Robert Shmerling, M.D., Harvard Medical School

Hi, Margaret - I'm sorry you were amazed and dismayed! But, I did mention physical therapy. (The Hartford Courant may have edited out my full answer).

Although I was answering a question about "home remedies" for sciatica, here's what I said about standard medical therapies:

"Standard medical approaches to treatment include:

- Rest, balanced with stretching and exercise (often with a physical therapist)
- Pain relievers, such as ibuprofen, naproxen or acetaminophen
- Drugs for nerve pain, such as amitriptyline (Elavil) or gabapentin (Neurontin)
- Injections of corticosteroids near the area of the compressed nerve
- Surgery to repair a slipped disc or to decompress spinal stenosis (though surgery is generally considered a treatment of last resort and only in cases in which a surgically correctable abnormality is present)."

I just read the article Home Remedies for Sciatica Pain, in the Hartford Courant, Tuesday January 6th, 2010
I was amazed and dismayed that Dr. Shmerling did not mention physical therapy as a remedy.
A physical therapist can assess posture, strength, balance, coordination, flexibility and movement patterns and then devise a treatment plan directed at any shortfalls. A therapist can direct a patient as to which exercises would be most beneficial depending on the specific condition(stenois, disc) ie. show which muscles need more flexibility, which muscles need more strengthening, which joints may be out of alighnment and which postures need to be avoided. A physical therapist can also provide education regarding common conditions as well as proper postures, alignment, and positioning to help aleviate the pain. A client could then perform the appropriate exercise and positioning at home. If being treated in a clinic setting then modalities like traction, interferential current, ultrasound, laser, etc. could also be utilized
Margaret Afheldt RPT
Canton Physical Therapy

1) Slouching may not damage joints, but my neck and back still flare up whenever I do it.

2) Obesity is linked only with arthritis of the knee and hip, correct? Doesn't that hint that increased weight bearing is the cause of the knee/hip arthritis?

I recently read your article "Top Ten Things That Don't Cause Arthritis" and I have some concerns. I am certain you are a fine physician and you mean well. This communication is purely for academic discussion. I am concerned that someone will read it and misinterpret what is being written.

Several times in the article you state that the true causes of arthritis are simply not known. That being said, you state what does not cause arthritis. I don't find that responsible. Studies have not been conducted that prove those factors "do not" cause arthritis so in fact - they COULD cause it.

Osteoporosis can cause malformations on the outside of the bone which COULD cause problems with the cartiladge that attaches to it (arthritis).

Getting older is not a cause in itself, but people who DO get arthrities more often that not DO get it when they get older. So you can't rule out age as a factor.

Food affects all aspects of our health - including connective tissues and body functions. It can not be ruled out as a factor. The likelyhood is that it IS a factor. That needs to be said.

Weather - though not a root cause - can certainly be a stimulator of increased symptoms at least temporarily. Constant cold weather can certainly exaserbate the pain consistently. Those reports of pain are real.

I just want people to truly consider possible factors since they have to live with the disease. Because something is not proven does not mean it is not true. The relationships of these possible causes are sensible.

Thank You.

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Dr. Shmerling:

I just read your article on MSN.com regarding hiccups and would like to share some information on the subject. Many years ago I happened upon an article postulating that hiccups are a vestigial characteristic left over from the time in our history as hunter/gatherers. Much the same as the appendix is a vestigial structure; not used anymore, but still there.

This seems to make sense since the most common cause of hiccups is eating too much too quickly.

As such, once the individual (our hunter/gatherer ancestor) scarfed down as much food as possible they would head home. The hiccups would indicate to others the presence of food, and would also facilitate the regurgitation of the food either as a result of the hiccups or self-induced vomiting by the individual. Once the food was disgorged, the hiccups would stop.

The food wouldn't be completely digested, but rather denatured (chemically "cooked") by the hydrochloric acid in the stomach. This would be especially beneficial to the very young and the old and infirm whose digestive systems would have difficulty processing raw food.

That being said, here's the 'cure' for hiccups: digitally induce vomiting.

Severely persistent hiccups may require several applications of this procedure, but if you do this at the onset of the hiccups actual vomiting isn't always necessary; many times just making oneself gag will eliminate the hiccups.

This method hasn't failed me yet, but I suspect individual results may vary. Give it a try the next time you get the hiccups.

Best regards,

Wade Morgan

wmorgan64@hotmail.com

Dr. Shmerling I just read an article by you in Med Track: 10 Things That DON'T Cause Arthritis. I can not thank you enough for this article. I am 51 years young with a 75 year old spine and have already had decompression surgery and am now facing lumbar fusion. I have severe arthritis, I am not overweight and fairly active. This started 2 years ago and shows no sign of stopping. I am sick and tired of reading articles that talk about "Prevention" and "Cure". I didn't do anything to get this and out of 5 treating physicians no one has even implied that there is much they can do for me and they promise no cure only hope of remission. I have widespread tendonitis which I am insisting is probably fibromyalgia or very early stage of OA in my ankles, elbows, knees. No RA, No Lupus, No Lyme, Sed Rate between 2 and 7. I have no inflammation, no redness, no swelling. Just pain.
Thank you for your article which shows your true understanding of this devil of a disease. People do not take it seriously when you tell them you have arthritis, they don't think its a big deal. Some doctors don't even understand it, they call it wear and tear, they ask "what did you do to yourself?" then I switch to someone else.
Again, thanks for your message I needed that today.

Sharon