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Osteoarthritis : Degenerative Spinal Joint Disease
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Osteoarthritis is a disease of the joints. Also know as degenerative joint disease, it is the most common form of arthritis, affecting more than 20 million American adults. It should not be confused with rheumatoid arthritis, which is not the same as osteoarthritis. Osteoarthritis is caused by a breakdown of cartilage, the substance that provides a cushion between the bones of the joints. Healthy cartilage allows bones to glide over one another and acts as a shock absorber during physical movement. In osteoarthritis, the cartilage breaks down and wears away. This causes the bones under the cartilage to rub together, causing pain, swelling and loss of motion of the joint.

What Causes Osteoarthritis?
Most cases of osteoarthritis have no known cause. Risk factors include :
  • Age - osteoarthritis affects more people over the age of 45
  • Female - osteoarthritis is more common in women than in men
  • Certain hereditary conditions such as defective cartilage and joint deformity
  • Joint injuries caused by sports, work-related activity or accidents
  • Obesity
  • Diseases that affect the structure and function of cartilage, such as rheumatoid arthritis, hemochromatosis (a metabolic disorder), Paget's disease and gout
Signs and Symptoms of Osteoarthritis
Osteoarthritis usually begins slowly. Early in the disease, joints may ache after physical work or exercise. Often the pain of early osteoarthritis fades and then returns over time, especially if the affected joint is overused. Other symptoms may include :
  • Swelling or tenderness in one or more joints, especially before or during a change in the weather
  • Loss of flexibility of a joint
  • Stiffness after getting out of bed
  • A crunching feeling or sound of bone rubbing on bone
  • Bony lumps on the joints of the fingers or the base of the thumb
  • Steady or intermittent pain in a joint (although not everyone with osteoarthritis has pain)
Osteoarthritis : Commonly Affected Joints
Which joints are affected by Osteoarthritis?
Osteoarthritis can occur in any joint but most often occurs in the spine, hips, knees or hands.
  • Spine
    Stiffness and pain in the neck or in the lower back can result from osteoarthritis of the spine. Weakness or numbness of the arms or legs can also result. Some people feel better when they sleep on a firm mattress or sit using back support pillows. Others find help from heat treatment or an exercise program to strengthen the back and abdominal muscles. In severe cases, surgery to reduce pain and help restore function may be necessary.

  • Hips
    Osteoarthritis in the hip can cause pain, stiffness and severe disability. People may feel the pain in their hips, groin, inner thigh or knees. Osteoarthritis in the hip may limit moving and bending. This can make daily activities such as dressing and foot care difficult. Walking aids (such as canes and walkers), medication, and exercise can help relieve pain and improve motion. If the pain is severe and not helped by other methods, hip replacement surgery may be necessary.

  • Knees
    The knees are the body's primary weight-bearing joints. For this reason, they are among the joints most commonly affected by osteoarthritis. They may be stiff, swollen, and painful, making it hard to walk, climb, get in and out of chairs and use bathtubs. If not treated, osteoarthritis in the knees can lead to disability. Medications, losing weight, exercise, and walking aids can reduce pain and disability. In severe cases, knee replacement surgery may be necessary.

  • Hands
    In osteoarthritis of the hands, small, bony knobs appear on the end joints of the fingers. They are called Heberden's nodes. Similar knobs, called Bouchard's nodes, can appear on the middle joints of the fingers. Fingers can become enlarged and gnarled, and may ache or be stiff and numb. The base of the thumb joint is also commonly affected by osteoarthritis. Medications, splints or heat treatment can usually help osteoarthritis in the hands.
How do I know if I have Osteoarthritis?
No single test can diagnose osteoarthritis. However, if you are experiencing any of the symptoms listed above, see your doctor. Most doctors use a combination of tools to determine if you have osteoarthritis, including :
  • History
    Your doctor will begin by asking you to describe any symptoms you are having and how they have changed over time. Tell your doctor about any pain, stiffness, or decreased joint function you are experiencing and how it is affecting your daily life. Also talk to your doctor about how you have been treating these symptoms. Be sure to also tell your doctor about any other medical problems you have and if you are taking any medications.

  • Physical Examination
    After talking with you about your symptoms, your doctor will examine you by checking your reflexes and muscle strength. Your doctor may also ask you to walk and bend to observe your flexibility.

  • Tests
    Since there is no single test for osteoarthritis, your doctor may need to do a variety of tests including x-rays of your joints to see if there has been any cartilage loss, bone damage or bone spurs. Other tests may include blood tests and a test called "joint aspiration" where fluid is drawn from the joint to be examined.
It is usually not difficult to tell if a patient has osteoarthritis. It is more difficult to tell if the disease is causing the symptoms. Osteoarthritis is so common, especially in older people, that other conditions may play a role in the symptoms. Your doctor will try to find out what is causing the symptoms and rule out any other health problems you may have.

Osteoarthritis : Treatment Options
Treatment of Osteoarthritis
Even though there is no cure for osteoarthritis, its symptoms can be treated. Osteoarthritis treatment generally includes the following :
  • Pain Control
    Many different medications can be used to control pain, including corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs). If NSAIDs do not provide relief to inflamed joints, glucocorticoids (an injection) may be used. For mild pain without inflammation, acetaminophen or aspirin may be used. Non-drug treatments may provide temporary pain relief and include hot/cold therapy, acupuncture and herbal remedies.

  • Exercise
    Exercise to improve flexibility and improve muscle strength. Regular exercise can also improve your mood and outlook, decrease pain, improve your heart and blood flow and maintain your weight.

  • Weight Control
    Maintaining an acceptable body weight will help prevent extra stress on weight-bearing joints.

  • Spine Surgery
    Spine surgery (in severe cases) may be necessary to relieve chronic pain in damaged joints.
One of the most important things you can do is to take care of yourself and adopt healthy lifestyle habits. People with osteoarthritis can enjoy good health despite having this disease. Research shows that patients who take part in their own care report less pain and make fewer doctor visits. They also enjoy a better quality of life. The best way to start is what you are doing right now - learning as much as you can about osteoarthritis. Talk to your doctor about programs that you can join that are designed to help you manage your condition and develop a healthy lifestyle.
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Back Pain
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Back PainMore than 60% of the UK population reports regular back pain, amounting to around 100 million days a year of lost working time. A bad back can be the bane of your life. Everyday tasks can result in agony and there's no quick-fix solution. But if you suffer from back pain, you're certainly not alone. Back pain affects 28.3 million Brits, according to a recent survey. Celebrity sufferers include Sean Connery, Emma Thompson and Michael Caine.

Three in five adults in the UK admit to suffering from an occasional aching back and slouching in chairs has been named as the number one cause, according to mattress company Relaxsan. "The tragedy is that this is the UK's leading cause of disability, and even more disturbing is that recent research is showing back pain is increasingly prevalent among children," says Barrie Savory, back specialist.

"Current statistics from the Department of Health indicate that back pain is costing British industry £5 billion a year in lost production through absenteeism - and the National Health Service £481 million a year in treating it."

Types of Back Pain
In 95% of cases, the cause is linked to the way the bones, ligaments and muscles of the back work together. Pain is often based in the lumbar region (lower back), and will come and go at different times depending on different levels of activity.

Simple back pain triggers include poor posture, lack of exercise, sleeping on a mattress that doesn't provide enough back support or a trip or fall. Other causes of back problems are much less common. Nerve root pain is the cause in less than 5% of people. The pain is usually caused when a vertebral disc becomes displaced or bulges out from its normal position, putting pressure on the nerve root. This is called a slipped disc.

Causes
Lifting heavy objects may trigger a nasty twinge in your back but surprisingly most backache is actually caused by doing nothing at all. Savory continues: "The biggest factor behind back pain is the fact we're too sedentary. Our creature comforts - the bed, the soft armchair, the car, the office desk and the computer - are the very instruments of our torture. Our backs have become weaker and weaker as we've become more sedentary."

Unfortunately, once you've experienced back pain you may well be prone to more problems, Savory adds. "Disc problems at the base of the spine are one of the most common back injuries. Recurrent episodic lower back pain is down to an instability between vertebrae and vertebrae, where the disk has lost its fluid content and can effectively 'wobble' about. Once you've got a degree of instability, unless you do an enormous amount of core muscle strength exercises to regain it, you'll always be vulnerable."

TreatmentTreatment
If you suffer from recurrent back pain it's wise to seek advice from an expert. Back pain can be treated in many ways, including physiotherapy, osteopathy and chiropractic treatment. "All of these have an input in helping to restore the back to normal but much of it is down to self-help and prevention," Savory says.

"We are all dealing with the same body - its structure and function remain the same; it's only our approaches to its management that are different."

Prevention
Prevention is better than cure and back pain can be kept at bay with a few simple changes. "Don't let yourself be a victim of your surroundings. The invisible enemy - the desk and computer - programme you into a shape and before you know it you're suffering with back pain and need a lot of treatment to try and change it," Savory says.

He has these tips to help you wave goodbye to a bad back:

Walk more and try to do a spot of daily exercise. You don't need to join a gym; get off one bus stop early, run up a flight of stairs or balance on one leg while you're trying to clean your teeth. Sitting just loses muscle tone.
  • Pilates is recommended for strengthening core muscles. Yoga can over-stretch and does not give the same degree of muscle control.
  • Get out of 'desk mode'. Every time you get up from sitting, deliberately put your hands behind the back, make your shoulder blades meet at the back so you open the front of the chest and hold for five seconds. Effectively you're coming out of 'desk mode' and into an upright posture.
  • Spend time on shoulder shrugging sessions when you're sitting for long periods of time. This gets blood supply moving and relieves tension at the top of the shoulders.
  • Find a mattress that gives support. Don't go for super-hard mattresses but ones with a soft top surface that's firm enough to hold you.
  • Warm-wrap therapy - a form of heat therapy to relieve pain caused by muscle spasms in the lower back - is an effective treatment, according to new research.
TreatmentThe Taj Medical Group provide an all inclusive package comprising specific X-rays, MRI scans, tests and investigations for determining the root cause of your back ache, including 2 nights fully inclusive stay (for you and a companion) followed by consultation with our Spinal Surgeons in India for £395 - for more details - Back Ache Investigation Package.
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Lower Back Pain
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What is Lower Back Pain?
Low back pain (LBP) is often described as sudden, sharp, persistent, or dull pain felt below the waist. LBP is very common and affects the majority of people at some point during their life.

Low back pain is most commonly caused by muscle strain associated with heavy physical work, lifting or forceful movement, bending or twisting, awkward positions, or standing in one position too long. Any of these movements can exacerbate a prior or existing back disorder.

Other conditions that can cause low back pain include spinal stenosis, arthritis (osteoarthritis), spinal infection (osteomyelitis), spinal tumors (benign and malignant), spondylolisthesis, and vertebral fractures (e.g. burst fracture).

Low back pain is either acute or chronic. Acute LBP may begin suddenly with intense pain usually lasting less than 3 months. Chronic pain is persistent long-term pain, sometimes lasting throughout life. Even chronic pain may present episodes of acute pain.

Other symptoms include localized pain in a specific area of the low back, general aching, and/or pain that radiates into the low back, buttocks, and leg(s). Sometimes pain is accompanied by neurologic symptoms such as numbness, tingling, or weakness.

Neurologic symptoms requiring immediate medical attention include bowel or bladder dysfunction, groin or leg weakness or numbness, severe symptoms that do not subside after a few days, or pain prohibiting everyday activities.

Low Back Pain : Diagnosis
Pain felt in the low back (lumbar spine) is not always indicative of a spinal problem. A thorough physical and neurologic assessment may reveal the cause of the low back pain. The physical examination begins with the patient's current condition and medical history.

Range of Motion
The patient's range of spinal motion is evaluated while standing straight, bending forward, and to the side. Asymmetry, posture, and leg length is noted. Methodical palpation of the spine can reveal muscle spasm, possible bony displacement, and tender points. Abdominal palpation is performed to determine if the cause of low back pain is possibly organ related (e.g. pancreas).

Neurologic Assessment
The neurologic assessment evaluates weakness, absence of reflexes, tingling, burning, pain, diminished function, and other signs that may indicate nerve involvement. In some cases electrodiagnostic studies such as electromyography (EMG) or nerve conduction velocity (NCV) are performed to confirm a diagnosis or localize the site of nerve injury.

Lab Tests
If infection, malignancy, fracture, or other risk factors are suspected, routine lab tests may be ordered. These tests may include complete blood count (CBC), erythrocyte sedimentation (ESR), and urinalysis.

Imaging Studies
Plain radiographs (x-rays), CT Scan, and/or MRI studies are performed when fracture or neurologic dysfunction is suspected. An MRI represents the gold standard in imaging today. An MRI renders high-resolution images of spinal tissues such as the spinal cord and intervertebral discs. X-rays are still the imaging methods of choice to study the bony elements in the low back.

The results of the physical and neurologic examinations combined with test results are carefully evaluated to confirm a diagnosis.

Non-Surgical Treatment
Most patients with low back pain (lumbar spine) are treated without surgery. A conventional treatment plan may include bed rest for a day or two combined with medication to reduce inflammation and pain.

Medications recommended by the physician are based on the patient's medical condition, age, other drugs the patient currently takes, and safety.

MedicationMedication
The first choice for pain relief is often nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs should be taken with food to prevent stomach upset and stomach bleeding. Muscle relaxants may provide relief from muscle spasm but are actually benign sedatives, which often cause drowsiness. Narcotic pain relievers are prescribed for use during the acute phase.

Physical Therapy
Physical therapy (PT) is started as soon as the patient can tolerate activity. A managed PT program can help build muscle strength, flexibility, improve mobility, coordination, stability, balance, and promotes relaxation. Patients who participate in a structured physical therapy program often progress to wellness more rapidly than those who do not. This includes low back maintenance through a home exercise program developed for the patient by the physical therapist.

PT may include ice therapy to slow nerve conduction thereby decreasing inflammation and pain. Heat treatments may be used to accelerate soft tissue repair. Heat increases blood flow and speeds up the metabolic rate to assist healing. Heat also helps decrease muscle spasm, pain, and promotes a relaxed feeling. Ultrasound is a treatment used to deliver heat deep into soft tissues. Sometimes a heat treatment is given prior to a session of therapeutic exercise.

Spine Surgery
Seldom is surgery required to treat low back pain. Surgery may be considered if the patient is experiencing bowel or bladder dysfunction, increased nerve impairment, progressive weakness, incapacitating pain, or spinal instability. The surgical procedure depends on the diagnosis or the cause of low back pain.

Recovery
First and foremost, follow the treatment plan outlined by the physician and physical therapist. To enhance recovery from surgery, an episode of low back pain, or to help prevent future exacerbation try to maintain good posture, be consistent in a home exercise program, and eat sensibly to maintain proper body weight.
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