Q: AN MRI last year showed I have scoliosis. My spine is curving at the base, and some discs and vertebrae have degenerated, causing considerable pain in my back and my legs and making it difficult to walk up and down stairs. Physio has not so far helped. Should I try Pilates?
BT
A: I AM sorry to hear about all the problems with your spine and the discomfort and disruption these have caused in your life.
The kind of degeneration of the spine you describe is common, with a number of potential causes including osteoporosis, wear and tear of the shock-absorbing discs that sit between the vertebrae (or bones) of the spine, and inflammation of the facet joints, which connect the bones of the spine.
The underlying problem is usually ageing, although genetics, your diet in adolescence (95 per cent of peak bone mass is reached before the age of 20, so adequate calcium intake is vital) and the amount of exercise you've taken over the years (exercise builds up bone strength) also play a role.
Apart from the disabling pain you're experiencing, another problem is inflammation. This is the body's way of trying to heal the damage to the bone, but can lead to narrowing of the spinal canal, which carries the nerves that relay messages between your trunk and limbs.
This narrowing puts pressure on the nerves, which is why you're also getting pain in your legs.
Treating spinal pain can be complicated, which is why we now have so-called iPASS clinics (integrated pain and spinal service), dedicated to the management of chronic spinal pain.
You mention in your longer letter that you have been referred to an iPASS clinic. Essentially, you will be assessed by a multi-disciplinary team, hopefully leading to advice about the best approach for your treatment.
This may initially involve being seen first by a specialist physiotherapist. Even if the physiotherapy that was recommended has not helped, I would not try Pilates sessions without further advice from the team caring for you.
For instance, a member of the neurology team or one of the neurosurgical specialists might recommend that you need surgery to relieve pressure on the nerves in your spine.
In the meantime, I would urge you to stick with the exercises as it can take weeks or months to see the benefits of physio.
Q: I'VE BEEN prescribed statins because of a slight narrowing of one artery. I've since heard plant sterols do the same but are more 'natural'. Are they a good alternative?
AS
A: STEROLS AND stanols are molecules found in many plants - from grains and fruits to vegetables and nuts - that reduce the amount of cholesterol absorbed from the food we eat. And now they are being incorporated into some manufactured foods (such as spreads).
You have been put on statins because your doctor has diagnosed early coronary heart disease and there is lots of evidence that lowering cholesterol levels (especially LDL, or 'bad' cholesterol) reduces the build-up of fatty deposits in the arteries and the risk of a heart attack or stroke.
Statins are the most powerful tool for achieving this, but the best results are when they're combined with a healthy diet, such as a Mediterranean diet.
Furthermore, studies confirm that consuming sterols and stanols, as well as taking statins, can further reduce cholesterol.
So eating foods rich in plant sterols and stanols could bring added benefit to your statins, but they're certainly not a substitute for them.
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