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What cause lower back pain?
Back Pain
This is for people who have back pain, as well as family members, friends, and others who want to find out about causes, diagnosis, and treatments, and research efforts, many of which are supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and other components of the Department of Health and Human Services' National Institutes of Health (NIH). If you have further questions after reading this, you may wish to discuss them with your doctor.
What Is Back Pain?
Back pain is an all-too-familiar problem that can range from a dull, constant ache to a sudden, sharp pain that leaves you incapacitated. It can come on suddenly - from an accident, a fall, or lifting something too heavy - or it can develop slowly, perhaps as the result of age-related changes to the spine. Regardless of how it happens or how it feels, you know it when you have it. And chances are, if you don't have it now, you will eventually.
How Common Is It?
At some point, back pain affects an estimated 8 out of 10 people. It is one of our society's most common medical problems.
What Are the Risk Factors for Back Pain?
Although anyone can have back pain, a number of factors increase your risk. They include:
Age: The first attack of low back pain typically occurs between the ages of 30 and 40. Back pain becomes more common with age.
Fitness level: Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. "Weekend warriors" - people who go out and exercise a lot after being inactive all week - are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise is good for the discs that cushion the vertebrae, the individual bones that make up the spine.
Diet: A diet high in calories and fat, combined with an inactive lifestyle, can lead to obesity, which can put stress on the back.
Heredity: Some causes of back pain, including disc disease, may have a genetic component.
Race: Race can be a factor in back problems. African American women, for example, are two to three times more likely than white women to develop spondylolisthesis, a condition in which a vertebra of the lower spine - also called the lumbar spine - slips out of place.
The presence of other diseases: Many diseases can cause or contribute to back pain. These include various forms of arthritis, such as osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, and cancers elsewhere in the body that may spread to the spine.
Occupational risk factors: Having a job that requires heavy lifting, pushing, or pulling, particularly when this involves twisting or vibrating the spine, can lead to injury and back pain. An inactive job or a desk job may also lead to or contribute to pain, especially if you have poor posture or sit all day in an uncomfortable chair.
Cigarette smoking: Although smoking may not directly cause back pain, it increases your risk of developing low back pain and low back pain with sciatica. (Sciatica is back pain that radiates to the hip and/or leg due to pressure on a nerve.) For example, smoking may lead to pain by blocking your body's ability to deliver nutrients to the discs of the lower back. Or, repeated coughing due to heavy smoking may cause back pain. It is also possible that smokers are just less physically fit or less healthy than nonsmokers, which increases the likelihood that they will develop back pain. Furthermore, smoking can slow healing, prolonging pain for people who have had back injuries, back surgery, or broken bones.
What Are the Causes of Back Pain?
It is important to understand that back pain is a symptom of a medical condition, not a diagnosis itself. Medical problems that can cause back pain include the following:
Mechanical problems: A mechanical problem is a problem with the way your spine moves or the way you feel when you move your spine in certain ways. Perhaps the most common mechanical cause of back pain is a condition called intervertebral disc degeneration, which simply means that the discs located between the vertebrae of the spine are breaking down with age. As they deteriorate, they lose their cushioning ability. This problem can lead to pain if the back is stressed. Other mechanical causes of back pain include spasms, muscle tension, and ruptured discs, which are also called herniated discs.
Injuries: Spine injuries such as sprains and fractures can cause either short-lived or chronic pain. Sprains are tears in the ligaments that support the spine, and they can occur from twisting or lifting improperly. Fractured vertebrae are often the result of osteoporosis, a condition that causes weak, porous bones. Less commonly, back pain may be caused by more severe injuries that result from accidents and falls.
Acquired conditions and diseases: Many medical problems can cause or contribute to back pain. They include scoliosis, which causes curvature of the spine and does not usually cause pain until mid-life; spondylolisthesis; various forms of arthritis, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis; and spinal stenosis, a narrowing of the spinal column that puts pressure on the spinal cord and nerves. While osteoporosis itself is not painful, it can lead to painful fractures of the vertebrae. Other causes of back pain include pregnancy; kidney stones or infections; endometriosis, which is the buildup of uterine tissue in places outside the uterus; and fibromyalgia, which causes fatigue and widespread muscle pain.
Infections and tumors: Although they are not common causes of back pain, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis, or when they involve the discs that cushion the vertebrae, which is called discitis. Tumors, too, are relatively rare causes of back pain. Occasionally, tumors begin in the back, but more often they appear in the back as a result of cancer that has spread from elsewhere in the body.
Although the causes of back pain are usually physical, it is important to know that emotional stress can play a role in how severe pain is and how long it lasts. Stress can affect the body in many ways, including causing back muscles to become tense and painful.
Can Back Pain Be Prevented?
One of the best things you can do to prevent back pain is to exercise regularly and keep your back muscles strong. Four specific types of exercises are described in How Is Back Pain Treated?. All may help you avoid injury and pain. Exercises that increase balance and strength can decrease your risk of falling and injuring your back or breaking bones. Exercises such as Tai Chi and yoga - or any weight-bearing exercise that challenges your balance - are good ones to try.
Eating a healthy diet also is important. For one thing, eating to maintain a healthy weight - or to lose weight, if you are overweight - helps you avoid putting unnecessary and injury-causing stress and strain on your back. To keep your spine strong, as with all bones, you need to get enough calcium and vitamin D every day. These nutrients help prevent osteoporosis, which is responsible for a lot of the bone fractures that lead to back pain. Calcium is found in dairy products; green, leafy vegetables; and fortified products, like orange juice. Your skin makes vitamin D when you are in the sun. If you are not outside much, you can obtain vitamin D from your diet: almost all milk and some other foods are fortified with this nutrient. Most adults don't get enough calcium and vitamin D, so talk to your doctor about how much you need per day, and consider taking a nutritional supplement or a multivitamin.
Practicing good posture, supporting your back properly, and avoiding heavy lifting when you can may all help you prevent injury. If you do lift something heavy, keep your back straight. Don't bend over the item; instead, lift it by putting the stress on your legs and hips.
When Should I See a Doctor for Pain?
In most cases, it is not necessary to see a doctor for back pain because pain usually goes away with or without treatment. However, a trip to the doctor is probably a good idea if you have numbness or tingling, if your pain is severe and doesn't improve with medications and rest, or if you have pain after a fall or an injury. It is also important to see your doctor if you have pain along with any of the following problems: trouble urinating; weakness, pain, or numbness in your legs; fever; or unintentional weight loss. Such symptoms could signal a serious problem that requires treatment soon.
Which Type of Doctor Should I See?
Many different types of doctors treat back pain, from family physicians to doctors who specialize in disorders of the nerves and musculoskeletal system. In most cases, it is best to see your primary care physician first. In many cases, he or she can treat the problem. In other cases, your doctor may refer you to an appropriate specialist.
How Is Back Pain Diagnosed?
Diagnosing the cause of back pain requires a medical history and a physical exam. If necessary, your doctor may also order medical tests, which may include x rays.
During the medical history, your doctor will ask questions about the nature of your pain and about any health problems you and close family members have or have had. Questions might include the following:
- Have you fallen or injured your back recently?
- Does your back feel better - or hurt worse - when you lie down?
- Are there any activities or positions that ease or aggravate pain?
- Is your pain worse or better at a certain time of day?
- Do you or any family members have arthritis or other diseases that might affect the spine?
- Have you had back surgery or back pain before?
- Do you have pain, numbness and/or tingling down one or both legs?
During the physical exam, your doctor may
- watch you stand and walk
- check your reflexes to look for slowed or heightened reflexes, either of which might suggest nerve problems
- check for fibromyalgia by examining your back for tender points, which are points on the body that are painful when pressure is applied to them
- check for muscle strength and sensation
- check for signs of nerve root irritation.
Often a doctor can find the cause of your pain with a physical and medical history alone. However, depending on what the history and exam show, your doctor may order medical tests to help find the cause.
Following are some tests your doctor may order:
X rays: Traditional x rays use low levels of radiation to project a picture onto a piece of film (some newer x rays use electronic imaging techniques). They are often used to view the bones and bony structures in the body. Your doctor may order an x ray if he or she suspects that you have a fracture or osteoarthritis, or that your spine is not aligned properly.
Magnetic Resonance Imaging (MRI): MRI uses a strong magnetic force instead of radiation to create an image. Unlike an x ray, which shows only bony structures, an MRI scan produces clear pictures of soft tissues, too, such as ligaments, tendons, and blood vessels. Your doctor may order an MRI scan if he or she suspects a problem such as an infection, tumor, inflammation, or pressure on a nerve. An MRI scan, in most instances, is not necessary during the early phases of low back pain unless your doctor identifies certain "red flags" in your history and physical exam. An MRI scan is needed if the pain persists more than 3-6 weeks, or if your doctor feels there may be a need for surgical consultation. Because most low back pain goes away on its own, getting an MRI scan too early may sometimes create confusion for the patient and the doctor.
Computed Tomography (CT) scan: A CT scan allows your doctor to see spinal structures that cannot be seen on traditional x rays. It is a three-dimensional image that a computer creates from a series of two-dimensional pictures that it takes of your back. Your doctor may order a CT scan to look for problems including herniated discs, tumors, or spinal stenosis.
Blood tests: Although blood tests are not used generally in diagnosing the cause of back pain, your doctor may order them in some cases. Blood tests that might be used include the following:
- Complete blood count (CBC), which could point to problems such as infection or inflammation
- Erythrocyte sedimentation rate (also called sed rate), a measure of inflammation that may suggest infection. The presence of inflammation may also suggest some forms of arthritis or, in rare cases, a tumor.
It is important to understand that medical tests alone may not diagnose the cause of back pain. In fact, experts say that up to 90 percent of all MRI scans of the spine show some type of abnormality, and sometimes the x rays and CT scans of people without pain show problems. Similarly, even some healthy pain-free people can have elevated sed rates.
Only with a medical history and exam - and sometimes medical tests - can a doctor diagnose the cause of back pain. Many times, the precise cause of back pain is never known. In these cases, it may be comforting to know that most back pain gets better whether or not you find out what is causing it.
What Is the Difference Between Acute and Chronic Pain?
Pain that hits you suddenly - after falling from a ladder, being tackled on the football field, or lifting a load that is just too heavy, for example - is acute pain. Acute pain comes on quickly and often leaves just as quickly. To be classified as acute, pain should last no longer than 6 weeks. Acute pain is the most common type of back pain.
Chronic pain, on the other hand, may come on either quickly or slowly, and it lingers a long time. In general, pain that lasts more than 3 months is considered chronic. Chronic pain is much less common than acute pain.
How Is Back Pain Treated?
Treatment for back pain generally depends on what kind of pain you experience: acute or chronic.
Acute Back Pain
Acute back pain usually gets better on its own and without treatment, although you may want to try acetaminophen, aspirin, or ibuprofen to help ease the pain. Perhaps the best advice is to go about your usual activities as much as you can with the assurance that the problem will clear up. Getting up and moving around can help ease stiffness, relieve pain, and have you back doing your regular activities sooner. Exercises are not usually advisable for acute back pain, nor is surgery.
Chronic Back Pain
Treatment for chronic back pain falls into two basic categories: the kind that requires an operation and the kind that does not. In the vast majority of cases, back pain does not require surgery. Doctors will almost always try nonsurgical treatments before recommending surgery. In a very small percentage of cases - when back pain is caused by a tumor, an infection, or a nerve root problem called cauda equina syndrome, for example - prompt surgery is necessary to ease the pain and prevent further problems.
Following are some of the more commonly used treatments for chronic back pain.
Nonoperative treatments
Hot or cold: Hot or cold packs - or sometimes a combination of the two - can be soothing to chronically sore, stiff backs. Heat dilates the blood vessels, improving the supply of oxygen that the blood takes to the back and reducing muscle spasms. Heat also alters the sensation of pain. Cold may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area. Although cold may feel painful against the skin, it numbs deep pain. Applying heat or cold may relieve pain, but it does not cure the cause of chronic back pain.
Exercise: Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and perhaps reduce its risk of returning. The following four types of exercise are important to general physical fitness and may be helpful for certain specific causes of back pain:
Flexion: The purposes of flexion exercises, which are exercises in which you bend forward, are to 1) widen the spaces between the vertebrae, thereby reducing pressure on the nerves; 2) stretch muscles of the back and hips; and 3) strengthen abdominal and buttock muscles. Many doctors think that strengthening the muscles of the abdomen will reduce the load on the spine. One word of caution: If your back pain is caused by a herniated disc, check with your doctor before performing flexion exercises because they may increase pressure within the discs, making the problem worse.
Extension: With extension exercises, you bend backward. They may minimize radiating pain, which is pain you can feel in other parts of the body besides where it originates. Examples of extension exercises are leg lifting while lying prone and raising the trunk while lying prone. The theory behind these exercises is that they open up the spinal canal in places and develop muscles that support the spine.
Stretching: The goal of stretching exercises, as their name suggests, is to stretch and improve the extension of muscles and other soft tissues of the back. This can reduce back stiffness and improve range of motion.
Aerobic: Aerobic exercise is the type that gets your heart pumping faster and keeps your heart rate elevated for a while. For fitness, it is important to get at least 30 minutes of aerobic (also called cardiovascular) exercise three times a week. Aerobic exercises work the large muscles of the body and include brisk walking, jogging, and swimming. For back problems, you should avoid exercise that requires twisting or vigorous forward flexion, such as aerobic dancing and rowing, because these actions may raise pressure in the discs and actually do more harm than good. In addition, avoid high-impact activities if you have disc disease. If back pain or your fitness level makes it impossible to exercise 30 minutes at a time, try three 10-minute sessions to start with and work up to your goal. But first, speak with your doctor or physical therapist about the safest aerobic exercise for you.
Medications: A wide range of medications are used to treat chronic back pain. Some you can try on your own. Others are available only with a doctor's prescription. The following are the main types of medications used for back pain.
Analgesics: Analgesic medications are those designed specifically to relieve pain. They include over-the-counter acetaminophen (Tylenol1) and aspirin, as well as prescription narcotics, such as oxycodone with acetaminophen (Percocet) or hydrocodone with acetaminophen (Vicodin). Aspirin and acetaminophen are the most commonly used analgesics; narcotics should only be used for a short time for severe pain or pain after surgery. People with muscular back pain or arthritis pain that is not relieved by medications may find topical analgesics helpful. These creams, ointments, and salves are rubbed directly onto the skin over the site of pain. They use one or more of a variety of ingredients to ease pain. Topical analgesics include such products as Zostrix, Icy Hot, and Ben Gay.
1 Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.
NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs that relieve both pain and inflammation, which may also play a role in some cases of back pain. NSAIDs include the nonprescription products ibuprofen (Motrin, Advil), ketoprofen (Actron, Orudis KT), and naproxen sodium (Aleve). More than a dozen others, including a subclass of NSAIDs called COX-2 inhibitors, are available only with a prescription.
All NSAIDs work similarly: by blocking substances called prostaglandins that contribute to inflammation and pain. However, each NSAID is a different chemical, and each has a slightly different effect on the body2.
2 Warning: NSAIDs can cause stomach irritation or, less often, they can affect kidney function. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Many other drugs cannot be taken when a patient is being treated with NSAIDs because NSAIDs alter the way the body uses or eliminates these other drugs. Check with your health-care provider or pharmacist before you take NSAIDs. Also, NSAIDs sometimes are associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation of the stomach or intestine. People over age 65 and those with any history of ulcers or gastrointestinal bleeding should use NSAIDs with caution.
Side effects of all NSAIDs can include stomach upset and stomach ulcers, heartburn, diarrhea, and fluid retention; however, COX-2 inhibitors are designed to cause fewer stomach ulcers. For unknown reasons, some people seem to respond better to one NSAID than another. It's important to work with your doctor to choose the one that's safest and most effective for you.
Other Medications: Muscle relaxants and certain antidepressants have also been prescribed for chronic back pain, but their usefulness is questionable.
Traction: Traction involves using pulleys and weights to stretch the back. The rationale behind traction is to pull the vertebrae apart to allow a bulging disc to slip back into place. Some people experience pain relief while in traction, but that relief is usually temporary. Once traction is released, the stretch is not sustained and back pain is likely to return. There is no scientific evidence that traction provides any long-term benefits for people with back pain.
Corsets and braces: Corsets and braces include a number of devices, such as elastic bands and stiff supports with metal stays, that are designed to limit the motion of the lumbar spine, provide abdominal support, and correct posture. While these may be appropriate after certain kinds of surgery, there is little, if any, evidence that they help treat chronic low back pain. In fact, by keeping you from using your back muscles, they may actually cause more problems than they solve by causing lower back muscles to weaken from lack of use.
Behavioral modification: Developing a healthy attitude and learning to move your body properly while you do daily activities - particularly those involving heavy lifting, pushing, or pulling - are sometimes part of the treatment plan for people with back pain. Other behavior changes that might help pain include adopting healthy habits, such as exercise, relaxation, and regular sleep, and dropping bad habits, such as smoking and eating poorly.
Injections: When medications and other nonsurgical treatments fail to relieve chronic back pain, doctors may recommend injections for pain relief. Following are some of the most commonly used injections, although some are of questionable value:
- Nerve root blocks: If a nerve is inflamed or compressed as it passes from the spinal column between the vertebrae, an injection called a nerve root block may be used to help ease the resulting back and leg pain. The injection contains a steroid medication and/or anesthetic and is administered to the affected part of the nerve. Whether the procedure helps or not depends on finding and injecting precisely the right nerve.
- Facet joint injections: The facet joints are those where the vertebrae connect to one another, keeping the spine aligned. Although arthritis in the facet joints themselves is rarely the source of back pain, the injection of anesthetics or steroid medications into facet joints is sometimes tried as a way to relieve pain. The effectiveness of these injections is questionable. One study suggests that this treatment is overused and ineffective.
- Trigger point injections: In this procedure, an anesthetic is injected into specific areas in the back that are painful when the doctor applies pressure to them. Some doctors add a steroid medication to the injection. Although the injections are commonly used, researchers have found that injecting anesthetics and/or steroids into trigger points provides no more relief than "dry needling," or inserting a needle and not injecting a medication.
- Prolotherapy: One of most talked-about procedures for back pain, prolotherapy is a treatment in which a practitioner injects a sugar solution or other irritating substance into trigger points along the periosteum (the tough, fibrous tissue covering the bones) to trigger an inflammatory response that promotes the growth of dense, fibrous tissue. The theory behind prolotherapy is that such tissue growth strengthens the attachment of tendons and ligaments whose loosening has contributed to back pain. As yet, studies have not verified the effectiveness of prolotherapy. The procedure is used primarily by chiropractors and osteopathic physicians.
Complementary and alternative treatments: When back pain becomes chronic or when medications and other conventional therapies do not relieve it, many people try complementary and alternative treatments. While such therapies won't cure diseases or repair the injuries that cause pain, some people find them useful for managing or relieving pain. Following are some of the most commonly used complementary therapies.
Manipulation: Spinal manipulation refers to procedures in which professionals use their hands to mobilize, adjust, massage, or stimulate the spine or surrounding tissues. This type of therapy is often performed by osteopathic doctors and chiropractors. It tends to be most effective in people with uncomplicated pain and when used with other therapies. Spinal manipulation is not appropriate if you have a medical problem such as osteoporosis, spinal cord compression, or inflammatory arthritis (such as rheumatoid arthritis) or if you are taking blood-thinning medications such as warfarin (Coumadin) or heparin (Calciparine, Liquaemin).
Transcutaneous Electrical Nerve Stimulation (TENS): TENS involves wearing a small box over the painful area that directs mild electrical impulses to nerves there. The theory is that stimulating the nervous system can modify the perception of pain. Early studies of TENS suggested it could elevate the levels of endorphins, the body's natural pain-numbing chemicals, in the spinal fluid. But subsequent studies of its effectiveness against pain have produced mixed results.
Acupuncture: This ancient Chinese practice has been gaining increasing acceptance and popularity in the United States. It is based on the theory that a life force called Qi (pronounced chee) flows through the body along certain channels, which if blocked can cause illness. According to the theory, the insertion of thin needles at precise locations along these channels by practitioners can unblock the flow of Qi, relieving pain and restoring health.
Although few Western-trained doctors would agree with the concept of blocked Qi, some believe that inserting and then stimulating needles (by twisting or passing a low-voltage electrical current through them) may foster the production of the body's natural pain-numbing chemicals, such as endorphins, serotonin, and acetylcholine.
A consensus panel convened by the National Institutes of Health (NIH) in 1997 concluded that there is clear evidence this treatment is effective for some pain conditions, including postoperative dental pain. Although there is less convincing evidence to support using acupuncture for back pain and some other pain conditions, the panel concluded that acupuncture may be effective when used as part of a comprehensive treatment plan for low back pain, fibromyalgia, and several other conditions.
Acupressure: As with acupuncture, the theory behind acupressure is that it unblocks the flow of Qi. The difference between acupuncture and acupressure is that no needles are used in acupressure. Instead, a therapist applies pressure to points along the channels with his or her hands, elbows, or even feet. (In some cases, patients are taught to do their own acupressure.) Acupressure has not been well studied for back pain.
Rolfing: A type of massage, rolfing involves using strong pressure on deep tissues in the back to relieve tightness of the fascia, a sheath of tissue that covers the muscles, that can cause or contribute to back pain. The theory behind rolfing is that releasing muscles and tissues from the fascia enables the back to properly align itself. So far, the usefulness of rolfing for back pain has not been scientifically proven.
Operative treatments
Depending on the diagnosis, surgery may either be the first treatment of choice - although this is rare - or it is reserved for chronic back pain for which other treatments have failed. If you are in constant pain or if pain reoccurs frequently and interferes with your ability to sleep, to function at your job, or to perform daily activities, you may be a candidate for surgery.
In general, there are two groups of people who may require surgery to treat their spinal problems. People in the first group have chronic low back pain and sciatica, and they are often diagnosed with a herniated disc, spinal stenosis, spondylolisthesis, or vertebral fractures with nerve involvement. People in the second group are those with only predominant low back pain (without leg pain). These are people with discogenic low back pain (degenerative disc disease), in which discs wear with age. Usually, the outcome of spine surgery is much more predictable in people with sciatica than in those with predominant low back pain.
Some of the diagnoses that may need surgery include:
Herniated discs: a potentially painful problem in which the hard outer coating of the discs, which are the circular pieces of connective tissue that cushion the bones of the spine, are damaged, allowing the discs' jelly-like center to leak, irritating nearby nerves. This causes severe sciatica and nerve pain down the leg. A herniated disc is sometimes called a ruptured disc.
Spinal stenosis: the narrowing of the spinal canal, through which the spinal cord and spinal nerves run.
It is often caused by the overgrowth of bone caused by osteoarthritis of the spine. Compression of the nerves caused by spinal stenosis can lead not only to pain, but also to numbness in the legs and the loss of bladder and/or bowel control. Patients may have difficulty walking any distances and may also have severe pain in their legs along with numbness and tingling.
Spondylolisthesis: a condition in which a vertebra of the lumbar spine slips out of place. As the spine tries to stabilize itself, the joints between the slipped vertebra and adjacent vertebrae can become enlarged, pinching nerves as they exit the spinal column. Spondylolisthesis may cause not only low back pain but severe sciatica leg pain.
Vertebral fractures: fractures caused by trauma to the vertebrae of the spine or by crumbling of the vertebrae resulting from osteoporosis. This causes mostly mechanical back pain, but it may also put pressure on the nerves, creating leg pain.
Discogenic Low Back Pain (Degenerative Disc Disease): Most people's discs degenerate over a lifetime, but in some, this aging process can become chronically painful, severely interfering with their quality of life.
Following are some of the most commonly performed back surgeries:
For herniated discs:
- Laminectomy/discectomy: In this operation, part of the lamina, a portion of the bone on the back of the vertebrae, is removed, as well as a portion of a ligament. The herniated disc is then removed through the incision, which may extend two or more inches.
- Microdiscectomy: As with traditional discectomy, this procedure involves removing a herniated disc or damaged portion of a disc through an incision in the back. The difference is that the incision is much smaller and the doctor uses a magnifying microscope or lenses to locate the disc through the incision. The smaller incision may reduce pain and the disruption of tissues, and it reduces the size of the surgical scar. It appears to take about the same time to recuperate from a microdiscectomy as from a traditional discectomy.
- Laser surgery: Technological advances in recent decades have led to the use of lasers for operating on patients with herniated discs accompanied by lower back and leg pain. During this procedure, the surgeon inserts a needle in the disc that delivers a few bursts of laser energy to vaporize the tissue in the disc. This reduces its size and relieves pressure on the nerves. Although many patients return to daily activities within 3 to 5 days after laser surgery, pain relief may not be apparent until several weeks or even months after the surgery. The usefulness of laser discectomy is still being debated.
For spinal stenosis:
- Laminectomy: When narrowing of the spine compresses the nerve roots, causing pain and/or affecting sensation, doctors sometimes open up the spinal column with a procedure called a laminectomy. In a laminectomy, the doctor makes a large incision down the affected area of the spine and removes the lamina and any bone spurs, which are overgrowths of bone, that may have formed in the spinal canal as the result of osteoarthritis. The procedure is major surgery that requires a short hospital stay and physical therapy afterwards to help regain strength and mobility.
- For spondylolisthesis:
Spinal fusion: When a slipped vertebra leads to the enlargement of adjacent facet joints, surgical treatment generally involves both laminectomy (as described above) and spinal fusion. In spinal fusion, two or more vertebrae are joined together using bone grafts, screws, and rods to stop slippage of the affected vertebrae. Bone used for grafting comes from another area of the body, usually the hip or pelvis. In some cases, donor bone is used.
Although the surgery is generally successful, either type of graft has its drawbacks. Using your own bone means surgery at a second site on your body. With donor bone, there is a slight risk of disease transmission or rejection. In recent years, a new development has eliminated those risks for some people undergoing spinal fusion: proteins called bone morphogenic proteins are being used to stimulate bone generation, eliminating the need for grafts. The proteins are placed in the affected area of the spine, often in collagen putty or sponges.
Regardless of how spinal fusion is performed, the fused area of the spine becomes immobilized.
For vertebral osteoporotic fractures:
- Vertebroplasty: When back pain is caused by a compression fracture of a vertebra due to osteoporosis or trauma, doctors may make a small incision in the skin over the affected area and inject a cement-like mixture called polymethyacrylate into the fractured vertebra to relieve pain and stabilize the spine. The procedure is generally performed on an outpatient basis under a mild anesthetic. Used only if standard care, rest, corsets/braces, analgesics fail.
- Kyphoplasty: Much like vertebroplasty, kyphoplasty is used to relieve pain and stabilize the spine following fractures due to osteoporosis. Kyphoplasty is a two-step process. In the first step, the doctor inserts a balloon device to help restore the height and shape of the spine. In the second step, he or she injects polymethyacrylate to repair the fractured vertebra. The procedure is done under anesthesia, and in some cases it is performed on an outpatient basis.
For Discogenic Low Back Pain (Degenerative Disc Disease)
Intradiscal electrothermal therapy (IDT): One of the newest and least invasive therapies for low back pain involves inserting a heating wire through a small incision in the back and into a disc. An electrical current is then passed through the wire to strengthen the collagen fibers that hold the disc together. The procedure is done on an outpatient basis, often under local anesthesia. The usefulness of IDT is debatable.
Spinal fusion: When the degenerated disc is painful, the surgeon may recommend removing it and fusing the disc to help with the pain. This fusion can be done through the abdomen, a procedure known as anterior lumbar interbody fusion, or through the back, called posterior fusion. Theoretically, fusion surgery should eliminate the source of pain; the procedure is successful in about 60 to 70 percent of cases. Fusion for low back pain or any spinal surgeries should only be done as a last resort, and the patient should be fully informed of risks.
Disc replacement: When a disc is herniated, one alternative to a discectomy - in which the disc is simply removed - is removing it and replacing it with a synthetic disc. Replacing the damaged one with an artificial one restores disc height and movement between the vertebrae. Artificial discs come in several designs. Although doctors in Europe had performed disc replacement for more than a decade, the procedure had been experimental in the United States until the Food and Drug Administration approved the Charite artificial disc for use.
What Kind of Research Is Being Done?
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is currently supporting a number of studies to better understand and treat back pain. Goals of current research include the following:
To compare the effectiveness of surgery versus nonsurgical treatment for low back pain. Although the percentage of people having spinal surgery in the United States has increased sharply over time, there is not much information on whether back surgery is better than nonoperative treatments. One study is comparing the most commonly used surgical treatments to the most commonly used nonoperative treatments for three common back problems: herniated discs of the lumbar spine, spinal stenosis, and spinal stenosis from spondylolisthesis. The study, being conducted at 12 medical centers, will follow patients for at least 24 months after treatment to determine the medical- and cost-effectiveness of treatments.
To identify the best treatments for certain low back pain patients. Just as certain treatments are effective for some back problems and not others, the same treatment may be effective for some people and not others - even if those people have the same medical problem. Researchers at several centers will study more than 3,000 patients who have one of three common causes of back pain - herniated discs, spinal stenosis, and spondylolisthesis - and who respond well to specific treatments. Extensive testing and surveys will allow doctors to identify the best treatments for these patients.
To test the effectiveness of lumbar fusion and other treatments for disc-derived pain. Discogenic pain is low back pain due to the wearing away of a disc between the vertebrae. While treatment for this condition is often lumbar spinal fusion, its effectiveness, as well as that of other treatments, has not been established. A new study will compare the results of spinal fusion with those of nonsurgical care for patients with similar disc degeneration. Researchers will also try to find out 1) what distinguishes people who choose surgery from those who do not; 2) the consequences of common complications of spinal fusion surgery and how often they occur; 3) what predicts a good response to surgical therapy but not to other treatments; and 4) what are the characteristics and outcomes of patients who have repeat back surgery for this condition.
To measure the frequency of complications in lumbar fusion surgery. Lumbar spinal fusion is a commonly performed procedure for several back problems, including disc degeneration, spondylolisthesis, spinal stenosis, and scoliosis, but the procedure can have complications. A new study will follow 1,000 people who have spinal fusion for one of these diagnoses to find out 1) how often complications occur after surgery, 2) how the rates of specific serious complications vary with different types of lumbar fusion, 3) the consequences of specific types of complications, and 4) the characteristics of treatments or patients that predict particularly severe complications. The information will help doctors better assess the benefits versus the risks of the procedure.
To better understand the relationship between the loss of motor control and low back pain. Compared to people without back problems, those with low back pain show losses in motor control, including problems with trunk muscle response and posture. Some researchers believe that losses in motor control may predispose people to falls that result in back pain. Other researchers think losses in motor control may result from damage sustained by tissue during a fall. To explore the relationship between motor control loss and back pain, scientists will study varsity athletes to determine whether poor motor control of the lumbar spine increases the risk of low back injury. They will also study changes in the lumbar spine motor control of people with low back pain after they complete rehabilitation programs that emphasize motor control training.
To develop and evaluate a psychosocial program for people with acute low back pain. Acute low back pain is a common problem that affects people's abilities to work and function, and it contributes to high health care costs. There are few studies, however, that prove whether or not a treatment truly reduces limitation and prevents the recurrence of pain. One new project will develop a program to enhance the social support and self-efficacy of people with acute low back pain. After developing and testing the program, researchers will evaluate its effectiveness by comparing the results of 160 participants with those of 160 people receiving usual care.
To evaluate the nervous system mechanisms of low back pain. Scientists think that when a disc ruptures, material leaking from its jelly-like filling leads to inflammation and the release of chemicals that irritate cells within the spinal canal. Scientists believe that the effects of these chemicals on the nerve endings in discs and adjacent tissue lead to low back pain, while the effects on dorsal nerve roots lead to sciatica. One study will test these ideas using a variety of techniques. A better understanding of pain mechanisms related to herniated discs will allow researchers to develop better treatments.
To evaluate an Internet-based patient education program. Patient education can play an important role in managing back pain. Yet taking part in an educational program can be difficult and time-consuming for some people, particularly if they live far from an area where such a program is offered. This study, conducted with patients recruited from Silicon Valley employers and the Internet, will test the effectiveness of an Internet-based education program. Participants will receive a book and videotape, and they will interact with other program participants through a moderated Internet discussion group. Patient assessments will also be conducted through the Internet.
For More Information
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or
877-22-NIAMS (226-4267) (free of charge)
Fax: 301-718-6366
E-mail: email@example.com
National Institute of Neurological Disorders and Stroke
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Phone: 301-496-5751 or
800-352-9424 (free of charge)
National Center for Complementary and Alternative Medicine
P.O. Box 7923
Gaithersburg, MD 20898
Phone: 301-519-3153 (international)
or 888-644-6226 (free of charge)
Fax: 866-464-3616
E-mail: email@example.com
Agency for Health Care Research and Quality Clearinghouse
540 Gaither Road
Rockville, MD 20850
Phone: 301-427-1364
Clearinghouse for Occupational Safety and Health Information
Information Services Branch MSC-13
4676 Columbia Parkway
Cincinnati, OH 45226
Phone: 513-533-8326 or
800-356-4674 (free of charge)
American Academy of Orthopaedic Surgeons
P.O. Box 2058
Des Plaines, IL 60017
Phone: 800-824-BONE (2663) (free of charge)
North American Spine Society (part of AAOS)
22 Calendar Court
2nd Floor
LaGrange, IL 60525
Phone: 877-SPINE-DR (free of charge)
E-mail: email@example.com
American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345
Phone: 404-633-3777
Arthritis Foundation
1330 West Peachtree Street, Suite 100
Atlanta, GA 30309
Phone: 404-872-7100 or
800-568-4045 (free of charge)
American Chiropractic Association
1701 Clarendon Boulevard
Arlington, VA 22209
Phone: 800-986-4636 (free of charge)
Acupuncture - an ancient Chinese practice that involves inserting thin needles at various sites on the body to relieve pain or influence other body processes. Today, doctors use acupuncture for problems as diverse as addiction, morning sickness, and back pain.
Acute pain - the most common type of back pain. Acute pain often begins suddenly - after a fall or injury, for example - and lasts for 6 weeks or less.
Analgesics - medications designed to relieve pain. Analgesics used for back pain include those that are available by prescription or over-the-counter and those made to be taken orally or rubbed onto the skin.
Ankylosing spondylitis - a form of arthritis that affects the spine, the sacroiliac joints, and sometimes the hips and shoulders. In severe cases, the joints of the spine fuse and the spine becomes rigid.
Cauda equina syndrome - a condition in which the nerves that control the bowels and bladder are pinched as they leave the spine. Unless treated promptly, the condition can lead to the loss of bowel and/or bladder function.
Cervical spine - the upper portion of the spine closest to the skull. It is composed of seven vertebrae.
Chronic pain - the least common type of back pain. Chronic pain may begin either quickly or slowly; it generally lasts for 3 months or more.
Disc - circular pieces of cushioning tissue situated between each of the spine's vertebrae. Each disc has a strong outer cover and a soft jelly-like filling.
Discectomy - the surgical removal of a herniated disc. A discectomy can be performed in a number of different ways, such as through a large incision in the spine or through newer, less-invasive procedures using magnifying microscopes, x rays, small tools, and even lasers.
Facet joints - the joints where the vertebrae of the spine connect to one another. Arthritis of the facet joints is believed to be an uncommon cause of back pain.
Fibromyalgia - a condition of widespread muscle pain, fatigue, and tender points on the body. Fibromyalgia is one cause of low back pain.
Herniated disc - a potentially painful problem in which the hard outer coating of the disc is damaged, allowing the disc's jelly-like center to leak and cause irritation to adjacent nerves.
Intradiscal electrothermal therapy (IDT) - a treatment for herniated discs in which a wire is inserted into the disc through a small incision in the back. An electrical current is then passed through wire to modify and strengthen the collagen fibers that hold the disc together.
Kyphoplasty - a procedure for vertebral fractures in which a balloon-like device is inserted into the vertebra to help restore the height and shape of the spine and a cement-like substance is injected to repair and stabilize it.
Laminectomy - the surgical removal of the lamina (the back of the spinal canal) and spurs inside the canal that are pressing on nerves within the canal. The procedure is a major surgery requiring a large incision and a hospital stay.
Lumbar spine - the lower portion of the spine. It is composed of five vertebrae.
Osteoarthritis - a disease in which the cartilage that cushions the ends of the bones at the joints wears away, leading to pain, stiffness, and bony overgrowths, called spurs. It is the most common form of arthritis and becomes more likely with age.
Osteoporosis - a condition in which the bones become porous and brittle, and break easily.
Prolotherapy - a treatment for back pain in which a practitioner injects a sugar solution or other irritating substance into trigger points along the periosteum (tough, fibrous tissue covering the bones) to trigger an inflammatory response that promotes the growth of dense, fibrous tissue. The theory behind prolotherapy is that such tissue growth strengthens the attachment of tendons and ligaments whose loosening has contributed to back pain.
Rolfing - a type of massage that uses strong pressure on deep tissues in the back to relieve tightness of the fascia (a sheath of tissue that covers the muscles) that can cause or contribute to back pain.
Rheumatoid arthritis - a disease that occurs when the body's immune system attacks the tissue that lines the joints, leading to joint pain, inflammation, instablity, and misshapen joints.
Sacroiliac joints - the joints where the spine and pelvis attach. The sacroiliac joints are often affected by types of arthritis referred to as spondyloarthropathies.
Sciatica - pain felt down the back and outer side of the thigh. The usual cause is a herniated disc, which is pressing on a nerve root.
Scoliosis - a condition in which the spine curves to one side as a result of congenital malformations, neuromuscular disorders, injury, infection, or tumors.
Spinal fusion - the surgical joining of two more vertebrae together, usually with bone grafts and hardware. The resulting fused vertebrae are stable but immobile. Spinal fusion is used as a treatment for spondylolisthesis, scoliosis, herniated discs, and spinal stenosis.
Spinal stenosis - the narrowing of the spinal canal (through which the spinal cord runs), often by the overgrowth of bone caused by osteoarthritis of the spine.
Spondyloarthropathy - a form of arthritis that primarily affects the spine and sacroiliac joints.
Spondylolisthesis - a condition in which a vertebra of the lumbar (lower) spine slips out of place.
Transcutaneous Electrical Nerve Stimulation (TENS) - a treatment designed to relieve pain by directing mild electrical impulses to nerves in the painful area of the body.
Vertebrae - the individual bones that make up the spinal column.
Vertebroplasty - a minimally invasive surgical procedure that involves injecting a cement-like mixture into a fractured vertebra to relieve pain and stabilize the spine.
The NIAMS gratefully acknowledges the assistance of James Kang, M.D., University of Pittsburgh, PA; Jeffrey Katz, M.D., Brigham and Women's Hospital, Boston, MA; William Lauerman, M.D., Georgetown University, Washington, DC; and James Panagis, M.D., M.P.H., NIAMS, NIH, Bethesda, MD, in the preparation and review of this booklet. Special thanks also go to the other individuals who reviewed this publication and provided valuable assistance.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services' National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. Additional information can be found on the NIAMS Web site at www.niams.nih.gov.
For Your Information
This publication contains information about medications used to treat the health condition discussed here. When this booklet was printed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.
For updates and for any questions about any medications you are taking, please contact the U.S. Food and Drug Administration at 1-888-INFO-FDA (1-888-463-6332, a toll-free call) or visit their Web site at www.fda.gov.
This booklet is not copyrighted. Readers are encouraged to duplicate and distribute as many copies as needed.


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Property for commercial use in Angera (VA)
Sale Properties
€95.000 Commercial estate
Ref: LM 1101 170 sqm 4 Rooms 1 Bathrooms no Garage Year built: Heating: Energy efficiency class: G Kitchen: Balcony: no Garden: Cellar: no Terrace: no Condo fees: €
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€ 108,000.00 negotiable

subset: commoncrawl


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September 25, McNeill Elementary inducted its founding members into the school's chapter of the National Elementary Honor Society.
A total of 81 students were inducted – 35 5th-grade students and 46 4th-grade students – into the District's first ever chapter of the honor society. Amber Barbarow is the principal at McNeill Elementary and Toni Scott is the Assistant Principal.
Fourth Grade honorees are:
Samuel Afowowe, Sarah Alami, Eros John Baua, William Bibbs, Alicia Blanton, Charity Cobbs, Aurelio Compean, Joshua Cunningham, Jesse Dairo, Udoka Ezeani, Jayden Floyd, Jonah Galloway, Victoria Guevara, Timmy Hoang, Yaqueline Huerta, Ethan Kanthack, Arthur Kelley, Rahman Khandakar, Adefoluke Kuforiji, Kaitlyn Lam, M'Sahani Lawson, Lisette Leano, Alejandro Martinez, Alexx Mullins, Julie Nguyen, Alexis Obialo, Numan Osagie, Alexia Partouche, Auxil Perez, Lex Pham, Moriah Price, Gabriel Rocha, Caleb Sawyer, Charles Schuetz, Haden Schulte, Mathew Shelton, Sophia Solley, Briana Solomon, James Talley, Marion Temporal, David Vo, Bryce Wands, Demari Williams, Christopher Wilson, Elisa Wyke and Bryce Wynne.
Fifth Grade honorees are:
Princess Ajibola, Connor Ashby, Kevin Batres, Jabyn Capistrano, Lia Carabajal, Mathaly Carranza, Simren Dsouza, Alyssa Dunbrock, David Garza, Kyle Guinn, Trester Hamana, Tiffany Hoang, Adam Laird, Alicia Landen, Aminat Lawal,Emilia Martinez, Katelynn Molina, Anna Monleon, Sochinemelum Mozie, Samuel Mugweru, Safouh Naili, Laurence Nguyen-Thai, Olive Okoro, Shanita Paes, Yvonne Andrea Perez, Sebastian Poirier, Fabiana Saa, Karrington Searles, Ryan Stubblefield, Anthony Tran, Faith Uzo-Onwumere, Meggie Wang, Janee Welcome, Clara Whelan and Avonlea Yeakley.


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Welcome to Physicians & Surgeons OBGYN
It began as a dream for two Amory doctors, but it soon became a reality called Physicians & Surgeons Clinic. The idea was conceived in 1960 when obstetrician and gynecologist Dr. Richard Hollis returned to Amory to become the seventh physician in town. He joined Drs. John Murfee, B.O Moore, and Wendell Stockton at Murfee's Clinic. He and Stockton, a pediatrician, left Murfee's Clinic to start their own practice in October 1963. One day later, Hollis and Stockton opened their offices in Gilmore Memorial Hospital while awaiting a house to be remodeled by C&D Lumber. They moved into the "Green House" (seen below) as it was known, in November 1963.
Two years after Drs. Hollis and Stockton created their business, they decided that the philosophy of P&S Clinic would be to provide the best available heath care services for the people of Amory. At this time they also decided that they would build a new clinic. This dream would not have been possible had it not been for Dr. Hollis's wife Weesies's willingness to sign the note for the loan. The first phase of the new clinic at 900 Earl Frye Boulevard was completed in 1965. To allow easier access to patients now all over north Mississippi and northeast Alabama, satellite clinics were opened in Columbus, Houston, and Guin, Alabama. Since that time, P&S Clinic has closed its operations in Houston and Guin but expanded the Columbus satellite to a full service clinic in the outpatient pavillion of Baptist Memorial Hospital. This clinic remains very busy to this day.
In order to service not only obstetric patients but their children as well, in 2010 P&S Clinic added Preferred Pediatrics and hired Dr. Mary Ann King, an experienced Pediatrician. A nurse practitioner with much pediatric experience Rita Hargett joined the clinic in 2012, and then JR McPherson joined in 2015. The pediatric providers are supported by a skilled team of pediatric nurses.
Another service was added to the P&S Clinic in 2010 when Bel Amour Laser Spa was opened. This spa provides cosmetic hair removal, vein removal, and skin tightening services which before this time were not available in Amory.
Times have certainly changed since the Green Houses' humble beginnings, but the mission of P& S Clinic remains the same: to provide the best available health care for the people of Amory and surrounding areas.
Privacy Policy: We value your privacy and will not sell or provide your personal information to any 3rd party!
Recent News
obgyn.pandsclinic.com NOW OFFERING!!!!
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Just a reminder, if you call in and leave a message for a mediation refill, it can take up to 48 hours for the refill to be processed. Please make sure you call before the completion of your prescription to request a refill!


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Friday, April 13, 2012
In Praise of Punctuality (... or Why I'm Not an Optimist)
1 comment:
Apologies if you have received this info before.
I think your readers will want to know about this exciting, new Green Technology that is proven to neutralize pollution emissions.
Stockholm based HydroInfra Technologies STC AB has already began forming joint ventures to deploy the technology. http://www.hydroinfra.com
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After several years of research & development, HIT discovered a method to generate a nano gas that neutralizes all types of pollution emissions.
Hydro Nano Gas ( HNG ) has been independently tested and verified by government licensed inspectors. Please see the reports on the HIT web site
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Regards : Mike


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About Our Club
HMRRC organizes over 30 running events a year. Club races are held at many different locations throughout the Capital District. Our events offer something for everyone, novice and veteran alike. Some of our events include:
Most HMRRC races are low-key events with a minimal entry fees. Members can participate in over a dozen races throughout the year with NO entry fee and enjoy a discounted rate at our other races. We also have children's fun runs at many of our adult events.
HMRRC offers scholarships to local student-athletes and administers Just Run!, a youth running program that is in over 20 elementary schools in the Capital Region. HMRRC also offers special grants to other organizations to encourage running-related endeavors in our community. Check out www.hmrrc.com for more information.


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Woods Hole Inn
Woods Hole, Massachusetts
This Cape Cod inn, steps from the Martha's Vineyard ferry landing, was built in 1887 but has been revamped with modern furnishings like glass rain showers.
What we loved Scanning the names on the wallpaper made from authentic guest registration cards dating back to the 1880s, when the inn was known as the Avery House.
If you only have one night Grab a bite at Quicks Hole Taqueria, located on the first floor of the inn; try the fresh lobster taco or the sweet Baja shrimp bowl.
Bonus The inn is the original home of the iconic Red Chair, which has journeyed to over 205 inns and B&Bs across 23 states.508-495-0248, woodsholeinn.com


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Timmee, later Processed Plastics Corp, gave up its license to make marvel comic figures and remolded them into 90mm fantasy figures. You can still tell who most of these were originally. These started showing up in header bags in the early 1980s. There are three generations of bags, two vintage and one modern. The first generation are glow in the dark figures in bright green, orange, blue and white. The second generation are in pastel green, purple and yellow. The modern figures are pea green and gray.
|Gen 3,2,1. The new green is very close to the gen 2 green.
|Hulk is not just a caveman, he is a saber-toothed caveman.
|Gen 1 bag.
|Gen 2 bag.
|Modern bag.
|Alternate modern bag.


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Vapman Replacement Spare Parts Mouthpieces and Filter Sections
Lost a piece to your vapman when out and about? Don't worry we carry a full range of spares to help you repair your vapman vapouriser and get you back vaping as soon as possible.
These spares are genuine Vapman products manufactured to the highest standards.


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School Choice: Pros And Cons
Part of the School Choice Series
Series About:
Focus on the Family believes that children are a heritage and blessing from God and that parents are accountable to God for raising, shaping and preparing children to serve Him. This accountability includes a responsibility to protect the hearts and minds of their children, a vital part of which is actively choosing the best education environment for their children. Thus, we whole-heartedly support school choice in its many varied forms.
Each child is unique, having different strengths and weaknesses. This is why we encourage parents to consider all available types of schooling, including public, private and home schools. Each education option has its own set of pros and cons, so Focus also encourages parents to make their schooling decisions on a family-by-family, child-by-child basis:
- In the public classroom, parental rights to determine how and when a child is taught about sexual topics, families' Biblical principles and religious beliefs are sometimes held in disrespect.
- In private Christian schools, the educational offering is sometimes too limited or too expensive.
- In the case of home schooling, parents sometimes feel unqualified or emotionally unsuited to teach, or they believe that their children need more peer experiences.
- Charter schools, which are not available in every community, have particular curricular emphases that are not always suited to a student's education needs.
- Public schools, which offer a wide range of classes, are often the most affordable education option.
- Private Christian schools offer curriculum that supports parents' beliefs and values.
- Home schools provide parents the greatest discretion over and direct involvement with their children's education.
- Charter schools provide particular curricular emphases, which might appeal to students with specific academic and vocational interests.
Focus on the Family also supports school choice because we believe it improves quality of education – creating a situation where school personnel need to compete for students by offering the best possible programs and standards. Competition makes schools more responsive to parents. This is the heart of a free enterprise system, which puts power in the hands of the "customers" – in this case, parents and students.
We also believe school choice is the fastest and most efficient way to equalize educational opportunity for all children, regardless of socio-economic status or ethnicity. Today, if an upper-class family is dissatisfied with their local public schools, they have the resources to send their children where they wish. An underprivileged family, however, has no such alternative. We believe school choice levels the playing field by making schools accountable to the parents – instead of bureaucrats – and by making the best schools available to the families who need them most.
In summary, we believe school choice represents the cutting-edge future of education. It breaks up the current bureaucratic monopoly controlling our education system and places the power squarely into the hands of the people to whom it belongs: parents.


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Published: 25 February 2013
Article: Scottish Cross Country Association
Click here to download the SDA flyer
Have you or your club got an article to share? Email email@example.com
Scottish Cycling and the Scottish Downhill Association (SDA) are delighted to announce that online entries have now opened for all the 2013 race series.
The season offers great downhill racing on demanding and technical SDA courses, from the south at Ae Forest, Innerleithen in the Borders, Killin and Dunkeld in the Perthshire Hills, via the Rannoch Moor and Glencoe to the World Cup course at Fort William.
Each round offers nine categories of racing to accommodate all ages and abilities and as with all SDA events a friendly and welcoming helping hand from the experienced to the new starts coming to their first race and venue.
Race entries are live and riders can enter by using the following link: CLICK HERE
There are also special online pre-entry rates offering a discount on the on-the-day prices.
The dates & venues for the 2013 series are:
Series 1: 20/21st April, Innerleithen
Series 2: 18/19th May, Glencoe
Series 3: 22.23rd June, Killin
Scottish Championships: 13/14th July, Dunkeld
Series 4: 10/11th August, Ae Forest
Series 5: 7/8th September, Fort William
Click here to download the SDA flyer
You can also keep up to date and in contact via twitter: @SDA races or Facebook just search "Scottish Downhill Association"


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home > archive > 2007 > this article
Approaching critical mass
By Carol Devine-Molin
web posted September 24, 2007
One of life's pivotal maxims is to anticipate problems and head them off at the pass. And in this brave new world, where we find a very dangerous nexus among rogue states, terrorism, and nuclear proliferation, it's absolutely essential to grasp the big picture and think a few steps ahead. That being said, I appreciate the analysis being provided by conservative radio and television talk-show host Glenn Beck, especially on the theme he's dubbed "the perfect storm". In short, Beck underscores how a series of events can come together to produce a devastating synergy, which can wreak havoc upon our society.
But it's never enough to just anticipate catastrophe – Smart people proactively attempt to thwart catastrophe. And by "smart people", I mean those that are able to successfully negotiate life's difficulties utilizing their intellect, experience and basic common sense.
Mind you, it doesn't have to be WMDs that tear at the fabric of western civilization, although nuclear, chemical and biological warfare are clearly at the forefront of our concerns. On his website, Glenn Beck lists the crucial issues that could readily produce disasters of one kind or another: a) Hot Zones (Iraq, Afghanistan, Gaza, etc.) in this increasingly turbulent world, b) Iran and other lawless regimes, most notably Syria and North Korea, c) Terrorism, d) Oil and the economy, and, e) Border and culture-related matters.
To that I would add the political polarization that's taken hold in this nation, especially the far Left's willingness to aid and abet Islamo-fascists, and its twisted viciousness toward conservative Republicans and the military. The simple truth is that most Americans want to fight and win this global war on terror – However, we'll have to simultaneously fight off Leftist groups such as moveon.org, which are determined to throw a monkey-wrench into the mix at every opportunity.
Interestingly, not one of the Democrat presidential contenders voted for the Senate resolution to denounce moveon.org for their ad that denigrated General David Petraeus and, by extension, our troops and their efforts in Iraq. Why? Because Democrats have a tiger by the tail. Moveon.org and other members of the far Left do the dirty work for the Democrat presidential contenders, attacking and smearing conservatives and the GOP presidential field with alacrity. The Democrat presidential contenders dare not complain about moveon.org's methods, lest they be assaulted by their own thugs who boast they "bought and own" the Democrat Party.
Regarding terror threats on American soil, Glenn Beck regularly interviews security experts that suggest how we can anticipate and prevent future attacks. We have to ask ourselves fundamental questions: What are the most likely targets? What venues have terrorists targeted overseas? What has been their modus operandi? What has been the American experience with mass violence? And how can we best strengthen and protect potential targets such as schools, school buses, shopping malls, stadiums and entertainment arenas? A greater security presence, including more armed guards, could be enough to dissuade a terrorist attack simply because terrorists look for the easier targets. Furthermore, we should take heed and learn from past episodes of violence, even if they're not terror-related: For example, the "gun free" zone at the Virginia Tech campus made it possible for a psychotic such as Cho Seung-Hui to murder scores of fellow students, before the police were able to make it to the scene and take him down.
As to the escalating Iranian crisis, it's doubtful that the Bush administration is going to permit the fanatical mullah-run regime – that's in bed with every major terror group in the Middle East – to have nuclear weapons capability. With that in mind, military action taken against Iran will surely produce blowback or unintended consequences. Airstrikes upon Iran's nuclear infrastructure and military sites could very well activate terror cells in America and other western societies. Therefore, it's time for all Americans to adhere to the Boy Scout axiom, "Be Prepared!"
In this post 9/11 atmosphere, it's natural, even desirable, that we're on the look-out for circumstances on the world scene that can come back to bite us. Two recent news reports were red-flags, indicative of "warning" or "danger" for me and probably for many Americans: First, one of our crucial allies on this war on terror, Pakistan's President Pervez Musharraf, is in a very precarious position, with radical Islam on the ascendancy in Pakistan, and Osama bin Laden calling upon the citizenry to topple Musharraf. If Musharraf is ejected from power or assassinated, there's an increasing likelihood that elements sympathetic to al-Qaida and the Taliban are going to have a nuclear arsenal at their disposal. Do we really want these Islamic fundamentalists to possess nukes? It makes you wonder if the US has a sufficient plan to secure Pakistani nukes so that they don't fall into the wrong hands.
Second, Israel recently conducted airstrikes on a Syrian nuclear facility reportedly being set up by North Korea. So North Korea is now subcontracting out its nuclear program? It's evident that all of these "axis of evil" nations – Iran, Syria, North Korea, and new kid on the block, Venezuela – are involved in collaborative efforts. This is the new "Pinky and the Brain" gang. Each evening, "Brain Ahmadinejad" is asked by the other "axis of evil" nations, "Gee, what are we going to do tonight?" And "Brain Ahmadinejad" answers, "The same thing we do every night. Try to take over the world."
Carol Devine-Molin is a regular contributor to several online magazines.
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DagsVara 2014
Sub title
Introduction to Event
Find out how innovative newspaper organizations are developing strategies for the future! Get started in 2014 with an inspirational set of best practices that will help you lead your business growth, at DagsVara 2014.
+++ Presentations to be held mainly in Swedish, some of them in English +++
Further Information
The programme includes sessions on paid content strategies, strategy and organisation, new revenue streams, radical changes to streamline production, as well as the impact of start-ups in the news publishing business.
Join DagsVara 2014 to share with your peers and colleagues the latest trends in the publishing industry!
The DagsVara Committee
As in the past, the DagsVara programme has been enriched by the many contributions provided by its Committee, that comprises the following members:
Anette Novak, Interactive Institute Swedish - Björn Zitting, IKEA - Carin Andersson, Sydsvenska Dagbladet -Emanuel Karlsten, Digital Media Consultant - Håkan Helander, Konsult - Per-Arne Fernsund, Stampen
Date and Location
05 Feb 2014 - 06 Feb 2014StockholmSweden


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Barn At Strasburg Bed & Breakfast, The
- Barn At Strasburg Bed & Breakfast, The
- 308 Miller Street
- Strasburg, PA 17579
- Primary - (717) 687-7870
Each of our three rooms at The Barn at Strasburg B&B has been exquisitely remodeled and furnished with hand-crafted furniture in keeping with each room's unique personality. Aside from a few purposely exposed hand-hewn beams in the Garden & Shaker Suites, you'll never know this was once a real barn! You'll also find in each room a private bath with tiled floors and showers, while the Master Suite will especially pamper you with an oversize whirlpool soaking tub. Our beds, king size in the Master Suite & queen in the others, promise a restful night's sleep on pillow-top mattresses with luxurious 300+ count linens. Cable TV, DVD's and high-speed wireless internet access in each room are also provided.
In the morning, you'll be served a generous home-cooked breakfast. Whether the hot entree includes an egg casserole or perhaps our stuffed french toast, you'll definitely be rewarded with fresh fruit, home-baked muffins, breads or pastries, juices and always fresh coffee and varied tea choices. We also promise to do our best to accommodate dietary restrictions.
The Gathering Room provides a microwave and refrigerator, including an assortment of late-night snacks & beverages for your convenience. Breakfast can be enjoyed either there or, weather permitting, outside on our patio. You'll also find our welcoming gardens to be a refreshing place for a casual stroll.
Only 1 mile west of the central square of historic Strasburg and tucked behind another vintage street-side home, The Barn at Strasburg provides enough privacy to feel secluded, and yet is convenient to major Lancaster County attractions, including the Strasburg Railroad, Sight & Sound Theatres and the ever-popular Rockvale & Tanger shopping outlets.
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On the map below, you'll find information for this item, as well as a few of the lodging, dining, shopping and activities that are close by. To see more nearby listings, click the "View Full Map" link in the legend below.
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When God speaks, many of us are like people in a fog, and we give no answer. Moses' reply to God revealed that he knew where he was and that he was ready. Readiness means having a right relationship to God and having the knowledge of where we are. We are so busy telling God where we would like to go. Yet the man or woman who is ready for God and His work is the one who receives the prize when the summons comes. We wait with the idea that some great opportunity or something sensational will be coming our way, and when it does come we are quick to cry out, "Here I am." Whenever we sense that Jesus Christ is rising up to take authority over some great task, we are there, but we are not ready for some obscure duty.
Readiness for God means that we are prepared to do the smallest thing or the largest thing— it makes no difference. It means we have no choice in what we want to do, but that whatever God's plans may be, we are there and ready. Whenever any duty presents itself, we hear God's voice as our Lord heard His Father's voice, and we are ready for it with the total readiness of our love for Him. Jesus Christ expects to do with us just as His Father did with Him. He can put us wherever He wants, in pleasant duties or in menial ones, because our union with Him is the same as His union with the Father. ". . . that they may be one just as We are one . . ." (John 17:22).
Be ready for the sudden surprise visits of God. A ready person never needs to get ready— he is ready. Think of the time we waste trying to get ready once God has called! The burning bush is a symbol of everything that surrounds the person who is ready, and it is on fire with the presence of God Himself.
Though Moses said, "Here I am," at the burning bush, his first response to God was not as such (Exodus 3:11). He doubted himself, he doubted God, he had a temper toward the Egyptians that resulted in murder.
For some reason God would not leave Moses alone over what He had called Him to do. It took Moses 40 years in Midian to finally get to the place where he responded to God at the burning bush; he was 80 years old.
Is there something that you feel God won't leave you alone about? How will you respond? Will it take you 40 years?


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I love the Spotnicks. They've got a unique sound and great shtick, not to mention Rocket Man was probably the song that got stuck in my head most last year and I ended up christening my blog with it.
I have here two Spotnicks albums that I haven't seen elsewhere, perhaps because I bought both of them in Europe (though the Spotnicks were from Sweden so that doesn't mean much). They both aren't very good for reasons I will detail, but first I should address the obvious question of "if they suck then why?"
First and foremost: I think that all records deserve the right to existence. I've come across so much great music from taking risks in the dollar bin, music that will never be written about in history books and are excluded from musical canon. A lot of it will be buried in time, plenty of it by the time the baby boomers croak. The internet provides a no-risk sampling environment for this music to be heard and continue to exist. And there's often a reason for bad music to exist, that Surfin' With Bo Diddley Album being a great example. There are better surf albums out there, but my curiosity was piqued and since it's the most visited page on this blog I'd wager I'm not the only one.
Secondly: This CD contains some of the only examples I can think of where all the foci of this blog come together: Sci-Fi, Rock & Roll and New Orleans. Specifically I'm talking about Take Me To The Mardi Gras and a vocals-present cover of Jambalaya. I'm kind of glad I got this album just to hear those alone, but there's some other odd ones like a cover of "My Baby Left me" and "The Great Snowman's" crazy banjo meltdown. They don't often make great songs, but really my judgement is clouded on all of these tracks; the production is just way too clean and cheesy throughout all these songs. The high-pitched undistorted guitar falls into Walgreens soundtrack territory. This claims to be a greatest hits collection but only out of their post-60's career, so despite what the cover might lead you to believe they've dropped the whole sci-fi thing and probably look more like this other album.
Oh my god how the mighty have fallen. "Yeah guys, the Spaceman thing didn't work but I'll tell you what's in right now is blue shirts, jeans and not getting haircuts. THAT'S our new uniform. However, I think synchronized guitar playing is still in. Except for you, fourth guitar player, you play guitar over there"
Just like 20 Nice Ditties or whatever the Swedish translates to, these are mostly covers and not particularly inspired, though they do have their moments. It's still got that clean sound, but not as unbearably so. And it does have their cover of Ghostriders in the Sky which rightfully made it onto my actual Greatest Hits album not featured in this post (I have it ripped but it just seems redundant considering that there are CD collections and albums available pretty easily. I could be convinced otherwise).
There you have it. You've got hard drive space you're a spotnicks nut, go forth and check these out, then watch that rocket man video again.
You can get "20 Heta Låtar" here
And Electrifying Spotnicks here


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Crossing Streams is the twentieth-eighth and last Chapter on the DVDs of Ghostbusters. In this Chapter the Ghostbusters Cross the Streams. The credits start at timestamp 1:37:26 standard black credits start at timestamp 1:40:05.
- Peter Venkman
- Ray Stantz
- Egon Spengler
- Winston Zeddemore
- Stay Puft Marshmallow Man (destructor form of Gozer)
- Zuul
- Vinz Clortho
- Walter Peck
- Dana Barrett
- Louis Tully
- Janine Melnitz
- Bill Walton as part of a crowd
- Slimer
- The marshmallows that rained down on Central Park West were two hundred pounds of shaving cream released by Chuck Gaspar's physical effects team from a giant plastic bag attached to a crane. It was mixed in 500 gallon batches. [1] [2]
- The explosion was reshot several times. Each time, the explosion was toned down. The final explosion was still big enough that no one should have survived it in realistic terms (but that was part of the joke). [3]
- On page 18 of Ghostbusters 101 #3, panel 1 recreates a scene from Chapter 28 when the Ghostbusters crossed the streams on the Temple of Gozer with the Stay Puft Marshmallow Man watching in horror.
- ↑ Shay, Don (November 1985). Making Ghostbusters, p. 195 annotation. New York Zoetrope, New York NY USA, ISBN 0918432685. Paragraph reads: "To achieve this gag, two hundred pounds of shaving cream - employed by physical effects supervisor Chuck Gaspar to simulate melted marshmallows - was released from a giant plastic bag attached to a crane."
- ↑ Neil Krepela (1999). Ghostbusters (1984) "SFX Team Featurette" (1999) (DVD ts. 11:33-11:39). Columbia Pictures. Neil Krepela says: "All that marshmallow is basically shaving cream. We had to mix it in 500 gallon batches."
- ↑ Shay, Don (November 1985). Making Ghostbusters, p. 197 annotation. New York Zoetrope, New York NY USA, ISBN 0918432685. Michael Gross says: "We reshot the final explosion several times, toning it down each time because it was just too big. It's still too big, actually. In reality, nothing on the rooftop could have survived that explosion. But I guess if an audience can believe a hundred-foot marshmallow man, they can accept an oversized explosion."
Selected ScreengrabsEdit
Behind the ScenesEdit
Secondary CanonEdit
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|Chapter 27: Stay Puft Man


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Synonyme von Tables and desks
bara counter or room where alcoholic drinks are served bedside tablea small table beside a bed billiard tablethe rectangular table used for playing billiards breakfast bara counter in a kitchen where people can sit and have breakfast breakfast tablea table, usually the table in a home where a family has most of its meals, laid for breakfast buffeta counter where light refreshments are served bureaua writing desk with pigeonholes, drawers, etc, against which the writing surface can be closed when not in use card tablea table used for playing cards carrela small individual study room or private desk, often in a library, where a student or researcher can work undisturbed coffee tablea low table, on which newspapers, etc, may be placed and coffee served console tablea table with one or more curved legs of bracket-like construction, designed to stand against a wall counter(in some cafeterias) a long table on which food is served to customers davenport (British)a tall narrow desk with a slanted writing surface and drawers at the side deska service counter or table in a public building, such as a hotel dining tablea table at which meals are eaten dressing tabledrop-leaf tabledrum tableescritoirea writing desk with compartments and drawers, concealed by a hinged flap, on a chest of drawers or plain stand folding tablegate-leg or gate-legged tablekitchen tablelapboarda flat board that can be used on the lap as a makeshift table or desk lowboy (US, Canadian)a table fitted with drawers nest of tablesoccasional tablea small table with no regular use pedestal deska desk with a writing surface supported by a pair of sets of drawers Pembroke tablea small table with drop leaves and often one or more drawers piecrust tablea round table, ornamented with carved moulding suggestive of a pie crust reading deskrefectory tablea long narrow dining table supported by two trestles joined by a stretcher or set into a base roll-top deska desk having a slatted wooden panel that can be pulled down over the writing surface when not in use secretairean enclosed writing desk, usually having an upper cabinet section side tablesnooker tableteapoya small table or stand with a tripod base tea tablea table that is being used for a meal eaten in the late afternoon or early evening tea trolleytraymobile (Australian)a small table on casters used for conveying food, drink, etc trestle tablea table supported by trestles or a braced frame wool tablea slatted wooden table in a shearing shed where fleeces are skirted and classed workbencha heavy table at which work is done by a carpenter, mechanic, toolmaker, etc worktableany table at which writing, sewing, or other work may be done writing deskwriting tablea table designed or used for writing at ▷ See table
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While you've already mastered contouring, highlighting, and other well-known tricks to sculpt your face, there a ton of other (more under-the-radar) options to test out as well. From hair color to makeup tricks to Botox (no judgment!), we're dishing on the most effective secrets we've learned from the beauty elite.
We already talked flattering haircuts that make your face look thinner (stay away from blunt lines), and now we're bringing you everything you need to know in terms of makeup and styling products that'll help you learn how to make your face look thinner. Keep reading because we're about to let you in on all our very best secrets to tone and slim your face.
1. Ask for Lowlights
Dark shades slim out your face, while lighter highlights actually make it appear wider. Add some lowlights along the strands closest to your face and use brighter hues on the tips of your hair and crown of your head. The best part? Ombré is still very much in style, and your new hair will look cool and work to make your face look thinner.
2. Try a Facial Massage
Waking up puffy and bloated can immediately effect your face. Drink a ton of water before bed (especially if you've recently gone ham on pizza or a delicious burger), and give a facial massage a go come morning. By using the contours of this butterfly-shaped quartz stone, you can massage and sculpt your jawline and cheekbones as well as drain away puffiness from under your eyes. Here's a step-by-step guide to getting it right.
3. Apply Blush Correctly
The placement of your blush (as well as the shade) is paramount when it comes to slimming your face. Look for a product with a slight brown undertone to show off the contours on your face without going full contour—a red undertone can often round out your face. Instead of applying to the apples of your cheeks, brush the brush just under your cheekbones up to the middle of each ear.
4. Accessorize With Earrings
This is perhaps the easiest way to elongate your face. Long, dangly earrings draw the eye to the length of your neck rather than the roundness of your face. And, of course, they're pretty glamorous with a glossy pink lip (try Dior Dior Addict Lip Glow, $33).
5. Practice Your Cat-Eye Liner
Playing up your eyes draws attention away from the rest of your face. A precise feline flick is just the thing to add sophistication to your makeup look and make your face look slimmer to boot. Eyeko's thin-tipped liner makes it almost impossible to mess up (and just as easy to fix).
6. Give Your Roots a Lift
Adding volume to your hair instantly elongates your face. To create height, grab a root-lifting product and section off the hair around your crown. Spray along the part and tease underneath, back-combing from your ends to your roots. Then, smooth the top of your hair and voilà! The higher the hair, the thinner face.
7. Arch Your Brows
The arch in your brows will help lift your face (or make it look wider). Have a professional create a bit more of an angular arch to nicely frame your face and slim it out instantly. Also, make sure not to over-tweeze. Patchy, thin brows will work in the opposite way and round out the look of your face.
8. Consider Botox
David Shafer, MD, a New York–based plastic surgeon, offers a bit more invasive (but long-lasting) solution. "Botox is a fantastic treatment for slimming the jawline," Shafer explains. "A few injections on either side of the jaw helps thin the masseter muscle, which, if untreated, can cause bulk in the lower face."
Looking for more beauty advice? Here's how beauty editors keep dark circles and puffiness at bay.