The clinic provides primary child care and physical examination from birth through adolescence on a routine and consultative basis. This includes immunizations, diagnosis and treatment of illnesses and proper guidance for the parents.
The clinic is covered by an international team of spinal specialists to provide the highest standard of management for different spinal disorders including scoliosis, back pain, neck pain, disc diseases, spinal injuries and infections.
The clinic is designated for patients who require joint replacement of the hip, knee, shoulder and ankle, with special protocols for preoperative, operative and postoperative management.
Specialized clinic for treatment of bone and joint disorders from birth through adolescence including; congenital anomalies, limb length discrepancy and other musculoskeletal concerns related to this age group.
Like most forms of exercise, weight lifting has many potential benefits for spinal health, but also has the potential to create or worsen back injuries.
- Extending or flexing the back muscles against resistance (the weight) during weightlifting and bodybuilding may result in a number of injuries, including muscle strain and ligament injury
- Certain types of weightlifting exercises can be particularly stressful to the joints and soft tissues, such as:
- Older persons (e.g. many over 50 years old) who do weightlifting may already have some disc degeneration and osteoarthritis in their spines, which may make them more susceptible to the strains while lifting weights
Preventing Back Injuries from Weightlifting
As a general rule, before one begins or makes changes to a weightlifting routine, it is important to know the condition of one’s back and keep weight amounts within personal limits. If anyone has experienced back pain, it is advisable to first get an evaluation from a primary care physician, chiropractor, physiatrist or other spine specialist before beginning lifting weights.
Specific guidelines that are useful in helping to prevent back injury include:
- Use less weight, but do more repetitions when lifting weights
- Consider using a training machine rather than free weights for certain weightlifting exercises. This point is important to discuss with both a spine specialist and trainer, understanding there is a trade-off
- A machine may reduce stress on the back (for example, quadriceps done sitting at a machine versus squats holding weights) and can generally be used by someone with little or no supervision
- But free weights add proprioception (self-regulation of posture and movement in response to the free weights) that a machine does not. Proprioception is an added benefit in helping enhance the body’s balance and stability.
- Use a spotter when working with free weights to protect the back from possible sudden movement or excess strain
- Consider wearing a belt for weightlifting (first ask the recommendation of an athletic trainer or spine specialist, as there are conflicting studies on the merits of belts). Some spine specialists maintain that while there is no concrete evidence that a belt protects the back while weightlifting, it does help as a reminder to maintain proper form
- Do not perform exercises such as the clean-and-jerk, dead-lift, snatch or squat without proper supervision, because these exercises may pose greater risk for back injury and back pain
Source: The article was written by Thomas E. Hyde for Spine-Health.
Women are more prone to bone loss and bone disease than men. What’s more, healthy bones go hand in hand with strong muscles. Fortunately, studies show that a few wasted years won’t necessarily doom you to accelerated bone loss and disease. One study found women who are active for at least 47 percent of their adult life tend to have higher bone mass density than those who are less active, so it’s never too late to start. There are three stages when significant bone loss usually takes place.
During child-bearing years, a healthy diet and regular weight-bearing exercise help prevent excessive bone loss. During pregnancy, the developing baby requires high amounts of calcium to form a healthy, strong skeleton, and if the baby doesn’t receive enough calcium from the mother’s diet, the next source is her bone stores.
Fortunately, the body has an amazing way of making up for calcium losses during pregnancy, and in most cases any lost bone mass is restored after delivery or breastfeeding. According to the National Institute of Arthritis and Muscoloskeletal and Skin Diseases, pregnancy also improves calcium absorption, which is just one other way the body protects women from excessive bone loss in the prenatal stages.
Women lose three to five percent of their overall bone mass during breastfeeding, for two primary reasons:
First, babies have high calcium needs, and if they breastfeed there’s only one place to get it.
Second, lactating women produce lower amounts of estrogen; estrogen helps protect against bone loss.
Once again, assuming your diet is healthy and balanced, bone loss that occurs during lactation normally resolves itself within six months of weaning.
Bone loss accelerates once women hit menopause, due to the significant drop in estrogen that occurs when menstrual cycles end. According to The Journal of Clinical Endocrinology & Metabolism, bone loss can begin well before the onset of menopause. During perimenopause, which can be as little as two or as many as eight years before the end of menstrual cycles, estrogen levels start to decrease. Between the ages of 30 and 35, your body will lose more bone mass than it can replace. That means women ages 35 and older should be particularly conscientious about maintaining strong, healthy bones.
So what are some good ways to build healthy bones? According to Patrice McKenney, CEO of the International Osteoporosis Foundation, “A nutritious calcium and protein-rich diet, sufficient vitamin D and daily weight-bearing exercise are essential components of a bone healthy lifestyle.” These recommendations may seem obvious, but the high rates of bone-related disease and injury in women suggests otherwise.
Experts agree that there are four primary ways to build healthy bones at any age:
- Strive for calcium balance in your diet. Remember that high intake of some foods can actually inhibit calcium absorption. As noted in The Paleo Diet, eating too many legumes, hard cheeses, cereals, eggs, salty processed foods, and even meat and fish can cause high calcium excretion, which causes calcium imbalance and subsequent bone loss. Balance your calcium intake by eating plenty of fresh fruits and vegetables every day.
- Take a daily calcium and vitamin D supplement to make sure you meet the daily requirements. Supplements are particularly beneficial if you’re at high risk for bone loss due to ethnicity (Caucasian and Asian women are more prone to bone loss than other populations), smoking, or certain medications, such as prednisone or cortisone.
- Get at least 20 minutes of weight-bearing activity every day, especially if you’ve already reached menopause. As noted in The Journal of Clinical Endocrinology & Metabolism, lack of exercise accelerates normal bone loss rates in the menopausal stages.
- Get some sun! Sunlight stimulates vitamin D production, which works with calcium to build strong bones. Adequate sun exposure is especially important if you don’t get enough vitamin D in your diet, although a combination of the two is ideal, as reiterated at the 2012 Annual Meeting of the American Academy of Dermatology.
Ladies, let’s face it: the odds are against us when it comes to bone loss. According to the International Osteoporosis Foundation, 61% of osteoporotic fractures occur in women. Menopause is inevitable, and hormones are just wacky sometimes. However, although bone loss may be a normal part of the aging process, it doesn’t have to cause problems. Prevent accelerated bone loss and related conditions with a healthy diet, regular exercise, sun exposure and supplements if needed.
Source: The article was written by Nicole Crawford for Breaking Muscle.
The summer wouldn’t feel complete without a pair of strappy sandals or colourful flip-flops. According to Dr. Roy Mathews, a Vancouver Podiatrist, his clinic sees an increase in patients complaining of foot pain during the warm summer months. “During the winter, women wear better, more supportive shoes,” he says. Once the snow has melted and patio season is back in vogue, we’re desperate to don footwear that’s airy, less constrained—and less supportive. While flip-flops, flats and sandals accessorize the perfect summer outfit, did you know that they can also do serious damage to the bones and joints in your feet?
The problem with flip-flops
They’re cute; they scream summer—but they’re also really tough on your feet. “With flip-flops, you’re walking on something that’s just a flat piece of rubber with no support,” says Mathews. Flip-flop fans may forget that their favourite footwear was created to be worn at the beach or pool. They weren’t designed for hours spent walking in the city. It’s the flip-flop’s no-frills design that contributes to summer’s most common foot injury, metatarsalgia. An extremely painful condition, metatarsalgia is inflammation of the ball of the foot. “To walk in flip-flops, you must grip the toe piece with your toes. While flexing your toes down, you’re driving the ball of your foot into the ground,” says Mathews. “You’re using muscles out of sequence and with no support, you get pain across the ball of the foot and in its joints—the metatarsal joints.” Left untreated, metatarsalgia can result in stress fractures of the metatarsal joints and several weeks in a cast—or worse, a complete bone fracture that requires surgery.
If you’re not experiencing foot pain and refuse to part with your flip-flops, Mathews suggests that you invest in a pair that has a stiffer sole, a bit of an arch and a rocker bottom such as the Fit Flop brand. And don’t keep wearing the same pair year after year. “The worst thing [for your feet] is to wear a pair that’s completely beaten up,” says Mathews. If you’re going to wear flip-flops and flexible shoes in the summer, buy new ones every year.”
Think flats are better? Think again.
Many women who steer clear of flip-flops believe that flats are a better, healthier option for their feet. They couldn’t be more wrong. “I don’t think there’s anything positive about flats,” says Mathews. Like flip-flops, flats are floppy and unsupportive of your feet. Frequent wearers often suffer from metatarsalgia as the ball of the foot and its adjacent joints receive a pounding with each step. And if you have foot problems already, you could be in line for even more discomfort. “People who need arch support in their shoe such as flat-footed people can get strains like plantar fasciitis or heel spur syndrome,” says Mathews.
Still love your flats despite your aching feet? Mathews says that there are options available to help support your foot in a bad shoe. The days of bulky or awkward orthotics stuffed into a shoe are long gone. “Orthotics can be made from graphite and fiberglass—they’re as thin as a credit card, so you hardly notice them. They’ll create a little more support and that’s better than wearing nothing inside these shoes,” he says.
The case for sandals
In the battle for summer footwear supremacy, sandals are actually the best bets for your feet. “They’re typically more supportive than a flip-flop. Sandals like Birkenstock and Mephistos have built-in arch support and a little bit of cupping to the heel, so they have more support,” says Mathews.
Look for sandals with a sole that doesn’t bend too much. A stiffer sole as well as straps that cross the foot will help distribute the pressure on your foot more evenly. The heel and arch will take some of the weight, so that the ball of your foot and its sensitive joints don’t receive the full impact of each step.
Podiatrists would prefer that people wear more supportive footwear in the summer, but they know that for fashion-sake, patients won’t necessary listen. “Fashion is what fashion is,” says Mathews, “but if you’re suffering in pain, you need to wear something more supportive, like a running shoe. If pain lasts for more than a few days, you should immediately seek help. Too many people with pain in their foot do nothing for weeks and [they end up with] a fracture.” If you expect to be doing lots of walking or standing, put the health of your feet first—before fashion—and step out into a pain-free summer.
Source: The article was written by Jackie Middleton for Best Health.
Wonder if it’s time for you to have a bone density test? Bone density tests (also called bone mineral density tests or bone scans) evaluate the strength of your bones by measuring a small part of one or a few bones. Knowing the strength of your bones can help your doctor recommend prevention steps and osteoporosis medication, if needed, to prevent bone loss and fractures.
Who Should Have a Bone Density Test?
According to National Osteoporosis Foundation guidelines, there are several groups of people who should consider bone density testing:
- All postmenopausal women below age 65 who have risk factors for osteoporosis.
- All women aged 65 and older.
- Postmenopausal women with fractures; this is not mandatory because treatment may well be started regardless of bone density.
- Women with medical conditions associated with osteoporosis; these diseases number more than 50. A primary care doctor can scan a patient’s list of medical illnesses to verify that one of these conditions is not present.
- Women whose decision to use medication might be aided by bone density testing.
Does Insurance Cover the Cost of a Bone Density Test?
While there is a cost for a bone density test, the information you gain about the health of your bones could save your life. Many health insurance companies cover the cost of a bone density test, as does Medicare. But you need to check ahead of time to see if the test is covered under your specific plan (or if you qualify according to Medicare’s criteria for who is eligible for testing).
Most health insurers will pay for this test if you have one or more risk factors such as:
- A fracture
- You are postmenopausal
- You are not taking estrogen at menopause
- You are taking medications that cause bone thinning
Medicare covers bone density testing for the following individuals aged 65 and older:
- Estrogen-deficient women at risk for osteoporosis
- Individuals with spinal abnormalities
- Individuals receiving, or planning to receive, long-term glucocorticoid (steroid) therapy
- Individuals with primary hyperparathyroidism
- Individuals being monitored to assess the response or efficacy of an approved osteoporosis drug therapy
Medicare permits individuals to repeat bone density testing every two years.
What Types of Bone Density Tests Are Available?
There are several different machines used to measure bone density. “Central” machines measure bone density in the hip, spine, and total body. “Peripheral” machines measure bone density in the finger, wrist, kneecap, shinbone, and heel. Here are some of the different types of bone density tests:
- DXA (Dual Energy X-ray Absorptiometry) measures the spine, hip, or total body.
- pDXA (Peripheral Dual Energy X-ray Absorptiometry) measures the wrist, heel, or finger.
- SXA (single Energy X-ray Absorptiometry) measures the wrist or heel.
- QUS (Quantitative Ultrasound) uses sound waves to measure density at the heel, shinbone, and kneecap.
- QCT (Quantitative Computed Tomography) is most commonly used to measure the spine, but can be used at other sites.
- pQCT (Peripheral Quantitative Computed Tomography) measures the wrist.
- RA (Radiographic Absorptiometry) uses an X-ray of the hand and a small metal wedge to calculate bone density.
- DPA (Dual Photon Absorptiometry) measures the spine, hip, or total body (used infrequently).
- SPA (Single Photon Absorptiometry) measures the wrist (used infrequently).
With the information obtained from a bone density test, you and your doctor can decide the necessary prevention or treatment steps that are best for you.
Are Bone Density Tests Used to Monitor Osteoporosis Treatment?
The American Medical Association and other reputable medical organizations have determined that repeat bone density testing (DXA scans) is not indicated in monitoring osteoporosis treatment or prevention on a routine basis. It is scientifically premature to measure bone density as a way of monitoring osteoporosis medications.
Bone density changes so slowly with treatment that the changes are smaller than the measurement error of the machine. In other words, repeat DXA scans cannot distinguish between a real increase in bone density due to treatment or a mere variation in measurement from the machine itself.
What’s the Goal of Osteoporosis Treatment?
The real purpose of osteoporosis treatment is to decrease future bone fractures. One density measurement taken during treatment will not help the doctor plan or modify your osteoporosis treatment. For example, even if the DXA scan shows continued deterioration in bone density during treatment, there is not yet research data demonstrating that changing a drug, combining medications, or doubling medication doses will be safe and helpful in decreasing the future risk of fractures.
It’s important to note that even if bone density deteriorates during treatment, it is quite likely that the patient would have lost even more bone density without treatment.
Recent research has shown that women who lose bone density after the first year of menopausal hormone replacement therapy will gain bone density in the next two years, whereas women who gain in the first year tend to lose density in the next two years of therapy. Therefore, bone density during treatment naturally fluctuates and this may not be relevant to how well the drug protects against broken bones.
For all of these reasons, as surprising as it may sound to many people (and even some doctors), rechecking bone density is not at all like checking blood pressure during its treatment. Routine bone density testing during treatment is unlikely to be helpful. In the future, however, if ongoing research brings new technology or new therapies, testing decisions could change.
Source: The article is provided by WebMD.
Parents are advised to make sure their children drink milk and eat other calcium-rich foods to build strong bones. Soon, they also may be urged to make sure their kids eat salmon, almonds and other foods high in magnesium — another nutrient that may play an important role in bone health, according to a study to be presented Sunday, May 5, at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC.
“Lots of nutrients are key for children to have healthy bones. One of these appears to be magnesium,” said lead author Steven A. Abrams MD, FAAP, professor of pediatrics at Baylor College of Medicine in Houston. “Calcium is important, but, except for those children and adolescents with very low intakes, may not be more important than magnesium.”
While it is known that magnesium is important for bone health in adults, few studies have looked at whether magnesium intake and absorption are related to bone mineral content in young children. This study aimed to fill that gap.
Researchers recruited 63 healthy children ages 4 to 8 years old who were not taking any multivitamins or minerals to participate in the study. Children were hospitalized overnight twice so their calcium and magnesium levels could be measured.
Participants filled out food diaries prior to hospitalization. All foods and beverages served during their hospital stay contained the same amount of calcium and magnesium they consumed in a typical day based on the diaries. Foods and beverages were weighed before and after each meal to determine how much calcium and magnesium the subjects actually consumed. In addition, parents were given scales to weigh their child’s food for three days at home after the first inpatient stay and for three days at home prior to the second inpatient stay so that dietary intake of calcium and magnesium could be calculated accurately.
While hospitalized, children’s levels of calcium and magnesium were measured using a technique that involved giving them non-radioactive forms of magnesium and calcium, called stable isotopes, intravenously and orally. Urine was collected for 72 hours. By measuring the stable isotopes in the urine, the researchers could determine how much calcium and magnesium were absorbed into the body. Bone mineral content and density were measured using total body dual-energy X-ray absorptiometry.
Results showed that the amounts of magnesium consumed and absorbed were key predictors of how much bone children had. Dietary calcium intake, however, was not significantly associated with total bone mineral content or density.
“We believe it is important for children to have a balanced, healthy diet with good sources of minerals, including both calcium and magnesium,” Dr. Abrams concluded.
Source: The article is provided by Science Daily.
Symptomatic knee osteoarthritis (OA) is now being diagnosed at relatively young ages, and almost one U.S. adult in 10 will develop the disabling condition by age 60, researchers predicted.
A validated computer simulation model estimated that the median age for the diagnosis of knee OA is now 55, according to Elena Losina, PhD, of Harvard University, and colleagues.
In addition, with estimates beginning at age 25, the model predicted a lifetime risk for symptomatic knee OA of 13.83% and a 9.29% risk by age 60 among the general population, the researchers reported in the May Arthritis Care & Research.
“Our findings have important implications for disease prevention and healthcare utilization. The early median age at diagnosis of symptomatic knee OA (55 years) suggests that public health officials should introduce prevention strategies relatively early in the life course,” they stated.
Arthritis in the knees has traditionally been considered an affliction of the elderly, but the increased incidence of obesity and knee trauma in younger individuals is likely to have influenced the pattern of disease onset, the researchers suggested.
To examine this, they collected data on prevalence from the 2007-2008 National Health Interview Survey, and estimated incidence rates in 10-year age groups using the Osteoarthritis Policy Model, which predicts the natural history of the condition, stratifying by gender and obesity.
They found that the estimated prevalence according to age groups was 0.74% for non-obese men ages 25 to 34 and 12.94% for those 85 and older; for obese men the rates were 1.54% and 23.54%, respectively.
For non-obese women, the prevalence rates were 0.88% and 14.97% in the 25 to 34 group and 85 and older group, respectively, while the rates for obese women ranged from 2.41% to 32.45%.
The estimated annual incidence also varied considerably, with the peak annual incidence occurring at ages 55 to 64:
Non-obese men, 0.37% (95% CI 0.37 to 0.38)
Non-obese women, 0.43% (95% CI 0.43 to 0.43)
Obese men, 0.64% (95% CI 0.64 to 0.65)
Obese women, 1.02 (95% CI 1.01 to 1.02)
The lifetime risk also differed according to sex and obesity. For example, the risk was 16.4% for women and 11.42% for men, and 19.67% in obese individuals compared with 10.85% for those with normal weight.
The lowest lifetime risk was for non-obese men, at 9.60%, and highest in obese women, at 23.87%.
The findings of this analysis differed from the last report on incidence of knee OA, published almost 2 decades ago, in which the incidence of OA continued to rise up to age 80.
The earlier peak seen in this study is consistent with recent observations that total knee replacement surgeries are occurring at young ages, with 40% of arthroplasties being done in patients before age 65.
The younger age at diagnosis also may reflect an increasing awareness of the condition on the part of both patients and physicians, the researchers noted.
“The early age at diagnosis of symptomatic knee OA may yield high levels of lifetime healthcare utilization and costs. In the last decade, the mean age of persons undergoing [total knee replacement] has decreased from 69 to 66 years and utilization of [total knee replacement] has tripled among U.S. adults ages 45 to 64 years,” Losina and colleagues observed.
“Physicians and policymakers can use our findings to direct resources toward preventing risk factors for knee OA … and can also use our estimates to prepare for the potential future burden on the U.S. healthcare system resulting from the early age at diagnosis of symptomatic knee OA,” they concluded.
Their analysis did have limitations, they acknowledged, such as reliance on self-report of diagnosis and the assumption of consistent incidence rates across 10-year age groups.
Source: The article was written by Nancy Walsh for Medpage Today.
Throughout your life, you constantly lose old bone and form new bone. As a teenager and young adult, your body makes more bone than it loses, but with age, bone production drops off and bone loss increases, putting you at risk for osteoporosis (porous bone, which fractures easily). According to the National Osteoporosis Foundation, roughly 10 million Americans have osteoporosis and 34 million have osteopenia (low bone mass). But osteoporosis and related fractures don’t have to be inevitable. Here are 10 things you need to know to lower your risk.
A broken bone might mean you already have osteoporosis.
A simple fall that results in a fracture is the most telling sign that you may have osteoporosis, says Connie Weaver, PhD, a calcium researcher and chairman of the department of nutrition science at Purdue University. “Many times, people just assume the fracture is due to the trauma and don’t investigate if they need to be treated for osteoporosis,” Weaver says. It’s possible that the fractured bone was already in a weakened condition due to osteoporosis before the fall. People who break a bone and have other risk factors for osteoporosis, such as a small build or a family history of fracture and low body weight, should be especially vigilant, she says.
Having diabetes raises your risk for osteoporosis.
People who have type 1 diabetes or type 2 diabetes are prone to weaker bones. “The quality of the bone they make isn’t good,” says Diane Schneider, MD, a geriatrician and author of The Complete Book of Bone Health. “In people with type 1 diabetes, there is more bone breakdown, and in people with type 2 diabetes, the bones are more fragile.” Medications for type 2 diabetes can also cause bones to be weaker. Even extra body weight doesn’t help. “We’re finding a growing connection between bone and fat,” Schneider says. “Being overweight is not as protective as we once thought.”
Being thin increases your chances for osteoporosis.
Having a small frame and a slight build means you have bones that are less dense and more vulnerable to osteoporosis and fracture. Some studies show you may be especially prone to developing osteoporosis if you weigh 127 pounds or less, Schneider says. Since there isn’t much you can do about the way you’re built, women who are small-boned need to take charge of osteoporosis risk factors that they can control. “You have to pay special attention to what I call the ABCDs of bone health,” Schneider says. “Activity, balance — because you need core strength to prevent falls regardless of bone density — calcium, and vitamin D.”
Not getting enough calcium puts your bones at risk.
A recent study showed that many Americans may not be getting enough calcium, a mineral essential to bone health. Before you reach for a bottle of supplements, new research suggests that taking calcium supplements may raise your risk of heart attack and kidney stones. The fact remains that calcium is a necessary part of our diets. According to the Institute of Medicine, women need 1,000 mg of calcium each day up to age 50, and 1,200 mg of calcium a day after age 50. Schneider recommends getting the bulk of your calcium from food, such as from milk, yogurt, broccoli, turnip greens, and calcium-fortified foods, and taking less than the recommended dose of calcium supplements.
A lack of vitamin D raises your risk for osteoporosis.
Vitamin D is essential for bone health because it helps your body absorb calcium. Spending just 20 minutes a day in the sunshine — without sunscreen — during the summer months provides enough vitamin D to last you through the year, says Dana Simpler, a private-practice physician in Baltimore, MD. “People with dark complexions may need up to an hour,” she says. You can also get vitamin D from supplements and foods such as fatty fish (for example, wild salmon or sardines), shrimp, and foods that are fortified with vitamin D (think vitamin-D fortified orange juice, cereal, milk, or soy milk). According to the Institute of Medicine, most people need 600 IUs of vitamin D a day. People 71 years and older require 800 IUs of vitamin D daily — possibly more, depending on their health.
Some medications can hurt your bones.
Certain medications — among them, antidepressants, corticosteroids and proton pump inhibitors — can put your bones at greater risk for osteoporosis. Anti-seizure medications, certain cancer treatments, and diabetes drugs may also cause bone loss. In most cases, the risk of osteoporosis goes up the longer you take these meds and the higher the dose. Before going on any medication, ask your doctor about the impact on your bones. If you must take one of these drugs, work with your doctor to take the lowest dose possible, and discuss ways to lower your risk of osteoporosis.
After menopause, your risk for osteoporosis goes up.
For women, menopause causes a steep drop in estrogen, a hormone essential for strong bones. The earlier you go into menopause, the higher your risk of osteoporosis. A recent Swedish study found that women who entered menopause before the age of 47 were nearly twice as likely to have osteoporosis later in life as those who entered menopause when they were older. “Women lose the most bone in the first three to five years of menopause,” Weaver says. “They can lose as much bone as they gain during puberty.” Menopause, Weaver says, is an important period to make lifestyle choices that protect against bone loss; namely, with exercise and diet.
A bone density test can detect bone loss.
Bone density is commonly measured with dual-energy X-ray absorptiometry (DXA), also known as a bone density test. This simple, painless test gauges bone strength by comparing your bone mass to those of young adults of the same gender at peak bone mass, using a T-score. A T-score of -2.5 or lower means you have osteoporosis. A score between -1.0 and -2.5 means you have osteopenia, low bone mass. A T-score of -1.0 or higher means your bones are normal. “Women usually don’t need a DXA scan until they’re 65 and men until age 70,” Schneider says. Talk to your doctor about when to get screened and about follow-up tests. The answer will depend on your age, osteoporosis risk factors, and previous bone density test results.
Physical activity protects you against osteoporosis.
Weight-bearing exercises — the kind that force your body to work against gravity, such as walking, running, dancing, and tennis — are the best for keeping bones healthy. The key, Schneider says, is to be active. “It doesn’t have to be exercise in the gym,” she says. “You simply want to spend more time on your feet and move. You want to spend less time sitting.”
Not everyone with osteoporosis needs medication.
In recent years, some drugs used to treat osteoporosis have come under fire for potentially increasing the risk for breakage of the femur bone, esophageal cancer, and the death of bone tissue in the jaw. In reality, only women at high risk for a fracture need treatment, says Ruth Freeman, MD, a professor of obstetrics-gynecology at Montefiore Medical Center in the Bronx. “I always recommend lifestyle changes first,” Freeman says. Women who have osteoporosis and other risk factors, such as rheumatoid arthritis, low body weight, and a family history of fractures, for instance, might want to take osteoporosis drugs. Women who have no other risk factors might consider opting out. Talk to your doctor about your best option.
Source: The article is provided by Real Age.
Knee pain facts
- The knee joint has three compartments: medial, lateral, and patellofemoral.
- Causes of knee pain include injury, degeneration, arthritis, infrequently infection, and rarely bone tumors.
- Ligaments within the knee (cruciate ligaments) and on the inner and outer sides of the knee (collateral ligaments) stabilize the joint.
- Surgical repair of ligament injury can involve suturing, grafting, and synthetic graft repair. Some patients require total knee replacement.
- Routine X-rays do not reveal meniscus tears but can be used to exclude other problems of the bones and other tissues.
- Arthroscopy and MRI studies are used most frequently to diagnose knee ailments; occasionally, a needle aspiration of fluid is done.
- The knee joint is one of the most commonly involved joints in rheumatic diseases (over 100 disease types). Rheumatic diseases are immune diseases that affect various tissues of the body, including the joints, by causing arthritis (pain, swelling, stiffness, and limited joint movements).
How is the knee designed, and what is its function?
The knee is a joint that has three compartments. This joint has an inner (medial) and an outer (lateral) compartment. The kneecap (patella) joins the femur to form a third compartment called the patellofemoral joint. The thighbone (femur) meets the large shinbone (tibia), forming the main knee joint.
The knee joint is surrounded by a joint capsule with ligaments strapping the inside and outside of the joint (collateral ligaments) as well as crossing within the joint (cruciate ligaments). These ligaments provide stability and strength to the knee joint.
The meniscus is a thickened cartilage pad between the two joints formed by the femur and tibia. The meniscus acts as a smooth surface for motion and absorbs the load of the body above the knee when standing. The knee joint is surrounded by fluid-filled sacs called bursae, which serve as gliding surfaces that reduce friction of the tendons. Below the kneecap, there is a large tendon (patellar tendon) which attaches to the front of the tibia bone. There are large blood vessels passing through the area behind the knee (referred to as the popliteal space). The large muscles of the thigh move the knee. In the front of the thigh, the quadriceps muscles extend the knee joint. In the back of the thigh, the hamstring muscles flex the knee. The knee also rotates slightly under guidance of specific muscles of the thigh.
The knee functions to allow movement of the leg and is critical to normal walking. The knee flexes normally to a maximum of 135 degrees and extends to 0 degrees. The bursae, or fluid-filled sacs, serve as gliding surfaces for the tendons to reduce the force of friction as these tendons move. The knee is a weight-bearing joint. Each meniscus serves to evenly load the surface during weight-bearing and also aids in disbursing joint fluid for joint lubrication.
The goal of this article is to give the reader an overview of causes of knee pain. Most of the topics covered in this article are further expanded in detail as separate articles. For example, bursitis, types of arthritis, total knee replacement, and others are covered in articles devoted to knee pain-related topics that include specifics on diagnosis, tests, treatments, and other details.
What are risk factors for knee pain?
Risk factors for knee pain include aging, athletic activities, and trauma injuries.
What injuries can cause knee pain, and what are symptoms? How is knee pain with injury diagnosed and treated?
Injury can affect any of the ligaments, bursae, or tendons surrounding the knee joint. Injury can also affect the ligaments, cartilage, menisci (plural for meniscus), and bones forming the joint. The complexity of the design of the knee joint and the fact that it is an active weight-bearing joint are factors in making the knee one of the most commonly injured joints.
Trauma can cause injury to the ligaments on the inner portion of the knee (medial collateral ligament), the outer portion of the knee (lateral collateral ligament), or within the knee (cruciate ligaments). Injuries to these areas are noticed as immediate pain but are sometimes difficult to localize. Usually, a collateral ligament injury is felt on the inner or outer portions of the knee. A collateral ligament injury is often associated with local tenderness over the area of the ligament involved. A cruciate ligament injury is felt deep within the knee. It is sometimes noticed with a “popping” sensation with the initial trauma. A ligament injury to the knee is usually painful at rest and may be swollen and warm. The pain is usually worsened by bending the knee, putting weight on the knee, or walking. The severity of the injury can vary from mild (minor stretching or tearing of the ligament fibers, such as a low grade sprain) to severe (complete tear of the ligament fibers). Patients can have more than one area injured in a single traumatic event.
Ligament injuries are initially treated with ice packs, immobilization, rest, and elevation. It is generally recommended to avoid bearing weight on the injured joint, and crutches may be required for walking. Some patients are placed in splints or braces to immobilize the joint to decrease pain and promote healing. Arthroscopic or open surgery may be necessary to repair severe injuries.
Surgical repair of ligaments can involve suturing alone, grafting, and synthetic graft repair. These procedures can be done by either open knee surgery or arthroscopic surgery (described in the section below). The decision to perform various types of surgery depends on the level of damage to the ligaments and the activity expectations of the patient. Many repairs can now be performed with arthroscopic surgery. However, certain severe injuries will require an open surgical repair. Reconstruction procedures for cruciate ligaments are increasingly successful with current surgical techniques.
The meniscus can be torn with the shearing forces of rotation that are applied to the knee during sharp, rapid motions. This is especially common in sports requiring reaction body movements. There is a higher incidence with aging and degeneration of the underlying cartilage. More than one tear can be present in an individual meniscus. The patient with a meniscal tear may have a rapid onset of a popping sensation with a certain activity or movement of the knee. Occasionally, it is associated with swelling and warmth in the knee. It is often associated with locking or an unstable sensation in the knee joint. The doctor can perform certain maneuvers while examining the knee which might provide further clues to the presence of a meniscal tear.
Routine X-rays, while they do not reveal a meniscal tear, can be used to exclude other problems of the knee joint. The meniscal tear can be diagnosed in one of three ways: arthroscopy, arthrography, or an MRI.
Arthroscopy is a surgical technique by which a small diameter video camera is inserted through tiny incisions on the sides of the knee for the purposes of examining and repairing internal knee joint problems. Tiny instruments can be used during arthroscopy to repair the torn meniscus.
Arthrography is a radiology technique whereby a contrast liquid is directly injected into the knee joint and internal structures of the knee joint thereby become visible on X-ray film.
An MRI scan is another radiology technique whereby magnetic fields and a computer combine to produce two- or three-dimensional images of the internal structures of the body. It does not use X-rays and can give accurate information about the internal structures of the knee when considering a surgical intervention. Meniscal tears are often visible using an MRI scanner. MRI scans have largely replaced arthrography in diagnosing meniscal tears of the knee. Meniscal tears are generally repaired with arthroscopic surgery.
Tendinitis of the knee occurs in the front of the knee below the kneecap at the patellar tendon (patellar tendinitis) or in the back of the knee at the popliteal tendon (popliteal tendinitis). Tendinitis is an inflammation of the tendon, which is often produced by a strain event, such as jumping. Patellar tendinitis, therefore, also has the name “jumper’s knee.” Tendinitis is diagnosed based on the presence of pain and tenderness localized to the tendon. It is treated with a combination of ice packs, immobilization with a knee brace as needed, rest, and anti-inflammatory medications. Gradually, exercise programs can rehabilitate the tissues in and around the involved tendon. Cortisone injections, which can be given for tendinitis elsewhere, are generally avoided in patellar tendinitis because there are reports of risk of tendon rupture as a result of corticosteroids in this area. In severe situations, surgery can be required. A rupture of the tendon below or above the kneecap can occur. When it does, there may be bleeding within the knee joint and extreme pain with any knee movement. Surgical repair of the ruptured tendon is often necessary.
With severe knee trauma, such as motor vehicle accidents and impact traumas, bone breakage (fracture) of any of the three bones of the knee can occur. Bone fractures within the knee joint can be serious and can require surgical repair as well as immobilization with casting or other supports.
What are diseases and conditions that can cause knee pain, and what is the treatment for this knee pain?
Pain can occur in the knee from diseases or conditions that involve the knee joint, the soft tissues and bones surrounding the knee, or the nerves that supply sensation to the knee area. In fact, the knee joint is the most commonly involved joint in rheumatic diseases, immune diseases that affect various tissues of the body including the joints to cause arthritis.
Arthritis is inflammation within a joint. The causes of knee joint inflammation range from noninflammatory types of arthritis such as osteoarthritis, which is a degeneration of the cartilage of the knee, to inflammatory types of arthritis (such as rheumatoid arthritis or gout). Treatment of the arthritis is directed according to the nature of the specific type of arthritis. Many people suffer from arthritis; the pain and discomfort can be so limiting that some patients may require a total knee joint replacement. Knee replacement surgery often allows the patient to regain much of their mobility.
Swelling of the knee joint from arthritis can lead to a localized collection of fluid accumulating in a cyst behind the knee. This is referred to as a Baker cyst and is a common cause of pain at the back of the knee.
Infections of the bone or joint can rarely be a serious cause of knee pain and have associated signs of infection including fever, extreme heat, warmth of the joint, chills of the body, and may be associated with puncture wounds in the area around the knee. These infections are often diagnosed by aspirating joint fluid accumulations with a needle (joint aspiration) and examining the fluid microscopically and with microbial culture techniques. Treatment involves antibiotics and sometimes joint surgery.
Tumors involving the joint are extremely rare (for example, synovial sarcomas, and giant cell tumors). They can cause ambulatory problems with local pain. Treatment usually involves surgery; a few individuals may require amputation of the knee and lower leg. Treatments and surgery depend on the tumor type.
The collateral ligament on the inside of the knee joint can become calcified and is referred to as Pellegrini-Stieda syndrome. With this condition, the knee can become inflamed and can be treated conservatively with ice packs, immobilization, and rest. Infrequently, it requires a local injection of corticosteroids.
Osgood-Schlatter disease is caused by chronic inflammation at the area of the tendon below the kneecap where it attaches to the tibia bone. This can cause local pain and tenderness of the attachment point. It requires treatments to reduce inflammation, restricted activity, and gradual rehabilitation. Osgood-Schlatter disease is a common cause of pain in the front of the knee in children.
Chondromalacia refers to a softening of the cartilage under the kneecap (patella). It is a common cause of deep knee pain and stiffness in younger women and can be associated with pain and stiffness after prolonged sitting and climbing stairs or hills. While treatment with anti-inflammatory medications, ice packs, and rest can help, long-term relief is best achieved by strengthening exercises for the quadriceps muscles of the front of the thigh.
Bursitis of the knee commonly occurs on the inside of the knee (anserine bursitis) and the front of the kneecap (patellar bursitis, or “housemaid’s knee”). Bursitis is generally treated with ice packs, immobilization, and anti-inflammatory medications such as ibuprofen (Advil, Motrin) or aspirin and may require local injections of corticosteroids (cortisone medication) as well as exercise therapy to develop the musculature of the front of the thigh.
What is the outlook (prognosis) for knee pain?
The outlook for an individual with knee pain depends on the particular cause of the pain. For examples, knee pain caused by degenerative cartilage can be chronic, while knee pain from injury sometimes resolves completely with appropriate treatment.
Can knee pain be prevented?
Knee pain can be prevented only to the extent that injuries can sometimes be avoided can knee pain be prevented.
Source: The article is provided by MedicineNet.com.
Exercising with arthritis
While it may not be obvious, weight loss and exercise can help people with arthritis. The more your body weighs, the more wear and tear on your joints. Exercise can help you lose weight, but it can also help in other ways. Stretching and strengthening exercises—if done carefully—can improve joint mobility and lower pain intensity.
Here’s how to get started.
Talk to your doctor first
Why it helps: It’s wise for anyone to talk with their doctor before starting an exercise regime, but it is especially important if your joints are injured by arthritis and your fitness level is low from taking it easy to stay out of pain.
Ask about exercise time and weight limits, motivational support, and the appropriate after-exercise pain treatment.
Think big, start small
Why it helps: Exercise will help improve your joints’ range of motion; strengthen the muscles around the joints, which protects them and improves function; and increase your aerobic fitness and help you lose weight, which reduces the stress on your joints.
So you should plan to address three exercise goals and types: flexibility, strength, and cardiovascular health.
Join a group
Why it helps: Group participation is an important motivator for people who want to begin exercising, losing weight, and changing their habits.
Arthritis, like any chronic pain condition, can be an isolating disease, so finding support will not only help you achieve your fitness goals, but it will also help you tackle this disease.
Ask arthritis clinics, community centers, physical therapy clinics, and gyms to recommend group programs.
Why it helps: The emphasis on stretching, whole-body well-being, and group practice makes yoga especially relevant to some arthritis sufferers.
Although the scientific evidence of arthritis-specific benefits is limited (few studies have been done), the Johns Hopkins Arthritis Center still recommends yoga to its patients.
Take to the water
Why it helps: A 2007 Australian study, though small, found “significant” benefits from the low-impact, body-supporting medium of water.
Check with your local community center, YMCA, or a nearby pool for arthritis-focused facilities and sessions.
Why it helps: Mayo Clinic’s arthritis center advises a 20-minute joint-warming routine before you begin—warm towels, hot packs, etc.
Follow it with a postexercise ice-pack cooldown.
Go easy: Neither the heat nor the cold should be painful.
Your spine has many nerves, muscles and ligaments that serve as connections to areas throughout your body, so keeping your back in top condition is one of the best things you can do for both your back and your overall health. There are a number of simple things you can try to help keep your spine as healthy as possible and minimize complications from your back condition and/or prevent future painful episodes.
Let your spine really rest while sleeping
While you’re sleeping, all of the structures in your spine that have worked hard all day finally have an opportunity to relax and be rejuvenated. Using the right mattress and pillow will support the spine so the muscles and ligaments can be stress-free and have a chance to become refreshed. A large part of the decision of what type of mattress and pillow to use is based on personal preference. As long as the basis for the choice includes ensuring that the correct support and sleeping position will be attained, any of the many available types of mattress can be helpful.
Choose your shoes carefully
Whether you’re walking for exercise, or just to get where you’re going, the shoes you wear have a big effect on your back. They should be well balanced, flexible and most certainly comfortable. Good shoes provide not only protection for your feet, but also a supportive base that helps the spine and body remain in alignment. Selection of the right shoes, and correctly using inserts if needed to provide even further balance, can help you avoid muscle strain and possible injury.
Enjoy the benefits of a massage chair
Many people love a good massage to relax their muscles and relieve stress. Therapeutic massages not only improve flexibility and decrease tension; they can also improve blood flow and increase the level of endorphins in your bloodstream, which is a chemical in the body that makes us feel good. While it’s not the same as going to a massage therapist, having a massage chair in your home can be a practical and easy way to get some of the benefits of a Shiatsu or Swedish massage.
Source: The article was written by Stephanie Burke for Spine-Health.