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5StepsTowardsManagingAchesandPains©2010,Dr.AnjaliAroraarora_doc@hotmail.comISBN9788120749191E-ISBN9788120790391

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Contents1.ArthritisandTheJoints2.OsteoporosisandOsteopenia3.SportsInjuries4.PhysiotherapyandAcupuncture5.DifferentSensationsofPainMythsandFactFile

FindOuttheLevelofYourAwarenessAboutAchesandPains1.Paininkneescanbepartiallyrelievedbya.Puttingonweightb.Losingweightc.Justsittingthewholeday

2.Sleepingonafoammattressforlongdurationa.Isgoodforthebackb.Isbadforthebackc.Doesnotmakeadifference

3.Muscleachesandpainscanbeduetotheintakeofmedicationlikea.Analgesicsb.Statinsc.Zyloric

4.Legcrampsnormallyoccurduetoa.Headacheb.Electrolyteimbalancec.AninjuryTheabovequestionnairewillhelpyoufindoutastohowawareyouareaboutyourachesandpains.Ifyouanswermoreof(b)thenyouknowhowtohelpyourself.

1ArthritisandTheJoints

Thebody’s206bonesareconnectedthroughdifferenttypesofjoints.Thesedifferentkindsofjointsperformvariousfunctions.Someofthesejointsare:

Theballandsocketjoints(hipsandshoulders)Hingejoints(e.g.helpconnectingknees)Pivotjoints(wrist)Saddlejoints(connectingthethumbtothehand)VertebraljointsThejointsaretiedtogetherbyligamentsandcoveredwithcartilage.Thecartilageissmooth,but

made up of tough, elasticmaterial. It acts as a shock absorber and allows the bone ends to glidesmoothlyacrosseachother.Ajointcavityexistsbetweenthebones.Thisgivesthebonetheroomtomove.Thejointspacebetweenthebonesisenclosedbyacapsule.Theinnerliningofthiscapsule,isthesynovium,whichproducesathickfluidthathelpslubricateandnourishthejoints.

ArthritisPrimaryFormsofArthritis

OsteoarthritisRheumatoidarthritisGoutandpseudogoutSepticarthritisJuvenileidiopathicarthritisAnkylosingspondylitisStill’sdisease

SecondaryFormsofArthritisPsoriaticarthritisLupuserythematosusReactivearthritis

Somediseaseswhichpresentthemselveslikearthritisare:-OsteoporosisMultiplemyelomaHypertrophicosteoarthropathy

OsteoarthritisOsteoarthritis is basically an ailment of the joints. Osteoarthritis is not a primary inflammatorydisorder,butisduetothegradualwearandtearoftheaffectedarea.Pathologically,osteoarthritisisdefinedaslossofarticularcartilageanddamageofthebone.

Osteoarthritis(OA)canbePrimaryorSecondary

Primary OA – The cause of osteoarthritis is primarily related to ageing. Primary osteoarthritisoccurswithoutanyidentifiablecause.SecondaryOA–Itisnormallyduetothepresenceofanunderlyingconditionordiseaselike

InjurytojointfromanaccidentInflammatorydisorder,e.g.septicarthritisDeficiencydisorderasbowlegMetaboliccondition,e.g.acromegaly

SymptomsofOsteoarthritisOsteoarthritis symptoms start appearing in middle age. Around 65 years of age most people getaffectedbyit.Itismorecommoninwomenaround55yearsofage.OAwhichpresentsitselfwithpainandstiffnessinthejointsisduetothepresenceofalowgradeinflammation.Thewearandtearofthecartilage(whichnormallyactsascushion)insidethejointresultsinthisdisease.Thedecreaseofsynovialfluidlubricatingthejointalsogetsaffected.Weightbearinglikestandingandwalkingcausespaininthejoints.Lessprotectionofthebonesbythecartilage,resultsinthismalady.Painreducesmovementofthejointresultinginatrophyofmusclesaroundthejoint.Theligamentsintheaffectedareaalsobecomelesselastic.Newpiecesofbonescangrowaroundthemarginsofthejoints(spursorosteophytes).Thesebonychangesalongwiththeinflammationcanleadtoapainfulanddebilitatingosteoarthriticcondition.Diagnosisofosteoarthritis is normally throughX-rays andMRI.The incidenceofosteoarthritis

increaseswithage.

TreatmentofOsteoarthritisRubefacients, emollients or topical analgesics are used in sprains, strains, lower back pain, andrheumaticpain.Theingredientsincludesalicylates,nicotinates,histamine,etc.Theirapplicationoftencausesalocalsensationofwarmth.Mentholandcamphorintherubefacientproducescoolness.

MedicationNSAIDS(non-steroidalanti-inflammatorydrugs)LocalinjectionsofglucocorticoidsOmega3fattyacidsAntioxidants(VitaminCandE)Otherspecificmedicationasrequired.

SupportiveTreatmentWeightlossAwalkercanbehelpfulRegularexercise(walking,swimming)Moistheathelpseasingpainandswellingandcanimprovecirculation.

OtherFormsofTreatmentInclude:AcupunctureLowlevellasertherapyRadiosynovirothesis(aradioactiveisotopeisintroducedintothejointtosoftenthetissue).

Lastbutnottheleastissurgery.Fragmentremoval,repositioningbonesetccanbeconsidered.Ifmedicalmanagementfails,thenjointreplacementsurgerymayberequired.

JointReplacementThe success storyofmodernorthopaedic surgeryhasbeenwith joint replacements. It is the art ofreplacing painful, arthritic, worn partswith artificial surfaces. These are shaped such so that theyallowjointmovement.

Pre-OperativePlanningTheanesthetistsdoacompletepre-anestheticworkup.Asthesurgeryrequiredismostlyinelderlypatients, ECG, X-rays, urine tests, MRI, hematology and biochemistry blood tests are conducted.Crossmatchingofbloodandrequirementofbloodisalsoplacedwiththebloodbank.AccurateX-raysoftheaffectedjointsaretakenandimplantdesignisselectedandthesizeismatchedtotheX-rayimages(i.e.templating).

Post-OperativeRehabilitationThisinvolvesearlymobilizationofthepatienttoreducethechancesofcomplications,e.g.venousthromboembolismandpneumoniaPhysiotherapyhelpsthepatientsrecoverthejointfunctionafterjointreplacementsurgeryAplannedexerciseprogramisstartedforthepatientTheambulationandmotionofthejointsisnottobestrenuous.Strengtheningexercisesarerecommendedafteraperiodoftime.Artificialjointsutilizejunctionslikemetal/bone,cement/bone,etc.Ceramicmaterialsarenow

beingofferedasnewoptionsforjointreplacementsurgery.

SepticArthritisSepticarthritis is alsoknownas infectiousarthritisorpyogenicarthritis.Septicarthritis canaffectanyagegroup.Itoccurswhensometypeofinfectingorganism,mostoftenbacteria,infectsajoint.Itisaseriousinfectionofthejointscharacterizedbypain,fever,chills,inflammationandswellinginoneormorejoints.Septicarthritiscanoftenresultinthelossoffunctionoftheaffectedjoint.Itmayresult inamedicalemergencybecauseitdamagestheboneaswellascartilage.Itcanalsocreateacondition for septic shock. Patients receiving corticosteroid injections into the joints for

osteoarthritismustbecarefulofcontractingthisdisease.

InfectiousArthritisInfectious arthritis results in pain and swelling of the joints (inflammation) and can affect one ormorejoints.Thisinflammationcanbeduetobacterium,avirusorafungus.Bothmenandwomencangetinfectedbyit.Itcanaffectpeopleofanyage.

Individualsmorepronetosufferfrominfectiousarthritisarethosesufferingfrom:DiabetesSeverekidneydiseaseAIDSAnyformofimmunedeficiencyAnyformofcancerAlcoholism

SymptomsWhenthisdiseaseiscausedbyabacterium,thepainandswellingpresentisonlyinonespotandcanbesudden.Itmaybeaccompaniedbyfeverandchills.Wheninfectiousarthritisisduetoviralinfection,theremaybegeneralizedbodypain.Whenthecauseisfungal,thepainandswellingdevelopoveraperiodoftime.Mildfevermaybepresent.

RheumatoidArthritis(RA)RAisanautoimmunedisease.Rheumatoidarthritis(RA)causesredness,pain,swellingorahot(orwarm)feelingintheliningofajoint(i.einflammation).Theinflammationcanaffectotherinternalorgans,e.g.eyes,lungs,orheart.ThemostcommonareasaffectedinthebodybyRAarehandsorfeet.IncidenceofRheumatoidArthritis-Rheumatoidarthritisaffectswomenthreetimesmoreoftenthanmen.MostpeopledevelopRAbetween25and50yearsofage.

SymptomsofRheumatoidArthritisMorningstiffnessinjoints.Paininthreeormorejointsatthesametime.Stiffnessandswellinginfingersandwrists.Paininthesamejointsonbothsidesofthebody.RAcanstartgraduallyorwithasudden,severeattack(flu-likesymptoms).Thediseasecanbemildshowingsomeperiodsofactivityandjointinflammation.

DiagnosisofRheumatoidarthritisisbyRheumatoidfactordeterminationassay.Rheumatoidarthritisspecificautoantibodies(AntiCCP)RAismorecommon in the familiesofpeoplewhohave thisdisease. IfyouaredevelopingRA,

thenconsultyourdoctororarheumatologist.

FootandHandWearAvoidwearingtightpointedanduncomfortablefootwear(shoes,sandalsorchappals).Theycausethefeettoswellandmayleadtobonyarthritis.Tightsocksandstockingswhichcausetoecompressionshouldalsobeavoided.

Ifoutduringcoldweatherwearlongwarmgloveswhichprotectyourwristsfromthecold.Keepyourfeetandtoeswarmwithcomfortablesocks(orwearadoublelayerofsocks).

MedicationandDietMedication given for rheumatoid arthritis tends to ‘upset the stomach’. Long termmedication cancausegastritis leading to development of gastric ulcer. Spicy and fried food shouldbe avoided.Anutritious balanceddiet is recommended (fresh fruits, green vegetables, chicken, leanmeats, soya,etc).Ifanindividualisoverweightthenfoodsrichinstarchshouldbeavoided.

MedicineNormallyPrescribedforRheumatoidArthritisAnalgesicsDiseasemodifyinganti-rheumaticdrugs(DMARD’s) Leflulnomide is a newer class ofDMARD for the treatment of rheumatoid arthritis. It helps inreducingtenderofswollenjoints.Itshouldbetakenonlyontheadviceofyourdoctorasregularbloodcountsandotherbloodtests(hepatotoxicity,etc)mustbeassayedforsideeffects.Intra-articularcorticosteroidinjections(tohelpcontrolexacerbation)

ManagementofRheumatoidArthritisRestRest is important in rheumatoid arthritis, but correct positionwhile resting ismore essential. It isessentialtorestmostofthetimewithyourlegsstraight,otherwise,inafewdaysyouwillfindyourlegsbecomingstiffandfixedinthatposition.Theindividualwillhavetothenhobblearound.Restingafterawhile,shouldbeaccompaniedbyrepeatedde-freezingexercises.All thejointsby

turn,shouldbeputthrougharangeofmovementeveryday.

ExercisesFeetandAnkleLiedownwithyourlegsoutstretched.Bendyourtoestightlythenrelaxthem.Performthisexercise7times.Fortheankleslieorsitwithyourkneesinapositionandmoveyourtoesandankleclockwiseandanticlockwise.

KneeYoucanlieonyourbackandperformcyclingmovements.Youcanperform“vajarasan”foraminutesittingwithyourlegsunderthethighs.

HipsHelp rotate the hip joint. Lie on your back, bend both your legs. Then separate both your kneeskeepingtheheelstogether.Putyourkneesbacktogetherandthenstraightenyourlegs.Thisexercisebesideshelpingrotatethejointsametime,preventsthecapsulearoundittocontract.

SpineStandupstraightandbendforwardtotouchyourtoes.Straightenupslowly.Putyourhandsonyourhips and rotate your spine,withoutmovingyour feet.Rotate first to right and then to left.Do it anumberoftimes.

ShoulderandNeckAfteradayofworkingonthecomputerordesk,shouldersbecomestiffandpainful.Forthisshruggingyourshouldersuphighisagoodexercise.Dothis7times. Alsoclaspyourhandstogetherfirst infrontofyourhead.Pullyourshouldersbackandrelease.Thenclaspyourhandsbehindyourheadandpullyourshouldersbackandrelease.Dothisexercise

7timeseach.

HandsandFingersOpenyourhandsandfingersseveraltimesandclose.Rotateeachwristclockwiseandanticlockwiseseveraltimesaday.Foryourelbowssitcomfortablyandstretchyourarmasfarasyoucan.

AnkylosingSpondylitis(AS)Ankylosingspondylitisisarthritisinvolvingthespineandthesacroiliacjoints.Mendevelopitmorethanwomen.Often,inwomenittakesmoretimetodiagnosethedisease.ASappearsbetweentheagesof15yearsand40years.Itcanstartaroundtheknees,hipsand,heels.Theexactcauseofthisdiseaseisunknown.Itcanbepresentincertainfamilies.Itcausespainandstiffnessinthebackresultinginabent posture. This is as a result of inflammation in the spinal joints. In severe inflammation thevertebraecanfusetogetherleadingtolimitedimmobility.

SymptomsChronicbackpainwhichlastsformanymonthsoryears.Backpainthatoccursduringthenight.Stiffnessinthebackinthemorningorafterperiodsofrest.Recurringinflammationintheeyescausingpain,redness,blurredvision,andsensitivitytobrightlight.

TreatmentThedoctormayaskforX-raysorbloodtestslikeESR(ErythrocyteSedimentationRate)tobedone.Youmaybeaskedtoconsultarheumatologistwhowillprescribemedicationstorelievepain.

MedicationNon-steroidalanti-inflammatorydrugs(NSAIDs) Disease-modifying anti-rheumatic drugs (DMARDs) – Patients with severe AS, the drug calledsulfasalazinecanhelpmanage thesymptoms.ThemostcommonDMARDs likemethotrexateandsulfasalazineareoftengivenalongwithothermedication.Corticosteroids-Forseverepainandinflammation,cortisoneisinjecteddirectlyintotheaffectedjoint. Biologics are newer drugs that are becoming available for AS patients that fail to respond toconventional treatment. Biologics are DMARDs which are made up of genetically modifiedproteins.Theyworkbyblockingspecificpartsoftheimmunesystem,calledcytokines,whichplayaroleincausingankylosingspondylitis.

ManagementofAnkylosingSpondylitisExerciseExerciseplaysaveryimportantroleinmanagingankylosingspondylitis.Ithelpsthejointsmoveandreducespain.Strengtheningexercisescanbelearntfromaphysiotherapist.Activitieslikeswimming,and walking can help to keep a good posture. Exercise is also important for maintaining chestexpansion.

HeatHeatcanhelprelaxachingmuscles.

SurgeryInsevereoradvancecases,ankylosingspondylitismayrequiresurgeryforbadlydamagedjoints.SomeotherwaysforkeepingAnkylosisSpondylitisundercontrolare-

Protectyourjointsbyavoidingexcessivemechanicalstressfromdailytasks.Pacing,byalternatingheavyorrepeatedtaskswitheasiertasksorbreaksAvoidkeepingthejointsinthesamepositionforalongtime.Useacaneorraisedchairtohelpmakedailytaskseasierandavoidfalls.Useafirmsupportivesurfacetomaintaingoodspinalalignment.

SpondylitisSpondylitisisagroupofchronicdiseases.Thesediseasesprimarilyaffectthespine,althoughotherjointsandorgansoftengetinvolved.

Thediseasesunderspondylitisinclude:Psoriaticarthritis:Itappearsinabout5-10%patientssufferingfrompsoriasis.Psoriasisprecedesthearthriticdisease.Reactivearthritis:ItisalsoknownasReiter ’sSyndrome.Itcausesinflammationandpaininjoints,skin,eyes,bladder,genitalsandmucusmembranes.Thisisprobablyareactiontotheinfectionwhich

primarilystartedinsomepartsofthebody.Juvenile spondyloarthropathy –It is the medical term defining a group of childhood rheumaticdiseases.Thesediseasescouldcontinuethroughadultlifealso.Ankylosingspondylitis (AS)–It isaformofchronicautoimmunearthritis.Itprimarilyaffects thespineandsacroiliacjoints.Otherjointsoftenbecomeinvolved.Enteropathic arthritis – It is a form of chronic, inflammatory arthritis. It is associated with thepresenceofaninflammatoryboweldisease(IBD)e.g.ulcerativecolitisandCrohn’sdisease.Pott’s disease – It is a form of spondylitis and develops due to the presence of extrapulmonarytuberculosis.

SomeOtherPainfulAilmentsCervicalSpondylosisCervical spondylosis is a common disorder of the cervical spine. Degenerative changes in thevertebraeandbetweenthe intervertebraldiscs leadtorheumatoiddisease(duetoageingor injury).Compressionof the spinal cordoccursdue to spondyloticmyelopathywhichcanbepresent in theadvancedstagesofthisdisease.

Symptoms(e.g.pain)areduetoOsteophytespresentonthesidesofthevertebraeDegenerationoftheintervertebraldiscsChangesinthespinalcordandnervesduetoinsufficientbloodsupply

Management Anti-inflammatorymedication,e.g.ibuprofen,piroxicam,aspirinareadvisedtohelprelievepainandswelling.Cervicalimmobilizationisdonewiththehelpofacollar,etc.Studiesshowthat18%ofpatientswithCSMimproveontheirown,andstabilizeout.Itisonly40%thatdeterioratewithouttreatment.Ifuncontrollablepaincontinuesorbecomesworse,surgicalinterventionisrecommended.

FrozenShoulderFrozenshoulder(adhesivecapsulitis)isaconditionwhichpresentswithpainandlossofmotionorstiffnessintheshoulder.Frozenshoulderoftenaffectsindividualpatientsbetween40and60yearsofage.Frozen shoulder ismuchmorecommon in individualswithdiabetes. Increased riskof frozenshoulderalsooccursinindividualssufferingfromdiseaseslikehypothyroidism,hyperthyroidismorParkinson’sdisease.

Symptoms

Frozenshoulderpainisdulloraching.Itworsenswithmovement.Thepainisusuallylocatedovertheoutershoulderareaandsometimesintheupperarm.Frozen shoulder first starts with a slow onset of pain. As pain worsens the movement of the

shoulderbecomesdifficult.Inthenextor‘frozen’stagethereisaslowimprovementinpain,butthestiffnessremains.Inthelaststage(thawingstage)offrozenshoulder,motionslowlyreturnstowardsnormal.X-rays and MRI studies can be performed. Frozen shoulder mostly gets better on its own. It

sometimestakesalongertime,recoveryoccuresovertwotothreeyears.Paincanbecontrolledwithantiinflammatorymedication.Medicaltreatmentisdonethroughoralmedicationorbycorticosteroidinjections.Applyingheatorcoldcompressioncanalsohelpinpainrelief.

ManagementPhysiotherapyIt includes “stretching or range-of-motion” exercises for the shoulder. If pain is not relievedwithtime, nerve blocks are sometimes used to subside the pain. More aggressive physical therapy isrecommended.

SurgicalTreatmentSurgicalinterventionisconsideredifthereisnoimprovementinpainorshouldermotionislimited(after an appropriate course of physical therapy and antiinflammatory medications). In surgicalintervention stretching or releasing the contracted joint capsule of the shoulder is done. Shoulderarthroscopy is also an alternative for non-improvement of the disease even aftermedication. Thesurgeon makes several small incisions around the shoulder. A small camera and instruments areinsertedthroughtheincisions.Tightportionsofthejointcapsulearecutwiththehelpoftheinsertedinstrumentandpressureisrelieved.Manipulationcanalsobedone.Aftersurgery,physicaltherapyisneededtomaintainthemotionoftheshoulder,whichwasachievedwithsurgery.Recoverytimecantakesixweekstothreemonthsapproximately.

ChronicBackPainWhenanindividualexperiencespaininanyareaofthebackforalongperiodoftime,henotonlysuffersthephysicalaspectbutalsolosesconfidence.Itthispainremainsforalongperiodoftimeitiscalledchronicbackpain.Themostcommonareaofchronicbackinjuryandpainisthelowerbackorthelumbarspine.

CommonCausesofChronicBackPain

Poorposture-slouching,combinedwithweakabdominalmusclesleadstoaswayback,resultingincurvingofthespine.Thisexaggeratedcurvemakesthebackligamentstostretch.Overaperiodoftimethediscsbetweenthevertebraebecomethinanddistorted.Frequentcauseofbackpainisinjuryduetoliftingheavyobjects.Thiscanresultinstraininganddischerniation. 80%ofbackpain isattributed to lackofexerciseandpoorphysical fitness.While liftingheavyobjects,strongmuscles,especiallytheabdominalmusclesareknowntosupportthebackandhelpdistribute weight. Back and abdominalmuscles that have lost their flexibility and strength causemorestressontheattachedligaments.Certainsportsandactivitiescanalsobeassociatedwithinjuryandbackpain. Diseases suchasosteoarthritis, ankylosing spondylitis, compression fracturesetc.,may result inchronicbackpain.

TreatmentforChronicBackPainAfterhavingperformedaphysicalexaminationthedoctormayrecommendX-rays,MRIorotherteststomakethediagnosis.Forreliefanti-inflammatoryanalgesicdrugsmayberecommended.

TheImportanceofExerciseinChronicBackPain Exercise helps reduce pain and prevents further joint damage. It also helps maintain a healthyweight.Therearedifferenttypesofexercises:i)Strengtheningexercises:Thesemaintainorincreasemusclestrength.ii)Motionexercises:Thesehelptoreducestiffnessandkeepthejointsmoving.

Heat/ColdCompresses

Applyingheatcom-pressionhelpsrelaxachingmuscles.Itreducesjointpainandsoreness.Ahotshowerisalsorecommendedfortheache.Swellingandpaininajointisrelievedbyapplyingacoldpack(iceinatowel).

PreventionBekindtoyourbody.Afterdoingheavywork,slowdownbydoinganeasytask,ortakerest.Whenyouliftaheavyitemkeepitasclosetoyourbodyaspossible.Maintainahealthyweightandavoidputtingextrastressonyourjoints.Beawareofyourposturetostandandsitstraight.Wearpropershoesforwalking.Sleeponafirmmattress.Donotsleeponyourstomachasitcanstrainyourneck.

RelaxationAlsotryandrelaxthemusclesaroundyourjoint.PhysiotherapywithUltrasoundcanhelp.Trydeepbreathingexercises.

Listentomusicorrelaxationtapes.Meditateorpray.Visualizeapleasantactivitylikesittingonthebeaches.

SurgeryIfnomedicaltreatmentprovidesrelief,yourdoctororrheumatologistmayrecommendsurgerye.g.foraherniateddisc.

GoutHippocratesdescribeditssymptoms2500yearsago.Ithasbeenreferredtoasa“diseaseofKings”.Goutispredominantlyadiseaseofadultmenwhohaveahigherstandardofliving.Itmaybegenetictoo.Goutoccursmostlyinmenbetween40-50yearsofage.Thepredispositionofthisdiseaseislessinwomenascomparedtomen.Goutisanacutelypainfuldisease.Thepainisaresultofthebuildupofuricacidcrystalsinthe

joints.Itmostoftenaffectsthebigtoebutalsocanaffectknees,feet,ankles,elbows,wristsandhands.GoutcanbeduetothedeficiencyofHypoxanthine-GuaninePhosphoribosylTransferase(HGPRT).

Thefeedbacktoinhibituricacidproductionislesssothatmoreofuricacidisproduced(Uricacidisanaturalwasteproductofthebody,whichisexcretedbythekidneys).Goutisacaseofexcessiveuricacidproductionornotenoughexcretion.Theuricacidformedintocrystalsdepositsintothejoints(urate)causingswelling,painandtendernessintheaffectedarea.Other causes of excessive uric acid production can be due to certainmedication like low dose

aspirinandthiazidediuretics.Theseinterferewithuricacidexcretionbythekidneys.Hyperuricemia(orexcessiveuricacidproduction)canbeduetosecondarycausesaswell.

RememberFreshfruitsandvegetableshelptoreduceuricacidlevels.

Medicationlikeallopurinol,corticosteroids,orcolchicinecanberecommendedbythedoctorfortreatinggout.Strengtheningexercisesmustbedonetoincreasethemusclestrengthoftheaffectedjoints. Avoid high uric acid and non-vegetarian foods, e.g. kidney, liver, brain, gravies, and alcoholicdrinkslikeredwine,port,heavybeersandChampagne.

MyalgiaMyalgiameans‘musclepain’.Itisthecauseofmanydiseases.Themostcommoncausesofmyalgiaareoveruse,injuryorstressofmuscles.Myalgiacanalsobecausedduetocertainmedication,asaresponsetovaccinationandwithdrawalsyndromes(e.g.alcoholorbarbituratewithdrawal).Formusclepainfromoveruseorinjury,takeacetaminophenoribuprofen.Applyiceforthefirst

24to72hoursofaninjurytoreducepainandinflammation.Later,heatapplicationontheaffectedsiteoften feelsmoresoothing.Muscleaches fromoveruseandfibromyalgiaoften respondwell tomassage.Regularexercisecanhelprestorepropermuscletone.High-impactaerobicactivitiesshouldbe avoidedwhen injured orwhile in pain. Plenty of sleep and reducing your stress help. If homeremediesdon’twork, visit yourdoctor.Hemay considermedication, physical therapy referral, orreferral toaspecialisedpainclinic.Ifyourmuscleachesareduetoaspecificdisease,followyourdoctor ’sadviceandtreattheprimaryillness.

Consultadoctorif:

Yourmusclepainpersistsbeyond2daysYouhavesevere,unexplainedpainYouhaveanysignlikeswellingorrednessaroundthetendermuscleYouhavepoorcirculationintheareawhereyouhavemuscleaches(forexample,inyourlegs).Yourmusclepainhasbeenassociatedwithstartingorchangingdosesofamedicine,suchasastatin.

2OsteoporosisandOsteopenia

Osteoporosis is more common in women but can also develop in elderly men. It occurs due tohormonaldisorders,chronicdiseasesandasasideeffectofmedication(likeglucocorticoids).

FracturesduetoOsteoporosisVertebral collapse or (‘compression fracture’) is observedwith sudden back pain in osteoporosis.Multiple vertebral fractures often lead to a stooped posture, loss of height, and chronic pain.Fractures of the long bones can impair mobility and may require surgery. Hip fracture requirespromptsurgery,ascomplicationssuchasdeepveinthrombosisandpulmonaryembolismcanoccur.

RiskofFallAnincreasedrisk,toapersoninthegeriatricagegroup.Theindividual’sfallcanleadtofracturesofthewrist, spineorhip.Causesof fallingaremany,e.g. irregularheartbeat,vasovagalsyncope,etc.Removalofobstacleslikeloosecarpets,slipperytilesorgraniteinthebathroommaysubstantiallyreduceslippingandfalling.

DiagnosisThediagnosisofosteoporosisismadebymeasuringthebonemineraldensity(BMD).X-rayabsorptiometry(DXAorDEXA)istheusualmethod.AlsobloodtestsandX-raysifrequiredmaybeconductedonthepatient.

RisksLeadingtoOsteoporosisNon-modifiableRisksEstrogendeficiencyinwomenfollowingmenopause.FamilyhistoryofosteoporosisThereareatleast30knowngenesassociatedwiththedevelopmentofosteoporosis.

ModifiableRisksVitaminDdeficiency:MildvitaminDinsufficiencyisseentoincreasewithParathyroidHormone(PTH)production.PTHincreasesbonereabsorption,leadingtoboneloss.

Calcium–lowlevelsofcalciumanddecreasedproteinintakeisassociatedwithlowerpeakbonemassduringadolescence.Lowerbonemineraldensitywasobservedinelderlyindividuals.Excessalcohol–heavydrinking(intakegreaterthan2units/day)increasestheriskfordevelopingosteoporosis.

Tobaccosmoking- tobaccosmoking inhibits theactivityofosteoblasts. It isan independentriskfactorfordevelopingosteoporosis.

Weightbearingexercisehelpsincreasepeakbonemass.Physicalinactivityleadstosignificantboneloss.Excessphysicalactivityontheotherhandleadstoconstantdamagesofvariouspartsofthebody(e.g. ligaments, joints, etc). In women, heavy exercise can lead to decreased estrogen levels,predisposingthemtoosteoporosis. Heavy metals, eg. cadmium often leads to loss of bone mineral density leading to pain andincreasedriskoffractures.

SecondaryOsteoporosisCausesHypogonadalstates,e.gTurnersyndrome Abilateraloophorectomy (surgical removalof theovaries)ordeficient estrogenproduction. Inmales,testosteronedeficiencyisthecause.

Common endocrine disorders causing bone loss can be due to hyperparathyroidism,thyrotoxicosis,hypothyroidism,diabetesmellitustype1and2,adrenalinsufficiency,etc. Malnutrition, parenteral nutrition and malabsorption can lead to osteoporosis. Certaingastrointestinaldisorders(e.g.coeliacdisease)predisposeanindividualtoosteoporosis,. Rheumatologic disorders like rheumatoid arthritis, ankylosing spondylitis, etc can lead toosteoporosis.Hematologicdisorders,e.g.multiplemyelomaarealsolinkedtoosteoporosis.

MedicationMedicationwhichcanbeassociatedwithanincreaseinosteoporosisare:

Anticoagulantsandwarfarin.Long-termuseofheparinisalsoassociatedwithadecreaseinbonedensity. Protonpump inhibitors inhibit theproductionof stomachacid.Theyalso interferewithcalciumabsorption(e.g.rabeprazole,omeprazole).

Thiazolidinedione (used for diabetes) e.g. rosiglitazone has been linked to an increased risk ofosteoporosisandfracture.

RoleofCalciumandMagnesiuminPreventingBoneLossMagnesiumisamineralwhichhelpsinmaintaininghealthybones.Itcontributestoincreasedbonedensityandhelpspreventtheonsetofosteoporosis.Magnesiumhelpsthebodyabsorbcalcium. Osteoclasts and osteoblasts are stimulated by hormones like parathyroid hormone (PTH) andcalcitonin.PTHmakestheosteoclastsdepletecalciumfromthebones, Lack of magnesium causes imbalance between PTH and calcitonin resulting in bone loss.Magnesiumsupplementationhelpscorrectthisprocess.Largeamountsofprocessedfooddepletemagnesiumfromthediet.A2:1calcium-to-magnesiumratioisrequiredforanindividual.Lackofcalciumandmagnesiummaycauselegcrampsduringthenight.Alsoformaximumabsorptionofmagnesium,calciumsupplementsshouldbetaken.

OsteopeniaOsteopeniaisbonemineraldensity(BMD)whichislowerthannormalpeakBMD.

Asoneadvanceswithage,bonesstartlosingminerals,heaviness(mass),andstructure.Thismakesthebonesweakerandincreasestheirriskofbreaking.Individualsbeginlosingbonemassafterabout30yearsofage.Some people having osteopenia may not have bone loss. They just have a natural lower bone

density.WomenaremorelikelytodeveloposteopeniaduetoalowerpeakBMD.Thelossofbonemassincreaseswithhormonalchanges,especiallyduringperimenopausalormenopausalstage.

Causes

EatingdisordersormetabolicproblemsChemotherapy,ormedications(e.g.steroids)ExposuretoradiationFamilyhistoryofosteoporosisTakingaerateddrinksoralcoholexcessivelyincreasestheriskofosteopenia.

TreatmentofOsteoporosisandOsteopeniaLifestylechangesCalciumsupplementscombinedwithvitaminDshouldbetaken.VitaminDhelpsthebodyabsorbcalciumandotherminerals.VitaminD ispresent in,eggs, salmon,sardines, swordfishandsomefishoils.Calciumispresentinmilkandmilkproducts. Exercise is important in maintaining strong bones. Weight-bearing exercises such as walking,hiking,anddancingareallgoodchoices.Addingexercisewith lightweightsorelasticbandscanhelpbonesintheupperpartofthebody.

OsteomalaciaOsteomalaciaresultsinsofteningofthebonesduetodefectivebonemineralization.Osteomalaciaisspecificallyadefect inmineralizationof theprotein frameworkknownasosteiod.Osteomalacia isderivedfromtheGreekword‘osteo’referringtoboneand‘malacia’meanssoftness.

SymptomsDiffusebodypainsMuscleweaknessFragilityofthebones

Causes DeficiencyinVitaminD(whichisobtainedfromthedietand/orsunlightexposure)especiallyindark-skinnedindividuals.FaultymetabolismofVitaminDorphosphorusRenaltubularacidosisMalnutritionduringpregnancyMalabsorptionsyndromeChronicrenalfailure

TreatmentAdministrationof200,000IUweeklyofvitaminDfor4to6weeks,followedbyamaintenancedoseof1600IUdailyor200,000IUevery4to6months.

LaboratoryValues

RicketsRicketsleadstofracturesanddeformityduetosofteningofbonesinchildren.ThepredominantcauseofricketsisdeficiencyofVitaminD.Lackofadequatecalciuminthedietmayalsoleadtorickets.

ChildrenathigherriskfordevelopingricketsincludeBreast-fedinfantswhosemothersarenotexposedtosunlight.Breast-fedinfantsnotexposedtoenoughsunlight.Childrenconsumingfortifiedmilkduetolactoseintolerance.

SymptomsofRicketsPaininthebonesortendernessDentalproblemsMuscleweaknessIncreasedtendencyoffracturesSkeletaldeformity,bowedlegs,knock-knees,cranial,spinal,andpelvicdeformitiesTetanyCraniotabes(softskull)Costochondralswelling(‘ricketyrosary’)

DiagnosisBloodtests:Serumcalciummayshowlowlevelsofcalciumandserumphosphorus.Serumalkalinephosphataselevelsmaybehigh.X-ray:X-rayofaffectedbonesmayshowalossofcalciumfrombonesorachangeintheshapeofstructureofthebones.

Treatmentandpreventionofrickets: Increaseddietary intakeofcalcium,phosphatesandvitaminD(ultraviolet light),alongwithcodliveroil,halibut-liveroil,andviosterol.Ultravioletinthesunlighteachdayandadequatesuppliesofcalciumandphosphorusinthedietcanprevent rickets. Darker-skinned babies should be exposed longer to the ultraviolet rays.Recommendationsarefor200internationalunits(IU)ofvitaminDadayforinfantsandchildren.

RoleofVitaminsVitaminD deficiency leads to rickets in children and osteomalacia in adults. VitaminD ismostlyobtainedfromtheactionofultra-violetlightontheskin.VitaminDishydrozylatedbythekidneytoitsactiveform.Ondiagnosisofeitherricketsorosteomalacia,adoseofintramuscularvitaminDisgivenfollowedbyregularoralsupplementation.

NaturalSourcesofVitaminD

Fishliveroils,suchascodliveroil,1tbs.(15ml)provides1,360IUFattyfishe.g.Salmon(cooked)–3.5ozprovides360IUHerring–85gm(3oz)provides1383IUSardines(cannedinoil),drained–1.75oz,250IUTuna(cannedinoil)–3oz,200IUMackerel(cooked)–3.5oz,345IUMushroomprovidedover2700IUperserving(approx½cup)ofvitaminD,ifexposedtojust5minutesofUVlightafterbeingharvested.Onewholeegg,20IU

Note:InthemajordietarysourcesofvitaminD,onlyfishisnaturallyrichinvitaminD.OthersourcesofvitaminDarefortifiedfoodslikebreakfastcereals,vitaminDsupplementsand

soyamilk.

RecommendedDietaryAllowance(RDA)VitaminD:RDA-200internationalunitsformostindividuals;400IUsforpeoplefrom51to70yearsofage.VitaminE:RDA-15milligrams.Upperlimit-600milligrams.HighlevelsofvitaminEcancausebleeding. Calcium: RDA formost adults - 1,000milligrams daily; for teenagers - 1,200milligrams; forindividualsabove theageof50-1,000milligrams.Therichestsourcesofcalciumaredairyandcalcium-fortifiedorangejuice. Protein: An individual should increase his content of protein to about 60 mg/day. It helps inrepairingofcellsandtissues.Proteinsareavailableinmostanimalfoodslikeeggs,meat,poultry,fish.Invegetarainfoods,diaryproducts,legumes,nutsandbeanshaveagoodproteincontent.

3SportsInjuries

A sports injury is related to an injury occuring during a sports activity. Injuries often result fromaccidents, e.g. two sportsmen colliding during a game, use of improper exercising equipment, orinsufficientwarmupandstretching.Anypartofthebodycanbeaffectedduringanysportsactivityorexercise. Sports injury normally involves themusculoskeletal system (which includes themuscles,bones,andassociatedtissueslikecartilage).

CommonTypesofSportsInjuries

MusclesprainsandstrainsLigamentTearsTearsofthetendonsthatsupportjointsandallowthemtomoveFracturedbones,includingvertebraeDislocatedjointsSprainsandStrains

Sprain

Sprainisastretchortearofaligament(ligamentisthebandofconnectivetissuesthatjoinsoneendofthebonewithanother).Sprainscanrangefromafirst-degreeminimallystretchedligament(toa

thirddegreetear),i.e.acompletetear).Areasmostvulnerabletosprainsareankles,knees,andwrists.Signs of a sprain involve pain, bruising, inflammation, inability to move a limb or joint andinstabilityoftheaffectedpart.

StrainStrain is a twist, pull, or tear of amuscle or tendon (a cordof tissue connectingmuscle to bone).Symptoms of a strain include pain,muscle spasm, and loss of strength. Severe strains not treatedprofessionallyoftencausedamageandlossoffunction.

AchillesTendonInjury

Thisinjuryiscausedwhenthetendonconnectingthecalfmuscletothebackoftheheelisstretchedortorn.Thiscanoccursuddenlyandisextremelypainful.ThemostcommoncauseofAchillestendonteariscalledtendonitis(adegenerativeconditioncausedbyoveruseoraging).

FractureAfractureisabreakinthebone.Itcanbeaone-timeinjuryorrepeatedstresstotheboneovertimeleadingtoastressfracture.Acutefracture:Acutefracturecanbesimple,i.e.cleanbreakwithlittledamagetothesurroundingtissues.Compoundfracture:Itisabreakinwhichthebonepiercestheskin.

DislocationsSeparationof twoboneswhich forma joint leads todislocation.Majorityofdislocationsoccur incontact sports such as football and basketball. High-impact sports lead to excessive stretching orfalling can also result in dislocation of a joint. A dislocated joint requires immediate medicaltreatment.Themostlikelydislocatedjointsarethoseofthehandsandshoulders.

AcuteandChronicInjuriesAcuteInjuries–Asprainedankleorafracturedhand,onactivity,isclassifiedunderanacuteinjury.ItcanresultinSwellingSuddenandseverepainInabilitytomoveajointthroughitsfullrangeofmotionVisibledislocationorbreakingofaboneChronicInjuries-Chronicinjuriesresultfromoverusingaparticularareaofthebodyoveralongperiodoftime.Chronicinjuryresultsin:

PainonactivityAdullachewhenrestingSwellingoftheareaaffected

AdviceonInjuryWorkoutshouldnotbedoneduringthephaseofacuteinjuryorseverepain.Rest-Reduceyourregularexerciseoractivities,tillthepainsubsides.Ice-Anicepackshouldbeappliedtotheinjuredsiteforabout20minutesatatime.Itcanbedonefourtoeighttimesaday.Acoldpackoricebagwithcrushedicewrappedinatowelcanbeused.Donotapplytheiceformorethan20minutes,asitcanresultincoldinjury.Compression-Compressionoftheinjuredareahelpsreduceswellingandsplints.Toprovidesupport,asplintcanbeattachedtotheinjuredarea.Askyourdoctorforadvice,onthetypeofsplittobeused.

Elevation-Ifpossible,keeptheinjuredparte.g.ankle,knee,elbow,orwristelevatedonapillow.Itshouldbeplacedabovetheleveloftheheart,tohelpdecreasetheswelling.

CautionDonotuseheatimmediatelyafteraninjury.Thistendstoincreasetheinternalbleedingorswelling.Heatisusedlatertorelievemuscletensionandpromoterelaxation.

TreatmentNon-steroidalAnti-InflammatoryDrugs(NSAIDs)toreduceinflammationandpainImmobilizationSlingtoimmobilisethearm,shoulder.

Splintandcasttosupportandprotectinjuredboneandsofttissues.Legimmobilisertokeepthekneefrombendingafterinjuryorsurgery.Surgery-Surgerymaybeneededtorepairtornconnectivetissue.ACompoundfracturemayalsoberealigned.Often,manytypesofsportsinjurydonotrequiresurgery. Rehabilitation -After a sports injury, repair and earlymobilisation is seen to speeduphealing.Mobilisation can be with gentle stretching and strengthening exercises. Slowly weights may beaddedtoyourexerciseroutine.

CommonSportsInjuriesBadmintonInjuriesAnkleSprainMusclestrainMeniscusTear

OtherinjuriesLateralepicondylitis(TennisElbow)MedialEpicondylitis(Golfer ’sElbow)In any sport, a chronic degenerative change of the Achilles tendon can occur due to repetitive

jumping,poorrecovery,warmupandstretching.Cramps–occurassudden,tightandintensepainbyagroupofmusclelockedinspasm.Thiscanbeduetoexcessivefluidloss,excessiveheatgain,fatigueandinadequatemusclerecovery.

Blisters–Occurmostlyontheheelsandtoesorthehand.Theyarefluidfilledspaceundertheskincausedbydirectcontactwithahardsurface.

RepetitiveStressInjury

Repetitive stress injury is thenamegiven to agroupof conditions that are causedwhen toomuchstressisplacedonajoint.Repetitivestressinjuryoccurswhenthesameactionisperformedoverandoveragain.Itcancausepainandswellingintheaffectedareasmuscles,tendonsandbursae.Tendonsare thestrongflexiblebandsof tissue thatattachmuscles to thebones.Bursaearesmallsacs filledwith fluid that act as cushions between tendons and bones. The common types of repetitive stressinjuryaretendinitisandbursitis(inflammationofbursa).Repetitivestressinjurygenerallyoccursinthoseover theageof30.This isdue to thenormalwearand tearofaging. Itcanalsooccurmorefrequentlyinthoseparticipatinginsportsactivities.

SignsofrepetitivestressinjuryPaininaspecificareaTheaffectedareabecomesinflamed,tenderandswollen.Specifictypesofrepetitivestressare:

TenniselbowItisaninflammationofthemusclesattachedtotheoutsideoftheelbow.

Golfer’selbowItisaninflammationofthemusclesontheinsideoftheelbow.

TriggerfingerItisaninflammationofthetendonsinyourhand(thesetendonshelpyouusemakeafist).

Housemaid’sknee

Itisaninflammationofthebursaonthefrontofthekneecap.

RemedyAphysicalexaminationoftheareaisperformedbythedoctortoconfirmthediagnosis.

MedicationNon-steroidalanti-inflammatorydrugs.Sometimescortisoneisprescribed,iftheswellingpersists.

KneeLigamentInjuriesThekneeistheweightbearingjointofthebody.Itsstabilitydependsupontheligamentsandmusclesaround it.Thekneehas two important setsof ligaments– the cruciate ligaments and the collateralligaments.

TheCruciateLigamentsThe cruciate ligaments are present within the knee joint. They are connected from the thighbone(femur)totheshinbone(tibia).Theyhelptoholdthebonesofthekneejointtightlytogether,whentheleg isbentorstraight.Thisaids inproperknee jointmovement.Thecruciate ligamentscrosseachothertoforman‘X’.ThetermcruciateisderivedfromtheLatinwordcrux,whichmeans‘cross.’

AnteriorCruciateLigamentInjuryCauses

ChangingdirectionrapidlyDirectcollision,e.g.infootballplayLandingfromajump

DiagnosisYourdoctorwillorderanX-rayMRI(MagneticResonanceImaging)ofthekneejoint.

TreatmentNon-surgicaltreatment–Musclestrengtheningalongwiththeuseofabracetoprovidestability.Activitieswillbelimitedforaperiodoftime.SurgicalTreatment–Arthroscopicsurgeryoropensurgerymaybeperformed.

PosteriorCruciateLigamentInjury

CausesBlowtothefrontofthekneePullingorstretchingoftheligamentDiagnosiswillbedoneafterthedoctorhasseenyourX-rayandaMRI.Inmostpatientsnothavingsymptomsofkneeinstability,surgeryisnotrequired.

CollateralLigamentInjuryThe collateral ligaments are situated on the inner and outer side of the knee joint. They providestabilitytothekneejoint.Theinjurytotheinnerormedialcollateralligamentusuallyoccursduetoimpactontheoutsideoftheknee.Itisoftenaccompaniedbyasharppaininsidetheknee.

TreatmentRestPuttingicepacksonthekneejointYoumayhavetowearabandageforawhileElevatethekneewheneverpossibleRehabilitationexercisesforgoodhealingshouldbedone.

CollesFractureA colles fracture is break across the end of the radius, (or distal fracture) with dorsal (posture)displacementofthewrist.Theradiusisthelongboneoftheforearm.

CauseTheprimarycauseofthecollesfractureisduetoafall.Theimpactofthefallandbodyweightcausetheradiustobucklethroughinjuryandbreak.Fallintheelderlyoftenleadstoacollesfracture.

TreatmentAnicepackisputonthewristtoreducetheswelling.Thewristiselevatedandplacedinasling.ConsulttheOrthopaedicianX-raysandcastingofthewristcanberecommendedbyyourorthopaedician.Acastisputonthe

affectedarea.Rehabilitationistocontinuerangeofmovementinthefingers,thumbandshoulderonthesideoftheaffectedwrist.Thiswillhelppreventstiffnessintheseareas.Theplasterisnormallyremovedafter6weeksofinjury.ThiswillbeafteryourorthopaedicianhashadalookatyourX-ray.

4PhysiotherapyandAcupuncture

Physiotherapy helps the individual (suffering from injury, disease or age) restore maximummovementandfunctionalabilitythroughlife.Physiotherapyisassociatedwithsomespecialitieslikecardiopulmonary, orthopaedic, neurology and pediatrics. Patient rehabilitation facilities can beavailablewith educationand researchcentres, schools, hospitals, industrialworkplaces, fitness andsportscentresandsomehomes.

SpecialitiesCardiopulmonaryCardiovascular and pulmonary rehabilitation deals with clearing of lung secretions, e.g in cysticfibrosis, heart attacks, post coronarybypass surgery and chronicobstructivepulmonarydisease tonameafew.Treatmentcanbenefitmuchfromcardiovascularandpulmonaryphysicaltherapy.

Pediatric

Children with cerebral palsy, spina bifida, developmental delays are treated by physiotherapists.Treatmentfocusingonmodalitieslikegrossandfinemotorskills,coordination,strength,cognitiveandsensoryperceptionsarehelpedbythepediatrictherapists.

OrthopaedicOrthopaedic therapists diagnose, manage and treat disorders and injuries of the musculoskeletalsystem. Orthopaedic therapists help to treat fractures, acute sport injuries, arthritis, sprains, post-operative orthopaedic procedures etc. Therapeutic exercises, hot and cold packs, electricalstimulation,manipulationarepartoftheiroperationalprocedure.

Neurological

Neurological disorders or diseases including Alzheimer ’s disease, brain injury, cerebral palsy,multiple sclerosis and Parkinson’s disease are some of the ailments treated by a neurologicaltherapist.Thesetherapistshelptheirpatientstoimprovetheseareasofdysfunction.

GeriatricGeriatricphysiotherapyhelpsthenormalageingadult.Maladieslikearthritis,osteoporosis,cancer,Alzheimer ’sdisease,jointreplacement,balancedisorders,etcarelookedafterinthisgroup.Theaimhereistohelprestoremobility,reducepain,andincreasefitnesslevel.

AcupunctureAcupuncture is derived from the Latin word Acuspungere, Acus meaning ‘needle’, and pungere,‘prick’. World health organization (WHO) comments that this procedure is safe, but needs moreresearch.Itisatechniqueofinsertingandmanupulatingfinefilliformneedlesintospecificpointsonthe body. The aim of this technique is to relieve pain and be used for therapeutic purposes.AccupunctureisdescribedinthetraditonalChinesemedicaltexts,aspathwaysthroughwhichQiand“Blood” flow. Treatment of acupuncture points are performed along several layers of pathwaysthroughoutthebody(tweleveprimarychannelsormai).Thepointstobetreatedbytheacupuncturistaredecidedaftertallyingandobservationofdetailedhistoryofthepatient.

5DifferentSensationsofPain

EaracheEarache is a commonmedical problem occuring both in children and adults.Common conditionscausingearachecanbeinfectionoftheouterear(otitisexterna)andinfectionofthemiddleear(otitismedia).Otitis externa– It is the infection of the outer ear or ear canal. It often occurs after swimming.Earachecanbesevere.Mildcasespresentwithanitchmorethanthepain.Therecanbehearingloss,ringingorbuzzingsoundsintheearandswellingoftheear.Otitismedia- It leads to an infection of themiddle ear and eardrum. This occurs due to bacteriagrowinginthemiddleear.Presentationofsymptomsispainintheear,hearinglossandringingorbuzzingsoundsintheear.Dischargefromtheearcanbepresent.Afterexaminationoftheear,thedoctorwouldadviseyoutreatment.

OtitisexternaTreatmentwithantibioticeardropsfor7-10days.Thedropsareplacedintheearwhilethepersonislyingonhisorherside,withtheaffectedearup.

Incertaincasesoralantibioticsmaybeadvisedaswell.

PainmedicationisgivenasrequiredProtecttheearfromwater.EitheranearplugorsmallcottonballcoatedwithVaselinecanbeusedduringbathing.

Otitismedia

Anoralantibioticisadvised.Adecongestantmedicationtobeadministered.Painmedicationisgivenforthefirstfewdays.

Toothache

Whenthenerverootofatoothisirritateditresultsinatoothache.Infection,dentalabscess, injury,decay,orlossofatootharethemostcommoncausesoftoothache.Toothpainalsooccursaftertheextractionofatooth.Otherpainswhichradiatetothejawandresultintoothpainareearpain,heartproblemsorpaininthejawjoint.Molarsorwisdomteethsurfacingcanalsoleadtotoothache.

SymptomsoftoothacheHotorcoldsensitivity.Painonchewingfood.Swellingaroundatoothorswellingofyourjaw.

Bleedingordischargefromaroundatoothorgums.Injurytothetootharea.

TopreventtoothtroubleMaintainahealthydiet.Endyourmealwithafibrousfruit.Itisimportanttocleanyourteethusingdentalflosseveryday.Massageandbrushyourgumsdaily.Preventtoothdecaywithfluoride.Brushyourteethaftereverymeal.Visityourdentisttwiceayearforcheckup.

HeadacheAheadacheisaworklimitingmalady.Majorityofheadachesarebenignandself-limiting.Commoncausesofaheadachecanbetension,migraine,eyestrain,dehydration,lowbloodsugar,andsinusitis.The more serious ones can be due to meningitis, encephalitis, cerebral aneurysms, high bloodpressure,andbraintumors.Headachesamongwomencanbepresentduringtheirmenstrualyears.

TypesofHeadachesVascularCervicogenicMyogenic(muscletension)Inflammatory

VascularHeadacheAvascularheadacheismostoftencalledmigraine.Itischaracterisedbyathrobbingorpulsatingheadandisoftenonesided.Itisassociatedwithnauseaandvomiting.Sensitivitytolight,soundandsmellsisacute.Avascularheadachecanleadtodepression.Therecanbeafamilyhistoryofmigraine.

MigraineTriggersofftoanystimulusthatresultsinaheadache.Stimulicanbe:StressEnvironmentalfactors(e.g.weather,altitude,timezonechanges)FoodscontainingcaffeineandmonosodiumglutamateHormonalchangesinwomenLackofsleepAlcohol(e.g.redwine)

SomeOtherTypesofMigraine Abdominalmigraine–Mostcommon inchildrenwitha familyhistoryofmigraine.Abdominalpainwithoutagastrointestinalcause.Nausea,vomiting,andflushingorpalenessisseen.Childrenhavingabdominalmigraineoftendeveloptypicalmigraineastheyage.OpthalmoplegicMigraineStatueMigraineCarotidyniaorfacialmigraine–Itproducesdeep,dull,achingandsometimespiercingpaininthejaworneck.Basilararterymigraine–Itinvolvesadisturbanceofthebasilararteryinthebrainstem.

TensionheadacheIt is themost common formofmyogenic headache.Muscular (ormyogenic) headaches appear toinvolvethetighteningofmuscles.Theycanradiatetotheforehead.CervicogenicHeadacheoriginatesfromdisordersoftheneck(cervicalrootsC1-C3).Thisheadacheisoftenprecipitatedbyneckmovementand/orsustainedawkwardheadpositioning.

Inflammatoryheadache1.Sinusinfection2.Tensionheadache3.Vascularheadache4.Hangover(causedbyheavyalcoholconsumption)5.Toxicheadache

6.Migraine7.Stroke

Medication

Analgesicsprovidesymptomaticrelieffrompain.Theseareusuallywell-toleratedmedication.Theyareavailableinoralandinjectableforms.

AbdominalPaininAdults

Abdominalpainisacommonproblem.Normallythispainisself-limitedorcuredbyhomeremedies.

Inseriouscausesitmayrequireurgentinterventionandhospitalisation.Abdominalpainisnormallydescribedasacuteorchronic.Itsnatureisdefinedassharp,dullorcolicky.Theareafromwherethepain arises, its distribution, radiation and other factors are observed to help make a provisionaldiagnosis.

CausesofAbdominalPainPerforation,e.g.pepticulcer,diverticulumItcanbeasaresultofinflammation(e.g.appendicitis,cholecystitis,pancreatitis)Traumafrombluntorperforatinginjuriesofstomach,bowel,spleenetc. Obstruction of small bowel and large bowel (due to previous surgery, e.g. colorectal cancer,hernia,etc)

TreatmentBloodtestsincludingfullbloodcount,electrolytes,urea,creatinine,liverfunctiontests,pregnancytest(inyoungwomen)andlipase.UrinalysisImagingincludingerectchestX-rayandplainfilmsoftheabdomen.Anelectrocardiographtoruleoutaheartattackwhichcanoccasionallypresentasabdominalpain.Ifdiagnosisofabdominalpainremainsunclearafterhistory,examinationandbasicinvestigations,

thenmoreadvancedinvestigationslikecomputedtomographyoftheabdomen/pelvis,abdominalorpelvic ultrasound, endoscopy and colonoscopy (not used for diagnosing acute pain) should beincludedtoclinchthediagnosis.

RecurrentabdominalpaininchildrenandadolescentsisoftenduetoirritablebowelsyndromeRaynaud’sPhenomenonRaynaud’sphenomenon isnamedafter theFrenchdoctorMauriceRaynaud.She firstdescribed thecondition in the mid-1800s. Raynaud’s phenomenon results from poor circulation affecting theextremities(i.e.,fingersandtoes).Inthisphenomenon,whenanindividual’sskinisexposedtothecold,thebloodvesselsunderthe

skinundergovasospasm(slowingtheflowofblood).Itthenbecomesharderforthebloodtoreachtheseareasandthereforelessoxygenreachestheskin.Theskinturnsblueandfeelscold.Thenoseandearsmayalsobeaffected.Paininthefingersortoesisexperiencedwhentheyarecold.Atinglingfeelingorpain in the fingersor toeswhen theywarmup.WomendevelopRaynaud’sphenomenonmoreoftenthanmen.Medicinesthatrelaxthewallsofthebloodvesselsmaybeprescribedbyyourdoctor.

OtherAdviceKeepyourhandsandfeetwarm.Wearglovesandwarmsocksincoldweather. Do not smoke. Smoking causes blood vessels to constrict,making the symptoms of Raynaud’sphenomenonworse.Smokingcanalsotriggervasospasminthewholebody.

DeepVeinThrombosis(DVT)Veinsarebloodvesselscarryingbloodtowardstheheart.WhenyouhaveaDVTthebloodflowintheveinispartiallyorcompletelyblockedbyathrombus.Therecanbeseverepaininthecalfregionduetotheformationofathrombus.Bloodflowisnormallysmoothandquickthroughtheveinsanddoesnot lead toclotting.Bloodflowin the legveins ishelpedalongby legmovementsasmuscleactionsqueezestheveinsoftheleg.Adeepveinthrombosis(DVT)isaresultofabloodclotlodginginadeepveinoftheleg.

CausesofDVTSurgerymorethan30minutesinanindividualisthemostcommoncauseofDVT.Whenthepatientisunderanesthesia,freeflowofbloodinthelegveinsflowsdownduetonolegmovement.AnyillnessorinjurythatcausesimmobilityincreasestheriskofDVT.LongjourneysbyplanemaycauseanincreasedriskofDVT(especiallyifthepassengerdoesnotmovehislegswhilesitting).Vasculitis(inflammationoftheveinwall)andsomedrugs(e.g.chemotherapydrugs)candamagetheveinandincreasetheriskofhavingaDVT.Somemedicalconditionscancausethebloodtoclotmorereadilythanusual.

Hormone replacement therapy (HRT) thatcontainsestrogencancause theblood toclot.Womentaking‘thepill’or‘HRT’areatagreaterriskofdevelopingDVT.

PeoplewithcancerorheartfailurehaveanincreasedriskofDVT.Duetopoormobility,olderpeoplearemoresusceptibletodevelopDVT.ObesityalsoincreasestheriskofhavinganattackofDVT.

ComplicationsofDeepVeinThrombosisPulmonaryembolus(abloodclotthattravelstothelung)Post-thromboticsyndrome(persistentcalfsymptoms)

TreatmentofDeepVeinThrombosisAnticoagulationtohelppreventtheclotfromgettingbigger.CompressionandraisingthelegStopsmokingCertaintestsforclottingtime,lipidprofile,bloodsugar,etcwillbeadvisedbyyourdoctor.Appropriatemedicationwillthenbeadvisedtoyou.

HerpesZosterIt iscommonlyknownas ‘shingles’. It iscausedby thevaricellazoster virus.Chickenpoxa shortlived illnessalsooccursdue to thisvirus.Once theepisodeofchickenpoxhas resolved, thevirusmaynotgeteliminatedfromthebodyas it lies in thebodiesof thenervecells.Herpeszostermayoccurindependently,(withoutarecentattackofchickenpox).

SymptomsofHerpesZosterHeadache,feverandmalaiseThesesymptomsareoftenfollowedbyitchingandaburningpain.Hyperesthesiaorparasthesia(i.e.sensitivitytotouch,heat,coldetc).

The pain in Herpes Zoster mostly extends along the torso of the body. It can present itself asstinging,tinglingandorachingpain.Adayortwoaftertheabovesymptoms,rashappearswhichcanspreadtoface,eyes,andotherpartsofthebody.Initially therashappears inhives,but later itbecomesvesicular(informofsmallblisters,filled

withserousexudate).Feverandgeneralmalaiseoftencontinue.Thepainfulvesiclesbecomedarkastheygetfilledwithblood.About10dayslater,thecrustfallsoffandtheskinstartstoheal.Incaseofblisteringandscarringdiscolorationoftheskinoccurs.

DiagnosisofHerpesZosterLaboratorytestofthisailmentisthroughabloodsample.

TreatmentAnti-viraltreatmentisrecommended.Oralcorticosteroidsifrequiredareaddedtothedrugregimen.Formildpainanalgesicsareadvised.Inseverecasesopoidmedicationlikemorphinecanbeadministered.Oncrustingoflesions,capsaicincreamcanbeused.

PreventionLivevaccineforV2V(Zostavar)isusedinadultstopreventthedisease.Alsoastudyhasshowedthatfreshfruitintake(aboutthreeservingaday)helpsreducetheriskofdevelopingHerpesZoster.

ChestpainChestpaincanbeasymptompresentdue toanumberof seriousconditions. Itcouldbecardiac innature and therefore considered amedical emergency.When the chest pain is not associated withheartdisease,itistermedasnon-cardiacchestpain.

CausesofchestpainCardiopulmonarycanbeAnginaPectorisAcutecoronarysyndromeMyocardialinfarction(“heartattack”)Aorticdissection

PulmonaryembolismPneumoniaHaemothorax

OthercausesofchestpainUpper gastrointestinal diseases e.g. gastroesophageal reflux disease (GERD),Hiatus hernia (whichmaynotaccompanyGERD)andachalasiacardia.

OtherstypesofchestpainFibromyalgiaChestwallproblemsandbreastconditionsHerpeszosterSpinal,nerveproblem Tietze’s syndrome - a benign and harmless form of osteochondritis or costochondritis (oftenmistakenforheartdisease)Abdominalpaincanalsomimicchestpain.

Dependinguponthetypeofpain,anumberoftestscanbeorderedbyyourdoctorX-raysofthechestand/orabdomenCTScanECGPulmonaryangiogramAngiography

Bloodtests

Completebloodcountwitherythrocytesedimentationrate(ESR)KidneyfunctiontestLiverfunctiontestCreatininekinaseSomeotherspecifictestscanalsobeconducted.

MythsandFactFile

MythWitharthritis,Idonotneedtomove,justsit

FactAlongwithyourmedication,acertainamountofmobilizationofjointsisveryimportant.Themoreyouareimmobile,theworsewillbeyourarthritis.

MythForosteoporosisthecalciumandothermedicationadvisedisenough

FactTo go for a walk is necessary. Mobilization of calcium comes through mobility. Onlysupplementationofcalciumisnotenoughforpropercalciumdeposition.

MythOsteoporosisisonlypresentinwomen.

Fact

Osteoporosis candevelop inmen also. It canoccur in anyonewith chronic disease, due to certainmedicationorhormonaldisorder.

MythGoutrunsinfamilies.Ithasnothingtodowithfoodordrink.

FactGoutmayormaynotbefamilial.ItoccursduetodeficiencyofanenzymeHGPRtase.Alcoholandhighuricacidfoods,precipitatetheonsetofthisdisease.