Published by
Stanford Medicine



Orthopedics, Research

Walking-and-texting impairs posture – and walking, and texting

Walking-and-texting impairs posture - and walking, and texting

Figure 1My yoga teacher, Annie Carpenter, frequently includes movement directions in class that counteract a modern epidemic she calls “text head.” (Look down at your phone and notice your posture.) So I was delighted to come across a post today on highlighting a recent study on the very subject, citing many reasons you should bring your head into alignment with your spine right now.

Researchers from the University of Queensland, Australia used motion-capture technology to study how reading or typing with a mobile phone while walking affects the gait. The 26 participants walked in a straight line for approximately 8.5 meters.

PopSci reports that, “No surprise, the people reading or texting were slower, deviated from a straight line more, and on top of everything, didn’t text very accurately.”

From the study:

Gait performance was evaluated using a three-dimensional movement analysis system. In comparison with normal waking, when participants read or wrote text messages they walked with: greater absolute lateral foot position from one stride to the next; slower speed; greater rotation range of motion (ROM) of the head with respect to global space; the head held in a flexed position; more in-phase motion of the thorax and head in all planes, less motion between thorax and head (neck ROM); and more tightly organized coordination in lateral flexion and rotation directions. While writing text, participants walked slower, deviated more from a straight line and used less neck ROM than reading text. Although the arms and head moved with the thorax to reduce relative motion of the phone and facilitate reading and texting, movement of the head in global space increased and this could negatively impact the balance system.

The authors note, “Changes in gait associated with mobile phone use may undermine functional walking and impact on safety in common pedestrian environments.” So, keep your head up!

Previously: Toilets of the future, and the art of squatting, Exploring the use of yoga to improve the health and strength of bonesSpinal bracing for adolescents with scoliosis and “Barefoot” running craze still going strong
Photo by Schabrun et. al

Global Health, Orthopedics, Pediatrics, Rural Health, Stanford News, Technology, Videos

Two Stanford students' $20 device to treat clubfoot in developing countries

In the video above, Stanford graduate students Jeff Yang and Ian Connolly demo their design for a brace to correct clubfoot in a way that’s comfortable and functional for the children who need it, and reasonable for their families to afford. The $20 device uses injection molded plastic attached to cleats to hold a child’s legs in an upright position so that they can strengthen the muscles they need eventually to maintain the posture without assistance. It also allows them to stand and move around with ease, and the device looks more like a toy than a restraint.

Yang and Connelly visited Brazil to learn more about the birth defect that affects one in 1,000 children whose feet appear to be rotated internally. There, clubfoot is commonly treated using rigid, ineffective metal braces, notes this video and an article on The students began working with the organization Miraclefeet during a Stanford D.School course titled “Design for Extreme Affordability” and put their design into action at a hospital in São Paulo.

Previously: Support for robots that assist people with disabilities, New documentary focuses on Stanford’s Design for Extreme Affordability courseBiotech start-up builds artful artificial limbs and Improving treatment for infant respiratory distress in developing countries
Photo in featured entry box from Design for Extreme Affordability

Aging, Complementary Medicine, Health and Fitness, NIH, Orthopedics, Research

Measuring the physical effects of yoga for seniors

Measuring the physical effects of yoga for seniors

LeslieAs my grandmother marched into her 80s, she would regularly eyeball pieces of furniture before sitting on them. “I’m afraid I won’t be able to get up,” she’d say, in the spirit of fun but with some underlying fear. Even though she and my grandfather stayed active by taking yoga classes at a senior center, and were a neighborhood hit riding their tandem tricycle in matching helmets and T-shirts, declining strength and range of motion with age just made certain everyday movements difficult.

I thought of my grandma while reading about an NIH-funded study from the University of Southern California and University of California, Los Angeles on yoga for seniors. Published in the journal BMC Complementary and Alternative Medicine, the study quantified the physical effects of seven poses in 20 ambulatory older adults whose average age was 70.7 years. Participants attended hour-long Hatha yoga classes twice a week for 32 weeks. The researchers used biomechanical methods joint moments of force (JMOF) and electromyographic analysis at the beginning and end of the study to measure each pose’s demands on select lower-extremity joints and muscles.

In a Research Spotlight, the National Center for Complementary and Alternative Medicine noted:

Findings from the study may be used to help design evidence-based yoga programs in which poses are chosen for the purpose of achieving a clinical goal (e.g., targeting specific joints or muscle groups or improving balance). The physical demands, efficacy, and safety of yoga for older adults have not been well studied, and older adults are at higher risk of developing musculoskeletal problems such as strains and sprains when doing yoga.

Study author Leslie Kazadi, a Los Angeles-based experienced yoga therapist, designed the yoga program with a geriatrician, exercise physiologist/biomechanist, and physical therapist from the research team and taught participants the poses. She told me that standing poses were chosen to target areas of the body that tend to become weak or limited in seniors. Hip stabilizers, for example, help with mobility and balance – and confidence in everyday situations, such as rising from a chair. “What you need to move around in the world is to be strong in your lower body,” Kazadi said. “If you don’t have stability downstairs, then you’re not going to get freedom upstairs no matter what.”

Previously: Exploring the use of yoga to improve the health and strength of bonesAsk Stanford Med: Pain expert responds to questions on integrative medicineExercise programs shown to decrease pain, improve health in group of older adults and Moderate physical activity not a risk factor for knee osteoarthritis, study shows
Photo by NCCAM/RaffertyWeiss Media

Orthopedics, Pain, Parenting, Pediatrics

On being a parent with chronic pain

Mom3The Atlantic posted a moving piece today written by a mother whose severe scoliosis has left her body in a near-constant state of pain. The author, Rachel Rabkin Peachman, points to a recent review of scientific literature documenting how children of parents with chronic pain are affected by their mothers’ and fathers’ condition:

The results, published in the Journal of Child and Adolescent Psychiatric Nursing, are, well, painful to read. It turns out that children whose parents experience chronic pain are at increased risk for adjustment problems and behavioral issues, and are more likely to complain of pain themselves. The whole family suffers.

Peachman details some of the studies’ findings. She also describes her own history with pain and parenting, and discusses the times she was unable to pick up and soothe her crying daughter. She writes:

Science may say the odds are against parents with chronic pain. And I know there are days I’m sidelined and short-tempered. But I’m determined to raise children who feel supported, secure, and loved. I don’t know what my future holds—surgery, therapies, or a lifetime of pain. But I have to believe that despite a deteriorating body, it’s possible to be a successful mother.

The entire piece is worth a read.

Previously: Image of the Week: The agony of painStanford researchers address the complexities of chronic painLetting go of control during chronic illness or pain and Chronic illness in childhood: One patient’s story
Photo by Miki Yoshihito

Complementary Medicine, Orthopedics, Research

Exploring the use of yoga to improve the health and strength of bones

Exploring the use of yoga to improve the health and strength of bones

yogaosteo I’ve written before about research studies on yoga, as well as components of my yoga teacher-training program. Delighted to find connections between the two worlds, I was interested recently to attend a workshop on yoga for osteoporosis and osteoarthritis with Loren Fishman, MD, an assistant clinical professor of rehabilitation and regenerative medicine at Columbia University Medical Center, and Annie Carpenter, founder of SmartFLOW® yoga.

Fishman is a physiatrist, dedicated yogi and proponent of yoga as a non-surgical, non-pharmaceutical approach to healing and preventive medicine. He’s published books on yoga for back pain, arthritis, and sciatica, among others, and he’s conducting a study of yoga in people who have osteoporosis.

Based on a 2009 pilot (.pdf) that showed improvement in bone density over a two-year period for the group of yoga practitioners versus a slight loss of bone in the control group, the current study prescribes a sequence of 12 yoga poses designed to place stress on the bones to generate cells and strengthen the bone’s dynamic support system. Participants track the poses they complete using an online scorecard, and their bone density is measured before and after practice is introduced. So far, he recently reported, in 65,000 hours of practice among 575 participants worldwide, no yoga-related fractures have been documented.

It’s essential for a patient to have a physician’s diagnosis of his condition before beginning yoga or any treatment program, Fishman and Carpenter emphasized in their workshop. And the most important job of a yoga teacher or therapist, Carpenter said, is being able to see the problems people are dealing with in their practice. She provided instruction on how to look at bodies in all three planes, find imbalances, examine the patterning in structure and movement and determine what to offer students as tools to improve their own well-being.

Previously: Ask Stanford Med: Pain expert responds to questions on integrative medicine, Exercise programs shown to decrease pain, improve health in group of older adults, Moderate physical activity not a risk factor for knee osteoarthritis, study shows, Treatments to reduce fractures for children with brittle-bone disease and New genetic regions associated with osteoporosis and bone fracture
Photo by Tiffany Caronia

Aging, Health and Fitness, Orthopedics, Pain, Research

Exercise programs shown to decrease pain, improve health in group of older adults

Exercise programs shown to decrease pain, improve health in group of older adults

LASHER ILICEvery time I read about research on the benefits of exercise, I become eager to go outside and run. (Or, realistically, take a pleasant walk.) But before I do that today, I wanted to share a study showing that participating in an exercise program led to a decrease in pain from arthritis and other musculoskeletal conditions, as well as an improvement in mobility and overall health, among a group of older adults.

The research, which was presented today at the American Public Health Association Annual Meeting in Boston, involved 119 adults of Asian descent – most of them female and age 65 or older – living in New York City. Participants took part in multiple eight-week yoga exercise classes and sessions of the Arthritis Foundation Exercise Program between 2011 and 2013. The community-based classes were conducted by the Hospital for Special Surgery‘s Asian Community Bone Health Initiative using bilingual instructors at senior centers in the Chinatown, Flushing and Queens neighborhoods.

A release explained why the researchers focused on Asian adults:

The Asian older adult population in New York City grew by 64 percent from 2000 to 2010, and one in four seniors lived in poverty in 2010. “This population is at risk for osteoarthritis and osteoporosis,” said Laura Robbins, DSW, senior vice president of Education and Academic Affairs at HSS. “They are more than twice as likely to have no health insurance coverage compared to other major race and ethnic groups. Cultural and linguistic barriers limit access to healthcare services.”

And as for results:

In the survey, many participants reported that their pain intensity dropped and interfered less with their quality of life. The following statistically significant results are noteworthy:

  • 48% fewer participants had pain on a daily basis after completing the program
  • 69% more participants could climb several flights of stairs after the program
  • 83% more participants could bend, kneel, or stoop
  • 50% more participants could lift/carry groceries
  • 39% of participants felt the program reduced their fatigue
  • 30% participants felt that the program reduced their stiffness

Previously: Exercise is valuable in preventing sedentary deathModerate physical activity not a risk factor for knee osteoarthritis, study showsResearchers look at brain activity to study falling and Help from a virtual friend goes a long way in boosting older adults’ physical activity

Aging, NIH, Orthopedics, Technology

Support for robots that assist people with disabilities

Support for robots that assist people with disabilities

As if medical research funding wasn’t tight enough, now scientists must compete with robots for grants. Wait… I have that wrong. The National Institutes of Health recently announced the awarding of $2.4 million over the next five years for projects with robots. (The humans are still in charge of the studies.)

Now that that’s cleared up, let’s talk about the robots. As part of the second year of the National Robotics Initiative – a shared project of multiple federal agencies to design “co-robots” to improve mobility and functioning in people with disabilities – the NIH is funding three projects.

One is a co-robotic cane that can aid the visually impaired by sensing information about the environment and relaying it to its user. Another is a co-robotic active catheter for heart procedures.

And my favorite, the novel platform for rapid exploration of robotic ankle exoskeleton control, is a wearable robot. People with impaired mobility or strength from aging or due conditions such as cerebral palsy or spinal cord injury may be assisted by this device. Researchers from North Carolina State University and Carnegie Mellon University will test robotic control methods in patients recovering from a stroke to improve the product’s design.

Previously: Biotech start-up builds artful artificial limbs

Health Costs, Medicine and Society, Orthopedics, Research

How much for those healthy knees?

How much for those healthy knees?

hurt kneeWhat’s the cost of healthy, functional knees for life? Priceless, you might say, especially if yours feel achy or injured. But rehabilitation after a major injury, such as an anterior cruciate ligament (ACL), can be expensive, and results after surgery vary.

A recent study published in the Journal of Bone and Joint Surgery has examined the cost-effectiveness and quality-of-life impact of surgery to repair an ACL tear in relation to the price of the procedure, versus rehabilitation without surgery. Researchers found the average lifetime societal benefit of having ACL reconstruction surgery to be $50,000 per patient – or $10.1 billion across the U.S., which reports approximately 200,000 ACL tears annually.

This price includes not only money that would have been spent on rehabilitation and future injury repair, but also comparative lost wages and disability payments after surgery versus non-surgical rehabilitation. It also considers the patient’s ability to live with high function, low levels of pain and minimal risk of developing knee osteoarthritis.

From the study:

In the short to intermediate term, ACL reconstruction was both less costly (a cost reduction of $4503) and more effective (a [quality-adjusted life years – QALY] gain of 0.18) compared with rehabilitation. In the long term, the mean lifetime cost to society for a typical patient undergoing ACL reconstruction was $38,121 compared with $88,538 for rehabilitation. ACL reconstruction resulted in a mean incremental cost savings of $50,417 while providing an incremental QALY gain of 0.72 compared with rehabilitation. Effectiveness gains were driven by the higher probability of an unstable knee and associated lower utility in the rehabilitation group. Results were most sensitive to the rate of knee instability after initial rehabilitation.

Previously: Study shows men, rather than women, may be more prone to ACL injuries, Stanford study shows protein bath may rev up sluggish bone-forming cells andIron-supplement-slurping stem cells can be transplanted, then tracked to make sure they’re making new knees
Via Medical News Today
Photo by Carolyn Tiry

Cardiovascular Medicine, Orthopedics, Sports, Stanford News

Following treatment for thoracic outlet syndrome, Stanford athlete dives back to life

Following treatment for thoracic outlet syndrome, Stanford athlete dives back to life


Those of us who spend hours on a keyboard each day – especially ones that torque our wrists and thumbs out of their natural stance – may have already experienced the pain and stiffness that can come from asking our body parts to do the same thing over and over again. And such is the case for athletes, as well.

When Taylor Sishc arrived at Stanford as an All-American high school diver, with years of devoted practice responsible for that achievement, he found himself with a similar repetitive use injury. He had severe weakness in his left arm, and the trick – as with many medical challenges – was to figure exactly what was going on and how to fix it.

As a member of Stanford’s elite diving team, Sishc had access to expert coaches, trainers, therapists and doctors, including vascular surgeon Jason Lee, MD. As I wrote in an Inside Stanford Medicine article:

Lee, an associate professor of surgery at the School of Medicine, had his suspicions about what the problem was: Sishc might have thoracic outlet syndrome, a condition often seen in athletes but also found in people who use their arms in a repetitive motion, which can lead to the compression of nerves or blood vessels, or both, in the thoracic outlet — an area bounded by the base of the neck and the first rib.

Diagnosis of thoracic outlet syndrome, also known as TOS, is not straightforward. “There’s no one blood test or radiographic test or physical exam finding that gives you that ‘aha’ moment,” Lee said. “It’s a combination of positive and negative tests.”

Sishc had been a gymnast since childhood and a serious competitive diver since he was 13. By the time he reached Stanford, he had been lifting his arms over his head in a similar motion for years — exactly the kind of long-term overuse that creates thoracic outlet syndrome…

My story details how Lee’s hunch was correct and how the therapies Sishc received slowly but surely got him back on the diving board in championship form.

Previously: ‘Snorkel’ stents create lifeline to organs in method of treating complex abdominal aortic aneurysms
Photo by Todd Holland

Orthopedics, Pediatrics, Research, Stanford News

Spinal bracing for adolescents with scoliosis

Spinal bracing for adolescents with scoliosis

Scoliosis_cobbScoliosis, a condition marked by a spine curvature in the shape of an “S” (sideways) or a “C” (forward and backward), ranges in severity from mild to debilitating, affecting not only posture but sometimes also respiratory function. Children and adolescents who develop scoliosis may be monitored with X-rays to measure the degree of curvature and can be prescribed exercises, encouraged to wear a stiff brace around the torso or even undergo corrective surgery.

In the current issue of the New England Journal of Medicine, Eugene Carragee, MD, a professor of orthopaedic medicine at Stanford, co-authored an editorial titled “Spinal Bracing in Adolescent Idiopathic Scoliosis.” The piece considers whether spinal bracing – previously a problematic form of treatment for post-polio paralysis – is an effective solution for young people with adolescent idiopathic scoliosis (AIS) who have spinal curvature of 50 degree or greater. Carragee and his co-author, Ronald Lehman, MD, professor of orthopaedic surgery and neurological surgery at Walter Reed National Military Medical Center, review a multicenter study from the same NEJM issue measuring the effectiveness of bracing as means of preventing AIS progression.

Carragee and Lehman write that the study authors found bracing for AIS patients to be effective, and that longer times of wearing the brace each day was associated with greater effectiveness. Also noted in the editorial were challenges to the 242-subject study: difficulty with participant enrollment and compliance meant that much of the data was drawn from a non-randomized cohort.

From the editorial:

The decision to commit a12 or 13 year-old to several years of brace wear requires careful consideration of both the benefits and downsides. Although brace-wear in AIS does not have the serious physiological side effects apparent in polio-related scoliosis, it carries financial, emotional and social burdens to consider.

As the authors appropriately point out, 48% of the untreated subjects had a successful outcome, as did 42% of the braced subjects with little to no time in treatment. In retrospect, the bracing indications described are likely too broad, resulting in what may be unnecessary treatment for many patients. We agree with the authors that the equally important finding of this study is that so many growing children with AIS seem to do just fine with no treatment at all; the challenge for the field going forward is to identify those children who are most likely and those who are unlikely to benefit from bracing.

Previously: How orthopedic surgery straightened out one man’s lifeThe burden of carrying a heavy backpack and Image of the week: brass corset, 19th century
Photo by

Stanford Medicine Resources: