Upper Back Pain Related To Heart Problems

Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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The "normal" range (or negative test result) for rheumatoid factor is less than 14 iu/ml. Any result with values 14 iu/ml or above is considered abnormally high, elevated, or positive. Treatmentthere is no cure for rheumatoid arthritis. But clinical studies indicate that remission of symptoms is more likely when treatment begins early with medications known as disease-modifying antirheumatic drugs (dmards). Medicationsthe types of medications recommended by your doctor will depend on the severity of your symptoms and how long you've had rheumatoid arthritis. •nsaids. Nonsteroidal anti-inflammatory drugs (nsaids) can relieve pain and reduce inflammation. Over-the-counter nsaids include ibuprofen (advil, motrin ib) and naproxen sodium (aleve). Stronger nsaids are available by prescription. Side effects may include stomach irritation, heart problems and kidney damage. •steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication. •disease-modifying antirheumatic drugs (dmards). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common dmards include methotrexate (trexall, otrexup, others), leflunomide (arava), hydroxychloroquine (plaquenil) and sulfasalazine (azulfidine). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections. •biologic agents. Also known as biologic response modifiers, this newer class of dmards includes abatacept (orencia), adalimumab (humira), anakinra (kineret), baricitinib (olumiant), certolizumab (cimzia), etanercept (enbrel), golimumab (simponi), infliximab (remicade), rituximab (rituxan), sarilumab (kevzara), tocilizumab (actemra) and tofacitinib (xeljanz). These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections. In people with rheumatoid arthritis, higher doses of tofacitinib can increase the risk of blood clots in the lungs. Biologic dmards are usually most effective when paired with a nonbiologic dmard, such as methotrexate. Therapy your doctor may send you to a physical or occupational therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, you may want to pick up an object using your forearms. Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a hand grip helps protect your finger and wrist joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas. Surgeryif medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and improve function. Rheumatoid arthritis surgery may involve one or more of the following procedures: •synovectomy. Surgery to remove the inflamed lining of the joint (synovium) can be performed on knees, elbows, wrists, fingers and hips. •tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint. •joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option. •total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic. Surgery carries a risk of bleeding, infection and pain. Discuss the benefits and risks with your doctor. Rheumatoid arthritis multiple joint pains / early morning painit is called as rheumatic arthritis. Treatment goals •to protect the joint from further damages. •provide pin relief. •prevent deformity and disabilities. •increase functional capacity. •improve flexibility and strength. •encourage regular exercise. •improve general fitness. Physiotherapy modalities - hot/cold applications- electrical stimulation- hydrotherapy and spa therapy rehabilitation treatment technique - rest and splinting - compression gloves - assistive devices and adaptive equipment - massage therapy - therapeutic exercise - patient education assistive devices and adaptive equipment occupational therapy improves functional ability in patients with ra. Occupational therapy interventions such as assistive devices and adaptive equipments have beneficial effects on joint protection and energy conservation in arthritic patients.Assistive devices are used in order to reduce functional deficits, to diminish pain, and to keep patients' independence and self-efficiency. Loading over the hip joint may be reduced by 50% by holding a cane. In fact, most of these instruments are originally designed for patients with neurologic deficits; therefore, certain adaptations may be needed for them to be used in patients with arthritis. Elevated toilet seats, widened gripping handles, arrangements related with bathrooms, etc. Might all facilitate the daily life. The procedures needed to increase compliance of the patient with the environment and to increase functional independence are +mainly determined by the occupational therapist. Massage therapy that improves flexibility, enhances a feeling of connection with other treatment modalities, improves general well being, and can help to diminish swelling of inflamed joints. Massage is found to be effective on depression, anxiety, mood, and pain. Therapeutic exercise every joint should be moved in the rom at least once per day in order to prevent contracture. In the case of acutely inflamed joints, isometric exercises provide adequate muscle tone without exacerbation of clinical disease activity. Moderate contractures should be held for 6 seconds and repeated 5–10 times each day. Dynamic exercise therapy in improving joint mobility, muscle strength, aerobic capacity and daily functioning in patients with rheumatoid arthritis (ra). Finally, in chronic stage with inactive arthritis, conditioning exercises such as swimming, walking, and cycling with adequate resting periods are recommended. They increase muscle endurance and aerobic capacity and improve functions of the patient in general, and they also make the patient feel better. It might be due to lack of blood circulation which is the reason for you to have scrotum pain / back pain. You have to do basic aerobic exercises for you to become fit and also to maintain the blood circulation and tone. Patient education in patients with ra, sociopsychological factors affecting the disease process such as poor social relations, disturbance of communication with the environment, and unhappiness and depression at work are commonly encountered. The treatment of rheumatic diseases should provide education and information to their patients about their condition and the various physical therapy and rehabilitative options that are available to improve their quality of life. Passive treatments for rheumatoid arthritis •cold therapy reduces circulation, which ultimately decreases swelling. For example, a cold compress may be placed on the painful area. •cold therapy in acute phase •dosage 10-20mints/1-2 times a day. •heat therapy eases muscle tension and gets blood to flow more quickly to the painful area. For example, a moist, warm cloth may be used to promote circulation. •heat therapy in chronic phase •dosage 20-30mints/1-2 times a day. •hydrotherapy involves reducing your ra-related pain and other symptoms with water. With hydrotherapy, you will be submerged in warm water to relieve your symptoms. •massage can help reduce muscle tension and promote good circulation. It's also a fantastic way to help you manage stress (especially important for people with rheumatoid arthritis). •transcutaneous electrical nerve stimulation (tens) works by blocking pain signals from getting to your spinal cord. It also helps decrease muscle spasms. •tens short term pain relief (6 to 18 hrs) •ultrasound creates warmth using sound waves, whichenchanes circulation and decreases joint pain, inflammation, and stiffness. Exercise for acute phase: •preformed exercise at least once a day. •general assisted movement through normal range (joint mobilisation). •isometric-“static movements” helps to maintain muscle tone without increasing inflammation. Exercise for the chronic phase: •can progress the above exercise to include use of light resistance. •postural/core stability exercises. •swimming/walking/cycling to maintain cardiovascular fitness. •gentle stretch for areas that become tight, such as knees &calves. Regular exercises: •maintaing muscle strength is important for joint stability & preventing injury. •muscles can become weak following reduced activity. •pain signals from yours nerves and swelling can both inhibits muscles. •muscle length can be affected by prolonged positions immobilization and tightness can limit daily activities. Alternative therapies: •thi chi. •musical therapy. •yoga therapy. •relaxation techniques. •pilates. Active treatments for rheumatoid arthritis •flexibility and strengthening exercises improve your range of motion and help you build muscle strength. Yoga and pilates are flexibility and strengthening exercises. •low-impact aerobic exercise is gentle but effective at helping you manage rheumatoid arthritis symptoms. Light walking is an example of this type of exercise. Your physical therapist will let you know how often to do these exercises. For example, you may need to do a few specific exercises 3 times a day, or your physical therapist may recommend a routine that incorporates 30 minutes of low-impact aerobic exercise a day and 30 minutes of strengthening exercises every other day. If your pain is more in the proximal joints, ie.in the upper limbs if the pain is present in the fingers/wrist and in the lower limbs it the pain is present in the toes/ ankle, then we shall definitely say it is rheumatic arthritis. Wear elbow brace and wrist brace which will make her to feel warm and that will make the joints become firm. Hot water fermentation will helpknee cap will also help to prevent the damaged cartilagesif your pain is more in the distal joints, ie. In the upper limbs if the pain is present in the fingers/wrist and in the lower limbs it the pain is present in the toes/ ankle, then we shall definitely say it is rheumatic arthritis. If your proximal joints (ie. Shoulder, hip & knee has pain) then you can pour hot (warm) water in that area to reduce the inflammation. If you have pain in the distal joints ie. Wrist, fingers, ankle, toes then you can wear either elbow brace or wrist brace which will help you to feel warm and very protective. And also immerse the distal joints in the hot water tub which will help you to reduce the pain. Knee pain during driving or watching movie. It might due to lack of movements in the knee while the joints are immobilized during driving and while watching movies. It is important that you need to have movements in and around the knee so that the blood flow will not be disturbed. 

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Dr. Vivek Mathew EapenMBBS Bachelor of Medicine and Bachelor of Surgery, Certificate in clinical nutritionGeneral Physician

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Pain on breathing, localized to the right side is most probably due to; musculoskeletal pain. Which can be resolved with use of paracetamol. However a detailed examination to rule out lung diseases are required. This is not an indication for heart related problems: cardiac problems are more likely associated with pain on exertion, which goes away with taking rest. It is mostly seen on central chest and to the left side, with pain radiating to the left upper arm, jaws, shoulder or back. 

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Hello, if you have already had an mri done and it doesn't show much of a problem other than l3 l4 and l5 -s1 disc bulge please be assured that its most likely lifestyle related. Although, confirmed diagnosis can only be made on direct examination. You must do back strengthening exercises but in a graded way. Don't over exert and gradually increase the intensity of exercise. Also before exercise, if you can relax your muscles by hot fomentation, it would work better. Also, keep a check on your posture while working/sitting. If you continue to experience symptoms then consult an ortho/ rheumat for opinion. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Back pain can affect people of any age, for different reasonsas people get older, the chance of developing lower back pain increases, due to factors such as previous occupation and degenerative disk disease. Lower back pain may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdominal and pelvic internal organs, and the skin around the lumbar area. •acute pain starts suddenly and lasts for up to 6 weeks. •chronic or long-term pain develops over a longer period, lasts for over 3 months, and causes ongoing problems. Home advise: •resting from strenuous activity can help, but moving around will ease stiffness, reduce pain, and prevent muscles from weakening. •applying heat, ice, ultrasound, and electrical stimulation — as well as some muscle-release techniques to the back muscles and soft tissues — may help alleviate pain. •as the pain improves, the physical therapist may introduce some flexibility and strength exercises for the back and abdominal muscles. Techniques for improving posture may also help. •the patient will be encouraged to practice the techniques regularly, even after the pain has gone, to prevent back pain recurrence. Regular exercise helps build strength and control body weight. Guided, low-impact aerobic activities can boost heart health without straining or jerking the back. Before starting any exercise program, talk to a health care professional. There are two main types of exercise that people can do to reduce the risk of back pain: •core-strengthening exercises work the abdominal and back muscles, helping to strengthen muscles that protect the back. •flexibility training aims at improving core flexibility, including the spine, hips, and upper legs. We suggest you to wear lumbosacral corset (belt) which is available at our clinic. If you want you can buy from us, if you are far away from chennai we can send you by courier. The reason why we are conveying you to buy from us is we can demonstrate over the videocall (using whatsapp) and also we can monitor you throughout when to wear it and how long to wear it. And also if you find any difficulty wearing the brace you can also revert back to us for few more suggestions and we can propose you good solution how to go about it. Uses of lumbosacral corset (belt) a lumbosacral corset adds pressure to the intra-abdominal area. This adds stability to the spine. It is prescribed to people suffering from moderate to severe pain. Other benefits of using a lumbar spine belt are: 1.helps in a certain degree of immobilization of facet joints. 2.reduces pain to allow continuation of normal activities. 3.speeds up the healing process. 4.the pressure exerted by a lumbar spine belt helps in stretching the erector spine muscles. 5.this belt can also be used to support the lower back while exercising. Ohelps prevent rolling oprovides stability to lumbar and sacral regions of the back ocan be used when performing actions like lifting and handling heavy items ocan also be used when playing sports orestricts back movement to aid treatment of back problems do’s and don’ts sitting do: • sit as little as possible and then only for short periods. • place a supportive towel roll at the belt line of the back especially when sitting in a car. • when getting up from sitting, keep the normal curves in your back. Move to the front of the seat and stand up by straightening your legs. Avoid bending forward at the waist. • try to keep the normal curves in your back at all times. Don’t: • do not sit on a low soft couch with a deep seat. It will force you to sit with your hips lower than your knees and will round your back. You will loose the normal curve in your back. • do not place your legs straight out in front of you while sitting (e.g. Sitting in the bath tub). Standing do: • if you must stand for a long period of time, keep one leg up on a foot stool. • adapt work heights. Don’t: • avoid half bent positions. Lifting avoid lifting if you can. Do: • use the correct lifting technique. Keep your back straight when lifting. Never stoop or bend forward. Stand close to the load, have a firm footing and wide stance. Kneel on one knee, keeping the back straight. Have a secure grip on the load and lift by straightening your knees. Do a steady lift. Shift your feet to turn and do not twist your back. Don’t: • do not jerk when you lift. • do not bend over the object you are lifting. Lying do: • sleep on a good firm surface. • if your bed sags, use slats or plywood supports between the mattress and base to firm it. You also can place the mattress on the floor, a simple but temporary solution. • you may be more comfortable at night when you use a pillow for support. Don’t: • do not sleep on your stomach unless advised to do so by your doctor or physical therapist. Bending forward do: • keep the natural curves of your back when doing these and other activities: making a bed, vacuuming, sweeping or mopping the floor, weeding the garden or raking leaves. Coughing and sneezing do: • bend backwards to increase the curve of your back while you cough or sneeze. Driving a car do: • drive the car as little as possible. It is better to be a passenger than to drive yourself. • move the seat forward to the steering wheel. Your seat must be close enough to the wheel to keep the natural curves of your back. If your hips are lower than your knees in this position, raise yourself by sitting on a pillow. Exercises for low back pain safety guidelines • an increase in your low back pain can be expected with these exercises. This is acceptable as long as your leg symptoms are not increasing. • if while doing these exercises, your pain worsens or you have new pain or symptoms, stop the exercises and discuss your symptoms with your doctor or physical therapist. • stop exercising and let your doctor or physical therapist know right away if you have any change in your bowel or bladder control or any increase in weakness in your leg or foot. Exercises ‰ •press-ups: keep your back and buttocks relaxed and use your arms to press up. Concentrate on keeping your hips down and push up your upper body as high as possible. •double knee to chest: grasp both your knees with your hands and pull toward your shoulders. Hold the stretch for 1 second. Let your knees return, but keep them bent at arms length. ‰ •lumbar spine stretches: lie on your back. Bring your knees towards your chest. Rotate your knees towards the pain. •side-lying position: lie on your side and face forward. Have both arms straight in front and bend your knees. Turn your head as you move your top arm across your body as far as you can. Keep your arm in place and turn your head back to the starting position. Look back again and turn your head farther if you can. Bring your head and arm back to the starting position. Relax and repeat 10 times on each side. •hamstring stretch: lie on your back with your legs out straight. Raise your leg up and put your hands around the upper leg for support. Slowly straighten the raised knee until you feel a stretch in the back of the upper leg. Hold, then relax and repeat 10 times on each leg. •standing arch: stand with your feet apart and hands on the small of your back with fingers pointing backwards. Bend backwards at the waist, supporting the trunk with your hands. Keep your knees straight. Hold for 5 seconds. Repeat 3 to 5 times. Side glides: stand at a right angle to the wall about 2 feet o eliminate your pain improve your muscular endurance and strength attain better posture, balance, body awareness and co-ordination improve your balance and flexibility learn to lift properly. 

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Dr. Karuna ChawlaBHMSHomeopathy Doctor

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Do this 1. Don't take tea empty stomach. Eat something like a banana (if you are not diabetic). ) or any seasonal fruit or soaked almonds and a glass of water first thing in the morning (within 10 mins of waking up). No only biscuits or rusk will not do. 2. Don't Overeat 3. Take your breakfast every day. Don't skip it. U can eat whatever ur mother or grandparent eat in bfast. I mean to say whatever is ur traditional food. If punjabi eat paratha, if belongs to south then take idli/ dosa etc. 4. Have light meals every 2 hours (in addition to your breakfast, lunch n dinner) e.g. Nariyal paani, chaach, a handful of dry fruits, a handful of peanuts, any fresh n seasonal fruit, a cup of curd/milk etc 5. Finish your dinner at least 2 hours before going to sleep. 6. Maintain active life style 7. Avoid fast foods, spicy n fried foods, Carbonated beverages 8. Take a lot of green vegetables n fruit. It contains a lot of fiber which will help reduce tendency for constipation 9. Drink lot of water. 10. Everyday preferably sleep on same time 11. Take half cup of cold milk when u feel acidity, it will help. Curd is good for u. 12. If its very severe then Elevate your bed Raising the head of your bed six to eight inches can help gravity keep gastric acid down in your stomach. This is for long term results But for now to bring your digestive system back on track you need to take medicines. For that I need more details, you can consult me 

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GagandeepMS - OrthopaedicsOrthopedic Doctor

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There could be multiple reasons for your pain. It is important to understand whether your pain is arising from neck, thoracic spine, digestive sysmtem (esophageal disorders) or cardiac (heart) cause. Do you have fever, weight loss, appetite issues? Do you have relief in symptoms with gabaneuron? Is disc bulge at c3c4 more on left side? Usually disc bulge at c3c4 shouldnot give rise to pain in left hand. It is more related with disc bulge at c5c6/ c6c7. It is important to have a look on your mri again. Do you have bulge at these levels too. Please consult orthoepdic surgeon (me or anyone of your choice) to rule out pain arising from neck. 

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Dr. Prakhar SinghMBBS, Basic Life Support (B.L.S), Advanced Cardiac Life Support, Fellow of Academy of General Education (FAGE)General Physician

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I am sorry to hear about your concern but will be happy to assist you. The most common symptom of chronic pancreatitis is repeated episodes of severe pain in your tummy (abdomen). The pain usually develops in the middle or left side of your tummy and can move along your back. It's been described as a burning or shooting pain that comes and goes, but may last for several hours or days. Let's connect over a call so that we can discuss your concern in details and make a suitable treatment plan for you. 

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Dr. Karuna ChawlaBHMSHomeopathy Doctor

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Since when r you having this?What r other symptoms that you r experiencing? By doing what like walking, exertion, eating or empty stomach- it increases or decreases in intensity. For how much time it remains?How is your appetite?R you constipated or having loose stools? Is there stiffness also? Any problem in urine?It can be because of gas or acidity or indigestion, gastritis, gerd, diarrhoea, constipation, ibs etc but I need details of the case. In the meanwhile follow this 1. Take your breakfast every day. Don't skip it. U should eat whatever your mother or grandparent eat in bfast. I mean to say whatever is your traditional food. If punjabi eat paratha, if belongs to south then take idli/ dosa etc. (preferably within 10 mins of waking up). No only biscuits or rusk will not do. 2. Don't overeat 3. Don't take tea empty stomach. Eat something like a banana (if you are not diabetic) or any seasonal fruit or soaked almonds and a glass of plain water first thing in the morning 4. Have light meals every 2 hours (in addition to your breakfast, lunch n dinner) e.g. Nariyal paani, chaach, a handful of dry fruits, a handful of peanuts, any fresh n seasonal fruit (eat whole fruit not juice), a cup of curd/milk etc 5. Take simple food like rice n dal in dinner. Finish your dinner at least 2 hours before going to sleep. 6. Maintain active life style7. Avoid fast foods, spicy n fried foods, carbonated beverages 8. Take a lot of green vegetables n fruit. 9. Drink lot of water.10. Everyday preferably sleep on same time 11. Take 1tsp of ghee in bfast, lunch n dinner. Exercise in the form of yoga, cycling, swimming, gym etc. For more details, you can consult me. 

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Dr. Karuna ChawlaBHMSHomeopathy Doctor

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It can be gas/acidity. But I need to know more to be able to make diagnosis. In the meanwhile follow this 1. Don't take tea empty stomach. Eat something like a banana (if you are not diabetic) or any seasonal fruit or soaked almonds and a glass of water first thing in the morning (within 10 mins of waking up). No only biscuits or rusk will not do. 2. Don't overeat 3. Take your breakfast every day. Don't skip it. U should eat whatever your mother or grandparent eat in bfast. I mean to say whatever is your traditional food. If punjabi eat paratha, if belongs to south then take idli/ dosa etc. 4. Have light meals every 2 hours (in addition to your breakfast, lunch n dinner) e.g. Nariyal paani, chaach, a handful of dry fruits, a handful of peanuts, any fresh n seasonal fruit (eat whole fruit not juice), a cup of curd/milk etc 5. Take simple food like rice n dal in dinner. Finish your dinner at least 2 hours before going to sleep. 6. Maintain active life style7. Avoid fast foods, spicy n fried foods, carbonated beverages 8. Take a lot of green vegetables n fruit. 9. Drink lot of water.10. Everyday preferably sleep on same time exercise in the form of yoga, cycling, swimming, gym etc. For more details, you can consult me. 

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Dr. Jatin SoniMBBSGeneral Physician

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For pain take tablet paracetamol 650 mg and Get your vital parameters of the body checked from a nearby doctor and follow up with findings 

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