It seems like everyone I know has a bad back. What's wrong with us?

Here are some telling numbers:

• 85% of all US adults will suffer debilitating back pain during their life
• Back pain is the number 1 cause of lost work time
• The US spends $100 billion yearly on low back treatment, more on indirect costs
• The number of spinal fusion surgeries has tripled in the past 10 years

      …and the most amazing number of all…

• Despite this huge investment, we're really not any better off!

Although there are many causes of back pain, the vast majority stems from injury, overuse or age related wear and tear (osteoarthritis). Common medical diagnoses include lumbosacral strain, herniated disc, degenerative disc disease, spinal stenosis and osteoporosis. Together, these conditions account for over 90% of all low back problems.

The anatomy (structure) and physiology (biochemical function) of the spine render it uniquely vulnerable to injury and wear. Our spinal columns have the same basic design as those of four legged animals. Since humans spend most of their waking hours upright, gravity plays a major role in spinal disease.

Why is my injured knee more comfortable when it's a little flexed?

All joints are surrounded by a fibrous sheath called the joint capsule. When inflamed or injured, tension on the capsule causes pain. Tension is decreased when the capsule is most relaxed. For the knee, that usually means about 15 to 30 degrees of flexion. In the hip it requires some flexion and external (outward) rotation of the knee.

Why does my back feel better when I elevate my knees?

There are two reasons for this. First, the hollow of the low back (lordosis) is reduced by flexion of the hips which happens when your knees are raised. Secondly, this position leads to better alignment of the small facet joints of the lumbar spine and lowers the internal pressure in the spinal discs.

How does elevation help my varicose veins?

Varicose veins and leg edema (swelling) are gravity related conditions. Your arms and legs have two sets of veins, each of which are equipped with valves so blood can flow only toward the heart. The deep veins are buried in the muscles, while the superficial veins lie just under the skin. Muscle action propels blood in the deep veins back to the heart; in some people the valves of the superficial veins leak allowing the blood to "back up" causing the veins swell (varicose). This is unsightly and can be painful. Compressive stockings are useful during the day, but may interfere with sleep at night. Elevation of the legs puts gravity to work to return blood to the heart and let the superficial veins relax. Exercising the muscles is also helpful. Improving blood flow in the deep veins removes some load from the superficial ones.

Why do my ankles swell as the day goes on?

Edema is the general medical term for swelling. There are many causes of edema of the legs; some common causes are injuries, hypertension, heart disease, kidney disease and lymphatic disease. Fluid in the blood normally travels into the tissues to provide nutrients and remove wastes. If the normal mechanisms that return the fluid to the veins are impaired, fluid builds up in the tissues causing edema. The normal muscle action of the calves usually is sufficient to return blood to the heart, but if you have a leg injury, varicose veins, heart disease or even just sit all day at a desk, you may notice swelling of the ankles by afternoon. In most cases, external compression of the superficial veins and elevation of the legs at night makes gravity your servant rather than your enemy. Although an ordinary pillow may elevate the legs somewhat, they aren't high enough to provide significant help, and multiple pillows don't stay put through the night. Specially designed products such as the Berkie™ System and the OneUp® Leg Rest address this problem, and maintain comfort so you can spend all day or a full night in the best position. Calf muscle exercise during the day is also beneficial.

I'm confused about what I should do for my arthritis. What kind of doctor should I see?

That depends. The best place to start is with your primary care provider. They can determine if they can handle the problem themselves, or if a specialist is needed. Generally, rheumatologists provide medical treatments for arthritis, especially in complicated autoimmune diseases like rheumatoid arthritis or lupus. Orthopedic surgeons offer medical and surgical treatments, like joint replacement. Any physician can prescribe physical therapy and/or orthotics (braces, etc.) for arthritis.

Is osteoarthritis permanent?

Osteoarthritis is far and away the most common type of arthritis. Most often it results from wear and tear secondary to repeated heavy loads, although surface damage from local injury can cause it even in young people. That's why it tends to affect the weight bearing joints, like the hip, knees and spine. Surprisingly, because of their small contact surfaces, the last joint of the fingers, especially the index finger, are subjected to high pressures and are among the most common site for osteoarthritis. Since the condition involves degeneration of cartilage, a tissue with very limited ability for repair, it is not reversible with medical means. Treatment is relatively straight forward, with medication, pressure relief and physical therapy as mainstays. When conservative treatments are inadequate, surgery can provide a permanent solution. Since pain tends to increase at night, comfort positioning in the so-called position of function makes sleep easier. The Berkie System, OneUp Leg Rest, Avana™ Body Rest and Avana™ Side Sleeper are excellent aids.

Just what is heart failure, what are the symptoms and what's the best way for me to relax?

Congestive Heart Failure (CHF) is the medical term doctors use to describe compromised efficiency of the heart's pumping action. Symptoms include easy fatigue, labored breathing (dyspnea), sweating (diaphoresis), swelling of the legs (edema) and difficulty lying flat in bed (orthopnea). Elevation of the head helps with orthopnea just as elevation of the legs does with edema. The Berkie™ Systemadapts to give you just the right amount of head and/or leg elevation. The OneUp® leg rest safely elevates either or both legs to limit edema. Enhanced positioning can keep intimacy in your life by letting your partner provide a greater share of the energy to prevent fatigue. Sexual intercourse can be healthy as well as pleasurable vital to your emotional well being. It also burns about 200 calories, almost the same as 1/2 hour on a treadmill. Check out the photos and descriptions of the Wedge, Ramp, Wedge-Ramp Combo and Whirl for ideas.