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Think you’re destined to die before your time because you’ve been sedentary (physically inactive) your entire life? Not so fast. While consistent exercise is associated with a host of health and wellness benefits including significant reductions in disease risk, new research suggests even middle-aged and older adults who haven’t been active their entire lives can benefit dramatically from a little more movement.

Researchers evaluated the exercise habits of more than 315,000 adults ages 50-71 by reviewing surveys each study participant had completed from adolescence, then tracked them for almost 15 years to see who passed away over that time period. Compared to participants who stayed essentially inactive throughout their lives (including the study period), participants who were not active previously, but became active from ages 40-61, were 35 percent less likely to die of all causes during the study period.

Interestingly, people who had been active from the start (youth through middle age) were only slightly less likely to die during the study period: 36 percent less likely compared to the permanently inactive group. In other words, the health benefits of physical activity (at least in terms of longevity) were essentially the same regardless of whether one exercised his/her entire life or became active starting in middle age or older.

With respect to two of the major causes of death, cardiovascular disease and cancer, the risk reductions were also remarkably similar: 42 percent lower risk of death from heart disease and 14 percent lower risk of death from cancer for always exercisers (compared to people who stayed sedentary their entire lives), vs. 43 percent and 16 percent lower risks, respectively, for late exercise adopters. Study findings were published in JAMA Network Open.

The moral to this story: You’re never too old to start exercising – and reaping the longevity benefits. Talk to your doctor for more information on why exercise matters, and ask for help designing a consistent physical activity program suitable to your health and fitness needs.

By Deborah Pate, DC, DACBR

Use of epidural steroid injections has increased dramatically in recent years, despite the fact that studies have failed to demonstrate evidence this procedure is clinically helpful (while other studies suggest it may actually be dangerous).Considering that lack of evidence – not to mention the terrible 2012 outbreak of fungal meningitis / infections caused by contaminated vials used for epidural corticosteroid injections – it is prudent at least to take a critical look at this procedure as it relates to sciatica or pain affecting the sciatic nerve, which extends from the lower back down the back of each leg.

Small Relief, Big Potential Side Effects

In a recent meta-analysis of 23 randomized trials involving more than 2,000 patients in which epidural steroid injections were compared with placebo for sciatica, epidural steroid injections produced small, statistically insignificant short-term improvements in leg pain and disability (but not less back pain) compared to placebo. This improvement also was only over a short period of time – two weeks to three months. Beyond 12 months, there was no significant difference between groups.

Besides infection, there are other side effects associated with epidural steroid injections: bleeding, nerve damage and dural puncture. Then there are side effects associated with the steroid medication, which include the following: a transient decrease in immunity, high blood sugar, stomach ulcers, cataracts and increased risk of fracture.

This last complication is certainly not emphasized in clinical circles. Therapeutic steroids may reduce pain, however the use of steroid injections seem to promote deterioration of skeletal quality, which is not surprising since other forms of steroid medication have long been associated with osteoporosis.

A retrospective study published in the Journal of Bone and Joint Surgery looked at lumbar epidural steroid injection (LESI), and the potential impact on bone fragility and vertebral fractures (spinal fractures). Researchers identified a total of 50,345 patients who had medical diagnosis codes involving the spine; within that group, a total of 3,415 patients had received at least one LESI.

Three thousand patients were randomly selected from the 3,415 injected population and 3,000 additional patients were selected from the non-injected group as a control group. There was no significant difference between the injected and non-injected groups with respect to age, sex, race, hyperthyroidism or corticosteroid use.

When incidence of vertebral fractures was assessed, researchers discovered that an increasing number of injections was associated with an increasing likelihood of fractures, and each successive injection increased the risk of spinal fracture by 21 percent. Based on this evidence, LESIs clearly exacerbate skeletal fragility. They promote deterioration of skeletal quality similar to the use of exogenous steroids, which is the leading cause of secondary osteoporosis. In fact, the rate of vertebral fracture following epidural steroid injections may be underestimated.

Both European and American guidelines, based on systemic reviews, conclude that epidural corticosteroid injections may offer temporary relief of sciatica, but do not reduce the rate of subsequent surgery. This conclusion is based on multiple randomized trials comparing epidural steroid injections with placebo injections, and monitoring of subsequent surgery rates. Facet joint injections with corticosteroids seem no more effective than saline injections.

Rising Costs, Limited Benefits

Despite the limited benefits of epidural injections, Medicare claims show a 271 percent increase during a recent seven-year interval. Earlier Medicare claims analyses also demonstrated rapid increases in spinal injection rates. For patients with axial back pain without sciatica, there is no evidence of benefit from spinal injections; however, many injections given to patients in the Medicare population seem to be for axial back pain alone.

Charges per injection have risen 100 percent during the past decade (after inflation), and the combination of increasing rates and charges has resulted in a 629 percent increase in fees for spinal injections. Yet during this time, the Medicare population increased by only 12 percent.

It all begs the question: Why such a huge increase in the use of a procedure that has limited benefit?

Take-Home Points

• Epidural steroid injections have little clinical benefit (short or long term) and are associated with significant risks.
• Steroid injections cause deterioration of bone quality, elevating the risk of spinal fracture.
• Use of epidural steroid injections has increased dramatically despite lack of evidence to justify the procedure.

Talk to your doctor of chiropractic for more information on sciatica and nondrug alternatives to your pain.

Deborah Pate, DC, DACBR, is a San Diego chiropractor specializing in radiological assessment of the spine and musculoskeletal system. In fact, she was the first chiropractor accepted into a fellowship in osteoradiology at the University of California at San Diego.

You’re probably aware of the opioid crisis by now, notably the fact that for years, opioids have been overprescribed, overused and abused – with deadly consequences. Here’s one consequence you may not be aware of: Opioid users are significantly more likely to be involved in fatal car crashes than non-users. Let’s look at the latest evidence suggesting opioids are actually your No. 1 enemy when it comes to managing pain.

Drivers prescribed opioids are more than twice as likely to be involved in deadly two-vehicle accidents compared to drivers not prescribed opioids. In reviewing data from the Fatality Analysis Reporting System, researchers analyzed two-vehicle crashes on U.S. public roads that took place over a 25-plus-year period (1993-2016), including whether drivers had tested positive for prescription opioids. Among 36,642 drivers involved in 18,321 fatal two-vehicle crashes during that time period, drivers who were deemed the initiator of the crash were significantly more likely to test positive for opioids than non-culpable drivers.

The most common reason for crashes by opioid users (more than half of all fatal crashes): failure to keep in the proper lane. These findings were independent of any alcohol or other drug use, implicating opioids as the primary culprit. Even worse: Although opioid awareness (including studies such as this one) will hopefully make a dent in these horrific statistics in years to come, researchers, summarizing their findings in JAMA Network Open, noted that in the past two decades, when opioid prescribing flourished, “the prevalence of prescription opioids detected in fatally injured drivers has steadily increased to more than 7%” (compared to only 1 percent in the mid-1990s).

The lessons: 1) Opioids are a deadly way to manage your pain. 2) Non-drug pain management options (such as chiropractic care) should be your first choice, not your last. Talk to your doctor for more information about the opioid crisis and why chiropractic care is becoming the first choice for effective pain management.

Jogging at the same pace for hours and frustrated that you’re not losing the weight you hoped you’d lose? Try mixing your speed up and see what happens! Interval training – bursts of high-intensity exercise interwoven with recovery periods – appears to increase weight loss compared to training at a consistent intensity.

Case in point: a review study published in the British Journal of Sports Medicine that found people who participated in interval training for four weeks or more lost a greater amount of weight than people whose workout regimens consisted of moderate-intensity training based on continuous effort, such as jogging, walking or cycling at a steady, essentially unchanging pace. The additional weight loss also took less time: 28 minutes per session, on average, for interval training versus 38 minutes for continuous moderate-intensity sessions. Sprint interval sessions (alternating sprinting with recovery) only took 18 minutes per session.

According to the analysis, which included more than 40 studies and 1,100 participants, the most common interval workout alternated four-minute bursts of high-intensity exercise with three-minute recovery periods. Talk to your doctor to learn more about interval training, and click here for a few sample high-intensity interval workouts for beginners.

By K. Jeffrey Miller, DC, MBA and Matthew Marry, DC

Exercise machines that isolate individual muscles are great for general strength training. Muscle isolation helps you understand the different muscles of the body and their actions. The machines are also user-friendly, safe and efficient.Diagrams for how to perform the exercise / movement are provided on most machines. You need only to sit or lie on the padded portion of the machine, move the weight pin to the desired resistance and proceed. Time is never spent on lifting, loading and unloading heavy weights.

All of the above make these machines popular in most fitness centers. The machines require minimal supervision and the safety features are beneficial to gym patrons and owners. The potential for gym-related injuries is minimal compared to use of free weights like barbells and dumbbells.

With this said however, minimal risk means there is still risk. Injuries do occur. In most of these cases, the cause is user error. One of the most common of these errors is failure to utilize proper form. Proper form involves stabilizing the body areas that are not exercised by a machine.

Diagrams on the machines usually depict proper form. Unfortunately, most exercisers only use the diagrams to get the “general idea.” Proper form requires a closer look. You need to look at all regions of the body depicted in the diagrams, not just the region that will be involved in performance of the exercise.

Are You Exercising Properly? Maintain Five Points of Contact

Gym members frequently resemble contortionist while using strength machines. They twist, lunge, heave, jerk and strain their entire bodies while using the equipment. This is a sure indicator that the individual is attempting to lift too much weight. The twisting, lunging, heaving, jerking and straining are efforts to recruit other muscles to help lift the weight. The isolation principle is lost, the exercises lose their effectiveness and the possibility of injury escalates.

The key to success when using a weight machine is establishing specific points of body contact with the machine for both action and stabilization. Action contact points are created by the arms and legs as they grip, push or pull the parts of a machine that move during the exercise. For exercises involving the trunk, the abdomen or back may create the action contact points. The action contact points are easy to establish, as without them the machine will not move.

Figure 1A and 1B: The Chest-Bench Press Exercise. 1A: Proper contact; the hands are the active points of contact, while the stabilizing points of contact are the feet, buttocks, upper back and head. 1B: Improper contact; the hands are the active points of contact; however, the stabilization points of contact are not well-established. The feet are not set properly, and the upper back and head are not in contact with the machine. Photo credit: Leigh Ann Osborne, Vinton, Virginia.It is the stabilization contact points that are the primary focus here. There are five common stabilization contact points; the two extremities not involved in the exercise movement, the buttocks, the upper back and the head. These areas should be in contact with the padded portions of the machine.

For example, if the exercise involves the arms, the feet, buttocks, upper back and head are the stabilization points. If the exercise involves the legs, the hands, the buttocks, upper back and head are the stabilization points. (See the table and images in this article for example points of stabilization contact, along with visual examples of proper and improper contact while using weight machines.)

When you employ proper form utilizing appropriate points for active and stabilization contact, exercises using strength machines are safe and effective. Otherwise, there is risk of injury and gains in fitness are minimal.

Changing Your Stabilization Habits to Maximize Your Workout

A frequent response by exercisers attempting to change from poor to good stabilization habits is, “I can’t lift as much weight the new way. I’m stronger than that.” It is true; they are not lifting the same amount of weight as before – but, reiterating a previous point, they were not lifting the previous weight with just the muscles the machines are designed to isolate. They were lifting (heaving, straining) with their entire bodies. Proper form in strength training cannot be overemphasized.

Some strength machines require that you lie on your abdomen or back. Contact points are important in these exercises as well. For these machines or any others you may choose to use, follow these simple rules for stabilization contact points.

Try to maintain as much body contact with the padded portions of the machine as possible.

Figure 2A and 2B: The Leg-Press Exercise. 2A: Correct contact; the feet are the active points of contact while the stabilization points of contact are the hands, buttocks, upper back and head. 2B: Incorrect contact; the feet are the active points of contact; however, the stabilization points of contact are faulty. The upper back and head are not in contact with the machine and the exerciser is pushing downward with their arms. Photo credit: Leigh Ann Osborne, Vinton, Virginia.

Keep the spine as straight as possible during the entire exercise. This includes the neck. Alignment from the back of the head to the lower back should be as straight.

The head should be in a neutral position. The chin should not be flexed to the chest, and the head should not be tilted back or rotated to the right or left side while performing the exercise.

Exercise is safer, more effective and more enjoyable when it’s done correctly. The result is that you are more likely to continue to exercising and maintaining a healthy lifestyle. Following these simple instructions will help in this endeavor. Remember, whenever you have questions about which exercises you should be doing or how to do them correctly, ask a fitness professional with training and experience for help. Exercise is important enough to do it right.

K. Jeffrey Miller, DC, MBA,is an assistant professor of chiropractic at the University of Missouri Orthopedic Institute, a branch of the University of Missouri Health System. He is a graduate of Palmer College of Chiropractic and the author of several practitioner and patient texts.

Matthew Marry, DC, is a former athletic trainer for the National Football League’s Detroit Lions and a 2010 graduate of Palmer College of Chiropractic. He practices chiropractic at Foley Health and Fitness Training in Blacksburg, VA.