orthopedics

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The Key To Gardening Without Blowing Out Your Back? It’s Not What You Think


Say you love gardening, like Boston-based landscape designer Barbara Quartier in the video above. Say you, like her, find that your happy toil is tinged with dread, with the foreknowledge that one of these days, you’ll be pulling at a recalcitrant weed or hefting a heavy pot and boing: There goes your back. Or your knee. Or your neck. But you get carried away in the absorbing process of earthly beautification. You take chances you know you shouldn’t. What’s a gardener to do?

I asked Dr. Sharon Bassi of New England Baptist Hospital, which specializes in orthopedics and spine care, and she responded with evidence- and experience-based wisdom that diverges surprisingly from the usual folk wisdom. You know the usual maxims: Above all, bend your knees when you lift. Avoid prolonged repetitive movement without breaks. Know your weight limits.

All good pointers, Dr. Bassi says, but her central message, based on research and countless encounters with injured patients, is this: Strengthen your core, particularly your back muscles. Studies and experience suggest that matters more than specific postures.

Her advice, lightly edited:

“Many people feel that they have to lift a certain way or bend a certain way or not carry excess amounts of loads. But the reality is that it’s different for each individual, and a lot depends on how strong you are at baseline. One of the key pieces of our bodies that we fail to strengthen is the spine.

We talk about core strengthening a lot, about getting the abdominal muscles strong. But in parallel, the muscles that are less often talked about are the para-spinal muscles, and there are many of them: There are very tiny ones that hold the joints together, and there are larger ones that really help stabilize your back. And those are the muscles that we need to focus on a lot. In people who present with back strain or pain, we talk about core but we talk equally about getting the para-spinals in the back very, very strong, because that’s what helps holds you erect, that’s what helps to prevent sprain and strain injuries.

It’s especially important in people who are doing prolonged periods of gardening, or any type of prolonged activity — almost every activity involves your spine to a certain degree — that in parallel, those individuals strengthen those two key components. That will help prevent a lot of injuries and allow you to do almost anything in any comfortable posture and lift many pounds of weight without worrying about injuring your back.

So I think this whole notion of correct biomechanics — like bending from the knees — is really a little bit over-rated, and a little bit over-talked-about. We see plenty of people who have injuries having lifted in what is considered an ergonomically correct posture. And we don’t have great studies that show that by lifting in that manner you’re going to prevent an injury. We have more studies telling us that if we strengthen, that we can pretty much lift however we want, however it feels comfortable, because we will inherently be engaging the right muscles.”

(Here both Barbara Quartier — who goes by Barbara Peterson in her landscape design business — and I expressed some shock. We’d heard forever about bending our knees, but never a word about our para-spinals.)

“It really is a common misbelief,” Dr. Bassi responded. “We see patients who say, ‘I knew I lifted this wrong, and that’s why this happened,’ but that’s not necessarily true.”

So the question instantly arises, of course: How to strengthen those para-spinal muscles? Continue reading

Knees, Food, Periods: Top 10 Medical Tips If Your Daughter Plays Sports

(AP Photo/Gerald Herbert)

(AP Photo/Gerald Herbert)

You could call this “Title IX Medicine.”

Title IX, of course, refers to the landmark 1972 anti-discrimination law that gave huge added impetus to school sports programs for girls, helping create cohorts of more athletic grrrrrrrls.

In Title IX’s 40-plus years, American girls’ participation in high-school and college sports has jumped more than 10-fold to well over 3 million. That means many stronger, healthier girls — but it also means more girls at risk for sports-related injuries and what’s known as the Female Athletic Triad, a worrisome mix of poor nutrition, menstrual dysfunction and danger to bone health.

This week, Boston Children’s Hospital announced the creation of its new “Female Athlete Program,” aimed at treating “the entire female athlete – not just a single injury.”

“We know that the build of girls — both their musculature and bone structure — is different than boys’, as is their hormonal milieu,” said the program’s co-director, Dr. Kathryn Ackerman. “We really need to start tailoring our care of these athletes in a slightly different way.”

Certain specific issues need extra attention among girl athletes, she said. They’re at a five to eight times higher risk of anterior cruciate ligament knee injuries. “Aesthetic” activities like ballet tend to be linked with higher risks of eating disorders. If menstrual cycles become abnormal, bone development could suffer.

Some articles suggest that girls’ soccer is second only to men’s football in terms of concussions.

The new program aims to contrast with the traditional piecemeal approach to girls’ injuries and other health issues, Dr. Ackerman said. For example, “A girl comes in having sustained multiple stress fractures, and no one has asked her about her menstrual status or her calcium or Vitamin D intake or her overall caloric intake.” Some studies, she said, suggest that up to 60 percent of girl athletes have at least one component of the Female Athlete Triad: eating dysfunction, loss of menstrual cycle or low bone density.

Dr. Ackerman, herself a former national team rower, and the program’s co-director, Dr. Martha Murray, an orthopedic surgeon with a swimming background, kindly generated this list of their top 10 tips for parents of girl athletes. Dr. Ackerman expands in the comments below.

Dr. Kathryn Ackerman (Courtesy BCH)

Dr. Kathryn Ackerman (Courtesy BCH)

1. Your daughter can minimize her risk of ACL (anterior cruciate ligament) injury with a simple training program.

It would include hamstring strengthening, landing bio-mechanics, core stability and overall muscular balance. More details in the program’s ACL handout.

2. She needs to be getting good nutrition to play well, especially enough calories and the right amount of calcium and vitamin D.

Calorie counts depend on a girl’s level of activity and growth, but she should be getting 1,300 milligrams of calcium a day until she’s 19, then 1,000 milligrams a day until menopause, when calcium again needs an increase. Vitamin D recommendations vary, but many bone experts recommend at least 800 international units a day for a blood level of at least 30. More details on nutrition here. Continue reading