Is there a non surgical answer to osteoarthritis knee?
Yes,There definitely are many non surgical interventions which can be done prior to attempting any surgical procedure on the knee.Osteoarthritis is a condition where the surfaces of your knee get eroded and degenerate such that the congruity of the knee joint gets lost and free painless movement is difficult.Medicines which can be taken orally which assist cartilage regeneration are very useful in early stages of disease.These medicines have to be taken for a long duration of six months to a year for a significant change to occur.Apart from these medications a new molecule resembling the joint fluid cell has been identified and is being successfully used as an intra articular injection.This injection offers pain relief within one month and is becoming increasingly popular.Physiotherapy,rehabilitation and vacuum therapy play a very important role in pain relief but are not commonly administered bcause of patient compliance.
Dr Santhosh Jacob
Enhance your fracture healing by 40 percent
Good news for all you unfortunate people who have sustained accidents and have fractured any or some of your bones. There has been recent interest in using new methods or I should rather say innovative methods to increase the speed at which your bones heal. Man’s greatest desire when hurt physically is to heal, heal well and heal faster. We as physicians and scientists have tried many new techniques to give man’s greatest desire a chance and I must say we are doing pretty well. Any fracture is a break in the continuity of a normal bone and depending upon the number of fragments it is broken into a fracture is classified as a communited (many fragments) or a non communited fracture. Normally a communited fracture takes more time to heal because the injury sustained by the soft tissues surrounding the bone are more and the fracture buy itself is a more complicated one. Recent studies by Renowned orthopedic surgeons have provided substantial evidence that low intensity ultrasound radiation and electromagnetic therapy enhance and speed up fracture union by almost 30 to 40 %.Electromagnetic and ultrasound stimulation have shown to release twice the amount of growth factors in a fractured bone. Time to complete healing of the fracture has been reduced by up to thirty days in certain patients. This is substantial as it helps patients to get back to work almost a month earlier and saves many labour days. Ultrasound waves are low intensity sound waves which are generated by a frequency monitored ultrasound device. The dose, intensity and schedule have to be decided by the physician and no one else as wrong administration can worsen the fracture healing. Much caution has to be exercised while attempting this modality of treatment and this should not be tried by non professionals.
Pathological Fracture ? and why is it a serious problem ?
This term to the patient should mean nothing more than a fracture occurring on a diseased bone. A pathological fracture is very difficult to treat because we would require to treat the general condition of the bone and also attempt to treat the fracture. Many problems like fracture recurrence, delayed union of the fracture or even non-union of the fracture very commonly occurs in a patient who has had a pathological fracture. Osteoporotic hip fractures are the most commonly occurring pathological fractures and require to be treated with a lot of care.
What is a “sprain”?
This is a term, which is very commonly misunderstood and misused. I have had many patients come to me and say;” I think I sprained my ankle”. What they actually mean is that they twisted their ankle and it is very painful now. I am sure all of us would want to know what the word “sprain” actually means to an orthopedist.
Sprain signifies a ligamentous injury. All of us are aware that our joints are held in position by strong bands of tissue called ligaments. Each of these ligaments is made of many smaller fibrils or strands of strong tissue very similar in nature to a nylon thread. A sprain is said to occur when there is a partial detachment of these ligaments from the point where they are attached on to the bone. This can also be a partial tear of the fibers of the ligament. Any movement of the injured or sprained part could worsen the injury by converting a partial strain into a complete one. A sprain can be diagnosed only by a clinical examination or by a MRI scan, which can also tells us about the exact location and degree of ligament injury.
A sprain more often than not heals on its own provided you rest the joint and do not exert it further by moving it. Analgesics, like paracetamol, rest and ice application go a long way in helping the sprain to heal. Many orthopaedists prefer to splint the joint helping it to rest, which also accelerates healing
Alcohol is(not) Good ?
It is imperative for us to know that Alcohol is a substance bound to be abused and as a result it is not advisable for anybody to consider alcohol as a form of medication.It is also not advisable for non drinkers to start drinking based on the evidence provided in this study.Alcohol taken in any amount excess to what is mentioned doubles the risk of all the diseases mentioned below.
Alcohol consumption in moderation is said to have many advantages.Over the years many legitimate scientific studies have been done and many conclusions have been arrived at.I have summarized the important conclusions of all the studies done till date.
1.Moderate consumption of Alcohol reduces the risk of myocardial infarction and all other causes of mortality by 15 to 18 %.
2.Moderate consumption of alcohol reduces tthe risk of coronary heart diseaes by 35 percent in people with moderately healthy lifestyles.
3.Moderate consumption of alcohol reduces the risk of coronary events in people with healthy lifestyles by 50%.
4.Moderate consumption of alcohol reduces the incidence of hypertension ,stroke,dementia and diabetes by 25-30%.
5.Moderate consumption of alcohol reduces the incidence of metabolic diseases by 12 -15%.
What is moderate consumption of alcohol? A question which is almost impossible to quantify and answer,because the metabolism of alcohol depends on our body mass,weight,liver function,renal function and many other parameters which are beyond the scope of this article.According to many leading cardiac journals,45-60 ml of 40% alcohol a day for women and double the quantity for men is considered as moderate amount of alcohol.
Source:American heart association guidelines and journals of cardiology.
The above article is just a summary of various sources available on the internet and medical journals,it is not the doctor's opinion on this subject.
Two most common gym mistakes
Mistake#1: No warm up /No cool down
As far as statistics are concerned, this is the most common gym mistake. People come to the gym with a set frame of mind to work out for half an hour and leave, which I think is a very good idea, as it helps in planning your workout. Unfortunately, what happens, is that we skip the warm up and the cool down in our daily routine in order to accommodate our exercise plan within the given time.
What exactly constitutes a warm up, you may ask.. A “warm up” is basically sensitizing your body and your joints to the rigorous workout session which lies in store for it. Even though the mind and body are interrelated, they are two separate entities. Your mind may be ready to run at twelve kilometers per hour as soon as you hit the treadmill, but your body is not. Our bodies are systems which are controlled by a higher centre, the mind.Even though,the mind instructs the body to perform certain activities,our bodies can only peform certain tasks which they are capable of.For example,just because you are an F1 driver you cannot compete on the track with a maruti 800.Similarly,motivation alone cannot enable you to run a marathon without causing damage to your body.
As a Doctor, I do not completely agree with the idea that if your mind wants to, you can push your body to reach unattainable heights. I say ”I do not completely agree”, because the above statement is the “Half Truth” and half truths are much more dangerous than Lies. People are unique, different from each other in every way; even twins do not weigh the same, they just look similar. The truth is “ If your mind wants you to, you can push your body to reach unattainable heights, PROVIDED YOU TRAIN YOUR BODY IN A SYSTEMATIC AND INTELLIGENT MANNER,UNDERSTANDING WHEN YOUR BODY IS TIRED AND RESPONDING BY ADEQUATELY RESTING IT.
Mistake#2: No Parallel strengthening
I am sure you have not heard this term. The term “Parallel Strengthening” is defined as: Training the accessory muscles and strengthening them, such that they share the added stress on the working muscle when necessary.
I will explain this with a very simple example. When you run on the treadmill, your knee joint, hip joint, ankle joint, heel and spine are all under stress. Every muscle, big and small , working to move these joints is constantly under tension and stress balancing your entire body every second. This is why running is such a good exercise, as it strengthens your cardiovascular system and your muscular system. There is an entire chapter on the gait cycle (a scientific analysis of the way we walk) which proves that when you run or jog the weight on your legs or should I say on the “stepping leg” is equivalent to almost five times your body weight. Just imagine the stress!!!
Yet, how many of us take the time to strengthen our calf and thigh muscles, leave alone the muscles of the hip and the ankle. This is a typical example of NO PARALLEL STRENGTHENING, which is something we need to work upon.
Dr Santhosh
Five Interesting Facts About Tennis Elbow
1.Tennis elbow is more common in women than men and it is a degenerative disorder.
2.Even though it is called Tennis elbow it is more common in non tennis players.
3.X-Rays are almost always normal.
4.Sachin Tendulkar is the most famous non tennis sporting personality affected by the this syndrome.
5.Using heavy tennis rackets and cricket bats are cited to be the commonest cause of Tennis Elbow in Sports persons.
Preventing "preventable" Sports Injuries !!
An important role of a musculoskeletal specialist is to be able to identify and prevent injuries that are primarily due to ignorance and arrogance.This can be done cautiously by minimizing activity related injury and simultaneously increasing the benefit:risk ratio associated with physical activity,exercise and sport.Thus, many people can take to exercise as a healthy way of life rather than just going on a diet and consuming weight loss pills.Preventive sports medicine is a new branch of the widely expanding field of sports medicine.It is primarily identifying the people who are susceptible to sports injuries and advicing them against attempting certain exercises and sports so that the benefit of the training and sport exceeds the risk of injury.Prevention is Primary,Secondary and Tertiary.Primary prevention includes health promotion and injury prevention (e.g. lumbar supports worn during standing bicep curls).Secondary prevention is defined as early diagnosis and intervention to limit the seriousness of the initial injury and prevent re-injury.At this stage the role of a sports surgeon is of utmost importance in suggesting the appropriate investigation and to advice appropriate amount of rest needed for complete recovery.Reinjuries are almost always detrimental to soft tissue healing.Sprains and strains if identified early and treated will very rarely progress to a complete tear of the muscle.Tertiary prevention is the focus on rehabilitation and interventional treatment in order to enhance healing of the injured tissue and restore normalcy or atleast near normalcy.
Why not "paracetamol" ?
Paracetamol!!The wonder drug,the drug that is said to be so "safe" that it often replaces grandmother's home remedies when it comes to "pain relief" and "sardard se aaram". Its vital for us should know about the side effects and when not to take paracetamol.
The side effects primarily are liver,kidney and pancreatic damage when taken in dosages exceeding the allowed dose per day ,that is around 4000 mg.These changes are not evident on the first day of medication but are seen after four or five days(cumulative effect).People have had skin rashes and mild digestive problems after consumption of paracetamol.
If you are on a low calorie diet, have had jaundice recently, have consumed more than 350ml of hard liquor during the last 24 hours,are pregnant or are breast feeding you have to be very cautious about taking paracetamol.Please consult a physician before medication.
What exactly does ARTHRITIS mean?
Any inflammation of your joints which occurs with such repetitive consistency( I mean again and again) that it changes the surface of the joint, in such a way that your joint is unable to function painlessly is Arthritis. Sometimes, arthritis is fleeting or temporary, but it could also be persistent and occur at regular intervals such that it damages the congruity of the joint surfaces. Any two surfaces that are not congruous cannot function without causing problems like stiffness and pain.Stiffness is commonly experienced as soon as you wake up in the morning and attempt to stretch your muscles.Pain,also known as "start up pain" is characteristically felt when you start to use a joint.This pain disappears after the initial few moments. These symptoms commonly start in the smaller joints of your body like fingers, toes and ankles and then spreads to the larger joints like the knee and hip joint.
Unfortunately, there are very few disease modifying drugs for arthritis, most of the drugs available will only help in slowing down the disease.
The take home point today is-IF YOU THINK YOU MIGHT HAVE ANY FORM OF ARTHRITIS,IT IS BETTER TO KNOW WHAT KIND OF ARTHRITIS YOU HAVE,SO THAT WE CAN START WORKING ON SLOWING DOWN THE PROGRESSION OF THE DISEASE.... in order to give you a pain free life in the future.
Dr.Santhosh Jacob
"My heel hurts when I walk,what could it be ?"
Heel pain is pure misery
Did you realize, that it is one part of your body which is constantly and continuously at work, whatever you do.Yes! even when you sleep,you wiggle your toes and stretch your heel and ankle.Your feet have a thick layer of skin on which you walk,cushioned by a layer of fat inside.Now,this fat is something you would never want to loose,because it exposes your inner sole muscles and your plantar fascia.The plantar fascia is a band of fibrous tissue which runs from the ball of your foot to the base of the calcaneum(the bone on which you land when you take a step).The bones of your foot,the inner small sole muscles and the plantar fascia form the arch of your foot which is the most integral part of your walking mechanism.
An injury to, or defect in any of the above mentioned structures could be a cause of heel pain.The bad news is heel pain is considered too common a problem to see the orthopedist.As a result, many of us suffer silently all our lives till a point comes when we cant take it anymore,and then we call our physician.BY THIS TIME THOUGH, THE DAMAGE IS DONE!
So if you are not yet one of the many who have heel pain or are just starting to experience it,I will share a few things about the causes and treatment modalities available.Osteoporosis is one of the commonest causes of heel pain in women above forty.When the bones of your foot loose their integral strength and become sparsely populated with bone cells,due to more bone loss than bone formation(osteoporosis explained in a very simple way) the remaining bone cells are overburdened and cause severe pain when subjected to high levels of stress.This includes walking ,jogging and climbing stairs.
This can be treated by certain nutritional supplements and vitamin D based injections.Physiotherapy and rehabilitation play a major role in strengthening the muscles surrounding the bone.Plantar fascitis is an another cause of heel pain.A characteristic feature is that you will have relief of pain when you passively stretch your foot.You will also have pain when you press the heel of your foot.Plantar fascitis is an inflammation of the plantar fascia most commonly due to overuse and wearing high heels.Pain killers and modified footwear should suffice initially.Injecting steroids into your heel(Don't worry!! it wont hurt that much,you will be given local anesthesia first) gives symptomatic relief. At a later stage release of the plantar fascia is attempted and the results are promising.