Dr. Pardeep Bageja

The Anterior Cruciate Ligament or ACL tear is a very common problem with athletes and with people who have an active lifestyle. In fact, this can also be caused by any accident due to sudden movement.

Importance of ACL

The ACL is the supporting ligament, which runs diagonally from back to front right in the middle of the knee, connecting the femur bone and the tibia, and helps the tibia not to come before the femur. Thus the balance of the knee during back and forth movements and the entire stability of the knee joint is secured by this very important piece of ligament.

What leads to an injury to the ACL?

Here are a few actions that may result in a ligament tear.

1. Sudden stopping while running or slowing down from a fast speed

2. Sudden change in direction

3. Uncontrolled jumping from a height

4. Direct hitting with an object or person

What happens when the ACL is torn?

If the ACL is torn, the stability of your knee is gone, and you feel as if you have no control over the joint. Moreover, it causes extreme pain and instant swelling. Swelling usually appears within 24 hours of the injury.

Treatment of ACL Injury-

Recovery from an ACL tear is possible only after a surgery. Without surgery, the affected will not be able to return to sports or athletics, or may not be able to run and make swift movements again as before. However, to avoid surgery, there are non-invasive treatments for the aged and people who require moving less.

• Non-invasive Treatment: Bracing is one treatment where braces are given to support the knee joint during movement and also to avoid further injury. This is effective for the elderly who need minimum movement and may manage daily activities with a braced knee. Also, crutches add to the support and let the weaker knee get rest. This is followed by physical therapy. But the swelling has to reduce before starting it. Many exercises and controlled movements over a long time help in getting back agility in movement gradually.

• Surgical Treatment: Once the swelling subsides, doctors would plan for an Arthroscopic (Key-Hole Surgery) ACL reconstruction. In this Doctor make a graft of a tendon. This graft is inserted into the joint and fixed in anatomical position in femur and tibia Arthroscopically so that the newly created ACL functions like the natural one. This is the only way to get back the ligament in whole as the torn ligament cannot be stitched. Surgery is done through arthroscope and recovery time is 15 days for resuming day to day activities and 3 to 6 month for resuming sports activities with continued physical therapy after the surgery.

Heel bone spur is a form of calcium deposit that causes a bony protrusion under the heel bone. An X-ray can reveal up to a half inch elongation under the hill. Without image report, this condition is commonly known as heel spur syndrome. Heel spurs are mostly painless but reports of pain in not uncommon. They are often related to plantar fasciitis. The latter is an inflammation of the connective tissue that stretches through the foot bottom connecting the heel bone and the football.

What causes heel spurs?
Heel spurs are a result of prolonged calcium deposit. This condition can result from the heavy strain on the muscle of the foot and ligament, stretching of fascia and wear and tear of the heel bone membrane. These injuries are frequently observed among athletes who are involved with activities such as jumping and running. 

What are the risk factors?
1. Walking abnormalities that involve putting more than normal stress on the bone, nerve and ligament in and around the heel.
2. Running on surfaces that are hard in nature
3. Shoes lacking arch support
4. More than normal body weight 
5. Spending too much time on the feet
6. Too flat or too high arches
7. A person suffering from diabetes
8. In case the protective pad of the heel is fading away due to old age or other bone disorder

Non-Surgical treatment
Unlike common belief, only rest may not be the best way to treat heel bone spurs. On the contrary, a patient might feel sharp pain immediately after sleep. This happens when he tries to walk and the plantar fascia elongates all of a sudden. The pain decreases with more walking. Some treatment methods that work for 90 percent of the sufferers includes wearing the right shoe, stretching exercises, wearing orthotic devices inside the shoes and physical therapy. Over the counter medicine such as Aleve, Tylenol and Advil can be consumed to reduce the pain and for improving the overall condition. Corticosteroid injection also tends to give relief from the inflammation.

Surgical treatment
If heel spurs persist for more than 8-9 months, surgical options should be explored by the patient. There are two angles on which a doctor works, either removing the spur or release the plantar fascia. Pre-surgical exams are necessary to ensure that a person is eligible for surgery and all non-surgical avenues are explored. Post-surgical activities are equally important for the process of healing. Usage of bandages, crutches, splints and surgical shoes is a mandate to avoid complications such as infection, numbness, and scarring. Possible side effects should be discussed with the surgeon well before the surgery. The estimated healing time from this procedure is close to 8-12 weeks.

Foot arch pain is used in broader context for describing pain in bones, ligaments, muscles and nerve on the foot bottom. Slight damage to any of the components in the foot bottom can cause great pain. For starters, the pain lasts for a brief period, but increases over time if the condition is left untreated. Foot arch pain is more commonly witnessed in people over the age of 60 and among athletes engaged in sports of high impact.
The treatment plan of the pain totally depends on the cause. An early and right diagnosis goes a long way in treating the condition faster. For occasional mild to moderate pain, simple solutions such as footwear change can do the trick. Doctors often suggest four simple methods. This starts with rest followed by applying ice and then trying compression and elevation.

Anti-inflammatory medications are used to treat foot arch pain. Cases that are severe in nature can be treated with steroid and anti-inflammatory injections. For extreme cases, cortisol injections are prescribed too. This is done to relieve pain and release plantar fascia. Even stretching exercises are known to give relief from the pain. Some of the recommended exercises during this period are:

1. Stretch-related to plantar fascia: This exercise should be performed by crossing the legs at the junction of the knee. The body weight should be rested on the unaffected leg and it should gradually come down to touch the toe. The idea is to stretch the plantar fascia. A set of 20 such movements should be practised on a daily basis. Each movement should last for about 10 seconds.
2. Foot flexing: This exercise can be practised before getting out of bed. This is the tie when the pain from the plantar fascia is felt the most. This exercise should be repeated 20 times each lasting for about 10 seconds.
3. Rolling stretch: This exercise should be started by sitting in a chair. A tennis ball should be placed under the foot arch and the same should be rolled back and forth for ten times at a time. The same should be repeated with the second foot. Once this posture gets comfortable, the same should be practised by standing on the ball. It is known to be extremely useful for people suffering from foot arch pain.

How to prevent foot arch pain?
1. Wear shoes that are half an inch lose as they will make feel comfortable while walking
2. Losing weight; obese tends to cause pain in the foot arch
3. Performing free hand exercise and simple stretching on a daily basis
4. Not to overuse the foot. People who stand for more than 5-6 hours at stretch on a daily basis are observed to have foot arch pain.

What is Osteoporosis?
Osteoporosis is a medical condition wherein the bone becomes fragile and breaks easily even with a minor fall. The bones of spine, wrists and hips get affected the most. These fractured bones lead to severe pain and can force a person to become immobile. A spine fracture can even lead to a loss of height.

What is parathyroid hormone?
Parathyroid is a naturally occurring hormone that regulates the amount of calcium present in the body. They mitigate the risk of bone breakage in the body for a patient suffering with osteoporosis. These hormones are injected into the body on a daily basis to maintain the normal flow of calcium in the body.

How does the treatment work?
Treatments are available in the form of drugs and injections. A doctor can prescribe drugs, if the patient is at an increased rate of bone breakage. The parathyroid hormone helps to protect the bone from breaking, but have no role when the bone actually breaks. The body has a natural process of breaking a bone and rebuilding it by itself. Osteoporosis sets in motion when this process of bone formation is disturbed.

When does a doctor prescribe hormonal treatment?
If a patient has undergone a number of vertebral compression fractures and the condition has not improved, a doctor might suggest to undergo parathyroid hormone treatment. The treatment requires nursing support due to a patient’s delicate bone condition. A maximum dosage of 20 micro grams of parathyroid can be injected for a time duration not exceeding 2 years.

Things to know about the treatment:

1. Be informed: It is good to be well informed about the course of the treatment, treatment duration, plausible problems etc. This will help a patient to be on top of the decision making process. The helpline of the 'National Osteoporosis Society' can be reached to understand the preparation required for a patient to undergo the treatment.
2. Take the right dosage at the right time: Parathyroid injections should be injected on a daily basis for a maximum time period of 2 years. These injections are taken daily at the same time. It should be ensured that none of the injections are skipped without the prior approval of a doctor. The injection, which lasts for 28 days, needs to be stored in a refrigerator. In case a patient is travelling, special bags are available that has space for storing gel packs.
3. Side effects: Most patients do not report any side effects, but they do exist. Possible side effects include dizziness, arthralgia, depression and headache. These symptoms often suggest that your body is reacting to the parathyroid hormone treatment. A doctor may or may not prescribe any further drugs to address these symptoms.

Dislocation refers to an injury, which causes the bones to abnormally separate from each other in the joint, which is the meeting place of the bones. Dislocation causes intense pain and is most common in the fingers, shoulders and the elbows. Although a timely diagnosis can make your pain go away, any future injury in the tendons or the ligaments might bring back the injury. 

What can cause a dislocation?
The causes of dislocation are as follows:

1. A body joint can get dislocated if you have suffered a fall.
2. If you are into any form of sports that requires strenuous physical activity and intense exertion on certain body parts like gymnastics, football or volleyball you have a chance of suffering from dislocated body joints.
3. Automobile accidents can also cause dislocation of joints.
4. Some People who are with a loose ligament and are more likely to get a dislocated joint than other people. This may happen without the influence of a major physical trauma or stress.

Understanding the signs and symptoms
In the majority of the cases, a dislocation of the joint is easily detectable as it induces inflammation along with redness and deformation of the affected area. Some of the other symptoms that might occur as a result of the dislocation of the body joints could be: 

1. You might experience severe pain while moving the dislocated joint.
2. There will be a lack of sensation near the dislocated portion.
3. There might be a stinging sensation in the dislocated area.
4. In certain areas you may not be able to move the joint at all

If you have a dislocated joint, the doctors can easily relocate them. Depending on the amount of swelling and pain you are experiencing, the doctor might administer local anesthesia during the process. If the joint dislocation is too severe or has multiple instances of dislocation, then you may have to undergo surgery. Surgery may also be suggested if the adjoined ligaments or tendons are severely affected along with the joints. In case you have a concern or query you can always consult an expert & get answers to your questions!

As you age, the cartilage cushioning your joints starts wearing down, causing the bones to rub against each other. This causes osteoarthritis, which is a type of degenerative disease caused. The rubbing of the bones causes inflammation of the joints. The joints of the arms and legs along with the lower back are most commonly affected by this condition.

Here are some common symptoms, which indicate that you are suffering from osteoarthritis:

1. Pain and tenderness: An aching back, knees, neck and hip with severe pain are some of the most common symptoms of osteoarthritis. The pain caused during the early stage of arthritis is classified into tenderness and pain. A sharper pain may be felt while moving the affected joint in a certain way. Tenderness is the discomfort experienced when the joint is pressed along with visible swelling in the affected area.

2. Joint stiffness: Joint stiffness is another early symptom of osteoarthritis. It refers to the wooden feeling, which makes a person feel slow and sluggish. The urge to rest or go to bed should be resisted. Warming up the joints with gentle exercise or moving around cause relief. It also helps in reducing the stiffness and you can continue your regular activities with more ease.

3. Abnormal sensations: When the cartilage wears down, the rubbing of the bones against each other may lead to some abnormal sensations. Grating of the joints is common in people with osteoarthritis. One may feel that their joints are cracking or clicking while moving.

4. Loss of flexibility: People who are in their early stages of osteoarthritis may face difficulty with moving the areas which are affected. This joint stiffness and pain may lead to a loss of flexibility or loss of range of motion. Range of motion refers to the extent up to which one can move his joints normally. In case you are not being able to bend your knee fully or as far as you would have done it normally, you might be experiencing osteoarthritis.

Loss of flexibility occurs slowly and gradually. A person may hurt his back unusually during a football game or may experience a stiff back in the morning after waking up. This gets more intense with time. In the later stages, you may experience joint pain even while resting.

In case you experience any symptoms of osteoarthritis, you must consult a doctor immediately. The doctor will provide you with a plan aimed at managing and getting a quicker relief from the pain caused due to osteoarthritis. Several over-the-counter medicines, braces for supporting affected joints and range of motion exercises are also effective ways of managing osteoarthritis. In case you have a concern or query you can always consult an expert & get answers to your questions!