Dr. Bharat Singh

Back pain is a common problem that most of us have suffered from. A pain anywhere in the spine- upper, middle or lower back – are all classed under the category of back pain. It’s a large category but it’s important to note that back pain can be caused due to a number of factors.

Causes
The causes of back pain can be varied because the human vertebra is composed of a complex structure of muscles, ligaments, tendons, disks and bones. Disks are cartilage-like pads that cushion the vertebrae, and problems with any of these can lead to back pain. Some of the common causes of back pain are:

1. Changes in the bony lumbar spine
2. Problems in discs between the vertebrae like hernias, bulges etc.
3. Problems in ligaments around the spine and discs
4. Due to changes in spinal cord and nerves
5. Weakened lower back muscles
6. Problems in abdomen and pelvic internal organs
7. Osteoporosis
8. Posture and lifestyle

Some of the other factors that can cause back pain are:

• Age: You can suffer from back pain at any age but the older you get, the more your chances of getting back pain. It is significantly more common among adults aged 35 or above. Strain is the most common cause of back pain. It can be due to strained muscles, ligaments or a muscle spasm caused due to lifting something too heavy or not using the correct posture when lifting something. It can also be caused due to an abrupt and awkward movement Arthritis can also cause back pain as it may cause a narrowing of the space around the spinal cord known as stenosis. Abnormal curvature of the spine can also cause back pain.
• Other reasons: Issues such as Cauda equina syndrome which affects the bundle of spinal nerve roots that arise from the lower end of the spinal cord and cancer of the spine or a tumour located on the spine which presses against a nerve can result in back pain. Infections of the spine or other infections such as pelvic inflammatory disease in women, bladder, or kidney infections may also lead to back pain.

Symptoms
Pain in the spine is the most common symptom of back pain. Other symptoms can be tenderness, numbness, inflammation, and pain in legs or hands. The nerves of the back could be affected by structural problems in the spine such as a bulge in the disc or herniation or disc rupture. This can press against a vital nerve which controls muscles in arms and legs, causing pain.

Treatment

• Back pain can usually be managed with over-the-counter (OTC) painkillers and by applying a hot compress or an ice pack to the area to relieve pain.
• Resting also helps.
• A change in lifestyle especially by improving body posture while using the computer at work, will be effective.

If the first line of treatment doesn’t work, doctors would prescribe

1. NSAID Medication: These are non steroidal anti-inflammatory drugs such as Codeine or hydrocodone which are prescribed for short periods
2. Physical therapy: This therapy uses the application of heat, ice, ultrasound and electrical stimulation to the back muscles and soft tissues to help alleviate pain. A physical therapist would suggest flexibility and strength exercises for the back and abdominal muscles. They would also suggest ways to improve posture and hence reduce back pain.
3. Cortisone injections: In severe cases, back pain sufferers would be given cortisone injections in the epidural space, which is the space around the spinal cord, to reduce pain by reducing inflammation.
4. Surgery: This is useful for treating herniated discs, ruptured discs or a bulge. Tumours are also removed surgically to treat back pain.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Bones and muscles, together known as the musculoskeletal system, are responsible for all bodily movements. The bones and muscles move in unison, as they are connected by what are known as tendons, which are thin fibrous tissue. These tendons are prone to damage and inflammation known as tendinitis (this can cause inflammation in any organ). It can occur in any bone/joint but most common in areas which are prone for repetitive use including the wrists, arms, elbows, shoulder, knees, and ankles.

Read on to understand how it happens and how it can be managed.

Causes: Depending on the onset, tendinitis can be acute or chronic. Though it can occur in any individual, the risk increases with age, as bones lose their elasticity and can tear.

• Acute is caused by a sudden injury like a fall or accident or infections
• Chronic is caused by repetitive movements, poor posture, poor stretching, overuse, etc. Some common movements include carpentry, painting, golfing, tennis, gardening, lawn mowing, badminton, etc.

Symptoms: As with any inflammation, the symptoms of tendinitis would include swelling, pain, redness, and warmth. There is also a reduced range of motion of the affected joint, producing what is known as adhesive capsulitis.

Prevention: Tendinitis is preventable to some extent by avoiding repetitive work and overuse of the joint. Those who are used to a lazy week and an active weekend should definitely watch out. Sudden, excessive stress can cause tendinitis. The tendons should be subjected to limited stress and activity. With any kind of activity, if there is even a slight hint of pain or any issue, get it checked with the doctor. Continuing to do the same activity will only make it worse. Symptoms to watch for include fever, swollen and painful joints, and limited movement of the affected joint.

Management: If identified and arrested in the early stages, tendinitis can be managed conservatively. Progressive measures of treatment would include the following.

• As soon as there is discomfort identified, rest the joint and stop any activity, which you think could have caused the problem. Usually, this should help the condition to subside on its own. Ice and heat therapy can also help.
• If it is the ankle or the knee, keep it elevated.
• Pain killers may be taken if the pain cannot be tolerated or is affecting daily routine.
• After the initial week, mild exercises to strengthen the tendon can be started.
• Steroid injections may be required in cases where the joint pain and swelling is significant.
• As a last resort, if the above measures do not work, surgery may be recommended. This will again be followed by rest, medications, and physical therapy.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Osteoporosis in very simple terms is a condition that causes spongy bones. The bones develop pores and become fragile with an increased susceptibility to fractures. In average, all our bones get weak after the age of 35 years which means that the bone mass decreases. Women after menopause are especially susceptible to this condition and also osteoporotic fractures. What are the other risk factors for osteoporosis? Knowing this is important for your bone health as it will help to prevent fractures. But before we discuss the causes of osteoporosis, it’ is important to point out that osteoporosis has no symptoms and it can only be diagnosed when you have a fracture for no reason at all, or you get a bone density test to diagnose osteoporosis.

Some of the factors that can lead to osteoporosis are:

• Genetics
• Lack of exercise
• Low calcium and low vitamin D levels
• A personal history of fracture as an adult
• Smoking
• Excessive alcohol consumption
• Rheumatoid arthritis
• Low body weight
• Family history of osteoporosis which means having a mother with an osteoporotic hip fracture doubles your risk of a hip fracture as well
• Chemotherapy for treating cancer also increases the risk for osteoporosis as it causes early menopause.
• In men low testosterone levels known as hypogonadism can cause this condition.
• The absence of menstrual periods known as amenorrhea in younger women also predisposes them to osteoporosis as it causes low estrogen levels. Amenorrhea can occur in women who undergo extremely vigorous physical training or those that practice extreme dieting. As their body fat goes down they experience amenorrhoea.
• Chronic inflammation, due to chronic inflammatory arthritis and also liver disease can cause osteoporosis.
• Any condition that interferes with walking such as stroke can cause spongy bones.
• Hyperthyroidism, a condition that causes an increase in production of the thyroid hormone can cause spongy bones too.

Some other factors that can lead to it

• Hyperparathyroidism a disease where there is an increased parathyroid hormone production by the parathyroid gland. This hormone maintains blood calcium levels by absorbing calcium from the bones. This can cause osteoporosis.
• Low vitamin D causes low absorption of calcium from diet and hence you are at a risk of developing osteoporosis. Conditions such as celiac sprue or biliary cirrhosis which hamper the absorption of vitamin D can also cause osteoporosis.
• Medications such as heparin, a blood thinner, anti-seizure medicines such as Dilantin and phenobarbital, and long-term use of oral corticosteroids- can all up osteoporosis risks.

The diagnosis of osteoporosis is simple and it is advisable that older people especially women get periodic X- rays and bone density tests to rule out this bone condition.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Rheumatoid arthritis (RA) is an auto-immune disorder which induces inflammation in the joints. What causes the condition is not exactly clear, but a lot of studies have been done to establish a connection between various factors such as, diet, exercise, etc., with this condition. These studies have come up with correlation between foods and rheumatoid arthritis. There are some foods which should be a part of your diet, and some that should definitely be avoided if you have to keep the joint inflammation under control. Read on to know the top 5 foods to eat and to avoid.

What to eat?

1. Soy: Being rich in protein and fiber and low in fat, soy is a great food for RA. It also contains omega-3 fatty acids and vegetarians especially should ensure they get enough soy in their diet.
2. Fish: Salmon and tuna are fish that are rich in omega-3 fatty acids and these are proven to be natural anti-inflammatory agents. Therefore, it is highly recommended that people with RA eat fish about 3 to 4 times per week.
3. Oils: While an oily diet is definitely to be avoided, some healthy oils should be included. These include sunflower oil, walnut oil, olive oil, and avocado oil. These are known for their anti-inflammatory properties and are beneficial in people with RA.
4. Green tea: Known for their polyphenols and antioxidants, green tea reduces damage caused by inflammation in RA. People with RA are recommended to have at least 2 servings of green tea daily.
5. Beans and legumes: The high content of fiber, protein, folic acid, zinc, iron, potassium, and other minerals makes beans a must-have for RA patients. The red and kidney variety of beans are the preferred ones.

What to avoid?

1. Grilled foods: Grilled chicken or red meat have high levels of advanced glycation end products (AGEs) which are known to worsen inflammation. So, while they are good for weight watchers, not so if you have RA. These also contain higher levels of saturated fat, which is again not advisable for RA.
2. Fried foods: These contain 6-omega fatty acids, which have been proven to worsen inflammation. They are also high in saturated fats, which is a strict no-no for inflammation.
3. MSG: Monosodium glutamate which is used generously in various Oriental dishes including soups, salad dressings, etc. should be avoided as it affects liver health and worsens inflammation.
4. Salt: Reduce overall salt intake. Limiting the intake of pickles, salad dressings and processed foods, etc., which contain high amounts of sodium.
5. Alcohol: This again increases inflammation and should be avoided in RA.

A healthy lifestyle improves not just the overall quality of life, but also reduces the severity of symptoms of RA.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Rheumatoid arthritis is an autoimmune disorder. It affects the joints as well as the skin, lungs, heart, eyes and blood vessels. This condition is most notorious for the pain and discomfort it causes in the joints. Unlike osteoarthritis, it does not attack the cartilage but affects the lining of the joints.

This results in erosion of the bone tissue and can even cause deformities. There is no known cure for this condition and treatment is mostly focused on relieving the pain caused. Some of the ways to manage your pain are:

1. Medication: Medication can help control the inflammation and pain caused by rheumatoid arthritis. Disease-modifying antirheumatic drugs or DMARDs are usually the first course of treatment. These may be accompanied by steroids and help reduce inflammation. The best medication to relieve pain is non-steroidal anti-inflammatory drugs or NSAIDs. In some cases, stronger pain relievers may be prescribed but these should be used cautiously. Excessive dependence on pain relievers can cause addiction.
2. Change Your Diet: A diet rich in Omega 3 fatty acids can help control inflammation. In turn, this can help relieve discomfort and slow the progression of the disease. Cold water fish and fish oil supplements are rich sources of omega 3 fatty acids. In addition, it is important to have a well-balanced diet and to avoid excessive carbs and sugars that can lead to weight gain. It is important to note that heavier people suffer from more pain as their weight puts pressure on the joints.
3. Exercise Regularly: Rheumatoid arthritis makes movements difficult and hence exercising may seem counterintuitive but this can help in the long run. Avoid high-intensity workouts and pick low-intensity activities like walking, cycling, swimming etc. Water aerobics is one of the best forms of exercise for rheumatoid arthritis. Yoga can also be very beneficial. Regular exercise is important but it is also important not to overdo it. Put exercising on hold during acute flare-ups and avoid doing anything that increases your pain. It is a good idea to consult a physical therapist to know what the best type of activity is for you.
4. Hot and cold packs: Heat and cold therapy can help relieve pain immensely. A hot pack will help relax the muscles while the cold pack will numb the pain. Heat packs and cold packs can be used alternatively. Alternatively, you could soak the affected joint in hot water and cold water.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Juvenile rheumatoid arthritis also known as juvenile idiopathic arthritis is a commonly occurring arthritis in children under the age of 15. Some common problems that are faced by patients with this disease include stiffness, joint pain, and swelling. While the symptoms might persist for a few months for some patients, for others it might continue for the rest of their lives. Patients might face serious complications such as inflammation of the eye, problems related to growth etc. The treatment of this condition focuses on preventing the bones from getting damaged, pain control and improving the function of the body.

What are some of the common symptoms of juvenile arthritis?

1. Pain: A child suffering from juvenile rheumatoid arthritis might face extreme pain in the joints. They might limp after a nap or night sleep due to pain or stiff joints.
2. Swelling: Larger joints such as the knee might swell frequently. The swelling might occur in smaller joints too.
3. Stiffness: In addition to limping the child might appear rough and clumsy after waking from night sleep or a nap.

Other conditions could include rashes, swollen lymph nodes, frequent fever, headache, etc.

What are the causes of Juvenile Rheumatoid Arthritis?
Juvenile Rheumatoid Arthritis occurs when the immune system of the body attacks its own tissues and cells. It is still unclear as to why it happens, although, researchers believe that the environment and heredity have a role to play. Certain geneticmutations might make a childmore vulnerable and susceptible to microbes that can trigger this condition.

What are the complications involved?
There could be several complications that might arise due to this condition. It is, therefore, wise to keep a close watch on the child. Seeking immediate medical attention can go a long way in mitigating the risk of these complications.

• Problems related to the eye: Juvenile Rheumatoid arthritis can damage the eye by causing an inflammation known as uveitis. If this condition is not treated, it might result in other conditions such as glaucoma, cataracts, blindness etc.
• Growth problems: Juvenile rheumatoid arthritis could result in growth problems. To treat this, a child would require a dose of corticosteroid.

How to diagnose juvenile arthritis?
It is not very easy to diagnose juvenile arthritis. Doctors often prescribe blood tests to get an idea of erythrocyte sedimentation rate, rheumatoid factor, C-reactive protein, anti-nuclear antibody, cyclic citrullinated peptide etc. A doctor might also prescribe imaging tests such as X-rays, MRI etc to detect congenital defects, fractures, tumors etc.

What are the treatment options available?
Some of the medications that are prescribed for this condition include NSAID such as ibuprofen and naproxen, DMARD such as Trexall and Azulfidine, TNF blockers such as Humira and Enbrel, immune suppressants such as Kineret, Rituxin and Orencia. In addition to this doctors would also prescribe corticosteroids and therapies.

In case you have a concern or query you can always consult an expert & get answers to your questions!

There are so many things we take for granted. For example, have you ever thought about how your fingers bend or how your knees open and fold to help you walk? It is only when these simple acts start becoming uncomfortable that we take a closer look at them. Osteoarthritis is a common musculoskeletal condition that affects the cartilage in our joints. As the cartilage breaks down, bones lose the buffer between them and every movement becomes stiff and painful.

Here are a few things you should know about osteoarthritis.

1. Osteoarthritis is common: Osteoarthritis can affect both men and women but men have a higher risk of osteoarthritis as compared to women. This risk increases with age. Other risk factors associated with osteoarthritis include obesity, genetics, muscle weakness and previous joint injuries. The joints most commonly affected by osteoarthritis include the knees, hips, and spine. It is important to note that though this condition is common, it is not inevitable.
2. You can reduce your risk of Osteoarthritis: By making a few lifestyle changes you can reduce the chances of suffering from this condition. Controlling your blood sugar and weight are primary amongst these. Regular exercise is also necessary as it increases flexibility and keeps the joints supple. It also strengthens the bones and muscles. If your work involves heavy lifting avoid placing stress on your knees and instead lift the weight with your hips.
3. Different people have different symptoms: This condition has a very slow progression rate and hence may go unnoticed in its early stages. While some people experience pain in the early stages, others may not realize anything is amiss until an X-ray shows the degenerated cartilage. It also progresses at different rates for each individual. The condition will progress faster in the case of people living with heavy stress or those with a sedentary lifestyle. Some of the common symptoms associated with osteoarthritis include pain, stiffness, and swelling of the joints. Along with an X ray, blood tests will also be conducted to diagnose osteoarthritis. This helps rule out any other type of arthritis. In rare cases, osteoarthritis can cause joint deformities.
4. Exercise is the best treatment for osteoarthritis: At present, there is no known cure for this disease. Medication can help relieve the pain caused by movement but cannot help stop the cartilage degeneration or help new cartilage grow. However, exercise can be very beneficial. This helps strengthen the muscles around the joint and can even slow down the rate of degeneration. Low-intensity exercises such as walking, swimming, yoga, and cycling are ideal for osteoarthritis patients as they do not put any pressure on the joints.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Normally, the body’s immune system recognizes any foreign body as an antigen and produces what are known as antibodies. However, in autoimmune disorders, the body produces antibodies against the body’s own tissue. This is an abnormality and depending on what factor is triggering the production of antibodies, there are various types of autoimmune disorders (AID). When we look at the musculoskeletal system, there are quite a few, the top 4 being:

1. Scleroderma
2. Systemic lupus erythematosus
3. Sjogren’s syndrome
4. Rheumatoid arthritis

In all these conditions, the body produces antibodies against its own tissue, producing these conditions.

Causes:

1. Family history is definitely an attribute to developing autoimmune diseases
2. Environmental pollution
3. Lifestyle including lack of exercise, smoking, excessive alcohol use

Know more about these:

1. Scleroderma: Can be localized or generalized, the upper layers of the skin get thicker (sclerosis). This can be nodular or diffuse, and can also affect children. The skin and muscles are usually affected, but in severe cases, it can affect internal organs such as lungs and heart.
2. Systemic lupus erythematosus: SLE, as it is often called, is very common and can be diagnosed as scleroderma in the initial stages. It can also occur with other autoimmune conditions and some of the types include cutaneous lupus, systemic lupus, drug-induced lupus, and neonatal lupus.
3. Rheumatoid arthritis: The most common autoimmune rheumatic disease is RA, which causes inflammation of the joint spaces. There would be pain, stiffness, and swelling of the joints. This needs to be segregated as RA, as the symptoms are similar to any other form of arthritis. Treatment includes a combination of pain killers, heat and cold therapy, massage, steroid injections, and immune controlling agents.
4. Sjogren’s syndrome: The symptoms are characteristic with dry mucous membranes including those of the eyes, mouth, and vagina. There could be accompanying pain and redness, significant fatigue, fibromyalgia, and complications relating to other organs.

Diagnosis: Autoimmune diseases are tricky to diagnose as other diseases with similar symptoms need to be ruled out first. In some cases, there are specific antibodies, and checking their levels can help identify the underlying condition.

Management: For all the rheumatic autoimmune diseases, treatment is a multipronged approach with lifestyle changes, drugs, and alternative therapies.
Lifestyle changes: A healthy diet, regular exercise, and adequate vitamin and mineral supplementation is a must.

Drugs: Some drugs used are:

1. Anti-inflammatory drugs
2. Steroids
3. ACE inhibitors
4. Immunomodulatory therapy
5. Stem cell transplants

Alternative therapies such as massages with herbal oils, acupuncture, and cold therapy are widely used to control inflammation. In addition, alcohol and smoking and exposure to environmental pollution need to be controlled.

In case you have a concern or query you can always consult an expert & get answers to your questions!

The human spine has 33 vertebrae. However, some conditions can fuse these vertebrae. Ankylosing Spondylitis is one such condition. This disease may also be known as AS or Bechterew's disease. It is an inflammatory disease that can make the spine less flexible by fusing the vertebrae of the lower back together. In some cases, it can also affect the rib cage and make it difficult to breathe. This disease typically affects more men as compared to women. Most patients begin showing symptoms in early adulthood.

Ankylosing Spondylitis affects the sacroiliac joints. These joints are located just above the tailbone. It causes inflammation of the spinal bones that in turn cause pain and stiffness. With time, this inflammation spreads to the entire spine and the vertebrae begin fusing together. This can make movement difficult and painful. In severe cases, it can also lead to the development of a hunchback. This disease also affects the other tissues of the body. For example, it can affect other joints and aggravate arthritis or affect organs such as the kidney, heart, lungs, and eyes.

A specific cause has not yet been identified for Ankylosing Spondylitis. However, studies show that genetic factors can be a trigger. In particular, the presence of the HLA-B27 gene increases a person’s risk of developing symptoms pertaining to this condition. However, it is important to note that merely the presence of this gene does not make Ankylosing Spondylitis inevitable. Other genes that are associated with this disease are ARTS1 and IL23R. These genes influence the functioning of the immune system. While it can affect people of all ages, adults are at a higher risk of suffering from this condition.

In many cases, the initial inflammation of the spine is due to a bacterial infection of microbial infection. Though the infection itself may be treated and cured, it may cause the immune system to react and trigger inflammation. Once activated, if the immune system cannot be turned off, this inflammation will continue and can trigger Ankylosing Spondylitis. In each case, the disease presents a unique pattern of progression.

There is presently no cure for this condition, but with an early diagnosis and treatment, the symptoms can be managed and progression can be slowed. This treatment usually takes the form of medication to relieve pain, inflammation and discomfort and physical therapy. Surgery cannot be used to treat Ankylosing Spondylitis but in cases where it has caused severe joint damage, surgery may be advised to replace the damaged joint. If you wish to discuss about any specific problem, you can consult a Rheumatologist.