Disorders of the MusculoSkeletal System
Arthritis is truly a universal illness like hypertension, diabetes, obesity and digestive disorder–a disease of the unhealthy lifestyle of the modern world. Prevention of arthritis is actually better than cure, although all forms of arthritis can be treated.

Arthritis is the inflammation of a joint. There are many types and as many as 96 have been identified. When a joint becomes arthritic there will be swelling and damage to underlying tissue. Pain and stiffness are most common symptoms one experiences. As the disease progress, the range of motion gradually diminishes with the joint becoming increasingly stiff. Once the joint becomes stiff the muscles around it are not exercised adequately and they shrink in size resulting in muscular weakness known as disuse atrophy. This in turn leads to increased risk of injury to joints and the arthritic condition aggravates. Current enthusiasm for running, aerobics, jogging for pleasure and fitness also result in some musculoskeletal problems.

How does the joint work?
Before going into the details about arthritis, let us take a look at how a joint works. There are several types of joints in the body. Some are highly mobile, some stable and mobile and some immobile. What is amazing about the human body is its architectural arrangement of bones, muscles and joints strong enough to support its weight, rigid enough to protect soft internal organs, flexible enough to provide the agility that ensures man’s survival.

Although the joint formation varies with the types of joint, most joints are made up of the same elements. The joint is enclosed in a tough fibrous capsule of connective tissue which secretes a fluid, the synovial fluid, which lubricates the moving parts. Outside this capsule the fibrous anchors, called ligaments, surround the joint and link the two bones protecting the capsule and keeping the movements of the joint within safe limit. An American novelist Herman Melville observed: “The human body is like a ship, its bones being the stiff rigging and the tendons are small running ropes that manage all the motions.”

What can go wrong with a joint?
The simplest example is a sprain, an ankle injury caused by a twist. The joint becomes swollen with fluid, the blood supply to the part increases and it becomes warm and painful. Movements become restricted because of swelling and pain. In fracture of the bone, even if pain is not severe, one feels instinctively that one should avoid putting weight on it. A sprain becomes better after sometime and fracture takes time to heal. During an attack of gout, the joint is inflammed and in rheumatoid arthritis there is no such obvious reason and the disease itself appears to be the source of inflammation.
There are several kinds of Arthritis

1. Degenerative – e.g. osteoarthritis, cervical and lumbar spondylitis.
2. Inflammatory–rheumatoid, arthritis, ankylosis spondylitis and psoriatic.
3. Arthritis
4. Infective–bacterial pneumo, gono, meningo, strepto and styphylo and viral (rubella).
5. Metabolic–Gout

Ankylosing Spondylitis

It is an inflammatory disorder of the spinal cord resulting in fusion of vertebrae due to loose bodies formed around the structures causing stiffness and rigidity. Totally fused spinal cord is quite an advanced stage of the disease and the spinal cord looks like a bamboo stick and hence it is also known as ‘Bamboo Spine’.

Treatments

Treatments listed for lower and upper back pains hold good for this condition also.

Cervical Spondylosis

This is the condition where the bones of the neck (Cervical vertebrae) undergo changes of wear and tear. Cervical Spondylosis is more common among the aged but that does not mean younger age group is free from it. In fact irrespective of age, it is striking all now, which is mainly due to unhealthy lifestyle and the way the spinal cord is used for daily activities. Incorrect posture, whiplash while driving vehicles, constantly bending forward while working, stress and strain, result in pain and stiffness at the neck region due to spasm/strain. Apart from stiffness are radiating pains to shoulder and hands with feeling of pricking of pins and needles and frequent giddiness (due to basilar artery deficiency or compression on the basilar artery supplying to brain).

Sometimes, Cervical Spondylosis suffers are advised to wear a collar belt that immobilizes the area and provides relief from pain. But immobilization can lead to permanent stiffness and muscles may become weak.

Treatment

• Avoidance of constant bending forward and pressure over the neck.
• Gentle massage to neck, spine and shoulder followed by hot and cold affusions or neutral affusion.
• Hot and cold fomentations in case of acute spasm and pain.
• Arm contrast baths to relieve radiating pain to hands.
• Regular head and neck exercises.
• Maintenance of correct posture during all activities.

Other Disorders of the Lower Limbs

Calcaneal Spur

It is a condition occurring due to the deposition of calcium around the Calcaneum bone (heel bone) resulting in pain. Pain is particularly felt when the foot is placed on the floor and disappears after one walks a few steps.

Treatment

• Since excess weight adds to the existing problem, reduction of weight is essential.
• Hot foot immersion with Epsom salt before going to bed and in the morning, on raising from bed, relieves the pain.
• Wear soft slippers cushioned at the heel.

Other Disorders of the Lower Limbs

Disorders of the Shoulder

True, arthritis in the shoulder is uncommon. Pain and loss of movement occur when structures around the joint are affected. The innervation’s of the shoulder joint and surrounding structures is mainly through the 5th cervical root (issuing from the vertebrae of the neck) lying in the area of the deltoid muscle extending over the shoulder, upper arm and hence pain is often felt over the deltoid region.

Frozen shoulder is the commonest ailment in the 50–70 age group, with women affected twice as often as men. The trigger factors are painful external conditions, which lead to immobilization of the shoulder. These include heart attack, removal of breast, cerebro–vascular accidents and any other major surgery in the chest region.

The ailment starts with pain and soreness in the upper arm. With increase in severity, it often disturbs sleep.

Osteoarthritis in the shoulder, though rare, is termed as periarthritis and at times crepitation is heard on movements of the shoulder.

Treatment

• Gentle massage to the shoulder area followed by hot and cold fomentation or affusion.
• Exposing the painful area to infrared rays, followed by colds compresses or direct mud application.
• Cold packs for 45–60 minutes in the night regularly.
• Exercises–movement of the shoulder joints in all directions.

Other Disorders of the Lower Limbs

Gouty Arthritis
Gout is a metabolic disease and often runs in families. It is associated with abnormal accumulation of urates in the body and characterized early by a recurring acute arthritis, usually mono–articular (single joint involvement) and later on, deforming chronic arthritis. About 90% of patients of Gout are men, usually of over 30 years of age.In acute Gouty Arthritis involvement of peripheral joint, mainly metatarsal joint of the big toe is common.

It becomes so much red, hot, swollen and tender that even touching of bed clothes may become agonizing. The attack is insidious, sometimes explosively sudden and may even wake up the patient from sleep.

After a few days, the symptoms and signs usually disappear followed by peeling of skin overlying the affected joint. Attacks may recur after weeks, months or even years.

In chronic Gouty Arthritis, recurrent attacks of Gout result in progressive erosion of the cartilage and bone associated with the formation of tophi (urate crystal deposition) causing considerable disability with osteoarthritis super–imposed over it. Tophi are nodular thickenings which occur in tendon sheaths, bursa and cartilage of the ear. Renal Calculi (stones in the kidneys) occur in 10% of Gout sufferers. The uric acid level in the blood would be high.

Treatment

• Treatments used for osteoarthritis of knees and ankles also hold good for Gouty Arthritis.
• Diet – To help reduce high blood uric acid level following items should be avoided.
• Meat, fish and other non–vegetarian food.
• Vegetables such as beans, peas, cauliflower, mushrooms and spinach.
• Coffee, tea, chocolate and alcohol.
• Reduce whole grains, legumes, milk, cheese, butter and sugar.
• Drinking of plenty of water helps in excretion of uric acid.

Low Backache

Most people suffer from back pain at some time or other in their lives. This is the penalty to be paid for assuming wrong posture. Back pain is second only to headache among the leading causes of pain. Most of the back pain sufferers otherwise lead a normal life.

Though drugs provide relief from severe pain or relax the muscles, they are not a cure for backache. If they are overused, they may become a habit and actually increase the recurrence of pain.

Recurring back pain often results in devitalization, fatigue and depression. Recurrence of back pain is quite common amongst the diagnosed low back sufferers. Psychological stress, a known factor in precipitating back pains, is responsible for stiffness of the back muscles which then causes painful spasm resulting in back pain.

Apart from overuse of the spine, stress and sedentary habits, the other causes of back pain include weakened back muscles, protruded abdomen which pulls back muscles placing extra stress on the back, over exercising such as jogging, aerobics etc. and obesity. The aging process also contributes to back pain.

In fact, about 80–85% of back pain is due to muscular weakness, stress etc., and 15–20% as a result of structural defect or disease such as osteoarthritis, prolapsed inter–vertebral disc, lumbar spondylosis, spinal canal stenosis, facet joint syndrome and spondylolisthesis.

Compared with standing, sitting increases the pressure by 40%, while lying down decreases it to 25% of the pressure exerted on standing. Sneezing, laughing and coughing also increase disc pressure and hence aggravates the back pain.

Treatment

• RICE principle is to be adopted in case of acute or severe low back pain for first 24–48 hours.
  R – Resting the painful area.
  I – Ice–cold packs at repeated intervals.
  C – Cold compresses application frequently.
  E – Elevation of the affected area to help movement of accumulated blood to other areas.
• Gentle low back massage followed by hot and cold affusions or fomentation.
• Infrared treatment to the affected area followed by direct mud application or a cold compress.
• Neutral spinal bath to relieve referred pain and numbness in the lower limbs.
• Neutral immersion and half bath with epsom salt for 10–20 minutes.
• Hot tip bath for 10–12 minutes for relieving back pain.
• Neutral jet massage, whirlpool baths and underwater massage to relax the stiff back muscles.
• Steam bath is also useful in providing muscular relaxation by its thermic effect.
• Regular back bending exercises coupled with maintenance of proper back posture, avoidance of lifting heavy weights and sudden jerks.
• Regular practice of breathing exercises help in movement of spinal cord resulting in relief from referred pains due to the compression on the nerve endings.

Rheumotoid Arthritis

It is a systemic or whole body disease. In addition to stiff, hot, painful and swollen joints, many patients experience acute fatigue, weakness, fever, malaise, and loss of appetite, anemia and weight loss. Connective tissue and organs in the body, including heart, lungs, nerves and eyes, may get damaged.

Again, as in many other diseases, the cause of Rheumatoid Arthritis is not known. It is an autoimmune disorder in which the body attacks its own tissues. There is often hereditary predisposition though the disease is not inherited.

Spinal Problems

The spinal column comprises of 33 tiny bones aligned perfectly from the bottom of the skull and running down to the hip region. Spinal cord supports the brain at the top, anchors the rib cage at the center and joints the pelvis at the bottom. The spine must carry the weight of human frame, be flexible and allow bending and rotation in all directions even with heavy load. It should also be hollow to allow delicate nerves and blood vessels to pass through it and emerge from its sides, not being damaged during movement and function adequately for a lifetime.

The individual vertebra is held together by ligaments. The spinal cord travels down a hollow vertebral canal towards the back sending out nerve roots through openings at the side of each vertebra. The sciatic nerve, which extends from lumbar region supplying to the lower limbs, is often involved in severe back pain. Between each vertebra there is a cushion made of gelatinous center called disc, which acts as a shock absorber and can withstand the weight equivalent to the weight of two refrigerators.

Osteoarthritis

The most frequent forms of arthritis are Osteoarthritis, a wear and tear disease that becomes increasingly common with age. It results from a wearing down of the cartilage in the joints. The pads of cartilages at the end of the bones become splayed and rough instead of smooth, preventing normal movements of the joints. The joints begin to grate like a rusty gate instead of operating smoothly like that of a well–oiled machine. Osteoarthritis most often affects the large weight–bearing joint, knees and hips as well as spine.

Gravity is the enemy of the man’s weight–bearing joints. The repeated impact on them cause minute trauma which leads to degeneration of the joint i.e. Osteoarthritic changes set in. People who are overweight are more likely to get Osteoarthritis. Osteoarthritis often follows an injury to or a repeated abuse of a joint, as often in case of athletes. It is still not known why many people who subject their joints to constant abuse often escape from Osteoarthritis while others suffer from it.

Pain and stiffness are the most common symptoms, they are usually noticed by weather changes.
Sometimes the affected joints become tender and swollen.

Treatment

The frequency and the duration of the treatment varies depending on the severity and the effect sought.

Osteoarthritis of the Knee and Ankle Joints

The following treatments are useful in relieving pain and swelling of the knee and ankle joints.

• Gentle massage to the joints to strengthen muscles around the joints.
• Hot and cold fomentation and affusion to the joint to relieve pain and spasm.
• Cold compress to joints to treat localized inflammation and pain.
• A heating compress (pack) is also helpful in relieving pain/stiffness/swelling.
• Neutral immersion and neutral half–bath with epsom salt for 15–20 minutes.
• Contrast foot baths are also very helpful in relieving pain and spasm.
• Neutral jet, whirlpool and underwater massages help in relaxing the muscles of joints and also give relief from pain and spasm.
• Direct hot mud applications relieve pain.
• Regular exercises such as flexion and extension of the joints help to strengthen the muscles.
• It is also important to reduce the weight by following a controlled diet program under the guidance of a doctor.