Anxiety in Surrey causes Inflammation !

A few patients are surprised by some of the questions during their first appointment for what they see as simple spinal or joint pain. This is especially true regarding queries regarding their emotional ‘wellbeing’. One of the reasons for these questions is the effect of what I like to call ‘brain states’ on the physical functioning of the body, it’s vulnerability to injury & it’s ability to heal.

More and more research is showing the actual mechanisms by which this occurs. The following is one example from the US (Anxiety and Depression Association of America 2020 ) ;

ANXIETY & INFLAMMATION.

Worry and anxiety are strongly linked to fluctuations in levels of inflammatory markers, which can compromise the immune system, potentially leaving individuals at increased risk for physical illness, new research suggests.

Investigators at the Ohio State University College of Medicine in Columbus found that increases in levels of the inflammatory cytokines interleukin-6 (IL-6) and interferon-gamma (IFN-γ) corresponded to increased levels of worrying.

“Worry has clear physiological effects. It basically creates wear and tear on the body that may, across time, have implications for physical health,” study investigator Megan Elizabeth Renna, PhD, told Medscape Medical News.

“Further, stress significantly impacts the immune system, but very few studies have looked at how worry specifically influences inflammation,” Renna said.

The findings were scheduled to be presented at the Anxiety and Depression Association of America (ADAA) 2020 in March, but the meeting was canceled because of the coronavirus pandemic.

Changes in Cytokine Levels

Although physiologic stress is known to have detrimental effects on long-term health, research is lacking on the specific mechanisms that underlie the relationship between prolonged worrying and poor health outcomes, the researchers note.

The study included 85 healthy adults who were subjected to a single-session experimental worry condition, which involved asking the participants to choose the thing they worry about the most and to worry about it as much as possible during a 10-minute worry induction.

This exercise was followed by a 10-minute relaxation induction task that focused on deep breathing.

Results showed that blood samples taken in three consecutive draws displayed significant changes in levels of the inflammatory cytokines IL-6 and IFN-γ .

IFN-γ significantly increased during the worry condition compared with baseline. Levels then decreased during relaxation, highlighting that IFN-γ may particularly be influenced by worry.

Renna noted that high levels of IFN-γ indicate more systemic inflammation in the body.

“Basically, high levels of inflammatory markers like IFN over time can be related to numerous chronic health conditions,” she said.

In addition, “high levels of IL-6 are generally not good and may be a marker of disease/poor health,” she added.

“A Potent Process”

Interestingly, levels of IL-6 did not change significantly from baseline during a state of worry, but levels increased significantly when participants transitioned from worry to relaxation and continued to increase throughout the relaxation condition.

“We believe that [this was] a delayed reaction to the initial worry. Inflammation is a relatively slow-changing marker, so we believe that may be part of what is explaining that somewhat strange finding,” Renna noted.

Trait anxiety ― or a general state of anxiety ― did not influence this pattern of change. Renna said that this was surprising and that the researchers are unsure of why that was the case.

“We interpret the lack of trait anxiety moderation as indicating that there is something unique to the process of worry over and above just anxiety alone,” she explained.

“Worry may be a potent process in and of itself,” she added.

Among participants with higher depressive symptoms, there were patterns of change in IL-6.

For those with low depressive symptom scores, increases in inflammation were less during the worry condition, whereas for those with higher depressive symptom scores, inflammation was greater during both the worry and the relaxation conditions.

Mind-Body Connection

Overall, the findings are evidence of an important mind-body connection that is influenced by stress, Renna noted.

“This study showed that worry causes increases in some inflammatory markers,” she said.

Although the findings were experimental, the impact of worry on the immune system “is very important to understand,” particularly in the era of the COVID-19 pandemic, Renna said.

The investigators called for further examination of the trajectories of inflammatory change in the context of worry and relaxation in both laboratory and real-world settings.

“In doing so, future research may highlight how to better intervene on the relationship between worry and physical dysfunction at both the psychological and physiological levels and ultimately reduce the physical health implications of perseverative processes,” they write.

With respect to whether anxiety or worry increases susceptibility to respiratory illness or coronavirus, “to date, there is no evidence that worry can contribute to the flu or coronavirus,” Renna said.

“However, given that we see how stress influences the immune system, finding ways to manage stress and worry is one way among many others to buffer against the impact of any acute physical illnesses,” she added.

The findings add to those reported in a recently published systematic review and meta-analysis by Renna and her colleagues. The researchers examined the role of chronic inflammation in 41 studies of individuals with anxiety disorder, posttraumatic stress disorder, or obsessive-compulsive disorder (OCD) compared to healthy control persons.

Results showed significant differences between those with anxiety disorders and the control group. The differences appeared to be largely mediated by changes in levels of IL-1β, IL-6, and TNF-α

“These findings may provide an initial step in disentangling the relationship between anxiety and basic health processes,” the researchers note.

Anxiety in the Era of COVID-19

Commenting on the study for Medscape Medical News, Jeanette Bennett, PhD, Department of Psychological Science, the University of North Carolina Charlotte, said the findings underscore that “the relationship between stress and inflammation is cyclical.”

Part of the reason for this cyclical relationship involves maintenance of homeostasis, said Bennett, who was not involved with the current research.

“The association between anxiety/stress and inflammation is strong, and reducing one often leads to improvement of the other,” she added.

Bennett noted that the unprecedented social distancing and stress-inducing changes in lifestyle brought about in response to the COVID-19 epidemic may increase susceptibility to illness.

“How one responds to the social distancing, working from home, income lost because they can’t work from home, managing kids’ schooling, and potential social isolation if they live alone can diminish the functioning of their immune system, making them more susceptible to COVID-19 as well as other viruses and bacteria,” she said.

“Furthermore, once–psychologically healthy individuals may find themselves having more negative thoughts and potentially developing their first depressive or anxious episode,” she said.

In research published online last month in the Journal of Evaluation in Clinical Practice, Bennett and colleagues call on clinicians and psychiatrists to approach patients with a “psychoneuroimmunological lens” that connects immunologic dysfunction to both mental and physical illness.

In their article, the investigators note that subclinical immunologic abnormalities are observed in a variety of psychiatric conditions, and although the observations blur the historical distinctions between mental and physical illness, “clinical practice remains fragmented and primarily focused on differentially treating individual symptoms.

“Utilizing a psychoneuroimmunological lens, health psychologists and clinicians can reconceptualize healthcare through integrative treatment approaches and advocacy for comprehensive policy-level reform at both the individual-level of care as well as community-wide prevention approaches,” they write.

Richard Katesmark comments; “As mentioned above ( before research article) patients attending the Epsom and Ewell osteopathic clinic will have a full case history taken whatever the problem; be it a simple tennis elbow or a more complicated disc problem with sciatica. Any emotional component can be identified, it’s relevance accessed and addressed if necessary .“

DO KNEE SUPPORTS WORK ?

We treat & advise on the management of osteoarthritis of the knee for many people in the Epsom, Ewell & Chessington area so I though i’d postthe following short abstract which was published in Medscape & whilst not much detail is given it was an interesting bit of research. 

Wearing a soft knee brace has been shown to reduce self-reported knee instability in persons with knee OA. There is a need to assess whether a soft knee brace has a beneficial effect on objectively assessed dynamic knee instability as well. The aims of the study were to evaluate the effect of a soft knee brace on objectively assessed dynamic knee instability and to assess the difference in effect between a non-tight and a tight soft knee brace in persons with knee OA.

Methods:Thirty-eight persons with knee OA and self-reported knee instability participated in a laboratory study. A within-subject design was used comparing no brace vsbrace and comparing a non-tight vsa tight brace. The primary outcome measure was dynamic knee instability, expressed by the perturbation response (PR). The PR reflects deviation in the mean knee varus–valgus angle during level walking after a controlled mechanical perturbation. Linear mixed-effect model analysis was used to evaluate the effect of a brace on dynamic knee instability.

Results:Wearing a brace significantly reduced the PR compared with not wearing a brace. There was no difference between a non-tight and a tight brace.

Conclusion:This study is the first to report that wearing a soft knee brace reduces objectively assessed dynamic knee instability in persons with knee OA. Wearing a soft brace results in an objective improvement of knee instability beyond subjectively reported improvement.

Richard Katesmark comments; Generallyour aim here at Epsom and Ewell osteopathic clinic is to manage Knee osteoarthritis with treatment & stabilising home exercises so that supports are not needed. However there is no doubt that a good well fitting support can help particularly in the more severe cases. 

FOR EWELL OR EPSOM RESIDENTS CONSIDERING KNEE SURGERY

RESEARCH FININGS FROM THE NETHERLANDS;

In a randomized controlled trial, patients with degenerative, non-obstructive meniscus tears assigned to a structured program of physical therapy (PT) had similar patient-reported knee function as patients who underwent arthroscopic partial meniscectomy (APM) during a 2-year period.
The findings “are consistent with current consensus that APM should not be the first treatment in middle-aged and older patients with nonobstructive meniscal tears,” the investigators write.
Victor A. van de Graaf, MD, from the Department of Orthopedic Surgery, Joint Research, OLVG Oosterpark Hospital, Amsterdam, the Netherlands, and colleagues published their findings online October 2 in JAMA.
The authors of an accompanying editorial agree that the findings provide additional support for a structured, nonoperative treatment approach to managing this knee condition.
To evaluate the relative effectiveness of PT and APM in this study, the investigators enrolled 321 patients aged 45 to 70 years with degenerative meniscus tears without knee locking, instability, or severe osteoarthritis. Of these, they randomly assigned 159 to receive APM within 4 weeks and 162 to receive a PT exercise protocol developed by a knee-specialized physical therapist. The PT protocol consisted of 16 half-hour sessions over the course of 8 weeks, beginning within 2 weeks of randomization. Surgery patients were only referred to PT if they did not recover as anticipated, and PT patients that did not attain the desired outcomes could extend their PT or elect APM.

Of the patients randomly assigned to PT, 29% underwent delayed APM, “demonstrating that not all patients initially treated with PT were satisfied with their results,” the authors write. “The post-hoc exploratory findings on effect modification could guide future research on the characteristics of individuals who may be less likely to respond to PT to improve their treatment options and functional outcome.”
On the basis of the study results, the authors state that PT may be considered an alternative to surgery for patients with nonobstructive meniscal tears.

RICHARD KATESMARK OF CHEYHAM LODGE OSTEOPATHS COMMENTS; For those of you who don’t know, non-obstructive meniscal tears refer to torn cartilages in the knee which do not cause locking of the joint or severely impede passive movement of the knee. In my experience surgery can often be avoided in these cases as most of them do settle with a combination of treatment & exercises. However it takes time & many people want a quick fix which surgery can offer.
Of course my position is too avoid surgery whenever possible so trying a course of physical therapy with a good osteopath or physiotherapist ( both available here at Epsom & Ewell osteopathic clinic) is advisable. But you have to do the exercises !!!

Management of hand arthritis in Epsom & Ewell

A recent review on the management of hand arthritis has been published ;

The 2018 update of recommendations for the management of hand osteoarthritis (OA) from the European League Against Rheumatism (EULAR) incorporate new evidence developed during the last decade, emphasizing the role of the patient in the OA treatment plan and the importance of multimodal/multidisciplinary therapy.

Margreet Kloppenburg, MD, PhD and colleagues publishedonline August 28 in the Annals of the Rheumatic Diseases.

The recommendations add a new emphasis on optimizing and maximizing symptom control (rather than “joint protection”) 

EULAR recommends topical ( skin creams/gels )nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line pharmacologic treatment for hand OA. EULAR also recommends education about ergonomic principles, activity pacing, use of assistive devices, and exercises to improve function and muscle strength as the initial steps in managing hand OA, with or without topical NSAIDs.

The EULAR update recommends againstusing conventional or biologic disease-modifying antirheumatic drugs in hand OA and discourages the use of heat therapies, ultrasound, most intra-articular glucocorticoid injections, Symptomatic Slow Acting Drugs for Osteoarthritis

Richard Katesmark comments;

The main principal in the management of hand OA treatment is to control symptoms and optimize hand function to maximize activity, participation, and quality of life. 

Conservative osteopathic treatment may well be of benefit if the arthritis is not too severe/advanced. Patient education is also important and should include information on the nature and course of OA, self-management principles, ergonomics, pacing of activity, exercises, use of assistive devices, and other treatment options (such as acupuncture .)

Advice on diet & the use of certain supplements can also be helpful to target & reduce the underling inflammation which is important

Either way an appointment with your local osteopath for an opinion is likely to be helpful in the first instance.

Patients in Epsom & Ewell considering Shoulder surgery ?

NEW YORK (Reuters Health) – Subacromial decompression is no better than diagnostic arthroscopy for treating shoulder impingement, according to a recent study.

As many as 70% of patients with shoulder pain have shoulder impingement syndrome, which is commonly treated by arthroscopic subacromial decompression (ASD) of the passage of the rotator-cuff tendon. Although this is one of the most frequently performed orthopedic procedures in the world, it remains uncertain whether it actually benefits patients.

Dr. Mika Paavola from Helsinki University Hospital in Finland and colleagues assessed the efficacy of ASD (versus diagnostic arthroscopy alone) in a randomized controlled trial of 122 adult patients with shoulder symptoms consistent with shoulder impingement syndrome that were unresponsive to conventional conservative treatment.

From baseline to 24 months, the primary outcomes of pain at rest and pain on arm activity improved markedly and to a similar extent in both the ASD and diagnostic arthroscopy groups, the team reports in The British Medical Journal, online July 19.

“The results of this randomized, placebo surgery controlled trial show that arthroscopic subacromial decompression provides no clinically relevant benefit over diagnostic arthroscopy in patients with shoulder impingement syndrome,” the researchers conclude. “The findings do not support the current practice of performing subacromial decompression in patients with shoulder impingement syndrome.”

Dr. Eivind Inderhaug from Haraldsplass Deaconess Hospital and the University of Bergen, in Norway, who has studied the procedure, told Reuters Health by email, “This study adds to the evidence that ASD should not be a first line of treatment for subacromial pain syndrome and that resources need to be allocated to facilitate better systems for providing early exercise intervention.

Richard Katesmark from the Epsom & Ewell Osteopathic Clinic comments;

“ Shoulder pain related to the Subacromial joint -be it tendon tears/irritation, bursitis, or impingement mentioned above- is one of the most common problems seen at my clinic. Whilst surgery has a place in the most severe examples, accurate diagnosis followed by appropriate expert manual treatment (including exercises) is effective in most cases. However patients should be aware that it is rarely a quick fix & can take several weeks for significant improvement to occur ”.

If you live in Epsom or Ewell, don’t keep taking the pills !

Many people may have heard about potential problems with long term use of anti-imflammatories such as neurofen/ibuprofen . The following research published in Medscape adds further evidence to this ;

AMSTERDAM — For patients with osteoarthritis, nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk for cardiovascular disease to more than twice the rate of the general population, new research shows.

“There’s no cure for people with osteoarthritis, and you have to treat the pain. But when you treat it with NSAIDs, you increase cardiovascular risk,” said Aslam Anis, PhD, from the University of British Columbia in Vancouver, Canada.

NSAIDs are commonly used to treat the stiff joints that osteoarthritis patients experience, especially in the morning. Thinning of the cartilage in joints causes bones to rub against each other, leading to the common symptoms of joint swelling and pain.

“It’s one of those situations when the treatment can be just as bad as the problem,” Anis told Medscape Medical News. “We don’t have solutions.”

Osteoarthritis has already been shown to be an independent risk factor for cardiovascular disease, but Anis and his colleagues wanted to “disentangle” the role of NSAIDs in this association.

The team identified 7743 people with osteoarthritis and an age- and sex-matched cohort of 23,229 people without osteoarthritis from 720,055 administrative health records in British Columbia.

With multivariable Cox proportional hazards models, risk for the primary outcome of cardiovascular disease was estimated to be 23% higher in people with osteoarthritis than in those without after adjustment for age, sex, socioeconomic status, body mass index, hypertension, diabetes, hyperlipidemia, chronic obstructive pulmonary disease, and Romano comorbidity score.

For secondary outcomes, risk for congestive heart failure was 42% higher in people with osteoarthritis, for ischemic heart disease risk was 17% higher, and for stroke risk was 14% higher.

When prescription dispensing records for current NSAID use were linked to the healthcare database, approximately 67.5% of the total effect of osteoarthritis on cardiovascular disease risk was related to NSAID use.

Specifically, the risk for congestive heart failure increased by 44.8% with NSAID use, the risk for ischemic heart disease increased by 94.5%, and the risk for stroke increased by 93.3%.

These results are likely conservative, because the records only captured prescription NSAIDs; the effect of over-the-counter NSAIDs, such as ibuprofen and naproxen, were not accounted for.

 

Richard Katesmark comments “ It has been known for sometime that taking certain ( in fact most ) anti-imflammatory medications over long periods can have disadvantages & health implications. If you are regularly using these medications, which includes many over-the-counter painkillers, it would be worth having a conversation with your heath specialist/G.P regarding relative risks & benefits.

If people are taking the medications to help reduce joint & muscle pain it is often worth seeing a musculoskeletal specialist. Here at Epsom & Ewell Osteopathic Clinic (https://www.epsomewellosteo.co.uk) many patients find that after assessment & treatment they can stop or at least reduce the number of painkillers they are taking .”

Any army personnel in Epsom & Ewell with back pain ?

Results of a moderately large trial in America was recently published. A summary of findings were as follows;

Adding manipulative treatments to standard medical management of low back pain (LBP) in a military population reduced patient-reported pain and disability and improved satisfaction scores compared with standard treatment alone, new data show.

The findings, reported by Christine M. Goertz and colleagues in in the US & published online May 18 in JAMA Network Open, confirm results from the team’s pilot study.

In addition, the new data align with recent guidelines from the American College of Physicians that recommend inclusion of spinal manipulation, among other nondrug treatments, as first-line therapy for acute and chronic low-back pain.

For the current study, Goertz and colleagues enrolled 750 active-duty US service members aged 18 to 50 years with LBP from three military facilities in a pragmatic comparative effectiveness trial.

Patients were screened between September 28, 2012, and November 20, 2015, and 250 patients from each of the study sites were allocated to receive usual medical care with manipulative care (375 participants) or usual medical care alone (375 participants). Usual/Standard medical care was defined as any care recommended or prescribed by nonchiropractic military clinicians to treat LBP, including self-management advice, drug treatment, physical therapy, or referral to a pain clinic.

Additional therapies, such as rehabilitative exercise, interferential current therapy, ultrasound therapy, cryotherapy, superficial heat, and other manual therapies, could also be included in manipulative care.

The primary outcomes of self-reported pain intensity & disability & associated patient satisfaction, as measured by the Numerical Rating Scale, and disability, showed clear benefitsof manipulative care compared to standard care.

Manipulation-related adverse events included short term muscle or joint stiffness, but no serious treatment-related adverse events were reported.

Mr Katesmark comments; “On reading the research methods in detail I note there were some design ‘flaws’ in the trial including very generalised/non specific definitions of back pain & of couse the patients were not ‘average’- consisting of young, fit army recruits ! However I welcome further evidence showing that manipulative approaches can be of benefit ( although it is worth noting that other therapies were included in treatment – as would be the case here at Epsom & Ewell osteopathic clinic).  ” 

 

Ewell and Epsom Osteopathic Clinic now open all weekend.

Good news ; Epsom & Ewell osteopathic clinic is now open Saturdays AND Sundays.

As it can be difficult to find time for appointments during the working week we have made the decision to offer appointments on Saturdays & Sundays .

So anyone locally in Ewell , Epsom, Banstead, Cheam, Sutton, Chessington , Kingston or elsewhere in Surrey who is suffering from back or neck pain, sciatica , joint pains and stiffness, sports injuries such as tennis elbow or painful shoulder can now make appointments at their convenience .

Posture problems & Chronic Pelvic Pain in Postmenopausal Women

A small study from Spain and reported on Reuters Health suggests postmenopausal women who have chronic pelvic pain may also have problems with their balance and posture.

“Women with chronic pelvic pain presented with poor balance including anticipatory, reactive postural control, sensory orientation, dynamic gait. Posture showed a head forward position, higher values on the dorsal angle, and lower sacral inclination,” Dr. Marie C. Valenza and colleagues from the Faculty of Health Sciences of the University of Grenada report in Menopause.

“They also presented less spine alignment and a more prevalent posture with increased kyphosis and lumbar lordosis,” 

Between 2016 and 2017, the research team performed a cross-sectional study of 48 women with CPP who were recruited from the gynecology departments of two academic hospitals and 48 control women matched according to age and body characteristics. The women in the chronic pelvic pain group had a normal neurological examination and pelvic pain lasting over six months.

Potential participants were excluded if they had had radiation or pelvic cancer, pelvic or abdominal surgery, or had been diagnosed with neurological or muscular disorders, fibromyalgia or irritable bowel disease, diabetes, or pregnancy, or if they had a psychiatric disorder, cognitive impairment, or dementia.

The control group of women – without chronic pelvic pain – were matched with the experimental group by age, weight, height, body mass index (BMI) and similarity of muscle development.

The authors found significant differences in all Mini Balance Evaluation Systems Test incl: anticipatory/reactive postural control, sensory orientation & dynamic gait .

Using photogrammetry and a hand-held inclinometer, the researchers demonstrated that the women with CPP also had significantly different spinal cervical angles compared with the controls, indicating forward head posture. Their global spine alignment deviated significantly more than the spine alignment of the controls, and a higher percentage of them had increased thoracic kyphosis and lumbar lordosis.

Richard katesmark comments; Over the years I have had good results treating women with pelvic pain, many of whom have been referred to me by gynaecologists (once they have ruled out any overt illness). So it’s nice to see some research showing definitive links between musculoskeletal factors & pelvic pain.

The Case Against Sitting for long periods.

I thought the following article is from medscape was relevant as everyone returns to work in 2018;

Sitting and back pain

If anyone should know about the danger of being sedentary, it’s Bethany Barone Gibbs, PhD. A professor of health and physical activity at the University of Pittsburgh, Pennsylvania, she was writing grant proposals to study just that topic when her back began to hurt.

“I’m 30 years old,” she thought to herself. “How do I already have back pain?”

It didn’t seem to be a matter of getting more exercise. Dr Gibbs takes spinning classes twice a week; runs after her two kids, now aged 5 and 8 years; and traverses campus on foot rather than sending emails to her colleagues.

All that activity, she eventually realized, couldn’t compensate for the time she had to spend sitting still to write about the problem of sitting still. Fortunately, that same research provided the solution. After looking at the data on sit/stand desks, she got one for herself. Soon, the back pain ended.

In a pilot study, Dr Gibbs has now shown that she is not alone. Alternating positions between sitting and standing can go a long way toward alleviating back pain.

Most of the research into the problems of sitting has focused on damage to circulation and metabolism. Perhaps the most striking finding is that too much time sitting can increase the risk for death, even among people who meet standard exercise recommendations. To overcome the effects of sitting 8 hours a day, you’d have to exercise at least 1 hour, according to the authors of a 2016 meta-analysis.

This discovery has sparked interest in desks that allow the user to stand or even walk in place while working. Studies have shown that people burn more calories when standing than sitting at their desks and suggested that some people could lose weight that way or improve cholesterol levels.

Counterintuitive Findings 

Of course, there’s a reason that people usually sit at desks. When researchers began looking at the benefits of standing at a desk, they immediately worried about muscle and skeletal pain. Previous research had shown that workers who spend more than one half their time standing up are more likely to experience this sort of discomfort.As a result, many of the early studies considered musculoskeletal pain as a possible side effect of standing at a desk. Whereas some studies found a slight increase in pain, most found no effect or a slight benefit.

Why might standing hurt less than sitting? Both postures can exert compressive forces on the intervertebral discs. But in a sitting position, the lumbar muscles are minimally activated, shifting their burden to passive structures, such as ligaments and discs. In addition, says Dr Gibbs, while sitting long-term, hip flexors may shorten. Standing up after a long period of sitting puts stress on these muscles, forcing the low back compensates for their lack of flexibility. About 60% of office workers experience back pain, and prolonged sitting is thought to be a major reason.

A recent meta-analysis of studies on standing desks found that offering employees sit/stand desks reduced their back pain by 0.30-0.50 on a scale of 0-10 points, where 0 is no pain and 10 is the worst pain imaginable. That may not sound like much, but in some studies, that meant a reduction in pain of about 50%.

For example, researchers at Stanford University, in Palo Alto, California, randomly divided 46 university employees into two groups. One group received work stations that could be adjusted to either a sitting or standing position and had access to them for 12 weeks. The others got nothing but a promise of such work stations at the end of the trial.

After 12 weeks, the people who got the sit-work desks reported a 55% improvement in back pain on their worst days, compared with a 15% change for the control group, a statistically significant difference. And importantly for employers, those who got the sit/stand desks reported a 60% improvement in their ability to concentrate, compared with 34% for the control group.

But few, if any, researchers believe that office workers would benefit simply by standing instead of sitting. One problem is that blood flowing to the legs while standing has more trouble returning to the heart. This pooling effect can result in clotting and varicose veins, says Jamie Burr, PhD, an assistant professor of human health and nutritional science at the University of Guelph in Canada. “Standing at your desk for hours and hours is probably not the answer.”

 

Richard Katesmark comments ; “Seems to be more research just confirming what we already know anecdotally; ie Staying mobile at work with frequent changes of position reduces the likelihood of musculoskeletal ( and other medical ) problems .

It’s worth noting that some research shows compression through the lower lumbar discs on sitting is 3x that on standing. However it is also worth pointing out that certain spinal problems may be aggravated by long periods of standing . Hence my advice to try & have a mixture of both, ideally with some walking on & off throughout the day . ”

Happy New year to all.