OSTEOARTHRITIS

*Osteoarthritis is the most common form of arthritis.
* It is caused by the breakdown of cartilage. Cartilage is the tough elastic material that covers and protects the ends of bones. Bits of cartilage may break off and cause pain and swelling in the joint between bones. This pain and swelling is called inflammation.
*Over time the cartilage may wear away entirely, and the bones will rub together.
*Osteoarthritis can affect any joint but usually affects hips, knees, hands and spine.
Osteoarthritis is a disease that affects joints in the body. It can involve any joint, but usually concerns hands and weight-bearing joints such as hips, knees, feet and spine.
It affects men and women in equal numbers.
Most people develop osteoarthritis after the age of 45, but it can occur at any age.

WARNING SIGNS OF OSTEOARTHRITIS

Pain, stiffness and swelling around a joint that lasts longer than two weeks.

The joints that are usually affected are the hips, knees, feet and spine. Finger and thumb joints might also be affected.

If you are experiencing persistent joint pain, visit your family doctor.

CAUSES OF OSTEOARTHRITIS

The exact cause is unknown.

The chances of getting osteoarthritis seem to increase with age.

Some people with osteoarthritis have other family members with it.

Being overweight can increase your risk of getting osteoarthritis.

Excess weight puts stress on joints such as hips and knees.

Injury to a joint or repeated overuse of it can also damage the cartilage and lead to osteoarthritis.

Other types of arthritis can also damage joints and lead to osteoarthritis.

Excess WeightExcess weight puts extra stress on the weight-bearing joints, especially the knees and hips. The good news is losing weight, even just 10 pounds (4.5 kilograms), can help prevent osteoarthritis in your knees. Even if you have osteoarthritis in your knees, losing weight can make you feel better. Less body weight means less stress on Wear and Tear?
Osteoarthritis used to be thought of as the inevitable result of “wear and tear” on the joints. Research now shows that normal wear does not actually cause “tear.” Normal activity and exercise is good rather than bad for joints and does not cause osteoarthritis your knees

MEDICINE:ANALGESICS

Acetaminophen is often the first medication chosen to treat osteoarthritis. It can relieve pain but does not reduce inflammation

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a type of medication that helps reduce the pain and swelling of the joints and decrease stiffness. However, they do not prevent further joint damage.
Medicine: Corticosteroids
Cortisone may be injected into the joint to relieve severe inflammation. Cortisone is a steroid that reduces inflammation and swelling

EXERCISES

Regular exercise is known to be very effective for relieving the pain and stiffness of osteoarthritis and may help slow the progression of the disease. Exercise also helps you reach or maintain a healthy weight, which reduces the stress on your joints. Here are some good reasons to exercise if you have arthritis:

Exercise strengthens the muscles that support your joints, which helps protect the joints from further damage and can reduce the pain of arthritis.

Exercise improves the flexibility of your joints; the more flexible your joints are, the more easily you can move them without pain.

Exercise can make you feel better mentally and emotionally by relieving stress and elevating your mood.

Exercise can spark your energy and generally improve the quality of your life.

The exercise program that will work best for you is one that fits your lifestyle and physical abilities. Doctors generally recommend a combination of stretching exercises, mild strengthening exercises (such as lifting weights), and low-impact aerobic exercises (such as swimming, walking, or bicycling).

Make exercise a part of your life If your exercise routine is comfortable and enjoyable for you, it will become a habit that will be easy to keep up. It doesn't have to be a formal exercise program. Just fitting more activity into your daily routine, such as taking the stairs instead of the elevator and walking or riding your bike instead of driving, can provide many benefits. You will get the most out of your exercise program if you plan workouts for those times of the day when your pain is least severe and your joints most flexible.

For many people, pain and stiffness are often worse in the morning than at other times. If this is the case for you, try exercising after you have taken a hot shower, which can help loosen your joints.

Begin and end each exercise session with a warm-up and cooldown by walking around slowly for 5 minutes before and after.

at a rate at which you can speak comfortably.

STRETCHING EXERCISES, which are also called range-of-motion exercises, are good for helping to reduce stiffness in your joints and improve their flexibility. Stretching exercises include anything that requires regular movement of a joint to its fullest capacity.
For example, holding your arms out to your sides and circling them in a windmill fashion stretches your shoulder joint.

Some forms of water exercise use warm water to loosen joints and help them stretch. Doing stretching exercises for a few minutes every day can significantly improve the movement in your joints.

STRENGTHENING EXERCISES help maintain or build the muscles around your joints, which helps keep the joints stable. Stronger muscles also improve the joint's movement.
Lifting light weights, such as 1- to 2-pound dumbbells, every other day is often enough to make a difference. (Muscles need a day off in between to rest and rebuild.). You will need to be carefully instructed in this type of exercise to avoid injury and further damage to your joints.

Some forms of water exercise include strengthening exercises. Fitness exercises Fitness exercises, also called aerobic exercises, increase your endurance, strengthen your heart and lungs, and give you energy.

Try to exercise aerobically for at least 60 to 90 minutes each week.

Brisk walking, swimming, and bicycling are good fitness exercises if you have arthritis because they allow for smooth rather than jerky movements. You should avoid high-impact exercises—such as jogging, tennis, or step aerobics—because they can put too much pressure on your joints and can worsen your symptoms.Swimming is especially good if you have arthritis in your knees or hips because the water supports your weight, which reduces stress on those joints.

Walking is also a good exercise for relieving the pain and stiffness of arthritis.

HEAT AND COLD

The use of heat and cold are time-honored techniques for relieving the pain, stiffness, and occasional swelling that can result from osteoarthritis. Some people get better results with heat; others prefer cold.

Do not apply either heat or cold for longer than 20 minutes at a time. Your skin should be allowed to return to normal temperature between applications. And do not combine either heat or cold with rubbing or the use of creams. This combination can cause burns.Heat

Heat is usually used to relax muscles and sometimes to warm them up before exercising.
You can heat up your sore joints with heating pads or hot packs or by sitting in a hot tub or heated pool.

For many people who have arthritis, a hot shower in the morning is all they need to loosen their stiff joints. Cold Applying cold to a sore joint reduces the pain by numbing the area

Use ice or reusable cold packs. Never apply ice directly to your skin because it can burn the skin; wrap ice and cold packs in a towel.

Although applying cold can be helpful for short-term pain relief, you have to be careful because the lack of feeling may cause you to overuse the sore joint or muscle.

NUTRITION AND DIET

Obesity causes strain on the weight bearing joints and induces osteoarthritis. Balanced diet with adequate supplementation of calcium in the diet can be helpful to patients. It is also advisable to avoid foods rich in fat. These are the general principles of diet therapy. However the diet regime of patients can be individualized depending on the clinical scenario.

BUTTOCK EXERCISE

Gluteus Maximus muscle strengthening (buttock exercise)
To strengthen this muscle, lie on the stomach with the hips and legs off the end of a table or bench. Tighten the buttock on one side and extend the leg up toward the ceiling while maintaining a neutral spine. Movements should be slow. Initially, it is common to only be able to perform a few repetitions at a time.

*

Hold 5 seconds
*

4-10 repetitions per side
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1 time per day
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4-5 days per week

LOW BACK PAIN RELIEF

Strengthening exercise program for low back pain relief

Transversus Abdominis muscle strengthening (abdominal exercise)
Many people think of performing abdominal crunches or situps to strengthen the abdominal muscles. While “six pack abs” look nice to some, it is more important to work the Transversus Abdominis (TVA) through abdominal exercise to achieve spinal stability. When retraining the TVA, it is important to maintain a neutral lumbar spine (don’t try pushing the back all the way into the floor). The back is most often in a neutral spine position, so it makes less sense to strengthen the back in a flexed or extended position. Lie on one’s back with the knees bent. Knees and feet should be shoulder width apart. Draw the belly button toward the spine while maintaining a neutral spine. Upon exhalation, reach toward the ceiling as if trying to grab a trapeze overhead. Then raise the head and shoulders off the floor, just to the point where the shoulder blades are barely touching the floor, and hold 1-2 seconds. Inhale upon return and repeat at the end of the next exhalation. Continue until it is not possible to maintain a neutral spine or when fatigued.



* Hold 1-2 seconds


* Repeat until fatigued


* 1 time per day * 4-5 days per week

McKenzie therapy for low back pain

McKenzie therapy for mechanical low back pain McKenzie Method assessment and treatment Of the many frustrations back pain patients face, the lack of a standardized or uniform treatment approach is high on the list. Especially for those patients with longer-lasting symptoms of sub-acute pain (lasting between six and twelve weeks) or longer than twelve weeks (chronic back pain), treatment approaches are very inconsistent. While the McKenzie Method is successful with treating acute low back pain, it is also very helpful for those patients with sub-acute and chronic back pain. One of the benefits of the McKenzie Method (or McKenzie Therapy) is that it is a standardized approach to both the assessment and treatment of low back pain and/or leg pain (sciatica). The McKenzie Method is not simply a set of exercises; it is a defined algorithm that serves to classify the spinal problem so that it can be adequately treated.
The McKenzie Method is grounded in finding a cause and effect relationship between the positions the patient usually assumes while sitting, standing or moving, and the generation of pain as a result of those positions or activities. The therapeutic approach requires a patient to move through a series of activities and test movements to gauge the patient’s pain response. The approach then uses that information to develop an exercise protocol designed to centralize or alleviate the pain.
While there are certainly other forms and schools of physical therapy, this article discusses the components of the McKenzie assessment and classification system, and summarizes the experience of a typical patient whose pain classification reflects that he or she would benefit from McKenzie exercises.
McKenzie Method assessmentWhen a patient’s pain symptoms can be made better or worse by adopting various, differentiated active positions, it is said that a patient has a directional preference of movement for treatment. The identification of a directional preference through mechanical means is the hallmark of the McKenzie Method (which is often referred to Mechanical Diagnosis and Therapy or MDT). The patient’s beneficial ‘directional preference’ also is the direction of movement that causes pain symptoms to move more centrally (toward the mid-back or neck),
Correct assessment or mechanical diagnosis is the key to prescribing effective exercises. Without the aid of a good assessment, there are no McKenzie exercises; there are just exercises, the efficacy of which is questionable. The McKenzie assessment consists of taking a patient history and performing a physical exam. Both are used to gauge the degree of impairment as well as identify any red flags that might be contrary to exercise-based treatment (e.g. fracture, tumor, infections, or systemic inflammatory disease).
During the McKenzie physical examination, patients may be asked to perform single and/or repeated flexion or extension movements forward and backward. These movements are done to ‘end range’ —the point at which the patient’s range is limited for any reason—and are done in both standing and lying positions. Lateral flexion movements may also be performed.
McKenzie therapy classifications The Mechanical Diagnosis and Therapy system has three broad treatment classifications: postural, dysfunction and derangement syndromes.
A postural syndrome is the result of prolonged postures or positions that can affect joint surfaces, muscles or tendons. Pain may be local and reproducible when end range positions, such as slouching, are maintained for sustained periods of time. Repeated movements do not change symptoms in postural syndrome patients, and response (i.e. pain relief) is usually immediate. It is valuable to have the patient perform poor postural positions followed by the symptom-abolishing positions in order for them to ‘understand’ what is leading to their discomfort and train patients to avoid them.
The dysfunction classification is so named because it implies some sort of adaptive shortening, scarring or adherence of connective tissue causing discomfort. A dysfunction may be intermittent or chronic, but its hallmark is a consistent movement loss and pain at the end range of movement. When the patient moves away from end range their pain is decreased. Successful treatment takes time because it focuses on tissue remodeling which requires constant attention. Patient education is critical for this syndrome, because the patient will need to understand that remodeling tissue can be slow and often uncomfortable because the exercises prescribed are intended to challenge any adhesions or tissue scarring that has occurred.
The derangement classification is the most common syndrome that presents clinically. Its hallmark is its sensitivity to certain movements and its preference for particular movement patterns. When certain movements are performed, such as a flexion and/or extension (bending or straightening) the symptoms (e.g. low back pain) become either more central (e.g. just in the low back) or less intense. It is not uncommon for a patient to experience rapid reduction of their symptoms immediately during the assessment. That is to say, if their symptoms were pain in their right thigh, the pain may be moved more centrally to their buttock, or in some cases be completely aMcKenzie therapy for mechanical low back pain
McKenzie Method assessment and treatment McKenzie therapy for mechanical low back pain
McKenzie Method assessment and treatment bolished. Treatment for the patient with derangement syndrome, as with the postural and dysfunction syndromes, is directly guided by the patient’s response to these provocative assessment movements.
While not all patients are successfully treated by Mechanical Diagnosis and Therapy exercise, it could be strongly argued that all patients with neck pain or low back pain may be successfully assessed by the Mechanical Diagnosis and Therapy method. Failure to find a mechanical component to the patient’s pain is a significant finding, in that it is as important to know for whom McKenzie exercises will be successful and those for whom they will not.

Isthmic Spondylolisthesis

Exercise for sciatica from isthmic spondylolisthesis

Sciatica can be caused by isthmic spondylolisthesis if the condition results in nerve root irritation or impingement. In most cases, if isthmic spondylolisthesis affects or pinches a nerve root it will affect the L5 nerve root. For more information on this condition, see Overview of isthmic spondylolisthesis.

When treating sciatica resulting from isthmic spondylolisthesis with exercise, the spine specialist will typically recommend an exercise program that is a hybrid of:

• Flexion based exercises (as when treating spinal stenosis), and

• Stabilization program (as when treating degenerative disc disease).

The goal of this type of exercise program is to teach the lumbar spine to remain stable in a flexed position. Therefore, the exercises for scia

tica caused by isthmic spondylolisthesis are a combination of both programs.

Sciatica exercises for isthmic spondylolisthesis

These sciatica exercises often require specific hands-on instruction because they offer much less benefit if done incorrectly, and the exercises tend to be much more difficult to do than they appear.

Three exercises that are commonly prescribed for sciatic pain from isthmic spondylolisthesis include: Hook-lying march. As another form of stabilization exercise, Curl-ups. Strengthening the abdominals with the curl-upsthe hook-lying march.

water therapy

Water therapy exercise program

Water therapy pain relief

Water therapy exercise programs (sometimes called pool therapy, hydrotherapy, or aquatic therapy) consist of a variety of aquatic-based treatments and exercises that are designed for back pain relief, to condition and strengthen muscles. Water therapy exercise offers many of the same benefits associated with a land-based exercise program, including development of a treatment plan that is carefully tailored to the individual. Water therapy exercise is especially helpful in cases where a land-based exercise program is not possible due to pain, decreased bone density, disability or other factors. As such, water therapy is a versatile exercise and is particularly good for people with conditions such as:

• Osteoarthritis

• Advanced osteoporosis (with susceptibility to and/or pain from fracture)

• Muscle strain or tears

Benefits of water during exercise therapy

The physical properties of water make it a highly desirable medium in which to exercise to treat back pain and other musculoskeletal injuries. Some of the most important properties of water that make exercise easier are:

• Buoyancy: water counteracts gravity and helps to support the weight of the patient in a controlled fashion as the patient is immersed. This can aid the development of improved balance and strength.

• Viscosity: water provides resistance by means of gentle friction, allowing strengthening and conditioning of an injury, while reducing the risk of further injury due to loss of balance.

• Hydrostatic pressure: there are powerful effects produced by hydrostatic pressure that improve heart and lung function, making aquatic exercise a very useful way to maintain and strengthen heart and lung function. This pressure effect also aids in improving muscle blood flow.

Together, these properties allow development of an exercise regimen that minimizes the weight placed on the spine (axial load) and risk of injury due to unintended movements during exercises. For example, individuals with osteoarthritis in the neck (cervical spine) and shoulder could practice arm circles or shoulder rolls in water to improve their range of motion and strength. Because the water provides both mild resistance and support through buoyancy, the person would most likely not experience the pain caused when a tired arm drops suddenly, as it can do at the end of land-based exercises.

Moreover, the perception of pain may be diminished as a result of many factors including the relaxing sounds as well as the warmth of the water during water therapy exercise, making it a different and often very pleasurable experience. Finally, the buoyancy of water permits a greater range of positions due to the virtual elimination of gravitational forces, particularly for exercises that require lifting the legs, the heaviest limb of the body for most people. Exercises such as range of motion stretches for hip flexors and abductors are generally much easier to try out first in water because the leg is supported somewhat as the individual learns the right positioning. Buoyancy when doing water therapy exercises can be increased with the use of floats.

Limitations to consider during water therapy exercise

For many back pain patients, water-based exercises should only be performed under the guidance of a qualified health professional. Water therapy exercise should usually be avoided if a person has any of the following:

• Fever

• Severe heart failure

• Incontinence

• Infection

Individuals with severely limited endurance or range of motion may not be able to safely navigate a tiled (and slippery) pool apron to participate in a water therapy exercise program. Rubber mats are often used to increase traction to reduce this risk.

The perception of objects (like the instructor demonstrating exercises) in water is also affected by refraction, leading to difficulty in learning specific motor skills in patients with limited eyesight, or impaired sense of body position or balance due to stroke or other injury. Also, the water temperature may be too warm to accommodate some conditions. Therapy is generally conducted in pools or tanks with water that is between 90 to 94 degrees (Fahrenheit), almost as warm as bath water, so blood circulation is increased. Consequently, patients with any of the conditions listed above should avoid or limit their water therapy exercise, or make sure the pool or tank used is cooler so that their conditions are not exacerbated.

Finally, for patients with low bone density or osteoporosis, the buoyancy provided by the water may not be as beneficial for building bone as weight bearing land-based exercises although the added strength and balance achieved through an aquatic exercise program may facilitate a safe return to land-based exercise.

Water therapy exercises muscles and joints, as well as the back

Some of the basic techniques for pool therapy exercises are as follows (they can be modified for varying degrees of difficulty):

• Knee-to-chest exercise. This movement is performed with one hand on the side of the pool or with back to the wall. Alternating between legs stretches the lower back, as well as the gluteus (buttocks), quadriceps (front thigh) and hamstring (back thigh) muscles.

• Leg raise exercise. This movement is performed with one leg outstretched and the supporting leg slightly bent while one hand holds onto the side of the pool. It strengthens and stretches the muscles in the leg, hip and lower back.

• Wall-facing leg stretch exercise. In this stretching exercise individuals assume a “Superman” position with hands resting on side of pool and the body and legs outstretched into and supported by water. This extends all regions of and joints in the back as well as stretching shoulder muscles.

• Pool walking exercise. Walking both forward and backward in chest-high water works the leg muscles while exerting no impact of the knees or hips, particularly important for people who have arthritis in those joints. The walking exercise can be made more demanding with the addition of hand floats or light weights, so a stroll in the pool becomes an aquatic version of power walking.

• Quadruped activity and exercise. This exercise works legs and arms and is performed while floating on one’s back (sometimes achieved with a therapist supporting the trunk or using a flotation jacket). The individual makes paddling motions with his/her arms and legs.

Combined water therapy for back exercise with land-based methods

Water therapy for back exercise can be a short-term exercise option if back pain or a back injury makes land-based exercise too difficult. Or it can be adopted as part of an ongoing exercise program if land-based methods worsen symptoms or if the person prefers water exercises. If their functional status or competitive goals require it, people may transition to exercise in a dry environment once they are successfully performing exercises in water.

Some people may find mixed use of wet and dry exercise therapy environments most beneficial.

OBESITY

People gain weight when the body takes in more calories than it burns off. The amount of weight gain that leads to obesity doesn't happen in a few weeks or months. Because being obese is more than just being a few pounds overweight, people who are obese have usually been getting more calories than they need for years.
many problems have solved by the treatment.
Genes - small parts of the DNA that people inherit from their parents and that determine traits like hair or eye color - can play an important role in this weight gain. Some of your genes tell your body how to metabolize food and how to use extra calories or stored fat. Some people burn calories faster or slower than others do because of their genes.

Obesity can run in families, but just how much is due to genes is hard to determine. Many families eat the same foods, have the same habits (like snacking in front of the TV), and tend to think alike when it comes to weight issues (like urging children to eat a lot at dinner so they can grow "big and strong"). All of these situations can contribute to weight gain, so it can be difficult to figure out if a person is born with a tendency to be obese or overweight or learns eating and exercise habits that lead to weight gain. In most cases, weight problems arise from a combination of habits and genetic factors. Certain illnesses, like thyroid gland problems or unusual genetic disorders, are uncommon causes for people gaining weight. the obesity leads to several incurable diseases

Arthritis

Actemra (tocilizumab), a biologic drug being developed to treat rheumatoid arthritis by Roche Pharmaceuticals, has produced successful results in the third Phase III trial conducted. Actemra is a first-in-class humanized anti-interleukin-6 receptor monoclonal antibody. There were 498 patients in the trial known as Actemra RADIATE (Rheumatoid Arthritis Study in Anti-TNF Failures). The RADIATE trial studied Actemra in moderate to severe rheumatoid arthritis patients who failed to respond to anti-tumor necrosis factor treatments (anti-TNF drugs) e.g., Enbrel, Remicade, and Humira.