According to a growing body of evidence featured in a recent article in the NY Times, acetaminophen may greatly increase the risk of getting asthma.

For instance, a study published in The Lancet in 2008 examined information collected on more than 205,000 children from 31 countries as part of the International Study of Asthma and Allergies in Childhood, known as the Isaac study. The 2008 analysis found that children who had taken acetaminophen for a fever during the first year of life had a 50 percent greater risk of developing asthma symptoms, compared with children who had not taken the drug. The risk rose with increasing use — children who had taken acetaminophen at least once a month had a threefold increase in the risk of asthma symptoms.

A study published by British researchers in 2000 using data from the Isaac study found that the prevalence of asthma increased in lock step with sales of acetaminophen in the 36 countries examined. The more acetaminophen used in a country, the greater that country’s prevalence of asthma.

The causal link hasn’t yet been firmly established, according to the article, but randomized trials are under way to see just how safe acetaminophen really is.

Says one doctor quoted in the article when talking about how to use acetaminophen responsibly:  “We should be reserving paracetamol for very high fevers or for major pain relief,” he said.

If you or someone you know is  using acetaminophen for “major pain relief” to handle a chronic pain issue, you may want to weigh the benefits of short term relief against the possibility of long term breathing issues.

From the New York Times:

…Dr. Fu told him his ligament was not torn after all. His pain was from a fracture in a long bone in the lower leg that the other doctors had also noticed was broken. An M.R.I. at the University of Pittsburgh confirmed it, showing a perfectly normal A.C.L. (Dr. Fu adds that Mr. Ganobcik’s original scans had an image that was ambiguous. He wanted a better one, to see if Mr. Ganobcik’s ligament had been partly torn and was healing or had never been torn at all. He would not need surgery with a partial tear, but he would need more careful recuperation.)

Two scans. Three doctors. Two doctors convinced he had an ACL tear and only one who figured out with physical examination that a full ACL tear was impossible. Careful rehab was all that was needed.

Another doctor, James Andrews in Gulf Breeze, Florida, has also noticed instances of the unreliability of MRI’s like this in his practice as well, and decided to test the reliability of MRI’s by taking 31 healthy, asymptomatic professional baseball pitchers. None of the pitchers had reported any shoulder pain whatsoever. None.

But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. Andrews says.

Neither of doctors suggest that MRI’s are not medically useful for serious situations, it’s that they are overused and overtrusted. Just like studies that have shown that MRI’s are not reliable for finding the cause of back pain, Dr. Andrews’ study and Dr. Fu’s experience show that MRI’s are not reliable for figuring out what’s wrong when a shoulder hurts.

This should provide some solace for those out there who think an MRI can tell you why you experience pain. The results are in: they don’t.

Read the full New York Times article to read about another study on MRI’s and find out what makes doctors use MRI’s even when they know they don’t need them.

A fiery lady named Lorna came into my office a few weeks ago at the behest of one of my other clients to see what could be done about her shoulder.

After months of shoulder pain, weeks of PT and promises of surgery, I went to see Matt. After just one session with him I can tell I have found the road to recovery. Matt is very patient and encouraging. After a few more sessions I think I might even be able to challenge him to a hot game of hockey!!!

When Lorna walked in, she was unable to lift her left arm out to the side beyond about 30 to 35 degrees from her body. She physically couldn’t do it. It hurt. She also couldn’t lift her arm out in front of her beyond about 40-50 degrees without pain in the shoulder joint. An MRI by a  doctor showed an old rotator cuff injury which seemed too old to be “fixed” as well as signs of bone spurs within the shoulder joint.

So the doctor told her that if physical therapy didn’t help, she should consider surgery to clear out the bone spurs.  After several weeks of rotator cuff strengthening exercises and some painful attempts to restore ROM, she was no better off than when she had started.

But after one session at Upright Health, Lorna dramatically improved.

What ended up helping Lorna regain her range of motion in her first session with me? Restoring the proper alignment of the rest of Lorna’s body. She had a very strong asymmetry between the left and right sides of her back that was causing her whole torso to rotate. Her ribs were rotated, putting the shoulder blades into an odd position that did not allow for full range of motion.

With a few preliminary exercises to restore some balance to the back muscles, she regained some motion in her shoulder joint, and with a few other stretches, she was able to bring her hand up over her head to point at the sky. And all it took was just over an hour of postural work (versus more than 3 weeks of physical therapy).

So the lesson is that even if an image appears to tell you something, it might not. If medical images were fully, 100% conclusive, the doctor wouldn’t even have bothered telling Lorna to try physical therapy. If the bone spurs had really been the cause of her lack of range of motion, then no amount of rotator cuff strengthening would remove those bone spurs.

The trick was that the lack of range of motion was coming from the twisting in her back — NOT from the bone spurs, and all you needed was your low-tech eyeballs to see the problem!

“In a 1994 study published in the New England Journal of Medicine, a group of researchers imaged the spinal regions of ninety-eight people who had no back pain or back-related problems. The pictures were then sent to doctors who didn’t know that the patients weren’t in pain. The result was shocking: the doctors reported that two-thirds of these normal patients exhibited “serious problems” such as bulging, protruding, or herniated discs. In 38 percent of these patients, the MRI revealed multiple damaged discs. Nearly 90 percent of these patients exhibited some form of “disc degeneration.” These structural abnormalities are often used to justify surgery, and yet nobody would advocate surgery for people without pain. The study concluded that, in most cases, “the discovery by MRI of bulges or protrusions in people with low back pain may be coincidental.”

How We Decide by Jonah Lehrer, Page 162-163

There is also this brilliant gem in the same book:

“Forget about your MRI. What it’s showing you is probably not important.” ~Dr. Sean Mackey, Professor of at Stanford School of Medicine and associate director of the hospital’s pain-management division.

How We Decide by Jonah Lehrer, Page 163

Well, I don’t have to tell you that it very definitely affects your posture and your musculoskeletal health. You feel that at the end of the day anyway.

But Travis Saunders, a Certified Exercise Physiologist in Canada, sounds the very important alarm in a recent post on Scientific American’s website.  Here’s a snippet:

…in healthy human subjects, just 5 days of bed rest has been shown to result in increased plasma triglycerides and LDL cholesterol, as well as increased insulin resistance—all very bad things. And these weren’t small changes—triglyceride levels increased by 35%, and insulin resistance by 50%!

via Scientific American Guest Blog: Can sitting too much kill you?.

The gist of it is that the more you sit on a daily basis, the likelier it is that you will end up with a shocking number of diseases ad disorders as well as a noticeably higher risk of dying! I strongly recommend you check this article out.  Scientific American Guest Blog: Can sitting too much kill you?

The list of treatments includes, ice, heat, stretching, pills, orthotic inserts, cortisone injections, and — of course when all else has failed — surgery!

A few months ago, NPR ran a story about a brand new therapy for plantar fasciitis called schock-wave therapy that’s catching on in the U.S.

It’s like shock and awe for your feet and your pocketbook.

The main idea is to blast your foot with micro trauma so that the fascia (connective tissue) of your feet have to heal.  “Micro-bleeding” is the term a surgeon from Massachusetts uses in the article.  Hopefully, it makes the pain go away.  The price tag: from five hundred to several thousand dollars.  Effectiveness: unknown.

The problem is that the theories of what is going on with plantar fasciitis keep changing, so the technology and approaches keep getting more elaborate.

Many think that plantar fasciitis is caused by heel spurs, bony hook-like growths that develop on many people’s heels due to stress. But specialists don’t think that anymore.

As ideas of what plantar fasciitis is change, so have treatments. Doctors don’t do surgery for it anymore except in rare cases, largely because they’ve found surgery often makes people worse off.”

Patients have to be patient,” Duggal says. “They have to understand that this condition unfortunately is not fully understood.” [emphasis added]

via Experimental Therapy For Sore Heels Has Skeptics : NPR

The point here is that the focus on the symptomatic site forces the medical system to look at a body-wide problem as a mysterious local problem. This leads to an incomplete understanding of what’s happening.  And this incomplete understanding yields treatments that don’t make sense and often don’t work.

When the treatments don’t work, doctors either have to invent new treatments (like shockwave) or resort to the worst option of all: surgery.

If your foot hurts, look higher up! Look for knee alignment.  Look for proper hip mobility.  Look at the mid and upper back and see how extreme the curves are.

In my practice and in my personal life, I’ve noticed a correlation between a strong curve in the mid and upper spine and the symptoms of plantar fasciitis. It’s not 100% causative, but it’s definitely involved!  Hip mobility is also involved. Stretching the calf muscles alone barely makes a dent in the pain experienced with plantar fasciitis because it’s too narrowly focused.

Guess what? Research shows that tennis elbow ISN’T about inflammation. In fact, the pain from repetitive motions isn’t from inflammation at all!  Whether it’s typing, tennis, or track and field…

…numerous studies have shown, persuasively, that these overuse injuries do not involve inflammation. When animal or human tissues from these types of injuries are examined, they do not contain the usual biochemical markers of inflammation. Instead, the injury seems to be degenerative. The fibers within the tendons fray. Today the injuries usually are referred to as tendinopathies, or diseased tendons.

via Do cortisone shots actually make things worse? – NYTimes.com.

So why is it important to know that repetitive strain injuries aren’t actually problems with inflammation? Because it means treatment has to be totally different!  Ice won’t help reduce inflammation if isn’t there, and yet treatment protocols for tennis elbow (and typist’s syndrome) still include icing the site of pain! Does that make sense? Only if you think that numbing the nerves in your elbow or arm and reducing blood flow is the best way to get some momentary relief from the pain.

Tennis elbow is really a build up of micro-trauma.  You are gradually fraying the cables that move your arm.  How are you fraying them? Well, I’m not a trained medical professional or a scientific researcher, but in my mind, fraying means friction.

With tennis elbow, you get friction right where some tendons (extensor carpi radialis brevis and extensor digitorum communis in many cases) pass by some bones and other tendons (Current Concepts Review – Tendinosis of the Elbow).

These tendons and bones are very close together, and the slightest imbalance can throw off how these tendons and bones interact.

Proper movement at the elbow depends on what’s going on above and below the joint.  You have muscles and tendons that run into your fingers as well as up into the shoulder girdle. As tensions become imbalanced from what you might call “overtraining” certain muscle and tendon groups, you throw off the mechanics of your elbow joint.

Do that long enough, and your body tells you that the fraying from the friction in your elbow is not a good thing.  And it will tell you that with the signal of PAIN.  That pain tells you that there are some major problems happening that, if you leave them long enough, will develop into some very interesting changes on a cellular level to the soft tissues in the area.

Of course, when you realize that movement of the shoulder joint affects the elbow joint, you have to think about what affects proper movement at the shoulder joint (hello, spinal muscles, pelvic stabilizers, etc.)…and that’s why you need to think about the rest of your body and not JUST focus on the elbow when dealing with “tennis elbow.”