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Dr Jean-Marc Parisaux is a doctor of sports medicine and traumatology with expertise in manual medicine, osteopathy and rehabilitation. He is a specialist at the prestigious Monaco-based sports medicine center, IM2S, which helps world-class athletes and ordinary folk with their goals towards attaining optimal physical performance. Send your health and fitness questions to: askthedoc @

Avoiding injuries on the slopes

Dear Dr Parisaux,

I will be taking up skiing this year as an adult. It looks like a fun sport, but I've heard that most accident and emergency cases during winter are from the ski slopes. Is there any way to reduce the risk of injury?

- Pamela

Dear Pamela,

When it comes to alpine skiing, the greatest number of injuries are to the knees, accounting for more than 70 per cent of the cases. Often, there are lesions to the anterior cruciate ligament (or ACL), one of the most important ligaments of the knee. The incidence of these injuries can be decreased by an adapted physical preparation. Ask your doctor or seek out a sports training professional for advice on a pre-ski exercise program. Physical preparation must be centered on muscular work, endurance (aerobic capacity), balance and proprioception (the body's awareness of position, posture and movement). Warming up before beginning the day of skiing is also highly advised. If you practise snowboarding instead, the major risk is fractures to the wrist (more than 50 per cent of the cases). When snowboarding, it's essential to wear protection for the wrist, in particular at the beginner level.

Dealing with arthritis medicine

Dear Dr Parisaux,

My mother is a big smoker and as long as I can remember has suffered with ulcers. Now, she has been told she has arthritis in her knees. She's heard from her friends that arthritis medication causes ulcers and does not want to take any because she says her body wouldn't be able to handle it. How can I convince her that she needs to get on this medication despite the side effects?


Dear Carrie,

Several kinds of medication can be useful for arthritis. The risk of ulcers is caused by NSAID (Nonsteroidal Antiinflammatory Drugs). So you have to be careful with this kind of medication on her. Indeed, with her previous ulcers, two conditions have to be met before she could take NSAID: her ulcers shouldn’t be evolutive (that is, they should be completely cured) and she has to take pills to protect her stomach lining along with this kind of treatment.

Moreover, new osteoarthritis treatments for the knees have made it possible to reduce the need of NSAID. Cartilage protectors and hyaluronic acid injections (viscosupplementation) are very helpful for the pain and for cartilage protection. I recommend she should talk with her doctor as soon as possible about starting this kind of treatment.

Any cure for lower back pain?

Dear Dr Parisaux,

Any suggestions to get rid of lower back pain? I don't do anything stressful to cause it. It's not as if I ever have to lift anything heavy at the office or at home. Yet this pain is always there.

- Sylvan

Dear Sylvan,

First of all, you have to see your doctor and probably do x-rays and maybe a blood test. It is necessary to do this first to eliminate any medical problems as the cause. Then, if everything is normal or just a pain on a degenerative spine, several suggestions can be followed: adopting a good sleeping position (avoid lying on your stomach); ensuring you have good bedding to provide proper support; sitting well; carrying weights in a good position.... You may also consider rehabilitation options such as massage, physiotherapy, stretching and strenghtening the back muscular chain, and activities such as bicycling. If you have the opportunity, I suggest you to do a spine isokinetic evaluation (strength test) so you can plan the best rehabilitation program.

Are heavy scoolbags harmful?

Dear Dr Parisaux,

My daughter is to start school soon and every time I see kids carrying big, heavy knapsacks filled with books I cringe. Can carrying these heavy loads on their backs cause children to damage to their spine?


Dear Melissa,

You're right to be concerned. Carrying heavy bags can be stressful for the spine during a child's growth years. To guard against this, you should ensure the weight of your daughter's bag is not more than 10 per cent of her body weight. Also, advise her not to carry the bag on only one shoulder or with only one hand, as it is better to balance the weight by carrying the bag symmetrically. Bags with wheels are an interesting option you could try too.

I’m glad you raised the issue about heavy bags, but you should take comfort from knowing that the lumbar spine is able to carry a certain amount of weight for a short while. Interestingly, it appears that the main reasons for back pain among teenagers are obesity and physical inactivity. So to help many teens with their back problems, we have to advise them to choose sports instead of TV or video games!

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