When we speak of bone health, calcium is usually the hero of the story. However, by itself, calcium is not enough for healthy bones. Vitamin D is equally important for healthy bones and the prevention of orthopedic conditions.

What does Vitamin D do?
Vitamin D helps the body absorb calcium from the food being eaten. It also controls the calcium and phosphate levels in the body. This is critical for the growth and development of new bones. Vitamin D also controls how much calcium and phosphates are being expelled by the body. In this way, vitamin D helps strengthen the bones and improve overall bone health.

Vitamin D Deficiency
Vitamin D is not commonly found in food. It is present only in certain types of oily fishes, egg yolks and mushrooms. Most of the vitamin D we eat comes from fortified cereals, breads and dairy products. The sun is an important source of vitamin D but exposing yourself to too much sunlight could cause various skin problems. Thus, vitamin D deficiency is very common. When it comes to bone health, vitamin D deficiency can cause low-density bones. This, in turn, can cause rickets and osteoporosis. People with vitamin D deficiency are likely to suffer frequent fractures. Vitamin D deficiency can also cause skeletal deformities such as bow legs and a stooped spine.

Vitamin D and Osteoporosis
Osteoporosis is a musculoskeletal condition that is marked by low bone density. Studies have shown that people with osteoporosis have lower levels of vitamin D as compared to others. Some studies also suggest that fractures are more common in winter as compared to summer. The winter sun is often hazy and many days can go by without strong sunlight. Thus it can be inferred that people do not get their required quota of vitamin D from the sunlight in winters leading to a deficiency and aggravated osteoporosis-related fractures.

Who is most susceptible to bone conditions caused by vitamin D deficiency?
Vitamin D deficiency is a very common condition across the globe. Some surveys have claimed that approximately 30% of the global population suffers from vitamin D deficiency. People with dark skin, women and elderly people are most susceptible to this deficiency. People suffering from kidney diseases may also be affected by vitamin D deficiency. Vitamin D supplements are usually very helpful in combatting this deficiency. These can be taken by young children as well as adults.

Relation Between Vitamin D Deficiency And Bone Problems!

Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

4 exercises to strengthen your knees

Knee pains and pains in the joints are not restricted to a certain age group anymore. Younger people of today face this problem too. To stay active all your life and escape the severe aches associated with weakening of muscles, joint pains or arthritis, you must start now. The only way to keep your knees fine and working is to exercise. 
4 moves that help you strengthen your knees.
1. Leg lifts (inner thigh) - lie on any one side, lay your head on the arm of the side below you. Make sure this hand is straight above your head, touching the ground. Keep your legs straight, one above the other. Lift the leg on top a few inches above, hold for few seconds and bring it back. Do this for 10 times and then with the other leg, on the other side. This exercise strengthens your inner thighs, eventually strengthening the knees.
2. Hip raises: lie flat on your back, your shoulders touching the ground. Bend your legs comfortable, your feet resting firmly on the ground. Raise your hips and thighs so that from your head to feet, you form an angle. Wait in this position for about 10 seconds, lower your hip until it touches the ground. Repeat for ten counts.
3. Lunges: stand straight. Take a step ahead with your right leg. Left leg remains in its place. With your back straight, bend your knees so that both are at 90 degrees. Go back to standing position; take your right leg back to where it was. Do the same step with your left leg. Repeat both sides ten times.
4. Bent leg extensions: this is pretty easy and all that you need to do it sit on a chair comfortably, with your back straight first. Your feet firmly flat on the ground in front of you, lift the right leg straight extending to the front. Make sure your thighs stay on the chair. Bring your leg back to the original position, firmly planted on the ground. Do the same with your left leg. Repeat 10 times on both sides.
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The Only 4 Moves That Strengthen Your KNEES

Care for shoulder pain and related problems

Shoulder problems usually happen because of internal problems or external trauma. People who are into any form of manual labour, pick up a lot of heavy things regularly or play sports experience shoulder pain at some point of time or other. Shoulder pain can be detected by physical examination, mri, x-ray, ultrasound and medical history.

The most common types of shoulder problems are arthritis, fracture, dislocation, frozen shoulder, rotator cuff tear, and rotator cuff disease. Cures for the different shoulder pains are different. Follow these simple ways to help you manage the pain.

1. Rest the hurtful shoulder: you need to take ample rest. Using the arm which is affected is not a good idea and needs to be avoided. If your job involves manual labour, it is advised that you stay at home to rest.

2. Ice pack healing: applying ice pack on the wound is also advised around 3-4 times in a day. This varies as per the kind of shoulder pain, so doctor's advice must be followed.

3. Be consistent with exercise: depending upon the source of pain, physiotherapist will advise certain sets of shoulder exercises. It is very important that they should be performed diligently for fast recovery.

4. Support it well: wearing a sling is extremely important and should not be taken lightly at any point of time. A good support will ensure there is no mislocation and faster recovery.

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Shoulder Pain Care - 4 things you must not ignore!

Myths about Total Knee Replacement

Myth#1 - Knee replacement is a surgery for old people. “I’m too young for a knee replacement.”
Fact - Candidacy for a knee replacement is not based on age, but on the person’s level of pain and immobility. Living with a painful joint that prohibits you from working or participating in normal life activities is an outdated way of thinking. Age is not necessarily a limiting factor. Often times, a patient is actually fearful about the uncertainty of surgery. Once they are able to resume many of the activities they enjoyed before the surgery, with increased mobility and with less pain, they are very happy they had the surgery. The quality of life one achieves by living without knee pain is priceless.

Myth#2 - “I should wait as long as possible to undergo knee replacement surgery” 
Fact - You don't need to suffer by waiting until the pain is intolerable. The longer life of joint replacements enables people to consider surgery earlier and at a younger age. Osteoarthritis is a degenerative disease that continues to damage the joint and delaying surgery makes both surgery and return to activity more difficult. Delaying surgery lowers a patients’ quality of life not only before the operation, but even for up to two years following surgery.

Myth#3 - “I should continue with medications as long as possible”
Fact - Medicines including painkillers just give symptomatic relief for a temporary duration and prolonged usage is riddled with serious side effects such as renal failure, peptic ulceration  etc. All these medicines are NOT curable.

Myth#4 - Alternative therapies such as acupressure, ozone treatment, massage beds, oils, laser therapy, magnetic therapy; braces will cure my advanced arthritis and knee pain.
Fact - Till date there is NO cure for advanced knee arthritis and these alternate therapies are not backed by established scientific data. All these modalities give temporary pain relief in early to moderate arthritis for some duration only and are NOT curative. Often times, a patient who is actually fearful about the uncertainty of surgery lands up trying these in order to avoid surgery. 

Myth#5 - After a knee replacement, it takes months to recover.
Fact - Depending on the activity, most patients who undergo knee replacement are able to perform routine tasks within a few weeks. A return to rigorous activity takes only a few months. One becomes independent for himself before discharge from hospital. There’s no prolonged best rest required after the surgery.


Myth#6 - After knee replacement, I’ll have to give up some activities and sports.
Fact - You have a high probability of getting back to activities like brisk walking or cycling in 6 to 12 weeks. It will take a bit longer to return to more rigorous activities and contact sports. Squatting and sitting cross legged though possible but at best should be kept to minimal.

Myth#7 - Knee replacement surgery leaves a large scar that is noticeable.
Fact - Scarring is minimal compared to traditional surgery. In fact, the scar is typically only 3 to 5 inches long. As time passes, the scar will fade and become less noticeable.

Myth#8 - Knee replacement is a very painful surgery. There is lots of pain in post operative period.
Fact - With modern day pain management such as in a multimodal approach, ensures that the patient does not feel any pain in post op period and has a smooth recovery.

Myth#9 - Knee replacement is done one at a time.
Fact - Both the knees can be operated at the same time if the patient does not have significant co morbidities and is deemed fit to undergo the procedure by the doctor.

Myth#10 - The new knee lasts for 5-6 yrs. only.
Fact - With modern day precision including computer assisted knee replacement and advancement in biomaterials, the survivorship has increased considerably. Today's joint replacements last 25 years or longer and, for most people, will last a lifetime.

Myth#11 - Knee replacement cannot be done a second time.
Fact - Knee replacement can be done multiple times what is called as a revision joint replacement surgery with good survivorship.

Myth#12 - “I am obese, I cannot undergo Knee replacement surgery.”
Fact - Knee replacement can be successfully done in an obese patient though the recovery is somewhat prolonged and might require additional implants. However, patients who are morbidly obese and have restricted mobility primarily due to obesity are better off after a bariatric procedure.

Myth#13 “I have diabetes or hypertension or heart ailment, so  I cannot undergo Knee replacement surgery.”
Fact  - diabetes hypertension or heart.



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 13 Myths About Total Knee Replacement (TKR), Busted!

Are you experiencing a swollen and painful joint and are looking for an effective way to treat it? You can choose homeopathic treatment, which is considered to be ideal for joint pain and inflammation, as it does not have any side effects. When a joint swells up, gets inflamed, or damaged due to an injury, joint pain is experienced. Aging and several medical conditions such as gout, osteoarthritis, rheumatoid arthritis, general injuries, and sprains are common causes of joint inflammation and pain. A wide range of homeopathic medicines is used for the management of joint pain and inflammation.

Here is a list of the top homeopathic medicines used for this condition along with the symptoms when they are prescribed for use:

Rhus Tox- This homeopathic medicine is very effective in treating joint pain. Both acute and chronic joint pains are cured by this medicine. It is used when a patient experiences marked stiffness in the joints along with intense pain. The medicine treats all kinds of joint pains, starting from rheumatic reasons to injuries caused due to overexertion. Usually, the joint pain gets better with movement and worsens if you are immobile.

Sanguinaria Can and Ferrum Met- Sanguinaria Can is used for treating joint pains which occur in the shoulder. It is most effective in the case of right-sided shoulder joint pains. The right-sided shoulder of the patient may feel stiff and the pain worsens with any kind of motion. The right shoulder joint pain increases during the night. On the other hand, Ferrum Met is used in the case of left-sided shoulder pain. The patient experiences stiffness and cracking in the left shoulder joint along with great pain. The pain increases if you raise your arm and with any kind of movement.

Bryonia and Ruta- These homeopathic medicines are used for the management of joint pain in the elbows. Bryonia is used when the elbow joint pain increases even without movement. It provides sustained relief. The pain is also accompanied by stiffness and swelling in the elbow joint. Ruta, is an effective homeopathic medicine which is used for elbow joint pain treatment, especially when the pain is located near the condyles. Stretching and raising your arms trigger the pain. This medicine is also used in case of inflamed and sore tendons near the elbow joint, which cause pain.

Other homeopathic medicines such as Actaea Spicata and Rhododendron are used in the case of treating joint pains in the wrist. You should consult a qualified homeopathic practitioner before taking medicines for joint pain.

Homeopathic Medicines for Joint Pain & Inflammation 

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