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	Featured Article BACK TO BED AGING IN PLACE HEALTH & FITNESS QUICK-TAKES READERS' FORUM

BACK TO BED

Low back pain (LBP) drives some people to take extreme measures. From slipping thick plywood boards between their extra-firm mattress and the box spring, to sleeping on the floor, those with back problems have endured all types of discomforts in the belief that firm surfaces provide the best relief from back pain. Research published in The Lancet debunks this myth. The study involved 313 people with insidious onset of LBP that they experienced while lying in bed or upon getting up in the morning. Half the subjects participating in the study slept on firm mattresses (rated 2.5/10) and half slept on mediums (rated 5.6/10), with one being the firmest and 10 the softest on the scale. The subjects recorded their LBP on a one to 10 scale before receiving the new mattresses, and then again after sleeping on them for three months. They also measured changes in pain-related disability. About 82% of those on the medium mattresses said they improved, compared with 68% of the people who had slept on firm mattressess. The authors of the study believe that the results were skewed against the medium mattresses. They say that people knew whether or not they had been given a firm mattress, and most people believe that a firm mattress is better for LBP. Because of this known bias, the scientists conjecture that medium mattresses are even better for LBP sufferers than the already impressive results suggest. While Goldilocks figured it out intuitively, she probably did not understand why the medium bed was "just right" for her. A soft bed does not provide enough support for the spine and muscles, while a firm mattress causes pressure points to develop. The medium mattress provides an equal distribution of support across the whole body surface that comes in contact with the bed. View Abstract... »

AGING IN PLACE

According to a recent AARP housing survey, 83 percent of older Americans want to stay in their current homes for the rest of their lives. They find their homes comfortable and convenient and feel secure and independent there. Survey responders said that they would prefer to remain in their homes even if they needed assistance with their basic activities of daily living (ADL's). However, as people age, the design of their homes plays an increasingly important role in how they manage their daily activities. Homes that were perfectly convenient at age 55 can cause problems in later years, as diminishing physical abilities make daily routines more difficult without some design modifications. People often find that they can no longer make it up the stairs, and there is no bedroom or bathroom on the first floor. There may be no railing at the front steps. The inside doorways are often too narrow to accommodate a walker or a wheelchair. Many people find they are unable to get up off the toilet once they sit down because it is too low, or that they can not safely get in and out of the tub or shower. Experts in the health, homebuilding, and retirement- planning fields recommend that younger people should plan their homes for their retirement years just as they plan their finances and a number of other important considerations. As one remodeling contractor quoted in BusinessWeek online says, "When you're framing out a bathroom, it's a simple process to reinforce the walls so that grab bars could be mounted to a solid structure. It takes a $20 to $30 piece of hardware, and maybe 15 minutes of a carpenter's time." But if you don't think ahead and decide later that you want grab bars, he says, removing tile and plaster and then doing the reinforcement "could take a half a day or more," and be much more expensive. So the best time to do these projects is when the house is first being built, or during already planned renovations. Take a good look at your home. Simple alterations can prevent one-third of all home accidents. These changes not only increase your safety, but enhance your comfort and increase the likelihood of your remaining independent in your home and community. THE FOLLOWING WEBSITES CONTAIN VALUABLE INFORMATION ABOUT AGING IN PLACE INITIATIVES AND UNIVERSAL HOME DESIGN: (If you have trouble reaching any of the links, press "Ctrl" and click on the link at the same time.) National Center for Seniors' Housing Research Concrete Change Senior Safe Home LifeEase LifeEase Practical Guide to Universal Home Design PDF AARP Universal Home Guidelines

HEALTH & FITNESS QUICK-TAKES

For decades, doctors have recommended ipecac syrup to induce vomiting in children who have ingested poisonous substances. This derivative from the root of the tropical ipecac plant has been one of the necessities for a well-stocked first aid kit. However, the American Academy of Pediatrics (AAP) is now discouraging the use of ipecac, and the U.S. Food and Drug Administration (FDA) may end over-the- counter sales of the drug as early as next year. According to the AAP, many people use the syrup inappropriately, without consulting a doctor or a poison control center. They say that ipecac can cause symptoms which are similar to an overdose of sedatives, complicating the proper diagnosis and treatment of the child. Furthermore, ipecac does not work completely; it usually leaves residual poison in the stomach. It may also stay in the body too long, causing a child to vomit up other antidotes administered by health-care personnel. One study found that using ipecac does not improve medical outcomes. This American Academy of Pediatrics Policy Statement: Poison Treatment in the Home is a meta-analysis that also discusses the difficulties of using charcoal in the home as a poison antidote. The November 2003 Pediatrics contains several articles discussing the new AAP stand on ipecac. DID YOU KNOW? PRIVACY ALERT: Google now provides reverse listings on phone numbers. Typing a phone number into the Google search window will elicit the owner's name, address, and Map Quest directions to the address of record for that number. Private information may be removed from the Google reverse listings by clicking on the telephone icon next to the phone number when the listing comes up in the search results, but Google takes 48 hours to process the removal. Unlisted phone numbers may or may not be in the Google database, so if having this information listed is a concern, it is a good idea to check. Go to http://www.google.com, type the telephone number into the search box, and hit "Enter". Many other sites also provide reverse listings, and removing the information from Google does not remove it from the other databases. On their page that details how to remove the private information, Google provides a partial list of the other databases, and they recommend performing a web search for a more complete list. THE GREAT AMERICAN SMOKEOUT IS NOVEMBER 20, 2003 (It is always the third Thursday in November) FOLLOW THESE LINKS FOR ACTIVITIES, IDEAS, AIDS, AND OTHER VALUABLE INFORMATION RELATED TO QUITTING SMOKING: American Cancer Society TobaccoFree.org Telephone Quitlines Rotator cuff tears are common, painful, and they can be debilitating. Depending on the extent of the tear, they often respond well to Physical Therapy. Sometimes therapy is not enough, and then the injury requires surgical repair. But what happens when the musculotendinous unit is too far gone, making it impossible to repair the tear? In the case of the subscapularis tendon, research published in the October 1, 2003 American edition of the Journal of Bone and Joint Surgery found that transferring the pectoralis major tendon worked pretty well in substituting for lost subscapularis function, even when there was an associated irreparable supraspinatus tear. However, the results were less favorable when the supraspinatus tendon was also involved, and surgeons may be less willing to perform the pectoralis major tendon transfer in those cases. Swiss Balls have long been used in the clinic to successfully train and reeducate postural muscles, improving their control. Now, a growing number of people are using these exercise balls as office furniture, replacing their desk chairs. Physical Therapists should caution people to build up their sitting time on the balls slowly. The postural muscles are very susceptible to fatigability, so sitting on the physioballs for eight to 12 hours at a time is not a good idea. Sitting for 20 to 30 minutes at a time is a good starting point for someone who is at a reasonable level of fitness, and that time can be increased slowly. However, sitting on the ball throughout the whole workday should not be the end goal in any case.

READERS' FORUM

This spot features answers to questions from our readers. Send your physical therapy-related questions to: pt@oaktreept.com. If we answer your question in this column, we will send you an Oak Tree PT ergonomic pen. Please be sure to include your mailing address, to be used strictly for mailing the pen only, and no other purpose. I will also be happy to publish in this Readers' Forum any original, relevant, well-written articles submitted by readers. Just forward your material to: pt@oaktreept.com. I ASKED THE FOLLOWING QUESTION IN OCTOBER'S ISSUE: What is the physiological cause of the dark circles people get under their eyes when they go for prolonged periods with little or no sleep? PENNY GERSHMAN WROTE BACK TO ME IMMEDIATELY (She says she is very competitive) WITH THIS ANSWER: Here is what I found about the dark circles: from: http://www.abc.net.au/science/k2/h omework/s95516.htm "First, the blood supply from that skin drains into the internal jugular vein. That drainage is a lot better when you're lying down than when you're standing up - so the blood tends to pool there. This is one factor that will give you dark half-circles under the eyes. Second, you have huge numbers of Mast Cells in the skin under the eyes. These Mast Cells will release histamine (sometimes by themselves, and sometimes when you rub them), which will cause swelling under the eyes - and darkness. Third, when you get dehydrated (which sometimes happens when you get tired), the skin under the eyes gets dark. And finally, not a reason but an observation. Eyes in animals are an important signalling area. " -Peninah (Editor's note: The website goes on to say that this phenomenon therefore signals to other humans that we are tired.) An Oak Tree PT ergonomic pen was pony expressed to Penny for her enterprising answer to my question.