The Bones and Muscles

the bones and muscles (the bones and muscles)


the bones and muscles (the bones and muscles)
The Bones and Muscle

the bones and muscles (the bones and muscles)
bones Every movement we make depends on the coordinated interaction of the muscles, bones, ligaments and tendons that make up the musculoskeletal system. The 206 major bones that form the skeleton are the body scaffolding, but they do much more than provide simple support. The skull and spine protect the brain and spinal cord, while the rib cage and pelvis shield other vital organs. the bones and muscles (the bones and muscles)

the bones and muscles (the bones and muscles)

bones The joints-those elegantly engineered intersections where bones meet and are bound together by ligaments-permit the wide range of movements of which we are capable. The bones also serv as living storehouses for minerals, constantly releasing and reabsorbing calcium and other essential elements. And inside certain bones lies the red marrow that manufactures most of our new blood cells. the bones and muscles (the bones and muscles)

the bones and muscles (the bones and muscles)

bones The 650 or so muscles in the body are grouped into three main categories. Skeletal muscles make it possible for us to move. They are anchored to two or more bones, usually by means of tendons, and most of them work in pairs. When triggered by nerve impulses, one muscle contracts, its counterpart relaxes, and the bones they are attached to move and so do we. Unlike the skeletal muscles, which are under our consious control, the cardiac muscles of the heart and the visceral muscles of the stomach and other internal organs function automatically.

the bones and muscles (the bones and muscles)

bones Because of the stresses to which they are subjected, bones and muscles are prone to various injuries and problem: muscles tear and tendons become inflamed; osteoporosis can make bone brittle; arthritis can devastate joints-and millions of lives are distruped each year by back pain. In this section you will learn what can go wrong with the musculoskeletal system, how to deal with problems, and what you can do now to avoid trouble later on.

the bones and muscles (the bones and muscles)

the bones and muscles (the bones and muscles)

the bones and muscles (the bones and muscles)

Common Questions

the bones and muscles (common questions)

the bones and muscles (common question)

I know that bones are hard and strong and that they support the body, bu I`m not sure what they are made of. Can you tell me?

Bone tissue is composed of living cells intermixed with minerals, mainly calcium and phosphorus, which give bone its characteristic hardness. Bones vary in shape and size-from the long bones of the limbs to the short bones of the hands and feet; there are also flat bones, such as the breastbone and skull bones, and irregular bones, such as the vetebrae. In adults, most bones ate made up of two types of tissue: hard comppact bone on the outside and porous spongy bone on the inside. In a long bone like the femur, or thighbone, the shaft consist mostly of compact bone; it is hollow and filled with fat called yellow marrow. The bulging ends of the bone consist primarily spongy bone, surrounded by a thin outer layer of compact bone. The spongy bone contains red marrow, which manufactures the blood cells. Most bone surfaces are covered with a dense fibrpous membrane, called the periosteum. Blood vessels and nerve fibres pass into the spongy interior of a bone through small channels in the hard outer layer.

It`s hard to imagine bone as living, growing tissue. How do bones grow?

Bones grow in their own unique way: the process begins with the formation of new cells. These cells then produce and surround themselves with a special organic material that forms a kind of matrix. Calcium salts are deposited in this framework and gradually harden it. Bones begin forming as warly asa two months after conception and continue growing until the age of about 16 in girls and 18 in boys. Although the final hardening of the breastbone occurs at about 25 years old, the strength and calcium content of the bones keep increasing until 35 or so. Bone remodelling, the breaking doen and replacement of bone tisue, continiues throughout most of life. Bone form in the foetus in two ways. Those at the top of the skull begin growing within a membrane of soft connective tissue. Most bones, however, start off as cartilage `models`. The models are similar in shape to the true bones that will eventually replace them, but are more pliable and better suited to the very rapid growth before birth. Each cartilage model is gradually replaced by bone tissue. In a long bone, the process begins in the centre of the shaft and at both ends. Eventually only a thin layer of cartilage, called a growth palte, remains between the shaft and each end. By continuing to form new layers of cartilage that are then replaced by bone, these plates make bone growth possible. When the plates stop forming cartilage, growth stops.

What did my doctor mean when he referred recently to my son`s bone age?

Duriong growth, the cartilage layers near the ends of the long bones-the growth plates-thin out at a predictable rate, and eventually disappear when growth ceases. Your doctor can determine the thickness of your son`s growth plates through X-rays, and thus determine his bone age. In general, bone age should match chronological age, although bone growth rate does vary from child to child. A major difference between the two can signal a harmonal problem.

It is possible for a bone to bruise?

Yes, it is. A sharp blow or a bad fall can sometimes cause bleeding just beneath the periosteum, the fibrous membrane that covers most bone surfaces and which contains blood vessels and nerves. Bone bruises are painful, but they usually heal within a few days. If the pain persists, or gets worse with activity, consult your doctor. An X-ray may be necessary to distinguish a bone bruise from a fracture.

What is the difference between a simple and a compound fracture?

All bone fracture are the result of severe trauma, whether from a fall, a violent blow or some other source.In a simple fracture, the bone is cracked or broken, but the surrounding tissues are not seriously damaged, and the skin isn`t broken. In a compound fracture, surrounding damage is often extensive, and the broken bone may protrude through neighbouring tissue and the skin. In compound fractures the danger of infection occuring is always present, and surgical treatment is necessary in most cases.Rest, and perhaps a splint or an arm sling, may suffice to treat some minor fractures. In more severe cases, the pieces of broken bone will have to be realigned. Depending on the severity of the fracture, this may or may not involve surgically opening the site of the fracture.Once the bone has been realigned, it must be immobilised either by a cast, traction or an internal device such as a pin a or a plate.

What are joints, and how are they constructed?

A joint is the structure that connects any two or more bones. Although they allow no movement, the fibrous connections that join the bones of the skull are joints, but it is the movable variety that are more usually thought of as such. Bones are held together at a joint by tough, fibrous bands called ligaments; the ends of bones are covered with smooth cartilage that provides a low-friction surface for movement. The joint space is lined with a layer of tissue, called the synovium, which produces a fluid that lubricates the joint and nourishes the cartilage. Major joints include the shoulders, elbows, wrists, hips, knees, ankles and jaw; there are also many small joints in the hands and feet and between the vertebrae of the spine. Different types of joints allow different types of movement. hinge joints, such as those at the fingers, elbows, and knees, permit back and forth motion in one plane. A ball-and-socket joint, such as the hip or shoulder joint, allows sideways and rotary, as well as back and forth, motion.

I have been cracking my knuckles for years. My wife says this habit will eventually cause arthritis. Is she right?

The biggest problem with knuckle cracking seems to be the annoyance it causes other people. Doctors are not exactly sure what produces the cracking sound, but there doesn`t appear to be a connection between chronic knucklecracking and the development of arthristis or any other physical problem.

My son dislocated his shoulder while playing football. What is a dislocation?

A dislocation is a displacement of a bone from its normal position at a joint. It is usually caused by a powerful blow or injury that tears the ligaments holding the bones in place. A common result of contact sports, dislocations can occur at almost any joint. Symptoms are severe pain, rapid swelling, discoloration and immobility; the joint also looks misshapen. For a dislocation to heal properly, the bone must be repositioned by a doctor (this may have to be done under an anaesthetic), then immobilised, possibly with splints.

What`s the difference between a tendon and ligament?

Tendons are thin, though, relatively inelastic bands of tissue that attach muscles to bones and direct their motions. Ligaments are bands of strong but elastic tissue that keep adjacent bones together and in place. Both ligaments and tendons can be injured when excessive demands are made upon them.

A friend of mine who likes to play cricket says that he has tendinitis of the shoulder. What is this condition, and how os ot treated?

Tendinitis is an inflammation of one of the many tendons in the body. It can be caused by overworking or otherwise injuring a tendon, or by muscles that are so tight that they pull on a tendon even at rest. Often the inflammation involves also the synovial sheath which protects the tendon and allows it to slide easily over a bony or joint surface, a condition known as tenosynovitis. Tendinitis can strike wherever a tendon links muscle to bone, but it is most common in the wrist, elbow (tennis elbow), back of the foot, shoulders and knees.The symptoms of tendinitis are localised soreness, swelling and restriction of movement. The first line of treatment is to rest the affected area. Applying an ice pack and taking aspirin or ibuprofen can help in reducing the pain and swelling. In more severe cases, prescription medications may be ordered by the doctor. Once the pain has subsided, the objective is to provent stiffness while being careful not to aggravate the original condition. This can be accomplished with slow, gentle stretching exercises in which the affected limb or joint is extended as far as possible with out pain and held there for at least 20 seconds. It is important not to allow the area to become immobilised through disuse. If the pain or stiffness doesn`t improve within a week, a doctor should be consulted.

What is a sprain, and how can I distinguish it from tendinitis?

A sprain is a partial tear in the ligaments that hold bones together at a joint. Sprains are most common in the ankles, knees ad fingers, but they can occur in other joints as well. The symptoms of a mild sprain are not very different from those of tendinitis; both conditions cause localised soreness and tenderness. With tendinitis, however, symptoms usually develop slowly, over a period of several days, and you will probably be able to put weight on the affected aea right away (even though the condition wll worsen without rest). Sprains, on the other hand, are nearly always the immediate result of a direct injury. They are often more incapacitating in the short term, are usually accompanied by a bruise, and may take longer to heal. A severe sprain, in which ligaments are completely torn, requires prompt medical care and may take months to heal.

Why are my muscle often sore in the morning?

Probably because you exercised them the day before. Each muscle contraction stretches muscle fibres, which may swell when you stop using them and become stiff and painful hours later. Strenuous exerxcise may actually produce tiny tears in the muscle fibres, which then swell as part of the healing process as you rest.

I developed a severe pain in my calf muscle during an aerobics class. My doctor said I had a pulled muscle. Is this the same as a ruptured muscle?

Pulled and ruptured muscles are both commonly caused by overexertion, but there is a significant difference between them. When a muscle is overstretch, particularly by making a sudden movement, some of its fibres may tear, causing pain, swelling and weakness. This is called a pulled muscle, a common injury among athletes who have not warm up sufficiently. Pulled muscles usually heal quickly and uneventfully.A muscle is said to be ruptured when there is complete or partial separation of the muscle from the bone. A ruptured muscle has little or no strength and may require surgery to repair the damage.

Is whiplash a real condition, and if so, what is it?

Despite its reputation as an insurance ploy, whiplash is real. It is a common description of what happen, often in a car accident, when the neck is subjected to a sudden jolt. The head is thrown vionlently forwards, then jerked back; pain and stiffness are the result, sometimes lasting for long periods. In severe accidents there may be rapture of the spinal cord itself, leading to qiadriplegia or even death.The injuries sustained are most likely to be tears or sprains in the muscles and ligaments around the cervival vertebrae. The damage may require several weeks to heal, during which time the neck should be supported by a padded collar. Muscle spasm and pain may persist even after the initial injuries have heald.Rest, moderate applications of heat and massage can help to relieve the soreness and stiffness. Pain relievers and muscle relaxants can help in some cases, but reliance on such drugs may lead to dependency problems. Emotional stress seems to hinder the healing process, perhaps because the neck muscles remain tense. As a result, anyone recovering from a whiplash injury should try to relax and avoid stressful situations.

Over the weekend, I played outfield in a club cricket match. Now I can barely lift my arm. Could this be bursitis?

It could be. Bursitis is an inflammation of one of the bursae, thr sacs filled with lubricating fluid situated between bones, or between tendons and bones, to reduce friction. Injury, infection or long-term wear and tear are common causes, but flare-ups can also occur for no identifiable reason. Bursitis is characterised by localised pain and swealling, and is common in the knee ( housemaid`s knee), the elbows (student`s elbow), the shoulders, the hips, the heel of the foot and the base of the big toe. In your case, you probably irritated the bursa in the shoulder of your throwing arm. Try to rest your arm and shoulder; use a splint or sling, if necessary, for support; take aspirin or paracetamol and apply an ice pack for the pain. If you do not feel better after three or four days, or if movement becaomes more difficult, call your doctor. In severe cases of bursitis, prescription drugs may be needed; if there is extreme swealling, your doctor may anaesthetise the area, drain the bursa and inject a drug into the empty sac.

What can I do to alleviate the pain of a pulled muscle?

First of all you should stop the activity that may have caused the injury, apply ice to the affected muscle and elevate it to prevent swelling, then rest the muscle until the pain subsides, usually within a few days. If the pain and swelling are severe you should see your doctor. If you must move around with a pulled leg muscle, try bandaging the area for support or using crutches to avoid further damage. After a severly pu;;ed muscle has healed, it should be stretched and strengthened through physiotherapy before your return to your usual activities.

My friend says that hernias are really a muscle problem. Is he right?

In a sens he is. A hernia is a protrusion af all or part of an organ through a weak spot in the muscle or other tissue that contains it. In a common form of hernisa, a part of the intestine or some of the fat that covers it squeezes through a gap in the muscles of the abdominal wall-the sheet of muscles of the front and sides of the abdomen that keeps the abdominal organs in place. The muscle weakness that cause a hernia may be congenital, or it may result from strain or poor muscle tone. In the early stages, the only sign may be a bulge. Hernias are sometimes accompanied by tenderness at the site of the bulge and by a feeling of heaviness.Of the more common types of hernia, men are mote prone to inguinal hernias, in which the abdominal organs squeeze through the abdominal wall just above the groin crease, making quite a large bulge. Women, particularly if overweight, tend to have femoral gernias, which make a small bulge just below the groin crease; in some cases there is no swelling at all. Hiatus hernias occur in the diaphragm.Hernias can be dangerous. The trapping of a piece of the intestine by the herniated muscle can prevent the bowel from clearing properly. In a more serious from clearing properly. In a more serious complication, the flow of blood to the affected section of intestine may be cut off, causing gangrene, or tissue death.Surgery is the best remedy for abdominal hernias. The operation, in which the protruding tissue is pushed back in place and the muscle wall repaired, is fairly simple, and usually tkaes about an hour.

the bones and muscles (common questions)

Disease of the Bones

the bones and muscles (disease of the bones)

the bones and muscle (disease of the bones)

What exactly is osteoporosis , and how common a problem is it?

It is a serious and very common condition in which skeletal bones may lose strength to such a degree that they break with little or no trauma. Hip, wrist and spinal bones are those most likely to fracture. Weakened vertebrate, in particular, may collapse under the pressure of body weight, decreasing height and producing the condition know as a widow`s hump. All people suffer some degree of osteoporosis as part of the ageing process, but women are affected by it more than men and at an earlier age. It is estimated that in the first few years following menopause, the rate of bone loss in women may be as high as 4 per cent year, compared with only 0.5 per cent in men.

What causes osteoporosis?

Although the intricacies of osteoporosis are not fully understood, it apperats that a combination of factors contributes to the gradual erosion of bone strength that is characteristic of the disease.The density and strength of bones increase until the age of 35 or so; after that bone strength decreases naturally at the rate of about one per cent each year. People who, because of hereditary factors, have relatively low bone strength at 35 years old - this is especially true of women who are fair haired, fair skinned and slender-may begin experiencing problems with fractured bones and loss of stature in their early sixties. In many women, the bine weakening process may be accelerated by the onset of menopause and the cessation of oestrogen production by the ovaries-oestrogen plays an important role in sustaining bone strength. Younger women who experience premature menopause because of surgical removal of their ovaries are also more likely to suffer from the disease. Cigarette smoking, excessive alcohol consumption, insufficient excessive alcohol consumption, insufficient exercise and poor dietary calcium intake appear to increase tha tendency to osteoporosis.

How can I tell if I have osteoporosis, and what can I do about it?

Many people don`t discover that they have osteoporosis until it well established. In some, the first indication may be a hip or wrist fracture that occurs either spontaneously or as a result of a fall or a blow. A more typical symptom, however, is pain in the lower back due to the collapse pf a vertebra, or a `crush` fracture. It is the unchecked disintegration of the vertebrae over the years that eventually leads to the condition that is known as widow`s hump, in which height diminishes and the spine takes on a pronounced forward curve in the upper back. Newly developed techniques can measure bone density in th spine, wrist and hip. They include dual photon absorptiometry and quantitative CT scanning. These tests show the extebt of demineralisation that has occured in hight-risk subjects , but have limited pre dictive value in normal subjects. Hence the use of such tests in screening is not cost-effective.Doctors and researchers do not fully agree on how best to treat osteoporosis. Prevention is by far the most effective approach and includes adequate dietary calcium intake, bone-stressing exercises such as jogging and tennis, and the avoidance of other risk factors such as smoking and immoderate drinking, from adolescence onwards. Excessive exercise and weight loss can also predispose to osteoporosis.For women in a high-risk category hormone-replacement therapy after menopause is valuable. Oestrogen therapy is not for everyone, and should probably be avoided if there is a history of blood clots, stroke, liver diseases, or breast or uterine cancer. Also it has been shown to increase slightly the incidence of uterine cancer in women who have not had a hysterectomy. The risks is reduces by giving progestogen as wll but this combination may produce cyclic bleeding similar to periods. The risk and benefits of hormone-replacement theraphy should be dicussed with a doctor.Several approaches to treating women who have lost bone strength and are suffering fractures are being studied and used. These include such medications as sodium fluoride combined with calcium and vitamin D, active vitamin D hormone and injections of a substance called calcitonin.

Can a proper diet help to prevent osteoporosis?

Yes, it can. Adequate comsumption of calcium-risch foods can play a significant role in keeping the bones strong and healthy.What makes this particularly important is that calcium tablets or supplements alone do not prevent osteoporosis in highrisk women, nor are they an effective treatment for women who already have the condition. Unfortunately the average woman doesn`t consume sufficient dietary calcium. All women should cultivate the habit of eating calcium-rich foods, consuming at least 800 milligrams of calcium daily (more during pregnancy), together with adequate vitamin D, either by regular moderate exposure to the sun or as medication, to help in the absorption of calcium. For postmenopausal women, the recommended amount is 1000 milligrams daily according to some authorities, as much as 1500 milligrams according to others.Milk is the best source of dietary calcium, but you would need to drink almost a litre a day to meet your calcium needs.Fortunately, good calcium supplies are available in cheeses and other foods.

I have trouble digesting dairy foods and am also watching my weight. How can I get enough calcium in my diet?

Many people who are sensitive to dairy products (because of an inability to digest milk sugar, or lactose) can usually tolerate yoghurt also break down lactose. Other natural sources of calcium include fish (especially canned unfilleted salmon or sardines), broccoli, broad and kidney beans, fennel, okra and dried figs. Although dark green leafy vegetables are also rich in calcium, some, like spinach and kele, contain oxalic acid, a substance that hinders calcium absorption. It isn`t necessary to gorge yourself on calcium-rich foods; just make regular use of them in your regular diet.A variety of calcium supplements are now avaible in tablet form, the simplest and least expensive of which is calcium carbonate. But before deciding on supplements, you should consider increasing your consumption of natural sources of calcium, and remember too that excess calcium may be counterproductive.

I have heard that children can contract a dangerous bone disease from cuts that become infected. Is this true?

Yes, it is. Osteomyelitis is a rare but serious infection of the bone and its marrow. It is caused by bacteria that spread to the bone from a nearby open wound, such as that produced by a compound fracture, or that travel through the blood from an infection elsewhere in the body. The symptoms of osteomyelitis are hard to overlook: extreme pain and tenderness at the site of infection, high fever, reluctance to use the affected limb, and severe redness and swelling if the infection remains untreated for more than a few days.The principal treatment for osteomyelitis involves the use of antibiotics, but treatment must begin early to be effective. If it is delayed and the infection spreads, more complicated procedures, such as surgical drainage, may be necessary. In severe cases, these measures may be continued on a regular basis for several years, and permanent bone damage is possible.

Is rickets still a problem, and if so, what causes it?

Rickets is a childhood condition in which bone fail to harden because of a shortage of vitamin D. This vitamin helps to regulate the body`s absorption of calcium and phosphorus, needed for bone formation. Although still common in some parts of the world, rickets has become increasingly rare in the West. It is easily avoided by eating a normal diet, taking vitamin D-fortified milk, and by moderate exposure to sunlight, which helps the body to synthesise vitamin D.

Isn`t there also a condition called adult rickets? Is this related to the childhood disease?

Like childhood rickets, adult rickets, or osteomalacia, is also caused by vitamin D defeciency. The main symptom of the disease in adults is increased susceptibility to bone fracture. Pregnant women are at a greater risk because their increased need for calcium (for foetal bone development) also boosts their need for vitamin D. Older people may develop osteomalacia because of poor diet and too little sunlight, or because their ability to utilise the nutrients they eat and the sunlight they receive is impaired. The disease often occurs in people undergoing renal dialysis or who are taking certain drugs. The usual treatment involves increasing the patient`s supply of vitamin D, calcium and phosphorus, either in the diet or by means of vitamin-mineral supplements.

When my uncle broke his leg recently, his doctor told him he had something called called Paget`s disease. What is this, and can it be cured?

In this disease, also called osteitis deformans, the normal process of bone production and replacement speeds up and becomes dangerously disorganised. Poorly formed new bone is produced at a faster rate than that at which old bone tissue is more fragile than normal bone tissue, the result of Pager`s disease is a gradual weakening of all or part of the affected bones, usually of the hip, leg, spine and skull; they are often painful and vulnerable to fracture and deformation, and may become enlarged and press against adjacent nervers, causing intense pain. When the skull is affected, it may press against the auditory nerves and cause hearing loss.The underlying cause of Paget`s disease is not know, although a virus is suspected. It may occur at any age, but seldom appears before the age of 50, more commonly in men than in women. Paget`s tends to progress slowly and may go unnoticed until the symptoms- repeated fractures or bone pain that worsens at night-attract special medical attention. There is as yet no cure for Paget`s disease, but aspirin or prescription drugs may relieve tha pain. In certain cases, aggressive drug theraphy may help to stop abnormal bone growth.

the bones and muscles (disease of the bones)

Arthritis

the bones and muscles (arthritis)

the bones and muscles (arthritis)

Do the terms arthritis and rheumatism mean the same thing?

The terms arthritis and rheumatism are both commonly used to describe pain, swelling and stiffness of the joints, but there is a difference between the two. In its strictest sense, arthritis means, literally, inflammation (-itis) of the joints (arthro-). Rheumatism, on the other hand, is a more general term for pain and stiffness in the muscles, bones, joints and tendons. There are, in fact, many different types of arthritis, all of which are classified, together with connective tissue diseases that can affect not only the joints but the skin and internal organs as well as rheumtic disorders. Doctors who specialise in the diagnosis and treatment of arthritis and other rheumatic disorders-of which there are more than one hundred-are called rheumatologists.

What are the most common types of arthritis?

The most common type is osteoarthritis, which occurs mainly in people over 40.The next most common, and potentially the most serious, form is rheumatoid arthritis, which affects women more often than men and may strike at any age.

My mother says that arthritis is an inevitable part of ageing. Is that true?

It depends on what your mother means by arthritis. Osteoarthritis, or degenerative joint disease, is very common- almost everyone over 60 has it to some degree. In mild cases, the disease is almost indistinguishable from normal wear and tear on the joints. In others, the degenerative process speeds up, suggesting the presence of a still unidentified trigger. Previous injury seems to be a contributing cause, as osteoarthritis often occurs at the site of earlier joint damage. Many people, however, get osteoarthritis in joints that have never been injured.

What happens exactly to a joint affected by osteoarthritis?

Osteoarthritis starts with slow but irreversible erosion of the carti;age layers which line opposing bone ends in a joint and ease joint movement. In the early stages of the disease, the cartilage begins to soften, crack and break loose; this restricts the motion of the joint, causes pain and inflammation, and may induce the bone to compensate by growing new bone. In time, the unprotected, raised ends of the bones may grind together. Mobility may then be further limited by the build-up of cartilage fragments and other debris in the joint. In the later stages of the disease, bone spurs may form at the damaged ends of the bone and, if they press on nearby nerves, the result will be furthr, severe pain.

How can I tell if I am developing osteoarthritis?

Sensations of pain, visible swelling and stiffness in the joint, especially after you use it, are the usual early signs. They may occur sporadically at first, and continue intermittently for years before becoming troublesome enough to warrant medical attention. As the deterioration of the joint continues, however, the symotoms may begin to interfere with daily life. The pain may become severe enought to distrupt sleep; osteoarthritis in the hip or knee can make walking difficult; in the spine, it can preclude bending and lifting; in the fingers or hands, it can make simple tasks like brushing teeth or laying the table a misery.

Is there anything I can do to prevent osteoarthritis or to slow its course?

So far, there seems to be no way to prevent the onset of osteoarthritis usually consist of plenty of rest, to prevent overuse and irritation of the joints; regular moderate therapeutic exercise, to preserv mobility and strengthen the muscles supporting the joints; and aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling. Application of moist heat and massage are also helpful, while swimming and other aquatic activities (inwhich most of the body`s weight is supported by water) are both soothing and excellent for maintaining long-term condition and flexibility.For severe discomfort, your doctor may recommend injecting corticosteroids-synthetic hormones with a strong anti-inflammatory effect-into acutely inflamed joints. In cases of extreme joint degeneration, surgery to remove damaged tissue or replace a joint (usually the hip or the knee) may be needed. The important thing is to consult your doctor when you are first aware of the symptoms and to begin a treatment programme that will enable you to manage your arthritis rather than allow it to control you.

My aunt could stand to lose some ten kilos. Does being overweight increase her chances of getting osteoarthritis?

Being overweight does not directly cause osteoarthritis, but it can certainly make existing symptoms worse. Carrying too heavy a load increases the stress on the weight-bearing joints (those of the spine, hip and knee, primarily), and if osteoarthritis is present, excessive weight can help to hasten its destructive course. Many sufferers find that even a modest reduction in weight helps to relieeve pain.

My brother-in-law was recently told by his doctor that he has osteoarthritis of the spine. What causes this disease, and what can be done about it?

Osteoarthritis of the spine, or spondylosis, is fairly common in people over 40. It may have several contributory causes, the most common of which is cumulative wear and tear on the joints, called facet joints, that link pairs of vertebrae. As the joints erode, the vertebrae may grind together, causing pain, stiffness and loss of flexibility. Sometimes, bone spurs may form where the ends of worn vertebrae meet; if these protruding growths press on a nerve, intense pain may result. Prior injury to the spine or damage to one of the discs that act as buffers between vertabrae can lead to spondylosis. Many of the preventive measures that are recommended for lower back pain, or lumbago, are useful for relieving mild spondylosis. In more severe cases, the doctor may recommend a variety of treatments, including physiotherapy and a corset or brace. Aspirin or other antiinflammatory drugs may help to reduce pain and stiffness.

What is the difference between osteoarthritis and rheumatoid arthritis?

There are several important distinctions. Osteoarthritis is a localised breakdown of onr or more joints. If you have osteoarthritis in one hip, for example, it doesn`t necessarily mean that your other hip, or any other joint, will be affected. Rheumatoid arthritis, however, is a systemic, or widespread, disease, which typically occurs in many joints simultaneously, and may affect other body tissues. In osteoarthritis, inflammation is a consequence of cartilage loss and the resulting friction between bone ends in the affected joint; it is usually minimal and restricted to the joint itself. In rheumatoid arthritis, inflammation is the primary event, typically starting in the synovial membrane that lines the jont and spreading to the cartilage and underlying bone. In severe cases, the inflammation may spread to other connective tissue and sometimes even ti the eyes, arteries and internal organs.Another difference is that osteoarthritis uasually progresses slowly and appears in middle or later life, while the onset of rheumatoid arthritis may be rapid. The disease also generally strikes a younger, more often female, population.

Are rheumatoid arthritis symptoms always more severe than those of osteoarthritis?

Like osteoarthritis, rheumatoid arthritis can cause pain, stiffness and restricted mavement, ranging from mild to severe. With proper care, sufferers can lead a fairly comfortable life, but in advanced cases the symptoms are more severe. The disease can then cause joint deformity, weight loss, anaemia and fatigue.

Does the fact that my mother had rheumatoid arthritis increase my chances of developing the disease?

There is evidence suggestng that susceotibility to rheumatoid arthritis may be inherited. Researchers havefound that about half the people who have rheumatoid arthritis share a `marker`, or a distinctive genetic feature, on their white blood cells, while the marker appears in only about a quarter of the population at large.Although the cause of rheumatoid arthritis is not know, most authorities agree that it is an autoimmune disease, that is, one on which tha body`s defence mechanism-the immune system-turns against the body`s own tissues. It is this overreaction by the immune system and the resulting inflammation that produce the painful swelling of rheumatoid arthritis.What sets off this autoimmune reaction isn`t known, although many triggering factors have been proposed, including an unknown virus that attacks the joints; other, apparently unrelated diseases; allergic reaction to certain foods or other substances; and emotional stress. None of these has been proved, although many researchers support the virus theory.

Are there any early warning signs of rheumatoid arthritis that I should watch out for?

Sometimes the onset of rheumatoid arthritis is preceded by a period of listlessness, muscle pain and appetite loss, after which specific symptoms of joint inflammation-swelling, redness, tenderness, stiffness, pain-appear. This gradual onset may make the disease hard to recognose at first. In other cases, in flammatory symptoms come on suddenly and without warning. The most common initial sites are the hands, feet and knees, eith both sides often affected. The disease may also affect the neck, shoulders, elbows, wrists and hips.

I have recently learned from my doctor that I have rheumatoid arthritis. What course will the disease take, and what is my outlook for the future?

Untreated, rheumatoid arthritis can become increasingly severe and widespread in the body. Even with proper care, the course of the disease is hard to predict. Symptoms may disappear for a long time for no know reason; remissions lasting several years aren`t uncommon. On the other hand, symptoms may flare up at any time, often after overexertion or emotional stress, but sometimes for no apparent reason. The worst-case outcome of the disease-deformation and crippling-obviously causes great anxiety in people who, like yourself, have recently been told they have rheumatoid arthritis. But in the great majority of cases, such consequences can be avoided with current medical treatment; most sufferers are able to lead rewarding, productive lives.

What is the treatment for rheumatoid arthritis?

The treatment of persistent rheumatoid arthritis requires a team effort, involving not only you, the patient, but also you family, your doctor, a rheumatologist, physio- and occupational therapists and an orthopaedic surgeon. The basic treatment programme consists of cautious therapeutic exercises, warm compresses and plenty of rest during flare-ups. and anti-inflammatory medication-usually aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). But, if necessary, your doctor may also prescribe additional and more powerful medications that require careful monitoring on his part as well as a high degree of cooperation on yours. These so-called disease-modifying, or remissive, agents include gold salts, penicillamine and azathioprine. They can halt and even reverse the course of severe rheumatoid arthritis. Corticosteroid drugs are usually reserved for resistant cases. Because these drugs can all cause potentially serious side effects or adverse reactions, it`s important for a patient to advise his physician immediately of all effects he may experience as a result of taking such drugs.

I don`t like relying on my doctor alone to treat my rheumatoid arthritis. What can I do to help myself?

The first and most important step is to understand your disease and its treatment by seeking correct information. Take your medications exactly as prescribed, and tell your doctor if any drug seems to be losing its effectiveness or is causing adverse reactions or side effects.Successful management of your condition also depends on the proper mix of rest and exertion-which only you can control. This may mean building rest periods into your dailyschedule; using devices such as buttonhooks, special door handles, and raised toilet seats that reduce stress on affected joints; and sticking to a regular exercise programme, which may include gentle stretching and swimming in a heated pool. It is also important to maintain a regular, wellbalance diet. Above all, a realistic attitude towards the disease is needed. Rheumatoid arthritis can interfere with normal activity can interfere with normal activity, but it rarely does so without let-up. Through trial and error you can learn when to push yourself and when to take it easy. This is one of the most crucial lessons to be learnd in living with artritis. For more information contact the Arthritis and Rheumatism Foundation in Wellington if you live in New Zealand, or the state office of the Arthritis Foundation of Australia in your capital city if you live in Australia.
Even though she is only 60, my syster has begun to use a alking-stick because of her rheumatoid arthritis. Is she giving in to her condition?
No, she isn`t. Your sister is much better off walking with a cane than staying at home. In fact, anything a person can do to relieve the strain on arthritic joints while maintaining mobility should definitely be encouraged.

My brother-in-low wears a copper bracelet that he says helps his rheumatoid arthritis. Is this possible?

You brother-in-low has lots of hopeful company. In chronic unpredictable conditions like arthritis, people try all sorts of folk remedies, diets or physical treatments. Most of these are not harmful although they may not be of benefit either, and may be very costly. Copper bracelets are one of the traditional folk remedies. But before dismissing the idea of wearing them as completely foolish, you might be interested to know that doctors are at present trying out a cream containing copper, which is rubbed into the skin.

I know of people who have moved to warmer climate to relive their arthritis. Is this a wise move?

Evidence which suggests that moving to a warmer, drier climate eases arthritis symptoms is very sketchy. However, several scientific studies do show that arthritis symptoms may worsen with a drop in barometric pressure and a rise in humidity. Clearly then, there is some logic in choosing a climate with a steadier barometric pressure, but first consider the effects this step will have on your life, especilly since there is no guarantee your arthritis will improve if you move.

I have heard that sex is good for arthritis. Is it true?

Yes, it is. But researchers have no sure answers as to why it should be so. They suspect that it may be due to the stimulation of the adrenal glands that follows sexual arousal. The adrenal glands produce cortisone, which reduces inflammation, thus perhaps bringing relief from arthritis pain.A thciker and more important question is how to encourage arthritis sufferers to be sexually active in the first place. Arthritis of the hips, for example, can make sexual relations extremly difficult. In addition, the pain and debilitation that arthritis produces often work against sexual interest; they can also dampen related feelings od independence, personal attractiveness and self-esteem. For many, this can become a hard-to-break cycle that may require professional help.

Is it true that there`s a type of arthritis that mostly affects young men?

It is terue. Ankylosing spondylitis is an inflammatory disorder of the spine that usually strikes young men in their twenties and thirties. Not to be confused with spondylosis, or osteoarthritis of the spine, ankylosing spondylitis can often be overlooked, especially in younger patients, although it is the third most common form of arthritis in Australia and New Zealand. As is the case with rheumatoid arthritis, susceptibility to the disease may be inherited, but spondylitis patients do not caeey the rheumatoid factor in their blood. A possible trigger is bowel infection.The disease begins with inflammation of the connective tissues that tie the vertebrae together, which leads to decreased spinal mobility. In some cases arm and leg joints may be affected. The inflamed connective tissues may harden, or calcify, and cause permanent stiffness of the spine. In advanced cases where treatment has been delayed, the entire spine may be frozen in a chatacteristic stooped position.Like rheumatoid arthritis, spondylitis requires careful lifetime management to main tain flexibility and to minimise structural deformity. Nonsteroidal anti-infalmmatory drugs (NSAISs) are the main medications, together with physiotherapy to improve posture and to strecth the spine and its supporting muscles. Steroids and radiotherapy may also be used to treat the disease.

Before a neigbour`s child developed arthritis, I wasn`t aware that the disease could strike children. How common a problem is it in children?

Juvenile chronic arthritis (previosly known as Still`s disease or juvenile rheumatoid arthritis) begins before the age of 16. It is estimated that it affects about 7 out of every 100 000 children per year worldwide-about the some prevalence as diabetes and cerebral palsy. Actually there are three different types of juvenile arthritis, but inflammation of the joints is a common feature in all of them.Treatment consists of rest, phydiotherapy and anti-inflammatory medications, together with regular eye care. (Some children-girls especially-with the disease develop potentially serious eye inflammations.) Some of the stronger drugs used to treat rheumatoid arthritis in adults are also effective in children. Treatment may extend over a very long period, which puts stress on the child and other members of the family. Although there is emphasis on pjysical treatment, the intellectual, social and physiological development of the child must also be considered. The good news about juvenile rheumatoid arthritis is that it is much less likely to cause permanent damage than the adult disease. Although some children are left with deformities as a result of the interference with the normalgrowth pattern, 70 per cent of children make a good recovery.

I thought gout was a disease of the overindulgent rich, but that`s apparently not true. What is gout?

Some of history`s famous gout suffers have been rich men, but wealth is not necessarily the cause; it is more accurate to say that gout is a disease of overweight, middle-aged men in whose families susceptibility to the condition runs. Women are less often affected by gout, and they rarely get it all before menopause.Gout is an arthritis condition brought on by excess uric acid, which lodges in crystal form in the joints, and causes severe pain. The usual site of a first attack is the base of the big toe. There is visible swelling, the skin covering the affected area takes on a dry, red brightness, and the pain may be so acute that not even the touch of a sock can be tolerated. Later attack may involve the knees, wrists and ankles, and may occur at increasingly frequent intervals. Chronic gout can lead to the formation of kidney stones or of large uric acid deposits, called tophi, under the skin.There exists a secondary form of gout that isn`t inherited; this may be triggered by other diseases or by certain drugs. Blood pressure medications, for example, may hinder the body`s ability to dispose of uric acid.

How is gout treated, and does diet play a role in preventing the disease?

The first goal in the treatment of gout is to stop the inflammation and pain of an attack; this is usually accomplished by means of nonsteroidal anti-inflammatory drugs (NSAIDs) (excluding aspirin, which is ineffective against gout and may even raise uric acid levels in the blood). A drug called colchicine can limit a gout attack, but it can also cause unpleasant side effects. Once the attack has subsided, the doctor may prescribe medications that lower uric acid production in the body or increase uric acid excretion through the urine, or he may suggest taking one or two colchicine tablets every day. These drugs block further attacks, but to do so effectively, they must be taken every day for life. Not everyone with gout needs these drugs; some sufferers rely on weight loss and immediate treatment with anti-inflammatory agents or colchine when an attack occurs. As for diet, any gout sufferer who is overweight should consider a reasonable and gradul weight-loss diet (losing too much weight too fast can cause the level of uric acid in the blood to rise).Beyond that, most people with gout can eat more or less what they want, in moderation. Certain foods-offal, shellfish, sardines, anchovies, fish roe and wine-contain high levels or purines, the class of compounds from which uric acid is derived, and therefore should be avoided or sharply restricted. A large intake of fruit can also raise uric acid levels, while sudden and excessive alcohol intake - overindulgence at a party, for example - can trigger gout attacks in susceptible people.

What other types of arthritis are there? I have heard of Reiter`s disease. What is it?

There are some types of arthritis that need to be distinguished from rheumatoid arthritis; some of them, like spondylitis, are triggered by an infection. They are seronegative, that is, they do not have the rheumatoid factor in the blood, and may follow a number of viral and other infections. whether in children or in adults. Lyme disease (named after the American town where it was first identified in 1975) is cause by a bacterial organism transmitted by a tick bite. Reiter`s disease is characterised by acute arthritis, conjunctivitis and nonspecific urethritis; it affects mainly males and usually follws exposure to sexually transmitted diseases or an attack of bacillary dy sentery. Arthritis may also fl=ollw chlamydial orgonorhoeal infections.A detailed medical history may give the clue to the origin of the arthritis. Anti-inflammatory drugs can be used to ease the pain and swelling, but the underlying cause must be diagnosed and treared, with antibiotics if necessary. Usually recovery occurs in a few weeks if treatment is started early, but some case are more difficult and may recur.

What is lupus? I always thought it was a form of cancer, but my causin, who has it, is being treated by a theumatologist.

Lupus, or systemic lupus erythematosus (SLE), is not a form of cancer, but rather a potentially serious rheumatic disorder. It is a generalised autoimmune disease with a wide variety of symptoms. It affects women (usually in their childbearing years) much more often than men, and its cause is unknown. A rash extands across the cheeks and gives the patient a vaguely lupine, or wolflike, look, hence the name of the disease.Joint inflammation occurs in about 89 per cent of cases, but it is seldom as severe as in rheumatoid arthritis and rarely results in deformity. But the inflammation may affect connective tissues throughout the body and cause problems in the eyes, skin, muscles, heart, lungs, kidneys and central nervous system.SLE is an unpredictable disease, with divergent effects in different individuals, and symptoms that may come and go without apparent reason. Although the variability of SLE makes initial diagnosis difficult, there are certain diagnostic blood test used to detect the disease.In some people SLE causes only occasional discomfort, appetite loss and fatigue, while in others it can produce potentially life-threatning problems such as convulsions, inflammation of the hearth of lungs, and kidney failure. Some blood disorders may also occur, and the diseases can damage various organs and systems simultaneously. Nevertheless, with careful treatment, SLE can be controlled in the majority of patients.There is a much milder, nonsystemic form of the disease, called discoid lupus. Its main symptom is a patchy skin rash.

What sort of tratment can a lupus patient like my cousin expect to undergo?

There is no single standard treatment. Proper diet and exercise are important for maintaining general health, and rest is essential during periods of active disease. Patients should avoid excessive exposure to sunlight, which may trigger or worsen lupus symptoms. The patient must be cared for by a rheumatologist experienced in dealing with SLE.Specfiv medical treatment depends on the severity of the disease and its symptoms. Some people with mild lupus need no medications; others require treatment only during flare-ups; still others must take combinations of powerful drugs on a regular basis. Moreover the symptoms may change with time, requiring the drug schedule to be adjusted.Lupus treatments include aspirin or other nonsteroidal anti-inflammatory agents for joint pain and swelling; antibiotics for the secondary infections that effect some lupus patients; and blood transfusions for certain blood disorders. If your causin has severe lupus, and especially if the internal organs are affected, the doctor may prescribe corticosteroid drugs. Antimalarial drugs of the chloroquine group are also used to treat certain lupus cases. Kidney failure, probably the most severe complication of lupus, may require dialysis or, id appropriate, a kidney transplant. Some of the newer immunosuppressive drugs have been used successfully against severe SLE.

Is it true that a women with lupus cannot or should not get pregnant?

Women with lupus do have a higher than normal risk of mis carrying and, not too long ago, the standard recommendation was that they shouldn`t bear children. But recent advances in controlling the disease have lowerd that risk, and many women whose lupus is mild or has not been recently active are now having normal pregnancies. Such a patient should discuss the possibilities with her doctor before deciding to become pregnant. Although lupus does appear to have a genetic component, it is not a directly inherited disorder like haemophilia.

the bones and muscles

Spine and Back

the bones and muscles (spine and back)

the bones and muscles (spine and back)

I know that my spine plays an important role in holding me up, but what holds up the spine itself?

The spine is in fact a flexible column of bones called vertebrae that supports the body from the base of the skull to the pelvis and is supported in turn by other skeletal bones and a network of ligaments and muscles. stacked one above the other and increasing in size the top, the vertebrae are separated by shockabsorbing pads called discs. Extending from each vertebra are three bony projections called processes, to which supporting ligaments and muscles are attached and which form a protective channel for the spinal cord.

It seem as if everyone I talk to these days is suffering from back trouble. Why is back pain so common?

Back pain is possibly the price human beings have to pay for being members of the only fully erect species on earth-and one of the most sedentary.Back pain can come on suddenly or in tha course of time; it can be the immediate result of an attempt to lift a large object or the cumulative effect of endless hours camped in front of a television set. In most cases, the actual cause is weak muscle tone in the lower back and abdominal areas, muscles that are critical in the support of the aeching spinal column. When they are not doing their job-or are straining to do it under a pressure-back problems are all but inevitable. In fact, most people experience back pain at some time in their lives, and millions of dolllars are spent every year in search of rilief.

What actually is hurting when my back aches? Is it my spine or my muscles?

Back pain can have several causes, and more than one may be involved simultaneously. The pain is usually located in the lower lumbar regionm where the spine curves inwards just before it reaches the buttocks. A sudden wrenching movement or prolonged stress on this area can cause muscle spasms, in which the tensed muscles cannot relax, or tiny tears in the muscles or ligaments-any of which can cause pain.In some cases, a sudden injuruy or the prolonged failure of the surrounding muscles to support the lower spine may cause the vertebrae to squeeze one of the discs that separate them. As the disc flattens, its jelly-like core may protrude to the side. Called a prolapsed or slipped disc, this protrusion can press on one of the nerves branching out from the spinal cord and produce sharp pain that often extends down the leg.To relieve the pressure of a slipped disc, the muscles surrounding the spinal cord may go into spasm. But this protective response can also cause a problem: The muscles on one side of the spine may contract so strongly that the hip and shoulder on the other are drawn up several centimetres higher than normal. Such a spasm can result in pain as acute as that caused by a pinched nerve itself. Another common cause of lower back pain, especially in middle-aged and older people, is osteoarthritis of the spine. The pain in the facet joints that link pairs of vertebrae can also mimic that caused by a slipped disc.

What is the difference between back strain and back sprain?

Back strain is not a medical term, but people often use it to describe pain that develops over time and is nonspecific, that is, it lacks an immediate and obvious cause. Such pain is usually the result of poor conditioning and posture. Back strain, however, can also refer to a pulled or torn muscle resulting from a specific action or injury. Back sprain, on the other hand, is aterm reserved for ligament damage. It is often caused by a fall or an attempt to lift a heavy object: a ligament partially tears, pain results and muscle spasms produce more pain.One condition is not necesserily worse than the other; pain and treatment of both are identical. If you are a victim of a specific back injury, however, there may be some comfort in knowing the immediate cause of the pain-such knowledege can also make a big difference when applying for a disability allowence.

How can I tell if what I have is a sillped disc rather than a strain, a sprain or facet joint pain?

The pain of a slipped disc is extreme, piercing and usually specific. If it occurs in the neck, you will feel the pain there, sometimes accompanied by pain, numbness, or a tingling sensation in the shoulder or arm. More usuallym however, slipped discs occur in the lower spine, causing pain and spasm at the site as well as pain in the buttocks. If the resultong pinched nerve root is part of the sciatic nerve, which extends all the way down to the toes, you are likely to feel sharp, radiating pain down one leg, known as sciatica. Unlike the other common cause of lower back pain, a slipped disc can result in numbness and weakness in the leg, or it can damage the damage the nerves that control bowel or bladder function.If you think you havee a slipped disc, see your doctor right away. Depending on your condition, he may recommend one or more of the treatment options described in the following questions. If the problem is in the neck area, he may also suggest that you wear a neck collar for a few weeks. In certain cases, surgery may be recommanded to relieve the pain of a slipped disc and prevent furthere nerve damage.

What can my husband do to ease his lower back pain?

There is no single standard treatment for lower back pain, but the measures recommended are usually rest, moderate applications of heat, such as warm baths or conservative use of a hot-water bottle, and mild analgesics (aspirin,paracetamol or ibuprofen). To relieve acute sapsms, get your husband to sleep on his back with a pillow under his knees. Your doctor may prescribe muscle-relaxing or anti-infalmmatory drugs; a back brace or traction treatment may be recommended for a chronically bad back. Most back problems, however, respond to rest and home care; without preventive care the problem is likely to return.

What can I do to avoid back pain in the first place or keep it from recurring?

Your best defence against back injury is to get in shape and learn how to use your body properly. There are many recommended exercises that will benefit your back by improving the body tone generally, but pay special attention to strengthening your abdominal and leg muscles, which together do most of the work of supporting the back. Ask your doctor or physiotherapist to give you an exercise schedule. Aerobic classes may sometimes aggravate your conditionSit-ups (with legs bent) are excellent for the abdomen, as are swimming, cycling and rowing. Regular walking is great, but beware of sports like tennis, in which bursts of sports like tennis, in which bursts of exertion alternate with sudden stops, lurches and periods of inactivity. I fou are overweight, slim down: extra fat means extra strain on your back.Learn how to walk, sit, sleep and lift properly. Good posture also helps: when standing or walking, contract your abdominal muscles and tuck your buttocks under slightly. Keep your shoulders back (but not in an ecaggerated arch) and your torso loose. If it is necessary to stand for a long time, raise one foot to take some of the weight off your lower back. Avoid high heels or any other uncomfortable shoes.Straight-backed chairs that keep you from slumping are better for the back than rounded ones. WHen sitting, keep your knees higher than your hips, and when rising from your chair, bend your knees and push off with your hands.Make sure your mattress is firm, and never sleep on your stomach, since this forces the spine into an exaggrated curve that can cause aggravation. If you can`t sleep lying on your back, try lying on one side, with knees tucked up in the foetal position. Let your legs, not your back, do the real work whenever you lift anything. Get close to the object you want to lift. slowly bend your knees, and then come up with your back straight. Be especially careful not to bend the waist!

When should I see a doctor about back pain?

That depends on the type of pain you have and its severity. If you are only mildly uncomfortable, and if the home treatment measures previously described bring relief within a few days, a visit to your doctor probably isn`t necessary. But if pain persists, and especially if you feel pain down the back of either leg, seek medical attention. Similarly, if you are immobilised, with or without persistent pain, for more than two or three days, consult your doctor.Back pain that is unrelenting or accompanied by other symptoms such as a high temperature, fainting or abdominal pain may be a sign of a serious underlying condition; in such a case, arrange to see your doctor right away.

Under what circumstances is back surgery usually recommended?

Before suggesting surgery to a patient with bak pain, most physicians recommend nonsurgical treatment followd by extensive studies to determine the exact cause of the pain. Even then, bak surgery is not always successful, and it should be undertaken only after careful consultation with a higly qualified surgeon. There may still be circumstances in which surgery is appropriate: for example, if a slipped disc threatens to cause irreversible damage to the spinalcord. Even then, it would be a good idea to get a second opinion.

Can electricity really be used to relieve back pain?

Transcutaneous electric nerve stimulation, or TENS, is the name of this procedure, which works on the theory that the stumulation of certain nerve pathways with a mild electric current will block the transmission of pain messages. The technique is now widely employed by physiotherapist, and the equipment can be bought or leased by the public. If used properly, TENS appears to have few drawbacks and no side effects, but the benefits vary with the individual.

What can a chiropractor actually do for back pain?

Chiropractors treat back problems by physically manipulating the back and spine. The manipulations are usually part of a more comprehensive therapy programme including heat applications and exercise. Many people claim they have gained relief from chiropractic treatment. Many medical doctors, however, consider that the spine is so tightly constructed that it cannot be truly realigned by manual manipulation. More importantly, if there is an underlying disease or structural problem, a chiropractor`s efforts may make it worse, or delay needed medical treatment. A full history and medical examination are necessary before manipulation is undertaken. Some doctors recommend chiropractors, just as they would physiotherapists, as part of a broader treatment programme.

My neighbour`s daughter has scoliosis. What is this condition?

Scoliosis is a lateral curvature of the spine that can range from a barely perceptible condition to a serious deformity. The curvature may progress with age, and in very severe cases sause heart and lung problems. For this reasons, early diagnosis and treatment are essential.Why it should be is not known, but scolisis appears in girls more often than in boys, starting between the ages of 10 and 14, and increasing until growth stops. It may be the result of a childhood disease such as juvenile arthritis or polio, but in the majority of cases the direct causes is unknown; the condition seems to run in families.Scolisis can be spotted by examining the curvature of a child`s spine as she bends over to touch the floor. But there are many other indications, including a shoulder that apperas to be higher than the other, a hip that just out when the child stands up, a hump on the back or a noticeably prominent shoulder blade, an arm that hangs at a lower level than the other, or an unusual gait.

How is scoliosis treated?

There are several treatment alternatives for scolisis; the one a doctor chooses depends on the type and severity of the curvature. In mild cases, regular medical checkups and physiotherapy to strengthen the muscles supporting the spine may be all that is necessary. When the curvature is more pronounced, the standard treatment involves the wearing of a brace to realign the spine gradully. Two types of brace are currently in use: the traditional Milwaukee brace, which provides support from the neck to the pelvis; and a modified plastic design that fits under the shoulder blades. To be effective, either type must be worn virtually around the clock (the brace may be removed for bathing) for many months.People with scoliosis often have muscle imbalances that cause the spine to curve towards the stronger side. This problem is usually treated with physiotherapy and exercise. A new treatment involves electric stimulation of the muscles on the weaker side, in the hpe that they will pull the spine towards the centre of the back. In extreme cases, surgery may be required to correct the curvature.

the bones and muscles (spine and back)

Shoulder, Arm and Hand

the bones and muscles (shoulder, arm and hand)

the bones and muscles (shoulder,arm and hand)

A friend complins that her shoulder `comes out of its socket` nearly every time she raises her arm. Is she exaggerating?

She may not be. Recurrent spontaneous dislocation of the shoulder is a condition that isn`t fully understood, but it often seems to follow an earlier and more severe injury to the area. Any extension of the arm-even for such unstrenuous activities as dressing or combing the hair-would seem then to cause dislocation. In some people, the condition is manageable; they find it possible to reposition the shoulder by themselves or with help. For others, surgery may be required.

After a recent painful shoulder injury, a friend of mine was told he was in danger of developing a frozen shoulder. What is that?

A so-called frozen shoulder can result from any painful condition, such as an injury,arthritis, bursitis or tendinitis, that brings about temporary inactivity of the shoulder joint. Failure to mive the joint leads to more stiffness, which sets in motion a hard-to-break spiral of further lack of activity, pain and stiffness.The main goal of treatment is to restore and maintain mobility in the joint. If pain is the chief problem, your friend may be given analgesic medications that will make it easier for him to move his shoulder regularly. His doctor may also prescribe oral anti-inflammatory agents or inject cortisone into the joint. Physiotherapy mat be recommended as well. Although an isidious and self-perpertuating condition, frozen shoulder can be rexersed with early and persisternt treatment. If left untreat, however, it can lead to permanent impairment.

Why do so many people who never play tennis complain of tennis elbow?

The term tennis elbow, or more correctly lateral epicondylitis, is used rather loosely to refer to any pain along the outside of the elbow joint; more specifically, it refers to a partial tearing and inflammation of the tendons that link the forearm muscles to the elbow. The pain is caused by the combination of tight gripping and rotary movement used in tennis. The same symptoms-radiating forearm aching and tenderness along the outside of the elbow-can also be brought on by prolonged use of a screw-driver or excessive handshaking. Playing golf may cause similar painful problems on the inside of the elbow.

My wife wants to take up tennis. How can she avoid getting tennis elbow? And if the problem develops, how is it treated?

The best prevention is probably to be professionally coached and learn how to grip the racket and perform the basic strokes correctly-especially the backhand and serve. Tennis elbow is rere among players who use the two-handed backhand and thus avoid racket arm stress. As for trearment, rest is the standard recommendation, followed by simple stretching and strengthening exercises once the pain subsides. Aspirin or ibuprofen, or cortisome shots may relieve the pain and imflammation. Elastic support bandages may also help. Surgery may be needed if movement is badly impaired, but this is rare. To avoid a recurrence of the injury, allow enough time for the elbow to heal before resuming the sport.

A schoolboy I know developed a locked elbow while playing football. What is this condition?

Both the elbow and the knee are prone to this problem, in which sudden or repeated stress on the joint causes a fragment of bone and cartilage to break loose. Eventually, this chip lodge in the joint, producing pain and restricted movement. Youthful sportsmen seem to be particularly vulnerable to the condition. With rest, the problem may heal on its own, but if pain persists for several months, surgery may be necessary to extract the fragment.

Is it true that there is an occupational disease that typists tend to develop?

Yes, it is. The condition, called De Quervain`s disease, is a form of tendinitis in which the coverings of the tendons that lead from the wrist to the thumb become irritated and cause tenderness and pain in the area. The repetitive action of typing can bring it on, as can activities that involve the gripping of tools- even playing golf. Treatment usually consists of rest, icing the area, and taking aspirin. If the thumb is still tender after a week or so, stronger anti-inflammatory drugs or cortisone injections may be prescribed. Surgery is rarely needed.

My mother complains of pain in her hand at night, and sometimes frops objects she i s carrying. What could cause this?

Your mother could be suffering from carpal tunnel syndrome, in which the median nerve that tuns from the forearm through the hand is squeezed by swelling and inflammation of the bone (carplas) and ligaments in the wrist. Arthritis can contribute to this condition, as can sudden weight gain or a wrist fracture, which is fairly common in older people. Women are more susceptible than man, and the conditionoccasionally flares up in pregnant women, and then subsides after they have given birth.For mild cases, resting-perhaps with the help of a wrist splint, especially at night-will often provide relief. If arthritis is the underlying problem in your mother`s case, her doctor may prescribe anti-inflammatory medications or cortisone. In severe cases, surgery may be required to cut through the carpal ligament and create more room for the nerve.

RSI has had a lot press coverage in the past few years. What exactly is this condition?

It is true that there has been an upsurge in a syndrome or group of conditions known collectively as repetition strain injury (RSI), or more recently as occupational overuse syndrome. It is characterised by tenosynovitis (inflammation of the tendon and its synovial sheath) of the fingers, wrists, elbows and/or shoulders, resulting in pain, weakness and loss of function.The condition has been known for many years to occur in people, such as musicians and knitters, who perform repetitive fine hand movements, but the incidence has increased with the introduction of new high-speed keyboard technology. The exact pathology is not known, and this has led some critics to suggest that there may be a psychological element to the syndrome. Management of the condition consists of pain-relieving drugs, physiotherapy and, above all, rest of the affected part; attention must be paid also to the patient`s general health and lifestyle. If the condition remains untreated, serious crippling deformity can result. There is now far more emphasis given to prevention in the workplace, including ergonomically sound work practices, attention to equipment so that posture is improved, and adequate rest breaks.

Member of my husband`s family all have a tendency towards a curving, or clawing, of the hand. Does this condition have a name, and is it inherited?

A number of disorders can result in clawing deformaties, but the only one known to run in families is Dupuytren`s contracture, in which a slow thickening and tightening of the tissue in the palm cause the hand to contract in a claw-like manner. It can be acquired also as a complication of certain chronic illnesses such as diabetes and liver disease. Severe cases can be disabling, and corrective surgery may be needed to restore the ability open the hand fully.

What is meant by the term mallet finger?

In mallet finger, the tendon that extends to the tip of a finger is ruptured, usually as a result of injury-often from a hard ball when failing to catch it-or possibly as a result of underlying arthritis, so that the tip of the finger cannot be straightened. The finger should be splinted while the tendon heals, or else the mallet position will persist. Surgery is occasionally needed to repair the tendon or, if this is not possible, to hold the joint in the straight position.

the bones and muscles (shoulder,arm and hand)

Hip, Leg and Knee

he bones and muscles (hip,leg and knee)

the bone and muscle (hip,leg and knee)

My grandmother broke her hip recently for no apparent reason. Why do hip fractures seem to be so common among the elderly?

With age comes greater sesceptibility to falls, which account for many hip fractures. However, most hip fractures in older people are caused by osteoporosis, which may decrease bone strength to the point that fractures ocur with little or no trauma. This may very well have been the cause of your grandmother`s problem.In fact, in some cases-and it`s not always easy to tell-it is a spontaneous break in the hip that actually causes an elderly person to fall. Although preventing such falls in difficult, some protective measures can be taken: spectacle prescriotions should be kept current, furniture disposed to permit clear passage, slippery floors carpeted, and rugs fastened down. An older person whose balance is precious may benefit from a walking stick or frame, and shoes should be confortable and well-fitted.

I know of several people who have had hip-replacement surgery. When is this operation needed?

Surgeons can now replace several different joints with prostheses, devices made of plastic and metal. Of these procedures, hip replacement is the most common and productive. If successful, as most such operations are, hip replacement can alleviate the patient`s pain and improve mobility. The typical condidate for hip replacement is an older person whose hip joint has been severely damaged by degenerative arthritis, and who is not likely to overwork the artificial joint. Hip prostheses can wear out; if one does, another replacements operation may be needed. However, the technology used to create and implant artificial joints has advanced a great deal in recent years, and hip replacements are now being performed with greater frequency on younger patients, including those afflicted with rheumatoid arthritis and certain congenital hip deformities.

How does one `pull a hamstring`?

The hamstring is not a single muscle, but a group of muscle that together fill and provide power at the back of the thigh. Unfortunately, the hanstring group is weaker than the quadriceps muscles, which make up the quadriceps muscles, which make up the front of the thigh, and such imbalances sometimes lead to troublesome injuries. Particularly in cold weather, when the muscles are tight, one or another of the hamstring group or their tendons may tear.The basic treatment for a pulled hamstring is to stop whatever activity caused the injury and to apply an ice pack to the affected area right away. This should be followed by extended rest and warm baths or judicious use of a heating pad. Hamstrings are especially difficult injuries to treat. Gentle stretching exercises can help with rehabilition, however, and guard against subsequent pulls, an all too common problem. Among athletes, prevention should be emphasised through appropriate warming-up and cooling-down exercises, proper clothing, and conditioning to ensure balanced deevelopment of the quadriceps and hamstring muscles.

After a trenuous work-out I sometimes wale up at night with a severe leg cramp. What causes this, and how can I relieve the pain?

Sudden, painful cramps, or spasms, in the muscles of the leg often occur at night and are common among athletes and people with circulatory problems.Cramps may be caused by an injury to the muscle, by overworking or overstretching the muscle, or by an abrupt constriction in one of the arteries supplying blood-and oxygen-to the muscle. When the muscle does not get the oxygen it needs, it goes into spasm, causing intense pain.Treat a cramp gently. Don`t jump up and down on the affected leg or slap the area that`s cramping. Stretching the muscle will help to relieve the pain. Gentle massage is also useful, as is walking about the room. Fotunately, the cramp will disappear on its own within a minute or two. If you are troubled by persistent, recurring leg cramps, see your doctor. Cramps that occur after exercise may have a serious underlying cause; most night cramps in older people, however, are not serious and can be relieved with simple medications.

I recently read about a football player who had arthroscopic surgery on his knee and was walking again a few days later. What does this operation involve?

Arthroscopic surgery is a relatively new technique for diagnosing and sometimes treating joint problems, especially those involving the knee. It is performed by an orthopaedic surgeon, who makes a small incision in the knee and inserts a thin, lighted viewing tube (arthoscope) that enables him to examine the joint.In some cases, the surgeon may also be able to remove bits of cartilage or repair damaged tissues by means of special surgical instruments which are inserted through separate incisions in the knee; the surgeon views the procedure through the arthroscope itself.Arthroscopic surgery may be done wnder local or general anaesthesia and, when appropriate, has obvious advantages over other types of knee surgery in that the amount of cutting is less, and recuperation is simpler and swifter.

Why are knee injuries so common among sportsmen?

As an engineering project, the interlocking bones, muscles, tendons and ligamnets of the knee are a true marvel. Nevertheless, the knee`s strength is not always equal to the demands placed upon it. The joint is held together mainly by four ligaments, two to limit sideways movement, two to limit back and forth movement. Whether from a side tackle in football, a fall on a ski slope, or some other unexpected trauma, these ligaments may be stretched or torn, often with additional damage to surrounding tissue and to the cartilage within the joint. One way of lowering the risk of knee injury is to strengthen the leg muscles with suitable exercises before engaging in sport activities. A mild sprain may be treated with ice packs, an elastic bandage and rest. A more severe injury to the ligaments of the knee requires prompt medical attention.

What causes knee cartilage to tear, and how is this injury treated?

The two wedge-shaped, washer-like cartilages of the knee are located at the outer edges of the joint and act as shock absorbers. They are especially vulnerable to tearing as a result of a sudden twisting of the knee. Acute pain, swelling and tenderness follow; depending on where the piece of torn cartilage settles, the knee may lock, requiring surgery to remove the fragment.Although worse injuries can occur to the knee, the difficulty with cartilage damage is the likelihood of recurrence. This may happen immediately after the injury has healed, or else not for years afterwards. And once torn, knee cartilage may eventually wear out and lead to osteoarthritis.Treatment for torn knee cartilage depends on the extent of the damage, on whether there have been previous tears, and on how they have healed. If the tear is small and knee movement is not impaired, a period of rest and elevation of the knee may suffice. With each recurrence, and the accompanying shifting and scraping of cartilage fragments, damage may accur in the joint. At some point, surgery to remove part or all of the cartilage may be required, followed by physiotherapy to strengthen the thigh and shin muscles.

I have heard taht a kneecap can become spontaneously dislocated. Is it true, or is a dislocated kneecap always the result of injury?

Knee injuries often dislodge the patella from its proper setting in the thighbone, but in some people this slippage occurs for no apparent reason. (Structural kneecap problems do, however, tend to run in families.) With luck, a dislocated patella will slip back into position of its own accord, but if it locks out of its normal location, the pain and swelling it causes can be severe.The first step in treatment is rest and carefully monitored quadriceps-strengthening exercises. If problems continue, surgery may be needed to prevent disablement and forestall chondromalacia.

I am 22, yet my knee hurts when I sit for a long time. What could be wrong?

You may have what is known as chondromalacia of the patella, or kneecap, a condition in which the cartilage lining the underside of the cartilage linig the underside of the kneecap deteriorates. Typical of the problem is pain in the front of the knee that becomes more severe during long periods of sitting, or while squatting or climbing stairs, together with a creaking or popping noise when the knee is straightened.Chondromalacia affects young men and women. It may result from injury or overexertion, a loose or dislocated kneecap, or cogenital abnormality in the knee. In some cases, it is impossible to establish the cause. If cartilage injury is severe, chondromalacia may lead to osteoarthritis.The initial treatment of chondromalacia consists of rest and anti-inflammatory drugs, followed by a programme of exercises to strengthen the quadriceps, which supports the kneecap. If this standard therapy doesn`t work, either traditional or arthroscopic surgery may be needed to shave, or smooth, the underside of the patella. In extreme cases, tendon surgery to change pressure on the kneecap may be performed. Surgical removal of the kneecap is a treatment of last resort. Although such surgery almost invariably cures the problem, it also permanently weakens the knee.

My wife took up joging recently and promptly developed shin splints. Was it her shinbone or the surrounding muscles that suffered the injury?

Shin splints is an imprecise term for the lower leg pain that runners frequently get as a result of overexertion or inadequate conditioning. As a rule, it`s not the shinbone that is injured, but the muscles that extend from it to guide the movements of the ankle and foot. Worked too hard, or jolted repeatedly by running on hard surfaces, these muscles begin to pull away from the bone; this causes shooting paints along the shaft of the shinbone.The usual treatment for simple shin splints is time off from exercise, with applications of ice to rilieve the immediate pain. When activity cannot be avoided, horizontal taping of the front of the leg may help. If pain persists for more than two weeks, medical attention should be sought.

What is a stress fracture?

A stress fracture is a hairline break in a leg or foot bone, caused when the bone has been forced to bear too great a load. This often occurs in amateur athletes who push themselves too hard too fast, and at the onset may be confused with shin splints. Because X-rays may not reveal a stress fracture for up to two weeks, diagnosis can be delayed; sometimes a bone scan is required for proper diagnosis. A stress fracture is treated with rest (up to six weeks) and pain medication. Use of a cast may help to reduce pain in some cases, but is usually not needed to hold the bones in place.

the bones and muscles (hip,leg and knee)