The vast majority of American adults have experienced acute low back pain at some point in time, and a notable percentage of them suffer from varied levels of chronic pain. In fact, nearly 90% of adults acknowledge spine pain to their primary physician – most commonly radiating through the lumbar spine area. In response, many visit the local chiropractor for relief but an adjustment may not be the best remedy.

Low back pain can be caused by numerous factors ranging from significant pathologies like spinal impingement, to a cancerous tumor, to mechanical issues including congenitally-derived scoliosis. More commonly though low back pain is associated with mechanical issues derived from both hypo and hyperkinetic induced postural deviations.

Hypokinetic disease is a fancy way of saying sedentary; individuals that do not move enough will likely be overweight and have seated posture issues including weak and shortened hip extensors. Watching television promotes a posterior pelvic tilt and flexed knees, which creates pelvic instability. Conversely, the chronic exerciser, who runs marathons, is likely hyperkinetic and may present an anterior pelvic tilt, denoting tight hip flexors.

Sometimes, lateral aspects of the body can create equal complications in the hip complex. In cases such as these, the hip is fixed in tilted position and can cause kinetic disturbances. The muscles adjust to the structural misalignment which is observationally discernible as a lateral pelvic tilt, or more commonly referred to as a limb-length disparity.

Another area associated with low back pain is the foot. Pronation of the foot causes negative outcomes up the kinetic chain which often manifests in low back stress. Studies have linked flat feet, ankle instability and excessive pronation to low back pain. Excessive pronation, in particular, has been shown to cause limb-length discrepancies.

Low back pain presents with many contributing factors and it takes a full-body assessment to identify the possible dysfunctions that may contribute to the condition.

GALLSTONES IN DIETERS  (from  Nutrition Action Healthletter,  August 2013)

A very-low-calorie diet may mean more weight loss…but a higher risk of gallstones

Swedish researchers monitored 6,640 overweight or obese people (mostly women) who chose either a very-low-calorie diet (500 calories a day) or a low-calorie diet (1,200 to 1,500 calories a day) for three months. Then both groups entered the same weight maintenance phase—including exercise and diet advice—for nine months.

At the end of the 12 months, the very-low-calorie dieters had lost more weight (24 pounds) than the low-calorie dieters (18 pounds). However, there were 48 gallstones requiring hospital care in the very-low-calorie dieters, but only 14 in the low-calorie dieters.

What to do: If you’re thinking about going on a very-low-calorie diet, consider gallstones as a possible downside. Although rare, they were roughly three times more common than on the low-calorie diet. (And don’t assume that a very-low-calorie diet leads to greater weight loss. It’s possible that the more-ambitious dieters picked that option.)

Source: Int. J. Obesity 2013. doi:10.1038/ijo.2013.83.

CALCIUM CONFUSION   (from Nutrition Action Healthletter,  August 2013)

Three new studies have fueled confusion over calcium and heart disease

Swedish researchers who tracked more than 61,000 women for 19 years found that calcium-supplement takers who got at least 1,400 milligrams of calcium a day (from food and calcium supplements) were 2½ times more likely to die than calcium-supplement takers who got 600 to 1,000 mg a day.

German researchers who followed nearly 24,000 men and women for 11 years found that those who took calcium supplements had roughly double the risk of a heart attack of those who didn’t take calcium supplements. (However, less than 4 percent of the participants reported taking calcium, and the study didn’t report how much they took.)

In the NIH-AARP Study, which tracked more than 388,000 Americans for 12 years, men who took at least 1,000 mg of calcium a day from calcium supplements or multivitamins had about a 20 percent higher risk of dying of heart disease than men who took no calcium, though there were hints that the risk was only higher among those who smoked. Women who took calcium supplements or multivitamins had no higher risk.

What to do: Shoot for the Recommended Dietary Allowance for calcium, but no more. (The RDA is 1,000 mg a day for women up to age 50 and men up to age 70, and 1,200 mg for anyone older than that.) But don’t forget: the RDA includes the calcium you get from foods. Cheese, yogurt, and milk each has about 300 mg per serving, and a typical diet gets around 300 mg from other foods. So you could hit 900 mg if you eat, say, two dairy foods a day.

Why stop at the RDA? Though the evidence is far from conclusive, it’s possible that taking high daily doses of calcium supplements (1,000 mg or more) may harm the heart. And there’s no evidence that more is better.

Sources: BMJ 346: f228, 2013; Heart 98: 920, 2012; JAMA Intern. Med. 173: 639, 2013.

Debora’s Note:  People diagnosed with osteopenia or osteoporosis may need more calcium than indicated by these studies, and should check with their physician.