This March, I was fortunate to attend our annual AAOS (American Academy of Orthopaedic Surgeons) meeting in Orlando. Being in the midst of the entire hubbub is always a bit overwhelming. There is no way to see or do everything available in the courses, symposia, poster displays, and then the exhibits and running into old friends. I came home with a sense of pride having been involved with this medical industry for so long and a secure feeling that I have been a cog in the wheels that make it all work.
I also learned some interesting facts worth sharing: [The information is from The United States Bone and Joint Initiative (USBJI).]
- One in two Americans has a musculoskeletal condition costing an estimated $213 billion each year. An estimated 126.6 million Americans are affected by a musculoskeletal condition--comparable to the total percentage of Americans living with a chronic lung or heart condition.
- Arthritis is the most common cause of disability, with 51.8 million--half of U.S. adults age 65 and older--suffering from the disease. With the aging of the American population, the report projects arthritis prevalence to increase to 67 million people, or 25 percent of the adult population, by 2030. Arthritis is not just a disease for older Americans, with two-thirds of arthritis sufferers under age 65.
- Back and neck pain affects nearly one in three or 75.7 million adults.
- Osteoporosis affects 10 million Americans, with 19 million more (mostly women) at risk for the disease. One in two women and one in four men over the age of 50 will have an osteoporosis-related fracture, and 20 percent of hip fracture patients over age 50 will die within one year of their injury.
- Among children and adolescents, musculoskeletal conditions are surpassed only by respiratory infections as a cause of missed school days.
In my world, back here at home, I treat adult degenerative conditions, mainly spine. We joke in my office about "stamping out back pain - one patient at a time." Most of these conditions do not require surgery. I try to keep things simple.
Recently, a friend asked if patients usually do what I tell them. Unfortunately, my answer was, "no, I ask patients many times every day to stop smoking and lose weight." Nicotine has been proven without a doubt to be detrimental to the health of intervertebral discs and tissue healing. A BMI of over 40 has been shown to cause adverse joint problems and increase operative complications four to five fold.
If you are seeing patients who suffer from spine problems, my general advice is:
- avoid nicotine products
- try to achieve reasonable body weight (bariatric advice may be helpful)
- stay active and fit (at a minimum, try to walk 30-45 minutes every other day)
- avoid heavy lifting (over 30-50 pounds)
- avoid prolonged sitting (shift positions or stand at work)
- do housework or yardwork in intervals (work 20-30 minutes, take a 15-20 minute break and then return to your work).
I have found that in many situations a six to eight month course of body reconditioning and fitness can be more effective than surgery. I have also come to realize in some difficult cases, multimodal pain management can be lifesaving. I encourage elderly patients to work on core strengthening and on balance. I also feel it is important they have evaluation for osteopenia and Vitamin D.