’t let embarrassment keep you from bringing up concerns or asking questions of your doctor or other health care providers.
Sexually transmitted diseases (STDs), or sexually transmitted infections (STIs), are infections usually acquired though unprotected sexual contact with someone who’s infected.
But, you can’t always tell if someone is infected, because many STIs cause no symptoms. In fact, many people who have an STI don’t know it.
That’s why you have to be vigilant about STI prevention. Barrier methods of birth control, such as condoms, also help reduce your risk of getting most STIs. If you’re sexually active, having just one partner who agrees to remain sexually exclusive with you can also help prevent STIs.
Woman’s Sexual Health
Sexual health is important for a woman’s well-being, whether you’re trying to prevent pregnancy and sexually transmitted infections or you’re worried about low sex drive, painful intercourse or other problems related to women’s sexual health.
Learn how to achieve a fulfilling sexual relationship, and know how to protect yourself from sexually transmitted infections. As you get older, understand common changes in women’s sexual health — and how to maintain a healthy and enjoyable sex life at any age.
Men’s sexual Health
Sexual health is important for a man’s well-being, whether you’re trying to prevent pregnancy and sexually transmitted infections or you’re worried about erectile dysfunction or other problems related to men’s sexual health.
For some men, worries about penis size top the list of their sexual health concerns. However, you’re probably more normal than you think — and penis-enlargement products and procedures aren’t likely to be effective and may have risks.
As you get older, understand common changes in men’s sexual health — and how to maintain a healthy and enjoyable sex life at any age.
Sex and Aging
Adults can remain sexually active regardless of their age. In fact, many older adults desire and enjoy an active sex life.
An ongoing interest in sex, as well as satisfaction with the frequency and quality of sexual activity, is positively associated with health in later life. Of course, there are some challenges when it comes to sex and aging. Physical changes, illness, disabilities and some medicines can make sex challenging or difficult to enjoy.
There are many resources available to older adults to help them achieve a satisfying sex life. Don’t be afraid to bring up concerns with your doctor or other health care provider. And remember, whatever your age, take precautions to protect yourself from sexually transmitted infections.
Talking to kids about SEX
Kids and sexuality — those words strike fear into the hearts of many parents. But talking to kids about sex is an important part of parenting. Children and teens get a lot of information from peers and media sources, so they need your guidance to help them make healthy and appropriate decisions about their sexual behavior.
When it comes to talking to kids about sex, there’s no standard script. Your decision to educate your children about sexuality will likely be based on the child’s maturity, as well as your personal goals and values.
Look for everyday opportunities and let your child set the pace with his or her questions. As your child matures, you can provide more-detailed responses.
It’s normal to feel uncomfortable when talking to kids about sex. But by providing accurate and open communication, you increase the odds that your child will understand your values and make appropriate choices about sex.
