April 10, 2008 -- People may not always talk about it, but many in America feel hurt over their body type and physical features.
There's the obvious emotional angst of those whose figures don't compete with those of swimsuit models or Hollywood starlets. But then, there's the actual physical pain.
At least 15 percent of the population has complained of musculoskeletal pain in the last year: more than people with allergies and headaches combined, according to "The Burden of Musculoskeletal Disease in the United States," a publication from the United States Bone and Joint Decade.
Some of this pain comes from injury, but some also occurs as a result of a person's specific body type. If you ask orthopaedists, it turns out that, what we might think makes us beautiful, doesn't help us feel pain-free.
The name "pigeon-toed" probably arose more from the distinctive gait — a bit of a waddle that comes from walking with toes pointed inward — rather than the look of the toes themselves.
A pigeon-toed frame, which appears as toes, as well as knees, pointed inward, frequently occurs in toddlers between 8 and 15 months.
Though children usually outgrow being pigeon-toed, called in-toeing by doctors, the stance can persist or get worse in adulthood, often caused by a rotational twist in the tibia (shin bone) or a twist in the femur (thigh bone) as it connects to the hip.
If the problem worsens, so might the person's pain. The weight of a person who walks with a pigeon-toed frame puts stress on parts of the body not designed to take it.
"The forces on your ankles, on the tendons around your ankles, can cause pain," said Dr. Lonnie Paulos, director of the Texas Sports Medicine Alliance in Houston, Texas. Paulos noted that flat feet, another painful problem, often accompanies a pigeon-toed stance.
If a person's pigeon-toed gait worsens, the kneecap can wear out faster, as well as the joints in the ankles. That wear and tear can cause an early or more severe onset of osteoarthritis.
Funny how the same silhouette can strike feelings of appeal in one sex and feelings of distress in the other.
Big-bosomed women with little waistlines to match often suffer more than inappropriate stares and difficulty when shopping for dresses.
A buxom woman can suffer welts on her shoulders from her bra straps, and running or other aerobics can hurt without the right support. Even sitting still can cause pain for big-breasted women.
"If they are real large, they pull your shoulders forward," Paulos said. "The shoulders, neck and back will hurt."
Female patients accounted for about 60 percent of the health care visits for neck pain in 2004, according to "The Burden of Musculoskeletal Disease in the United States."
Unlike many other forms of pain from body types, there's not much a full-chested woman can do.
"That's the reason why, many years ago, they developed the support bra," Paulos said.
Beyond bras, the American Society of Plastic Surgeons reports that 106,000 women had breast reduction surgery in 2007. In the same year, more than three times that number of women decided to get breast augmentation.
Underweight, Thin Frame
For all the magazine, catalogue, advertisement, movie, talk show, sitcom and self-help hype over being thin, slight people don't have it all — especially when it comes to body types and pain.
"If it's a natural thinness, and you're eating healthy, and exercising, it's not an issue," Paulos said. But he added that it's another story, "if your thinness is from an eating disorder, or excessive dieting."
People who stay thin unnaturally may lose critical elements for conditioning the joints, Paulos said. They may have bone pain from loss of calcium, vitamin C and vitamin D.
Even the so-called enviable people who stay thin naturally, but never exercise and eat whatever they want, might be at risk. These people, especially women, are more likely to get painful fractures from osteoporosis later in life.
"Having a thin frame is a recognized risk factor," said Dr. Laurence Laudicina, a spokesman for the American Academy of Orthopaedic Surgeons.
It turns out that so-called big-boned women truly do have more bone than thin-framed women. Once menopause hits, these big-boned women have more bone to lose before one breaks.
And for thin women who like to party, take note: combine a thin frame with a sedentary lifestyle, smoking and heavy drinking and a woman increases her risk for osteoporosis even more, Laudicina said.
For now, America's weight problem — a third of the population is obese — may be causing diabetes and heart problems. But soon, and perhaps already, this extra weight will cause pain.
Weight alone is not to blame, but a combination of weak muscle and extra pressure can up the forces bearing down on ligaments, cartilage and bone.
"The stronger you are, the more weight you can carry safely," Paulos said. For example, a professional football lineman can survive a lot more athletic activity than could a 300-pound couch potato.
"The muscles act like springs, so if you're jumping and running around and have very weak springs, all of the forces will go to your bones," Paulos said.
Without the cushion of strong muscles, some of the most essential joints in the hips, the back and the knees will suffer, sometimes permanently.
"If you think of someone who is heavy or overweight, while their bones become denser, there's more pressure on the cartilage," Laudicina said. Over time, the cartilage wears away, slowly causing arthritis and pain.
And the more you gain, the more pain.
"If a person is 10 pounds overweight and goes up the stairs, they will see 80 pounds extra weight on the knee," Paulos said. "So you can imagine the forces a knee will see if they're at 250 pounds, overweight and weak."
For big-bellied men and women, body pain trouble might come from many sides. Extra weight anywhere on the body will put extra pressure on joints and bones, causing pain in the knees and hips.
However, a concentrated bump on the abdomen will also painfully throw off a person's alignment.
When a person stands with good posture, the abdomen muscles should pull up while the buttocks muscles should pull down, according to health information from Indiana University-Purdue University, Indianapolis.
With this proper alignment, a person's back will have three natural curves. But with a big belly out front, the muscles in the back take on extra stress to hold the person upright. The result is bad lower back pain.
"It pulls your back in the wrong direction," Paulos said. "If your lower back is weak, then you'll have more arthritis in your spine."
Besides the obvious goal to lose the belly weight, Laudicina advised all people to pay attention to their posture and alignment.
"That has a definite impact over time," Laudicina said. Sitting up straight — Forest Gump-style with both feet planted on the floor — and simply standing up straight will save many people from unwanted aches and pains.
Women who happen to be pregnant have a tough and painful time of it.
First, the more the fetus grows, the more it pulls on the mother's back. A recent scientific paper showed that women's spines have evolved to curve during pregnancy to help balance. But pregnant women still feel lower back pain from the extra muscle strength it takes to keep themselves upright.
The change in body mass distribution also puts women at risk for hip, ankle and calf pain.
Then, enter the hormones. In order to push the baby out, it helps if the joints in the pelvis can flex and move a bit, Paulos said. To accommodate this need, the body releases joint-relaxing hormones.
"But they don't discriminate," Paulos said. "When you're pregnant, all your ligaments in your joints relax."
As a result, pregnant women's kneecaps can start to wobble and hurt. So may their spines. The best thing to do, Paulos said, is to be fit before pregnancy and stay fit during pregnancy.
"As far as the orthopaedic aspects of being heavy, carrying extra strength to carry the extra weight will reduce pain," Paulos said.
Overweight as a Child
Children have an easier time losing weight than adults, but their years with extra pounds may cause a long-lasting burden of pain.
About 19 percent of children age 6-11 are overweight, according to the National Center for Health Statistics. For these growing kids, growing pains can get worse.
Children's bones grow at specific areas of very thick lining called growth centers, which sometimes cause pains for kids.
"As the bones grow, they do cause a little inflammation and pain," Paulos said. "But if you are heavy as a kid, it separates the growth center from the rest of the bone and it can cause pain and inflammation.
"Bad alignment and heavy weight can affect the growth centers of growing children," he said, adding that disease and rickets can have the same effect.
The problem of overweight children is growing, along with adult obesity in America. Sixteen percent of children and teenagers are overweight — triple what the proportion was in 1980.
In January, the surgeon general put out a call to fight childhood obesity and overweight problems. In addition to bone pain, overweight children face a higher life risk for type 2 diabetes, heart disease and a 70 percent chance of becoming overweight or obese as adults.
People may first associate the bow-legged body with the side-to-side swagger of a cowboy, but real bow legs, sometimes called genu varum in medicine, arise from less glamorous sources.
When bow-legged people stand with their feet together, their legs tend to bend outward from each other, leaving a round space between the knees, or below the knees. Sometimes only one leg bends while the other remains straight, giving a true bow appearance.
Infants often look bow-legged before the age of two, but the shape naturally corrects itself as the child grows and begins to walk. However, several factors, like genetics, Blunts' disease (a bone growth disorder) or rickets (caused by vitamin deficiencies) may contribute to the permanent bone curvatures that give the distinctive "bow" shape.
Though not particularly painful if temporary in children, over time, bow-legged adults may face knee pain from the change in their legs' alignment.
"All your weight goes through the center of gravity, down through the center of your pelvis," Paulos said.
But when a person is bow-legged, the majority of the weight can't bear down on the center of the knee, its strongest part. Instead, the force is greater on the inside of the knee.
Think shrinking in height is only a phenomenon in nursing homes? Wrong.
Starting at age 40, people typically start losing half an inch of height every decade, according to the Harvard Health Letter.
Shrinking doesn't often cause health problems, unless it gets severe. Weak bones from osteoporosis can cause vertebrae to flatten out over time, Laudicina said. The result can be debilitating back pain.
Even without osteoporosis, severe kyphosis (the medical term for being hunched over) can cause neck and back pain. Kyphosis can even cause breathing problems.
But don't feel doomed to shrink. Stand up straight, literally.
Over time, strengthening the muscles in your back can keep you from hunching and may also improve your alignment, preventing further pain. "The forces exchange from one joint to the other," Laudicina said. "There can be weak links in those chains."
Eating enough vitamin D and calcium can keep bones strong, preventing the tiny fractures that contribute to height loss. However, according to the Harvard Health Letter, the best way to keep your bones strong is to stay active.
In World War II, young recruits were turned away for being flat-footed because the U.S. military believed they would be in too much pain to march for long distances.
This old idea has largely been overturned by medicine, but it does point to the pain the flat-footed among us can occasionally feel.
When a person with normal feet walks, his or her heel hits first and the foot rolls toward the toes, flattening the arch slightly. Then, the arch springs back as the person pushes off the ball of the foot, according to the American Orthopaedic Foot & Ankle Society.
Walking with flat feet will cause over-pronation, meaning the foot rolls too much to the inside, frequently causing pain to the inside of the knee.
"Tendons around your ankles also tend to wear out when you're really flat-footed," Laudicina said.
Flat feet are usually inherited and are caused by lax tendons and ligaments in the foot.
An easy way to determine flat feet is the wet test. Step in an inch of standing water or even paint and then step on cardboard.
A person with a high arch will have little to no mark between the heel and the ball of the foot. A person with a normal foot will have some flesh between the heel and the ball of the foot, while a person with a flat foot will have full pad marks from the heel to the toes.
Often, a trip to an orthopaedist for shoe inserts can greatly help pain from flat feet.