Headaches and Migraines: Chiropractic Saves Federal and Private Insurers $13,680,000,000

A great article published by a friend of mine...

Headaches and Migraines:

Chiropractic Saves Federal and Private Insurers $13,680,000,000

and Resolves Many Issues Facing Emergency Rooms Today

by Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Published in Dynamic Chiropractic, Volume 29, Issue 22
It was reported by Doheny in 2006 that migraine headaches cost U.S. employers more than $24 billion annually, including direct health care costs and indirect expenses such as absenteeism. Doheny goes on to report that according to Michael Staufacker, director of program development for StayWell Health Management in St. Paul, Minnesota, "The programs are so few and far between because many companies ‘don't perceive it as a priority’" (p. 10).
Much of the public perceive headaches and migraines as normal occurrences. For example, a patient will enter a doctor's office and report they get normal headaches, not realizing that pain is never a normal occurrence. Symons, Shinde and Gilles (2008) highlighted a statement from http://www.iasp-pain.org saying that pain is "'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage'" (p. 277). As a result of the public not taking many types of headaches as potential serious problems, they let the condition linger and that can lead to negative sequella.
According to Munakata, Hazard, Serrano, Klingman, Rupnow, Tierce, Reed and Lipton (2009) "...neuroimaging studies have provided compelling evidence that suggests progressive brain changes in persons with migraines...migraine frequency is associated with posterior circulation infarcts and diffuse white-matter lesions...Welch et al. showed that impairments in iron homeostasis in periaqueductal grey areas that were associated with migraine duration and chronic daily headache" (Munakata et al., 2009, p. 499).
Munakata et al. also reported that the economic impact of migraines in both direct healthcare costs and indirect costs of absenteeism is a huge economic burden. The direct cost of migraines ranges from $127 to $7,089 per and the indirect cost due to absenteeism ranges from $709 to $4,453 per victim, making migraines an economic burden to the individual, the insurer, the employer with absenteeism and increased benefits paid and local, state and federal entities who will experience a lowered tax base from lost wages. It was also reported that between 2005 and 2006 there were 1,729,555 physician office visits, 186,603 advanced imaging procedures, 59,589 other diagnostic procedures, and 22,168 hospital days with a primary diagnosis of migraine or headache; all of which are paid by private or public insurers or out of the pockets of individuals. In short, the costs are staggering and a burden to the economy.
Friedman, Feldon, Holloway and Fisher (2009) reported that acute headaches account for 5% of emergency department (ED) visits in hospitals. In addition, they also reported that "…the ED environment that may also contribute to unsatisfactory treatment response include limited physician contact time that may preclude a detailed history, overuse of ED by patients with substance abuse problems, the need for rapid triage, the competing distraction of patients with life-threatening conditions, and directives (or lack thereof) for care dictated by the referring physician…Thus, the treatment of migraine patients in the ED appears to be suboptimal and the high rate of recurrent headache may be attributed to underutilization of relatively ‘migraine specific’ treatment" (Friedman et al., 2009, p. 1164).

Nelson, Suter, Casha, du Plessis and Hurlbert (1998) reported on randomized clinical trials that took place over an 8-week course. The results showed there was minor statistical differences in outcomes for improvement during the trial period for chiropractic care and for amatriptyline and over-the-counter medications for treating migraine headaches. It was also reported that there was no statistical benefit in combining therapies. However, the major factor is that in the post-treatment follow-up period, chiropractic was 57% more effective in the reduction of headaches than drug therapy. In addition, it was reported that, with the drug group, "...58% experienced medication side effects important enough to report them. In the amatriptyline group, 10% of the subjects had to withdraw from the study because of intolerable side effects. Side effects in the SMT (Spinal Manipulative Therapy) group were much more benign, infrequent, mild and transitory. None required withdrawal from the study (Nelson et al., 1998, p. 511). Although this study was conducted 13 years ago, a more current study by Chaibi, Tuchin and Russell (2011) reported that that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine, supporting the previous findings. Although more research is desperately needed, the above conclusions give the public clear directions with migraines and headaches.

Using the 57% increased effectiveness that chiropractic has over drug therapy (leaving out the overlap that chiropractic could help without drugs) and the $24,000,000,000 ($24 billion) Americans pay for headaches and migraines, the savings would result in $13,680,000,000. back in the insurers, the public's and the government's pockets. In addition, if chiropractic reduced the necessity for emergency room visits by 57%, then the ED doctors could focus on what their primary purpose is, to save lives in urgent scenarios.
Chiropractic offers solutions to the federal government, local government, public and private insurance companies, eases the burden on emergency rooms and prevents unnecessary side effects of drugs that are not clinically indicated, with a more viable and proven drugless solution. Although much more research is desperately needed to explore the benefits of chiropractic with migraines and headaches, the research that is available clearly reports that chiropractic offers immediate solutions. These solutions will add to the economy of local, state and federal governments by increasing the tax base and productivity in the marketplace as a result of keeping workers at work and circulating money into local economies with increased paychecks at the end of the year and productivity avoiding absenteeism. The research is conclusive and chiropractic has solutions to many of the economic and societal problems in the United States and worldwide.
References:
1. Doheny, K. (2006). Recognizing the financial pain of migraines. Workforce Management, 85(16), 10-12.
2. Symons, F. J., Shinde, S. K., & Gilles, E. (2008). Perspectives on pain and intellectual disability. Journal of Intellectual Disability Research, 52(Pt 4), 275-286.
3. Munakata, J., Hazard, E., Serrano, D., Klingman, D., Rupnow, M. F. T., Tierce, J., Reed, M., & Lipton, R. (2009). Economic burden of transformed migraine: Results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache, 49(4), 498-508.
4. Friedman, D., Feldon, S., Holloway, R., & Fisher, S. (2009). Utilization, diagnosis, treatment and cost of migraine treatment in the emergency department. Headache, 49(8),1163-1173.
5. Nelson, C. F., Bronfort, G., Evans, R., Boline, P., Goldsmith, C., & Anderson, A. V. (1998). The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. Journal of Manipulative & Physiological Therapeutics, 21(8), 511-519.
6. Chaibi, A., Tuchin, P. J., & Russell, M.B. (2011). Manual therapies for migraine: A systematic review. The Journal of Headache and Pain, 12(2), 127-133.

his research indicates that chiropractic is 457% more effective than medicine for chronic low back pain.

Low Back Pain:

Chiropractic Adjustments vs. Muscle Relaxants

by Mark Studin DC, FASBE(C), DAAPM, DAAMLP

 

Chiropractic had a better outcome in 24% of the patients

 

Low back pain is one of the most common maladies among the general population and the incidence of occurrence was reported by Ghaffari, Alipour, Farshad, Yensen, and Vingard (2006) to be between 15% and 45% yearly. Hoiriis et al. (2004) reported it to be between 75% and 85% over an adult lifetime in the United States. Chou (2010) writes that, "Back pain is also the fifth most common reason for office visits in the US, and the second most common symptomatic reason..." (p. 388). Historically and based upon this authors 3+ decades of treating low back pain with treatment options that range from heating pads, ice packs, over-the-counter drugs, prescription drugs, surgery, acupuncture and beyond, the most important questions are, "What works? What's proven and what has the best results with the least side effects allowing the patient to regain a normal lifestyle as quickly as possible."
Muscle relaxers are a common drug that has been prescribed by medical doctors for years for nonspecific low back pain. According to Chou (2010), " The term ‘skeletal muscle relaxants’ refers to a diverse collection of pharmacologically unrelated medications, grouped together because they are approved by regulatory agencies for treatment of spasticity or for musculoskeletal conditions such as tension headache or back pain." They are drugs that has been long studied and the effects and side effects have been well documented. Van Tudlar, Touray, Furlan, Solway, and Bouter (2003) concluded that, "Muscle relaxants are effective in the management of nonspecific low back pain, but the adverse effects require that they be used with caution"(p. 1978).
Chou (2010) also stated that, "Skeletal muscle relaxants are an option for acute nonspecific low back pain, although not recommended as first-line therapy because of a high prevalence of adverse effects" (p. 397). He reported that muscle relaxants had a moderate success rate defined by a 1-2 decrease in pain scales rated out of 10. Simply put, if a patient had a pain scale of 9, one could expect the muscle relaxers prescribed to bring the pain to an 8 or 7 at best and include all of the side effects. According to Drugs.com, side effects of muscle relaxants include:
More common
Blurred or double vision or any change in vision; dizziness or lightheadedness; drowsiness
Less common
Fainting; fast heartbeat; fever; hive-like swellings (large) on face, eyelids, mouth, lips, and/or tongue; mental depression; shortness of breath, troubled breathing, tightness in chest, and/or wheezing; skin rash, hives, itching, or redness; slow heartbeat (methocarbamol injection only); stinging or burning of eyes; stuffy nose and red or bloodshot eyes
Less common or rare
Abdominal or stomach cramps or pain; clumsiness or unsteadiness; confusion; constipation; diarrhea; excitement, nervousness, restlessness, or irritability; flushing or redness of face; headache; heartburn; hiccups; muscle weakness; nausea or vomiting; pain or peeling of skin at place of injection (methocarbamol only); trembling; trouble in sleeping; uncontrolled movements of eyes (methocarbamol injection only)
Rare
Blood in urine; bloody or black, tarry stools; convulsions (seizures) (methocarbamol injection only); cough or hoarseness; fast or irregular breathing; lower back or side pain; muscle cramps or pain (not present before treatment or more painful than before treatment); painful or difficult urination; pain, tenderness, heat, redness, or swelling over a blood vessel (vein) in arm or leg (methocarbamol injection only); pinpoint red spots on skin; puffiness or swelling of the eyelids or around the eyes; sores, ulcers, or white spots on lips or in mouth; sore throat and fever with or without chills; swollen and/or painful glands; unusual bruising or bleeding; unusual tiredness or weakness; vomiting of blood or material that looks like coffee grounds; yellow eyes or skin.(http://www.drugs.com/cons/skeletal-muscle-relaxants.html)
　
When comparing chiropractic spinal adjustments to muscle relaxants for low back pain, it first must be clarified that we are not discussing physical therapy or osteopathic manipulation. While different specialists render tremendous benefits to patients specific to various diagnoses, this research review is limited to a chiropractic spinal adjustment.
Wilkey, Gregory, Byfield, & McCarthy (2008) studied randomized clinical trials comparing chiropractic care to medical care in a pain clinic. "The treatment regimens employed by the pain clinic in this study consisted of standard pharmaceutical therapy (nonsteroidal anti-inflammatory drugs, analgesics, and gabapentin), facet joint injection, and soft-tissue injection. Transcutaneous electrical nerve stimulation (TENS) machines were also employed. These modalities were used in isolation or in combination with any of the other treatments. Chiropractic group subjects followed an equally unrestricted and normal clinical treatment regimens for the treatment of [chronic low back pain] were followed. All techniques that were employed are recognized within the chiropractic profession as methods used for the treatment of [low back pain]. Many of the methods used are common to other manual therapy professions" (p. 466-467).

After 8 weeks of treatment, the 95% confidence intervals based on the raw scores showed improvement was 1.99 for medicine and 9.03 for the chiropractic group. This research indicates that chiropractic is 457% more effective than medicine for chronic low back pain.
Within that group of 457% falls patients cared for by muscle relaxants.
Hoiriis et al. (2004) reported in their raw data that the chiropractic groups responded 24% better in reducing pain and concluded that, "Statistically, the chiropractic group responded significantly better than the control group with respect to a decrease in pain scores" (p. 396). This was done in "blinded, randomized clinical trials [which] are considered the gold standard of experimental design" (Hoiriis et al., 2004, p. 396).
　
REFERENCES
1. Ghaffari, M., Alipour, A., Farshad, A. A., Yensen, I., & Vingard, E.(2006).Incidence and recurrence of disabling low back pain and neck-shoulder pain. Spine, 31(21), 2500-2506.
2. Hoiriis, K. T., Pfleger, B., McDuffie, F. C., Cotsonis, G., Elsangak, O., Hinson, R., & Verzosa, G. T. (2004). A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics, 27(6), 388-398.
3. Chou, R. (2010). Pharmacological management of low back pain. Drugs, 70(4) 387-402.
4. van Tudlar, M. W., Touray, T., Furlan, A. D., Solway, S., & Bouter, L. M. (2003). Muscle relaxants for nonspecific low back pain: A systematic review within the framework of the cochrane collaboration. Spine, 28(17), 1978-1992.
5. Drugs.com, (2004). Skeletal muscle relaxants (systemic). Retrieved from http://www.drugs.com/cons/skeletal-muscle-relaxants.html
6. Wilkey, A., Gregory M., Byfield, D., & McCarthy, P. W. (2008). A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. The Journal of Alternative and Complementary Medicine, 14(5), 465-473.

Chiropractic Care Saves Money

Work Related Injuries, Recurring Low Back Pain, Chronic Care and Chiropractic Treatment:

A Proven Solution to Save Federal, State and Private Insurers $2,871,485,223

 

by Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Published in Dynamic Chiropractic 8/26/2011 

　

Low back pain and its treatment are a worldwide epidemic in human suffering and as a result, an economic burden to federal, state, public and self-insured risk takers who insure the injured. In 2009, Russo, Weir and Elixhauser reported that hospital stays for low back pain were 3.9 out of every 1000 people aged 55-64 years. That was rated as the #8 reason for hospital stays and fell closely behind cardiac conditions and degenerative arthritis. While low back pain has been well chronicled, recurring low back pain and the necessity for chronic care is now beginning to realize results that necessitate the proper approach to mitigate its frequency, duration and economic impact as sequella.
A very significant component of low back patient is its recurrence after initial care has been rendered as well as complications that ensue. Wasiak, Kim and Pransky reported in 2006 that, "Recent studies suggest that acute low back pain evolves into a chronic or recurrent condition more often than previously suspected" (p. 220). They went on to report that 40% of individuals with recurring low back pain sought additional care when the pain recurred and 42.9% of those had continued care and work disability lasting more than 201 days, underscoring the significance of the problem.
According to Dagenais, Caro and Haldeman in 2007, "The economic burden of a disease is the sum of all costs associated with that condition which would not otherwise be incurred if that disease did not exist. Given the many categories of costs that must be considered, it can be challenging to fully estimate the economic burden of an illness as data are often unavailable. The term 'cost' in health economics refers to the value of the consequences of using a particular good or service rather than its price...Despite this example, it should be made clear that estimating the economic burden of a disease is not simply a matter of tabulating the amount reimbursed for all clinician services related to a particular diagnosis. The total cost of illness—or economic burden—has three components: (1) direct (medical and nonmedical) costs; (2) indirect costs; and (3) intangible costs" (p. 9). Although indirect and intangible costs are significant burdens, this paper will focus solely on direct costs.
When considering direct costs for work related claims, studies indicate that non-work related indemnity plans should be included for work related low back injuries. Lipscomb, Dement, Silverstein, Cameron, and Glazner reported in 2009 that, "The private health insurance payment rates for workers with one work-related injury were 40% higher than for those with no history of work injury..." (p. 1188). The reasons are simple; indemnity carriers are victims of many workers' compensation carrier tactics created by the indemnity carriers, as reported by Griffin (2007), to deny, delay and defend. Patients need care and will access any system at their disposal so they can get necessary care and return to a normal, pain free lifestyle, leaving the indemnity carriers to absorb those financial costs. Although this is a significant factor, it is difficult to assign numbers and amounts that are directly tied to work related injuries, although those statistics undoubtedly tally in the billions.
Utilizing the Joint Report to the Governor by New York State Workers’ Compensation Board in 2009 as a reference, in 2004 the total number of claims in New York was 143,667 and out of those claims, 19.3% were low back related. The total costs for treating low back was $579,675,476.96, calculated for inflation to 2011 (Tom's Inflation Calculator, 1997-2011, http://www.halfhill.com/inflation.html). This equates to $29.88 per resident to treat work related low back pain. Nationally, this equates to $9,262,855,559 based upon US Census statistics.
Cifuentes, Willets and Wasiak (2011) compared the treatment of recurrent or chronic low back pain. They considered any condition recurrent or chronic if there was a recurrent disability after a 15 day absence and return to disability. Anyone with less than a 15 day absence was excluded from the study.
The study concluded that chiropractic care during the health maintenance care period resulted in:
16% Decrease in disability duration of first episode compared to physical therapy
240% Decrease in disability duration of first episode compared to medical physician's care
6.6% Decrease in opioid (narcotic) use during maintenance care compared to physical therapy care
17.2% Decrease in opioid (narcotic) use during maintenance care compared medical physician's care
32% Decrease in average weekly cost of medical expenses during disability episode compared to physical therapy care
21% Decrease in average weekly cost of medical expenses during disability episode compared to medical physician's care
The study concluded that chiropractic care during the disability episode resulted in:
24% Decrease in disability duration of first episode compared to physical therapy
250% Decrease in disability duration of first episode compared to medical physician's care
5.9% Decrease in opioid (narcotic) use during maintenance care compared to physical therapy care
30.3% Decrease in opioid (narcotic) use during maintenance care compared medical physician's care
19% Decrease in average weekly cost of medical expenses during disability episode compared to physical therapy care
43% Decrease in average weekly cost of medical expenses during disability episode compared to medical physician's care
Based upon the Joint Report to the Governor (2009) and the statistics rendered by Cifuentes et al. (2011), the savings with chiropractic care utilized exclusive from medicine and physical therapy ranges from $1,759,942,556 with physical therapy to $3,983,027,890 with medicine. Understanding that most medical physicians utilize physical therapy as a primary tool for back related pain, we will average the savings to $2,871,485,223 by utilizing chiropractic care.
Cifuentes et. al (2011) started by stating, "Given chiropractors are proponents of health maintenance care...patients with work related Low back pain who are treated by chiropractors would have a lower risk of recurrent disability because that specific approach would be used (p. 396). They concluded by stating, " After controlling for demographic factors and multiple severity indicators, patients suffering nonspecific work-related LBP who received health services mostly or only from a chiropractor had a lower risk of recurrent disability than the risk of any other provider type (Cifuentes et. al, 2011, p. 404).
References
1. Russo, A., Wier, L. M., & Elixhauser, A. (2009, September). Hospital utilization among near-elderly adults, ages 55 to 64 years, 2007. Agency for Healthcare Research and Quality, Retrieved from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb79.jsp
2. Wasiak, R., Kim, J., & Pransky, G. (2006). Work disability and costs caused by recurrence of low back pain: Longer and more costly than in first episodes. Spine, 31(2), 219-225.
3. Dagenais, S., Caro, J., & Haldeman, S. (2008). A systematic review of low back pain cost of illness studies in the United States and internationally. Spine, 8(1), 8-20.
4. Lipscomb, H., Dement, J., Silverstein, B., Cameron, W., & Glazner J. (2009). Who is paying the bills? Health care costs for musculoskeletal back disorders, Washington State Union Carpenters, 1989-2003. Journal of Occupational and Environmental Medicine, 51(10), 1185-1192.
5. Griffin, D. (2007, February 7). Insurance companies fight paying billions in claims. Anderson Cooper Blog 360°, Retrieved from http://www.cnn.com/CNN/Programs/anderson.cooper.360/blog/2007/02/ insurance-companies-fight-paying.html
6. New York State Workers’ Compensation Board (2009, March). Joint report to the Governor, From the Superintendant of Insurance and Chair, Workers' Compensation Board, summarizing and benchmarking workers' compensation data and examining progress on prior recommendations for improvement in data collection, Retrieved from http://www.wcb.state.ny.us/content/main/TheBoard/ 2009DataCollectionReport.pdf
7. Halfhill, T. R. (1997-2011). Tom's Inflation Calculator. Retrieved from http://www.halfhill.com/ inflation.html
8. U.S. Census Bureau (2010, December 22). U.S. POPClock Projection, Retrieved from http:// www.census.gov/population/www/popclockus.html
9. Cifuentes, M., Willets, J., & Wasiak, R. (2011). Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine, 53(4), 396-404.
　

Can I borrow $25?

Can I Borrow $25?

Can I borrow $25?
A man came home from work late, tired and irritated, to find his 5-year old son waiting for him at the door.

SON: 'Daddy, may I ask you a question?'
DAD: 'Yeah sure, what it is?' replied the man.
SON: 'Daddy, how much do you make an hour?'
DAD: 'That's none of your business. Why do you ask such a thing?' the
man said angrily.
SON: 'I just want to know. Please tell me, how much do you make an
hour?'
DAD: 'If you must know, I make $50 an hour.'
SON: 'Oh,' the little boy replied, with his head down.
SON: 'Daddy, may I please borrow $25?'

The father was furious, 'If the only reason you asked that is so you
can borrow some money to buy a silly toy or some other nonsense, then
you march yourself straight to your room and go to bed. Think about why you are being so selfish. I don't work hard everyday for such childish frivolities.' The little boy quietly went to his room and shut the door.

The man sat down and started to get even angrier about the little boy's questions. How dare he ask such questions only to get some money? After about an hour or so, the man had calmed down , and started to think:

Maybe there was something he really needed to buy with that $25.00 and
he really didn't ask for money very often. The man went to the door of
the little boy's room and opened the door. 'Are you asleep, son?' He
asked. 'No daddy, I'm awake,' replied the boy. 'I've been thinking,
maybe I was too hard on you earlier' said the man. 'It's been a long
day and I took out my aggravation on you. Here's the $25 you
asked for.'

The little boy sat straight up, smiling. 'Oh, thank you daddy!'
He yelled. Then, reaching under his pillow he pulled out some crumpled
up bills. The man saw that the boy already had money, started to get
angry again. The little boy slowly counted out his money, and then
looked up at his father. 'Why do you want more money if you already
have some?' the father grumbled. Because I didn't have enough, but now
I do,' the little boy replied. 'Daddy, I have $50 now. Can I buy an
hour of your time? Please come home early tomorrow. I would like to
have dinner with you.'

The father was crushed. He put his arms around his little son, and he
begged for his forgiveness. It's just a short reminder to all of you
working so hard in life. We should not let time slip through our
fingers without having spent some time with those who really matter to
us, those close to our hearts. Do remember to share that $50 worth of
your time with someone you love.

If we die tomorrow, the company that we are working for could easily
replace us in a matter of hours. But the family & friends we leave
behind will feel the loss for the rest of their lives.

Can I Borrow $25?

Why your desk job is killing you?

Why your desk job is slowly killing you

Even if you exercise, the more hours a day you sit, the greater your risk of early death

 

 

By Maria Masters, Men's Health

Mens Health

updated 10/26/2010 8:38:01 AM ET 2010-10-26T12:38:01

Do you lead an active lifestyle or a sedentary one? The question is simple, but the answer may not be as obvious as you think. Let's say, for example, you're a busy guy who works 60 hours a week at a desk job but who still manages to find time for five 45-minute bouts of exercise. Most experts would label you as active. (Put your body to the test: 10 standards to assess your fitness level.) But Marc Hamilton, Ph.D., has another name for you: couch potato. Perhaps "exercising couch potato" would be more accurate, but Hamilton, a physiologist and professor at the Pennington Biomedical Research Center , in Baton Rouge , Louisiana , would still classify you as sedentary. "People tend to view physical activity on a single continuum," he says. "On the far side, you have a person who exercises a lot; on the other, a person who doesn't exercise at all. However, they're not necessarily polar opposites."

Hamilton's take, which is supported by a growing body of research, is that the amount of time you exercise and the amount of time you spend on your butt are completely separate factors for heart-disease risk. New evidence suggests, in fact, that the more hours a day you sit, the greater your likelihood of dying an earlier death regardless of how much you exercise or how lean you are. That's right: Even a sculpted six-pack can't protect you from your chair.

But it's not just your heart that's at risk from too much sitting; your hips, spine, and shoulders could also suffer. In fact, it's not a leap to say that a chair-potato lifestyle can ruin you from head to toe.

Statistically speaking, we're working out as much as we were 30 years ago. It's just that we're leading more sedentary lives overall. A 2006 University of Minnesota study found that from 1980 to 2000, the percentage of people who reported exercising regularly remained the same—but the amount of time people spent sitting rose by 8 percent.

Now consider how much we sit today compared with, say, 160 years ago. In a clever study, Dutch researchers created a sort of historical theme park and recruited actors to play 1850s Australian settlers for a week. The men did everything from chop wood to forage for food, and the scientists compared their activity levels with those of modern office workers. The result: The actors did the equivalent of walking 3 to 8 miles more a day than the deskbound men. That kind of activity is perhaps even more needed in today's fast-food nation than it was in the 1800s, but not just because it boosts calorie burn. (Tied to the treadmill? Try these seven ways to burn more fat on the belt.)

A 2010 study in the Journal of Applied Physiology found that when healthy men limited their number of footsteps by 85 percent for 2 weeks, they experienced a 17 percent decrease in insulin sensitivity, raising their diabetes risk. "We've done a lot to keep people alive longer, but that doesn't mean we're healthier," says Hamilton .

Today's death rate is about 43 percent lower than it was in 1960, but back then, less than 1 percent of Americans had diabetes and only 13 percent were obese. Compare that with now, when 6 percent are diagnosed with diabetes and 35 percent are obese.

The definition of an active life
Make no mistake: "Regularly exercising is not the same as being active," says Peter Katzmarzyk, Ph.D., Hamilton 's colleague at Pennington, the nation's leading obesity research center. Katzmarzyk is referring to the difference between official exercise activity, such as running, biking, or lifting weights, and so-called nonexercise activity, like walking to your car, mowing the lawn, or simply standing. "A person may hit the gym every day, but if he's sitting a good deal of the rest of the time, he's probably not leading an overall active life," says Katzmarzyk.

You might dismiss this as scientific semantics, but energy expenditure statistics support Katzmarzyk's notion. In a 2007 report, University of Missouri scientists said that people with the highest levels of nonexercise activity (but little to no actual "exercise") burned significantly more calories a week than those who ran 35 miles a week but accumulated only a moderate amount of nonexercise activity.

"It can be as simple as standing more," Katzmarzyk says. For instance, a "standing" worker—say, a sales clerk at a Banana Republic store—burns about 1,500 calories while on the job; a person behind a desk might expend roughly 1,000 calories. That goes a long way in explaining why people gain 16 pounds, on average, within 8 months of starting sedentary office work, according to a study from the University of North Carolina at Wilmington .

Work your entire body in 15 minutes with these three moves for fast muscle.

Why sitting too much is never a good thing
But calories aren't the only problem. In 2009, Katzmarzyk studied the lifestyle habits of more than 17,000 men and women and found that the people who sat for almost the entire day were 54 percent more likely to end up clutching their chests than those who sat for almost none of the time. That's no surprise, of course, except that it didn't matter how much the sitters weighed or how often they exercised. "The evidence that sitting is associated with heart disease is very strong," says Katzmarzyk. "We see it in people who smoke and people who don't. We see it in people who are regular exercisers and those who aren't. Sitting is an independent risk factor."

This isn't actually a new discovery. In a British study published in 1953, scientists examined two groups of workers: bus drivers and trolley conductors. At first glance, the two occupations appeared to be pretty similar. But while the bus drivers were more likely to sit down for their entire day, the trolley conductors were running up and down the stairs and aisles of the double-decker trolleys. As it turned out, the bus drivers were nearly twice as likely to die of heart disease as the conductors were.

A more recent interpretation of that study, published in 2004, found that none of the participants ever exercised. But the two groups did sit for different amounts of time. The analysis revealed that even after the scientists accounted for differences in waist size—an indicator of belly fat—the bus drivers were still more likely to die before the conductors did. So the bus drivers were at higher risk not simply because their sedentary jobs made them resemble Ralph Kramden, but also because all that sitting truly was making them unhealthy.

Hamilton came to call this area of science "inactivity physiology" while he was conducting studies to determine how exercise affects an enzyme called lipoprotein lipase (LPL). Found in humans as well as mice, LPL's main responsibility is to break down fat in the bloodstream to use as energy. If a mouse (or a man) doesn't have this enzyme, or if the enzyme doesn't work in their leg muscles, the fat is stored instead of burned as fuel.

Hamilton discovered that when the rodents were forced to lie down for most of their waking hours, LPL activity in their leg muscles plummeted. But when they simply stood around most of the time, the gene was 10 times more active. That's when he added an exercise session to the lab-rat routine and found that exercise had no effect on LPL. He believes the finding also applies to people.

"Humans sit too much, so you have to treat the problem specifically," says Hamilton . "The cure for too much sitting isn't more exercise. Exercise is good, of course, but the average person could never do enough to counteract the effect of hours and hours of chair time."

If you're chair-bound, perform these seven easy office stretches every 20 minutes.

"We know there's a gene in the body that causes heart disease, but it doesn't respond to exercise no matter how often or how hard you work out," he says. "And yet the activity of the gene becomes worse from sitting—or rather, the complete and utter lack of contractile activity in your muscles. So the more nonexercise activity you do, the more total time you spend on your feet and out of your chair. That's the real cure."

"Your body adapts to what you do most often," says Bill Hartman, P.T., C.S.C.S., a Men's Health advisor and physical therapist in Indianapolis , Indiana . "So if you sit in a chair all day, you'll essentially become better adapted to sitting in a chair." The trouble is, that makes you less adept at standing, walking, running, and jumping, all of which a truly healthy human should be able to do with proficiency. "Older folks have a harder time moving around than younger people do," says Hartman. "That's not simply because of age; it's because what you do consistently from day to day manifests itself over time, for both good and bad."

Inactivity affects more than the heart
Do you sit all day at a desk? You're courting muscle stiffness, poor balance and mobility, and lower-back, neck, and hip pain. But to understand why, you'll need a quick primer on fascia, a tough connective tissue that covers all your muscles. While fascia is pliable, it tends to "set" in the position your muscles are in most often. So if you sit most of the time, your fascia adapts to that specific position.

Now think about where your hips and thighs are in relation to your torso while you're sitting. They're bent, which causes the muscles on the front of your thighs, known as hip flexors, to contract slightly, or shorten. The more you sit, the more the fascia will keep your hip flexors shortened. "If you've ever seen a guy walk with a forward lean, it's often because of shortened hip flexors," says Hartman. "The muscles don't stretch as they naturally should. As a result, he's not walking tall and straight because his fascia has adapted more to sitting than standing."

This same effect can be seen in other areas of your body. For instance, if you spend a lot of time with your shoulders and upper back slumped over a keyboard, this eventually becomes your normal posture. "That's not just an issue in terms of how you look; it frequently leads to chronic neck and shoulder pain," says Hartman. Also, people who frequently cross their legs a certain way can experience hip imbalances. "This makes your entire lower body less stable, which decreases your agility and athletic performance and increases your risk for injuries," Hartman says. Add all this up, and a person who sits a lot is less efficient not only at exercising, but also at simply moving from, say, the couch to the refrigerator.

There's yet another problem with all that sitting. "If you spend too much time in a chair, your glute muscles will actually 'forget' how to fire," says Hartman. This phenomenon is aptly nicknamed "gluteal amnesia." A basic-anatomy reminder: Your glutes, or butt muscles, are your body's largest muscle group. So if they aren't functioning properly, you won't be able to squat or deadlift as much weight, and you won't burn as much fat. After all, muscles burn calories. And that makes your glutes a powerful furnace for fat—a furnace that's probably been switched off if you spend most of the day on your duff.

It gets worse. Weak glutes as well as tight hip flexors cause your pelvis to tilt forward. This puts stress on your lumbar spine, resulting in lower-back pain. It also pushes your belly out, which gives you a protruding gut even if you don't have an ounce of fat. "The changes to your muscles and posture from sitting are so small that you won't notice them at first. But as you reach your 30s, 40s, 50s, and beyond, they'll gradually become worse," says Hartman, "and a lot harder to fix."

So what's a desk jockey to do? Hamilton 's advice: Think in terms of two spectrums of activity. One represents the activities you do that are considered regular exercise. But another denotes the amount of time you spend sitting versus the time you spend on your feet. "Then every day, make the small choices that will help move you in the right direction on that sitting-versus-standing spectrum," says Hamilton . "Stand while you're talking on the phone. It all adds up, and it all matters."

Of course, there's a problem with all of this: It kills all our lame excuses for not exercising (no time for the gym, fungus on the shower-room floor, a rerun of The Office you haven't seen). Now we have to redefine "workout" to include every waking moment of our days. But there's a big payoff: more of those days to enjoy in the future. So get up off your chair and start nonexercising.

Learn six more health threats you can't ignore.

© 2011 Rodale Inc. All rights reserved.

Whiplash or Fibromyalgia?

A recent study published in the journal Pain sheds some light on the ongoing debate about the causal relationship between neck injuries sustained during a car accident and the development of the pain condition fibromyalgia. Chiropractors commonly treat patients with both conditions, and separating these diagnoses can improve treatment. The latest research suggests that fibromyalgia may be overdiagnosed in patients who have a history of whiplash injury due to a motor vehicle accident.
People with fibromyalgia experience a range of life-disrupting symptoms, include general and localized pain, fatigue, and difficulty sleeping. Neck and shoulder tenderness is one common indicator that practitioners use to diagnose fibromyalgia; general pain lasting longer than three months is another. However, these symptoms also are common among patients experiencing the lingering effects of whiplash. Some past research has shown that people with neck injuries incurred in a motor vehicle accident are 13 times more likely to develop fibromyalgia than those with other injuries. Other studies have questioned these conclusions.
Researchers at the University of Washington set out to investigate the prevalence of fibromyalgia in whiplash patients with persistent neck pain. They questioned whether the most common set of criteria used for diagnosing fibromyalgia may rely too heavily on evaluating trigger points located in the neck and shoulder. The study participants included 326 individuals with whiplash-associated neck pain that had lasted longer than 3 months. The participants were enrolled in a 6-week treatment program for their symptoms that consisted of educational therapy sessions.
The researchers evaluated the patients for fibromyalgia both at the beginning and the end of the program. Two sets of criteria were used to diagnose fibromyalgia: the standard guidelines and adjusted guidelines that discounted the importance of pain in the neck and shoulder area. Using the standard guidelines, the researchers initially diagnosed 14% of the whiplash participants with fibromyalgia. This rate dropped to 8% using the adjusted guidelines.
These findings suggest that health practitioners who treat patients with persistent neck pain, such as chiropractors, may be led to significantly overdiagnose fibromyalgia in their patients. People with a history of whiplash-associated injuries should be aware of this unintended bias, and report their injury history.

Robinson JP, Theodore BR, Wilson HD, Waldo PG, Turk DC. Determination of fibromyalgia syndrome after whiplash injuries: Methodologic issues. Pain. 2011 Mar 16.

More Reasons to Eat Your Fruits!

• APRIL 7, 2011

Strawberries Fight Cancer, Study Finds

By JENNIFER CORBETT DOOREN

Strawberries have the potential to prevent esophageal cancer, according to a preliminary study released Wednesday.
Researchers, led by Ohio State University, were able to show that freeze-dried strawberries slowed the growth of dysplastic, or precancerous, lesions in about 30 people who consumed the fruit for six months.
The study's lead researcher, Tong Chen, an assistant professor in the oncology division of Ohio State University, presented the study at the American Association for Cancer Research's annual meeting.

European Pressphoto Agency

Strawberries have the potential to prevent esophageal cancer, according to a preliminary study released Wednesday.

Esophageal cancer is the third most common gastrointestinal cancer and the sixth most frequent cause of cancer death in the world, Dr. Chen said. About 16,000 new cases of esophageal cancer a year are diagnosed in the U.S., according to the American Cancer Society.
Dr. Chen and a group of researchers are studying esophageal squamous cell carcinoma, the dominant type of esophageal cancer world-wide. They are looking at whether food or other substances might prevent cancer. Previous work showed that freeze-dried strawberries were able to significantly inhibit tumor development in rats.
The research team designed a small study in humans and approached the California Strawberry Commission, which agreed to fund the study and make available the freeze-dried strawberries. The commission is a state agency funded by the strawberry industry.
Dr. Chen's team recruited 38 people in China who had mild-to-moderate dysplasia in the esophagus; 36 people completed the study. Biopsies of the esophagus were taken before and after the study. On average, patients were about 55 years old.
They were instructed to consume 30 grams of freeze-dried strawberries dissolved in a glass of water twice daily for a total of 60 grams a day for six months. Dr. Chen said the freeze-dried substance is about 10 times as concentrated as fresh strawberries, but suggested people could still benefit from eating whole strawberries on a daily basis.
Overall, the results showed 29 out of 36 participants experienced a decrease in histological grade of the precancerous lesion, or a slowing in the growth of the lesion during the study. Dr. Chen said larger, randomized placebo-controlled studies are needed to confirm the results. She said it isn't clear exactly what the anti-cancer agent in strawberries might be. But she noted that strawberries contain a variety of vitamins, minerals and other substances known as phytochemicals, which are also found in some other types of berries.

Copyright 2011 Dow Jones & Company, Inc.